Nocturnal incontinence poses major burden after female bladder reconstruction

Apr 22 2014

By Joanna Lyford, Senior medwireNews Reporter

Health-related quality of life (HRQoL) is lower in women who have undergone radical cystectomy and neobladder reconstruction for bladder cancer than in the general female population, shows research.

Of the various procedural complications, night-time incontinence had a particularly severe and far-ranging detrimental impact on women’s QoL, the researchers report in the International Journal of Urology.

Mohamed Zahran (Mansoura University, Egypt) and colleagues retrospectively analysed data on 74 women who underwent radical cystectomy and orthotopic neobladder reconstruction for muscle-invasive bladder cancer over a 17-year period.

The women’s mean age at baseline was 51 years and they were followed-up for a mean of 8 years. In all, 18 (24.4%) women were completely continent with spontaneous voiding, 29 (39.1%) had night-time incontinence and 27 (36.5%) had chronic urinary retention.

HRQoL was assessed using two well-established, validated measures: the European Organization for Research and Treatment of Cancer-Quality of Life Questionnaire and the Functional Assessment of Cancer Therapy bladder cancer-specific form.

Compared with a control group of 72 healthy age-matched women, women with bladder cancer scored significantly lower on all domains of the HRQoL measures. These encompassed emotional, functional, physical and social wellbeing, as well as specific symptoms such as fatigue, nausea and vomiting, cognitive functioning and financial difficulties.

Among the women with bladder cancer, HRQoL was similar in all domains between women who were fully continent and those with chronic urinary retention.

However, several domains of HRQoL were significantly worse in women with night-time incontinence than in those who were fully continent. This was evidenced by their significantly lower mean scores for global health (34.5 vs 52.7), social functioning (29.3 vs 55.5) and functional wellbeing (13.2 vs 16.0), and their significantly higher mean score for pain (52.9 vs 34.3).

None of the baseline factors examined were found to be significant predictors of HRQoL in the women with bladder cancer.

Zahran and co-authors say that their study demonstrates the negative impact of nocturnal incontinence on HRQoL, which poses a more significant issue to women than chronic urinary retention, “especially from the social point of view”.

“Further studies are required to investigate the causes, and how to prevent and treat nocturnal incontinence in order to improve HRQOL”, they write.

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