Health related quality of life after radical cystectomy: Comparison of ileal conduit to continent orthotopic neobladder

Abstract

Aims

To compare health related quality of life (HRQOL) between patients with two different types of urinary diversion, ileal conduit and orthotopic neobladder, and between them and an age-matched population of healthy subjects.

Materials and methods

Eighty eight patients treated with radical cystectomy for bladder cancer at our institutions between 2002 and 2007 were contacted for this survey. All of them had a follow-up of more than 12 months after surgery and were recurrence free. The SF-36 questionnaire was provided to each patient during a follow-up visit at outpatient clinics. Overall, 79 patients (90%) returned the questionnaire and were included in this analysis. They were divided into two groups: group 1 comprised 44 patients with an ileal conduit diversion, and group 2 included 35 patients with a neobladder. As a control, normative values of an age-matched healthy Italian population were considered.

Results

No significant difference was found in scale scores between the neobladder and ileal conduit groups. Scale scores for role-physical functioning, social functioning and role-emotional functioning in both the neobladder and ileal conduit groups were significantly below the Italian population norm. Patients with a neobladder 65 years old or older (n = 18) had significantly lower scores for role-physical functioning and role-emotional functioning than those younger than 65 years (n = 17; p < 0.05).

Conclusion

Few differences between ileal conduit and orthotopic bladder substitution have been detected. Thus, the assumption that continent reconstruction provides better HRQOL than ileal conduit diversion cannot be supported. Patient education and active participation in treatment decisions seem to be the key to postoperative satisfaction.

Introduction

Radical cystectomy with urinary tract reconstruction currently remains the standard treatment for invasive nonmetastatic bladder cancer.¹

Historically, conduit diversion has represented the mainstay of urinary tract reconstruction. However, during the last decade orthotopic and continent diversions have become the “gold standard” reconstructive procedure after radical cystectomy.² It has been estimated that 80% of men and 65% of women undergoing cystectomy for bladder cancer are candidates for orthotopic neobladder.³ Still, evidence supporting the current enthusiasm regarding orthotopic bladder replacement should be improved by well designed prospective studies, ideally in a randomized setting, comparing the various major forms of urinary diversion and bladder replacement surgery.⁴

The perceived advantage of the various forms of continent urinary diversion is a presumed improvement in quality of life compared with conduit diversion.

However, these more “advanced” forms of urinary diversion may have some disadvantages as well. They are technically more challenging and more time consuming. Postoperatively, patients leave the hospital with indwelling catheters. Once the catheters are removed, patients undergo a period of education in the techniques required to properly care for the reservoir or neobladder. Patients are also at a higher risk for diarrhea and vitamin mal-absorption. However, it is generally believed that the quality of life advantages of continent urinary diversions outweigh the potential disadvantages.

In the past decade, there has been an increasing focus on quality of life outcomes in urological malignancies. This has been aided by the development of new health related quality of life (HRQOL) instruments for use specifically in urology. HRQOL is a patient centered outcome and can be defined as a patient's evaluation of the impact of a health condition and its treatment on relevant aspects of life.⁵

In this study we compared HRQOL between patients with two different types of urinary diversion and between them and an age-matched population of healthy subjects.