Factors related to patient choice of bladder reconstruction following radical cystectomy

Abstract

Objective: To identify patient values and concerns related to choice of bladder reconstruction following removal, in order to provide understanding of factors important in making surgical decisions. Subjects and methods: Sixty-two patients treated for advanced bladder cancer (grade pT1 and above), and choosing either ileal conduit or orthotopic neobladder following cystectomy, each completed three questionnaires: European Organization for Research and Treatment quality of life questionnaire; bladder reconstruction satisfaction questionnaire; and life values inventory. Results: Health status (European Organization for Research and Treatment quality of life questionnaire) was not related to procedure satisfaction. Older, and female, patients had ileal conduit. Ileal conduit patients rated ease of postoperative maintenance, and perceived ease of surgery, as more important; neobladder patients rated returning to normality as more important (bladder reconstruction satisfaction questionnaire). Ileal conduit patients had higher life values (life values inventory) concerning environment, humility and loyalty; while neobladder patients had higher values concerning creativity, independence and science. Conclusion: Pre-existing concerns influence choices that patients make between ileal conduit and neobladder after removal of their bladder. Those wanting to minimise surgical difficulty and extra work following the reconstruction, and valuing living their life with regard to others, favour ileal conduit. Patients being younger, male, valuing the way they lived their life preoperatively, and valuing science/technology, favour neobladder. These findings are a stepping stone towards developing a tool to aid joint patient/consultant decision-making, when planning reconstructive surgery for bladder cancer. Level of evidence: Not applicable for this multicentre audit.