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Siracusano S, Gontero P, Mearini E, Imbimbo C, Simonato A, Dal Moro F, Giannarini G, Montorsi F, Colombo R, Porpiglia F, Bartoletti R, Minervini A, Rossanese M, Porcaro A, Romantini F, Magli IA, Pandolfo SD, Talamini R, Racioppi M, Ficarra V, Lonardi C. Short-term effects of bowel function on global health quality of life after radical cystectomy. Minerva Urol Nephrol 2024; 76:452-457. [PMID: 38842052 DOI: 10.23736/s2724-6051.24.05730-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2024]
Abstract
BACKGROUND Radical cystectomy (RC) shows an important impact on quality of life (QoL), for various clinical aspects. The aim of our study was to evaluate the short-term bowel function in patients that underwent RC. METHODS Two hundred and six patients with MIBC underwent RC with ONB or IC urinary diversion. QoL was measured using the EORTC QLQ C30 and the Short-Form SF-36 questionnaires before surgery and at 12 months postoperatively. Baseline characteristics, including demographic profile, BMI, Charlson Comorbidity Index (CCI), modified Frailty Index (m-FI), pathological tumor stage, Clavien-Dindo grade, and neo-adjuvant chemotherapy were recorded and compared. RESULTS The uni-variate and multivariate analysis (OR) were performed for constipation, diarrhea and m-FI of patients underwent RC for localized MIBC according to global health status score (poor/good vs. very good). Multivariate analysis showed that constipation medium/high was significant associated with global health status poor/good (OR=2.39; 95% CI: 1.22-4.71; P=0.01); Diarrhea medium/high was associated with global health status poor/good (OR=2.85; 95% CI:1.18-6.92; P=0.02), and m-FI ≥2 score (OR=2.13; 95% CI: 0.99-4.57; P=0.05). CONCLUSIONS Diarrhea and constipation are associated with a lower QoL in cystectomized patients, both with ONB or IC urinary diversion; such association is especially significant in more fragile patients (Frailty Index ≥2).
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Affiliation(s)
- Salvatore Siracusano
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy -
| | - Paolo Gontero
- Department of Urology, University of Turin, Turin, Italy
| | - Ettore Mearini
- Department of Urology, University of Perugia, Perugia, Italy
| | - Ciro Imbimbo
- Department of Urology, University Federico II, Naples, Italy
| | | | | | | | | | - Renzo Colombo
- Department of Urology, San Raffaele University, Milan, Italy
| | | | | | | | - Marta Rossanese
- Department of Urology, University of Messina, Messina, Italy
| | | | - Federico Romantini
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Igino A Magli
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Savio D Pandolfo
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | | | | | | | - Cristina Lonardi
- Department of Human Sciences, University of Verona, Verona, Italy
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Jing S, Yang E, Luo Z, Zhang Y, Ding H, Yang L, Dong Z, Shang P, Yue Z, Wu G, Bao J, Tian J, Wang J, Xiao N, Wang Z. Perioperative outcomes and continence following robotic-assisted radical cystectomy with mainz pouch II urinary diversion in patients with bladder cancer. BMC Cancer 2024; 24:127. [PMID: 38267934 PMCID: PMC10809619 DOI: 10.1186/s12885-024-11874-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 01/12/2024] [Indexed: 01/26/2024] Open
Abstract
PURPOSE To present the widely unknown perioperative outcomes and continence status of bladder cancer patients following robotic-assisted radical cystectomy (RARC) with Mainz pouch II urinary diversion (UD). MATERIALS AND METHODS From November 2020 to December 2023, 37 bladder cancer patients who underwent RARC with Mainz pouch II UD were retrospectively assessed (ChiCTR2300070279). The results, which included patient demographics, perioperative data, continence, and complications (early ≤ 30 days and late ≤ 30 days) were reported using the RC-pentafecta criteria. RC-pentafecta criteria included ≥ 16 lymph nodes removed, negative soft tissue surgical margins, absence of major (Grade III-IV) complication at 90 days, absence of clinical recurrence at ≤ 12 months, and absence of long-term UD-related sequelae. A numeric rating scale assessed patient satisfaction with urinary continence 30 days after surgery. The validated Patient Assessment of Constipation Symptoms (PAC-SYM) questionnaire was used to evaluate bowel function. The Kaplan-Meier curve was used to evaluate overall survival (OS). RESULTS Of the 