Assessment of the quality of life, complications, oncological outcome and change in renal function in patients with ileal neobladder due to invasive bladder cancer

The purpose was to assess the health-related quality of life outcome, complications, oncological outcome and changes in renal function in patients with ileal neobladder in comparison to those in patients with cutaneous diversion (ileal conduit or cutaneostomy). Between September 1992 and February 2003, we consecutively performed ileal neobladder (the Studer method) in 30 patients, and cutaneous diversion in 38 patients. In August 2004, questionnaires were mailed to all patients with invasive bladder cancer who received urinary diversion. The questionnaire included validated outcome measures, i.e. regarding the health-related quality of life (QOL) (SF-36) and a urinary incontinence questionnaire. Moreover, we also retrospectively examined the postoperative complications, oncological outcome, and changes in renal function in patients with urinary diversion. Data from 41 patients (21 ileal neobladder and 20 cutaneous diversions) were available for the analysis and the mean follow-up of respondents was 40.7 and 49.4 months, respectively. No differences in overall QOL were observed between the two groups using the SF-36. Complete daytime and night-time urinary continence was achieved in 21 patients (100%) and in 13 patients (61.9%), respectively. There were 19 early complications in 18 patients (60.0%), and 7 late complications in 6 patients (20.0%) with ileal neobladder. On the other hand, there were 15 early complications in 14 patients (36.8%), and 8 late complications in 6 patients (21.1%) with cutaneous diversions. Organ-confined disease was defined as no lymph node metastasis and pT3a or less. There were no significant differences in disease-specific survival between the NB group (26/30 cases) and the CD group (21/38 cases). There was no significant change in the serum creatinine of the CD group with regard to the transition of before and one year after the urinary diversion. Although a significant elevation (from 0.9 mg/dl to 1.0 mg/ dl) was noted in the serum creatinine of the ND group, it had little effect on clinical stage. The findings regarding the health-related QOL and the frequency of complications in the neobladder group and those in the cutaneous diversion group were similar. However, the functional results and the status of urinary continence in the neobladder patients were satisfactory.