Comparison of Health-Related Quality of Life Between Ileal Conduit Diversion and Orthotopic Neobladder in Women: A Meta-Analysis

Abstract

BackgroundOrthotopic neobladder (ONB) reconstruction and ileal conduit diversion (ICD) can have different impacts on health-related quality of life (HRQOL) in patients with bladder cancer.PurposeTo conduct a meta-analysis to explore the comparison of HRQOL between ICD and ONB in women.MethodsPubMed, Embase, and the Cochrane Library were searched for available papers published from inception up to December 2020. The outcomes were the score data from HRQOL questionnaires. The random-effects model was used for all analyses.ResultsFour studies (six datasets; 283 patients) were included. In the EORTC-QLQ-C30, there were no differences between ICD and ONB regarding cognitive functioning (weighted mean difference (WMD)=1.18, 95% confidence interval (CI): -20.52,22.88, P=0.915), global health (WMD=1.98, 95%CI: -15.26,19.22, P=0.822), emotional functioning (WMD=0.86, 95%CI: -19.62,21.33, P=0.935), physical functioning (WMD=0.94, 95%CI: -11.61,13.49, P=0.883), role functioning (WMD=-4.94, 95%CI: -12.15,2.27, P=0.180), and social functioning (WMD=-4.71, 95%CI: -20.83,11.40, P=0.567). There were no differences between ONB and ICD for specific symptoms (fatigue, nausea and vomiting, and pain) and single items (dyspnea, insomnia, appetite loss, constipation, diarrhea, and financial difficulties) (all P>0.05). In EORTC-QLQ-BLM30, there were no differences between ICD and ONB regarding bowel symptoms (WMD=5.45, 95%CI: -15.30,26.20, P=0.607), body image (WMD=-13.12, 95%CI: -31.15,4.92, P=0.154), sexual functioning (WMD=-5.55, 95%CI: -14.96,3.85, P=0.247), and urinary symptom (WMD=5.50, 95%CI: -7.34,18.34, P=0.401), but one study reported better future perspective with ONB (WMD=-14.9, 95%CI: -27.14,-2.66, P=0.017).ConclusionWomen who underwent ONB do not appear to have a statistically significantly better HRQOL than women who underwent ICD, based on EORTC-QLQ-C30 and EORTC-QLQ-BML30.

Neobladder “Function”: Tips and Tricks for Surgery and Postoperative Management

“…Few studies have evaluated QoL in female patients undergoing CR and UD [ 167 , 168 , 169 ]. Gacci et al demonstrated in their study that women undergoing ureterocutaneostomy have worse QoL than patients undergoing Bricker urinary shunt and ONB [ 170 ].…”

Effect of orthotopic neobladder reconstruction on quality of life: A systematic review

“…11 However, a study comparing open and laparoscopic radical cystectomy for neobladder found promising peri-and post-operative outcomes for laparoscopic surgery, including smaller incision length, less pain and complications, and faster recovery. 9,[11][12][13][14] These results suggest that orthotopic neobladder may have a significant impact on quality of life, but the choice of surgical technique may also play a role. For this reason, there are conflicting results in the current literature regarding the quality of life of patients who underwent ONB.…”

“…Research has identified several factors that may affect the quality of life in orthotopic neobladder patients. 8,9 These include preoperative performance status scores, nerve-sparing surgery, urinary incontinence, non-nerve-sparing surgery, and ureteral stenosis. 10 Despite the potential benefits of orthotopic diversion, its use is decreasing with the shift to minimally invasive surgical techniques.…”

“…ONB reconstruction is thought to minimize the change in body image while maintaining voiding from the urethra without increasing the rate of postoperative complications. Research has identified several factors that may affect the quality of life in orthotopic neobladder patients 8,9 . These include preoperative performance status scores, nerve‐sparing surgery, urinary incontinence, non‐nerve‐sparing surgery, and ureteral stenosis 10 .…”

“…Despite the potential benefits of orthotopic diversion, its use is decreasing with the shift to minimally invasive surgical techniques 11 . However, a study comparing open and laparoscopic radical cystectomy for neobladder found promising peri‐ and post‐operative outcomes for laparoscopic surgery, including smaller incision length, less pain and complications, and faster recovery 9,11–14 . These results suggest that orthotopic neobladder may have a significant impact on quality of life, but the choice of surgical technique may also play a role.…”