Health-related quality of life after radical cystectomy for bladder cancer in elderly patients with an ileal conduit, ureterocutaneostomy, or orthotopic urinary reservoir: A comparative questionnaire survey

Department of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8558, Japan.
Acta medica Okayama (Impact Factor: 0.7). 09/2007; 61(4):199-203.
Source: PubMed


To compare the health-related quality of life of elderly patients after radical cystectomy for bladder cancer in urinary diversion groups: ileal conduit, ureterocutaneostomy, or orthotopic urinary reservoir. The 109 participating elderly patients aged 75 or older completed self-reporting questionnaires: the QLQ-C30, and on satisfaction with urinary diversion methods. Fifty-six patients had undergone constructions for ileal conduit diversion, 31 for ureterocutaneostomy, and 22 for orthotopic urinary reservoir (OUR). The median follow-up period for each group was 4.0 years (range 0.3-11.2), 4.5 years (range 0.3-18.0), and 3.3 years (range 0.3-6.7), respectively. Regardless of the type of urinary diversion, the majority of patients reported having good overall quality of life, although with some problem of pain. No significant differences among urinary diversion subgroups were found in any quality of life area in the QLQ-C30 questionnaire. More patients in the OUR sub-group felt disappointment than those in the ileal conduit or cutaneostomy sub-groups. However, a questionnaire which asked which diversion method would be preferable showed a trend that more patients in the OUR subgroup would have chosen the same one. Health-related quality of life appeared relatively good in these 3 groups. Patient demands and expectations may be so different from the results that the details of each urinary diversion method should be explained thoroughly. OUR construction could be a candidate even for elderly patients.

Download full-text


Available from: Daisuke Manabe
  • [Show abstract] [Hide abstract]
    ABSTRACT: Aufgrund des demographischen Wandels wird die Inzidenz von Blasenkarzinomen zunehmen. Bei muskelinvasiven Tumoren ist die radikale Zystektomie durch Fortschritte im perioperativen Management auch beim älteren Patienten indiziert. Durch die ebenfalls altersabhängige Zunahme von Komorbiditäten stellt sich die Frage nach der optimalen Harnableitung für den Risikopatienten. Das Ileumconduit stellt dazu aufgrund seiner sicheren, erprobten und risikoarmen Anwendung den Goldstandard dar. Aufgrund der Darmbeteiligung weist es jedoch relevante Komplikationsrisiken für den Risikopatienten auf. Eine noch einfachere und sichere Alternative stellt die Harnleiterhautfistel dar, die jedoch zunächst hohe Stenosierungsraten aufwies. Neuere Daten weisen allerdings darauf hin, dass vergleichbar viele Patienten ohne Harnleiterstent auskommen wie beim Ileumconduit. Auch Untersuchungen zur Lebensqualität zeigen vergleichbare Ergebnisse. Aus diesem Grund sollte die häufig zurückhaltende Einstellung gegenüber der Harnleiterhautfistel bei Risikopatienten überdacht werden.
    No preview · Article · Sep 2012 · Der Urologe
  • [Show abstract] [Hide abstract]
    ABSTRACT: The purpose of this descriptive study was to describe health-related quality of life (HRQOL) concerns among cancer patients with continent urinary diversion (UD) and incontinent UD. Study participants were accrued from members of the California United Ostomy Association and 2 cancer centers in Southern California. The City of Hope HRQOL-Ostomy Questionnaire (COHHRQOL-O) is a modified HRQOL measurement tool based on the original work done over a number of years by Grant and colleagues. The COHHRQOL-O was mailed to 2,890 individuals. Of the 1,600 returns, there were 307 responses from patients with UD, indicating that they had a UD and a diagnosis that clearly indicated cancer. The majority of respondents were diagnosed with bladder cancer, and the average time since surgery was 9.5 years. While most patients reported being sexually active prior to UD, less than 27% resumed sexual activity after surgery. More than 75% of patients also reported difficulty in adjusting to their UD, with the majority reporting difficulty with urine leakage. Those who were incontinent reported a range of bothersome issues, such as skin problems around the UD, difficulties in managing UD care, fear of recurrence, financial worries, family distress, and uncertainty about the future. The results of this study add to our understanding of how patients adjust to a UD and what problems and issues can occur, even years after the initial surgery. Mastering UD care is best done under the guidance of a WOC nurse, and access to WOC nurse is essential when problems occur.
    No preview · Article · Nov 2009 · Journal of wound, ostomy, and continence nursing: official publication of The Wound, Ostomy and Continence Nurses Society / WOCN
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: To compare the quality of life (QOL) in patients with ileal neobladder and sigmoidal neobladder, a retrospective survey was conducted using a formulated questionnaire. Between January and March 1999, a QOL survey was conducted using self-administered questionnaires (EORTC QLQ-C30, IPSS, supplemented with detailed questionnaires about continence, sexual function, and patient's satisfaction with the selected urinary diversion method) for 78 patients with orthotopic urinary reservoir (OUR) who were followed-up for more than 3 months after cystectomy. Among 78 patients, 63 had OUR using an ileal segment (male/female=59/4, median age: 70.8 years old, median follow-up: 1.7 years). Fifteen patients had OUR using a sigmoidal segment (male/female=13/2, median age: 71.9, median follow-up: 3.9). The QLQ-C30 functional evaluation and the items in relation to sexual function showed no differences between the 2 groups. Concerning the voiding condition, bladder emptying, frequency, and urgency, scores in the sigmoidal OUR group were significantly higher. The QOL score concerning voiding conditions, daytime, and nighttime continence and quantity of pad showed a better score in the ileal OUR group. Concerning the satisfaction with methods of urinary diversion, patients in the sigmoidal OUR group expressed less satisfaction than their preoperative expectations. Considering several postoperative voiding conditions, ileal OUR seems superior to sigmoidal OUR.
    Preview · Article · Sep 2007 · Acta medica Okayama
Show more