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Postoperative Quality of Life in Patients with Ileal Neobladder at Short-, Intermediate- and Long-Term Follow-Up
Abstract
Background:
To evaluate the difference at different steps of follow-up of the postoperative quality of life (QoL) in patients who had undergone radical cystectomy and ileal orthotopic neobladder derivation.
Patients and methods:
A multicentric, cross-qualitative study was performed in 5 Italian centers of reference for the treatment of bladder cancer. One hundred seventy one patients who underwent radical cystectomy and creation of ileal orthotopic neobladder according to 'Vescica Ileale Padovana' between 2006 and 2011 have been analyzed. The validated and dedicated questionnaires EORTC QLQ-C30, IOB-PRO and EORTC QLQ-BLM30 were used.
Results:
All data gathered were then processed, specifically means ± SD were included for comparison during 4 periods of follow-up (quartile): the first ranging from 1 to 18 months; the second ranging from 19 to 36 months; the third from 37 to 72 months and the fourth >72 months. Cancer-specific and health-related factors were analyzed separately, and the change was determined during follow-up.
Conclusions:
The global QoL, highlighted by validated cancer-specific and health-related questionnaires, is certainly on a satisfactory level. Thus, the education of the patient, the exploration of the pros and cons of an orthotopic neobladder and the active participation in treatment decision seem to be the keys to better improve the post-operative QoL during the follow-up period.
... Two studies did not include the urinary symptoms, urostomy and catheter issues scales, because the authors of the studies wanted to compare the remaining scales between the different urinary diversion types [9,35]. Other studies did not employ the urostomy and catheter scales because the study took part before radical cystectomy (e.g., neoadjuvant chemotherapy) [13,14] or only in patients with a neobladder [36,37]. Another study only used the sexual functioning scale, because the study aim was to describe sexual functioning in patients after radical cystectomy [38]. ...
... Some studies employed multiple questionnaires and only used certain scales of the BLM30 module (most commonly used scales were the urinary [39,40], urostomy [41,42] and body image scales [39,41,43]) without providing a clear rationale. The original sexual functioning scale was sometimes broken down into 'sexual functioning' and 'sexual life' [11,35,36] and the 'urinary symptoms', 'urostomy', and 'catheter use' scales were also reported as one 'urinary symptom' scale [44]. After obtaining permission from the EORTC QLG, Catto et al. [17] and Ripping et al. [23] combined the BLM30 and the NMIBC24 to create a questionnaire which is relevant to both NMIBC and MIBC, while limiting participant burden. ...
... Furthermore, variability was observed in how the scales of both modules have been reported, suggesting the presence of reporting bias. Investigators often appeared to use only those scales of the modules that fit the aims of their study [36,37,51]. However, the majority (> 70%) did not give an explanation for reporting only a few scales, making it difficult to conclude why not all scales were reported. ...
PurposeInvestigating the use of the EORTC bladder cancer (BC) modules by evaluating: (a) study contexts/designs; (b) languages/countries in which the modules were administered; (c) their acceptance by patients/investigators; and (d) their psychometric properties.
MethodsA systematic review was performed with studies from 1998 until 20/10/2021 in five databases. Articles/conference abstracts using the EORTC-QLQBLM30 (muscle invasive BC) and the EORTC-QLQNMIBC24 (previously referred to as QLQ-BLS24; non-muscle invasive BC) were included. Two authors independently screened titles/abstracts/full-texts and performed data extraction.
ResultsA total of 76 eligible studies were identified. Most studies included the BLM30 (n = 53), were in a urological surgery context (n = 41) and were cross-sectional (n = 35) or prospective (n = 30) in design. The BC modules were administered in 14 languages across 19 countries. Missing data were low-moderate for all non-sex related questions (< 1% to 15%). Sex-related questions had higher rates of missing data (ranging from 6.9% to 84%). Most investigators did not use all scales of the questionnaires. One validation study for the original BLS24 led to the development of the NMIBC24, which adopted a new scale structure for which good structural validity was confirmed (n = 3). Good reliability and validity was shown for the NMIBC24 module, except for malaise and bloating/flatulence scales. Psychometric evidence for BLM30 is lacking.Conclusion
These results provide insight into how the EORTC BC quality of life modules could be further improved. Current work is ongoing to update the modules and to determine if the two modules can be combined into a single questionnaire that works well in both the NMIBC and MIBC settings.
