Bladder Cancer Index Research Articles

Prospective comparative study of quality of life in patients with bladder cancer undergoing cystectomy with ileal conduit or bladder preservation

ObjectiveTo compare health-related quality of life (HRQOL) in patients undergoing radical cystectomy with ileal conduit (RC) or bladder preservation (BP) with (chemo)radiotherapy for bladder cancer.Methods and analysisPatients with bladder cancer,...

Continent cutaneous diversion: Unveiling the interplay of neuro-urology and oncological challenges

ObjectivesThe objective of our study is to demonstrate the practical application of continent cutaneous urinary diversion (CCUD) in oncological patients, with a focus on various aspects of the procedure: surgical challenges, functional outcomes, and quality of life. Materials and methodsWe studied the perioperative and follow-up data of patients who underwent cystectomy for cancer associated with CCUD (Mitrofanoff, Monti or Casale). We retrospectively analyzed complications within 30days and beyond 30days post-surgery. We evaluated oncological outcomes. Patients’ quality of life was assessed using the Bladder Cancer Index (BCI) questionnaire. Results are given on an intention-to-treat basis. ResultsA total of 24 patients were included in the study (July 2001 and May 2022), with a median follow-up of 62.5months. We report three deaths due to neoplasic recurrence. Forty-six percent had an early postoperative complication, two of whom required revision surgery. Overall, the medium-term complication rate was 70% and the reoperation rate was 62%. There were 8 stomal cutaneous stenoses (33%) and 3 uretero-ileal stenoses (12.5%). Overall satisfaction was rated at 9.2/10 on average, and body image was unaltered or slightly altered in 62.5% of patients. Of the patients who responded to the BCI, 75% had complete continence. DiscussionThe experience gained with continent stomas in neuro-urology has allowed, in carefully selected cases, to offer patients an alternative that can improve their quality of life in a context already burdened by the shadow of cancer. CCUD can be proposed as an alternative to Bricker diversion in cases of urethral invasion or a high risk of neobladder incontinence, in selected patients. Level of evidence4.

Robot-assisted radical cystectomy with neobladder diversion in females: Safety profile and functional outcomes

ObjectiveRadical cystectomy (RC) is a standard treatment for localized muscle invasive bladder cancer and high-risk or very high-risk non-muscle invasive bladder cancer not responding to adequate endovesical therapy. In women, traditionally RC is performed with hystero-adnexectomy and resection of the anterior vaginal wall, often resulting in sexual disorders. Vaginal-sparing techniques have been developed to improve functional outcomes. The present study explores the safety and the functional outcome of vaginal-sparing techniques. MethodsWe retrospectively analyzed all consecutive female patients undergoing robot-assisted RC (RARC) with neobladder diversion between October 2017 and February 2022. The indications for vaginal-sparing RC were absence of tumor on bladder neck or urethra and no sign of infiltration of posterior bladder wall at the preoperative MRI. Functional results were evaluated with the aid of five questions out of the Bladder Cancer Index questionnaire. Complications were reported according to Clavien–Dindo classification and cancer control was evaluated by recurrence-free and cancer specific survival. ResultsA total of 22 female patients underwent RARC with neobladder diversion. Neoadjuvant chemotherapy was given in 17 (77%) cases. Clavien–Dindo grades III–IV complications occurred in four (18%) cases. After a mean follow-up of 29 (interquartile range 16–44) months, six (27%) patients developed distant metastases, and one (5%) woman loco-regional relapse. Sexual-sparing surgery was performed in 19 (86%) patients, and in the others the anterior vaginal wall was resected, but neobladder was still performed. During daytime, no patients reported total incontinence and 73% (11/15) reported total continence or only occasional leaks. Sexual results showed that seven of 15 (47%) women regained sexual activity after surgery, with a quality reported as “good” or “very good” in 40% of all 19 cases. ConclusionRARC in female with anterior vaginal wall preservation is feasible. The approach showed a good safety profile, with satisfying results on continence and sexual activity. Sexual-sparing approaches should be carried out after correct patient selection.

Prospective Comparative Study of Quality of Life in Bladder Cancer Patients Undergoing Cystectomy or Bladder Preservation

