Objective: To evaluate health-related quality of life (HR-QoL) outcomes in elderly patients with different type of urinary diversion (UD), ileal conduit (IC) and ileal orthotopic neobladder (IONB), after radical cystectomy (RC) for bladder cancer, by using validated self-reported cancer-specific instruments. Patients and Methods: We retrospectively reviewed 77 patients who received an IC or an IONB after RC. HR-QoL was assessed with specific and validated disease questionnaires, administered at last follow-up. Result: At univariate analysis, at a mean follow-up of 60.91 ± 5.63 months, IONB results were favourable with regard to the following HR-QoL aspects: nausea and vomiting (p = 0.045), pain (p = 0.049), appetite loss (p = 0.03), constipation (p = 0.000), financial impact (p = 0.012) and cognitive functioning (p = 0.000). This last functional aspect was significantly worse in female patients (p = 0.029). Emotional functioning was significantly better in patients without long-term complications (p = 0.016). At multivariate analysis, male gender and IONB were independent predictors of better cognitive functioning, while long-term complications negatively affected emotional functioning. Conclusions: Obtained results suggest that an IONB can also be suitable for elderly patients compared with an IC with few and selected advantages in favour of the former UD. Preoperative patient’s selection, counselling, education and active participation in the decision-making process lead to a more suitable choice of treatment.

Keywords:
Bladder cancer, Urinary diversions, Quality of life, Radical cystectomy, Orthotopic neobladder, Ileal conduit
1.
Schulman CC: The aging male: a challenge for urologists. Curr Opin Urol 2000; 10: 337–342.
2.
Izquierdo L, Peri L, Leon P, et al: The role of cystectomy in elderly patients – a multicentre analysis. BJU Int 2015; 116: 73–79.
3.
Cerruto MA, Siracusano S, D’Elia C, et al: Systematic review and meta-analysis of non RCT’s on health related quality of life after radical cystectomy using validated questionnaires: better results with orthotopic neobladder versus ileal conduit. Eur J Surg Oncol 2016; 42: 343–360.
4.
Cerruto MA, D’Elia C, Siracusano S, et al: Health-related quality of life after radical cystectomy: a cross-sectional study with matched-pair analysis on ileal conduit vs ileal orthotopic neobladder diversion. Urology 2017; 108: 82–89.
5.
Siracusano S, Niero M, Lonardi C, et al: Development of a questionnaire specifically for patients with ileal orthotopic neobladder (IONB). Health Qual Life Outcomes 2014; 12: 1–12.
6.
Aaronson NK, Ahmedzai S, Bergman B, et al: The European Organization for Research and Treatment of Cancer QLQ-C30: a quality-of-life instrument for use in international clinical trials in oncology. J Natl Cancer Inst 1993; 85: 365–376.
7.
Fayers PM, Aaronson NK, Bjordan K, et al: On Behalf of the EORTC Quality of Life Group. The EORTC QLQ-C30 Scoring Manual, European Organisation for Research and Treatment of Cancer. ed 3, Brussels, 2001.
8.
Hautmann RE, Abol-Enein H, Davidsson T, et al: ICUD-EAU International Consultation on bladder cancer 2012: urinary diversion. Eur Urol 2013; 63: 67–80.
9.
Siddiqui KM, Izawa JI: Ileal conduit: standard urinary diversion for elderly patients undergoing radical cystectomy. World J Urol 2016; 34: 19–24.
10.
Zattoni F, Palumbo V, Giannarini G, Crestani A, Kungulli A, Novara G, Zattoni F, Ficarra V: Perioperative outcomes and early survival in octogenarians who underwent radical cystectomy for bladder cancer. Urol Int 2018; 100: 13–17.
11.
Cerruto MA, D’Elia C, Siracusano S, et al: Is health-related quality of life after radical cystectomy using validated questionnaires really better in patients with ileal orthotopic neobladder compared to ileal conduit: a meta-analysis of retrospective comparative studies. Curr Urol 2016; 10: 57–68.
12.
Imbimbo C, Mirone V, Siracusano S, et al: Quality of life assessment with orthotopic ileal neobladder reconstruction after radical cystectomy: results from a prospective Italian multicenter observational study. Urology 2015; 86: 974–980.
13.
Saika T, Arata R, Tsushima T, et al: Health-related quality of life after radical cystectomy for bladder cancer in elderly patients with an ileal conduit, ureterocutaneostomy, or orthotopic urinary reservoir: a comparative questionnaire survey. Acta Med Okayama 2007; 61: 199–203.
14.
Sogni F, Brausi M, Frea B, Martinengo C, Faggiano F, Tizzani A, Gontero P: Morbidity and quality of life in elderly patients receiving ileal conduit or orthotopic neobladder after radical cystectomy for invasive bladder cancer. Urology 2008; 71: 919–923.
15.
Miyake H, Furukawa J, Muramaki M, Inoue T, Fujisawa M: Health related quality of life after radical cystectomy: comparative study between orthotopic sigmoid versus ileal neobladders. Eur J Surg Oncol 2012; 38: 1089–1094.
16.
Autorino R, Quarto G, Di Lorenzo G, De Sio M, Perdonà S, Giannarini G, Giugliano F, Damiano R: Health related quality of life after radical cystectomy: comparison of ileal conduit to continent orthotopic neobladder. Eur J Surg Oncol 2009; 35: 858–864.
17.
Gschliesser T, Eredics K, Berger I, Szelinger M, Klingler HC, Colombo T, Ponholzer A, Plas E, Grubmüller K, Dunzinger M, Jeschke K, Würnschimmel E, Krause FS, Shariat S, Leeb K, Pelzer A, Riedl C, Rauchenwald M, Hübner W, Brössner C, Madersbacher S; Cystectomy Registry of the Austrian Society of Urology: The impact of gender on tumour stage in in-house complications and choice of urinary diversion: results of the Austrian cystectomy registry. Urol Int 2017; 99: 429–435.
18.
Gacci M, Saleh O, Cai T, et al: Quality of life in women undergoing urinary diversion for bladder cancer: results of a multicenter study among long-term disease-free survivors. Health Qual Life Outcomes 2013; 11: 43.
19.
Rouanne M, Legrand G, Neuzillet Y, et al: Long-term women-reported quality of life after radical cystectomy and orthotopic ileal neobladder reconstruction. Ann Surg Oncol 2014; 21: 1398–1404.
20.
Cerruto MA, D’Elia C, Cacciamani G, et al: Behavioural profile and human adaptation of survivors after radical cystectomy and ileal conduit. Health Qual Life Outcomes 2014; 12: 46.
21.
D’Agostino D, Racioppi M, Pugliese D, et al: Postoperative quality of life in patients with ileal neobladder at short-, intermediate- and long-term follow-up. Urol Int 2016; 97: 54–60.
22.
Kikuchi E, Horiguchi Y, Nakashima J, Ohigashi T, Oya M, Nakagawa K, Miyajima A, Murai M: Assessment of long-term quality of life using the FACT-BL questionnaire in patients with an ileal conduit, continent reservoir, or orthotopic neobladder. Jpn J Clin Oncol 2006; 36: 712–716.
23.
Somani BK, Gimlin D, Fayers P, N’Dow J; Quality of life and body image for bladder cancer patients undergoing radical cystectomy and urinary diversion – a prospective cohort study with a systematic review of the literature. Urology 2009; 74: 1138–1144.
© 2018 S. Karger AG, Basel
2018
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.