Quality of life associated with orthotopic neobladder and ileal conduit in women: A multicentric cross-sectional study

Urinary function in female patients after traditional, organ-sparing and nerve-sparing radical cystectomy for bladder cancer: a systematic review and pooled analysis

OBJECTIVES

To determine and summarize the available data on urinary, sexual, and health-related quality-of-life (HRQOL) outcomes after traditional radical cystectomy (RC), reproductive organ-preserving RC (ROPRC) and nerve-sparing RC (NSRC) for bladder cancer (BCa) in female patients.

METHODS

The PubMed, SCOPUS and Web of Science databases were searched to identify studies reporting functional outcomes in female patients undergoing RC and urinary diversion for the treatment of BCa. The outcomes of interest were voiding function (for orthotopic neobladder [ONB]), sexual function and HRQOL. The following independent variables were derived and included in the meta-analysis: pooled rate of daytime and nighttime continence/incontinence, and intermittent self-catheterization (ISC) rates. Analyses were performed separately for traditional, organ- and/or nerve-sparing surgical approaches.

RESULTS

Fifty-three studies comprising 2740 female patients (1201 traditional RC and 1539 organ-/nerve-sparing RC, and 264 nerve-sparing-alone RC) were eligible for qualitative synthesis; 44 studies comprising 2418 female patients were included in the quantitative synthesis. In women with ONB diversion, the pooled rates of daytime continence after traditional RC, ROPRC and NSRC were 75.2%, 79.3% and 71.2%, respectively. The pooled rate of nighttime continence after traditional RC was 59.5%; this rate increased to 70.7% and 71.7% in women who underwent ROPRC and NSRC, respectively. The pooled rate of ISC after traditional RC with ONB diversion in female patients was 27.6% and decreased to 20.6% and 16.8% in patients undergoing ROPRC and NSRC, respectively. The use of different definitions and questionnaires in the assessment of postoperative sexual and HRQOL outcomes did not allow a systematic comparison.

CONCLUSIONS

Female organ- and nerve-sparing surgical approaches during RC seem to result in improved voiding function. There is a significant need for well-designed studies exploring sexual and HRQOL outcomes to establish evidence-based management strategies to support a shared decision-making process tailored towards patient expectations and satisfaction. Understanding expected functional, sexual and quality-of-life outcomes is necessary to allow individualized pre- and postoperative counselling and care delivery in female patients planned to undergo RC.

Radical cystectomy and women's sexual health - can we do better?

PURPOSE OF REVIEW

Female sexual function after radical cystectomy is a crucial, but historically overlooked component of bladder cancer survivorship. This review focuses on recent studies, which have investigated pelvic health and sexual function after radical cystectomy. We discuss modifiable factors, which may contribute to decreased sexual function after radical cystectomy and techniques, which may lead to improved outcomes.

RECENT FINDINGS

Sexual function is important to women and there is a significant desire (and unmet need) for more perioperative counseling and discussion regarding sexual function changes and quality of life impacts. Sexual function may be altered due to a combination of hormonal changes from ovarian removal, anatomic changes from vaginal alteration, and sensation changes due to damage to the neurovascular bundle. Techniques to preserve these structures have been developed.

SUMMARY

Sexual function is an important component of survivorship and increasing attention is being focused on this area. Long term studies with objective measures are needed for to compare various techniques and ensure oncologic safety. Ovarian preservation, anterior vaginal wall preservation, and vaginal estrogen replacement should be carefully considered for most patients.

Comparison of Health-Related Quality of Life Between Ileal Conduit Diversion and Orthotopic Neobladder in Women: A Meta-Analysis

Background

Orthotopic neobladder (ONB) reconstruction and ileal conduit diversion (ICD) can have different impacts on health-related quality of life (HRQOL) in patients with bladder cancer.

Purpose

To conduct a meta-analysis to explore the comparison of HRQOL between ICD and ONB in women.

Methods

PubMed, Embase, and the Cochrane Library were searched for available papers published from inception up to December 2020. The outcomes were the score data from HRQOL questionnaires. The random-effects model was used for all analyses.

Results

Four studies (six datasets; 283 patients) were included. In the EORTC-QLQ-C30, there were no differences between ICD and ONB regarding cognitive functioning (weighted mean difference (WMD)=1.18, 95% confidence interval (CI): -20.52,22.88, P=0.915), global health (WMD=1.98, 95%CI: -15.26,19.22, P=0.822), emotional functioning (WMD=0.86, 95%CI: -19.62,21.33, P=0.935), physical functioning (WMD=0.94, 95%CI: -11.61,13.49, P=0.883), role functioning (WMD=-4.94, 95%CI: -12.15,2.27, P=0.180), and social functioning (WMD=-4.71, 95%CI: -20.83,11.40, P=0.567). There were no differences between ONB and ICD for specific symptoms (fatigue, nausea and vomiting, and pain) and single items (dyspnea, insomnia, appetite loss, constipation, diarrhea, and financial difficulties) (all P>0.05). In EORTC-QLQ-BLM30, there were no differences between ICD and ONB regarding bowel symptoms (WMD=5.45, 95%CI: -15.30,26.20, P=0.607), body image (WMD=-13.12, 95%CI: -31.15,4.92, P=0.154), sexual functioning (WMD=-5.55, 95%CI: -14.96,3.85, P=0.247), and urinary symptom (WMD=5.50, 95%CI: -7.34,18.34, P=0.401), but one study reported better future perspective with ONB (WMD=-14.9, 95%CI: -27.14,-2.66, P=0.017).

Conclusion

Women who underwent ONB do not appear to have a statistically significantly better HRQOL than women who underwent ICD, based on EORTC-QLQ-C30 and EORTC-QLQ-BML30.