Effect of orthotopic neobladder reconstruction on quality of life: A systematic review

How does orthotopic neobladder reconstruction in the surgical treatment of bladder cancer patients affect the quality of life? In the literature, the results affecting the quality of life from patient-reported outcome measures in bladder cancer patients who underwent orthotopic neobladder are not fully known. In this systematic review, the effect of orthotopic neobladder reconstruction on the quality of life in patients with bladder cancer is examined. Literature search was conducted within the framework of PRISMA guidelines and PICO. The research question was conducted in line with the core elements of Population, Concept and Context (PCC) proposed by the Joanna Briggs Institute (JBI) methodology. In the study, international studies published in Medline/PubMed, Cochrane, Web of Science, ProQuest and Scopus databases between 2012 and 2022 and accessible with the keywords ‘quality of life, ileal conduit, orthotopic neobladder, and continent diversion’ were reviewed. Methodological evaluation was performed by three independent authors with the JBI checklist. Six cross-sectional studies with 1485 samples and 12 prospective cohort studies with 1555 samples were included in the review. The Cronbach's alpha coefficient of the checklists was 0.98 in cross-sectional studies and 0.97 in prospective cohort studies. In studies, it was observed that the European Organization for Research and Treatment of Cancer-Quality of Life (EORTC-Quality of Life) scale was mostly used in patients' quality of life. In cross-sectional studies, there is no difference in quality of life between orthotopic neobladder and continent diversions, the quality of life related to bowel function is high in orthotopic neobladder, the quality of life related to urinary and sexual function is low, different surgical techniques in orthotopic neobladder do not affect the quality of life between women and men. It was determined that the factors affecting the quality of life were different and that chemotherapy and radiotherapy had different effects on the quality of life. In prospective cohort studies, it was found that comorbid diseases affect the quality of life, but orthotopic neobladder improves the quality of life of patients in the long term, there is no difference in quality of life between incontinent and continent diversions, and orthotopic neobladder has a positive effect on quality of life, especially in women. The studies conducted show that the studies on the quality of life of patients with orthotopic neobladder are limited and studies with strong effect sizes are needed. This review recommends that more studies be conducted to improve the physical-psychological health, social relationships and environmental quality of life of patients with orthotopic neobladder and that support programs be developed for these patients.