title: Sleep disturbances decrease self-assessed quality of life in individuals who have undergone cystectomy.
abstract: OBJECTIVE
  The best possible urinary diversion after cystectomy, if any, is yet to be defined to our knowledge. Therefore, we investigated nocturnal urinary disturbances and quality of life in individuals who have undergone cystectomy with urinary diversion for bladder cancer.
  
  
  METHODS
  All patients 30 to 80 years old who had undergone cystectomy with urinary diversion at 7 urological centers in Sweden were included in the study. Sleep disturbances, nocturnal urinary leakage and urine evacuation frequency, as well as their effect on self-assessed quality of life variables were measured with a study specific questionnaire. We received the questionnaire from 452 (92%) of 491 identified individuals. Outcome variables were dichotomized and the results are presented as relative risks.
  
  
  RESULTS
  Those individuals with an orthotopic neobladder had an increased risk of nocturnal urinary leakage and/or urine evacuation frequency compared to those with a noncontinent urostomy or cutaneous continent reservoir. Of the patients with an orthotopic neobladder 37% reported negative effects on nocturnal sleep compared to 22% and 14% of those with a noncontinent or continent urostomy, respectively. Of those patients reporting that the urinary diversion had a negative effect on nocturnal sleep 88% had a decreased quality of life vs 65% of those who stated that the urinary diversion had no or little influence on nocturnal sleep.
  
  
  CONCLUSIONS
  Nocturnal urinary problems are of great concern for individuals with urinary diversion, especially those with an orthotopic neobladder. Regular disruption of sleep decreases quality of life.
authors.affiliation: Division of Clinical Cancer Epidemiology, Department of Oncology and Pathology, Karolinska Institutet, Stockholm, Sweden. Helena.Thulin@ki.se
authors.forename: Helena
authors.initials: H
authors.lastname: Thulin
authors.forename: Ulrika
authors.initials: U
authors.lastname: Kreicbergs
authors.forename: Hans
authors.initials: H
authors.lastname: Wijkström
authors.forename: Gunnar
authors.initials: G
authors.lastname: Steineck
authors.forename: Lars
authors.initials: L
authors.lastname: Henningsohn
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015653:Cystectomy; D005260:Female; D006801:Humans; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D011788:Quality of Life; D012307:Risk Factors; D012893:Sleep Wake Disorders / Q000453:epidemiology*; D011795:Surveys and Questionnaires; D013548:Sweden / Q000453:epidemiology; D014547:Urinary Diversion; D016476:Urinary Reservoirs, Continent; D014554:Urination