| Objective:To investigate the clinical effacy and quality of life of patients undergoing complete robotic-assisted laparoscopic radical cystectomy followed by cutaneous ureterostomy,ileal conduit and orthotopic bladder substitute.Methods:From January 2020 to September 2022,the Department of Urology II at First Hospital of Jilin University provided clinical data on patients who had undergone cutaneous ureterostomy,ileal conduit and orthotopic bladder substitute after robotic-assisted laparoscopic radical cystectomy.In September 2022,we conducted a retrospective analysis,with the patients split into three distinct groups based on inclusion and exclusion criteria as well as their urinary diversion methods: group A: cutaneous ureterostomy(CU)group,group B: ileal conduit(IC)group and group C: orthotopic bladder substitute(OBS)group.Comparing the basic data,perioperative conditions,complications,and postoperative quality of life of the three groups,analysis was conducted.Results:In our research,a total of fifty-six patients,fifty males and six females,eventually met the requirements according to the inclusion and exclusion criteria,there were twenty-five patients in group A,nineteen in group B and twelve in group C.All patients successfully completed their treatment at our centre.The results were consistent in terms of age and ASA(America Society of Anaesthesiologists)classification,with a difference between group A and group C(P <0.05)and no difference between group B and group C(P >0.05),the results showed that patients who opted for cutaneous ureterostomy were older and had a higher ASA classification;those who opted for ileal conduit and orthotopic bladder substitute were relatively younger and had a lower ASA classification.In terms of operative time,there was a statistical difference(P <0.05)between group A and both groups B and C respectively,and also between groups B and C(P <0.05);the results showed that in terms of operative time group A < group B < group C.In addition,in terms of intraoperative bleeding,there was a statistical difference between group A and both groups B and group C(P <0.05),while there was no statistical difference between groups B and group C(P >0.05),the results showed that in terms of intraoperative bleeding group A < group B ≈ group C.In terms of postoperative hospital stay,there was a significant difference in group A compared to groups B and group C(P <0.05),while there was no significant difference in groups B and group C(P >0.05),the results show that in terms of postoperative hospital stay group A < group B ≈ group C.No statistically significant disparity was observed in the total occurrence of near-term complications among the three groups(P >0.05).No statistically significant disparity was observed in the total occurrence of long-term complications among the three groups(P >0.05),there was no statistically significant difference in the overall postoperative complication rate,indicating that the safety or risk profile of the three different urinary diversions was comparable.In terms of quality of life scores,there was a significant difference in the physical status scores between groups A and B as well as group C(P <0.05),while no significant difference was seen in the physical status scores between groups A and B(P >0.05),the results showed that group A ≈ group B < group C in terms of physical status scores.In terms of functional status,there was a significant difference in the functional status scores between groups A and B as well as group C(P <0.05),while no significant difference was seen in the functional status scores between groups A and B(P >0.05),the results showed that group A ≈group B < group C in terms of functional status.In terms of total FACT-BL score,there was a significant difference in the FACT-BL scores between groups A and B as well as group C(P<0.05),while no significant difference was seen in the FACT-BL scores between groups A and B(P >0.05),the results showed that group A ≈ group B < group C in terms of FACT-BL scores.Conclusion:Patients in good health can choose ileal conduit and orthotopic bladder substitute,while older patients with underlying disease may prefer cutaneous ureterostomy.The three different types of urinary diversions are comparable in terms of safety or risk.Therefore,if the risks are comparable,we should prefer the urinary diversion that matches the initial voiding habits and adapts to the patient’s lifestyle.The use of orthotopic bladder substitute after robotic-assisted laparoscopic radical cystectomy is more consistent with physiological voiding characteristics and is of great value in improving the quality of life in postoperative patients.However,due to the small sample size and relatively short follow-up period in this study,further studies with larger prospective samples and longer follow-up are needed to confirm this in the future. |
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