37 patients evaluated over a median (range) follow-up period of 23.0 (12.0-36.5) months. The median (range) age was 65 (40-81) years. The median (range) time to urinary continence after surgery was 2.3 (1.5-6) months. Of the 37 patients, 31 (83.8%) were continent both during the day and at night, 34 (91.9%) were continent during the day, 32 (86.5%) were continent at night, 35 (94.6%) were satisfied with their urinary continence status, and 21 (56.8%) were very satisfied. The mean (range) voiding frequency was 6 (4-10) during the day and 3 (2-5.5) at night. The mean (range) PAC-SYM total score was 9.50 (4.00-15.00). In 12 (32.4%) of the patients, RC-pentafecta was achieved, and achieving RC-pentafecta was linked to better satisfaction scores (7.3 vs. 5.5, p = 0.034). There was no significant difference between RC-pentafecta and No RC-pentafecta groups in terms of OS (25.6 vs. 21.5 months, p = 0.16). 7 (19.4%) patients experienced late complications. CONCLUSIONS Mainz pouch II UD following RARC in bladder cancer patients results in a satisfactory continence rate. Achieving RC-pentafecta was correlated with better satisfaction scores. The intracorporeal approach to Mainz pouch II UD is beneficial for female patients due to its reduced invasiveness. TRIAL REGISTRATION ChiCTR2300070279; Registration: 07/04/2023, Last updated version: 01/06/2023. Retrospectively registered.
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Affiliation(s)
- Suoshi Jing
- Institute of Urology, Key Laboratory of Gansu Province for Urological Diseases, Lanzhou University Second Hospital, Gansu Nephro-Urological Clinical Center, 730030, Lanzhou, China
- Department of Urology, The First Hospital of Lanzhou University, 730030, Lanzhou, China
| | - Enguang Yang
- Institute of Urology, Key Laboratory of Gansu Province for Urological Diseases, Lanzhou University Second Hospital, Gansu Nephro-Urological Clinical Center, 730030, Lanzhou, China
| | - Zuoxi Luo
- Institute of Urology, Key Laboratory of Gansu Province for Urological Diseases, Lanzhou University Second Hospital, Gansu Nephro-Urological Clinical Center, 730030, Lanzhou, China
| | - Yunxin Zhang
- Institute of Urology, Key Laboratory of Gansu Province for Urological Diseases, Lanzhou University Second Hospital, Gansu Nephro-Urological Clinical Center, 730030, Lanzhou, China
| | - Hui Ding
- Institute of Urology, Key Laboratory of Gansu Province for Urological Diseases, Lanzhou University Second Hospital, Gansu Nephro-Urological Clinical Center, 730030, Lanzhou, China
| | - Li Yang
- Institute of Urology, Key Laboratory of Gansu Province for Urological Diseases, Lanzhou University Second Hospital, Gansu Nephro-Urological Clinical Center, 730030, Lanzhou, China
| | - Zhilong Dong
- Institute of Urology, Key Laboratory of Gansu Province for Urological Diseases, Lanzhou University Second Hospital, Gansu Nephro-Urological Clinical Center, 730030, Lanzhou, China
| | - Panfeng Shang
- Institute of Urology, Key Laboratory of Gansu Province for Urological Diseases, Lanzhou University Second Hospital, Gansu Nephro-Urological Clinical Center, 730030, Lanzhou, China
| | - Zhongjin Yue
- Institute of Urology, Key Laboratory of Gansu Province for Urological Diseases, Lanzhou University Second Hospital, Gansu Nephro-Urological Clinical Center, 730030, Lanzhou, China
| | - Gongjin Wu
- Institute of Urology, Key Laboratory of Gansu Province for Urological Diseases, Lanzhou University Second Hospital, Gansu Nephro-Urological Clinical Center, 730030, Lanzhou, China
| | - Junsheng Bao
- Institute of Urology, Key Laboratory of Gansu Province for Urological Diseases, Lanzhou University Second Hospital, Gansu Nephro-Urological Clinical Center, 730030, Lanzhou, China
| | - Junqiang Tian
- Institute of Urology, Key Laboratory of Gansu Province for Urological Diseases, Lanzhou University Second Hospital, Gansu Nephro-Urological Clinical Center, 730030, Lanzhou, China
| | - Jiaji Wang
- Institute of Urology, Key Laboratory of Gansu Province for Urological Diseases, Lanzhou University Second Hospital, Gansu Nephro-Urological Clinical Center, 730030, Lanzhou, China
| | - Nan Xiao
- Institute of Urology, Key Laboratory of Gansu Province for Urological Diseases, Lanzhou University Second Hospital, Gansu Nephro-Urological Clinical Center, 730030, Lanzhou, China
| | - Zhiping Wang
- Institute of Urology, Key Laboratory of Gansu Province for Urological Diseases, Lanzhou University Second Hospital, Gansu Nephro-Urological Clinical Center, 730030, Lanzhou, China.
