HRQOL related to urinary diversion in Radical Cystectomy: a systematic review of recent literature

Abstract

Introduction: The health-related QoL is a patient-centered evaluation covering several aspects. This evaluation seems to be particularly important in patients submitted to radical cystectomy (RC) and urinary diversion with ileal conduit (IC) or a neobladder (NB). Objective: Review all recent data comparing QoL outcomes after radical cystectomy with NB and IC diversions. Evidence Acquisition: A systematic search in PubMed/Medline, Embase, and Cochrane databases was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement in December 2018. All articles published from January 01, 2012 to December 31, 2018, were included. A study was considered relevant if it compared QoL outcomes using validated questionnaires (EORTC QLQ C30, FACT-G, FACT-BL, FACT-VCI, and BCI). Evidence Synthesis: In 11 included studies, a total of 1389 participants were accounted (730 NB and 659 IC cases). The studies were conducted in 8 different countries, two were prospective, and none was randomized. There were two studies favoring results with a neobladder, 3 with incontinent diversion and 6 with no differences. The EORTC-QLQ-C30 was the most used instrument (5 studies) followed by FACT VCI and BCI (3 studies each). Given the heterogeneity of data and lack of prospective studies, a meta-analysis was not performed. Conclusion: No superiority of one urinary diversion was characterized. It seems that the choice must be individualized with an extensive preoperative orientation of the patient and their relatives. That will probably infl uence how the patient accepts the new condition.

Quality of Life in Female Patients Following Ileal Neobladder and Ileal Conduit: Where Are We?

“…In this context, the current literature does not appear unanimous for both sexes in defining the IC as a better derivation than the ONB, in terms of quality of life. There are papers that favor the IC as a better derivation than ONB, while others favor ONB, and still others that have shown similar results between the two [ 17 ]. Three retrospective studies favored the IC diversion over ONB by using the FACT-VCI scores showing that patients with an IC diversion had a total score that averaged higher than those with ONB, after 12 months [ 18 , 19 , 20 ].…”

Predicting global QoL after orthotopic neobladder or ileal conduit diversion: nomogram development

“…The possibility to predict preoperatively how the treatment could impact patients’ QoL could be important to fully inform the patients about the benefits and potential risks of available treatment options directing the decision-making process ( 2 ). However, QoL is a multi-dimensional reality, and consequently, the prediction of QoL outcomes is challenging ( 18 , 19 ). The prediction of outcomes relevant to disease management has been generally based on physician judgment and risk classification systems ( 20 , 21 ).…”

Patient-reported outcomes and health-related quality of life after urinary diversions

“…They found that HRQOL was comparable between continent and incontinent diversions and concluded that patient's choice, in consultation with the treating surgeon, should be the determinant of urinary diversions. Other studies come to the same conclusion [3,[16][17][18][19]. Unfortunately, as shown by McMullen et al [20] in a qualitative study on patients after radical cystectomy, proper preoperative and postoperative counselling is not always self-evident.…”

“…Likewise, the above-mentioned study from Catto et al [13 ▪ ] reported that question completeness was more than 95% except for items relating to sexual intimacy (39%), sexual enjoyment (36%) and female sexual problems (28%). Unfortunately more studies struggle with lack of reporting on sexual health after radical cystectomy [3,19,21 ▪ ,25].…”

“…General consensus on which urinary diversion gives the best outcomes in terms of health-related quality of life (HRQOL) has not been reached. This is partly as high-level evidence is still lacking [3,4 ▪ ]. Studies on HRQOL after radical cystectomy often have methodological limitations like small sample size and a retrospective and cross-sectional design.…”