Health-related Quality of life (HRQOL) may be decisive when different treatments yield comparable survival outcomes. We compared QOL in patients undergoing radical cystectomy with ileal conduit (RCIC) or bladder preservation (BP) with (chemo)radiotherapy for bladder cancer. Patients with histological diagnosis of bladder cancer, stage T1-T4, N0-N1, M0 with a minimum follow-up of 6 months from the last treatment intervention (RCIC or BP) and alive without disease at the time of QOL assessment were eligible for inclusion. After ethics committee approval, two HRQOL instruments were translated, validated and administered: Bladder cancer index (BCI) for bladder cancer-specific HRQOL, which includes 36 items under three domains - bladder, bowel and sexual function and the EORTC QLQ C30 which includes 30 items under three domains - functional, symptom and global health. The mean QOL scores across various domains and specific questions were compared between the two treatment groups using the independent t-test. Of the 104 patients enrolled, 56 had RCIC, and 48 received BP, and included 95 (91.3%) males. The median time from treatment completion to QOL assessment was 22 months (IQR 10-56). The median age for the entire cohort was 62 years (IQR 55-68), 65.5 years (IQR 55-71) in BP and 59.5 years (IQR 55-66) in RCIC. Overall, mean BCI urinary scores and bowel scores were high in both groups, with no significant difference in function or bother subdomains between the two groups (Table 1). Overall, BCI sexual scores were low in both the groups but significantly better after BP (BPmean 56.9, RCICmean 41.5, p = 0.01). Mean scores for sexual function BPmean 38.4 and RCIC mean 25 p (0.07) and sexual bother BPmean 81 RCICmean 62 (p 0.02) subdomains. There was no significant difference in EORTC QOL outcomes in functional (BPmean 91.4, RCICmean 88.7 p 0.23), symptom (BPmean 89.8, RCICmean 89, p = 0.68) and global health scale (BPmean 76.8, RCICmean 78.5, p = 0.69) in both groups. On question-wise assessment, the ability to perform an exercise (BPmean 94.2, RCICmean 85, p = 0.06) and urinary leakage at night time (BPmean 91.7, RCICmean 77.6, p = 0.01) were better in the BP group, while scores for blood in the urine (BPmean 89.1, RCICmean 97, p = 0.05) were better in the RCIC group compared to BP. Overall, QOL was good in both groups in the urinary and bowel domains while it was low in the sexual domain. However, bladder preservation performed significantly better in the sexual domain than RCIC.

Translation, Linguistic Validation, and Cultural Adaptation of the Bladder Cancer Index (BCI) Questionnaire Into the Persian (Farsi) Language and Comparing it With WHO Quality of Life Questionnaire: An Observational Study.

Whether ileal conduit diversion (ICD) or orthotopic neobladder (ONB) urinary diversion provides better quality of life (QoL) is still under debate. The Bladder Cancer Index (BCI) is a specific tool for bladder cancer (BCa) patients, providing reliable results in previous studies. A validated Farsi version of the BCI concerning cultural aspects could help Farsi-speaking clinicians gain more reliable feedback on QoL following urinary diversion. Based on WHO suggestions, we translated the BCI questionnaire into the Persian language. Then, we performed a cross-sectional study on BCa patients who underwent ICD or ONB urinary diversion. We compared their QoL via BCI and WHO questionnaires. Chi-square and independent t-tests were used where appropriate. The content validity ratio and the content validity indexes were 1 and 0.8-1.0, respectively. Of 57 participants, six patients (10.5%) were women. The ICD was performed for 38 (66.7%) and ONB diversion for 19 (33.3) participants. The mean age of ICD and ONB was 68.71 ± 7.40 and 64.28 ± 8.34 years, respectively (p-value: 0.055). In all sub-domains of BCI, except bowel habits, the mean scores were higher in the ICD group. A significant difference between ICD and ONB groups was found regarding urinary function (p-value<0.001). There was no significant difference between ICD and ONB groups in none of the domains of the WHO questionnaire. The QoL of ICD and ONB patients did not differ significantly. Even ICD may be superior in ritual purification, while the psychological status of ONB patients was better.

Analysis of the efficacy of a single subumbilical stoma for bilateral cutaneous ureterostomy after radical cystectomy

BackgroundRadical cystectomy and urinary diversion are the standard surgical treatments for patients with muscle-invasive or high-risk, or recurrent non-muscle-invasive bladder cancer. Although this approach significantly prolongs patient survival, it can lead to postoperative complications. This study aims to compare the efficacy and complications of bilateral cutaneous ureterostomy with a single subumbilical stoma to those of cutaneous ureterostomy with two stomas and an ileal conduit as a means of urinary diversion after radical cystectomy. The findings of this study will provide valuable information for healthcare providers in selecting the appropriate urinary diversion method for their patients.MethodsThe clinical data for 108 patients who received bilateral cutaneous ureterostomy with a single subumbilical stoma (ureterostomy with a single stoma group), cutaneous ureterostomy with two stomas (ureterostomy with two stomas group), or an ileal conduit (ileal conduit group) after radical cystectomy were retrospectively analysed. The operative time, pathological stage, survival status, perioperative complication rate, rate of successful first extubation, rehospitalization rate at 6 months after surgery,ostomy-related medical costs,and postoperative quality of life were compared between the three groups of patients.ResultsA significant difference in the operative time was found between the three groups (P = 0.001). No significant differences in pathological stage, survival status, perioperative complication rate, rehospitalization rate at 6 months after surgery, or bladder cancer index (BCI) score were identified among the three groups. The difference in the successful first extubation rate between the three groups of patients was significant (P = 0.001). Significant differences in ostomy-related medical costs were observed among the three groups of patients (P = 0.006).ConclusionA single subumbilical stoma for bilateral cutaneous ureterostomy after radical cystectomy may result in shorter surgery time, increased success rates for initial catheter removal, and lower medical expenses. However, to confirm these findings, further prospective randomized clinical trials are necessary.

