Quality of life with reconstruction

Quality-of-life considerations were one of the main driving forces behind the development of continent urinary diversion. However, the field of formal quality-of-life study that allows us to document these aspects of treatment is still relatively young. In the past decade, a number of quality-of-life studies of cystectomy patients have been undertaken, with somewhat mixed results. Many of these studies have been limited by small patient numbers, and the differences in the various treatment groups, for example, in age and comorbidities. Most have shown that overall quality of life after cystectomy remains good for most patients, with the expected problems with urinary diversion and sexual dysfunction. However, few differences between the diversion groups have been demonstrated, suggesting that patients adapt to whatever is required of them. One large study from Germany did find significant improvement in several aspects of quality of life in patients with continent diversion. Patient education, exploration of the pros and cons of the various alternatives, and active patient participation in the treatment decisions seem to be key to postoperative satisfaction.