The Clinical Effect And Life Quality Of Urinary Diversion Following Radical Cystectomy

Objective:Cystectomy is one of the first choices of bladder muscle-invasivecancer. There are many kinds of operation method of urinary diversion andbladder reconstruction after cystectomy, which are lack of overall,long term comparison. Doctors always choose the method by experience. Fourkinds of urinary diversion are chosen to analyze in two aspect, clinicaleffect and life quality, to supply evidence of choosing suitableoperation method.Methods:Retrospective analysis is based on clinical data of 113 patients whounderwent urinary diversion and bladder reconstruction after cystectomyfrom Nov. 1992 to Oct. 2005. Among them, cutaneous ureterostomy wasperformed in 52 cases, Bricker' s ileal conduit was performed in 20 cases,detenia ceacal-colon continent urinary reservoir was performed in 39cases and orthotopic ileal neobladder was performed in 2 cases. Operationtime, volumnof blood transfusion, length of postoperative stay, shortand long-term complication, continence, and survival rate at one-year,two-year and five-year are summarized, and also WHOQOL-BREF is used asinquiring tool to compare and analysis life quality in four aspects, physiology, psychology, social relationship and environment.Results:Operation time of these four methods(cutaneous ureterostomy,Bricker' s ileal conduit, detenia ceacal-colon continent urinaryreservoir, orthotopic ileal neobladder)are respectively 3.81±0.77h,5.45±0.46h, 7.50±1.45, 6.0h/7.0h, volum of blood transfusion arerespectively 458±325ml, 520±307ml,581±310ml,400ml/0ml, length ofpostoperative stay are respectively 16.7±6.2d,22.6±6.0d,29.8±7.8d,35d/30d. There are significant differece among different methods inoperation time and length of postoperative stay(p＜0.001), but areinsignificant difference in volum of blood transfusion(p＞0.05).Short-term complication are respectively 13.5％(7/52), 10.0％(2/20),12.8％(5/39),0％(0/2), long-term complication are respectively13.5％(7/52),15.8％(3/19),15.4％(6/39),50.0％(1/2), survival rate atone-year are respectively 88.5％(46/52),90.0％(18/20),97.4％(38/39),100％(2/2), two-year are 71.2％(37/52),85.0％(17/20),89.7％(35/39),100％(1/1) and five-year are 57.7％(30/52),60.0％(12/20),62.5％(10/16),0％(0/0). There are no significant differece among differentmethods(p＞0.05). Life quality in physiological aspect are respectively41.75±8.86, 64.09±3.57, 67.15±2.57, 71.43/78.57, psychological aspectare respectively 25.00±4.04, 62.50±2.78, 70.36±2.21, 83.30/87.50,social relationship aspect are respectively 33.91±7.02, 50.00±7.00,49.52±6.98, 50.00/50.00, enviromental aspect are respectively 33.84±6.20, 59.55±4.60, 61.16±4.99, 62.50/65.63. Patients treated withcutaneous ureterostomy differ significanly with other operation methods in all aspects of life quality (p＜0.001).The other kinds of operationmethods are no significant difference in physiological, socialrelationship, enviromental aspect (p＞0.05), but are significantdifference in psychological aspect (p＜0.001).Conclusion:Cutaneous ureterostomy is operated easily, minimize trauma. But thepatients performed with it have low life quality. So it refer to thepatients that are in bad conditions, elder or can not tolerate othermethods. Bricker' s ileal conduit is also operated easily, with fewcomplications, good long-term effect, but affect the life quality dueto engirding urine container in life time. So it is suitable for thepatients who can not be performed continent urinary reservoir. Continenturinary reservoir is more complicated, but it is safe, with good curativeeffect, increase life quality obviously. Because the patients performedwith it can not answer the request of physiological urination, the lifequality also can be influenced. It is suitable to the patients who wantto maintain better life quality but with pathological changes in urethraor high risk factors. Orthotopic ileal neobladder should be chosen firstdue to the superiorities that approximate physiological urinationmaximatily, raise life quality and decrease incidence rate of urethralcancer. But more statistical evidence and cases are needed to prove theconclusion of this reasearch in orthotopic ileal neobladder.