Quality Of Life And Clinical Effect Among Different Urinary Divesions Following Radical Cystectomy

Objective: Increasing attention have been paid to the quality of life of urinarydiversions. The purpose of this study was to compare quality of life and clinical effectbetween the4diversion types after cystectomy.Ultimately, to supply evidence ofchoosing suitable operation method to Clinical application.Methods: To retrospectively review our clinical experience of consecutive157patientswho underwent urinary diversion and bladder reconstruction after cystectomy from Jan1995to Jun2009.41patients with IN,38with SN,32with CU,46with IC wereevaluated,concerning complications, functional outcomes and survival rate at1-year、3-year、5-year.23patients with IN,19with SN,15with CU,21with IC answered aquestionnaire concerning QoL(FACT-BL)and urinary function (I-PSS).All descriptive data were reported as the mean±standard deviation (x±SD).Analysed by single factor analysis of variance and SNK-q test. The data regarding thepercentage were analysed by X2test.Significance was defined at the5%level，statisticanalysis was completed by SPSS17.0.Results:78patients answered questionnaires(FACT-BL and I-PSS). Response rateswere79.3%(23/29),82.6%(19/23) and75.0%(15/20),75.0%(21/28)in IN, in SN,inCU,in IC patients respectively.There are significant differece among different meth-odsin operation time and length of post operative stay(p<0.05). The HRQOL of4UDgroups (IN,SN,CU,IC)were not observed significant difference(p>0.05).But the socresin phsycial scale were24.3±3.1、24.7±3.4、21.8±2.5、22.1±2.6respectively(p<0.01).The sexual function was compromised severly in all4gorups.Body image(CU,IC)was worse in BSS scale.The QOL of IN and SN was good similarly,but urinaryfunction differences were significant in nocturia, urgency, frequency, nighttimeincontinence and pad use(p<0.05).Short and long term complications of4UDgroups(157patients) were investigated.Short-term complications rate (IN,SN,CU,IC)were17.1%,13.2%,3.1%,2.2%respectively(p<0.05). survival rate of all4groups patiens at1-year、3-year、5-year accorded with recent available literatures.Therewere no significant differences among them (p<0.05). Conclusions:(1)4urinary diversions(IN,SN,CU,IC) were no significant differences inpostoperative quality of life. Orthotopic neobladder function recovery in body image isbetter than incontinent UD (CU and IC). High demand on the body image patientsshoud be proposed with orthotopic neobladder. Urinary diversion do damage to sexualfunction.surgic operation should strengthen the protection of neurovascularbundles(NVB). The SN group was worse than IN group in frequency, urgency, nocturia.(2) Orthotopic neobladder surgery have complicated trauma, long hospital stay, healthcare expensive, high incidence of early complications; incontinent UD (CU and IC) isrelatively simple, rapid recovery, health care costs is relatively small.(3)4urinarydiversions in bladder tumor control are similar (1,3,5year survival rates are nostatistical differences)...