原位回肠膀胱对上尿路功能影响的回顾性分析

目的:探讨原位回肠膀胱对上尿路功能的影响。方法:评估2006年3月至2011年6月陕西省核工业二一五医院泌尿外科收治的34例肌层浸润性膀胱尿路上皮癌行膀胱全切W形原位回肠代膀胱患者的上尿路功能,所有病例随访时间5年以上,均无复发及转移。评估项目包括肌酐测定、泌尿系B超测定膀胱残余尿量及肾积水量、膀胱造影明确有无尿液返流。结果:术后2年,膀胱造影5例（14.7%）患者出现反流致轻度肾积水,与术前比较差异无统计学意义（χ2=2.110,P>0.05）,术后5年,膀胱造影6例（17.6%）患者出现反流致轻度肾积水,与术前比较差异无统计学意义（χ2=1.531,P>0.05）;术前血肌酐（77.32±13.78） mmol/L,术后2年血肌酐（78.50±12.37） mmol/L（t=-1.93,P>0.05）;术后5年血肌酐（82.15±22.49） mmol/L（t=-2.36,P>0.05）,无统计学差异,且均在正常范围。术后2年膀胱容量（413±19） ml,残余尿量（57.3±36.1） ml,术后5年膀胱容量（423±17） ml,残余尿量（53.3±33.7） ml,残余尿量差异无统计学意义（t=-0.29,P>0.05）。结论:原位W型回肠膀胱可作为膀胱全切术后理想的代膀胱术式,对上尿路功能影响较轻。     

腹腔镜根治性膀胱切除+原位回肠新膀胱术治疗浸润性膀胱癌的临床疗效分析

目的:探讨腹腔镜根治性膀胱切除+原位回肠新膀胱术治疗浸润性膀胱癌的临床疗效.方法:回顾性分析2010年2月至2015年11月于蚌埠医学院第一附属医院行腹腔镜根治性膀胱切除+原位回肠新膀胱术的32例浸润性膀胱癌患者的临床资料,对手术方法(腹腔镜根治性膀胱切除+原位回肠新膀胱术)、围手术期资料、新膀胱功能、术后并发症以及肿瘤控制情况等进行分析.结果:成功随访32例,随访时间12 ～ 53个月,平均随访27个月,均为男性;所有患者手术均由同一术者顺利完成,手术时间310 ～530 min,平均370 min;术中出血300～ 850 ml,平均485 ml;术后3～5天肠道开始恢复功能;淋巴结清扫数目8～31个,平均16个;手术切缘均无阳性结果;术后12个月与6个月相比较,最大尿流率(15.2±1.3vs11.4±1.2 ml,P＜0.01)、最大膀胱容量(372.8±52.2 vs 247.9±60.3 ml,P＜0.01)、残余尿量(23.8 ±9.6 vs 39.6±11.7 ml,P＜0.01)、最大膀胱充盈压(33.7 ±5.7 vs 25.1±6.8 cmH2O,P＜O.01)、最大膀胱排尿压(63.7±15.9 vs62.9±17.6 cmH2O,P＞0.05)、膀胱顺应性(26.2±12.6 vs 25.7±13.3 cmH2O,P＞0.05)以及昼/夜控尿率(91％/81％ vs 84％/72％).术后近期并发症发生率为18.8％(6/32),远期并发症发生率为25.0％(8/32);随访期间,肿瘤局部复发率和远处转移率分别为6.3％ (2/32)和12.5％(4/32).结论:腹腔镜根治性膀胱切除+原位回肠新膀胱术是安全可行的,具有术后控尿效果好、满意的新膀胱功能和肿瘤控制效果等优点,是治疗浸润性膀胱癌的优先选择.     