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Liedberg F, Hagberg O, Baseckas G, Brändstedt J, Kollberg P, Lind AK, Lydrup ML, Löfgren A, Stenzelius K, Sörenby A, Starck M. Anorectal dysfunction after radical cystectomy for bladder cancer. Scand J Urol 2022; 56:155-161. [PMID: 35019814 DOI: 10.1080/21681805.2021.2025423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Objective: To prospectively assess anorectal dysfunction using patient-reported outcomes using validated questionnaires, manovolumetry and endoanal ultrasound before and 12 months after RC.Patients and methods: From 2014 to 2019, we prospectively included 44 patients scheduled for RC. Preoperatively and 12 months after surgery, 41 patients filled in a low anterior resection syndrome score (LARS-score) to assess fecal incontinence, increased frequency, urgency and emptying difficulties and a St Mark's score to assess fecal incontinence in conjunction with manovolumetry and endoanal ultrasound examinations. Pre- and postoperative patient-reported anorectal dysfunction were assessed by LARS-score and St Marks's score. At the same time-points, anorectal function was evaluated by measuring mean anal resting and maximal squeeze pressures, volumes and pressures at first desire, urgency to defecate and maximum toleration during manovolumetry. Wilcoxon's signed rank test was used to compare pre- and postoperative outcomes by questionnaires.Results: Postoperatively 6/41 (15%) patients reported flatus incontinence assessed by the LARS-questionnaire, and correspondingly the St Mark's score increased postoperatively. The median anal resting pressure decreased from 57 mmHg preoperatively to 46 mmHg after RC, but without any postoperative anatomic defects detected by endoanal ultrasound. Volumes and pressures at first desire, urgency to defecate and maximum toleration during manovolumetry all increased after RC, indicating decreased postoperative rectal sensation, as rectal compliance was unaltered.Conclusions: Postoperative flatus incontinence is reported by one out of seven patients after RC, which corresponds to decreased anal resting pressures. The finding of decreased rectal sensation might also contribute to patient-reported symptoms and anorectal dysfunction after RC.
