Self-perception, quality of life and ease of catheterization in patients with continent urinary diversion with the mitrofanoff principle

ABSTRACT Purpose: Continent urinary diversion (CUD) with the Mitrofanoff principle stands as an alternative to urethral catheterization by a route other than the urethra. The aim of the study was to determine self-perception of health-related quality of life (HRQoL), ease of catheterization and global and cosmetic outcomes in patient’s dependent on Mitrofanoff catheterization. Materials and methods: Records of all patients who underwent CUD with the Mitrofanoff principle between 2012 to 2018 were reviewed. Data were collected and analysed retrospectively from medical charts. We assessed HRQoL with the EuroQol EQ-5D-3L questionnaire, cosmetic and global satisfaction with a questionnaire designed by the reconstructive urology board and ease of catheterization with a Likert questionnaire adapted from the Intermittent Catheterization Difficulty Questionnaire (ICDQ) validated in patients reliant on retrograde CIC. Results: A total of 25 patients requiring CUD with the Mitrofanoff principle between 2012 and 2018 were assessed, the group was composed mainly of: appendiceal conduits 18 patients (72%) and 7 ileal conduits (Yang-Monti) and three of those requiring Casale (Monti Spiral) and 1 a double Monti technique. Median follow-up was 57 months, median age was 30 years. Visual Analogue Scale (VAS) of the EQ-5D-3L reported a Global health score of 86.5%. Fifty nine percent of the patients had no pain or bleeding with catheterizations. Regarding global satisfaction and cosmetic perception 91% were satisfied with their CUD. Conclusions: CUD is associated with good HRQoL, global satisfaction, ease and painless catheterization, adequate self-perception of cosmetic outcomes and a low complication rate, remaining a safe and viable option.

摘要
目的：遵循米特罗法诺夫（Mitrofanoff）原则的控制性尿路改道（Continent Urinary Diversion, CUD），是一种经尿道以外路径实施导尿的尿道导尿替代方案。本研究旨在明确依赖米特罗法诺夫导尿术患者的健康相关生活质量（Health-Related Quality of Life, HRQoL）自我认知、导尿便捷性，以及整体结局与美容结局情况。
材料与方法：回顾性分析2012年至2018年间所有接受米特罗法诺夫原则控制性尿路改道手术患者的临床病历资料。通过查阅医疗病历回顾性收集并分析相关数据。采用欧洲五维健康量表3级版（EuroQol EQ-5D-3L）评估患者的健康相关生活质量；使用重建泌尿外科学会设计的问卷评估整体满意度与美容满意度；采用经逆行间歇性清洁导尿（Clean Intermittent Catheterization, CIC）依赖患者验证的间歇性导尿困难问卷（Intermittent Catheterization Difficulty Questionnaire, ICDQ）改编的李克特（Likert）量表，评估导尿的便捷程度。
结果：2012年至2018年间共纳入25例接受米特罗法诺夫原则控制性尿路改道手术的患者进行评估，该组患者主要术式包括：阑尾通道术式18例（72%）、7例回肠通道术式（杨-蒙蒂（Yang-Monti）术式），其中3例采用卡萨莱（蒙蒂螺旋（Monti Spiral））术式，1例采用双蒙蒂（double Monti）技术。中位随访时间为57个月，中位年龄为30岁。EQ-5D-3L的视觉模拟评分（Visual Analogue Scale, VAS）显示整体健康得分为86.5%。59%的患者导尿时无疼痛或出血症状。在整体满意度与美容外观认知方面，91%的患者对其控制性尿路改道手术效果表示满意。
结论：米特罗法诺夫原则控制性尿路改道术可带来良好的健康相关生活质量、较高的整体满意度、便捷且无痛的导尿体验，患者对美容结局的自我认知良好，且并发症发生率较低，是一种安全且可行的手术选择。