经尿道辅助单孔腹腔镜下根治性膀胱切除联合原位回肠新膀胱术的疗效及安全性

目的:探讨单孔腹腔镜下根治性膀胱切除术联合原位回肠新膀胱术的疗效及安全性。方法:选取2017年01月至2019年12月于本中心收治的17例膀胱癌患者,其中7例患者在经尿道途径的辅助下行单孔腹腔镜根治性膀胱切除术联合原位回肠新膀胱术;另外10例为对照组,行多孔腹腔镜下根治性膀胱切除术联合原位回肠新膀胱术,并对两组患者围手术期资料、手术并发症以及术后随访情况进行分析。结果:两组共17例膀胱癌患者均顺利完成手术,无中转开放手术。两组患者的年龄、体质量指数（body mass index,BMI)等差异均无统计学意义（P＞0.05）。单孔组与对照组平均手术时间分别为（341.4±52.1）min和（333.0±59.5）min,术中平均出血量分别为（206.4±104.6）mL和（190.5±82.3）mL,盆腔淋巴结清扫平均个数分别为17（7~22）个和18（12~23）个,术后平均住院天数分别为（25.1±5.4）d和（26.8±6.0）d,差异均无统计学意义（P＞0.05）。而单孔组在术后VAS疼痛评分和切口满意度评分上则优于对照组（P＜0.05）。其中单孔组患者术后随访12个月时患者的最大尿流量、最大膀胱容量、最大膀胱充盈量均明显比6个月时高,而随访12个月时患者的残余尿量较6个月时低,差异均具有统计学意义（P＜0.05）。结论:经尿道辅助单孔腹腔镜下根治性膀胱切除术联合原位回肠新膀胱术是安全可行的,且术后的新膀胱功能较为良好。     

咀嚼口香糖对根治性膀胱全切+回肠膀胱术后患者胃肠功能恢复的影响

目的:探讨咀嚼口香糖对回肠膀胱术后患者胃肠功能恢复的影响.方法:2014年2月至2015年2月我科对146例恶性膀胱肿瘤患者均实施了根治性膀胱全切+回肠膀胱术,将146例患者随机分为实验组和对照组,每组各73例.对照组采用常规的床上活动的护理方法来促进胃肠功能恢复,实验组在采用床上活动的护理常规的基础上,在患者手术完毕回到病房后6小时后开始咀嚼口香糖,每天早、中、晚3次,每次2片,每次时间15分钟,直到肛门排气.观察两组患者术后首次排气时间以及术后发生腹胀的情况.结果:两组患者术后排气时间差异比较有统计学意义(Z=-4.633,P＜0.001),实验组患者术后排气时间短于对照组.结论:咀嚼口香糖有助于根治性全膀胱切除+回肠膀胱术后患者胃肠功能的恢复.咀嚼口香糖是一种价廉、方便的促进肠道蠕动、恢复肠道功能的方法,可作为术后辅助回肠膀胱术患者康复的护理措施.     

Current indications and results of orthotopic ileal neobladder for bladder cancer

During the past three decades, the reconstructive aspects of urologic surgery emerged and became a major component of our surgical specialty, and the most relevant developments have been observed in the field of urinary diversions. Health-related quality of life and self esteem have been improved following orthotopic bladder substitutions, which are actually the preferred method for continent urinary diversion. Patients with neobladders have enhanced cosmesis and the potential for normal voiding function with no abdominal stoma. Patient’s selection for orthotopic neobladder formation is mandatory as most of the surgical complications or consequences associated with a neobladder are correlated not only with surgical technique or management after surgery, but also with wrong patient’s selection. The principles of intestinal detubularization and reconfiguration to obtain spherical reservoir are the basis of continent urinary diversions and ileum seems to be preferable over any other segment. Nowadays, ileal neobladder is a widely adopted solution after cystectomy with a neobladder rate of 9–19% for population-based data with an increase to 39.1–74% for high-volume centers. However, controversies still exist in this urological field about the best candidates for neobladder construction, the best type of neobladder to offer, whether or not an antireflux uretero intestinal anastomosis should be used, the future of minimally invasive approaches, that is, robotic assisted cystectomy plus extracorporeal or intracorporeal neobladder, and last but very important, the functional results and the level of symptoms-induced distress and quality of life in the long term in patients with bladder cancer receiving an orthotopic bladder substitution. All these issues are discussed on the basis of the most recent published data.     

腹腔镜根治性膀胱切除+回肠原位新膀胱术疗效分析

目的:回顾分析腹腔镜下全膀胱切除+回肠原位新膀胱术的临床疗效与经验.方法:随访了2006年1月-2012年2月采用腹腔镜下根治性膀胱切除术+回肠原位新膀胱术治疗的87例患者,手术方法为腹腔镜下膀胱全切术+开放新膀胱构建及吻合,并对随访3年的临床数据进行总结分析.结果:大多数患者恢复良好,所有的新膀胱漏尿并发症均被有效处理;仅有1例患者因肠瘘行肠造口,3个月后行肠回纳;术后3年整体生存率为88.5％(77/87),无瘤生存率为92.2％ (71/77);整体控尿功能及肾功能保护方面取得良好效果.结论:腹腔镜下根治性膀胱全切+回肠原位新膀胱术,具有良好的控尿功能和较好的保肾功能,可以明显提高患者生活质量.     

