Health-Related quality of life with orthotopic neobladder versus ileal conduit according to the SF-36 survey

doi:10.1016/S0090-4295(00)00483-0

Urology

Volume 55, Issue 6, June 2000, Pages 862-865

https://doi.org/10.1016/S0090-4295(00)00483-0 Get rights and content

Abstract

Objectives. To compare health-related quality of life (HRQOL) in patients with a neobladder and in patients with an ileal conduit.

Methods. HRQOL was assessed using the SF-36 survey, supplemented with a questionnaire concerning micturition status.

Results. Patients (n = 36) with a neobladder were significantly younger at time of surgery and time of survey than patients with an ileal conduit (n = 20). Mean (± SD) follow-up periods for patients with a neobladder and with an ileal conduit were 31.3 ± 33.1 and 44.8 ± 30.7 months, respectively. No significant difference was apparent in any scale score between neobladder and ileal conduit groups. Role-physical functioning (RP) and role-emotional functioning (RE) scale scores in both neobladder and ileal conduit patients appeared to be below the general U.S. population norm. Patients with neobladder 65 years old or older (n = 17) showed significantly lower RP and RE scores than those younger than 65 years (n = 19; P <0.05). Duration of follow-up was not related to scale scores. Continence status did not measurably affect HRQOL.

Conclusions. All scales concerning HRQOL except RP and RE were favorable with both neobladder and ileal conduit, and no significant differences were observed between these two types of urinary tract reconstruction. Generally, patients with a neobladder or an ileal conduit were satisfied with their overall quality of life and health.

Section snippets

Material and methods

We obtained responses to questionnaires from 36 patients (26 males, 10 females) with an orthotopic neobladder and 20 patients (12 males, 8 females) with an ileal conduit. The participation rate of neobladder patients and ileal conduit patients was 100% and 86.9%, respectively. The preoperative diagnosis in all patients was transitional cell carcinoma. No metastasis or recurrence was observed in any patients who participated in this survey. The orthotopic neobladder was reconstructed using

Results

Data from the SF-36 survey are shown in Figure 1. In patients with a neobladder, PF, RP, BP, GH, VT, SF, RE, and MH were 78.9 ± 20.9, 54.9 ± 43.0, 71.1 ± 26.4, 56.9 ± 18.5, 62.7 ± 21.0, 76.2 ± 24.0, 55.6 ± 44.4, and 71.9 ± 17.6, respectively. In patients with an ileal conduit, these scores were 80.4 ± 15.0, 64.3 ± 36.3, 80.9 ± 22.0, 64.9 ± 18.9, 70.4 ± 18.8, 81.4 ± 24.9, 66.6 ± 43.4, and 76.9 ± 16.9, respectively. No significant difference was apparent in scale score between neobladder and

Comment

In this study, we assessed HRQOL according to the SF-36 after urinary tract reconstruction. The SF-36 survey has been used and accepted widely.5, 6 To our knowledge, previously reported studies2, 12, 13, 14 concerning urinary tract reconstruction all have used other assessment tools. In these studies,12, 13 ileal conduits produced few changes in recreational pursuits or in socializing with other people, although the conduit negatively influenced physical and psychological status. In addition,

Acknowledgements

To Dr. Takeki Sugiyama for assistance with the study.

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Citation Excerpt :
A possible reason of the worse results in the studies addressing on generic ONB could be the high heterogeneity of the studies' populations. Running the one study removed analysis, omitting 4 studies9,12,19,25 the pooled effect sizes became significant in advantage of the ONB subgroup. Moreover, excluding the two papers in whom a case series could be an updating of others previously published,12,15 the pooled analysis became in favor of ONB (Hedges' g = 0.190, p = 0.028).
The current literature on the impact of different urinary diversions on patients' health related quality of life (HR-QoL) showed a marginally better quality of life scores of orthotopic neobladder (ONB) compared to ileal conduit (IC). The aim of this study was to update the review of all relevant published studies on the comparison between ONB and IC.
Studies were identified by searching multiple literature databases, including MEDLINE, CINAHL, the Cochrane Library, PubMed Data were synthesized using meta-analytic methods conformed to the PRISMA statement.
The current meta-analysis was based on 18 papers that reported a HR-QoL comparison between IC and ONB using at least a validate questionnaire. Pooled effect sizes of combined QoL outcomes for IC versus ONB showed a slight, but not significant, better QoL in patients with ONB (Hedges' g = 0.150; p = 0.066). Patients with ileal ONB showed a significant better QoL than those with IC (Hedges' g = 0.278; p = 0.000); in case series with more than 65% males, ONB group showed a slight significant better QoL than IC (Hedges' g = 0.190; p = 0.024). Pooled effects sizes of all EORTC-QLQ-C30 aspects showed a significant better QoL in patients with ONB (Hedges' g = 0.400; p = 0.0000).
This meta-analysis of not-randomized comparative studies on the impact of different types of urinary diversions on HR-QoL showed demonstrated a significant advantage of ileal ONB compared to IC in terms of HR-QoL.
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Adult urologyHealth-Related quality of life with orthotopic neobladder versus ileal conduit according to the SF-36 survey

Abstract

Section snippets

Material and methods

Results

Comment

Acknowledgements

J Urol

Urology

J Urol

Am J Kidney Dis

J Clin Epidemiol

Quality of life in patients having an ileal conduit, continent reservoir or orthotopic neobladder after cystectomy for bladder carcinoma

Int J Urol

Assessing the validity of the SF-36 general health survey

Qual Life Res

Adult urology
Health-Related quality of life with orthotopic neobladder versus ileal conduit according to the SF-36 survey