Quality of Life Survey of Urinary Diversion Patients: Comparison of Continent Urinary Diversion Versus Ileal Conduit

Abstract

Background: Continent urinary reservoirs (CUR) have become one of the major options for patients requiring urinary diversion to improve their quality of life (QOL). To assess whether CUR enhanced postoperative QOL, we surveyed patients with CUR and ileal conduit (IC) using a questionnaire sent by mail. Patients and Methods:The questionnaire consisted of 133 questions that covered physical and mental status, social life, sexual habits and symptoms related to urinary diversions. A total of 172 questionnaires were sent out, and 137 (80%) patients (74 CUR and 63 IC patients) responded. Results: Basic physical conditions were similar in the 2 groups, except for sleeping habits. Regarding social life, however, the CUR group showed better scores in bathing habits and frequency of overnight travel. Parastonial dermatitis was more frequent in the IC group and the patients were more hesitant to show their stoma to others. On the other hand, about half of the patients in the CUR group complained of troublesomeness in self-catheterization, especially at night. Overall, 74% and 41 % of the patients in the CUR and IC group were satisfied with their urinary diversion. When the Kock pouch and Indiana pouch were compared, no statistically significant differences were found in average capacity, maximum capacity, o r frequency of self-catheterization. Conclusions: CUR recipients have enhanced QOL regarding the stoma, travel and sleeping habits as compared to ileal conduit. However, troublesomeness of night time self-catheterization was noted in the CUR group. Individualized selection of the type of urinary diversion with informed consent is essen tia I.

Editorial Comment

“…8 The questionnaire consisted of 35 questions divided into functional (physical, role [work situation], social and financial, emotional, cognitive, overall health), general (pain, fatigue, sleep disturbance, nausea and vomiting, constipation, diarrhea), and urinary diversion-related symptom categories (Appendix I). The questionnaire had five items relating to physical condition, two relating to role, three relating to social and financial interaction, five on mental condition, one on cognition, 12 on general symptoms, five on urinary diversion-related symptoms and two relating to overall health.…”

“…We modified two items in the EORTC QLQ-C30 and the questionnaire ordering, and added five items referring to urinary diversion-related symptoms of the QOL survey of Okada et al . 8 To assess the postoperative health-related QOL of IRB, we carried out a survey comparison of IRB patients and ileal conduit (IC) patients using this questionnaire sent by mail.…”

Determining when to recommend continent urinary diversion

“…Several prior studies have found that patients treated with orthotopic continent diversion are more likely to travel, to engage in leisure activities and to suffer fewer social deficits than those managed with incontinent diversions. 19,22,[30][31][32] Others have found that urinary leakage is a greater concern among patients treated with ileal conduit, compared with continent diversion, 14,33,34 which may contribute to less social behaviour.…”

“…22 Even so, each type of urinary diversion is associated with a different set of well-described treatment-related effects. In those managed with ileal conduit, concern centres…”

“…[14][15][16][17][18][19][20] While general health-related quality of life appears to be similar in both, 21 specific issues concerning body image, problematic urine leakage and decreased sexual functioning have been inconsistent, although more commonly reported following ileal conduit diversion. 22 Even so, each type of urinary diversion is associated with a different set of well-described treatment-related effects. In those managed with ileal conduit, concern centres Determining when to recommend continent urinary diversion Scott M. Gilbert, MD, MS; James E. Montie, MD…”