The S-shaped orthotopic ileal neobladder substitute incorporating a new seromuscular antireflux technique (split ileal end) in a series of 50 patients

Objective

The purpose of this study was to assess the function of our new technique, complications, continence, voiding patterns in those patients with the clinical evaluation of the S-shaped orthotopic ileal neobladder substitute incorporating a new antireflux technique.

Patients and methods

Between April 2002 and November 2006, 50 patients (44 men and 6 women) underwent radical cystectomy and S-shaped ileal neobladder reconstruction with our new antireflux technique (split seromuscular). The mean age of male patients was 58 years (45–71 years). The mean age of female patients was 50 years (45–55 years). In all patients an S-shaped ileal pouch was constructed incorporating the new antireflux technique. This antireflux has not yet been described in the literature before. All procedures are performed by the same surgeons and the mean follow-up was 30 months. Complications were registered as early (occurring within 3 months) or late (occurring after 3 months), and as diversion-related and diversion-unrelated. Continence and voiding patterns were also evaluated.

Results

There is no reflux in all patients except one. Early complications occurred in 8 patients. The most common early diversion-related complication was urinary leakage in 3 patients. No patients sustained an early diversion-related complication attributed to the new antireflux technique. Late complications occurred in 6 patients. Overall, 39 patients voided to completion without needing catheterization. A total of 7 patients required some form of clean intermittent catheterization to empty the new bladder completely including 5 of 44 men (12.5%) and 2 of 6 women (33.3%).

Conclusions

The functional results with this pouch incorporating the new antireflux technique were efficient. Our S-shaped pouch has reduced the length of intestine (37 cm) that minimized the metabolic and malabsorption complications. Moreover it is simple.     

The 'pitcher pot' ileal neobladder: early experiences

OBJECTIVE: To analyse initial results of newly designed ileal neobladder-a modification of Studer neobladder METHODS: Twenty-four patients with urinary bladder cancer underwent radical cystoprostatectomy from February 2005 to March 2006. Twenty-one of them had urinary diversion using ileal neobladder in spherical configuration with ileal neourethra (giving the shape of an inverted Indian earthenware container called a 'pitcher pot') to circumvent the problem of short mesentery and construct a low-pressure spherical ileal neobladder. RESULTS: Early post-operative complications occurred in 42% of patients. Late complications occurred in 23% of patients. Most of these complications were minor, mainly as a result of wound infection, urine leak or urinary tract infections and were managed conservatively. No early post-operative mortality was observed. Daytime continence was achieved in 100% of patients who completed the 1 year follow-up. Night-time continence was variable as it depended on timed voiding--75% of patients achieved nocturnal continence by 1 year. The functional neobladder capacity was 426 ml. The mean post-operative residual volume was 36 ml. Three patients required cystoscopic mucus evacuation and catheterization. None of them required clean intermittent catheterization. No significant metabolic disturbance occurred in any patient. CONCLUSIONS: Length of mesentery remains one of the factors in deciding the segment of intestine to be taken for neobladder. Ileal neourethra gives about 2-3 cm extra length to perform tensionless anastomosis, which is a key factor in the smooth recovery after such major surgery and also maintains optimum urodynamic features of neobladder.     

原位回盲肠新膀胱术的初步研究

目的:探讨逆行全膀胱切除术后原位回盲肠新膀胱术的手术方式、近期疗效和尿流动力学特点。方法:回顾性分析2018年11月至2019年8月我科收治并行原位回盲肠新膀胱术膀胱癌患者4例,所有患者先行腹膜外逆行根治性全膀胱切除,截取回盲肠构建新膀胱,再将新膀胱与尿道吻合重建尿流通道。术后定期复查尿动力、肾功能、彩超等检查。结果:本组患者随访6~16个月,术后初期患者均有不同程度溢尿现象,3个月后逐步恢复并能良好控尿。1例术后出现尿道吻合口轻度狭窄并输尿管返流。新膀胱最大储尿容量(401.7±53.0)ml,储尿期膀胱内压(19.0±5.7)cmH2O,尿道闭合压(53.6±9.4)cmH2O,储尿期膀胱内压明显小于尿道闭合压,最大尿流率(18.7±1.5)ml/s,平均残余尿量(21.3±4.4)ml。结论:全膀胱切除术后原位回盲肠新膀胱术具有储尿囊容量大、压力低、可控性好、操作简单的优点,是一种较理想的尿流改道方式。     

