Gellhaus Paul T, Cary Clint, Kaimakliotis Hristos Z, Johnson Cynthia S, Weiner Michael, Koch Michael O, Bihrle Richard
Department of Urology, Indiana University School of Medicine, Indianapolis, IN.
Department of Urology, Indiana University School of Medicine, Indianapolis, IN; Regenstrief Institute, Inc. and Indiana University Center for Health Services and Outcomes Research, Indianapolis, IN.
Urology. 2017 Aug;106:82-86. doi: 10.1016/j.urology.2017.03.053. Epub 2017 Apr 26.
To evaluate the long-term (>5 years) health-related quality of life (HRQOL) outcomes following radical cystectomy, comparing Indiana pouch (IP), neobladder (NB), and ileal conduit (IC).
The departmental radical cystectomy database was queried to identify patients who underwent radical cystectomy and urinary diversion for bladder cancer between 1991 and 2009 and had not died. Three hundred patients were identified and sent the validated Bladder Cancer Index instrument.
A total of 128 (43%) patients completed the survey. When adjusted for gender, age at surgery, surgeon, and time since surgery, IC and IP patients had significantly better urinary function than NB patients (P = .0013). Sexual bother was less in NB than IP (P = .0387). Among men ≥65 years of age, IC patients had significantly better urinary function (P = .0376) than NB patients (91.6 vs 49.4, respectively). Among men <65 years of age, IC and IP patients (76.0 and 82.8, respectively) had significantly better urinary function than NB patients (50.7) (P = .0199). Among women greater than 65 years, bowel bother was significantly better (P = .0095) for IC patients than IP patients (44.8 vs 69.5, respectively).
Urinary diversion type after radical cystectomy affects HRQOL differently in long-term survivors. Age and gender at surgery influenced HRQOL based on diversion procedure. Urinary function but not urinary bother was significantly better in IC and IP compared to NB diversions. Prospective longitudinal studies using validated HRQOL tools will further help guide preoperative diversion choice decisions between patient and surgeon.
评估根治性膀胱切除术后超过5年的健康相关生活质量（HRQOL）结局，比较回肠膀胱术（IP）、新膀胱术（NB）和回肠导管术（IC）。
查询科室根治性膀胱切除术数据库，以确定1991年至2009年间因膀胱癌接受根治性膀胱切除术和尿流改道且未死亡的患者。共识别出300例患者，并向其发送了经过验证的膀胱癌指数工具。
共有128例（43%）患者完成了调查。在对性别、手术年龄、外科医生和术后时间进行调整后，IC和IP患者的排尿功能明显优于NB患者（P = 0.0013）。NB患者的性困扰低于IP患者（P = 0.0387）。在年龄≥65岁的男性中，IC患者的排尿功能明显优于NB患者（P = 0.0376）（分别为91.6和49.4）。在年龄<65岁的男性中，IC和IP患者（分别为76.0和82.8）的排尿功能明显优于NB患者（50.7）（P = 0.0199）。在年龄大于65岁的女性中，IC患者的肠道困扰明显优于IP患者（P = 0.0095）（分别为44.8和69.5）。
根治性膀胱切除术后的尿流改道类型对长期存活者的HRQOL有不同影响。手术时的年龄和性别根据改道程序影响HRQOL。与NB改道相比，IC和IP的排尿功能明显更好，但排尿困扰无明显差异。使用经过验证的HRQOL工具进行前瞻性纵向研究将进一步有助于指导患者和外科医生在术前选择改道方式。
