HRQOL IN PATIENTS WITH ILEAL CONDUIT OR ORTHOTOPIC NEOBLADDER: A COMPARATIVE PROPENSITY SCORE MATCHED ANALYSIS

Introduction/Aim: Bladder cancer (BC) is a disease playing an important role in urological clinical practice. When a radical cystectomy (RC) is indicated, the ideal urinary diversion after RC should be easy to prepare and easy to handle, presenting few complications, low mortality and morbidity; moreover, it should protect the upper urinary tract function and should be well-accepted by the patient, thereby ensuring the best health- related quality of life (HR-QoL) as possible. The aim of this study was to compare HR-QoL domains with two forms of urinary diversions, including ileal conduit (IC) and ileal orthotopic neobladder (IONB) in patients with BC. Patients and Methods: This retrospective multicentre cohort study included 148 (115 males and 33 females; mean age=70.76±8.27 years) and 171 (156 males and 15 females; mean age=64.33±9.38 years) patients who underwent RC and urinary diversion with an IC and an IONB, respectively. Different domains of patients’ HR-QoL were assessed postoperatively using the EORTC QLQ C-30 and the EORTC QLQ BLM-30 as validated questionnaires. A comparative analysis using propensity score matching was performed with matching variables of age, gender, number of underlying diseases and pathologic T and N stages, for comparison of HR- QoL between IC and IONB. Results: In this series, at a mean follow-up of 48.35±39.21 months, in questions addressing physical functioning (PF), emotional functioning (EF), cognitive functioning (CF), symptoms of fatigue (FA), dyspnoea (DY), appetite loss (AP), constipation (CO) and abdominal bloating and flatulence (AB), patients with IONB had a significant more favourable outcome ( p= 0.006, p= 0.023, p= 0.000, p= 0.001, p= 0.007, p= 0.012, p= 0.000 and p= 0.000, respectively). Interpretation of Results: After propensity score matching, the best results of IONB -in terms of HR-QoL- were confirmed, thus adding other two aspects in favour of IONB (pain and sleep disturbance, p= 0.007 and p= 0.003, respectively). Conclusion: Ileal orthotopic neobladder after radical cystectomy provides, in many aspects, better results of HR-QoL as compared with ileal conduit diversion.