男性全膀胱切除后下尿路功能重建——附120例报告

目的 改良全膀胱切除和原位新膀胱术治疗浸润性膀胱癌的临床经验.方法 采用改良全膀胱切除和原位新膀胱术治疗局部浸润性膀胱癌患者120例,均为男性,平均年龄55.6岁.120例中移行细胞癌113例,鳞癌3例,腺癌4例.TNM临床分期T2N0M0101例、T3N0M0 7例、T3N1M0 2例.统计手术时间、术中出血和输血量,对新膀胱功能、并发症、肿瘤控制和病人生存情况进行随访分析.结果 120例患者无手术死亡,手术时间185～332分钟,平均254分钟.术中出血150～1270 ml,输血40例.病理分期T1N0M0 3例,T2N0M0 111例,T3aN0M0、T3aN1M0和T3bN1M0各2例.随访4～71个月,平均37个月.111例无瘤生存,因肿瘤死亡9例.新膀胱白天控尿良好112例(93.3%),夜间控尿良好95例(79.2%).残余尿量0～100 ml 112例,101～250 ml 8例.主要并发症:切口裂开3例,二次缝合治愈;输尿管吻合口漏1例,再吻合后治愈;输尿管口狭窄4侧,2侧经内镜下切开和扩张纠正,2侧行输尿管新膀胱再吻合治愈.输尿管口粘连4侧,经内镜下手术纠正;严重肠梗阻3例和慢性酸中毒低钾2例,均经内科处理纠正.结论 改良全膀胱切除和原位新膀胱术后严重并发症少、肿瘤控制满意,重建的新膀胱功能良好,能较好保持患者的生活质量,是目前治疗浸润性膀胱癌最理想的方法之一.     

Long-term functional outcome and late complications of Studer's ileal neobladder

OBJECTIVE: The purpose of this study was to evaluate the long-term functional outcome and late complications of Studer's ileal neobladder. METHODS: The study included 57 patients who underwent radical cystectomy and bladder reconstruction with Studer's ileal neobladder, and were followed-up for at least 3 months after surgery. The voiding and storage function, and late complications were evaluated. The times of evaluation after surgery were categorized into periods I (3-23 months), II (24-59 months), III (60-95 months) and IV (> or =96 months). RESULTS: Daytime and night-time continence rates were 95.6 and 88.6%, respectively. The averages of functional capacity (439 ml), maximum flow rate (15.7 ml/s) and residual urine (35 ml) evaluated in period I were maintained in period IV. Of the 57 patients, intermittent self-catheterization was needed in five (8.8%) due to incomplete emptying or urinary retention. Urethroileal anastomotic stricture was found in two patients (3.5%), who were successfully treated by transurethral intervention. Inguinal hernia was found in seven patients (12.8%), five of whom developed it within 2 years after surgery. CONCLUSIONS: Our results indicate that Studer's ileal neobladder had a favorable long-term functional outcome. Although late complication rates were low, the incidence of inguinal hernia was relatively high, and this was considered as a definite late complication in our study.     

A prospective randomised controlled trial of laparoscopic vs open radical cystectomy for bladder cancer: perioperative and oncologic outcomes with 5-year follow-upT Lin et al

Background:

Laparoscopic radical cystectomy (LRC) is increasingly being used for muscle-invasive bladder cancer. However, high levels of clinical evidence comparing laparoscopic vs open radical cystectomy (ORC) are lacking.

Methods:

A prospective randomised controlled clinical trial comparing LRC vs ORC in patients undergoing radical cystectomy for bladder cancer. Thirty-five patients were eligible for final analysis in each group.

Results:

The median follow-up was 26 months (range, 4–59 months) for laparoscopic vs 32 months (range, 6–60 months) for ORC. Significant differences were noted in operative time, estimated blood loss (EBL), blood transfusion rate, analgesic requirement, and time to resumption of oral intake. No significant differences were noted in the length of hospital stay, complication rate, lymph node yield (14.1±6.3 for LRC and 15.2±5.9 for ORC), positive surgical margin rate, postoperative pathology, or recurrence rate (7 for LRC and 8 for ORC). The 5-year recurrence-free survival with laparoscopic vs ORC was 78.5% vs 70.9%, respectively (P=0.773). The overall survival with laparoscopic vs ORC was 73.8% vs 67.4%, respectively (P=0.511).

