Sexual experience of urostomy patients with bladder cancer: a qualitative explorative study

Bladder cancer is a common malignant tumor of the urinary system worldwide. Radical cystectomy is the primary treatment for muscle-invasive bladder cancer and high-risk non-muscle invasive bladder cancer. Postoperatively, patients often undergo urostomy through urinary diversion to facilitate urine excretion. The physical presence of a stoma may impair patients' perception of bodily integrity, thereby affecting their sexual confidence and intimate behavior. A descriptive qualitative study using purposive sampling and semi-structured individual interviews was conducted among 21 bladder cancer patients who had undergone urostomy 6 months to 5 years previously. Interviews lasted approximately 60-90 min and were audio-recorded with participants' consent. Data were analyzed using Braun and Clarke's six-phase thematic analysis. Each interviewee emphasized that the urostomy significantly influenced their sexual experience.Three main themes and six sub-themes were identified. The three main themes were Low self-esteem and fragility, Prominent physiological and functional problems, and Partner relationship problems. The six sub-themes included Perceived Changes in Body Image, Anxiety and Fear, Sexual Dysfunction, Reduced Sexual Desire, Partner's Worries and Discomfort, and Emotional Alienation. Participants described complex sexual difficulties involving body image, physiological impairment, psychological distress, and intimate relationship challenges following urostomy. Patients with bladder cancer who undergo urostomy experience multidimensional sexual challenges that extend beyond physical dysfunction to include psychological and relational difficulties. Healthcare professionals should provide individualized sexual counseling, psychosocial support, and multidisciplinary follow-up to promote sexual wellbeing and postoperative quality of life.