A comparison of adjustments to urinary diversions: a pilot study

Cystectomy with urinary diversion is the treatment for many patients with bladder cancer. The ileal conduit continues to be an effective solution to the diversion problem, but it brings with it problems related to management and body image. The development of the orthotopic neobladder to the urethra is a recent effort to return the body to the most natural structure and function. This development, however, brings its own set of problems to be overcome. The purpose of this exploratory study was to examine the adjustments reported by male patients with ileal conduits and neobladder replacements. A questionnaire was mailed 10 to 30 months after operation to 30 patients who underwent ileal conduit and neobladder surgery. The questionnaire explored sickness-related dysfunction and adjustments the patients had to make after operation. Twenty-three patients (12 with ileal conduits and 11 with neobladders) responded to the questionnaire. There were no statistically significant differences in sickness impact scores between the ileal conduit and neobladder groups. Few patients with ileal conduits reported problems with the device. All the patients with neobladders reported some continued incontinence, primarily at night. All the patients reported erectile dysfunction, but few had sought treatment for this problem. The patients with ileal conduits reported impact on their social activities more frequently. Future research with a larger sample is needed, but this pilot study suggests that health care workers can do more to facilitate the adjustment to loss of sexual function and social interaction.