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Sowanthip D, Zennami K, Bejrananda T, Nukaya T, Takenaka M, Ichino M, Takahara K, Sasaki H, Kusaka M, Sumitomo M, Shiroki R. Older versus younger patients in robot-assisted radical cystectomy with intracorporeal ileal conduit comparing safety and clinical outcomes. Int J Urol 2024; 31:370-378. [PMID: 38180102 DOI: 10.1111/iju.15377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 12/10/2023] [Indexed: 01/06/2024]
Abstract
OBJECTIVE To evaluate the safety and efficacy of robot-assisted radical cystectomy using an intracorporeal ileal conduit in older compared to younger patients. METHODS We retrospectively analyzed 122 patients who underwent robot-assisted radical cystectomy with an intracorporeal ileal conduit at Fujita Health University Hospital and Fujita Health University Okazaki Medical Center between 2012 and 2022. Patients were categorized into two groups: older (age ≥ 75 years; n = 53) and younger (age < 75 years; n = 69). Perioperative outcomes, complications, recurrence-free survival, cancer-specific survival, and overall survival were compared between the cohorts. RESULTS The groups had no significant differences in perioperative outcomes, such as estimated blood loss, operative time, and blood transfusion rate. However, hospital stay was longer in the older patients than in the younger group (19 vs. 16 days; p < 0.001). The 30-day minor and major complication rates were 33.3% and 13.0%, respectively, for the younger group and 50.9% and 9.4% for the older group (p = 0.11). Urinary tract infection and bowel ileus were the most common complications in both groups. No significant differences were observed in recurrence-free survival, cancer-specific survival, and overall survival between the groups (p = 0.58, p = 0.75, and p = 0.78), and subgroup analysis in ≥cT3 revealed the older group tended to have poorer cancer-specific survival and overall survival (p = 0.07 and p = 0.01). Multivariate analysis indicated that older age was not associated with high-grade complications and cancer-specific survival. CONCLUSIONS Robot-assisted radical cystectomy with an intracorporeal ileal conduit is a safe and effective treatment option for older patients.
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Affiliation(s)
- Dutsadee Sowanthip
- Department of Urology, Fujita Health University School of Medicine, Toyoake, Japan
- Division of Urology, Faculty of Medicine, King Chulalongkorn Memorial Hospital, Chulalongkorn University, The Thai Red Cross Society, Bangkok, Thailand
| | - Kenji Zennami
- Department of Urology, Fujita Health University School of Medicine, Toyoake, Japan
| | - Tanan Bejrananda
- Department of Urology, Fujita Health University School of Medicine, Toyoake, Japan
- Division of Urology, Department of Surgery, Faculty of Medicine, Prince of Songkla University, Hatyai, Songkhla, Thailand
| | - Takuhisa Nukaya
- Department of Urology, Fujita Health University School of Medicine, Toyoake, Japan
| | - Masashi Takenaka
- Department of Urology, Fujita Health University School of Medicine, Toyoake, Japan
| | - Manabu Ichino
- Department of Urology, Fujita Health University School of Medicine, Toyoake, Japan
| | - Kiyoshi Takahara
- Department of Urology, Fujita Health University School of Medicine, Toyoake, Japan
| | - Hitomi Sasaki
- Department of Urology, Fujita Health University School of Medicine, Toyoake, Japan
| | - Mamoru Kusaka
- Department of Urology, Fujita Health University Okazaki Medical Center, Okazaki, Japan
| | - Makoto Sumitomo
- Department of Urology, Fujita Health University School of Medicine, Toyoake, Japan
| | - Ryoichi Shiroki
- Department of Urology, Fujita Health University School of Medicine, Toyoake, Japan
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Francolini G, Ghoshal A, Caini S, Piazzini T, Becherini C, Detti B, Di Cataldo V, Valzano M, Visani L, Salvestrini V, Olmetto E, Desideri I, Meattini I, Livi L. Quality of life after definitive treatment for bladder cancer: A systematic review and meta-analysis. Radiother Oncol 2024; 190:110038. [PMID: 38042498 DOI: 10.1016/j.radonc.2023.110038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 11/22/2023] [Accepted: 11/23/2023] [Indexed: 12/04/2023]
Abstract
Radical cystectomy (RC) is considered the standard treatment for muscle invasive bladder cancer (MIBC). However, RC is often burdened by significant impact on quality of life (QoL); Continence preserving methods (e.g., continent cutaneous urinary diversion and orthotopic neobladder-ONB), have been proposed as alternatives to improve postoperative QoL. Trimodal therapy (TMT) emerged as alternative to surgery. To assess the impact of these treatments from the patients' perspective, we undertook a systematic review and meta-analysis of literature, focusing on studies reporting QoL data about each of the abovementioned approaches. A systematic review was carried out including all prospective and retrospective studies enrolling patientstreated with radical intent for non-metastatic MIBC from 1999 to 2021 (either RC or TMT). All studies included specifically reported QoL for one of the main treatment approaches explored (RC followed by ileal conduit urinary diversion-ICUD, ONB or TMT). Pooled analysis for EORTC QLQ-C30 and BLM-30 questionnaires showed that ONB yielded a significant advantage only for Physical Functioning (pooled mean standardized difference -0.73 SD, p-value 0.019, I 2 = 93 %) and for Emotional Functioning (pooled mean standardized difference -0.16 SD, p-value 0.029, I 2 = 0 %). A trend in favour of higher mean reported values after TMT for Global Health Score, Physical Functioning and Role Functioning was found, if compared to both RC approaches. Significant benefit for ONB if compared to ICUD was detected only for specific subdomains of QoL questionnaires. No direct comparison with TMT is available, but data suggest advantage of this approach when compared to both reconstructive scenarios.
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Affiliation(s)
- Giulio Francolini
- Radiation Oncology Unit, Azienda Ospedaliera Universitaria Careggi, University of Florence, Florence, Italy.
| | | | - Saverio Caini
- Cancer Risk Factors and Lifestyle Epidemiology Unit, Institute for Cancer Research, Prevention and Clinical Network (ISPRO), Florence, Italy
| | - Tessa Piazzini
- Biblioteca Biomedica, University of Florence, Florence, Italy
| | - Carlotta Becherini
- Radiation Oncology Unit, Azienda Ospedaliera Universitaria Careggi, University of Florence, Florence, Italy
| | - Beatrice Detti
- Radiation Oncology Unit, Azienda Ospedaliera Universitaria Careggi, University of Florence, Florence, Italy
| | - Vanessa Di Cataldo
- Radiation Oncology Unit, Azienda Ospedaliera Universitaria Careggi, University of Florence, Florence, Italy
| | - Marianna Valzano
- Department of Experimental and Clinical Biomedical Sciences "M. Serio", University of Florence, Florence, Italy
| | - Luca Visani
- CyberKnife Center, Istituto Fiorentino di Cura ed Assistenza, Florence, Italy
| | - Viola Salvestrini
- CyberKnife Center, Istituto Fiorentino di Cura ed Assistenza, Florence, Italy
| | - Emanuela Olmetto
- Radiation Oncology Unit, Azienda Ospedaliera Universitaria Careggi, University of Florence, Florence, Italy
| | - Isacco Desideri
- Department of Experimental and Clinical Biomedical Sciences "M. Serio", University of Florence, Florence, Italy
| | - Icro Meattini
- Department of Experimental and Clinical Biomedical Sciences "M. Serio", University of Florence, Florence, Italy
| | - Lorenzo Livi
- Department of Experimental and Clinical Biomedical Sciences "M. Serio", University of Florence, Florence, Italy
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Fasanella D, Marchioni M, Domanico L, Franzini C, Inferrera A, Schips L, Greco F. Neobladder "Function": Tips and Tricks for Surgery and Postoperative Management. LIFE (BASEL, SWITZERLAND) 2022; 12:life12081193. [PMID: 36013372 PMCID: PMC9409805 DOI: 10.3390/life12081193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 07/21/2022] [Accepted: 07/29/2022] [Indexed: 11/23/2022]
Abstract
Orthotopic neobladder (ONB) reconstruction is a continent urinary diversion procedure increasingly used in patients with muscle-invasive bladder cancer following radical cystectomy (RC). It represents a valid alternative to the ileal duct in suitable patients who do not prefer a stoma and are motivated to undergo adequate training of the neobladder. Careful patient selection, taking into account the absolute and relative contraindications for ONB as well as an adequate recovery protocol after surgery are integral to the success of this procedure and the oncological and functional outcomes. The objective of this review is to summarize the current data on RC with ONB in terms of patient selection, preoperative preparation, surgical techniques and functional (continence and sexual activity) and oncological outcomes, with particular attention to the management of complications and the impact on quality of life (QoL).
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Affiliation(s)
- Daniela Fasanella
- Urology Unit, Department of Medical, Oral and Biotechnological Sciences, G. d’Annunzio University of Chieti, SS Annunziata Hospital, 66100 Chieti, Italy
| | - Michele Marchioni
- Urology Unit, Department of Medical, Oral and Biotechnological Sciences, G. d’Annunzio University of Chieti, SS Annunziata Hospital, 66100 Chieti, Italy
| | - Luigi Domanico
- Urology Unit, Centro Salute Uomo, Via Palma il Vecchio 4a, 24122 Bergamo, Italy
| | - Claudia Franzini
- Urology Unit, Centro Salute Uomo, Via Palma il Vecchio 4a, 24122 Bergamo, Italy
| | - Antonino Inferrera
- Urology Unit, Centro Salute Uomo, Via Palma il Vecchio 4a, 24122 Bergamo, Italy
| | - Luigi Schips
- Urology Unit, Department of Medical, Oral and Biotechnological Sciences, G. d’Annunzio University of Chieti, SS Annunziata Hospital, 66100 Chieti, Italy
| | - Francesco Greco
- Urology Unit, Centro Salute Uomo, Via Palma il Vecchio 4a, 24122 Bergamo, Italy
- Correspondence: ; Tel.: +39-3317918535
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Abstract
PURPOSE OF REVIEW To study the recent literature on health-related quality of life (HRQOL) in patients after radical cystectomy followed by urinary diversion. RECENT FINDINGS General consensus regarding, which urinary diversion is superior in terms of HRQOL has not been reached. Although there is an increase in studies favoring the orthotopic neobladder, overall quality of these studies is poor. Other studies suggest that HRQOL outcomes in different types of urinary diversions is similar and that other factors, such as age, comorbidities and sex are more important instead. Patient choice, in consultation with the treating surgeon should be the determinant of which urinary diversion is performed. Furthermore, sexual function can play an important role in HRQOL. However, practice shows that counselling on the option of sexual-preserving techniques is still not implemented in routine clinical practice. Furthermore, studies regarding differences in HRQOL after urinary diversion between male and female individuals are lacking. SUMMARY Thorough preoperative counselling on the different types of urinary diversion and options for sexual-preserving techniques decreases decision regret and increases HRQOL in patients after radical cystectomy.