MP22-17 THE BODY IMAGE SCALE (BIS) CAN IDENTIFY SYMPTOMS RELATED TO BODY IMAGE AFTER BLADDER CANCER TREATMENT: VALIDATION OF THE JAPANESE VERSION OF THE BIS

You have accessJournal of UrologyCME1 Apr 2023MP22-17 THE BODY IMAGE SCALE (BIS) CAN IDENTIFY SYMPTOMS RELATED TO BODY IMAGE AFTER BLADDER CANCER TREATMENT: VALIDATION OF THE JAPANESE VERSION OF THE BIS Takahiro Osawa, Miho Sato, Takashige Abe, Shuhei Yamada, Jun Furumido, Hiroshi Kikuchi, Ryuji Matsumoto, Yasuyuki Sato, Yoshihiro Sasaki, Toru Harabayashi, Satoru Maruyama, Norikata Takada, Keita Minami, Ken Morita, Sachiyo Murai, Katsuhiko Ogasawara, and Nobuo Shinohara Takahiro OsawaTakahiro Osawa More articles by this author , Miho SatoMiho Sato More articles by this author , Takashige AbeTakashige Abe More articles by this author , Shuhei YamadaShuhei Yamada More articles by this author , Jun FurumidoJun Furumido More articles by this author , Hiroshi KikuchiHiroshi Kikuchi More articles by this author , Ryuji MatsumotoRyuji Matsumoto More articles by this author , Yasuyuki SatoYasuyuki Sato More articles by this author , Yoshihiro SasakiYoshihiro Sasaki More articles by this author , Toru HarabayashiToru Harabayashi More articles by this author , Satoru MaruyamaSatoru Maruyama More articles by this author , Norikata TakadaNorikata Takada More articles by this author , Keita MinamiKeita Minami More articles by this author , Ken MoritaKen Morita More articles by this author , Sachiyo MuraiSachiyo Murai More articles by this author , Katsuhiko OgasawaraKatsuhiko Ogasawara More articles by this author , and Nobuo ShinoharaNobuo Shinohara More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003247.17AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The Body Image Scale (BIS), which consists of a 10-items, is a tool that can measure the body images of patients after cancer therapy. A multicenter cross-sectional survey was performed to validate the BIS for bladder cancer patients who received treatment in Japan. METHODS: The reliability and validity of the newly developed Japanese BIS were examined in 397 Japanese patients with bladder cancer. The patients simultaneously completed the Short Form (SF)-12, and Bladder Cancer Index (BCI). Internal consistency, criterion-related validity, and correlation were evaluated. The BIS, BCI and SF-12 scores were compared according to treatment type. RESULTS: Of 397 patients who had received bladder cancer surgery, 221 patients were treated by transurethral resection of bladder tumor (TURBT) endoscopically, 49 patients underwent cystectomy with neobladder, and 127 patients underwent cystectomy involving urinary stoma. The mean age was 70 years and a median disease duration was 29 months (IQR: 12–66 months). Cronbach's α coefficient was 0.924. Higher BIS scores indicate negative body image, and the median BIS score for patients with native bladders after TURBT (0.5) was significantly lower than those of the patients with neobladder (4.0) and stoma formation (7.0), which indicated the discriminatory ability of the BIS (p<0.001). Correlation analysis confirmed the convergent validity. A range of BIS scores were identified among patients who reported similar SF-12 scores (Figure 1). CONCLUSIONS: The validation of BIS for diverse treatment of bladder cancer is desirable and will provide an opportunity to identify effective interventions that promote body image in clinical settings. In addition, BIS scale can detect HRQOL-specific body image deterioration that the SF-12 cannot. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e303 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Takahiro Osawa More articles by this author Miho Sato More articles by this author Takashige Abe More articles by this author Shuhei Yamada More articles by this author Jun Furumido More articles by this author Hiroshi Kikuchi More articles by this author Ryuji Matsumoto More articles by this author Yasuyuki Sato More articles by this author Yoshihiro Sasaki More articles by this author Toru Harabayashi More articles by this author Satoru Maruyama More articles by this author Norikata Takada More articles by this author Keita Minami More articles by this author Ken Morita More articles by this author Sachiyo Murai More articles by this author Katsuhiko Ogasawara More articles by this author Nobuo Shinohara More articles by this author Expand All Advertisement PDF downloadLoading ...

MP08-16 COMPARISON OF INTRAVESICAL THERAPY AND SURGERY AS TREATMENT OPTIONS FOR RECURRENT BLADDER CANCER (CISTO): COLLECTION OF PATIENT-REPORTED OUTCOMES

