Ahmadi Hamed, Lee Cheryl T
aOregon Health and Science University, Portland, Oregon bUniversity of Michigan, Ann Arbor, Michigan, USA.
Curr Opin Urol. 2015 Nov;25(6):562-9. doi: 10.1097/MOU.0000000000000228.
Patients who undergo radical cystectomy and urinary diversion experience a lengthy period of postoperative recovery from physical, functional, social, and emotional challenges that greatly impact health-related quality of life (HRQoL). These changes affect nearly all patients and must be reviewed in detail as part of the preoperative consultation. However, quantifying a patient's risk for altered HRQoL is imprecise, thus complicating the choice for urinary diversion.
A recent prospective study observed improved global health status and physical, role, and social functioning in patients treated with orthotopic neobladder diversion compared with patients treated with ileal conduit diversion. In contrast, robotic-assisted radical cystectomy does not improve patient quality of life (QoL) over open radical cystectomy within the first year of surgery. Enhanced recovery protocols improve immediate postoperative QoL but their effect on long-term QoL is uncertain.
There is still a significant lack of understanding about the QoL between various types of urinary diversions. Recent and ongoing prospective randomized trials in the radical cystectomy population may shed light on urinary diversion-specific function and related effects on HRQoL. Ultimately, well designed, large multicenter prospective-controlled trials comparing functional, social, and emotional outcomes of continent and incontinent urinary diversion are still needed.
接受根治性膀胱切除术和尿流改道的患者术后需要很长时间从身体、功能、社会和情感方面的挑战中恢复，这些挑战对健康相关生活质量（HRQoL）有很大影响。这些变化几乎影响所有患者，术前咨询时必须详细评估。然而，量化患者HRQoL改变的风险并不精确，这使得尿流改道方式的选择变得复杂。
最近一项前瞻性研究观察到，与接受回肠膀胱术式尿流改道的患者相比，接受原位新膀胱术式尿流改道的患者总体健康状况、身体、角色和社会功能均有所改善。相比之下，在手术的第一年，机器人辅助根治性膀胱切除术相比开放性根治性膀胱切除术并未改善患者生活质量（QoL）。强化康复方案可改善术后即刻的QoL，但对长期QoL的影响尚不确定。
目前对于各种尿流改道方式对生活质量的影响仍缺乏足够了解。近期及正在进行的针对根治性膀胱切除术患者的前瞻性随机试验可能会揭示特定尿流改道方式的功能及其对HRQoL的相关影响。最终，仍需要设计良好的大型多中心前瞻性对照试验，以比较可控性和不可控性尿流改道方式在功能、社会和情感方面的结局。