... [16][17][18] Furthermore, as many as 50% of patients have been noted to complain about the use of jargon at diagnosis, 19 an observation also made when a new treatment plan is introduced, 20 and at the time of pre-surgical education. 21 In the BlCa context, poorer QoL has been associated with reduced role function, diminished body image and self-esteem, anxiety and depression, perceived burden, financial problems, loneliness, embarrassment, and stigma. [22][23][24][25] Despite this understanding, further qualitative research into the experiences of BlCa patients has been encouraged. ...
... Further, a pre-surgery dialogue explaining the positives and negatives of the procedure might also encourage participation in treatment decision making, which may be reflected in positive QoL outcomes. 21 Participants desired genuine support, and the chance to meet others with BlCa. This was to enable a glance at how others dealt with adverse effects and the very personal issues related to BlCa. ...
Background: Bladder cancer is characterized by recurrence and progression, ongoing surveillance and treatment, adverse effects, and complications and is associated with chronic ill health that may compromise relationships, social activities, and employment. Objective: The aim of this study was to gain an understanding of
quality of life disruptions among both those diagnosed with bladder cancer and their supportive partners (spouses or other family members).
Interventions/Methods:
Couples were recruited from a tertiary care public hospital database. Nine heterosexual couples (married/de facto) and another comprising a clinical participant and her daughter-in-law were interviewed for approximately 60 minutes. Interviews were audio recorded and transcribed, with qualitative description used to gain an in-depth understanding of participants’ experiences without previous agenda
or knowledge, allowing their viewpoints to be summarized in everyday terms.
Results: Thematic analysis highlighted 4 themes: physical responses, cognitive support and its assistance for clinical participants’ acceptance of and adaptation to their bladder cancer, surveillance, and treatment protocols.
Conclusion: A key finding was the value of a supportive partner in dealing with the effects of bladder cancer daily. From a health service perspective, the need for clear information provision and counseling/support to assist patient management was also evident.
Implications for Future Practice: Health professionals need to appreciate the quality of life implications for patients and partners, thus understanding the needs of couples. Greater collaboration with and by health professionals who assist in care may allow couples to move more confidently toward adaptation to bladder cancer.
... Chabowski et al procedures (which can be used in both men and women) (9)(10)(11). Although quality of life measures might productively be used to evaluate the outcomes of uro-oncology surgeries, studies on the subject are scarce. ...
... Another option is the creation of an intestinal reservoir which is periodically emptied with a catheter. The most advanced and comfortable technique includes the creation of an orthotopic neobladder from a segment of the bowel (9,11,16). Surprisingly, researchers have not yet found differences in terms of the different urinary diversion methods used in the levels of quality of life sustained by patients after radical cystectomy. Protogerou et al. measured quality of life with the QLQ C-30 questionnaire in 3 groups of participants: group 1 had an ileal conduit diversion, group 2 had a modified S-pouch neobladder, and group 3 was composed of healthy subjects. ...
Objective:
Bladder cancer is, in Poland, the fourth most common malignancy in men and the eighth most common in women. Radical cystectomy often seems to be the only method of treatment. This mutilating procedure may affect the quality of life of the patient. The aim of our study was to analyze the impact of factors influencing quality of life in patients after a cystectomy.
Methods:
From January to August 2015, 50 consecutive patients treated in the Department of Urology of the Wroclaw Medical University in Wroclaw were enrolled into the study. Sixty-three percent of the respondents were men. Fifty-two percent of the respondents lived in urban areas. Patients ranged in age from under 25 to over 51 years. Clinical and demographic data were collected. Quality of life was evaluated with the SF-36 health survey questionnaire. For statistical analysis, Student's t-test, the Mann-Whitney U test and Spearman's rank correlation coefficient were used. Statistical analysis was carried out with IBM SPSS Statistics for Windows Version 21.0.
Results:
A decrease in quality of life was observed in both genders. The impact of place of residence on the occurrence of pain, health perception, vitality, and levels of physical and mental activity was found to be significant (p<0.05). Pain intensity, health perception, vitality, and levels of physical and mental activity were higher in patients living in urban areas.
Conclusion:
Patients with bladder cancer who underwent a radical cystectomy were more likely to have a reduced quality of life if they lived in a village or small town than if they lived in an urban area.