You have accessJournal of UrologyCME1 Apr 2023MP08-16 COMPARISON OF INTRAVESICAL THERAPY AND SURGERY AS TREATMENT OPTIONS FOR RECURRENT BLADDER CANCER (CISTO): COLLECTION OF PATIENT-REPORTED OUTCOMES John Gore, Erika Wolff, Michael Nash, Bryan Comstock, Kristin Follmer, Solange Mecham, Sung Min Kim, Christopher Nefcy, Angela Smith, and CISTO Collaborative John GoreJohn Gore More articles by this author , Erika WolffErika Wolff More articles by this author , Michael NashMichael Nash More articles by this author , Bryan ComstockBryan Comstock More articles by this author , Kristin FollmerKristin Follmer More articles by this author , Solange MechamSolange Mecham More articles by this author , Sung Min KimSung Min Kim More articles by this author , Christopher NefcyChristopher Nefcy More articles by this author , Angela SmithAngela Smith More articles by this author , and CISTO Collaborative More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003223.16AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Patients with recurrent non-muscle-invasive bladder cancer weigh the risk of cancer progression and loss of a window of potential cure with medical therapy against the risk of morbidity and loss of quality of life (QOL) with radical cystectomy. The pragmatic CISTO Study (NCT03933826) includes the collection of patient-reported outcomes to help future patients make this treatment decision. METHODS: 572 patients will be enrolled and complete baseline and follow up surveys quarterly for up to 4 years. Centralized collection of follow-up surveys utilizes several modalities for contacting participants (email, mail, phone, text) as well as completing the survey (online, paper). Baseline and follow up surveys assess QOL and physical functioning (EORTC QLQ-C30), urinary, sexual, and bowel function (Bladder Cancer Index, BCI), financial distress (Comprehensive Score for Financial Toxicity, COST), anxiety and depression (PROMIS), and generic QOL (EQ5D). Follow up surveys also assess healthcare utilization and decision regret. RESULTS: 337 participants have been enrolled. The completion rate for the primary endpoint of QOL at 12 months is 93%. Among returned surveys, the overall rate of missingness at baseline and 12-months was low (<5%) and there was no evidence of survey fatigue. The BCI had the highest missingness rate (4% and 7%, respectively). The 10 items with the most missingness were in the BCI sexual function domain (8-13% and 11-18%, respectively). CONCLUSIONS: Based on the high rate of survey completion, the CISTO Study will be powered to compare outcomes across a variety of domains, including QOL, urinary function, and anxiety. The missingness of questions relating to sexual function makes it unlikely that this study will yield valid and generalizable results in this specific domain. This, in combination with anecdotal evidence that participants find these questions upsetting, even when optional, and confusing, as there is no place to indicate that the questions do not apply if they are not sexually active, highlights the difficulty in researching this intensely personal outcome. Source of Funding: Research reported in this work was funded through a Patient-Centered Outcomes Research Institute (PCORI) Award (PCS-2017C3-9380) © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e100 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information John Gore More articles by this author Erika Wolff More articles by this author Michael Nash More articles by this author Bryan Comstock More articles by this author Kristin Follmer More articles by this author Solange Mecham More articles by this author Sung Min Kim More articles by this author Christopher Nefcy More articles by this author Angela Smith More articles by this author CISTO Collaborative More articles by this author Expand All Advertisement PDF downloadLoading ...

Validation of the Japanese version of the Body Image Scale for bladder cancer patients

The Body Image Scale (BIS) is a 10-item tool that measures the body images of cancer patients. This study aims to validate the Japanese version of the BIS for bladder cancer patients. A multicenter cross-sectional survey was used to identify the participants, which included Japanese bladder cancer patients. The percentage of missing responses, internal consistency, and known-group validity were evaluated. The correlations between the BIS and two HRQOL instruments (the Bladder Cancer Index and the SF-12) were assessed to determine convergent validity. Among 397 patients, 221 patients were treated by transurethral resection of bladder tumor (TURBT) endoscopically, 49 patients underwent cystectomy with neobladder, and 127 patients underwent cystectomy involving stoma. The percentage of missing responses in the BIS ranged from 8.1 to 15.6%. Cronbach's α coefficient was 0.924. Higher BIS scores indicate negative body image, and the median BIS score for patients with native bladders after TURBT (0.5) was significantly lower than those of the patients with neobladder (4.0) and stoma formation (7.0), which indicated the discriminatory ability of the BIS. Each domain of the Bladder Cancer Index and the role summary score of the SF-12 correlated to the BIS scores, which confirmed the convergent validity. A range of BIS scores were identified among patients who reported similar physical summary scores and mental summary scores of the SF-12. This study confirmed the reliability and validity of the Japanese version of the BIS for bladder cancer patients.

Urodynamic assessment and quality of life outcomes of robot-assisted totally intracorporeal radical cystectomy and orthotopic neobladder for bladder cancer: a preliminary study.

Few data exist regarding the functional outcomes of robot-assisted radical cystectomy (RARC) with intracorporeal orthotopic neobladder. The aim of this study was to evaluate the urodynamic and functional outcomes in patients undergoing RARC and totally intracorporeal orthotopic neobladder for bladder cancer. In this monocentric, observational study carried out between 2016 and 2020, consecutive patients undergoing RARC and intracorporeal orthotopic neobladder in the Department of Urology, Pitié-Salpêtrière Hospital, were included. Reconstruction was totally intracorporeal Y-shaped neobladder. Main outcomes were urodynamic findings 6months post-surgery, continence and quality of life (QoL). Continence was defined by no pad or one safety pad. International Consultation on Incontinence Questionnaire (ICIQ), International Index of Erectile Function questionnaire (IIEF-5) and Bladder Cancer Index (BCI) scores were recorded. Fourteen male patients were included (median age: 64years [IQR 54-67]. Median maximal neobladder cystometric capacity was 495ml [IQR 410-606] and median compliance was 35.5ml/cm H2O [IQR 28-62]. All patients had post-void residual volume < 30ml, except for three (22%) who required clean intermittent-self catheterisation. Daytime continence was achieved in 10 patients (71%) and night-time continence in two (14.3%). Median ICIQ score was 7 [IQR 5-11]. Postoperative erectile function was present in 7% of patients (mean IIEF-5 = 5 [IQR 2-7]). Thirteen patients (93%) were satisfied with their choice of neobladder. RARC with totally intracorporeal orthotopic neobladder for bladder cancer provides satisfactory urodynamic results and good QoL. These findings should be confirmed long-term.

