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

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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.

About the authors

Konstantin Kh. Chibirov

Saint Petersburg State Research Institute of Phthisiopulmonology

Author for correspondence.
Email: 4chibirov@mail.ru
ORCID iD: 0009-0002-1724-6106
SPIN-code: 3552-7394
Russian Federation, Saint Petersburg

Vladimir V. Protoshchak

Kirov Military Medical Academy

Email: protoshakurology@mail.ru
ORCID iD: 0000-0002-4996-2927
SPIN-code: 6289-4250

MD, Dr. Sci. (Medicine), Professor

Russian Federation, Saint Petersburg

Pavel A. Babkin

Kirov Military Medical Academy

Email: pavelbabkin@yandex.ru
SPIN-code: 6551-4494

MD, Dr. Sci. (Medicine)

Russian Federation, Saint Petersburg

Nikolai P. Kushnirenko

Kirov Military Medical Academy

Email: nikolaj.kushnirenko@yandex.ru
SPIN-code: 3892-8959

MD, Dr. Sci. (Medicine)

Russian Federation, Saint Petersburg

Anna A. Gorelova

Saint Petersburg State University

Email: gorelovauro@gmail.com
ORCID iD: 0000-0002-7010-7562
SPIN-code: 8568-9004

MD, Cand. Sci. (Medicine)

Russian Federation, Saint Petersburg

Mikhail V. Paronnikov

Kirov Military Medical Academy

Email: paronnikov@mail.ru
ORCID iD: 0009-0005-1762-6100
SPIN-code: 6147-7357

MD, Dr. Sci. (Medicine)

Russian Federation, Saint Petersburg

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2. Figure. The distribution structure for the types of the intestinal urinary reservoir emptying in patients of groups 1 and 2; р = 0.015

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