Morbidity And Quality Of Life In Elderly Patients Receiving Ileal Conduit Or Orthotopic Neobladder After Radical Cystectomy

Main Category: Urology / Nephrology
Also Included In: Cancer / Oncology;  Clinical Trials / Drug Trials
Article Date: 10 May 2008 - 0:00 PST

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UroToday.com - Contemporary teaching is that the quality of life of patients with invasive bladder cancer undergoing a radical cystectomy and neobladder is superior to that of patients undergoing an ileal conduit. In this study, the authors evaluated the morbidity, survival, and quality of life in elderly patients with invasive bladder cancer undergoing a radical cystectomy who received an orthotopic neobladder or an ileal conduit. This was a retrospective review of 85 patients, aged 75 or older (median age 78), who had received an ileal conduit (n = 53) or an orthotopic neobladder (n = 32) after radical cystectomy at 3 Italian institutions. The European Organization for Research and Treatment of Cancer (EORTC) instruments quality of life questionnaire C30 (QLQ-C30) and QLQ-muscle-invasive bladder cancer module (QLQ-BLM) were utilized in 34 of the 37 patients alive at the time of evaluation

As expected, tumor stage significantly affected survival whereas the type of urinary diversion did not. The Global Health Status scores in the neobladder group were higher than in the ileal conduit group but the difference was not statistically significant. Similarly, the QLQ multi-item scales were comparable in the 2 groups. Overall, 56% and 25% daytime and nighttime complete continence rates were observed in patients with an orthotopic neobladder.

The authors conclude that a neobladder can be done safely in elderly patients with acceptable quality of life outcomes. However, for a neobladder to be justified in the elderly patient, an improved quality of life would be necessary. The high nighttime incontinence rate (75%) may explain why the quality of life was not better in the neobladder group. Likewise, a larger patient sample may be needed to demonstrate an improved quality of life outcome.

Reported by UroToday.com Contributing Editor David P. Wood, MD

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