Is Health-Related Quality of Life after Radical Cystectomy Using Validated Questionnaires Really Better in Patients with Ileal Orthotopic Neobladder Compared to Ileal Conduit: A Meta-Analysis of Retrospective Comparative Studies

Abstract

Introduction: From the most recent systematic revision of the literature, an orthotopic neobladder would seem to show marginally better health related quality of life (HR-QoL) scores compared with an ileal conduit. The aim of this study was to review all relevant published studies about the comparison between ileal orthotopic neobladder (IONB) and ileal conduit using validated HR-QoL questionnaires.

Materials and methods: Studies were identified by searching multiple literature databases. Data were synthesized using meta-analytic methods conformed to the PRISMA statement.

Results: The literature search identified 10 papers; pooled effect sizes of combined quality of life outcomes for ileal conduit versus IONB showed a significantly better HR-QoL in patients with IONB (Hedges' g = 0.278; p = 0.000);. The present study has an important limitation due to the type of the analyzed comparative studies, all retrospective and not randomized.

Conclusion: This meta-analysis of not-randomized, retrospective comparative studies on the impact of ileal conduit versus IONB on HR-QoL showed a significant advantage of IONB subgroups.

Keywords: Health related quality of life; Ileal conduit; Neobladder; Radical cystectomy; Urinary diversion.

Fig. 1

Articles identified and evaluated during the review process for meta-analysis.

Fig. 2

Forest plot of overall combined HR-QoL domains for IC vs. IONB. A fixed-effects model was used for meta-analysis because I² = 19.382%. Standard mean difference estimates for individual papers, calculated using Hedges' g, are shown in boxes and the summary of effect as a diamond; 95% CI indicates 95% confidence interval.

Fig. 3

Funnel plot with Egger's t test for publication bias of overall combined selected papers for meta-analysis.

Fig. 4

Forest plot of pooled effect sizes of the 8 aspects of the SF-36. A random-effects model was used for meta-analysis because I² = 61.839%. Standard mean difference estimates for individual papers, calculated using Hedges' g, are shown in boxes and the summary of effect as a diamond; 95% CI indicates 95% confidence interval.

Fig. 5

Forest plot of pooled effect sizes of outcomes from SF-36, analyzing physical and mental components scores. A random-effects model was used for meta-analysis because I² = 45.705%. Standard mean difference estimates for individual papers, calculated using Hedges' g, are shown in boxes and the summary of effect as a diamond; 95% CI indicates 95% confidence interval.

Fig. 6

Forest plot of pooled effect sizes of functional scales from EORTC-QLQ-C30. A fixed-effects model was used for meta-analysis because I² =0%. Standard mean difference estimates for individual papers, calculated using Hedges' g, are shown in boxes and the summary of effect as a diamond; 95% CI indicates 95% confidence interval.

Fig. 7

Forest plot of pooled effect sizes of symptoms scales from EORTC-QLQ-C30. A fixed-effects model was used for meta-analysis because I² =4.831%. Standard mean difference estimates for individual papers, calculated using Hedges' g, are shown in boxes and the summary of effect as a diamond; 95% CI indicates 95% confidence interval.

Fig. 8

Forest plot of pooled effect sizes of BI aspect from EORTC-QLQ-BLM30. A random-effects model was used for meta-analysis because I² =46.426 %. Standard mean difference estimates for individual papers, calculated using Hedges' g, are shown in boxes and the summary of effect as a diamond; 95% CI indicates 95% confidence interval.

Fig. 9

Forest plot of pooled effect sizes of the FACT-G domains. A random-effects model was used for meta-analysis because I² = 59.211%. Standard mean difference estimates for individual papers, calculated using Hedges' g, are shown in boxes and the summary of effect as a diamond; 95% CI indicates 95% confidence interval.