Orthotopic neobladder versus ileal conduit urinary diversion after cystectomy--a quality-of-life based comparison

Ann R Coll Surg Engl. 2009 Oct;91(7):565-9. doi: 10.1308/003588409X432293. Epub 2009 Jun 25.


Introduction: Radical cystectomy remains the gold standard in treatment of muscle invasive bladder cancer. Evolution of pathological guidelines has empowered centres to offer orthotopic substitution (OBS) to patients undergoing radical cystectomy. We compared health-related quality of life (HRQoL) between patients who underwent OBS or ileal conduit urinary diversion (ICD) following radical cystectomy.

Patients and methods: A total of 57 patients who underwent cystectomy were assessed pre-operatively using Karnofsky performance scale (KPS). Of these, 52 patients (28 OBS and 24 ICD) who responded to a postal questionnaire consisting of SF-36 and a functional index questionnaire were included.

Results: Median age of patients was 70 years. Pre-operative KPS scores were similar. All eight HRQoL scales were favourable in both groups. OBS patients had significantly better physical functioning. In the cohort, 42% of men with OBS and 25% of diversions could maintain an erection to varying degrees. Of the OBS patients, 85% were continent with two patients reporting reduced QoL with pad usage. Of ICD patients, 63% felt less complete and 42% were embarrassed due to the stoma, with 58% apprehensive of stomal leakage. Of OBS patients, 96% had significant relationships and a more active life-style.

Conclusions: In a similar age-group population, there was no significant difference in most QoL indices but body image issues persist in ICD patients. OBS patients had significantly better physical function, continuing to have a more active lifestyle. They attained urethral voiding with good continence. A detailed discussion of long-term functional outcome would engender a realistic expectation allowing better adaptation.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Cohort Studies
  • Cystectomy / methods
  • Cystectomy / psychology*
  • Female
  • Humans
  • Ileum / surgery
  • Karnofsky Performance Status
  • Male
  • Middle Aged
  • Outcome Assessment, Health Care
  • Quality of Life*
  • Surveys and Questionnaires
  • Urinary Bladder Neoplasms / psychology
  • Urinary Bladder Neoplasms / surgery*
  • Urinary Diversion / methods*
  • Urinary Diversion / psychology
  • Urinary Diversion / standards
  • Urinary Reservoirs, Continent / standards*