Quality of Life Following Cystectomy and Urinary Diversion Results of a Retrospective Interdisciplinary Study

Summary:

Continent urinary reservoirs are no longer surgical curiosities. but serious options replacin the incontinent conduit as the standard urinary diversion. Now that the frequency of specific complications diminishes with increasing experience the surgeon has to focus on the psychologic and social aspects of his treatment. In a retrospective study we investigated, whether continent diversion and wet urostomy disclose significant differences as to their impact on the patients' quality of life. For this purpose we developed an instrument based on a biopsychosocial model of disease. The questionnaire (102 items) was mailed to 600 patients with ileal conduits from all over Germany and to 130 of our own patients with ileocecal reservoirs. The sample included in the final analysis was restricted to those patients treated within the last five years (n= 192). The analysis did not reveal significant differences between the two groups concerning disease-related support and quality of life when expressed by means of the constructed instrument (total score). However, a statistically significant superiority of continent urinary diversion was found wiith regard to all the stoma related items and the patient's global self-assessment of their quality of line (single item) (p < 0,005), reflecting the subjective dimension of the concept. Superiority in self-ratings of physical strength, mental capacity, leisure time activities and social competence (p < 0,05) could be interpreted as indicators of vital power in patients with continent urinary diversion and thus supports our understanding that especially young women and men do have a benefit from continent reservoirs.

Key words:

Quality of life - Cystectomy - Urinary diversion