Quality of life after cystectomy and orthotopic neobladder versus ileal conduit urinary diversion

The impact of bladder removal and urinary diversion for patients' everyday life is largely unknown. The aims of this study were to compare subjective morbidity of ileal neobladder to the urethra versus ileal conduit urinary d iversion and to elucidate its influence on quality of life. A total of 102 patients who underwent cystectomy due to a bladder malignancy were included in the study. In 69 patients (67.6%) an orthotopic neobladder and in 33 pa tients (32.4%) an ileal conduit was performed as urinary diversion. The com pliance was 99% and mean follow-up was 37 months. All patients completed tw o retrospective quality of life questionnaires, namely the QLQ-C30 and a qu estionnaire developed at our institution to ask for urinary diversion speci fic times. the questioning and assessment was performed by non-urologists. The results obtained from the validated (QLQ-C30) and our own specially com plied questionnaire clearly demonstrate that patients with an orthotopic ne obladder are more able to adapt to the new situation than patients with an ileal conduit. In addition, neobladder to the urethra improves the quality of life because it improves self-confidence, causes better rehabilitation a s well as the restoration of leisure, professional, travelling, and social activities, and reduced risk of inadvertent loss of urine. For example, 92. 8% of neobladder patients did not feel handicapped at all, and 87% did not feel sick or ill, in contrast to 51.5% and 66.7% of ileal conduit patients, respectively. Of the neobladder patients, 74.6% felt absolutely safe with the urinary diversion in contrast to 33.3% in the ileal conduit group. Only 1.5% of neobladder patients had wet clothes caused by urine leakage during the day, versus 48.5% of ileal conduit patients. Moreover, 97% of our neob ladder patients would recommend the same urinary diversion to a friend suff ering from the same disease, but only 36% of ileal conduit patients would d o so. These results demonstrate that the quality of life is preserved to a higher degree after orthotopic neobladder than after ileal conduit urinary diversion.