Urdu Translation and Linguistic Validation of the Bladder Cancer Index Questionnaire.

BackgroundThis study aimed to translate the Bladder Cancer Index (BCI) questionnaire to Urdu and validate it to assess the quality of life of patients with bladder cancer.Material and methodsAfter forward and backward translation of the BCI questionnaire into Urdu, content validity was calculated using the content validity index (CVI) based on input from five health experts regarding the clarity and relevance of the questionnaire. Construct validity was measured by comparing the inter-scale domains and subdomains of BCI and by comparing BCI with Short Form 36 (SF-36) using correlations. For assessment of reliability, Cronbach’s alpha was calculated to measure internal consistency and for test-retest reliability, the questionnaire was re-administered four weeks later and the correlation of responses at baseline and at a four-week time point was evaluated.ResultsThe questionnaire has good content validity for clarity (0.91) and relevance (0.87). The construct validity of BCI was also adequately displayed by moderate to high correlation between different subdomains of BCI (Pearson’s r: urinary - 0.62, bowel - 0.78, sexual function - 0.43) and low to moderate correlation between responses of BCI compared with SF-36 (Pearson’s r mostly >0.45). Test-retest reliability was excellent (Pearson’s r 0.90-0.98), and there was good internal consistency (Cronbach’s alpha 0.79-0.92) in the different domains of the questionnaire.ConclusionThe Urdu-translated BCI is a valid and reliable tool to measure the impact of bladder cancer on the quality of life of patients.

Pelvic reconstruction and lateral prostate capsule sparing techniques improve early continence of robot-assisted radical cystectomy with orthotopic ileal neobladder.

To evaluate urinary outcomes of pelvic construction and lateral capsule sparing techniques in robot-assisted radical cystectomy with orthotopic ileal neobladder (RARC-OIN). A total of 107 male patients who underwent RARC-OIN during January 2017 and February 2021 in Sun Yat-sen Memorial Hospital were analyzed retrospectively. Standard RARC-OIN with or without nerve sparing technique was performed in 44 patients (standard group), lateral prostate capsule sparing technique was performed in 20 patients (LCS group), combined pelvic reconstruction (CPR) technique including anterior suspension and posterior reconstruction were performed in 43 patients (CPR group). The urinary function was assessed by the use of pads and the Bladder Cancer Index (BCI). Continence was defined as the use of 0-1 pad during daytime or night-time. There was no statistical difference between the three groups regarding demographic, perioperative, and pathological data. Continence rates were 6.8, 50.0 and 34.9% for daytime, 4.6, 40.0 and 32.6% for night-time in the standard group, LCS group and CPR group at 1month post-operation, respectively. Continence rates were 34.1, 80.0 and 69.8% for daytime, 27.3, 75.0 and 65.1% for night-time in the standard group, LCS group and CPR group at 3month post-operation, respectively. No statistically significant difference was observed in the daytime and night-time continence rates at 12months. Lateral capsule-sparing and combined pelvic reconstruction techniques are feasible to improve early daytime and night-time continence rates in RARC with orthotopic neobladder. The trial registration number: ChiCTR2100047606.

Continent cutaneous urinary diversion with an ileal pouch with the Mitrofanoff principle versus a Miami pouch in patients undergoing cystectomy for bladder cancer: results of a comparative study.

Radical cystectomy (RC) is currently the standard of care for non-metastatic muscle invasive bladder cancer. Few studies compare methods of cutaneous continent urinary diversion (CCUD) following RC. Theobjectivewas to compare perioperative morbidity and functional outcomes of CCUD using an ileal pouch with aMitrofanoff efferent versus a Miami ileocolic pouch in patients undergoing cystectomy of pelvic exenteration for bladder cancer. This retrospective two-centre study included all consecutive patients who underwent radical cystectomy or pelvic exenteration with CCUD for bladder cancer between 2001and 2020in two academic French hospitals with a median follow-up time of 5.4years. Patients were divided into two groups according to the type of urinary diversion: Miami ileocolonic pouch (group A) and ileal pouch with Mitrofanoff/Monti principle (group B). Continence rate, ability to perform intermittent self-catheterisation, complications and health-related quality of life (HRQoL) measured by the bladder cancer index were evaluated. Thirty-one patients were included. Continence was achieved in 11 out of 14 patients (79%) in group A versus 12 out of 17 patients (71%) in group B (P = 0.3). A significantly higher rate of cutaneous tube stenosis was reported in group B compared to group A (eight (47%) vs. one (7%) patient, respectively; P = 0.02). HRQoL outcomes were similar in both groups except less digestive discomfort observed in group A. When comparing the ileal pouch with Mitrofanoff/Monti's principle with a Miami pouch, no significant differences were found regarding continence rate, ability to self-catheterise, long-term complication rate and overall patient satisfaction.

