1424 QUALITY OF LIFE ANALYSIS IN PATIENTS FOLLOWING RADICAL CYSTECTOMY AND ORTHOTOPIC URINARY DIVERSION: A SINGLE-INSTITUTION COMPARISON OF STUDER- AND I-POUCH NEOBLADDER

Abstract

INTRODUCTION AND OBJECTIVES: The aim of this study was to evaluate health-related QoL differences in patients with different ileal neobladder substitutes of 40cm (I-Pouch) and 60cm (StuderPouch, S-Pouch) length. METHODS: Of a total of 171 ileal neobladder procedures (I-pouch: 91 pat., S-pouch: 80 patients) performed in a tertiary academic center between 2002 and 2011 we evaluated QoL aspects in 61 patients (51 men, 12 women) who underwent radical cystectomy for bladder cancer. Thirty-three patients (26 men, 7 women) underwent an I-pouch and 28 (19 men, 9 women) an S-pouch procedure. The following questionnaires were used: the EORTC QLQ-C30, QLQBLM30 and the GIQLI (evaluating changes bowel habits). Additionally, we assessed the rate of vitamin B12 supplementation, bicarbonate substitution and recurrent urinary tract infections. Median follow-up was 66 months (IQR: 41-104; total range: 9-161. RESULTS: Median age at surgery was 68 (IQR: 43-84) in the I-Pouch and 66 years (IQR: 39-74) in the S-Pouch group (p 0.47). Patients with an I-pouch reported similar QLQ-C30 overall health status (median: 6, IQR: 4-6) compared to patients with an S-pouch (median: 5; IQR: 4-6; p 0.24). Patients with I-Pouch reported better QLQ-C30 QoL status (median: 6, IQR: 5-6) compared to patients with an S-Pouch (median 5, IQR: 4-6; p 0.037). Patients with an S-pouch reported better QLQ-BLM30 general health status (median 19, IQR: 11-26) compared to patients with an I-pouch (median: 29, IQR: 26-34; p 0.001). The median GIQLI score was 0.5 in patients with an I-pouch (IQR: 0-3) and 2 (IQR: 0.75-5) in patients with an S-pouch (p 0.11). Median number of recurrent UTIs was 0 (IQR: 0-2) in patients with an I-Pouch and 1 (IQR: 0-4) in patients with an S-pouch (p 0.036). Patients with an S-pouch tended to be on vitamin B12 substitution compared to I-pouch patients (p 0.07). No significant difference was noted with regard to the rate of bicarbonate substitution between both groups (p 0.57). CONCLUSIONS: In this long-term study, patients with an Ipouch experienced a lower rate of recurrent UTIs and tended to be at lower risk of vitamin B12 supplementation. These findings may be attributable to the reduced length of ileum used for the formation of the pouch. The heterogeneity of findings suggests that questionnaires, as the QLQ-C30 and -BLM30 are not valid enough to adequately address QoL aspects in patients with ileal neobladders. These data hint at the necessity to develop neobladder-specific questionnaires to adequately address QoL issues in different ileal neobladders.