... RC is the standard treatment for MIBC and some high-risk NMIBC (1,2). The most commonly used procedures of urine diversion include cutaneous ureterostomy, ileal conduit and orthotopic ileal neobladder. ...
Background
Radical cystectomy (RC) is the standard treatment for muscular invasive bladder cancer (MIBC) and some high-risk non-muscular invasive bladder cancer (NMIBC). Cutaneous ureterostomy is a common form of urinary diversion. However, after radical cystectomy, recurrence of upper urinary tract malignancies is possible. There is no relevant report on how to improve this situation’s management.
Case Presentation
This case is a 56-year-old male patient hospitalized due to the development of a new tumor in the ureteral cutaneous stoma following radical cystectomy for more than five years. A biopsy of the tumor revealed high-grade urothelial carcinoma. Computed tomography (CT) revealed that the local soft tissue around the cutaneous stoma was thickened, but no other lesions were visible. After evaluating the case, we chose robot-assisted completely intracorporeal resection of cutaneous ureterostomy tumor and ileal conduit surgery. The total time for the operation and the blood loss were 400 minutes and 150 ml, respectively. Following surgery, the patient got standard chemotherapy in combination with immunotherapy. Additionally, ten months following the surgery, the patient did not experience disease progression or complications.
Conclusion
The robot-assisted operation is safe and feasible for upper urinary tract tumor recurrence following radical cystectomy with cutaneous ureterostomy.
... This will be extremely valuable to inform our future patients. The gHS/QoL in our population was comparable to other studies using the same EORTC QLQ-C30 questionnaire to assess QoL in post-RC-IONB patients (71.2 mean score in our study, 88.8 and 64.9 in two others [15,16]). Interestingly, we observed that the mean gHS/QoL in our population was very close to another study of a European population with almost the same age without cancer [17], and more different from all cancer populations with EORTC QLQ-C30 reference values [18]. ...
Purpose: Ileal orthotopic neobladder (IONB) reconstruction is the preferred urinary diversion among selected patients who have undergone radical cystectomy (RC) for bladder cancer (BCa). There is insufficient data regarding patients' quality of life (QoL), sexual and urinary outcomes. Our objectives were to assess QoL in a multicentre cohort study, and to identify related clinical, oncological and functional factors.
Methods: Patients who underwent RC with IONB reconstruction for BCa from 2010 to 2017 at one of the three French hospitals completed the following self-reported questionnaires: European Organization for Research and Treatment of Cancer (EORTC) generic (QLQ-C30) and bladder cancer specific instruments (QLQ-BLM30). To assess urinary symptoms, patients completed the Urinary Symptom Profile questionnaire (USP) and a three-day voiding diary. Univariate and multivariate analyses were computed to identify clinical, pathological, and functional predictors of global QoL score.
Results: Seventy-three patients completed questionnaires. The median age was 64 years and 86.3% were men. The median interval between surgery and responses to questionnaires was 36 months (range 12-96). Fifty-five percent of patients presented a high global QoL (EORTC-QLQC30, median score 75). A pre-RC American Society of Anesthesiologists score > 2, active neoplasia, sexual inactivity, and stress urinary incontinence were associated with a worse QoL. After a multivariate analysis, sexual inactivity was the only independent factor related to an altered QoL.
Conclusion: Patients with IONB reconstruction after RC have a high global QoL. Sexual activity could independently impact the global QoL, and it should be assessed pre- and post-operatively by urologists.
... The education of neobladder patients is an important factor for the complications that may appear. An active participation in treatment decision and a regularly follow up are connected to the patient quality of life with orthotopic neobladder [25]. ...
Purpose:
We report our experience with 23 cases in utilizing ileum to perform totally intracorporeal 3D laparoscopic neobladder reconstruction using two different surgical techniques.
Methods:
Patients candidates for reconstructive surgery were in a good biological status with a body mass index (BMI) in the range of 18.5-25 and presented a muscle-infiltrative bladder tumor with negative nodal frozen sections performed during the operation. Twenty-one modified Studer neobladder and 2 modified Y-shaped neobladder techniques for totally intracorporeal 3D laparoscopic ileal neobladder cases were performed using drawings and intra-operative images. An emphasis was made on different tips and tricks that can be applied when using ileum for the neobladder reconstruction, to avoid surgical complications and obtain optimal functional results.