PD03-10 PATIENT AND CAREGIVER COPING SKILLS, QUALITY OF LIFE, AND DECISION REGRET FOLLOWING RADICAL CYSTECTOMY

You have accessJournal of UrologyHealth Services Research: Practice Patterns, Quality of Life and Shared Decision Making I (PD03)1 Sep 2021PD03-10 PATIENT AND CAREGIVER COPING SKILLS, QUALITY OF LIFE, AND DECISION REGRET FOLLOWING RADICAL CYSTECTOMY Elizabeth Green, Richard Reich, Wenyi Fan, Paul Crispen, Michael Poch, Wade Sexton, Philippe E. Spiess, Paul Jacobsen, and Scott Gilbert Elizabeth GreenElizabeth Green More articles by this author , Richard ReichRichard Reich More articles by this author , Wenyi FanWenyi Fan More articles by this author , Paul CrispenPaul Crispen More articles by this author , Michael PochMichael Poch More articles by this author , Wade SextonWade Sexton More articles by this author , Philippe E. SpiessPhilippe E. Spiess More articles by this author , Paul JacobsenPaul Jacobsen More articles by this author , and Scott GilbertScott Gilbert More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000001967.10AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Though a complex and complication-prone operation, cystectomy (Cx) remains the standard of care for muscle invasive bladder cancer. However, the impact of Cx and urinary diversion on patient-centered outcomes (PCOs) such as quality of life (QOL) and decision regret (DR) has not been well characterized. METHODS: 132 Cx patients were accrued in a prospective PCO study between 2014 to 2016 and followed for 1 year after surgery. Study patients and their caregivers completed the Patient Health Questionnaire-8 (PHQ-8), Medical Outcomes Study Sleep Scale (MOS-Sleep) and Short Form (SF-36) before and after surgery. Patients also completed the Bladder Cancer Index (BCI) and Body Image Scale (BIS). Coping strategy (CS) was assessed before Cx and DR was evaluated with the Decision Regret Scale after Cx. Mediation analysis was used to compare PCOs between patients receiving different urinary diversions and dyad analysis was used to examine the effect of patient-caregiver dyad CS on patient outcomes. RESULTS: Patients receiving a catheterizable pouch had the most DR (p=0.048, Table 1). Lower post-Cx PCOs were also associated with greater DR (SF-36, urinary BCI, bowel BCI, BIS and PHQ-8 p<0.05). Body image was a significant predictor of DR in adjusted models. In mediation analysis, DR was mediated by urinary BCI. Avoidant CS in patient-caregiver dyads was linked to lower baseline SF-36 health rating (p=0.004), SF-36 mental health score (p=0.003), and PHQ-8 (p=0.003) with mean PHQ-8 scores at or near the threshold for depression. At 12 months, these deficits were replaced by low SF-36 physical health scores (p=0.010). CONCLUSIONS: Decision regret after Cx is driven by several PCOs. Patients with pouches appear to be a unique group in terms of depression symptoms and DR, and urinary function appears to mediate DR. Avoidant coping skills are associated with low mental health scores before surgery, but these abate after Cx. Source of Funding: Florida Biomedical Research Program, Bankhead-Coley Research Grant © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e47-e47 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Elizabeth Green More articles by this author Richard Reich More articles by this author Wenyi Fan More articles by this author Paul Crispen More articles by this author Michael Poch More articles by this author Wade Sexton More articles by this author Philippe E. Spiess More articles by this author Paul Jacobsen More articles by this author Scott Gilbert More articles by this author Expand All Advertisement Loading ...