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Affiliation(s)
- Fredrik Liedberg
- Institution of Translational Medicine, Lund University, Malmö, Sweden.,Department of Urology, Skåne University Hospital, Malmö, Sweden
| | - Oskar Hagberg
- Institution of Translational Medicine, Lund University, Malmö, Sweden.,Regional Cancer Centre South, Region Skåne, Lund, Sweden
| | - Gediminas Baseckas
- Institution of Translational Medicine, Lund University, Malmö, Sweden.,Department of Urology, Skåne University Hospital, Malmö, Sweden
| | - Johan Brändstedt
- Institution of Translational Medicine, Lund University, Malmö, Sweden.,Department of Urology, Skåne University Hospital, Malmö, Sweden
| | - Petter Kollberg
- Institution of Translational Medicine, Lund University, Malmö, Sweden.,Department of Urology, Skåne University Hospital, Malmö, Sweden.,Department of Urology, Helsingborg County Hospital, Helsingborg, Sweden
| | - Anna-Karin Lind
- Institution of Translational Medicine, Lund University, Malmö, Sweden
| | - Marie-Louise Lydrup
- Department of Surgery, Skåne University Hospital, Malmö, Sweden.,Department of Clinical Sciences, Lund University, Malmö, Sweden
| | - Annica Löfgren
- Institution of Translational Medicine, Lund University, Malmö, Sweden
| | - Karin Stenzelius
- Institution of Translational Medicine, Lund University, Malmö, Sweden
| | - Anne Sörenby
- Institution of Translational Medicine, Lund University, Malmö, Sweden.,Department of Urology, Skåne University Hospital, Malmö, Sweden
| | - Marianne Starck
- Department of Surgery, Skåne University Hospital, Malmö, Sweden.,Department of Clinical Sciences, Lund University, Malmö, Sweden
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Asanad K, Nazemi A, Ghodoussipour S, Ladi-Seyedian S, Nassiri N, Wayne K, Schuckman A, Djaladat H, Daneshmand S. Evaluation of Bowel Function Following Radical Cystectomy and Urinary Diversion Using Two Validated Questionnaires: What Are the Effects on Quality of Life? Urology 2021; 156:279-284. [PMID: 34058241 DOI: 10.1016/j.urology.2021.04.044] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 04/19/2021] [Accepted: 04/21/2021] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To assess both short- and long-term constipation symptoms and their impact on quality of life in patients who underwent radical cystectomy (RC) with three different types of urinary diversion: orthotopic neobladder (ONB), continent cutaneous diversion (CCD), and ileal conduit (IC). MATERIALS AND METHODS The validated Patient Assessment of Constipation Symptoms (PAC-SYM) and Patient Assessment of Constipation Quality of Life (PAC-QOL) questionnaires were administered to all patients at follow-up greater than 30 days from surgery. Clinical and pathological characteristics were prospectively recorded in an institutional review board approved bladder cancer database. Using multivariable linear regression analyses, we determined significant predictors of improved constipation symptoms and quality of life scores. RESULTS A total of 198 patients completed 255 PAC-SYM and PAC-QOL questionnaires with a median follow-up time of 1.7 years (IQR: 0.7 - 3.0 years). ONB, CCD, and IC were performed in 78%, 5.5%, and 16.5% of patients, respectively. Higher bowel function scores (i.e. worse symptoms) were noted at 3 months post-operatively, while these scores significantly improved over time for PAC-SYM total score (P = .004), abdominal subscore (P = .001), and rectal subscore (P = .018). On multivariable analysis, we found that patients <70 years old (B -2.1, P = .004), with follow-up >1 year (B -4.8, P = .001), and who received an IC (B -2.4, P = .02) had significantly lower PAC-SYM scores. CONCLUSION Patients have few constipation symptoms and are overall satisfied with their bowel function at long-term follow-up after RC. While patients with IC have significantly fewer constipation symptoms compared to those with ONB or CCD, all patients had significant improvement one year after the surgery.
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Affiliation(s)
- Kian Asanad
- USC Institute of Urology, USC/Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA
| | - Azadeh Nazemi
- USC Institute of Urology, USC/Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA
| | - Saum Ghodoussipour
- USC Institute of Urology, USC/Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA
| | - Sanam Ladi-Seyedian
- USC Institute of Urology, USC/Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA
| | - Nima Nassiri
- USC Institute of Urology, USC/Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA
| | - Kevin Wayne
- USC Institute of Urology, USC/Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA
| | - Anne Schuckman
- USC Institute of Urology, USC/Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA
| | - Hooman Djaladat
- USC Institute of Urology, USC/Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA
| | - Siamak Daneshmand
- USC Institute of Urology, USC/Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA.