Results:
The operations were performed in a mean time of 5 h, with a mean blood loss of 350 ml and grade II postoperative Clavien Dindo complications. The 23 patients were discharged after a mean hospital stay of 21 days and had a functional ileal neobladder after a mean of 30 days. The results were monitored also on the long-term, taking into account functional results and possible complications from utilizing ileum as a urinary reservoir.
Conclusion:
Resecting a digestive segment and using it as a urinary reservoir may lead to multiple complications. Therefore, laparoscopic technical adaptations and highly skilled surgical teams are required for performing a totally intracorporeal 3D laparoscopic orthotopic ileal neobladder reconstruction.
Introduction:
Radical cystectomy (RC) and urinary diversion by ileal conduit (IC) or ileal orthotopic neobladder (ONB) is the standard-of-care for surgical treatment of muscle-invasive bladder cancer. Yet, it is unclear how urinary diversion affects the patient's health-related quality of life (HRQOL) in the longer-term.
Methods:
HRQOL was assessed preoperatively, 3mo postoperatively and then annually until a maximum follow-up of 48 months using the validated EORTC QLQ-C30- as well as the bladder cancer-specific FACT-BL- and QLQ-BLM30-questionnaires. A propensity-score matching for the variables "age," "ASA-classification," "cardiovascular co-morbidity," "sex" as well as "tumor stage," and "preoperative physical functioning score" was performed. Hypothetical predictors for decreased general HRQOL were analyzed using multivariable logistic regression models.
Results:
After propensity-score matching, 246 patients were analyzed. HRQOL assessment revealed significant differences regarding preoperative QLQ-C30 symptoms which diminished during the postoperative time course. Similarly, we did not find significant differences based on bladder cancer-specific FACT-BL and QLQ-BLM HRQOL assessment including body image (48 months: 29.6.4 [IC] vs. 40.7 [ONB]; P = .733). Regarding general HRQOL, we found increased global health status scores for ONB throughout the whole observational period without reaching statistical significance (48 months: 55.0 [IC] vs. 70.1 [ONB]; P = .079). In multivariate analysis, cardiovascular comorbidity was an independent predictor of impaired HRQOL 24 months (HR 2.20; CI95% 1.02-5.72, P = .044) and 36 months (HR 6.84; CI95% 1.61-29.14, P = .009) postoperatively.
Conclusion:
We did not observe significant differences in bladder-specific as well as generic HRQOL in the longer-term and consequently, the type of urinary diversion was not an independent predictor of good general HRQOL in a follow-up period of 4 years.
Background:
Bladder cancer is one of the most frequent cancers in high-income countries. Information on bladder cancer in Italy is scattered across scientific literature and institutional and educational resources and no attempt has been made yet to organize and summarize this information across various sources of available data. We, therefore, present herein a critical literature review of recent epidemiological and healthcare data, including patients' unmet needs.
Methods:
We undertook a critical review of the scientific and grey literature by exploring several different databases and search browsers.
Results:
Available official statistics indicate a high burden of bladder cancer in Italy, where this neoplasm has one of the highest incidences worldwide and, in consideration of its relatively high survival, it ranks 4th in cancer prevalence. The limited therapeutic options for muscle-invasive and advanced/metastatic urothelial cancer are one of the major unmet needs for patients with this neoplasm, in Italy and worldwide. Advances in cancer immunotherapy and in understanding molecular biology of bladder cancer are, however, rapidly altering the therapeutic landscape for targeted subgroups of patients with advanced/metastatic disease. Other unmet needs include the low quality of life after radical cystectomy, the lack of widespread clinical pathway schemes to improve and standardize the quality of care and low Italian patients empowerment.
Conclusions:
Bladder cancer represents a health burden in Italy, with high incidence and prevalence rates, and important unmet needs for patients, including the limited therapeutic options for advanced/metastatic cancers, the low quality of life after radical cystectomy, the lack of widespread clinical pathway schemes, and the low patients empowerment.
Objective:
To evaluate health-related quality of life (HR-QoL) outcomes in elderly patients with different type of urinary diversion (UD), ileal conduit (IC) and ileal orthotopic neobladder (IONB), after radical cystectomy (RC) for bladder cancer, by using validated self-reported cancer-specific instruments.
Patients and methods:
We retrospectively reviewed 77 patients who received an IC or an IONB after RC. HR-QoL was assessed with specific and validated disease questionnaires, administered at last follow-up.