PD59-02 COMPLICATIONS, RECOVERY, AND PATIENT-REPORTED QUALITY OF LIFE AFTER RADICAL CYSTECTOMY

You have accessJournal of UrologyBladder Cancer: Invasive V (PD59)1 Sep 2021PD59-02 COMPLICATIONS, RECOVERY, AND PATIENT-REPORTED QUALITY OF LIFE AFTER RADICAL CYSTECTOMY Elizabeth Green, Ali Hajiran, Richard Reich, Logan Zemp, Aymet Aydin, Roger Li, Michael Poch, Wade Sexton, Alice Yu, and Scott Gilbert Elizabeth GreenElizabeth Green More articles by this author , Ali HajiranAli Hajiran More articles by this author , Richard ReichRichard Reich More articles by this author , Logan ZempLogan Zemp More articles by this author , Aymet AydinAymet Aydin More articles by this author , Roger LiRoger Li More articles by this author , Michael PochMichael Poch More articles by this author , Wade SextonWade Sexton More articles by this author , Alice YuAlice Yu More articles by this author , and Scott GilbertScott Gilbert More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002096.02AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Although cystectomy (Cx) is a morbid surgery, information regarding the effect difficult recovery has on patient-centered outcomes is lacking. Using validated patient-reported outcome (PRO) measures, we examined the relationship between perioperative complications, readmissions, diversion-related consequences and prospectively assessed PROs after Cx. METHODS: Patients undergoing Cx were enrolled in a prospective complication and PRO study from 2014 to 2016 and followed for 12 months. Participants completed the Medical Outcomes Study Short Form (SF-36), Bladder Cancer Index (BCI), Patient Health Questionnaire for Depression (PHQ-8) and Decision Regret Scale (DRS). Perioperative complications within 90 days of Cx were abstracted from medical records using Clavien-Dindo classification and urinary diversion adverse events (AEs) were prospectively assessed and graded 6 months after surgery using Common Terminology Criteria for Adverse Events (CTCAE) standards. The association between perioperative complications, readmissions, 6-month AEs, and PROs were analyzed using multivariable regression models. RESULTS: 113 patients enrolled in this study and had complication and AE data available for analysis. 47% experienced a low grade (LG) and 22% experienced a HG complication. 35% were readmitted. 82% experienced a LG and 19% experienced a HG AE within 6 months. Improved performance status was associated with decreased HG 90-day complications (p=0.009). SF-36 mental health composite score was significantly positively associated with readmission (p=0.04), but not complication or 6-month diversion AE. There was no significant relationship between the presence of a HG 90-day complication, readmission, or 6-month AE and SF-36 physical health (p=0.21, 0.26, and 0.20 respectively), urinary (0.46, 0.20, and 0.86), bowel (p=0.62, 0.63, and 0.85) or sexual domains of BCI (p=0.35, 0.28, and 0.30), PHQ-8 (p=0.89, 0.32, and 0.44), or DRS at 6 months (p=0.15, 0.97, 0.31, Table 1). CONCLUSIONS: HG 90-day complications, readmissions and 6-month AEs did not negatively affect PROs or QOL after recovery from Cx. These data suggest that perioperative complications and AEs do not lead to long-term QOL deficits. Source of Funding: Florida Biomedical Research Program, Bankhead-Coley Research Grant © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e1051-e1051 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Elizabeth Green More articles by this author Ali Hajiran More articles by this author Richard Reich More articles by this author Logan Zemp More articles by this author Aymet Aydin More articles by this author Roger Li More articles by this author Michael Poch More articles by this author Wade Sexton More articles by this author Alice Yu More articles by this author Scott Gilbert More articles by this author Expand All Advertisement Loading ...

Clinical efficacy of mebeverine for persistent nocturnal enuresis after orthotopic W-neobladder.

To investigate the efficacy of mebeverine for nocturnal incontinence in male patients with an ileal orthotopic bladder substitute (OBS). A randomised controlled trial was carried out for adult male patients who were nocturnal incontinent. Patients were allocated to receive mebeverine 200 mg or placebo once a day in the evening for 3 months. The primary outcome was to compare the continence status between groups, assessed by the urinary domain of the Bladder Cancer Index (BCI) and pad usage. The secondary outcomes were to assess the safety of mebeverine. There were 55 patients in the placebo group and 58 in mebeverine group who completed the follow-up. The median (interquartile range) interval between OBS surgery and starting treatment was 9 (4-13) years in the placebo group and 9 (6-13) years in the mebeverine group. The mean (SD) 3-month urinary domain score of the BCI was 70.8 (5.6) and 86.4 (14.2) in the placebo and mebeverine groups, respectively (P < 0.001). At 3 months, 54 (98.2%) and 26 (44.8%) patients required the use of a night-time pad in the placebo and mebeverine groups, respectively. Mebeverine reduced the risk of pad use by 53.4% (95% confidence interval 40.1-66.6; P < 0.001). Constipation occurred in one (2.1%) and three (5.8%) patients in the placebo and mebeverine groups, respectively; abdominal distention occurred in two (3.8%) of the patients in the mebeverine group (P = 0.25). Mebeverine decreases night-time pad use and improves the quality of life in male patients with an ileal OBS and is associated with minimal adverse events.

Pitcher pot neourethral modification of ileal orthotopic neobladder achieves satisfactory long-term functional and quality of life outcomes with low clean intermittent self-catheterization rate.

ObjectiveTo describe a decade of our experience with a neo‐urethral modification of ileal orthotopic neobladder (pitcher pot ONB). Multiple investigators have reported similar modifications. However, long‐term longitudinal functional and quality of life (QOL) outcomes are lacking.MethodsProspectively maintained hospital registry for 238 ONB patients comprising a mix of open and robotic surgery cohorts from 2007 to 2017, and minimum of 2 years of follow‐up was retrospectively queried. QOL was evaluated using Bladder Cancer Index (BCI). Longitudinal trends of QOL domain parameters were analysed. List of perioperative variables that have a biologically plausible association with continence, potency, and post‐operative BCI QOL sexual, urinary, and bowel domain scores was drawn. Variables included surgery type, Body Mass Index (BMI), T and N stage, neurovascular bundle (NVB) sparing, age, and related pre‐operative BCI QOL domain score. Prognostic associations were analysed using multivariable Cox proportional hazard models and multilevel mixed‐effects modeling.ResultsThe study comprised 80 and 158 patients who underwent open and robotic sandwich technique cohorts, respectively. Open surgery was associated with significantly higher “any” complication (40% vs 27%, P‐value .050) and “major” complication rate (15% vs 11%, P‐value .048). All patients developed a bladder capacity >400 cc with negligible post‐void residual urine, and all but one patient achieved spontaneous voiding by the end of study period (<1% clean intermittent self‐catheterization [CISC] rate). By 15 months, QOL for all three domains had recovered to reach a plateau. About 45% of patients achieved potency, and the median time to achieve day and night time continence was 9 and 12 months respectively. Lower age and NVBs spared during surgery were found to be significantly associated with the earlier achievement of potency, day and night time continence, as well as better urinary and sexual summary QOL scores.ConclusionsPitcher pot neobladder achieves satisfactory long‐term functional and QOL outcomes with negligible CISC rate. Results were superior with incremental nerves spared during surgery.

