MORBIDITY AND QUALITY-OF-LIFE IN PATIENTS WITH ORTHOTOPIC AND HETEROTOPIC CONTINENT URINARY-DIVERSION

Objectives. To evaluate morbidity and quality of life (QOL) in patient s with continent urinary diversion, Methods. Morbidity and neobladder function were analyzed in 56 consecutive patients with bladder substit utions. QOL assessment was performed using the Sickness Impact Profile (SIP), supplemented with a detailed voiding and continence questionna ire. Results. Mean age was 44.7 years. Mean follow-up was 41 months. T hirty-one men and 25 women were treated for transitional cell carcinom a (n = 22) or benign conditions (n = 34). In 33 patients, orthotopic ( 20 Mainz pouch and 13 ileal neobladder) substitutions were performed a nd in 23, heterotopic substitutions (Indiana pouch) were performed. Ea rly complications required five open reinterventions. Late complicatio ns (at more than 3 months) included ureteric stenosis in 5 patients. I n 38 patients (68%), full urinary continence was achieved. Spontaneous micturition was possible in 61% of orthotopic substitutions, whereas 15% of patients were required to perform intermittent catheterization only and 24% exhibited a combined voiding pattern. Compared to age-mat ched reference values, SIP scores showed a negative impact of heteroto pic or orthotopic diversion in the SIP categories of emotion, recreati on: and social interaction. The latter category included a statement a bout sexual activity, which was decreased in 50% of patients. In the c ategory of emotion, orthotopic substitutions compared favorably to het erotopic substitutions (P = 0.02). Conclusions. The morbidity profile is comparable to previous reports. QOL assessment using the SIP reveal ed a minor advantage for an orthotopic placement, which was due to a r elatively small number of patients. Most importantly, QOL was found to be favorable for both types of bladder substitute placement. (C) 1998 , Elsevier Science Inc. All rights reserved.