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Ng KS, Gladman MA. Patient-reported and physician-recorded bowel dysfunction following colorectal resection and radical cystectomy: a prospective, comparative study. Colorectal Dis 2020; 22:1336-1347. [PMID: 32180323 DOI: 10.1111/codi.15041] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Accepted: 02/18/2020] [Indexed: 02/08/2023]
Abstract
AIM Bowel dysfunction following anterior resection (AR) is termed low anterior resection syndrome. It is unclear whether such dysfunction occurs following other bowel/pelvic operations as well. This study aimed to characterize and compare bowel dysfunction following AR, right hemicolectomy (RH) and radical cystectomy (RC). METHOD A prospective study of consecutive patients undergoing AR, RH and RC (2002-2012) was performed at a tertiary referral centre in Sydney, Australia. Outcome measures included (i) patient-reported satisfaction with bowel function, self-described bowel function and self-reported change in bowel function; (ii) objective assessment of bowel function using validated criteria to identify symptoms and stratify patients into those with constipation and/or faecal incontinence (FI); and (iii) health-related quality of life (SF-36v2 Health Survey). RESULTS Of 743 eligible patients, 70% participated [AR, n = 338, mean age 69.6 years (SD 11.9), 59% men; RH, n = 150, 75.8 years (SD 10.5), 54% men; RC, n = 34, 71.1 years (SD 14.1), 71% men]. AR patients were three times more likely to report change in bowel function post-surgery and self-judged their bowel function as abnormal more frequently (64%) than RH patients (35%) and RC patients (35%) (P < 0.01). AR patients were four times more likely to meet criteria for concomitant constipation and FI. Patients with concomitant constipation and FI had lower physical and mental SF-36v2 scores (P < 0.001). CONCLUSION Bowel dysfunction occurred after RH and RC but rates were higher following AR. This suggests that low anterior resection syndrome occurs due to a direct impact of partial/complete loss of the rectum rather than just due to loss of bowel length and/or the consequence(s) of pelvic dissection.
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Affiliation(s)
- K-S Ng
- Academic Colorectal Unit, Sydney Medical School - Concord, University of Sydney, Sydney, New South Wales, Australia
| | - M A Gladman
- Gastrointestinal and Enteric Neuroscience Research Group, Adelaide Medical School, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia
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Pfister D, Niegisch G. [Bladder cancer - complications related to urinary diversion]. Aktuelle Urol 2020; 51:456-462. [PMID: 32462641 DOI: 10.1055/a-1134-6642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Even today, radical cystectomy with urinary diversion is one of the most complicated procedures in uro-oncology. Particularly in the long-term course, but also perioperatively, problems caused by urinary diversion play a significant role.Perioperatively, gastrointestinal problems such as an ileus, but also infections and early complications of the different anastomoses are most important. While ileus and perioperative infections can usually be treated conservatively, failure of the intestinal or ureteroileal anastomoses require regular surgical revisions.In the long-term follow-up, scarring can lead to chronic obstruction of urinary flow and, in the case of continental urinary diversions, to stone formation. These complications, as well as parastomal hernias in patients with poor conduits, may require further therapy. Functional bowel disorders may impair patients' quality of life significantly.Improved preoperative preparation and accompanying measures during the inpatient stay can significantly reduce non-surgical complications.Cystectomy with therapy-associated morbidity is a classical example of when surgery must be performed at specialised centers to reduce complications perioperatively as well as in follow-up.
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Affiliation(s)
- David Pfister
- Klinik für Urologie, Uro-Onkologie, Roboter-assistierte und spezielle urologische Chirurgie Universitätsklinik Köln
| | - Günter Niegisch
- Heinrich-Heine-Universität, Medizinische Fakultät, Klinik für Urologie, Düsseldorf
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Normann CO, Opheim R, Andreassen BK, Bernklev T, Haug ES. Health-related quality-of-life after radical cystectomy among Norwegian men and women compared to the general population. Scand J Urol 2020; 54:181-187. [DOI: 10.1080/21681805.2020.1754906] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Affiliation(s)
| | - Randi Opheim
- Faculty of Health and Society, University of Oslo, Oslo, Norway
| | | | - Tomm Bernklev
- Department of Research and Innovation, Vestfold Hospital Trust, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Erik S. Haug