Assessing the lifetime performance index of weighted Lomax distribution based on progressive type-II censoring scheme for bladder cancer

In this paper, Health-related quality of life has not been adequately measured in bladder cancer. A recently developed reliable and disease-specific quality of life instrument (Bladder Cancer Index, BCI) was used to measure. Progressive type II censoring schemes have potential usefulness in practice where budget constraints in place or there is a necessity for the speedy test. To test the process capability, the lifetime performance index [Formula: see text] is widely recommended for evaluating the performance of the product’s lifetime and evaluating the lifetime performance index [Formula: see text] for the three-parameter Weighted-Lomax distribution (WLx) under progressive type-II censoring sample for a lower specification limit ([Formula: see text]). The statistical inference concerning [Formula: see text] is conducted via obtaining the maximum likelihood of [Formula: see text] on the base of progressive type-II censoring. The asymptotic normal distribution of the MLE of [Formula: see text] and the confidence interval is proposed. Moreover, the hypothesis testing of [Formula: see text] for evaluating the lifetime performance of WLx data is conducted. Also, assuming the conjugate prior distribution and squared error loss function, this study constructs a Bayes estimator of [Formula: see text]. The Bayes estimator of [Formula: see text] is then utilized to develop a credible interval in the condition of known [Formula: see text]. Moreover, we propose a Bayesian test to assess the lifetime performance of products. We also propose a Bayesian test to assess the lifetime performance of products. Finally, two examples are given, one of them is considering a real life data of the remission times of bladder cancer patients in endurance lifetime test and the other is a simulated example to illustrate the usage of the proposed procedure.

PATIENT-REPORTED OUTCOME AFTER ILEAL NEOBLADDER

(Objectives) Investigation of patient-reported outcome (PRO) after ileal neobladder for bladder cancer. (Patients and methods) Forty patients who underwent radical cystectomy and ileal neobladder between July 2007 and December 2017 were asked to complete a questionnaire. PRO was evaluated using the Medical Outcomes Study Short Form-8 (SF-8) for general health-related quality of life (QOL) and the Bladder Cancer Index and the Japanese version of the Functional Assessment of Cancer Therapy-Bladder for disease specific QOL. Patients were divided into two groups according to the postoperative period (early and late), and the differences in questionnaire results between the groups were evaluated. (Results) All scores on the SF-8 were over 50 points, exceeding the Japanese national standard of 50 points for all items. The physical and mental summary scores were also favorable. For disease-specific QOL, only daytime incontinence was significantly higher in the late group, with daytime incontinence two or more times per week at 42.1%, compared to 20.0% in the early group (P=0.0403). A comparison of daytime urinary incontinence in four groups during the postoperative period showed that urinary incontinence was least frequent among patients between 64 and 101 months after surgery; patients in this group were also the youngest in age at the time of surgery. (Conclusions) Cross-sectional analysis of PRO revealed that patients with ileal neobladder had good general health-related QOL after surgery, but urinary incontinence was a significant problem.

Health-related quality of life in Japanese patients with bladder cancer measured by a newly developed Japanese version of the Bladder Cancer Index

IntroductionWe validated a Japanese version of the Bladder Cancer Index (BCI) as a tool for measuring health-related quality of life (HRQOL) in bladder cancer patients treated with various surgical procedures.MethodsThe reliability and validity of the Japanese BCI were examined in 397 Japanese patients with bladder cancer via cross-sectional analysis. The patients simultaneously completed the Short Form (SF)-12, EQ-5D, and the Functional Assessment of Cancer Therapy-General and Bladder (FACT-G and FACT-BL). The differences in BCI subscales among various treatment groups were analyzed.ResultsThis study involved 397 patients (301 males and 96 females), with a mean age of 70 years and a median disease duration of 29 months (IQR: 12–66 months). Of these patients, 221 underwent transurethral resection of a bladder tumor, and 176 patients underwent radical cystectomy (ileal conduit: 101 patients, ileal neobladder: 49, and ureterostomy: 26). Cronbach’s alpha coefficient was ≥ 0.78 for all subscales, except the bowel bother subscale. Despite moderate correlations being detected between the function and bother score in urinary and bowel domains, the sexual function score was inversely correlated with the sexual bother score (r = − 0.19). A missing value percentage of > 15% was associated with old age (p < 0.05). The mean domain scores differed significantly among distinct clinically relevant treatment groups.ConclusionsAlthough revisions are needed to make it easier for elderly patients to comprehend, we confirmed the reliability and validity of the Japanese BCI. The Japanese BCI could be used for cross-cultural assessments of HRQOL in bladder cancer patients.