Health-related quality of life after radical cystectomy and ileal orthotopic neobladder: effect of detailed continence outcomes

Abstract

Purpose

To objectively quantify continence rates and to correlate continence outcomes with health-related quality of life (HRQOL) after radical cystectomy and orthotopic ileal neobladder (ONB).

Methods

Questionnaires were sent to 244 patients who underwent radical cystectomy with ONB between 2004 and 2015, and information about the current continence status was retrieved. To objectify postoperative urine loss, daytime and nocturnal pad tests were performed. Continence was defined as need of up to one safety pad. HRQOL was assessed using EORTC QLQ-C30 scoring with global health status being the primary endpoint. Statistical analysis included Fisher’s test, Mann–Whitney U test, Pearson’s rank correlation, and binary regression models (p < 0.05).

Results

178 patients (73.0%) answered the QLQ-C30 questionnaires and were included in the study. Median follow-up was 61 months. Median daytime pad use was 1 and median daily urine loss based on pad testing was 4.0 g, leading to a daytime continence rate of 48.5%. Continence had a significant impact on postoperative HRQOL (p = 0.017). ICIQ-SF score (p = 0.001, OR = 0.805) and need for condom catheter during nighttime (p = 0.015, OR = 0.123) were independent predictors for worse HRQOL outcomes based on global health status. A history of pelvic floor muscle training was an independent predictor of increased HRQOL (p = 0.009, OR = 10.459).

Conclusions

Need of condom urinals and higher ICIQ-SF scores are independent predictors for worse HRQOL outcomes. We show significant beneficial effects of pelvic floor muscle training on patients' HRQOL.

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Fig. 1

Abbreviations

BMI:

Body mass index

CI:

Confidence interval

CIC:

Clean intermittent self-catheterization

ECOG:

Eastern Cooperative Oncology Group

EORTC:

European Organization for Research and Treatment of Cancer

HRQOL:

Health-related quality of life

ICIQ-SF:

International consultation on incontinence questionnaire short form

OR:

Odds ratio

ONB:

Orthotopic ileal neobladder

PFMT:

Pelvic floor muscle training

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Authors

Contributions

TG Project development, Data Collection, Manuscript writing. JG Project development, Data Collection. AB Project development, Data Collection. GS Project development, Data Collection. FJ Data Collection, Manuscript writing. CGS Project development. AK Project development. AK Project development, Statistical analysis, Manuscript writing.

Corresponding author

Correspondence to Tobias Grimm.

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The authors declare that they have no conflict of interest.

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Informed consent was obtained from all individual participants included in the study.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Grimm, T., Grimm, J., Buchner, A. et al. Health-related quality of life after radical cystectomy and ileal orthotopic neobladder: effect of detailed continence outcomes. World J Urol 37, 2385–2392 (2019). https://doi.org/10.1007/s00345-019-02643-8

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Keywords

  • Cystectomy
  • Urinary incontinence
  • Ileal neobladder
  • Bladder cancer
  • Quality of life