Conclusion:

Our study demonstrated that LRC is superior to ORC in perioperative outcomes, including EBL, blood transfusion rate, and analgesic requirement. We found no major difference in oncologic outcomes. The number of patients is too small to allow for a final conclusion.     

改良全膀胱切除和原位新膀胱术重建下尿路功能

背景与目的:全膀胱切除原位新膀胱术是治疗浸润性膀胱癌最有效的手段.但由于手术繁杂、时间长、出血和并发症较多,以及相当一部分患者控尿不佳等缺点,我们对全膀胱切除和原位新膀胱术进行了反复改良,获得了比较满意的效果,本文报告我们的经验.方法:采用改良的全膀胱切除和原位新膀胱术治疗119例临床诊断为浸润性膀胱癌的患者.男性109例,女性10例.年龄33～78岁,平均55岁.统计手术时间、术中出血和输血量,对新膀胱功能、并发症、肿瘤控制和生存情况进行随访分析.结果:对全膀胱切除和原位新膀胱术一共进行了八处改良.从2000年1月至2007年2月用改良术治疗119例,无围手术期死亡.手术时间150～330 min,平均245 min.输血39例(32.8%).术后病理分期浅表性膀胱癌(T1N0M0) 9例,浸润性110例(其中T2N0M0 102例、T3aN0M0 3例、T3aN1M0 2例、T3bN1M0 2例,、T4N1M0 1 例).随访6～72个月,平均45个月,108例生存,10例因肿瘤死亡,1例非肿瘤原因死亡.术后白天控尿良好113例(95%),夜间控尿良好97例(81.5%).主要并发症有切口裂开5例,二次缝合后治愈;输尿管新膀胱吻合口漏1例,经再次手术作输尿管再植治愈;肠梗阻3例需住院处理.输尿管末端粘连引起肾积水8例,经内镜下切断粘连后积水消退.无肠瘘和新膀胱尿道吻合口瘘或狭窄,无膀胱输尿管返流.结论:全膀胱切除后采用改良原位新膀胱术重建下尿路功能,手术时间短、出血少和并发症少,新膀胱控尿和排尿满意,是目前全膀胱切除后最理想的下尿路重建方式.     

Perioperative morbidity,bowel function and oncologic outcome after radical cystectomy and ileal orthotopic neobladder reconstruction: Studer-pouch versus I-pouch

Objective

To investigate whether the length of ileum used for ileal orthotopic neobladder (ONB) reconstruction (60 cm vs. 40 cm) after radical cystectomy (RC) for bladder cancer (BC) impacts on bowel function, postoperative complications or survival outcome.

Quality of life following urinary diversion: Orthotopic ileal neobladder versus ileal conduit. A multicentre study among long-term,female bladder cancer survivors

IntroductionWomen undergoing radical cystectomy (RC) followed by urinary diversion (UD) for bladder cancer experience a substantial reduction in health-related quality of life (HRQOL). At present, studies comparing long-term QOL outcomes for different UD methods, needed to inform evidence-based choices of bladder reconstruction for female patients, are sparse. Our objective was to compare two common UD methods in terms of their HRQOL outcomes in women.Materials and methodsWe retrospectively analysed HRQOL in 73 consecutive female bladder cancer patients having undergone orthotopic ileal neobladder (IONB, N = 24) or ileal conduit (IC, N = 49) following RC between 2007 and 2013 in six Italian academic urological centres. Patients had no evidence of tumour recurrence and were actively followed up. Validated Italian versions of the European Organisation for Research and Treatment of Cancer (EORTC) generic (QLQ-C30) and bladder-cancer-specific (QLQ-BLM30) questionnaires were used to evaluate HRQOL.ResultsPatients in the IONB group were significantly younger than those in the IC group (median age: 67 and 73 years, respectively, p = 0.02). Barring that, the two groups did not present statistically significant differences in median length of follow-up (43 vs 54 months), pathological stage, grading of the neoplasm, or adjuvant chemo - or radiotherapy. No significant differences in QOL were found between the groups, with the exception of financial difficulties, affecting IONB patients significantly more than IC patients (mean score on a scale of 0–100: 33.3 ± 29.5 vs 18.4 ± 19.3, respectively; p = 0.05).ConclusionFinancial difficulties was the only HRQOL item to differ between the two UD groups.     