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Hockman L, Bailey J, Sanders J, Muzzey C, Wakefield M, Christensen A, Murray K. A Qualitative Assessment of Patient Satisfaction with Radical Cystectomy for Bladder Cancer at a Single Institution: How Can We Improve? Res Rep Urol 2020; 12:447-453. [PMID: 33117744 PMCID: PMC7550214 DOI: 10.2147/rru.s269405] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 08/29/2020] [Indexed: 11/23/2022] Open
Abstract
PURPOSE To evaluate patient satisfaction (with emphasis on preoperative education) with radical cystectomy for bladder cancer at our institution, the University of Missouri Hospital, qualitatively in order to identify specific areas where improvements can be made. MATERIALS AND METHODS We developed a patient survey that used open-ended questions to identify positive and negative experiences that contributed to patient satisfaction. We administered the survey to radical cystectomy patients who met inclusion criteria and agreed to participate. We recorded, transcribed and qualitatively coded the responses. We identified four themes under which both positive and negative responses were placed, and constructed two diagrams to better illustrate contributors to patient experience and satisfaction. RESULTS We identified 25 patients who met inclusion criteria. Of those, 13 participated in the survey. Regarding overall experience, 92.3% of patients rated their care as excellent or good. Regarding preoperative education, 76.9% of patients reported they definitely or somewhat received enough information on what to expect after surgery, and 76.9% definitely received enough guidance on how to care for themselves after surgery. From qualitative coding of patient responses to open-ended questions, we identified preoperative preparation, delivery of care, caregiver availability, and patient-centered care as themes that contributed positively and negatively to patient experience. CONCLUSION Although the overall patient satisfaction could be perceived as high (92.3%), qualitative analysis revealed several areas where improvements can be made to improve patient experience with radical cystectomy at our institution. As previously expected, preoperative preparation was a contributor.
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Affiliation(s)
- Lukas Hockman
- Division of Urology, Department of Surgery, School of Medicine, University of Missouri, Columbia, Missouri, USA
| | - Jacob Bailey
- Division of Urology, Department of Surgery, School of Medicine, University of Missouri, Columbia, Missouri, USA
| | - Jacob Sanders
- Division of Urology, Department of Surgery, School of Medicine, University of Missouri, Columbia, Missouri, USA
| | - Catherine Muzzey
- Division of Urology, Department of Surgery, School of Medicine, University of Missouri, Columbia, Missouri, USA
| | - Mark Wakefield
- Division of Urology, Department of Surgery, School of Medicine, University of Missouri, Columbia, Missouri, USA
| | - Amy Christensen
- Department of Health Management and Informatics, University of Missouri, Columbia, Missouri, USA
| | - Katie Murray
- Division of Urology, Department of Surgery, School of Medicine, University of Missouri, Columbia, Missouri, USA
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6
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Qu LG, Lawrentschuk N. Orthotopic Neobladder Reconstruction: Patient Selection And Perspectives. Res Rep Urol 2019; 11:333-341. [PMID: 31850284 PMCID: PMC6912000 DOI: 10.2147/rru.s181473] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2019] [Accepted: 09/26/2019] [Indexed: 12/24/2022] Open
Abstract
Orthotopic neobladder (ONB) reconstruction is a continent urinary diversion procedure that may be performed in a patient with bladder cancer following a radical cystectomy. The selection of a patient for an ONB reconstruction is strict as not everyone may be suitable to undergo this complex surgery. Patients must be not only mentally competent but also physically dexterous enough to allow for appropriate neobladder training post-procedure, to achieve best urinary function. However, even with a carefully chosen patient population, various complications specific to ONB reconstruction may result. Metabolic acidosis may result from electrolyte shifts, resulting in secondary complications such as bone demineralization and urinary calculi. In addition, nutritional deficiencies may result from the use of a transposed intestinal segment for the fashioning of the reservoir. A widely used outcome measure when assessing for ONB reconstruction is continence. With a strict neobladder training regimen, daytime continence may be achieved in roughly 70% of patients post-ONB procedure. This number may increase over the course of several years, although may decrease in up to 20 years of follow-up. Similarly, quality of life (QoL) measures have been widely studied, and current literature suggests slightly better QoL achieved with ONB compared to other urinary diversion procedures. Of note, the tools used to assess continence and QoL vary between studies, limiting the interpretability of the summarized data. Nevertheless, ONB reconstruction is a procedure that is still evolving, with ongoing modifications that can reduce complications and improve patient urinary function.
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Affiliation(s)
- Liang G Qu
- Department of Urology, Austin Health, Heidelberg, VIC, Australia
| | - Nathan Lawrentschuk
- Department of Urology, Austin Health, Heidelberg, VIC, Australia.,Department of Surgery, University of Melbourne, Heidelberg, VIC, Australia.,Department of Surgical Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia.,EJ Whitten Prostate Cancer Research Centre, Epworth Healthcare, Melbourne, VIC, Australia
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7
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Gild P, Nguyen DD, Fletcher SA, Cole AP, Lipsitz SR, Kibel AS, Fisch M, Preston MA, Trinh QD. Contemporary Survival Rates for Muscle-Invasive Bladder Cancer Treated With Definitive or Non-Definitive Therapy. Clin Genitourin Cancer 2019; 17:e488-e493. [PMID: 30837209 DOI: 10.1016/j.clgc.2019.01.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Accepted: 01/19/2019] [Indexed: 12/29/2022]
Abstract
INTRODUCTION Definitive, curatively intended therapy for muscle-invasive bladder cancer can be associated with significant morbidity and adverse effects on quality of life, leaving patients reluctant to opt for these interventions. We sought to provide perspective to patients and clinicians exploring therapy options. MATERIALS AND METHODS We examined stage-by-stage overall survival of definitive therapy (DT) (either radical cystectomy in conjunction with neoadjuvant chemotherapy or trimodal therapy) versus non-DT (including palliative transurethral resection, chemotherapy and radiation treatment) among 42,144 patients within the National Cancer Database (2004-2012). RESULTS The median overall survival stratified by receipt of DT versus non-DT was 45.3 versus 16.4 months, 26.7 versus 9.6 months, and 21.2 versus 7.5 months in American Joint Committee on Cancer stages II, III, and IV, respectively. In multivariable Cox regression analysis, DT conferred a significant survival benefit in all stages, most pronounced in American Joint Committee on Cancer stage IV (hazard ratio, 0.46; 95% confidence interval, 0.43-0.49; P < .001). CONCLUSION Despite potentially significant morbidity and adverse effects on quality of life, DT is associated with a sizable survival benefit.
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Affiliation(s)
- Philipp Gild
- Center for Surgery and Public Health, Division of Urologic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - David-Dan Nguyen
- Center for Surgery and Public Health, Division of Urologic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | - Sean A Fletcher
- Center for Surgery and Public Health, Division of Urologic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Alexander P Cole
- Center for Surgery and Public Health, Division of Urologic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Stuart R Lipsitz
- Center for Surgery and Public Health, Division of Urologic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Adam S Kibel
- Center for Surgery and Public Health, Division of Urologic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Margit Fisch
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Mark A Preston
- Center for Surgery and Public Health, Division of Urologic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Quoc-Dien Trinh
- Center for Surgery and Public Health, Division of Urologic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
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8
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Shi H, Yu H, Bellmunt J, Leow JJ, Chen X, Guo C, Yang H, Zhang X. Comparison of health-related quality of life (HRQoL) between ileal conduit diversion and orthotopic neobladder based on validated questionnaires: a systematic review and meta-analysis. Qual Life Res 2018; 27:2759-2775. [PMID: 29926345 DOI: 10.1007/s11136-018-1902-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/01/2018] [Indexed: 11/29/2022]
Abstract
PURPOSE The question of whether orthotopic neobladder (ONB) reconstruction is superior to ileal conduit diversion (ICD) with respect to health-related quality of life (HRQoL) remains controversial. The goal of this study is to perform a meta-analysis to compare post-ICD and post-ONB HRQoL in patients with bladder cancer. METHODS A systematic search of Medline, Embase, the Cochrane Central Register of Controlled Trials, and the annual congress abstracts of the European Association of Urology (EAU), the American Urological Association (AUA) and the Société Internationale d'Urologie (SIU) up to June 2017 was conducted to identify all relevant clinical trials using validated questionnaires to assess HRQoL. A systematic review and meta-analysis were then performed. RESULTS A total of 2507 patients from 26 eligible studies were included. Meta-analyses showed significant differences favouring ONB patients in global health status (WMD + 9.13, p = 0.004), physical functioning (WMD + 11.57, p = 0.0001), role functioning (WMD + 9.64, p = 0.002), and social functioning (WMD + 6.81, p = 0.03) based on the EORTC-QLQ-C30 questionnaire and in the total score of FACT questionnaire (WMD + 6.80, p = 0.001). However, ONB patients were more likely to have postoperative urinary symptoms than ICD patients (WMD - 22.19, p = 0.0001). CONCLUSIONS ONB patients are more likely to have a better global health status than ICD patients. Regardless of the type of urinary diversion (UD) surgery, a gradual improvement in HRQoL over preoperative status tended to stabilise after 12 months postoperatively.
