Longitudinal Impact of Urinary Diversion on Health-Related Quality of Life After Radical Cystectomy: A Multicenter...

This multicenter longitudinal study was conducted across 24 institutions in Japan to examine the impact of urinary diversion on health-related quality of life (HRQOL) among bladder cancer patients who underwent radical cystectomy (RC). We evaluated bladder cancer-specific HRQOL and general HRQOL via the bladder cancer index (BCI) and the QOL General (QGEN-8), respectively, before the operation and at 3, 6, and 12 months postoperatively. The scores were compared across urinary diversion groups as well as across different time points within each urinary diversion group with linear mixed-effects models. Data from 227 patients were analyzed (151 with ileal conduits, 45 with ureterostomy, and 31 with neobladders). Neobladder patients were more likely to experience longitudinal impacts of their urinary diversion on urinary function than ileal conduit or ureterostomy patients were. Compared with that at baseline, the bowel function of neobladder patients remained impaired 12 months after surgery. All urinary diversion groups had worse sexual function scores at 3 and 6 months than at baseline, and the ileal conduit and neobladder groups had significantly worse sexual function scores at 12 months than at baseline. On the other hand, there was no significant difference in bother scores in the urinary, bowel, or sexual domain. The generic HRQOL was maintained from the preoperative to the postoperative period in all urinary diversion groups. This study explored longitudinal changes in HRQOL after RC, and the findings may help inform patient counseling regarding possible QOL trajectories.