Goldberg Hanan, Baniel Jack, Mano Roy, Rotlevy Guy, Kedar Daniel, Yossepowitch Ofer
Department of Urology, Rabin Medical Center, 39 Jabotinsky St., Petach Tiqva, 49100, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Department of Urology, Rabin Medical Center, 39 Jabotinsky St., Petach Tiqva, 49100, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Urol Oncol. 2016 Mar;34(3):121.e1-7. doi: 10.1016/j.urolonc.2015.10.006. Epub 2015 Dec 3.
The optimal form of urinary diversion following radical cystectomy remains controversial. We sought to compare the long-term health-related quality-of-life outcomes between patients with orthotopic neobladder and ileal conduit diversion (ICD).
We enrolled 95 patients following radical cystectomy and ICD (n = 49) or orthotopic neobladder reconstruction (ONR) (n = 46), with a minimum interval of 1 year from surgery. All patients completed the Bladder Cancer Index questionnaire, assessing their urinary, bowel, and sexual function, and bother scores.
Patients treated with ONR were generally younger and healthier compared with those who underwent ICD (P<0.01). Sex, marital status, disease status at the time of enrollment, and mean duration elapsing from surgery to interview were similar between the subgroups. Better functional scores in favor of ICD were recorded in the urinary domain (P<0.01), whereas the corresponding bother scores were roughly identical in both groups. Conversely, although higher functional scores were recorded in the sexual domain of patients with ONR (P<0.01), the corresponding bother scores in this group were lower compared with their counterparts with ICD (53.2 vs. 65.3; P<0.05). As patients grew older they were more likely to report on better urinary function and worse sexual function, but were less likely to be bothered by the decline in sexual function.
Our study suggests that the bother resulting from urinary incontinence and the risk of sexual dysfunction be highlighted to those electing for neobladder reconstruction, whereas patients preferring conduit diversion should be reassured that their expected quality of life is not compromised.
根治性膀胱切除术后尿流改道的最佳方式仍存在争议。我们试图比较原位新膀胱患者和回肠膀胱术（ICD）患者与健康相关的长期生活质量结果。
我们纳入了95例根治性膀胱切除术后接受ICD（n = 49）或原位新膀胱重建术（ONR）（n = 46）的患者，手术间隔至少1年。所有患者均完成了膀胱癌指数问卷，评估其泌尿、肠道和性功能以及困扰评分。
与接受ICD的患者相比，接受ONR治疗的患者通常更年轻、更健康（P<0.01）。亚组之间的性别、婚姻状况、入组时的疾病状态以及从手术到访谈的平均时间相似。在泌尿领域，有利于ICD的功能评分更高（P<0.01），而两组相应的困扰评分大致相同。相反，尽管ONR患者在性领域的功能评分更高（P<0.01），但该组相应的困扰评分低于接受ICD的患者（53.2对65.3；P<0.05）。随着患者年龄的增长，他们更有可能报告更好的泌尿功能和更差的性功能，但不太可能因性功能下降而感到困扰。
我们的研究表明，对于选择新膀胱重建的患者，应强调尿失禁带来的困扰和性功能障碍的风险，而对于选择导管改道的患者，应让他们放心，其预期生活质量不会受到影响。