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Affiliation(s)
- Hangchuan Shi
- Department of Urology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan, 430022, Hubei, China.,Clinical and Translational Science Institute, University of Rochester, Rochester, NY, 14642, USA
| | - Han Yu
- Department of Biostatistics, The State University of New York at Buffalo, Buffalo, NY, 14214, USA
| | - Joaquim Bellmunt
- Bladder Cancer Center, Dana-Farber/Brigham and Women's Cancer Center, Harvard Medical School, Boston, MA, 02215, USA
| | - Jeffrey J Leow
- Bladder Cancer Center, Dana-Farber/Brigham and Women's Cancer Center, Harvard Medical School, Boston, MA, 02215, USA
| | - Xuanyu Chen
- Department of Urology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan, 430022, Hubei, China
| | - Changcheng Guo
- Department of Urology, Shanghai Tenth People's Hospital, Tongji University, Shanghai, 200072, China
| | - Hongmei Yang
- Department of Pathogen Biology, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Xiaoping Zhang
- Department of Urology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan, 430022, Hubei, China.
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Cerruto M, D’Elia C, Siracusano S, Saleh O, Gacci M, Cacciamani G, De Marco V, Porcaro A, Balzarro M, Niero M, Lonardi C, Iafrate M, Bassi P, Imbimbo C, Racioppi M, Talamini R, Ciciliato S, Serni S, Carini M, Verze P, Artibani W. Health-Related Quality of Life after Radical Cystectomy for Bladder Cancer in Elderly Patients with Ileal Orthotopic Neobladder or Ileal Conduit: Results from a Multicentre Cross-Sectional Study Using Validated Questionnaires. Urol Int 2018. [DOI: 10.1159/000487644] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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10
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Abstract
Approximately 1 in 5 new cases of clinically localized bladder cancer is muscle invasive and requires the patient to choose from 1 of 2 prevailing options for treatment: radical cystectomy or radiation to the bladder. However, these treatments are associated with detrimental effects on patient well-being and quality of life, particularly with respect to functional independence, urinary and sexual function, social and emotional health, body image, and psychosocial stress. Compared with the literature on other malignancies like breast or prostate cancer, high-quality studies evaluating the effects of bladder cancer treatment on quality of life are lacking.
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Affiliation(s)
- Mark D Tyson
- Department of Urology, Mayo Clinic Arizona, Mayo Clinic Hospital, 5777 East Mayo Boulevard, Phoenix, AZ 85054, USA.
| | - Daniel A Barocas
- Department of Urologic Surgery, Vanderbilt University Medical Center, A1302 Medical Center North, Nashville, TN 37203, USA
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11
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12
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Cerruto MA, D'Elia C, Siracusano S, Saleh O, Gacci M, Cacciamani G, De Marco V, Porcaro AB, Balzarro M, Niero M, Lonardi C, Iafrate M, Bassi P, Imbimbo C, Racioppi M, Talamini R, Ciciliato S, Serni S, Carini M, Verze P, Artibani W. Health-related Quality of Life After Radical Cystectomy: A Cross-sectional Study With Matched-pair Analysis on Ileal Conduit vs Ileal Orthotopic Neobladder Diversion. Urology 2017; 108:82-89. [PMID: 28652163 DOI: 10.1016/j.urology.2017.06.022] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Revised: 06/10/2017] [Accepted: 06/13/2017] [Indexed: 11/12/2022]
Abstract
OBJECTIVE To examine the different and health-related quality of life (HR-QoL) outcomes between ileal conduit (IC) and ileal orthotopic neobladder (IONB) in patients who underwent radical cystectomy (RC), by using validated self-reported cancer-specific instruments. PATIENTS AND METHODS This retrospective, cross-sectional, multicenter cohort study included 148 and 171 patients with either IC or IONB. HR-QoL was evaluated with Quality of Life Core Questionnaire and bladder module (BLM)-30 European Organisation for Research and Treatment of Cancer questionnaires. Baseline HR-QoL scores were dichotomized at the median to give "good" or "poor" score profiles. A matched-pair analysis compared HR-QoL aspects between 79 IC patients and 79 IONB patients. RESULTS At univariate analysis IONB resulted favorable for physical functioning, emotional functioning, cognitive functioning (CF), fatigue, dyspnea, appetite loss, constipation (CO), and abdominal bloating flatulence (AB). At multivariate analyses, IONB showed better scores for emotional functioning (85 vs 79, P = .023), CF (93 vs 85, P <.001), CO (16 vs 31, P <.001), and AB (12 vs 25, P <.001). A significant worsening of sexual and urinary function was observed for IONB patients in the long-term. At matched-pair analysis, global health status was similar (65 vs 62, P = .385). Significantly better scores were observed in the IONB group for the following items: CF (P = .007), fatigue (P = .003), pain (P = .019), dyspnea (P = .016), CO (P = .001), and AB (P = .00). CONCLUSION IONB and IC after RC were similar in terms of global health status. IONB provides better results in some aspects of HR-QoL related to bowel function, but a worsening of urinary and sexual functions. Further randomized controlled trials are needed to confirm these data.
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Affiliation(s)
- Maria Angela Cerruto
- Urology Clinic, Department of Surgery Dentistry Paediatrics, and Gynaecology, University of Verona, Verona, Italy
| | | | - Salvatore Siracusano
- Urology Clinic, Department of Surgery Dentistry Paediatrics, and Gynaecology, University of Verona, Verona, Italy
| | - Omar Saleh
- Urology Department, Careggi Hospital, University of Florence, Italy.
| | - Mauro Gacci
- Urology Department, Careggi Hospital, University of Florence, Italy
| | - Giovanni Cacciamani
- Urology Clinic, Department of Surgery Dentistry Paediatrics, and Gynaecology, University of Verona, Verona, Italy
| | - Vincenzo De Marco
- Urology Clinic, Department of Surgery Dentistry Paediatrics, and Gynaecology, University of Verona, Verona, Italy
| | - Antonio Benito Porcaro
- Urology Clinic, Department of Surgery Dentistry Paediatrics, and Gynaecology, University of Verona, Verona, Italy
| | - Matteo Balzarro
- Urology Clinic, Department of Surgery Dentistry Paediatrics, and Gynaecology, University of Verona, Verona, Italy
| | - Mauro Niero
- TESIS Department, University of Verona, Verona, Italy
| | | | | | | | - Ciro Imbimbo
- Urology Department, University of Naples, Naples, Italy
| | - Marco Racioppi
- Urology Department, Catholic University Policlinico Gemelli, Rome, Italy
| | - Renato Talamini
- Unit of Epidemiology, and Biostatistics, IRCCS-CRO, Aviano, Italy
| | | | - Sergio Serni
- Urology Department, Careggi Hospital, University of Florence, Italy
| | - Marco Carini
- Urology Department, Careggi Hospital, University of Florence, Italy
| | - Paolo Verze
- Urology Department, University of Naples, Naples, Italy
| | - Walter Artibani
- Urology Clinic, Department of Surgery Dentistry Paediatrics, and Gynaecology, University of Verona, Verona, Italy
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Urinary Diversion for Incontinence and Voiding Dysfunction in Cancer Survivors: a Critical Review of the Literature. CURRENT BLADDER DYSFUNCTION REPORTS 2017. [DOI: 10.1007/s11884-017-0415-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Cerruto MA, D'Elia C, Siracusano S, Porcaro AB, Cacciamani G, De Marchi D, Niero M, Lonardi C, Iafrate M, Bassi P, Belgrano E, Imbimbo C, Racioppi M, Talamini R, Ciciliato S, Toffoli L, Rizzo M, Visalli F, Verze P, Artibani W. Is Health-Related Quality of Life after Radical Cystectomy Using Validated Questionnaires Really Better in Patients with Ileal Orthotopic Neobladder Compared to Ileal Conduit: A Meta-Analysis of Retrospective Comparative Studies. Curr Urol 2017; 10:57-68. [PMID: 28785189 DOI: 10.1159/000447153] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Accepted: 11/11/2016] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION From the most recent systematic revision of the literature, an orthotopic neobladder would seem to show marginally better health related quality of life (HR-QoL) scores compared with an ileal conduit. The aim of this study was to review all relevant published studies about the comparison between ileal orthotopic neobladder (IONB) and ileal conduit using validated HR-QoL questionnaires. MATERIALS AND METHODS Studies were identified by searching multiple literature databases. Data were synthesized using meta-analytic methods conformed to the PRISMA statement. RESULTS The literature search identified 10 papers; pooled effect sizes of combined quality of life outcomes for ileal conduit versus IONB showed a significantly better HR-QoL in patients with IONB (Hedges' g = 0.278; p = 0.000);. The present study has an important limitation due to the type of the analyzed comparative studies, all retrospective and not randomized. CONCLUSION This meta-analysis of not-randomized, retrospective comparative studies on the impact of ileal conduit versus IONB on HR-QoL showed a significant advantage of IONB subgroups.
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Affiliation(s)
| | | | | | | | | | | | - Mauro Niero
- TESIS Department, University of Verona, Verona
| | | | | | | | | | - Ciro Imbimbo
- Urology Department, University of Naples, Naples
| | - Marco Racioppi
- Urology Department, Catholic University Policlinico Gemelli, Rome
| | - Renato Talamini
- Unit of Epidemiology and Biostatistics, IRCCS-CRO, Aviano, Italy
| | | | | | | | | | - Paolo Verze
- Urology Department, University of Naples, Naples
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Crozier J, Hennessey D, Sengupta S, Bolton D, Lawrentschuk N. A Systematic Review of Ileal Conduit and Neobladder Outcomes in Primary Bladder Cancer. Urology 2016; 96:74-79. [PMID: 27374734 DOI: 10.1016/j.urology.2016.06.034] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Revised: 06/11/2016] [Accepted: 06/21/2016] [Indexed: 10/21/2022]
Abstract
Treatment for muscle invasive bladder cancer with curative intent includes radical cystectomy and urinary diversion. Using PRISMA guidelines, we conducted a systematic review assessing differences in patient selection, operative parameters, complications, and quality of life between ileal conduit and neobladder cohorts. Ileal conduit cohorts have more advanced age and disease, more comorbidities and complications, and poorer quality of life. Ileal conduit surgery is associated with adverse patient selection that inhibits reasonable comparison of outcomes with neobladder cohorts. Despite this, we observe longer operative times and hospital stays in neobladder cohorts, perhaps reflecting greater technical difficulty and the need for postoperative bladder training.