阑尾输出道盲升结肠可控膀胱术(附9例报告)

目的　改进膀胱癌患者膀胱全切后贮尿囊及排尿情况。方法　根治性全膀胱切除加阑尾输出道盲升结肠带切断或去管简单重建贮尿囊可控膀胱术。结果　术后随访 2～ 19个月 ,两种术式建立的贮尿囊顺应性均良好 ,平均容积为 3 0 2ml ,内压为 8cmH2 O ,阑尾输出道最大压力为 71cmH2 O ,平均 62cmH2 O ,尿控良好 ,自行导尿容易。结论　阑尾输出道盲升结肠可控膀胱术 ,操作相对简单 ,是一种较理想的尿路改道方法 ,具有较好的临床应用价值。     

Health related quality of life after radical cystectomy: Comparison of ileal conduit to continent orthotopic neobladder

Aims

To compare health related quality of life (HRQOL) between patients with two different types of urinary diversion, ileal conduit and orthotopic neobladder, and between them and an age-matched population of healthy subjects.

Materials and methods

Eighty eight patients treated with radical cystectomy for bladder cancer at our institutions between 2002 and 2007 were contacted for this survey. All of them had a follow-up of more than 12 months after surgery and were recurrence free. The SF-36 questionnaire was provided to each patient during a follow-up visit at outpatient clinics. Overall, 79 patients (90%) returned the questionnaire and were included in this analysis. They were divided into two groups: group 1 comprised 44 patients with an ileal conduit diversion, and group 2 included 35 patients with a neobladder. As a control, normative values of an age-matched healthy Italian population were considered.

Results

No significant difference was found in scale scores between the neobladder and ileal conduit groups. Scale scores for role-physical functioning, social functioning and role-emotional functioning in both the neobladder and ileal conduit groups were significantly below the Italian population norm. Patients with a neobladder 65 years old or older (n = 18) had significantly lower scores for role-physical functioning and role-emotional functioning than those younger than 65 years (n = 17; p < 0.05).

Conclusion

Few differences between ileal conduit and orthotopic bladder substitution have been detected. Thus, the assumption that continent reconstruction provides better HRQOL than ileal conduit diversion cannot be supported. Patient education and active participation in treatment decisions seem to be the key to postoperative satisfaction.     

Use of ileal urinary diversion in conjunction with intraoperative radiotherapy

Intraoperative radiotherapy (IORT) was introduced in the 1970s as a new modality of cancer therapy. It has been especially useful after local irradiation or surgical failure. We report on the use of IORT in 13 patients with pelvic tumors requiring urinary diversion. All 13 were managed with ileal conduits. Despite the associated problems of prior abdominal procedures (11/13 patients), prior external beam radiation to the pelvis (11/13 patients), systemic chemotherapy (4/13 patients), and prolonged operative time (> 10 hours), perioperative mortality (1/13) and morbidity rates were low. We conclude that in cases of prior colonic resection and pelvic radiation, potentially irradiated ileum can be safely used for urinary diversion. © 1995 Wiley-Liss, Inc.     

Assessment of long-term quality of life using the FACT-BL questionnaire in patients with an ileal conduit, continent reservoir, or orthotopic neobladder

OBJECTIVE: To assess and compare quality of life (QOL) of patients followed for a long time who underwent an ileal conduit (IC), continent reservoir (CR) or ileal neobladder (NB) using FACT-BL, a bladder-cancer-specific questionnaire. METHODS: One hundred and forty-seven patients underwent radical cystectomy and urinary diversion for bladder cancer from 1987 to 2002 at our institution. Of them, 79 (54%) patients were asked to participate in this study. Forty-nine patients (20 IC, 14 CR and 15 NB) returned the answered questionnaire for a survey response rate of 62%. Mean follow-up was 83.0 months. RESULTS: Four categories (physical, social/familial, emotional and functional well-being) in FACT-G were equally favorable in these groups. Patients with IC had less trouble controlling urine but had a worse image on altered body appearance compared with NB patients. Interest in sex was extremely low in all patients and capability of maintaining an erection was also low in 39 male patients. The mean total value of FACT-BL in IC, CR and NB patients was 106.3+/-16.4, 104.0+/-14.2, and 110.9+/-18.0, respectively, showing no significant difference. Ten (77%) of 13 IC, seven (78%) of nine CR and six (86%) of seven NB patients answered that they would choose the same type of diversion if they had the choice again. CONCLUSIONS: The type of urinary diversion does not appear to be associated with a different QOL by general cancer-related assessment. Urinary function and body image are affected and related to the method used to reconstruct the urinary system.