Modified S‐pouch neobladder vs ileal conduit and a matched control population: a quality‐of‐life survey

Abstract

urinary and sexual function and bother was also constructed. RESULTSThere were no differences in the QoL scores among the three groups; group 3 (control) tended to have a better QoL for all domains except emotional functioning. Urinary function was seriously affected in group 1, with more daytime leakage than in groups 2 and 3 (37.8% vs 10%, P = 0.005, and 9.3%, P = 0.01), night loss of urine (39.5% vs 28%, P = 0.07, and 3.7%, P = 0.002) and urine odour (58.6% vs 4%, and 5.5%, both P = 0.001). Patients in group 2 differed from healthy individuals only in night loss of urine. Consequently urinary bother was more pronounced in group 1, as fewer were satisfied (68.9% vs 86% and 83.2%, both P = 0.03). Sexual function was seriously and similarly affected in groups 1 and 2; the erection rate was 28.9% for group 1, 35.5% for group 2 ( P = 0.1) and 83.3% in group 3 ( P = 0.003), while firm erections were present at 17.7%, 22.2% ( P = 0.2) and 83.3% ( P = 0.002). Women reported equivalent dysfunction in all three groups (15.4%, 20% and 16.6%, P = 0.3). Sexual desire was also equal in all groups (48.2%, 50% and 48.1). Patients in group 1 expressed more bother, while those in group 2 seemed more satisfied by their sexual life (84.4%, 68% and 68.5%, P = 0.04). CONCLUSIONSRadical cystectomy does not affect QoL whichever urinary reconstruction is used, and this implies a determination by the patients to live and adjust to their new conditions. On the contrary, urinary and sexual function are affected and related to the method used to reconstruct the urinary system. KEYWORDSquality of life, bladder cancer, radical cystectomy, ileal conduit, modified S-pouch. OBJECTIVESTo measure the quality-of-life (QoL) outcome and urinary and sexual function and bother after radical cystectomy and different types of urinary tract reconstruction (Bricker vs modified S-pouch neobladder), also assessing differences between them and a normal population. PATIENTS, SUBJECTS AND METHODS

Sexuality and Fertility after Cancer

“…11 In contrast to men, women who have radical cystectomy or surgery to remove rectal cancer have similar sexual function to healthy controls. 6,12 If pelvic surgery impairs vaginal expansion and lubrication, it seems that women can compensate by using estrogen replacement or water-based lubricants.…”

“…5 Attempts at nerve-sparing radical cystectomy and rectal cancer surgery have also yielded disappointing rates of recovery of erections. 6,7 The benefits of nerve-sparing may be limited by fibrosis that builds in the soft tissue of the penis after surgery 8 or by concomitant injury to the vascular bed of the penis.…”

Brachytherapy after external beam radiotherapy and limited surgery preserves bladders for patients with solitary pT1–pT3 bladder tumors

“…Muscle-invasive cancers are treated with cystectomy, which yields considerable morbidity and mortality. In spite of the improved possibilities of neobladder construction, the loss of one's own bladder function can be considered a major type of mutilation [4][5][6][7]. Radiochemotherapy can be offered to selected groups of patients, resulting in improved local control [8][9][10].…”

Aspekte der Akzeptanz von Harnableitung

“…Obwohl alle Formen der Harnableitung mit auf den Harntrakt bezogenen ("urinary problems") und sexuellen Funktionsstörun-gen einhergehen, konnten die meisten Studien zeigen, dass sich die Mehrheit der Patienten einer hohen Lebensqualität erfreut. Einige Autoren fanden sogar heraus, dass sich die Lebensqualität von Patienten mit Harnableitung nicht von der Lebensqualität altersgleicher gesunder Probanden aus der gleichen geographischen Region unterscheidet [15,35].…”