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Affiliation(s)
- Jack Crozier
- Department of Surgery, Austin Hospital, University of Melbourne, Melbourne, Victoria, Australia; Austin Hospital, Olivia Newton-John Cancer Research Institute, Melbourne, Victoria, Australia.
| | - Derek Hennessey
- Austin Hospital, Olivia Newton-John Cancer Research Institute, Melbourne, Victoria, Australia
| | - Shomik Sengupta
- Department of Surgery, Austin Hospital, University of Melbourne, Melbourne, Victoria, Australia; Austin Hospital, Olivia Newton-John Cancer Research Institute, Melbourne, Victoria, Australia
| | - Damien Bolton
- Department of Surgery, Austin Hospital, University of Melbourne, Melbourne, Victoria, Australia; Austin Hospital, Olivia Newton-John Cancer Research Institute, Melbourne, Victoria, Australia
| | - Nathan Lawrentschuk
- Department of Surgery, Austin Hospital, University of Melbourne, Melbourne, Victoria, Australia; Austin Hospital, Olivia Newton-John Cancer Research Institute, Melbourne, Victoria, Australia; Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
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Moomjian LN, Carucci LR, Guruli G, Klausner AP. Follow the Stream: Imaging of Urinary Diversions. Radiographics 2016; 36:688-709. [DOI: 10.1148/rg.2016150180] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Anderson CB, Rapkin B, Reaves BC, Sun AJ, Morganstern B, Dalbagni G, Donat M, Herr HW, Laudone VP, Bochner BH. Idiographic quality of life assessment before radical cystectomy. Psychooncology 2015; 26:206-213. [PMID: 26620583 DOI: 10.1002/pon.4025] [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: 05/16/2015] [Revised: 09/03/2015] [Accepted: 10/16/2015] [Indexed: 12/17/2022]
Abstract
BACKGROUND We sought to determine if idiographic, or self-defined, measures added to our understanding of patients with bladder cancer's quality of life (QOL) prior to radical cystectomy (RC). We tested whether idiographic measures increased prediction of global QOL beyond standard (nomothetic) measures of QOL components. METHODS We administered the European Organization for Research and Treatment of Cancer Quality of Life Questionnaires (QLQ)-C30 and QLQ-BLM30, and our own idiographic Quality of Life Appraisal Profile prior to RC. Idiographic measures included number of goal statements, distance from goal attainment, and ability to complete goal attainment activities. Multivariate linear regression was used to predict measures of global QOL and related constructs of life satisfaction and mental health. RESULTS Two hundred fiftheen patients reported a median of 8 (interquartile range [IQR] 6, 11) goals and half had an average goal attainment rating above 6.9 out of 10 (IQR 5.5, 8.2). On multivariable analysis, QLQ-C30 role functioning and QLQ-BLM30 future perspective explained 15.7% of the variability in preoperative global QOL. Including goal attainment and activity difficulty explained an additional 12% of global QOL variance. Smaller gains were seen on measures of global health, life satisfaction, mental health, and activity, suggesting that idiographic measures capture aspects of QOL distinct from health and functional status defined by nomothetic scales. CONCLUSIONS Idiographic assessment of QOL added to prediction of global QOL above and beyond health-related components measured using nomothetic instruments. This self-defined information may be valuable in communicating with cancer patients about their QOL. Copyright © 2015 John Wiley & Sons, Ltd.
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Affiliation(s)
- Christopher B Anderson
- Urology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Bruce Rapkin
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Brieyona C Reaves
- Urology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Arony J Sun
- Urology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Bradley Morganstern
- Urology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Guido Dalbagni
- Urology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Machele Donat
- Urology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Harry W Herr
- Urology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Vincent P Laudone
- Urology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Bernard H Bochner
- Urology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
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Huang Y, Pan X, Zhou Q, Huang H, Li L, Cui X, Wang G, Jizhong R, Yin L, Xu D, Hong Y. Quality-of-life outcomes and unmet needs between ileal conduit and orthotopic ileal neobladder after radical cystectomy in a Chinese population: a 2-to-1 matched-pair analysis. BMC Urol 2015; 15:117. [PMID: 26610351 PMCID: PMC4662020 DOI: 10.1186/s12894-015-0113-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2015] [Accepted: 11/24/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Health-related quality-of-life (HRQoL) is an important consideration after radical cystectomy (RC). Lack of effective ways to assess HRQoL after RC and unawareness of disease-specific problems related to ileal conduit (IC) and orthotopic ileal neobladder (OIN) are serious problems. The present study was to evaluate and compare morbidity and HRQoL between IC and OIN after RC, and examine their unmet needs in the two groups. METHODS A retrospective analysis was made of 294 patients treated with RC in our hospital between 2007 and 2013. Matched pair analysis was used to determine the patients of IC and OIN groups. Patient HRQoL between IC and OIN groups was assessed using the bladder-specific bladder cancer index (BCI) and European Organization for Research and Treatment of Cancer Body Image scale (BIS) questionnaires. Unmet information of patients undergoing these two urinary diversions was recorded through individual interviews. RESULTS Of the 117 included patients, 39 patients were treated with OIN and the other 78 matched patients with IC as controls for matched pair analysis. There was no significant difference in baseline characteristics between the two groups. OIN patients showed significantly better BIS scores in terms of HRQoL outcomes after RC at a short-term (<1 year) follow-up level, but there was no significant difference at a long-term (>1 year) follow-up level between the two groups. Interestingly, urinary bother (UB) and urinary function (UF) were poor in OIN patients at the one-year follow-up level, but there was no significant difference in UB between the two groups at the long term follow-up level. Unmet needs analysis showed that OIN patients had a more positive attitude towards treatment and participated in physical and social activities more positively, although they may have more urine leakage problems. CONCLUSIONS The mean BIS score in OIN group patients was significantly better than that in IC group patients at the one-year follow-up level, but there was no significant difference at the long-term follow-up level. Due attention should be paid to some particular unmet needs in individual patients in managing the two UD modalities.
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Affiliation(s)
- Yi Huang
- Department of Urinary Surgery of Changzheng Hospital, Second Military Medical University, No. 415, Fengyang Road, Huangpu District, Shanghai, 200003, China. .,Department of Urinary Surgery of Navy Hospital of Xiamen, No. 23, Zhenhai Road, Siming District, Xiamen, 361000, China.
| | - Xiuwu Pan
- Department of Urinary Surgery of Changzheng Hospital, Second Military Medical University, No. 415, Fengyang Road, Huangpu District, Shanghai, 200003, China. .,Department of Urinary Surgery of Third Affiliated Hospital, Second Military Medical University, No. 700, Moyu Road, Jiading District, Shanghai, 201805, China.
| | - Qiwei Zhou
- Department of Urinary Surgery of No. 313 Hospital of PLA, No. 50, Haibinnan Road, Longgang District, Huludao City, Liaoning, 125000, China.
| | - Hai Huang
- Department of Urinary Surgery of Changzheng Hospital, Second Military Medical University, No. 415, Fengyang Road, Huangpu District, Shanghai, 200003, China.
| | - Lin Li
- Department of Urinary Surgery of Changzheng Hospital, Second Military Medical University, No. 415, Fengyang Road, Huangpu District, Shanghai, 200003, China. .,Department of Urinary Surgery of Third Affiliated Hospital, Second Military Medical University, No. 700, Moyu Road, Jiading District, Shanghai, 201805, China.
| | - Xingang Cui
- Department of Urinary Surgery of Third Affiliated Hospital, Second Military Medical University, No. 700, Moyu Road, Jiading District, Shanghai, 201805, China.
| | - Guodong Wang
- Department of Stomatology of Changzheng Hospital, Second Military Medical University, Shanghai, China.
| | - Ren Jizhong
- Department of Urinary Surgery of Changzheng Hospital, Second Military Medical University, No. 415, Fengyang Road, Huangpu District, Shanghai, 200003, China.
| | - Lei Yin
- Department of Urinary Surgery of Changzheng Hospital, Second Military Medical University, No. 415, Fengyang Road, Huangpu District, Shanghai, 200003, China.
| | - Danfeng Xu
- Department of Urinary Surgery of Changzheng Hospital, Second Military Medical University, No. 415, Fengyang Road, Huangpu District, Shanghai, 200003, China.
| | - Yi Hong
- Department of Urinary Surgery of Changzheng Hospital, Second Military Medical University, No. 415, Fengyang Road, Huangpu District, Shanghai, 200003, China.
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Systematic review and meta-analysis of non RCT's on health related quality of life after radical cystectomy using validated questionnaires: Better results with orthotopic neobladder versus ileal conduit. Eur J Surg Oncol 2015; 42:343-60. [PMID: 26620844 DOI: 10.1016/j.ejso.2015.10.001] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Revised: 09/21/2015] [Accepted: 10/13/2015] [Indexed: 11/20/2022] Open
Abstract
PURPOSE 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. MATERIALS AND METHODS 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. RESULTS 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). CONCLUSIONS 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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20
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Berry DL, Nayak M, Halpenny B, Harrington S, Loughlin KR, Chang P, Rosenberg JE, Kibel AS. Treatment Decision Making in Patients with Bladder Cancer. Bladder Cancer 2015; 1:151-158. [PMID: 27376115 PMCID: PMC4927892 DOI: 10.3233/blc-150029] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Background: Each stage of bladder cancer involves varying treatment issues and concerns that are discussed between patients and providers during the pre-treatment consultation. There is no documentation of how patients engage in decision making. Objective: To describe aspects of treatment decision making perceived by patients with bladder cancer using qualitative analysis of data from individual interviews. Methods: Patients with any stage bladder cancer were recruited from urology and medical oncology services at a comprehensive cancer center. A qualitative approach to data collection and analysis was applied. Individual, semi-structured interviews were conducted, recorded and transcribed. Coding of the transcripts was conducted by research team members, discussed for consensus and major themes derived. Results: 45 men and 15 women, the majority college educated, were recruited. Where to receive care, including from whom, was the initial and major decision. Challenges of decisions regarding urinary reconstruction were dominant. Personal characteristics, including age and being active, were considered. Participants with early stage tumors (n = 28) typically perceived only one treatment option and followed the physician’s recommendation. The 18 participants with stage II-III were aware of multiple options. In 14 stage IV participants, balancing quality of life and outcomes between treatments was common to the decision process. Conclusions: For this educated sample with bladder cancer, recruited at a comprehensive cancer center, the major decision was to seek treatment at a location with the highest level of physician expertise. Personal preferences informed decisions surrounding bladder reconstruction. Further research will be conducted in a diverse sample of patients making decisions in a non-urban, community setting.
