title: Quality of life assessment in heterotopic and orthotopic neobladder reconstruction: a comparison.
abstract: Several techniques for continent urinary diversion are developed and applied in recent years. Heterotopic or orthotopic bladder replacement is an effective treatment option in selected patients. We reviewed 45 neobladder reconstructions in 25 men and 20 women. Mean age at operation was 43.7 years, mean follow-up was 34.7 months. Indications for bladder reconstruction were transitional cell carcinoma of the bladder (18), interstitial cystitis (6), neurogenic bladder (4), refractory incontinence (3) and undiversion (14). In 27 patients an orthotopic replacement (Mainz pouch in 18 and ileal neobladder in 9) was performed, in 18 patients a heterotopic replacement (Indiana pouch) was performed. Standard radiologic evaluation included ultrasonography, intravenous urography and postoperative pouchography. Preoperative urodynamic investigation and postoperative neobladder function documentation was performed routinely. Quality of life assessment was achieved by interview and use of the sickness impact profile (SIP) questionnaire. Nineteen patients (42.2%) had a completely uneventful postoperative course. Postoperative complications were acceptable as only 2 out of 20 late complications needed an open procedure for ureteric stenosis. Peri- or postoperative mortality did not occur. The mean postoperative bladder capacity was about 600 ml; 500 ml for the ideal neobladder, 560 ml for the Indiana pouch and 700 ml for the Mainz pouch. This tendency was not statistically significant. In 34 (75.5%) patients full urinary continence was achieved. One patient was consistently stress incontinent. The final overall outcome of these reconstructive procedures was excellent in the majority of cases.
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011788:Quality of Life; D018434:Sickness Impact Profile; D016896:Treatment Outcome; D014547:Urinary Diversion / Q000379:methods / Q000523:psychology*; D016476:Urinary Reservoirs, Continent / Q000379:methods / Q000523:psychology*