Result:
At univariate analysis, at a mean follow-up of 60.91 ± 5.63 months, IONB results were favourable with regard to the following HR-QoL aspects: nausea and vomiting (p = 0.045), pain (p = 0.049), appetite loss (p = 0.03), constipation (p = 0.000), financial impact (p = 0.012) and cognitive functioning (p = 0.000). This last functional aspect was significantly worse in female patients (p = 0.029). Emotional functioning was significantly better in patients without long-term complications (p = 0.016). At multivariate analysis, male gender and IONB were independent predictors of better cognitive functioning, while long-term complications negatively affected emotional functioning.
Conclusions:
Obtained results suggest that an IONB can also be suitable for elderly patients compared with an IC with few and selected advantages in favour of the former UD. Preoperative patient's selection, counselling, education and active participation in the decision-making process lead to a more suitable choice of treatment.
Objective
To examine the different and Health-Related Quality of Life (HR-QoL) outcomes between ileal conduit (IC) vs. ileal-orthotopic-neobladder (IONB) in patients who underwent RC for primary BC, by using validated self-reported cancer-specific instruments.
Methods
This retrospective, cross sectional, multicentre cohort study included 148 and 171 patients who underwent RC with either IC or IONB with curative intent. HR-QoL was evaluated with QLQ.C-30 and BLM-30 EORTC questionnaires. Baseline HRQoL scores were dichotomized at the median to give “good” or “poor” score's profiles. A matched-pair comparative analysis was performed for comparison of HR-QoL aspects between 79 IC vs. 79 IONB patients.
Results
Univariate analyses showed significant differences favouring IONB in: physical functioning(PhF), emotional functioning(EF), cognitive functioning(CF), fatigue(FA), dyspnoea(DY), appetite loss(AL), constipation(CO), and abdominal bloating flatulence(AB). At multivariate analyses IONB showed better scores for EF (85vs.79, p=0.023), CF (93vs.85, p<0.001), CO (16vs.31, p<0.001), and AB (12vs.25, p<0.001). A significant worsening of sexual and urinary function was observed for IONB patients in the long-term follow-up. At matched pair analysis, Global health status(GQoL) was similar between the two groups (65vs.62, p=0.385). Significant better scores were observed in the IONB group for the following items: CF (p=0.007), FA (p=0.003), pain(PA) (p=0.019), DY (p=0.016), CO (p=0.001), AB (p=0.00).
Conclusions
IONB and IC after RC didn't show significant difference in terms of GQoL. IONB provides better results in some aspects of HR-QoL mainly related to bowel function as compared with IC but a worsening of urinary and sexual functions. Further RCTs are needed to confirm these data.
Purpose:
Analyze current knowledge and practice regarding tumor-related cystectomy with subsequent orthotopic neobladder both in male and female patients.
Design, setting, and participants:
Evaluate literature predominantly from the last decade dealing with long-term experience in large numbers of patients with an orthotopic neobladder following cystectomy. Oncological outcome specific to an orthotopic neobladder, functional aspects such as urinary continence, renal function, sexual activity and other quality of life issues are elucidated.
Results:
Local pelvic recurrences after urothelial bladder cancer occur in 7-12%. Urethral second primary tumors in male and female patients in contemporary series with bladder substitution are 4-6% and 1.4 o 4%, respectively. Upper tract recurrences vary between 2.4-17%. Complications regarding the upper urinary tract have dramatically diminished due to simplified forms of upper tract protection as well as a more refined technique of ureterointestinal anastomosis. Depending on the technique ureteroileal stenosis was lately reported to lie between 2.7 to 3.8%. Renal function remained stable in 96% after a mean follow-up of up to 5 years.
Conclusion:
Radical cystectomy in carefully selected patients has stood the test of time by providing adequate long-term survival and low local recurrence rates. Orthotopic bladder substitution does not compromise oncological outcome, yields excellent functional results, is cost effective compared to other types of urinary diversion, may improve quality of life and should therefore be the diversion of choice both in men and women. Chronological age is generally not a contraindication for cystectomy, but for orthotopic urinary diversion, tumor extent, functional pelvic floor deficits and general life expectancy are limiting factors.
