Quality of life outcomes after radical cystectomy: long-term standardized assessment of Studer Pouch versus I-Pouch.

Abstract

To investigate whether the ileal length used for the formation of two different orthotopic bladder substitutes [Studer (S)-Pouch vs. I-Pouch; 60 vs. 40 cm] impacts quality of life (QoL). In this cross-sectional study, a total of 56 patients underwent radical cystectomy with ileal neobladder for bladder cancer [S-Pouch: 23 pat, 19 men, 4 women); I-Pouch: 33 pat (26 men, 7 women)]. They completed general (SF-36), cancer-specific (QLQ-C30) and bladder cancer-specific questionnaires (QLQ-BLM30) as well as a novel neobladder-specific questionnaire (TNQ). The questionnaire-based follow-up was 66 months (IQR 41-104; total range 9-161). I-Pouch patients reported better SF-36 physical health status (p = 0.026), QLQ-BLM30 continence scores (p < 0.001) and a more favorable QLQ-C30 total score compared to S-Pouch patients (p = 0.044). S-Pouch patients reported better QLQ-BLM30 general health status (p = 0.001). For the TNQ, no significant difference was found between both groups (p = 0.09). S-Pouch patients reported use of condom urinals more frequently (p = 0.026). S-Pouch patients tended to be on vitamin B12 substitution (p = 0.06). I-Pouch patients reported significantly higher micturition volumes (≥300 ml) compared to S-Pouch patients (30/33 vs. 16/23; p = 0.040). No differences were found with regard to bicarbonate supplementation and recurrent urinary tract infections. Non-neobladder-specific questionnaires show controversial results for QoL outcomes of patients with Studer and I-Pouch. The TNQ suggests that none of these two types of neobladder is superior to the other in terms of QoL. Hence, general questionnaires are not valid enough to adequately address QoL aspects in patients with different neobladders. Development and validation of neobladder-specific questionnaires are needed.