Section of Urology, University of Chicago Medical Center, Chicago, Illinois, USA.
J Urol. 2010 Jan;183(1):201-6. doi: 10.1016/j.juro.2009.08.148.
Little is known about the health related quality of life of women who have undergone continent urinary diversion. We compared health related quality of life outcomes for women who underwent radical cystectomy with an orthotopic neobladder or Indiana pouch.
From 1995 to June 2008 a single surgeon (GDS) performed radical cystectomy with an orthotopic neobladder in 47 women and radical cystectomy with an Indiana pouch in 45. A comprehensive database provided clinical, pathological and outcomes data. The validated Functional Assessment of Cancer Therapy-Vanderbilt Cystectomy Index was mailed to 92 patients.
Complete data were available for 87% of patients treated with radical cystectomy with an orthotopic neobladder and 93% of those treated with radical cystectomy with an Indiana pouch, with a median followup of 34 and 24 months, respectively (p = 0.8). Median (IQR) age was 65 (58, 71) and 61.5 (51, 67) years for patients with an orthotopic neobladder and Indiana pouch, respectively (p = 0.03). No significant differences were found for pathological stage, nodal status, blood loss, Clavien grade III or greater complications, adjuvant therapy or hospital stay between the 2 treatment groups, or between respondents and nonrespondents. Five-year survival rates for patients with an orthotopic neobladder and Indiana pouch were 65% and 58%, respectively (p = 0.9). There were 21 (75%) living patients with an orthotopic neobladder and 19 (61%) with an Indiana pouch who completed the Functional Assessment of Cancer Therapy-Vanderbilt Cystectomy Index, and physical (p = 0.53), social (p = 0.97), emotional (p = 0.61), functional (p = 0.55) and radical cystectomy specific (p = 0.54) health related quality of life domains were not significantly different between the groups.
Women undergoing radical cystectomy with an orthotopic neobladder vs an Indiana pouch have similar health related quality of life outcomes. Larger series with longer followup and multiple surgeons are necessary to confirm these findings.
对于接受过控尿性尿流改道术的女性，其健康相关生活质量鲜为人知。我们比较了接受根治性膀胱切除术联合原位新膀胱或印第安纳袋的女性的健康相关生活质量结局。
1995 年至 2008 年 6 月，一位外科医生（GDS）为 47 名女性施行根治性膀胱切除术联合原位新膀胱，为 45 名女性施行根治性膀胱切除术联合印第安纳袋。一个全面的数据库提供了临床、病理和结果数据。经验证的癌症治疗功能评估-范德比尔特膀胱切除术指数（Functional Assessment of Cancer Therapy-Vanderbilt Cystectomy Index）被邮寄给 92 名患者。
接受根治性膀胱切除术联合原位新膀胱治疗的患者中，有 87%的患者和接受根治性膀胱切除术联合印第安纳袋治疗的患者中，有 93%的患者获得了完整的数据，中位随访时间分别为 34 个月和 24 个月（p = 0.8）。接受原位新膀胱和印第安纳袋治疗的患者中位（IQR）年龄分别为 65（58，71）岁和 61.5（51，67）岁（p = 0.03）。两组之间在病理分期、淋巴结状态、失血量、Clavien 分级 III 级或更高级别的并发症、辅助治疗或住院时间方面没有显著差异，也没有在应答者和非应答者之间发现差异。接受原位新膀胱和印第安纳袋治疗的患者的 5 年生存率分别为 65%和 58%（p = 0.9）。接受原位新膀胱治疗的 21 名（75%）存活患者和接受印第安纳袋治疗的 19 名（61%）存活患者完成了癌症治疗功能评估-范德比尔特膀胱切除术指数，身体（p = 0.53）、社会（p = 0.97）、情感（p = 0.61）、功能（p = 0.55）和根治性膀胱切除术特定（p = 0.54）健康相关生活质量领域没有显著差异。
接受根治性膀胱切除术联合原位新膀胱与印第安纳袋的女性具有相似的健康相关生活质量结局。需要更大的系列和更多的外科医生进行随访来证实这些发现。