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Affiliation(s)
- Donna L Berry
- The Phyllis F. Cantor Center, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Manan Nayak
- The Phyllis F. Cantor Center, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Barbara Halpenny
- The Phyllis F. Cantor Center, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Shannon Harrington
- The Phyllis F. Cantor Center, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Kevin R Loughlin
- Division of Urologic Surgery, Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA
| | - Peter Chang
- Division of Urologic Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Jonathan E Rosenberg
- Genitourinary Oncology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Adam S Kibel
- Division of Urologic Surgery, Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA
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21
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Liu C, Ren H, Li J, Li X, Dai Y, Liu L, Ma L, He Q, Li X. Predictors for quality of life of bladder cancer patients with ileal conduit: A cross-sectional survey. Eur J Oncol Nurs 2015; 21:168-73. [PMID: 26452686 DOI: 10.1016/j.ejon.2015.09.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2015] [Revised: 09/19/2015] [Accepted: 09/22/2015] [Indexed: 02/05/2023]
Abstract
PURPOSE To assess quality of life (QOL) and its influencing factors of bladder cancer patients after ileal conduit. METHODS From January 2012 to December 2013, a cross-sectional survey with questionnaires was performed in West China hospital, in which the effect of patient characteristics on their QOL was evaluated, and then the correlation of stomal self-management, social support and QOL of the patients were also explored. RESULTS A total of 188 patients were included. Poor sexual life satisfaction was common among responders. There was a positive correlation between QOL and social support as well as the stomal self-management (all p ≤ 0.002). Additionally, the patients who were female, aged less than 60, participated in work, family income more than 4000¥ per month, a longer postoperative period, and without any stomal complications (all p < 0.05) would have a better QOL. CONCLUSIONS The overall QOL of the patients was good except the satisfaction with sexual life. The better the stomal self-management and social support, the better the QOL. Personalized nursing care and health guidance should be provided to the patients, so as to improve their QOL and promote their health.
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Affiliation(s)
- Changqing Liu
- West China Hospital/West China School of Nursing, Sichuan University, Chengdu, 610041, Sichuan, China.
| | - Hongfei Ren
- Department of Gastroenterology of West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China.
| | - Jiping Li
- West China Hospital/West China School of Nursing, Sichuan University, Chengdu, 610041, Sichuan, China.
| | - Xiaoling Li
- West China Hospital/West China School of Nursing, Sichuan University, Chengdu, 610041, Sichuan, China.
| | - Yan Dai
- Day Surgery Ward of West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China.
| | - Ling Liu
- Department of Urology of West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China.
| | - Li Ma
- Department of Urology of West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China.
| | - Qiying He
- Department of Urology of West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China.
| | - Xiang Li
- Department of Urology of West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China.
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Satkunasivam R, Santomauro M, Chopra S, Plotner E, Cai J, Miranda G, Salibian S, Aron M, Ginsberg D, Daneshmand S, Desai M, Gill IS. Robotic Intracorporeal Orthotopic Neobladder: Urodynamic Outcomes, Urinary Function, and Health-related Quality of Life. Eur Urol 2015; 69:247-53. [PMID: 26164417 DOI: 10.1016/j.eururo.2015.06.041] [Citation(s) in RCA: 64] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Accepted: 06/22/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND Intracorporeal orthotopic neobladder (iONB) creation following robotic radical cystectomy is an emerging procedure and robust functional data are required. OBJECTIVE To evaluate urodynamic features of iONB and bladder cancer-specific and general health-related quality-of-life (HRQOL) outcomes. DESIGN, SETTING, AND PARTICIPANTS We retrospectively assessed 28 men who underwent iONB creation (January 2012 to October 2013) and compared results to a previously characterized cohort of 79 of open ONB procedures. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS iONB pressure-volume properties were characterized using multichannel urodynamics (UDS). The Bladder Cancer Index (BCI) questionnaire, modified with mucus- and pad-related questions, and the Short Form Health Survey (SF-36) were used to evaluate urinary function and HRQOL. ONB cohorts were compared for functional outcomes and BCI score. Multivariable linear regression was used to assess predictors of BCI score. RESULTS AND LIMITATIONS The median follow-up was 9.4 mo for the iONB and 62.1 mo for the open ONB group (p<0.0001); ≥2-yr follow-up had been completed for one (4%) patient in the iONB group compared to 75 (95%) patients in the open ONB group (p<0.0001). In UDS tests, the iONB group had minimal postvoid residual volume, normal compliance, and a mean capacity of 514 cm(3) (range 339-1001). BCI mean scores for urinary function (p=0.58) and urinary bother (p=0.31) were comparable between the groups. The surgical approach was not associated with the BCI score on multivariable analysis. Rates of 24-h pad use were comparable between iONB and open ONB groups (pad-free 17% vs. 19%; ≤2 pads 84% vs. 79%), as reflected by total pad usage (p=0.1); pad size and daytime wetness were worse in the iONB group. The clean intermittent catheterization rate was 10.7% in the iONB and 6.3% in the open ONB group. Limitations include the retrospective comparison, small number of patients and short follow-up for the iONB group. CONCLUSIONS iONB had adequate UDS characteristics and comparable bladder cancer-specific HRQOL scores to open ONB. However, pad size and daytime wetness were worse for iONB, albeit over significantly shorter follow-up. PATIENT SUMMARY We demonstrate that the volumetric and pressure characteristics are acceptable for a neobladder created using an entirely robot-assisted laparoscopic technique after bladder removal for cancer. Urinary function and quality-of-life outcomes related to the robotic technique were compared to those for neobladders created via an open surgical technique. We found that urinary function and bother indices were comparable; however, the robotic group required larger incontinence pads that were wetter during the daytime. This may be explained by the significantly shorter duration of recovery after surgery in the robotic group.
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Affiliation(s)
- Raj Satkunasivam
- USC Institute of Urology and Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Michael Santomauro
- USC Institute of Urology and Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Sameer Chopra
- USC Institute of Urology and Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Elisabeth Plotner
- USC Institute of Urology and Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Jie Cai
- USC Institute of Urology and Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Gus Miranda
- USC Institute of Urology and Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Salpi Salibian
- USC Institute of Urology and Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Monish Aron
- USC Institute of Urology and Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - David Ginsberg
- USC Institute of Urology and Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Siamak Daneshmand
- USC Institute of Urology and Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Mihir Desai
- USC Institute of Urology and Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Inderbir S Gill
- USC Institute of Urology and Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
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[Complications after ileal conduit: Urinary diversion-associated complications after radical cystectomy]. Urologe A 2015; 54:533-41. [PMID: 25895565 DOI: 10.1007/s00120-015-3812-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND We analyzed complications associated with urinary diversion after radical cystectomy (RC) and ileal conduit (IC) for bladder cancer (BCa). PATIENTS AND METHODS A total of 305 BCa patients after RC with IC were included in the study (June 2003-December 2010). IC complications (peristomal hernia, IC stenosis, stenosis of the ureteral anastomosis, IC bleeding, urolithiasis, urinary infections, and renal insufficiency) were identified according to the Clavien-Dindo classification (CDC). Kaplan-Meier plots were generated. Uni- and multivariable Cox regression analyses with backward selection for prediction of high-grade complications (CDC ≥ III) and IC revision surgery were conducted; covariates included age, previous abdominal/pelvic radiation, body mass index (BMI), previous abdominal/pelvic surgery, comorbidities, and advanced tumor stage. RESULTS An IC complication (CDC ≥ I) or a high-grade IC complication (CDC ≥ III) was experienced by 32.7 and 13.4 % of our cohort: 14.8 %, 4.3 %, 4.6 % developed a peristomal hernia, IC stenosis, stenosis of the ureteral anastomosis, respectively. IC revision was required by 10.5 % of patients (median follow-up 19.5 months, IQR 7-47 months). The estimated rate of IC complications at 5 years was 52 % (CDC ≥ I) and 22 % (CDC ≥ III). The final model of the multivariable analysis showed that patients with a history of previous radiation (HR 4.33), a BMI ≥ 30 (HR 2.24), or longer duration of surgery (HR 1.01; all p < 0.05) were at higher risk for IC revision surgery. A BMI ≥ 30 (HR 2.49, p = 0.011) was a risk factor for high-grade complications. CONCLUSION The risk of experiencing a high-grade IC complication is moderate. Previous radiation, obesity, and comorbidities represent risk factors for IC revision surgery. Moreover, obesity is a risk factor for high-grade complications.
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Abstract
Orthotopic neobladder reconstruction is becoming an increasingly common urinary diversion following cystectomy for bladder cancer. This is in recognition of the potential benefits of neobladder surgery over creation of an ileal conduit related to quality of life (QoL), such as avoiding the need to form a stoma with its cosmetic, psychological and other potential complications. The PubMed database was searched using relevant search terms for articles published electronically between January 1994 and April 2014. Full-text articles in English or with English translation were assessed for relevance to the topic before being included in the review. Patients with neobladders have comparable or better post-operative sexual function than those with ileal conduits. They also have comparable QoL to those with ileal conduits. Orthotopic neobladder is a good alternative to ileal conduit in suitable patients who do not want a stoma and are motivated to comply with neobladder training. However, the selection of a neobladder as the urinary diversion of choice requires that patients have good renal and liver functions and are likely to be compliant with neobladder training. With benefits also come potential risks of neobladder formation. These include electrolyte abnormalities and nocturnal incontinence. This short review highlights current aspects of neobladder formation and its potential advantages.
