Health related quality of life after urinary diversion. Which technique is better?

To compare quality of life (QoL) after urinary diversion (UD) following radical cystectomy (RC) using validated questionnaires.

Between January 2011 and June 2016, 150 patients (121 men [80.7%] and 29 women [19.3%]) with invasive bladder cancer who underwent RC and UD were included in this prospective study. Patients were divided into 2 groups; group I included the orthotopic neobladder 50 (33.3%) and uretro-sigmoidostomy 41 (27.3%) and group II included uretero-cutanoustomy 33 (22.1%) and ileal conduit 26 (17.3%) patients. QOL was evaluated using the Functional Assessment of Cancer Therapy-Bladder Cancer. The erectile function (EF) was assessed using the Sexual Health Inventory for Men Questionnaire. Evaluation was done before and after one year postoperatively.

The mean ± SD patient age was 55.0 ± 7.9 and 59.5 ± 8.5 years in both groups, respectively (p = 0.001). There was a significant difference in the physical, social/family, emotional and functional statuses that were significantly higher in group I. One year postoperatively, the emotional well-being became insignificantly different, but other QoL parameters remained significantly different between both groups. Regarding EF, there was a significant difference between patients who underwent nerve-sparing (No. 29) and non nerve-sparing RC (No. 59) (p < 0.001).

Which type of diversion is the best is still a controversial topic. Egyptian patients may prefer the continent UD to avoid the urostomy appliance and its associated daily-life constraints. Detailed patient counseling and active participation of the patient in selecting the treatment methods are important for better postoperative QoL.