Hobisch A, Tosun K, Kinzl J, Kemmler G, Bartsch G, Höltl L, Stenzl A
Department of Urology, University of Innsbruck, Austria.
Semin Urol Oncol. 2001 Feb;19(1):18-23.
Patients frequently complain about changes in their everyday life after radical cystectomy and urinary diversion. The aim of this study was to compare subjective morbidity of ileal neobladder to the urethra versus ileal conduit urinary diversion and to elucidate its influence on quality of life. A total of 102 patients who underwent radical cystectomy due to a bladder malignancy were included in the study: 69 patients (67.6%) with an orthotopic neobladder and 33 patients (32.4%) with an ileal conduit. The compliance was 99% and mean follow-up was 37 months. All patients completed two retrospective quality-of-life questionnaires, namely the QLQ-C30 and a questionnaire developed at our institution to elucidate specific items regarding urinary diversion. The questioning was performed by a nonurologist. The results obtained from the validated (QLQ-C30) and our self-designed questionnaire clearly demonstrate that patients with an orthotopic neobladder better adapt to the new situation than patients with an ileal conduit. In addition, neobladder to the urethra improves quality of life due to a better self-confidence, better rehabilitation as well as restoration of leisure, professional, traveling, and social activities, and reduced risk of inadvertent loss of urine. For example, 74.6% of neobladder patients felt absolutely safe with the urinary diversion in contrast to 33.3% in the ileal conduit group. Only 1.5% of neobladder patients had wet clothes caused by urine leakage during day versus 48.5% of ileal conduit patients; 92.8% of neobladder patients felt not handicapped at all; and 87% felt not sickly or ill in contrast to 51.5% and 66.7% of ileal conduit patients, respectively. Moreover, 97% of our neobladder patients would recommend the same urinary diversion to a friend suffering from the same disease in contrast to only 36% of ileal conduit patients. The results obtained by this study demonstrate that quality of life is preserved in a higher degree after orthotopic neobladder than after ileal conduit urinary diversion.
根治性膀胱切除术和尿流改道后，患者经常抱怨日常生活发生了变化。本研究的目的是比较回肠新膀胱与尿道改道及回肠导管尿流改道的主观发病率，并阐明其对生活质量的影响。共有102例因膀胱恶性肿瘤接受根治性膀胱切除术的患者纳入本研究：69例（67.6%）接受原位新膀胱手术，33例（32.4%）接受回肠导管手术。依从率为99%，平均随访时间为37个月。所有患者均完成了两份回顾性生活质量问卷，即QLQ-C30和我们机构编制的一份问卷，以阐明有关尿流改道的具体项目。问卷调查由一名非泌尿科医生进行。从经过验证的（QLQ-C30）问卷和我们自行设计的问卷中获得的结果清楚地表明，原位新膀胱患者比回肠导管患者能更好地适应新情况。此外，新膀胱尿道改道改善了生活质量，因为患者自信心增强、康复情况更好，休闲、职业、旅行和社交活动得以恢复，且意外漏尿风险降低。例如，74.6%的新膀胱患者对尿流改道感到绝对安全，而回肠导管组为33.3%。白天只有1.5%的新膀胱患者因尿液渗漏弄湿衣服，而回肠导管患者为48.5%；92.8%的新膀胱患者完全不觉得有障碍；87%的患者感觉没有病痛，而回肠导管患者分别为51.5%和66.7%。此外，97%的新膀胱患者会向患有相同疾病的朋友推荐相同的尿流改道方式，而回肠导管患者只有36%。本研究结果表明，原位新膀胱术后生活质量的保留程度高于回肠导管尿流改道术后。
