Frich Pål Stefan, Kvestad Camilla Angelsen, Angelsen Anders
Department of Cancer Research and Molecular Medicine, Norwegian University of Science, Trondheim, Norway.
Scand J Urol Nephrol. 2009;43(1):37-41. doi: 10.1080/00365590802473198.
To assess outcome and quality of life (QoL) aspects among patients treated with three different diversion techniques: Bricker, Studer or Hemi-Kock, after radical cystectomy.
Thirty-seven patients with Bricker conduit, 19 with Studer neobladder and 16 with Hemi-Kock neobladder answered a questionnaire concerning QoL, general health, relationship with partner, sexual function, satisfaction with information and follow-up, etc. Response rates were 79% (37/47), 100% (18/18) and 86% (19/22), in Bricker, Studer and Hemi-Kock patients respectively. Medical records were reviewed to assess cancer type, grade and stage.
Both Studer and Bricker patients reported a high mean value of QoL (p>0.05). QoL was not influenced by tumour stage (pTa-T2 versus pT3-4) (p>0.05). After surgery, more Studer patients (78%) experienced practical problems compared with Bricker patients (40%) (p=0.01). Studer patients reported a higher influence on the everyday life compared with Bricker and Hemi-Kock patients (p<0.01 and p=0.05, respectively). Leakage in day-time was reported by 53% of Studer patients and 16% of Hemi-Kock patients (p=0.03). Moreover, all Studer patients had leakage at night compared with 58% of Hemi-Kock (p<0.01). The follow-up time after surgery was 56 months for Hemi-Kock patients compared with 26 months for Studer patients. Erectile dysfunction was reported by 81% of the men, with no difference between the methods of diversion.
Patients in all diversion groups rated their QoL as high. Type of urinary diversion was not associated with any statistically significant difference in QoL outcome. However, Studer patients reported less favourable outcome regarding urinary continence compared with Hemi-Kock patients, probably owing to factors as shorter follow-up and surgical skill and experience. The results regarding urinary continence may explain why Studer patients reported more practical problems and a higher influence on their everyday life than Bricker and Hemi-Kock patients.
评估根治性膀胱切除术后接受三种不同改道技术（Bricker术、Studer术或Hemi-Kock术）治疗的患者的治疗结果及生活质量（QoL）方面的情况。
37例行Bricker导管改道、19例行Studer新膀胱术和16例行Hemi-Kock新膀胱术的患者回答了一份关于生活质量、总体健康状况、与伴侣关系、性功能、对信息及随访满意度等方面的问卷。Bricker术、Studer术和Hemi-Kock术患者的回复率分别为79%（37/47）、100%（18/18）和86%（19/22）。回顾病历以评估癌症类型、分级和分期。
Studer术和Bricker术患者均报告生活质量平均得分较高（p>0.05）。生活质量不受肿瘤分期（pTa-T2与pT3-4）的影响（p>0.05）。术后，与Bricker术患者（40%）相比，更多Studer术患者（78%）出现实际问题（p=0.01）。与Bricker术和Hemi-Kock术患者相比，Studer术患者报告对日常生活的影响更大（分别为p<0.01和p=0.05）。53%的Studer术患者和16%的Hemi-Kock术患者报告白天漏尿（p=0.03）。此外，所有Studer术患者夜间均有漏尿，而Hemi-Kock术患者的这一比例为58%（p<0.01）。Hemi-Kock术患者术后随访时间为56个月，而Studer术患者为26个月。81%的男性报告有勃起功能障碍，改道方法之间无差异。
所有改道组患者对其生活质量的评价都很高。尿流改道类型与生活质量结果的任何统计学显著差异均无关联。然而，与Hemi-Kock术患者相比，Studer术患者在尿失禁方面的结果较差，这可能归因于随访时间较短以及手术技巧和经验等因素。尿失禁方面的结果可能解释了为什么Studer术患者比Bricker术和Hemi-Kock术患者报告了更多的实际问题以及对他们日常生活的更大影响。