Men with good functional results following radical retropubic prostatectomy (RRP) and requiring radical cystectomy (RC) for subsequent bladder carcinoma seldom receive orthotopic bladder substitution. Four patients aged 62- 72 years (median 67 years), who had undergone RRP for prostate cancer of stage pT2bN0M0 Gleason score 6 (n = 1), pT2cN0M0 Gleason score 5 and 6 (n = 2) and pT3bN0M0 Gleason score 7 (n = 1) 27 to 104 months before, developed urothelial bladder carcinoma treated with RC and ileal orthotopic bladder substitution. After radical prostatectomy three were continent and one had grade I stress incontinence, and three achieved intercourse with intracavernous alprostadil injections. Follow-up after RC ranged between 27 and 42 months (median 29 months). At the 24-month follow-up visit after RC daily urinary continence was total (0 pad) in one patient, two used one pad for mild leakage, and one was incontinent following endoscopic incision of anastomotic stricture. One patient died of progression of bladder carcinoma, while the other three are alive without evidence of disease. The three surviving patients continued to have sexual intercourse with intracavernous alprostadil injections. Men with previous RRP have a reasonable chance of maintaining a satisfactory functional outcome following RC and ileal orthotopic bladder substitution. © 2014 S. Karger AG, Basel.
Objective:
To report continence and urodynamic findings after radical cystectomy and urinary diversion with modified S-ileal neobladder between January 1993 and January 2013.
Patients and methods:
181 patients were enrolled. Continence status, reservoir sensation, compliance, capacity and activity were assessed.
Results:
Daytime continence was reported by 88.0, 98.4 and 99.2%, while nighttime continence was reported by 70.2, 94.0 and 95.8% of our patients at 6 months, 5 years and 20 years, respectively. Enterocystometric capacity and maximum reservoir pressure were 366 vs. 405 ml and 502 ml, and 29 vs. 18 and 11 cm H2O, at 6 months, 5 years and 20 years, respectively. Median post-void residual urine volume was 32 ml at 6 months, 50 ml at 5 years and 120 ml at 20 years.
Conclusions:
The modified S-ileal neobladder technique has a very good long-lasting functional outcome, with high day- and nighttime continence levels as well as high acceptability rates from our patients.
Background: To compare the QOL in patients with ileal or colon conduits (IC), continent urinary reservoir (CR) and ileal neobladder (NB), a retrospective study was conducted using a questionnaire sent by mail.
Methods: Seventy-nine patients with a mean age of 60 years were included in this study. A total of 36, 22 and 21 underwent IC, CR and NB, respectively and were alive at the time of this study. A structured questionnaire consisting of 97 questions that covered general condition and physical condition, reconstruction-related symptoms, psychological status, sexual life, social status and satisfaction with the treatment was employed.
Results: The IC group frequently complained of changes in bathing habits and loss of using public baths in comparison with the CR and the NB groups. High scores for loss of sexual desire were obtained in the IC, the CR and the NB groups, in this order. Because of the nearly physiological voiding, the NB group desired a voiding condition like pre-operative status as compared with the IC and the CR groups. However, for most of the questionnaire items no difference was seen among the IC, CR and NB groups concerning general condition, reconstruction-related symptoms, psychological status, sexual life, social status, satisfaction with the treatment and global satisfaction with life and health.
Conclusions: There was little difference in the QOL score of the questionnaire and satisfaction among the IC, CR and NB groups. It was suggested that almost every patient accepted and adapted to the present status of general quality of life in each group.
Objective To compare the health-related quality of life after bladder substitution with that following ileal conduit diversion.Patients and methods Sixty-seven male patients with bladder cancer completed the questionnaire; 38 had undergone bladder substitution and 29 ileal conduit diversion; the median follow-up was 1.0 year (range 0.5–3.0) and 4.8 years (range 1.1–15.2), respectively. Semi-structured qualitative interviews were conducted and analysed, and the questionnaire was developed based upon these results.Results Both day- and night-time urinary leakage occurred more frequently following bladder substitution (18% against 10%, and 21% against 3%). Nevertheless, urinary leakage affected conduit patients more severely and they scored higher on a leakage distress scale. Furthermore, 58% of the ileal conduit but only 21% of the bladder substitution patients gave urinary leakage as their main concern (P=0.04). Ileal conduit patients did not retain their body image as well as those with bladder substitution. The frequency of both sexual and non-sexual physical contacts decreased in the majority of the conduit patients but only in a minority of the bladder substitute patients. Global satisfaction was high and similar in both groups.Conclusion These results show that the health-related quality of life is retained to a higher degree after bladder substitution and supports the use of this procedure as the standard method of diversion after cystectomy for bladder cancer.
