Impact of invasive bladder cancer and orthotopic urinary diversion on general health-related quality of life: An SF-36 survey

Abstract

Bladder cancer is a common type of genitourinary cancer, and radical cystectomy with urinary diversion is considered to be the most effective local treatment for invasive bladder cancer. In order to assess the functional results and health-related quality of life (QOL) in bladder cancer patients with an orthotopic neobladder, and to provide a reasonable basis for the evaluation of urinary diversion in situ, we conducted a study on 96 neobladder patients. In December, 2011, questionnaires were mailed to 96 patients that had undergone urinary diversion surgery between January, 2007 and December, 2009. The questionnaire included the validated health-related QOL questionnaire and the MOS 36-item Short-Form Health Survey (SF-36). We compared the functional results between patients with an orthotopic neobladder and those with other types of urinary diversion at 6, 12 and 24 months after surgery. Data from 82 patients (54 with orthotopic and 28 with non-orthotopic urinary diversion) were included in the analysis. The SF-36 patient scores following orthotopic urinary diversion were significantly higher than those following non-orthotopic urinary diversion. The majority of patients with orthotopic urinary diversion considered themselves as healthy and their scores of total health were higher compared to those of patients with non-orthotopic urinary diversion. However, there were no differences in the scores of physical functioning between patients with orthotopic and those with non-orthotopic urinary diversion. Our findings regarding health-related QOL and the frequency of complications in the orthotopic and the non-orthotopic urinary diversion groups were similar. However, the mental health of patients with orthotopic urinary diversion was more easily restored compared to that of patients with non-orthotopic urinary diversion, which reduced their overall recovery time.

Recent Trends in Postcystectomy Health-related Quality of Life (QoL) Favors Neobladder Diversion: Systematic Review of the Literature

“…This is in contrast to articles published after 2010 as 4 of the 6 (66.7%) recent studies have shown neobladder to be associated with better QoL outcomes than its comparators [13][14][15]17 . We identified 3 studies in which participants underwent radical cystectomy after the year 2005, all of which reported better QoL outcomes in the neobladder group and all were prospective in design.…”

“…We identified 3 studies in which participants underwent radical cystectomy after the year 2005, all of which reported better QoL outcomes in the neobladder group and all were prospective in design. [13][14][15] Until more recently, available studies assessing QoL have predominantly been retrospective and cross-sectional, taking a single time point post-cystectomy to assess QoL. Such study designs are limited in distinguishing variations in health status that may actually reflect preoperative differences.…”

“…Since the systematic review on this subject by Porter & Penson (2005) 6 , which reported no prospective studies comparing neobladder with other diversion types, there have been 5 such prospective studies published, the majority of which demonstrate neobladder to be associated with better QoL outcomes [13][14][15] .…”

“…6 Yang et al prospectively followed 82 patients who underwent either neobladder or cutaneous diversion and used the SF-36 questionnaire to assess QoL at multiple time points up to 24 months follow-up. 13 The study concluded that those participants undergoing neobladder had total health scores that were higher than the comparator group. In a prospective study by Prcic et al, neobladder provided significantly better QoL compared to ileal conduit according to SIP at 6 months follow-up.…”

“…Twenty-two studies met the inclusion criteria [6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22] (Table 1) with a total of 2450 participants who underwent urinary diversion of which 1159 (47.3%) had neobladder, 1017 (41.5%) and 175 (7.1%) formed the ileal conduit and cutaneous diversion groups, respectively. The remaining 99 (4.0%) participants underwent a diversion type that was not a comparator group in the respective studies.…”