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Affiliation(s)
- Dwayne T S Chang
- Department of Urology, Fremantle Hospital and Health Service, Fremantle, Western Australia
| | - Nathan Lawrentschuk
- Department of Surgery, University of Melbourne, Victoria ; Ludwig Institute for Cancer Research, Austin Hospital, Melbourne, Victoria ; Department of Surgical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia
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Best practices in robot-assisted radical cystectomy and urinary reconstruction: recommendations of the Pasadena Consensus Panel. Eur Urol 2015; 67:363-75. [PMID: 25582930 DOI: 10.1016/j.eururo.2014.12.009] [Citation(s) in RCA: 132] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2014] [Accepted: 12/03/2014] [Indexed: 12/20/2022]
Abstract
CONTEXT Robot-assisted surgery is increasingly used for radical cystectomy (RC) and urinary reconstruction. Sufficient data have accumulated to allow evidence-based consensus on key issues such as perioperative management, comparative effectiveness on surgical complications, and oncologic short- to midterm outcomes. OBJECTIVE A 2-d conference of experts on RC and urinary reconstruction was organized in Pasadena, California, and the City of Hope Cancer Center in Duarte, California, to systematically review existing peer-reviewed literature on robot-assisted RC (RARC), extended lymphadenectomy, and urinary reconstruction. No commercial support was obtained for the conference. EVIDENCE ACQUISITION A systematic review of the literature was performed in agreement with the PRISMA statement. EVIDENCE SYNTHESIS Systematic literature reviews and individual presentations were discussed, and consensus on all key issues was obtained. Most operative, intermediate-term oncologic, functional, and complication outcomes are similar between open RC (ORC) and RARC. RARC consistently results in less blood loss and a reduced need for transfusion during surgery. RARC generally requires longer operative time than ORC, particularly with intracorporeal reconstruction. Robotic assistance provides ergonomic value for surgeons. Surgeon experience and institutional volume strongly predict favorable outcomes for either open or robotic techniques. CONCLUSIONS RARC appears to be similar to ORC in terms of operative, pathologic, intermediate-term oncologic, complication, and most functional outcomes. RARC consistently results in less blood loss and a reduced need for transfusion during surgery. RARC can be more expensive than ORC, although high procedural volume may attenuate this difference. PATIENT SUMMARY Robot-assisted radical cystectomy (RARC) is an alternative to open surgery for patients with bladder cancer who require removal of their bladder and reconstruction of their urinary tract. RARC appears to be similar to open surgery for most important outcomes such as the rate of complications and intermediate-term cancer-specific survival. Although RARC has some ergonomic advantages for surgeons and may result in less blood loss during surgery, it is more time consuming and may be more expensive than open surgery.
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Siracusano S, Niero M, Lonardi C, Cerruto MA, Ciciliato S, Toffoli L, Visalli F, Massidda D, Iafrate M, Artibani W, Bassi P, Imbimbo C, Racioppi M, Talamini R, D'Elia C, Cacciamani G, De Marchi D, Silvestri T, Verze P, Belgrano E. Development of a questionnaire specifically for patients with Ileal Orthotopic Neobladder (IONB). Health Qual Life Outcomes 2014; 12:135. [PMID: 25174344 PMCID: PMC4160549 DOI: 10.1186/s12955-014-0135-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2014] [Accepted: 08/16/2014] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The ileal orthotopic neobladder (IONB) is often used in patients undergoing radical cystectomy. The IONB allows to void avoiding the disadvantages of the external urinary diversion.In IONB patients the quality of life (QoL) appears compromised by the need to urinate voluntarily. The patients need to wake up at night interrupting the sleep-wake rhythm with consequences on social and emotional life.At present the QoL in IONB patients is evaluated by generic questionnaires. These are useful when IONB patients are compared with patients with different urinary diversions but they are less effective when only IONB patients are evaluated. To address this problem a specific questionnaire-the IONB-PRO-was developed. METHODS A) Based on a conceptual framework, narrative-based interviews were conducted on 35 IONB patients. A basic pool of 43 items was produced and organized throughout two clinical and four QoL dimensions. An additional 15 IONB patients were interviewed for face validity testing.B) Psychometric testing was conducted on 145 IONB patients. Both classic test strategy and Rasch analysis were applied. Psychometric properties of the resulting scales were comparatively tested against other QoL-validated scales. RESULTS The IONB-PRO questionnaire includes two sections: one on the QoL and a second section on the capability of the patient to manage the IONB. For evaluation of the QoL, three versions were delivered: 1) a basic 23-item QoL version (3 domains 23-items; alpha 0.86÷ 9.69), 2) a short-form 12-item QoL scale (alpha = 0.947), and 3) a short-form 15-item Rasch QoL scale (alpha = 0.967). Correlations of the long version scales with the corresponding dimensions of the EORTC-QLQ C30 and the EORTC-BLM30 were significant. The short forms exhibited significant correlations with the global health dimension of the EORTC-QLQ and with the urinary subscales of the EORTC-BLM30. The effect size was approximately 1.00 between patients at the 1-year follow-up period and those with 3, 5, and > 5-year follow-up periods for all scales. No relevant differences were observed between the 12-item short-form and the Rasch scale. CONCLUSIONS The IONB-PRO long and short-forms demonstrated a high level of internal consistency and reliability with an excellent discriminanting validity.
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Affiliation(s)
- Salvatore Siracusano
- Department of Urology, Trieste University, Cattinara Hospital Via Strada di Fiume 447, Trieste, 34100, Italy.
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Messer JC, Punnen S, Fitzgerald J, Svatek R, Parekh DJ. Health-related quality of life from a prospective randomised clinical trial of robot-assisted laparoscopic vs open radical cystectomy. BJU Int 2014; 114:896-902. [PMID: 24862633 DOI: 10.1111/bju.12818] [Citation(s) in RCA: 65] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To compare health-related quality-of-life (HRQoL) outcomes for robot-assisted laparoscopic radical cystectomy (RARC) with those of traditional open radical cystectomy (ORC) in a prospective randomised fashion. PATIENTS AND METHODS This was a prospective randomised clinical trial evaluating the HRQoL for ORC vs RARC in consecutive patients from July 2009 to June 2011. We administered the Functional Assessment of Cancer Therapy-Vanderbilt Cystectomy Index questionnaire, validated to assess HRQoL, preoperatively and then at 3, 6, 9 and 12 months postoperatively. Scores for each domain and total scores were compared in terms of deviation from preoperative values for both the RARC and the ORC cohorts. Multivariate linear regression was used to assess the association between the type of radical cystectomy and HRQoL. RESULTS At the time of the study, 47 patients had met the inclusion criteria, with 40 patients being randomised for analysis. The cohorts consisted of 20 patients undergoing ORC and 20 undergoing RARC, who were balanced with respect to baseline demographic and clinical features. Univariate analysis showed a return to baseline scores at 3 months postoperatively in all measured domains with no statistically significant difference among the various domains between the RARC and the ORC cohorts. Multivariate analysis showed no difference in HRQoL between the two approaches in any of the various domains, with the exception of a slightly higher physical well-being score in the RARC group at 6 months. CONCLUSIONS There were no significant differences in the HRQoL outcomes between ORC and RARC, with a return of quality of life scores to baseline scores 3 months after radical cystectomy in both cohorts.
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Affiliation(s)
- Jamie C Messer
- Department of Urology, University of Texas Health Sciences Center at San Antonio, San Antonio, TX, USA
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Aboumarzouk OM, Drewa T, Olejniczak P, Chlosta PL. Laparoscopic radical cystectomy: neobladder or ileal conduit, debate still goes on. Cent European J Urol 2014; 67:9-15. [PMID: 24982773 PMCID: PMC4074712 DOI: 10.5173/ceju.2014.01.art2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2013] [Revised: 09/29/2013] [Accepted: 12/08/2013] [Indexed: 12/02/2022] Open
Abstract
Objective To compare the pre, intra, and post–operative data between ileal conduit and neobladder urinary diversions during laparoscopic radical cystectomy(LRC). Material and methods Between 2006 and 2011, 63 patients who underwent LRC and urinary diversion had their data input prospectively into a database and said data used for the analysis. The outcome comparators were the patient demographics, operative time, conversion rate, blood loss, transfusion rate, morphine analgesic requirement, length of hospital stay, complication rates, follow up, and quality of life assessments. A Mantel–Haenszel test was used for dichotomous data and an inverse variance method was used for continuous data. P values less than 0.5 were considered significant Results Thirty–nine patients (60 ±7.11 years) had ileal conduits and 24 patients (57 ±8.68 years) had neobladder urinary diversion. No difference was found (P >0.05) regarding age, BMI, smoking history, TURBT pathology result, blood loss, blood transfusion requirement, conversion rates, length of hospital stay, morphine requirement, complications, or follow–up and quality of life. The neobladder groups did have more previous abdominal operations and had significantly longer operative time. Conclusions We found no difference between either types of diversion in all comparative aspects except that the neobladder had longer operative times. This is the first comparative study between ileal conduit and neobladder urinary diversion after laparoscopic radical cystectomy and can pose as a bench mark for future comparisons.
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Affiliation(s)
- Omar M Aboumarzouk
- Islamic University of Gaza, College of Medicine, Gaza, Palestine ; Department of Urology, University Hospital of Wales, Heath Park, United Kingdom ; Department of Urology, Collegium Medicum Jagiellonian University, Cracow, Poland
| | - Tomasz Drewa
- Department of Tissue Engineering, Medical College, Nicolaus Copernicus University, Toruń, Poland ; Department of Urology, Nicolaus Copernicus University, Toruń, Poland
| | | | - Piotr L Chlosta
- Department of Urology, Collegium Medicum Jagiellonian University, Cracow, Poland
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EAU guidelines on muscle-invasive and metastatic bladder cancer: summary of the 2013 guidelines. Eur Urol 2013; 65:778-92. [PMID: 24373477 DOI: 10.1016/j.eururo.2013.11.046] [Citation(s) in RCA: 739] [Impact Index Per Article: 67.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2013] [Accepted: 11/29/2013] [Indexed: 01/08/2023]
Abstract
CONTEXT The European Association of Urology (EAU) guidelines panel on Muscle-invasive and Metastatic bladder cancer (BCa) updates its guidelines yearly. This updated summary provides a synthesis of the 2013 guidelines document, with emphasis on the latest developments. OBJECTIVE To provide graded recommendations on the diagnosis and treatment of patients with muscle-invasive BCa (MIBC), linked to a level of evidence. EVIDENCE ACQUISITION For each section of the guidelines, comprehensive literature searches covering the past 10 yr in several databases were conducted, scanned, reviewed, and discussed both within the panel and with external experts. The final results are reflected in the recommendations provided. EVIDENCE SYNTHESIS Smoking and work-related carcinogens remain the most important risk factors for BCa. Computed tomography (CT) and magnetic resonance imaging can be used for staging, although CT is preferred for pulmonary evaluation. Open radical cystectomy with an extended lymph node dissection (LND) remains the treatment of choice for treatment failures in non-MIBC and T2-T4aN0M0 BCa. For well-informed, well-selected, and compliant patients, however, multimodality treatment could be offered as an alternative, especially if cystectomy is not an option. Comorbidity, not age, should be used when deciding on radical cystectomy. Patients should be encouraged to actively participate in the decision-making process, and a continent urinary diversion should be offered to all patients unless there are specific contraindications. For fit patients, cisplatinum-based neoadjuvant chemotherapy should always be discussed, since it improves overall survival. For patients with metastatic disease, cisplatin-containing combination chemotherapy is recommended. For unfit patients, carboplatin combination chemotherapy or single agents can be used. CONCLUSIONS This 2013 EAU Muscle-invasive and Metastatic BCa guidelines updated summary aims to increase the quality of care and outcome for patients with muscle-invasive or metastatic BCa. PATIENT SUMMARY In this paper we update the EAU guidelines on Muscle-invasive and Metastatic bladder cancer. We recommend that chemotherapy be administered before radical treatment and that bladder removal be the standard of care for disease confined to the bladder.
