Objectives: To determine whether health and body image are important determinants of quality of life (QoL) for patients undergoing urinary diversion (UD). Patients with advanced bladder cancer who undergo cystectomy and UD face potential serious morbidity (25%-40%) and a small risk of mortality (0%-4%). The systematic review compares QoL and body image for different types of diversions.
Methods: One researcher trained in using schedule for evaluation of individual quality of life-direct weighting interviewed 32 consecutive patients undergoing radical cystectomy. The European Organization for Research and Treatment of Cancer QLQ-C30 and the Satisfaction With Life Scale questionnaire were also administered before cystectomy and 9-12 months postcystectomy. All QoL studies reporting on radical cystectomy and UD were reviewed between 1996 and March 2008.
Results: Family, relationships, health, and finance were the most important determinants of QoL, whereas body image was not mentioned by anyone. On using European Organization for Research and Treatment of Cancer QLQ-C30 and Satisfaction With Life Scale, it was found that there was no difference in QoL of patients pre- and postcystectomy. In our review of published data, 40 studies were identified reporting on 3645 patients. Only 2 studies reported a better QoL in favor of neobladders, whereas 2 other studies suggest a better body image perception in patients with neobladder.
Conclusions: This prospective cohort study suggests that health and body image may not always be important to patients for their QoL. Our systematic review suggests an overall good QoL in most studies irrespective of the type of UD, with no significant differences among the different diversion types.