ABSTRACT
ABSTRACT Introduction: The health-related QoL is a patient-centered evaluation covering several aspects. This evaluation seems to be particularly important in patients submitted to radical cystectomy (RC) and urinary diversion with ileal conduit (IC) or a neobladder (NB). Objective: Review all recent data comparing QoL outcomes after radical cystectomy with NB and IC diversions. Evidence Acquisition: A systematic search in PubMed/Medline, Embase, and Cochrane databases was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement in December 2018. All articles published from January 01, 2012 to December 31, 2018, were included. A study was considered relevant if it compared QoL outcomes using validated questionnaires (EORTC QLQ C30, FACT-G, FACT-BL, FACT-VCI, and BCI). Evidence Synthesis: In 11 included studies, a total of 1389 participants were accounted (730 NB and 659 IC cases). The studies were conducted in 8 different countries, two were prospective, and none was randomized. There were two studies favoring results with a neobladder, 3 with incontinent diversion and 6 with no differences. The EORTC-QLQ-C30 was the most used instrument (5 studies) followed by FACT VCI and BCI (3 studies each). Given the heterogeneity of data and lack of prospective studies, a meta-analysis was not performed. Conclusion: No superiority of one urinary diversion was characterized. It seems that the choice must be individualized with an extensive preoperative orientation of the patient and their relatives. That will probably influence how the patient accepts the new condition.
Subject(s)
Humans , Male , Female , Quality of Life/psychology , Urinary Diversion/rehabilitation , Cystectomy/rehabilitation , Time Factors , Urinary Diversion/methods , Urinary Diversion/psychology , Cystectomy/methods , Cystectomy/psychology , Surveys and Questionnaires/standards , Treatment OutcomeABSTRACT
Vários materiais aloplásicos têm sido preconizados na substituiçäo parcial da bexiga. Eles divergem em muitos aspectos, entre os quais o tempo adequado de reabsorçäo, a rejeiçäo, a formaçäo de cálculos, o tempo de reepitelizaçäo, a neoformaçäo de músculo e, o principal deles, a manutençäo das funçöes fisiológicas normais da bexiga, tais como: armazenamento com continência, esvaziamento adequado da urina e proteçäo aos rins. Com o objetivo de se avaliar, na bexiga, a repercussäo da cistoplastia com dura-máter e pericárdio bovino, estudaram-se, em 40 coelhos fêmeas, North Folk, com peso entre 1.350 e 4.500 g, os seguintes parâmetros: 1. cultura de urina; 2. estudo cistométrico; 3. uréia e creatinina plasmáticas. A pesquisa constou de quatro grupos experimentais, sendo cada um composto por dez coelhos, assim discriminados: G1 - Controle clínico, näo houve intervençäo cirúrgicas. G2 - Controle cirúrgico, realizamos cistectomia subtotal, e a porçäo excisada da bexiga era novamente anastomosada na regiäo trigonal. G3 - Dura-máter liofilizada, realizamos cistectomia subtotal e a parede vesical excisada era substituída por implante de dura-máter liofilizada de 3x1 cm. G4 - Pericárdio bovino, realizamos cistectomia subtotal e a parede vesical excisada era substituída por implante de pericárdio bovino de 3x1 cm. Os parâmetros foram estudados nos momentos: M1 - pré-operatório e M2 - doze semanas de pós-operatório. A avaliaçäoo cistomanométrica demonstrou näo haver diferenças significativas entre os diversos parâmetros, exceto uma tendência, em números absolutos, de reduçäo da capacidade vesical nos grupos 3 e 4. A complacência vesical ficou reduzida no grupo 4 nos diferentes momentos. Detectou-se 20 por cento de calculose vesical nos grupos 3 e 4. A análise físico-química do cálculo revelou composiçäo semelhante aos dois grupos