- Department of Urology, Vestfold Hospital Trust, Oslo, Norway
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Hupe MC, Vahlensieck W, Ozimek T, Struck JP, Hennig MJ, Tezval H, von Klot CA, Merseburger AS, Kuczyk MA, Kramer MW. Diarrhea and flatulence are major bowel disorders after radical cystectomy: Results from a cross-sectional study in bladder cancer patients. Urol Oncol 2018; 36:237.e1-237.e8. [DOI: 10.1016/j.urolonc.2017.12.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Revised: 11/26/2017] [Accepted: 12/23/2017] [Indexed: 12/14/2022]
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10
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Trainor S, Choudhury A, Huddart R, Kiltie AE, Kockelbergh R, Turner W, Birtle A, Crabb SJ. The National Institute for Health and Care Excellence (NICE) Guidance on Bladder Cancer; a Step in the Right Direction? Clin Oncol (R Coll Radiol) 2017; 29:344-347. [PMID: 28190637 DOI: 10.1016/j.clon.2017.01.040] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Accepted: 01/19/2017] [Indexed: 01/08/2023]
Affiliation(s)
- S Trainor
- Department of Medical Oncology, St James's Institute of Oncology, Leeds, UK
| | - A Choudhury
- The Christie NHS Foundation Trust and Manchester Cancer Research Centre, University of Manchester, Manchester Academic Health Sciences Centre, Manchester, UK
| | - R Huddart
- Institute of Cancer Research and Royal Marsden NHS Foundation Trust, Sutton, UK
| | - A E Kiltie
- CRUK/MRC Oxford Institute for Radiation Oncology, University of Oxford, Oxford, UK
| | - R Kockelbergh
- Department of Urology, University Hospitals of Leicester, Leicester, UK
| | - W Turner
- Department of Urology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - A Birtle
- Rosemere Cancer Centre, Royal Preston Hospital, Preston, UK
| | - S J Crabb
- Cancer Sciences Unit, University of Southampton, Southampton, UK.
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Vuttanon N, Vichittragoonthavon S, Chaisurin P, Thongchai C. Symptom Management for Bladder Cancer in Thailand. INTERNATIONAL JOURNAL OF UROLOGICAL NURSING 2017. [DOI: 10.1111/ijun.12132] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Affiliation(s)
- N Vuttanon
- Faculty of Nursing; Chiang Mai University; Chiang Mai Thailand
| | | | - P Chaisurin
- Faculty of Nursing; Chiang Mai University; Chiang Mai Thailand
| | - C Thongchai
- Faculty of Nursing; Chiang Mai University; Chiang Mai Thailand
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Quality of Life in Long-term Survivors of Muscle-Invasive Bladder Cancer. Int J Radiat Oncol Biol Phys 2016; 96:1028-1036. [DOI: 10.1016/j.ijrobp.2016.08.023] [Citation(s) in RCA: 89] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Revised: 08/10/2016] [Accepted: 08/16/2016] [Indexed: 01/13/2023]
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Bowel function in patients with urinary diversion: a gender-matched comparison of continent urinary diversion with the ileocecal pouch and ileal conduit. World J Urol 2016; 35:913-919. [PMID: 27734132 DOI: 10.1007/s00345-016-1949-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Accepted: 09/29/2016] [Indexed: 12/13/2022] Open
Abstract
PURPOSE To evaluate stool habits and associated quality of life (QoL) in a matched pair analysis of patients who underwent continent cutaneous diversion using the ileocecal segment [Mainz pouch I (MzPI)] with an intussuscepted ileal nipple as efferent segment with those receiving an ileal conduit (IC) after radical cystectomy. METHODS We identified 250 patients who underwent radical cystectomy and urinary diversion (UD) with either MzPI with an ileal nipple or IC in our database. A detailed history of stool habits using the modified Wexner score was obtained, and questions addressing general lifestyle, comparison of symptom differences before and after surgery considering bowel function as well as bowel-associated QoL were assessed. RESULTS Forty-five age- and sex-matched pairs could be compared. Overall, stool incontinence (p = 0.481) and the Wexner score (p = 0.464) revealed no differences between both groups. However, patients with MzPI as compared to those with IC had significant higher rates of stool frequency (53 vs 31 %), softer stool consistencies (60 vs 13 %), diarrhea (62 vs 20 %) and a lower rate of constipation (4 vs 22 %). Patients with MzPI had a trend toward lower bowel-associated QoL compared with patients with IC. Similarly, the MzPI group reported a significantly impaired overall postoperative QoL (51 %) compared to the IC group (29 %) (p = 0.024). CONCLUSIONS Patients following UD by MzPI have an increased stool frequency and softer stool consistency. However, there is no difference between both groups in terms of de novo stool incontinence. Change in bowel habits should be part of preoperative informed consent in any kind of UD. Careful patient selection is of paramount importance.
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