[Quality of life after cystectomy: French national survey conducted by the French Association of Urology (AFU), the French Federation of Stoma Patients (FSF) and the French Association of Enterostomy Patients (AFET) in patients with ileal conduit urinary diversion or orthotopic neobladder].
OBJECTIVE
National multicentre study based on specific self-administered quality of life questionnaires in patients with Bricker ileal conduit urinary diversion or orthotopic neobladder.


METHODS
Questionnaires were distributed by three associations (FSF, AFU, AFET) and comprised general questions and questions specific to the type of diversion. A disability score was also included.


RESULTS
Between September 2003 and March 2004, out of a total of 5739 questionnaires, 909 were returned and 877 were analysed: 738 patients with Bricker ileal conduit and 139 with orthotopic neobladder. The two populations differed at the time of the study (Bricker: 69% of men with a mean age of 70 years, orthotopic neobladder: 95.7% of men with a mean age of 64 years). The mean interval since the operation was seven years. Ninety-four percent of patients with Bricker ileal conduit and 93% of patients with orthotopic neobladder were satisfied or very satisfied with the diversion, despite mean disability scores of 5.2+/-3.7 and 3.1+/-3.6, respectively. A correlation between this score and patient satisfaction (Wilcoxon: p<0.0001) was only observed for patients with a Bricker ileal conduit. This score was significantly related to the presence of urinary incontinence with the two types of diversion. Incontinence was frequent (16.1% with Bricker ileal conduit) and 78% of patients feared episodes of incontinence, mainly due to the appliance. Daytime incontinence was frequent for 18.1% of patients with orthotopic neobladder and 40% of patients used at least one protection per day. Out of the patients with neobladder, 82.6% experienced nocturnal incontinence, interfering with sleep in 31.9% of cases. Sexual disorders and altered bowel habit (40%) were very frequent. Stoma-therapy management was insufficient for Bricker ileal conduit and exceptional after bladder replacement.


CONCLUSIONS
Cystectomy with either ileal conduit urinary diversion or orthotopic neobladder alters many aspects of the patient's life, but patients finally accept and adapt to their new way of life.
Association française d'urologie, 12, rue de la Croix-Faubin, 75011 Paris, France. nmottet@mutualite-loire.com
N
N
Mottet
C
C
Castagnola
P
P
Rischmann
M
M
Deixonne
M
M
Guyot
P
P
Coloby
P
P
Mangin
D000368:Aged; D015653:Cystectomy; D005260:Female; D005602:France; D006306:Health Surveys; D006801:Humans; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D012735:Sexual Dysfunction, Physiological / Q000209:etiology; D012955:Societies, Medical; D014547:Urinary Diversion / Q000009:adverse effects; D014549:Urinary Incontinence / Q000209:etiology; D016476:Urinary Reservoirs, Continent / Q000009:adverse effects