Functional Outcomes and Quality of Life after Orthotopic Bladder Substitution in Bladder Cancer Patients

ABSTRACT

Radical cystectomy is the golden standard treatment for muscle-invasive bladder cancer. Urinary diversion is the prerequisite procedure after cystectomy and various type of urinary diversion has been introduced. Urinary diversion carries surgical morbidities, postoperative complications in terms of urinary function and sexual function, and issues for quality of life, which are important considerations for selecting urinary diversion. Ileal conduit urinary diversion and orthotopic bladder substitution have been regarded as the representative urinary diversion after radical cystectomy. There have been great efforts to compare the functional outcomes and quality of life between these two types of urinary diversion. Although orthotopic bladder substitution seems to a more natural and desirable urinary diversion, the currently available evidence is insufficient to draw a conclusion that orthotopic bladder is an absolutely superior form of urinary diversion. However, the vast majority of studies demonstrated that orthotopic neobladder urinary diversion shows at least equal or a marginally better quality of life scores compared to ileal conduit diversion. The favorable outcomes of orthotopic neobladder would be more pronounced especially when considering relatively young and healthy patients.