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Orthotopic bladder substitution (neobladder): part I: indications, patient selection, preoperative education, and counseling. J Wound Ostomy Continence Nurs 2013; 40:73-82. [PMID: 23222970 DOI: 10.1097/won.0b013e31827759ea] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Bladder substitution following radical cystectomy for urothelial cancer (transitional cell carcinoma) has become increasingly common and in many centers has evolved to become the standard method of urinary diversion. In determining the best type of urinary diversion for a specific patient, consideration must be given to both the morbidity associated with surgery and the potential positive impact on the patient's quality of life. Decision-making and perioperative care is ideally multidisciplinary, involving physicians and nurse specialists in urology, continence, and ostomy therapy. Physiotherapists may also be involved for pelvic floor muscle retraining. This article highlights preoperative considerations for patients undergoing radical cystectomy with a focus on issues specific to orthotopic bladder substitution as the method of urinary diversion. The second article in this 2-part series will outline postoperative strategies to manage these patients.
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Singh V, Yadav R, Sinha RJ, Gupta DK. Prospective comparison of quality-of-life outcomes between ileal conduit urinary diversion and orthotopic neobladder reconstruction after radical cystectomy: a statistical model. BJU Int 2013; 113:726-32. [DOI: 10.1111/bju.12440] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Vishwajeet Singh
- Department of Urology; King George Medical University; Lucknow Uttar Pradesh India
| | - Rahul Yadav
- Department of Urology; King George Medical University; Lucknow Uttar Pradesh India
| | - Rahul Janak Sinha
- Department of Urology; King George Medical University; Lucknow Uttar Pradesh India
| | - Dheeraj Kumar Gupta
- Department of Urology; King George Medical University; Lucknow Uttar Pradesh India
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Hounsome LS, Abel GA, Verne J, Neal DE, Lyratzopoulos G. Predictors of the use of orthotopic bladder reconstruction after radical cystectomy for bladder cancer: data from a pilot study of 1756 cases 2004-2011. BJU Int 2013; 111:1061-7. [PMID: 23388085 DOI: 10.1111/j.1464-410x.2012.11644.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
| | - Gary A. Abel
- Cambridge Centre for Health Services Research; Department of Public Health and Primary Care; University of Cambridge; UK
| | - Julia Verne
- South West Public Health Observatory; Bristol UK
| | - David E. Neal
- Cancer Research UK Cambridge Research Institute; Department of Uro-oncology; Addenbrooke's Hospital; Cambridge UK
| | - Georgios Lyratzopoulos
- Cambridge Centre for Health Services Research; Department of Public Health and Primary Care; University of Cambridge; UK
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Miyake H, Furukawa J, Muramaki M, Inoue T, Fujisawa M. Health related quality of life after radical cystectomy: Comparative study between orthotopic sigmoid versus ileal neobladders. Eur J Surg Oncol 2012; 38:1089-94. [DOI: 10.1016/j.ejso.2012.07.117] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2012] [Revised: 06/13/2012] [Accepted: 07/19/2012] [Indexed: 11/16/2022] Open
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Erber B, Schrader M, Miller K, Schostak M, Baumunk D, Lingnau A, Schrader AJ, Jentzmik F. Morbidity and Quality of Life in Bladder Cancer Patients following Cystectomy and Urinary Diversion: A Single-Institution Comparison of Ileal Conduit versus Orthotopic Neobladder. ISRN UROLOGY 2012; 2012:342796. [PMID: 22523713 PMCID: PMC3302022 DOI: 10.5402/2012/342796] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/04/2011] [Accepted: 11/29/2011] [Indexed: 12/03/2022]
Abstract
Objective. To evaluate and compare noncontinent and continent urinary diversion after radical cystectomy in patients with bladder cancer. Methods. A total of 301 patients submitted to radical cystectomy at the Charité-University Hospital Berlin from 1993 to 2007 including 146 with an ileal conduit and 115 with an ileal neobladder. Clinical and pathological data as well as oncological outcome were retrospectively analyzed and compared. Quality of life was analyzed using the EORTC QLQ-C30 and BLM30 questionnaires. Results. 69.1% and 69.6% of all patients who received an ileal conduit and ileal neobladder, respectively, developed early complications. The two groups differed significantly concerning the occurrence of postoperative ileus (P = 0.02) favoring patients who received an ileal conduit but not with regard to any other early-onset complication evaluated. Patients with ileal neobladder had a significantly better global health status and quality of life (P = 0.02), better physical functioning (P = 0.02), but also a higher rate of diarrhoea (P = 0.004). Conclusion. Cystectomy with any type of diversion remains a complication-prone surgery. Even if the patient groups are not homogeneous in all respects, there are many arguments in favor of the ileal neobladder as the urinary diversion of choice.
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Affiliation(s)
- Barbara Erber
- Department of Urology, Charité-University Medicine Berlin, 10117 Berlin, Germany
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Miyake H, Furukawa J, Sakai I, Muramaki M, Yamashita M, Inoue TA, Fujisawa M. Orthotopic sigmoid vs. ileal neobladders in Japanese patients: a comparative assessment of complications, functional outcomes, and quality of life. Urol Oncol 2011; 31:1155-60. [PMID: 22153716 DOI: 10.1016/j.urolonc.2011.11.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2011] [Revised: 11/02/2011] [Accepted: 11/03/2011] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To compare the clinical outcomes of sigmoid and ileal neobladders (NBs) created following radical cystectomy. MATERIALS AND METHODS This study included 90 and 144 Japanese patients undergoing radical cystectomy and orthotopic NB reconstruction with a sigmoid and ileal segment, respectively. Postoperative clinical outcomes between the sigmoid and ileal NB groups (SNBG and INBG) were compared. RESULTS In this series, 110 early and 51 late complications occurred in 71 and 41 patients, respectively; however, there was no significant difference in the incidence of complications between SNBG and INBG. At 1 year postoperatively, there were no significant differences in the proportion of spontaneous voiders and the continence status between these 2 groups; however, despite the lack of significant differences in the maximal flow rate and voided volume, the post-void residual in SNBG was significantly smaller than that in INBG. Voiding functional outcomes at 5 years postoperatively were also obtained from 28 and 49 in SNBG and INBG, respectively. Although there were no significant changes in the functional outcomes in SNBG, the proportion of spontaneous voiders and post-void residual in INBG at 5 years postoperatively were significantly poorer than those at 1 year postoperatively. Furthermore, the postoperative health-related quality of life assessed by a Short-Form 36 survey did not show any significant differences in all 8 scores between these 2 groups. CONCLUSIONS Both types of NB reconstruction resulted in comparatively satisfactory outcomes; however, the voiding function, particularly that on long-term follow-up, in SNBG appeared to be more favorable than that in INBG.
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Affiliation(s)
- Hideaki Miyake
- Division of Urology, Kobe University Graduate School of Medicine, Kobe, Japan.
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Lotan Y, Amiel G, Boorjian SA, Clark PE, Droller M, Gingrich JR, Guzzo TJ, Inman BA, Kamat AM, Karsh L, Nielsen ME, Smith ND, Shariat SF, Svatek RS, Taylor JM. Comprehensive handbook for developing a bladder cancer cystectomy database. Urol Oncol 2011; 31:812-26. [PMID: 22056403 DOI: 10.1016/j.urolonc.2011.09.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2011] [Revised: 09/11/2011] [Accepted: 09/14/2011] [Indexed: 12/01/2022]
Abstract
OBJECTIVE In an effort to standardize data collection for research regarding bladder cancer, the Bladder Cancer Working Group sought to provide a handbook that can be used as a guide for prospective or retrospective data collection. METHODS Expert opinions for various data groups were compiled through a team of researchers at the BCAN. Peer review of each data group was performed from within the group. RESULTS Essential and comprehensive data elements are provided for 9 groups of data elements, including demographics, comorbidities, staging, laboratory data, operative details, pathology, complications, outcomes, and quality of life measurements. CONCLUSIONS Establishment of a comprehensive bladder cancer database is important in initiating multicenter collaborations. While not every data point is critical, this review may be useful in serving as a reference in initiating projects and providing a framework for collaborations.
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Affiliation(s)
- Yair Lotan
- The University of Texas Southwestern Medical Center, Dallas, TX 75390, USA.
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Modified technique for the creation of an orthotopic neobladder in patients with shortened mesentery: making up the difference between the bladder and the urethral stump. Urology 2011; 78:1430-4. [PMID: 21996104 DOI: 10.1016/j.urology.2011.07.1404] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2011] [Revised: 07/20/2011] [Accepted: 07/22/2011] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To describe an ileal neobladder reconstruction technique performed in 5 men who had previous abdominal surgeries and presented with a short mesoileum at the time of bladder replacement. METHODS The patients were 5 men scheduled for a radical cystoprostatectomy with bladder substitution and had a short mesoileum at the time of the surgery. All patients had a history of abdominal surgery. A neobladder was constructed in a "J" shape leaving the most proximal part of the ileum (8-10 cm) tubularized. We created a 3- to 4-cm flap from the surface of the most distal region of the reservoir. This flap was tubularized to lengthen the neobladder onto the urethral stump, resulting in a tension-free anastomosis. All patients underwent a complete clinical laboratory evaluation 12 months after the surgery. RESULTS At 1 year after surgery, all patients were able to void spontaneously. Day and night time continence were 80% and 60%, respectively. Urodynamic evaluation revealed a neobladder with good capacity (mean = 521 ml) and compliance (mean = 27.2 mL/cm H(2)O). Only 1 patient demonstrated a moderate hydronephrosis of the right kidney. CONCLUSION Candidates for orthotopic neobladders who have had previous abdominal surgeries and who have a short mesoileum at the time of the surgery are uncommon. Despite the small number of cases, our technique is noteworthy for having achieved good functional results during the short-term follow-up. This technique is advantageous because it is easy to perform and does not require any other bowel resection or anastomose.
