title: Bowel function in patients with urinary diversion: a gender-matched comparison of continent urinary diversion with the ileocecal pouch and ileal conduit.
abstract: OBJECTIVE
  To evaluate stool habits and associated quality of life (QoL) in a matched pair analysis of patients who underwent continent cutaneous diversion using the ileocecal segment [Mainz pouch I (MzPI)] with an intussuscepted ileal nipple as efferent segment with those receiving an ileal conduit (IC) after radical cystectomy.
  
  
  METHODS
  We identified 250 patients who underwent radical cystectomy and urinary diversion (UD) with either MzPI with an ileal nipple or IC in our database. A detailed history of stool habits using the modified Wexner score was obtained, and questions addressing general lifestyle, comparison of symptom differences before and after surgery considering bowel function as well as bowel-associated QoL were assessed.
  
  
  RESULTS
  Forty-five age- and sex-matched pairs could be compared. Overall, stool incontinence (p = 0.481) and the Wexner score (p = 0.464) revealed no differences between both groups. However, patients with MzPI as compared to those with IC had significant higher rates of stool frequency (53 vs 31 %), softer stool consistencies (60 vs 13 %), diarrhea (62 vs 20 %) and a lower rate of constipation (4 vs 22 %). Patients with MzPI had a trend toward lower bowel-associated QoL compared with patients with IC. Similarly, the MzPI group reported a significantly impaired overall postoperative QoL (51 %) compared to the IC group (29 %) (p = 0.024).
  
  
  CONCLUSIONS
  Patients following UD by MzPI have an increased stool frequency and softer stool consistency. However, there is no difference between both groups in terms of de novo stool incontinence. Change in bowel habits should be part of preoperative informed consent in any kind of UD. Careful patient selection is of paramount importance.
authors.affiliation: Department of Urology, University Medical Center, Mainz, Johannes Gutenberg University, Langenbeckstrasse 1, 55131, Mainz, Germany. sebastian.frees@unimedizin-mainz.de.
authors.forename: S
authors.initials: S
authors.lastname: Frees
authors.affiliation: Department of Urology, University Medical Center, Mainz, Johannes Gutenberg University, Langenbeckstrasse 1, 55131, Mainz, Germany.
authors.forename: A C
authors.initials: AC
authors.lastname: Schenk
authors.affiliation: Department of Pediatric Urology, University Medical Center, Mainz, Germany.
authors.forename: P
authors.initials: P
authors.lastname: Rubenwolf
authors.affiliation: Department of Urology, University Medical Center, Mainz, Johannes Gutenberg University, Langenbeckstrasse 1, 55131, Mainz, Germany.
authors.forename: C
authors.initials: C
authors.lastname: Ziesel
authors.affiliation: Department of Urology, University Medical Center, Mainz, Johannes Gutenberg University, Langenbeckstrasse 1, 55131, Mainz, Germany.
authors.forename: W
authors.initials: W
authors.lastname: Jaeger
authors.affiliation: Department of Urology and Pediatric, University Medical Center, Mannheim, Germany.
authors.forename: J W
authors.initials: JW
authors.lastname: Thüroff
authors.affiliation: Department of Adolescent Urology, University Medical Center, Mannheim, Germany.
authors.forename: R
authors.initials: R
authors.lastname: Stein
mesh_terms: D000328:Adult; D000368:Aged; D016022:Case-Control Studies; D003248:Constipation / Q000453:epidemiology / Q000503:physiopathology; D015653:Cystectomy / Q000009:adverse effects / Q000379:methods; D005242:Fecal Incontinence / Q000453:epidemiology / Q000503:physiopathology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011788:Quality of Life; D012189:Retrospective Studies; D018570:Risk Assessment; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D001749:Urinary Bladder Neoplasms / Q000473:pathology / Q000601:surgery*; D014547:Urinary Diversion / Q000379:methods* / Q000523:psychology*; D016476:Urinary Reservoirs, Continent
keywords: Bowel function; Ileal conduit; Mainz pouch I; Quality of life; Urinary diversion