Long-term Quality Of Life Assessment For Orthotopic Neobladder

Objection:Taking long term follow up of the patients undergoing orthotopic new bladder and urinary diversion, using FACT-BL scale to assess the health-related quality of life in patients,analyzing the results of long follow-up and providing a basis for further study of the operation of the new bladder in situ.Method:To retrospectively review our clinical experience of 73 patients who accepted radical bladder resection surgery and in situ neobladder from January of 2001 to October of 2012 for bladder cancer,(28 cases of the sigmoid colon orthotopic neobladder and 45 cases of orthotopic ileal neobladder). For patients who meet the inclusion criteria, we take long follow-up through letters, telephone. Investigating and analyzing the HRQOL status after operation by using FACT-BL.Result:Of all the 73 patients received radical resection of the bladder,67 cases were in accordance with the inclusion criteria. We lost 4 cases, 2 patients died of other diseases, and 2 patients did not complete long-term follow-up due to other reasons. The age of patients is between 48~73 years old, average 61 years old. The surgery were successfully completed and postoperative recovery is good, all patients were discharged from hospital.Of the 59 patients who completed the follow-up, 13 patients(22.03%) had early complications, and 16 patients(27.12%) had late complications. Preoperative and postoperative serum Cr contrast(t=1.305, P=0.196), BUN contrast(t=0.358, P=0.764), the difference between them were not statistically significant; Comparison of K+ before and after surgery(t=1.347, P=0.169), Na+(t=-1.748, P=0.144), and Ca+(t=1.097, P=0.319), the difference was not statistically significant, Cl- contrast(t=-4.701, P=0.000), the difference has statistical significance. After removal of the catheter in 4~6 weeks, 54 cases(91.53%) were self controlled urination during the day time, and the nocturnal incontinence rate was 100%(all 59 patients). By strengthening the urination function training, 55 cases(93.22%) were in good control during the day and 49 cases(69.49%) were good at night after two years of follow-up. Two years after surgery, the average maximum capacity of the new bladder was 286.48 + 78.16(266~417) ml, the mean maximum urinary flow rate was 11.27 + 3.51(5.32~22.07) ml/s, the average void resting pressure of the new bladder was 9.62 + 2.78(6.09~14.15) cm H2O(1cm H2O=0.098Kpa) and mean residual urine volume was 15.62 + 6.13(0~42) ml. Assessed by FACT-BL scale, after two years of follow-up, the FACT-BL score of the sigmoid colon new bladder group was 125 + 13.4 and the FACT-BL score of orthotopic ileal neobladder group was 124.5±13.4.Conclusion:1、After our long term follow up,the urine control rate of daily life and the night life of the patients with bladder cancer after operation can meet the requirements of daily life. The early and late complications are within the acceptable range. Follow up the urodynamic index of orthotopic bladder, the neobladder is more close to the physiological state of the urine storage, urination function. In the follow-up period, there are less electrolyte balance disorder occurred in patients and pper urinary tract function recovered well.2、The integrity of the body appearance was preserved in orthotopic bladder operation and the neobladder’s physiological characteristics are close to the normal bladder. After operation,patients can have a good quality of life. This urinary diversion can help patients build stronger confidence and will gradually become the main choice of urinary diversion in patients with bladder cancer.