Patients undergoing radical cystectomy with neobladder for bladder cancer are hypothesized to tolerate worse urinary function than ileal conduit patients because of improved body image. The purpose of this study was to compare body image and quality of life between the 2 diversion types after surgery.
Patients who underwent radical cystectomy at the University of Michigan from November 1999 onwards and completed follow-up between July 2007 and August 2008 were eligible for the study. Patients who had cystoscopy for bladder cancer were enrolled as a reference group. Urinary, bowel, and sexual outcomes were assessed using the Bladder Cancer Index, and body image was evaluated using the EORTC Body Image Scale. Cross-sectional analysis at baseline, 1 month, 6 months, and 1, 2, 4, 6, and 8 years after treatment was performed.
A total of 139 neobladder, 85 conduit, and 112 cystoscopy patients were studied. After cystectomy, both conduit and neobladder groups had worse body image scores that improved over time, although the neobladder group did not return to baseline. Age was associated with score but gender was not. Urinary function was better in conduit patients but urinary bother was the same in both diversion types.
Radical cystectomy has a significant impact on body image that improves slowly over time. No difference in body image scores between ileal conduit and neobladder patients exists after surgery. Factors other than just body image are likely involved in the patient's acceptance of worse urinary function associated with a neobladder.
We report the difference in quality of life (QOL) between patients with an orthotopic neobladder and normative values in the age matched Japanese population.
Between November 1996 and June 2003, 75 patients underwent orthotopic neobladder construction at our institution, of whom 47 males and 9 females were enrolled in this study. A total of 19 patients were excluded because of death or insufficient followup (less than 6 months). Two types of questionnaire, namely the RAND 36-Item Health Survey, version 2 and the Functional Assessment of Cancer Therapy-Bladder Cancer, were mailed to all 56 patients. The 48 patients (86%) who returned the completed forms were included in our analysis. Postoperative QOL was compared with age matched normative values in the control Japanese population.
Overall there was no significant difference in any scale between patients with a neobladder and the age matched control Japanese population. The patient bodily pain score in the seventh decade of life and the role-physical score in those older than 70 years were better than age matched normative values in the Japanese population (p < 0.005 and p < 0.05, respectively). Male patients in the seventh decade of life were more likely to have better QOL in the physical functioning, role-physical and role-emotional subscales in addition to the bodily pain subscale compared to age matched control values (p < 0.05, < 0.05, < 0.001 and < 0.001, respectively). Likewise in male patients older than 70 years role-physical scores remained better than age matched normative values in the Japanese population (p < 0.01). Further analysis of bladder cancer related QOL showed that patients followed more than 24 months were more likely to have a lower incontinence score than those followed less than 24 months (p < 0.05). In addition, the continence related QOL change alone did not affect any health related QOL scales, as analyzed by RAND 36-Intem Health Survey.
Our study shows that there is no essential difference in health related QOL between patients with a neobladder and the age matched Japanese control population. The current results provide some primary evidence to help in decision making and eliminate potential anxiety about worse QOL after cystectomy.
We critically examined the evidence supporting the widely accepted notion that patients undergoing continent urinary tract reconstruction after cystectomy experience superior quality of life outcomes than patients receiving a conduit.
Based on a comprehensive MEDLINE literature search we retrieved and evaluated all full-length articles published in the English, French, German, Italian and Spanish languages comparing conduit diversion with continent cutaneous diversion and/or orthotopic bladder substitution with respect to quality of life or similar concepts. All studies were rated according to the International Consultation on Urological Diseases modification of Oxford Center for Evidence-Based Medicine levels of evidence.
The literature on quality of life after radical cystectomy for bladder cancer was rather extensive but generally of questionable quality. The main problems were flaws in the patient materials and methodologies used. To our knowledge not a single randomized, controlled study exists in the field. Because only few articles achieved a level of evidence better than III, the International Consultation on Urological Diseases rating system does not allow further differentiation among studies. Most studies showed that overall quality of life after cystectomy remained good in most patients irrespective of urinary diversion type.
Existing studies are unable to prove that continent reconstruction after radical cystectomy is superior to conduit diversion. This review emphasizes the importance of performing well designed studies in the future.