Quality of life and functional outcomes after ileocystoplasty for microcystis of tuberculous etiology

Abstract

BACKGROUND: The outcome of tuberculous bladder lesions is its irreversible shrinkage, persistent disorder of accumulative function and a significant decline in the quality of patient’s life. Supratrigonal augmentation ileocystoplasty and replacement ileocystoplasty are standard treatments for microcystis of tuberculous etiology. Currently, the advantages and disadvantages of these methods have not been sufficiently studied.

AIM: To conduct a comparative assessment of the quality of life and functional outcomes of patients with tuberculosis etiology microcystis after supratrigonal augmentation and replacement ileocystoplasty.

MATERIALS AND METHODS: The patients of the study were divided into two groups. The first group included 19 patients who underwent supratrigonal bladder resection with augmentation ileocystoplasty, the second group included 20 patients treated with replacement ileocystoplasty. In the period from one to six years after the surgery, quality of life was assessed and a complex urodynamic study was carried out.

RESULTS: Analysis of the “General health” measure according to the King’s Health Questionnaire demonstrated the worst quality of life in the patient group after bladder resection (p = 0.013). In this group, the QoL scale indicated the worst measures of “Quality of Life due to Dysuria” (p = 0.019). The measures of the filling enterocystometry were consistent between the patient cohorts and varied in the satisfactory range. All key criteria reflecting the voiding function were significantly worse in group I: larger volume of residual urine (p = 0.001), lower maximum emptying rate (p = 0.034), and higher frequency of intermittent self-catheterization (p = 0.001). Calculation of the obstruction index showed a high prevalence of chronic urinary retention in the specified patient group (p = 0.015). Thus, abdominal pressure had to be increased several-fold for the patients underwent augmentation ileocystoplasty to initiate (p = 0.001) and maintain (p = 0.036) emptying of the intestinal urinary reservoir. The incidence of reservoir-ureteral reflux and incontinence is consistent in both groups (p > 0.05).

CONCLUSIONS: Cystectomy with replacement ileocystoplasty, as an intervention with the best quality of life and functional results, is the optimal choice in patients with microcystis of tuberculous etiology.

Keywords

urogenital tuberculosis / bladder tuberculosis / cystectomy / bladder resection / ileocystoplasty / urodynamic / quality of life

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