Henningsohn Lars
Division of Urology, Institution for Clinical Science, Intervention and Technology, Karolinska Institute, Karolinska University Hospital Huddinge, Stockholm, Sweden.
Curr Opin Urol. 2006 Sep;16(5):356-60. doi: 10.1097/01.mou.0000240309.62958.19.
Therapy for invasive bladder cancer should aim at cure, and besides radical organ-removing surgery, bladder-sparing alternatives are available. Here I report the current status on quality-of-life issues after therapy for invasive bladder cancer.
Consensus has not been reached on the definition of the concept 'quality of life', resulting in numerous ways of measuring it. It is reasonable to believe that the individually self-assessed level of quality of life is affected by the total post-therapeutic symptom burden, that is, the long-term side effects of a therapy are predictors for quality of life. The affection on quality of life by a symptom on an individual can never be predicted because of differences in symptom tolerance. On the group level, however, some symptoms are generally highly distressful, whereas others are generally low distressors. A new area of quality-of-life research is evolving, measuring symptoms, symptom distress and effects on quality of life.
Cystectomy followed by orthotopic bladder replacement seems to keep a high level of quality of life in select cases; however, ileal conduit is still an excellent option in other patients. Bladder-sparing alternatives are available. An individual pre-therapeutic consultation will aid in determining the radical therapeutic method in each individual patient.
浸润性膀胱癌的治疗应以治愈为目标，除了根治性器官切除手术外，还有保留膀胱的替代方案。在此，我报告浸润性膀胱癌治疗后生活质量问题的现状。
对于“生活质量”这一概念的定义尚未达成共识，导致了多种测量方法。有理由认为，个体自我评估的生活质量水平受治疗后总症状负担的影响，也就是说，治疗的长期副作用是生活质量的预测因素。由于症状耐受性的差异，个体症状对生活质量的影响永远无法预测。然而，在群体层面，一些症状通常极具困扰性，而另一些则通常困扰较小。一个生活质量研究的新领域正在兴起，即测量症状、症状困扰及其对生活质量的影响。
在特定病例中，膀胱切除术后原位膀胱替代似乎能保持较高的生活质量水平；然而，回肠膀胱术对其他患者而言仍是一个极佳的选择。有保留膀胱的替代方案。治疗前的个体化咨询将有助于为每位患者确定根治性治疗方法。