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Park J, Ahn H. Radical cystectomy and orthotopic bladder substitution using ileum. Korean J Urol 2011; 52:233-40. [PMID: 21556208 PMCID: PMC3085614 DOI: 10.4111/kju.2011.52.4.233] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2011] [Accepted: 03/10/2011] [Indexed: 12/24/2022] Open
Abstract
Over the past decade, continent urinary diversion, especially orthotopic bladder substitutions, has become increasingly popular following radical cystectomy for bladder cancer. The ultimate goal of orthotopic bladder substitution is to offer patients the best quality of life, similar to that of patients with native bladders. To achieve that purpose, surgeons should be familiar with the characteristics of good candidates for neobladders, the possible intraoperative and postoperative problems related to the surgery, and the solutions to these problems. Postoperative surveillance and instructions given to the patients also contribute to successful, functional results. Here, we reviewed the indications, pitfalls, and solutions for orthotopic bladder substitutions and the patients' quality of life after surgery. When performed properly, orthotopic continent diversion offers good quality of life with few long-term complications. Therefore, we believe it is the best option for the majority of patients requiring cystectomy.
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Affiliation(s)
- Jinsung Park
- Department of Urology, Eulji University Hospital, Daejeon, Korea
| | - Hanjong Ahn
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Vakalopoulos I, Dimitriadis G, Anastasiadis A, Gkotsos G, Radopoulos D. Does intubated uretero-ureterocutaneostomy provide better health-related quality of life than orthotopic neobladder in patients after radical cystectomy for invasive bladder cancer? Int Urol Nephrol 2011; 43:743-8. [PMID: 21336959 DOI: 10.1007/s11255-011-9904-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2010] [Accepted: 01/24/2011] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Ileal orthotopic neobladder (ONB) has not proved to provide better health-related quality of life (HRQoL) than other urinary diversion techniques after radical cystectomy. The aim of the study is to compare HRQoL assessed by four questionnaires between ONB and uretero-ureterocutaneostomy (UUC). METHODS Thirty-nine patients (35 men and 4 women) aged 66.95 ± 8.18 years old underwent radical cystectomy due to invasive bladder cancer and urinary diversion. Patients randomized to ileal ONB and UUC groups, except if certain limitations did not allow performing an ONB. Patients were interviewed face-to-face 7-84 months (median 17) after the operation and completed the Functional Assessment of Cancer Therapy Scale-General (FACT-G), the FACT Vanderbilt Cancer Index (FACT-VCI), the Beck Depression Index (BDI), and the generic RAND 36-item Health Survey Short Form (SF)-36 questionnaire, to asses HRQoL. RESULTS Comparing the two groups there were no statistically significant differences for the scores of FACT-G, FACT-VCI, and BDI. For VCI score there was a borderline nonsignificant difference (P = 0.051). No statistically significant differences were noticed also from the comparison of SF-36 subgroups for the two groups except SF. Role emotional subgroup on behalf of UUC (P = 0.022). CONCLUSIONS Patients with UUC surprisingly presented at least equal quality of life than the presumably less debilitating and more recent ONB. This could be explained due to lower complication rate and to lower expectations of the UUC group. UUC is a considerable option for urinary diversion after radical cystectomy in the era of HRQoL for selected patients.
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Affiliation(s)
- Ioannis Vakalopoulos
- A' Urologic Department of Aristotelian University of Thessaloniki in G. Gennimatas General Hospital of Thessaloniki, 81A Egnatia Str, 54635 Thessaloniki, Greece.
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Shimko MS, Tollefson MK, Umbreit EC, Farmer SA, Blute ML, Frank I. Long-Term Complications of Conduit Urinary Diversion. J Urol 2011; 185:562-7. [DOI: 10.1016/j.juro.2010.09.096] [Citation(s) in RCA: 119] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2010] [Indexed: 10/18/2022]
Affiliation(s)
- Mark S. Shimko
- Department of Urology, Mayo Medical School and Mayo Clinic, Rochester, Minnesota
| | - Matthew K. Tollefson
- Department of Urology, Mayo Medical School and Mayo Clinic, Rochester, Minnesota
| | - Eric C. Umbreit
- Department of Urology, Mayo Medical School and Mayo Clinic, Rochester, Minnesota
| | - Sara A. Farmer
- Health Sciences Research, Mayo Medical School and Mayo Clinic, Rochester, Minnesota
| | - Michael L. Blute
- Department of Urology, Mayo Medical School and Mayo Clinic, Rochester, Minnesota
| | - Igor Frank
- Department of Urology, Mayo Medical School and Mayo Clinic, Rochester, Minnesota
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Ileal Conduit and Continent Ileocecal Pouch for Patients Undergoing Pelvic Exenteration: Comparison of Complications and Quality of Life. Int J Gynecol Cancer 2011; 21:403-8. [DOI: 10.1097/igc.0b013e31820aab17] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Objectives:Creating a continent urinary pouch has become an alternative to the ileal conduit for patients undergoing exenteration for advanced gynecologic malignancies. The objective of this study was to compare clinical outcomes for the 2 methods.Methods:In this retrospective study, we compared intraoperative and postoperative complications and quality-of-life scores for the modified ileocecal pouch and the ileal conduit in anterior or total pelvic exenteration.Results:In 33 of 100 patients, an ileal pouch (IP) was created; the other 67 were treated by an ileal conduit (IC). Creating an IP prolonged the exenterative procedure by 97 minutes compared to an IC (IC, 453 minutes vs IP, 550 minutes;P= 0.009). Overall complication rates were similar, but patients with an IP had significantly more complications of urinary diversion (48%) than patients with an IC (31%;P= 0.03). Follow-up showed urinary loss and frequency of micturition to be comparable, but in patients with an IP, surgery for stomal complications (n = 2) and treatment of bladderstones were necessary more frequently (n = 3). Quality of life according to the 12-item Short Form Health Survey questionnaire was similar in both groups.Conclusion:A continent IP is an alternative to the IC in cases of pelvic exenteration. Early complications are more frequent with an IP than with an IC. The mode of urinary diversion has little influence on the quality of life in patients with advanced genital cancer.
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Wibmer AG, Kroesen AJ, Gröne J, Slavova N, Weinhold A, Buhr HJ, Ritz JP. Predictors of permanent ileostomy after restorative proctocolectomy. Br J Surg 2010; 97:1561-6. [PMID: 20632324 DOI: 10.1002/bjs.7135] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Proctocolectomy with ileal pouch-anal anastomosis (IPAA) is a surgical approach for ulcerative colitis and familial adenomatous polyposis. This study evaluated predictors of the need for a permanent ileostomy to identify patients at high risk of IPAA failure. METHODS This was a retrospective analysis of patients who underwent proctocolectomy and IPAA between 1997 and 2008. A logistic regression model was used for multivariable analysis of potential risk factors. RESULTS Proctocolectomy was combined with IPAA in 185 patients, of whom 169 had a loop ileostomy formed. IPAA and ileostomy closure were successful in 162 patients (87.6 per cent). Reasons for not closing the ileostomy included pouch failure (16 patients), patient choice (5) and death (2). Thus one in eight patients had a permanent ileostomy after planned IPAA. Age was the major predictor of the need for a permanent ileostomy in multivariable analysis (P = 0.002) with a probability of more than 25 per cent in patients aged over 60 years. However, advancing age was associated with colitis, co-morbidity, obesity and corticosteroid use. CONCLUSION The probability of the need for a permanent ileostomy after IPAA increases with age.
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Affiliation(s)
- A G Wibmer
- Department of General, Visceral, Vascular and Thoracic Surgery, Charité, Campus Benjamin Franklin, Berlin, Germany
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Kassouf W, Hautmann RE, Bochner BH, Lerner SP, Colombo R, Zlotta A, Studer UE. A Critical Analysis of Orthotopic Bladder Substitutes in Adult Patients with Bladder Cancer: Is There a Perfect Solution? Eur Urol 2010; 58:374-83. [DOI: 10.1016/j.eururo.2010.05.023] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2010] [Accepted: 05/12/2010] [Indexed: 10/19/2022]
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Current world literature. Curr Opin Urol 2010; 20:443-51. [PMID: 20679773 DOI: 10.1097/mou.0b013e32833dde0d] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Mottet N, Lebret T, Patard JJ, Pfister C, Rigaud J, Salomon L, Soulié M. La chirurgie des cancers des patients âgés présente-t-elle des particularités ? Prog Urol 2009; 19 Suppl 3:S93-5. [DOI: 10.1016/s1166-7087(09)73351-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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The use of a Meckel's diverticulum in the creation of an orthotopic neobladder in case of a short mesoileum: a case report. Adv Urol 2009:493236. [PMID: 19859565 PMCID: PMC2764375 DOI: 10.1155/2009/493236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2009] [Accepted: 08/25/2009] [Indexed: 11/17/2022] Open
Abstract
A 72-year-old patient was treated in our department for an invasive bladder TCC by cystoprostatectomy with the intention to create an orthotopic neobladder. During surgery it appeared to be impossible to mobilize part of the preterminal ileum into the small pelvis to make an anastomosis with the urethral stump. However, incidentally, a Meckel's diverticulum of about 8 cm was found on the preterminal ileum which could easily be mobilized onto the urethral stump. The intestinal insertion of the diverticulum served as the lowest point of the pouch. Above the diverticulum, we created a modified Studer-pouch. No major postoperative complications occurred and during the follow-up period of more than 12 months micturition was good.
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