Estudio de la calidad de vida en pacientes sometidos a sustitución vesical ortotópica versus ileostomía cutánea

Resumen

La calidad de vida se define como el grado de satisfacción con la vida y las circunstancias personales percibidas por la propia persona. Pretendemos comparar la calidad de vida entre los pacientes sometidos a derivación urinaria externa y sustitución vesical ortotópica, en ambos casos tras cistectomía radical.

Material y métodos

Se ha empleado un cuestionario basado en los publicados previamente, con 45 preguntas de múltiple respuesta estudiando los aspectos sociodemográficos, continencia y potencia pre y post-cirugía, estado psicológico, sexual, imagen corporal e imagen corporal percibida

Resultados

Los pacientes con derivación externa sufren una grave alteración de su imagen corporal, la fuga de orina, sobre todo nocturna es la mayor causa de estrés en estos pacientes. Los pacientes con sustitución ortotópica no se encuentran preocupados por el grado de continencia que poseen, viajan más, se sienten menos cansados y ansiosos, creen que han sido mejor informados y se volverían a someter a la intervención en un 100% de los casos

Conclusiones

Creemos que en la medida de lo posible es preferible realizar una derivación continente frente a una incontinente, en base al mayor impacto de esta última en la calidad de vida de los pacientes

Abstract

Purpose

Nowadays, pschycological and social aspects of treatment of urinary diversion after cystectomy, have become of utmost importance. Body image, potence, continence, emotional distress and dissatisfaction, functional and social activities are majors factors to improve quality of life after surgery. The aim of this study is to compare health-related quality of life after bladder substitution with ileal conduit diversion

Material and methods

We developed a questionnaire based upon a literature review, to compare health related quality of life between bladder substitution and ileal conduit (45 multiple choice mailed questionnaire). We examined functional and social activities, sexual dysfunction, urinary problems, and body image dissatisfaction

Results

78 male patients with bladder cancer, were interviewed. 91% of the questionnaires were answered, 48.7% by patients’ family and 42.3% by the patients themselves. 6 patients underwent ileal conduit and 27 underwent bladder substitution. Patients with ileal consuit presented higher body image dissatisfaction than those who underwerent bladder substitution. When urine leakageoccurred it caused more distress to the conduit patients, indicating urinary leakage as their main problem. Bladder substitution patients did not consider continence problems as very important, they had not interrupted social activities such as travelling or seeing friends. 100% of bladder substitution patients would not mind to undergo this operation again, while only 66% of ileal conduit patients would

Conclusions

Health-related quality of life is higher after bladder substitution. In our opinion we should use bladder substitution as the standard method of diversion after radical cystectomy for bladder cancer.