Abstract
Purpose: Health-related quality of life after urinary diversion has been increasingly recognized as an important outcome measure. However, few studies have directly compared patients with an ileal conduit with those with a continent orthotopic neobladder, and even fewer have used validated quality of life instruments. Therefore, we compared health-related quality of life in patients who underwent neobladder versus ileal conduit creation using validated questionnaires. Materials and Methods: We mailed two validated questionnaires that are measures of health-related quality of life, namely the RAND 36-Item Health Survey (SF-36) and Functional Assessment of Cancer Therapy-General (FACT-G), to patients who underwent radical cystectomy for urothelial carcinoma between January 1995 and December 1999. Statistical analysis was performed, including univariate and multivariate analysis. Results: A total of 112 patients were available for assessment. A total of 72 (64%) questionnaires were returned, including 23 (32%) and 49 (68%) from patients with an ileal conduit and neobladder, respectively. On the SF-36 questionnaire, there were significant univariable relationships between treatment and age ( P <0.001 and 0.01, respectively). Younger patients and those with a neobladder had higher health related quality of life scores, including significant differences in five of the nine SF-36 domains (general health, physical functioning, physical health, social functioning, and energy/fatigue). There was no relationship between health-related quality of life and the final pathological stage ( P = 0.25). On multivariate analysis adjusting for age led to a suggestive but nonsignificant difference in health related quality of life scores favoring neobladders ( P = 0.09). On the FACT-G, there were no significant differences in health related quality of life due to treatment ( P = 0.28), pathological stage ( P = 0.5), age ( P = 0.72), or current disease status ( P = 0.27). On the FACT-G 2 of the 4 domains (emotional and functional well-being) were significantly in favor of neobladders. Overall satisfaction was high in the two groups with 96% and 85% of patients with a neobladder and ileal conduit, respectively, reporting that they would make the same choice of diversion. Conclusions: Based on validated health-related quality of life instruments, these findings suggest that patients with an orthotopic neobladder have marginal quality of life advantages over those with an ileal conduit. However, differences in health-related quality of life in the two types of urinary diversion are confounded by age because patients who underwent orthotopic diversion were younger and as a result of age would be expected to have a higher health-related quality of life score. A prospective longitudinal study of health-related quality of life after adjusting for differences in age among patients undergoing urinary diversion is currently underway to extend further these observations.
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