Health‐related quality of life after cystectomy: bladder substitution compared with ileal conduit diversion. A questionnaire survey

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Abstract
Objective To compare the health‐related quality of life after bladder substitution with that following ileal conduit diversion. Patients and methods Sixty‐seven male patients with bladder cancer completed the questionnaire; 38 had undergone bladder substitution and 29 ileal conduit diversion; the median follow‐up was 1.0 year (range 0.5–3.0) and 4.8 years (range 1.1–15.2), respectively. Semi‐structured qualitative interviews were conducted and analysed, and the questionnaire was developed based upon these results. Results Both day‐ and night‐time urinary leakage occurred more frequently following bladder substitution (18% against 10%, and 21% against 3%). Nevertheless, urinary leakage affected conduit patients more severely and they scored higher on a leakage distress scale. Furthermore, 58% of the ileal conduit but only 21% of the bladder substitution patients gave urinary leakage as their main concern (P=0.04). Ileal conduit patients did not retain their body image as well as those with bladder substitution. The frequency of both sexual and non‐sexual physical contacts decreased in the majority of the conduit patients but only in a minority of the bladder substitute patients. Global satisfaction was high and similar in both groups. Conclusion These results show that the health‐related quality of life is retained to a higher degree after bladder substitution and supports the use of this procedure as the standard method of diversion after cystectomy for bladder cancer.