Orthotopic neobladder vs. ileal conduit urinary diversion: A long-term quality-of -life comparison
Orthotopic neobladder vs. ileal conduit urinary diversion: A long-term quality-of -life comparison
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DOI：
10.1016/j.urolonc.2015.10.006
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发表时间：
2016-03-01
影响因子：
2.7
通讯作者：
Yossepowitch, Ofer
中科院分区：
文献类型：
--
作者：
Goldberg, Hanan;Baniel, Jack;Yossepowitch, Ofer
目的：根治性膀胱切除术后尿流改道的最佳方式仍有争议。我们试图比较长期的健康相关的生活质量与原位新膀胱和回肠导管分流（ICD）患者之间的结果：患者和方法：我们招募了95例根治性膀胱切除术和ICD（n = 49）或原位新膀胱重建（ONR）（n = 46），与手术的最小间隔为1年。结果：与ICD组相比，ONR组患者总体上更年轻、更健康（P < 0.01）。性别、婚姻状况、入组时的疾病状况以及从手术到访谈的平均持续时间在亚组之间相似。两组患者的泌尿功能评分均优于ICD组（P < 0.01），而相应的困扰评分大致相同。ONR组性功能评分高于ICD组（P < 0.01），但其烦恼评分低于ICD组（53.2 vs.65.3; P < 0.05）。随着患者年龄的增长，他们更有可能报告更好的泌尿功能和更差的性功能，但不太可能受到性功能下降的困扰。我们的研究表明，尿失禁引起的麻烦和性功能障碍的风险应突出那些选择新膀胱重建，而更喜欢导管转移的患者应该放心，他们的预期生活质量不会受到损害。(C)2016 Elsevier Inc. All rights reserved.
Purpose: The optimal form of urinary diversion following radical cystectomy remains controversial. We sought to compare the long-term health-related quality-of-life outcomes between patients with orthotopic neobladder and ileal conduit diversion (ICD).Patients and methods: We enrolled 95 patients following radical cystectomy and ICD (n = 49) or orthotopic neobladder reconstruction (ONR) (n = 46), with a minimum interval of 1 year from surgery. All patients completed the Bladder Cancer Index questionnaire, assessing their urinary, bowel, and sexual function, and bother scores.Results: Patients treated with ONR were generally younger and healthier compared with those who underwent ICD (P < 0.01). Sex, marital status, disease status at the time of enrollment, and mean duration elapsing from surgery to interview were similar between the subgroups. Better functional scores in favor of ICD were recorded in the urinary domain (P < 0.01), whereas the corresponding bother scores were roughly identical in both groups. Conversely, although higher functional scores were recorded in the sexual domain of patients with ONR (P < 0.01), the corresponding bother scores in this group were lower compared with their counterparts with ICD (53.2 vs. 65.3; P < 0.05). As patients grew older they were more likely to report on better urinary function and worse sexual function, but were less likely to be bothered by the decline in sexual function.Conclusions: Our study suggests that the bother resulting from urinary incontinence and the risk of sexual dysfunction be highlighted to those electing for neobladder reconstruction, whereas patients preferring conduit diversion should be reassured that their expected quality of life is not compromised. (C) 2016 Elsevier Inc. All rights reserved.