Outcome and quality of life in patients operated on with radical cystectomy and three different urinary diversion techniques

Objective. To assess outcome and quality of life (QoL) aspects among patients treated with three different diversion techniques: Bricker, Studer or Hemi-Kock, after radical cystectomy. Material and methods. Thirty-seven patients with Bricker conduit, 19 with Studer neobladder and 16 with Hemi-Kock neobladder answered a questionnaire concerning QoL, general health, relationship with partner, sexual function, satisfaction with information and follow-up, etc. Response rates were 79% (37/47), 100% (18/18) and 86% (19/22), in Bricker, Studer and Hemi-Kock patients respectively. Medical records were reviewed to assess cancer type, grade and stage. Results. Both Studer and Bricker patients reported a high mean value of QoL (p0.05). QoL was not influenced by tumour stage (pTa-T2 versus pT3-4) (p0.05). After surgery, more Studer patients (78%) experienced practical problems compared with Bricker patients (40%) (p=0.01). Studer patients reported a higher influence on the everyday life compared with Bricker and Hemi-Kock patients (p0.01 and p=0.05, respectively). Leakage in day-time was reported by 53% of Studer patients and 16% of Hemi-Kock patients (p=0.03). Moreover, all Studer patients had leakage at night compared with 58% of Hemi-Kock (p0.01). The follow-up time after surgery was 56 months for Hemi-Kock patients compared with 26 months for Studer patients. Erectile dysfunction was reported by 81% of the men, with no difference between the methods of diversion. Conclusions. Patients in all diversion groups rated their QoL as high. Type of urinary diversion was not associated with any statistically significant difference in QoL outcome. However, Studer patients reported less favourable outcome regarding urinary continence compared with Hemi-Kock patients, probably owing to factors as shorter follow-up and surgical skill and experience. The results regarding urinary continence may explain why Studer patients reported more practical problems and a higher influence on their everyday life than Bricker and Hemi-Kock patients.