AUA 2016: Long-term 10-year health-related quality of life outcomes following radical cystectomy - Session Highlights

San Diego, California ( Nearly 7,000 patients undergo radical cystectomy (RC) with urinary diversion in the United States each year. Though RC improves mortality, it is associated with significant morbidity, especially with regards to bladder, bowel and sexual function. Ileal conduit (IC), neobladder (NB) and Indiana pouch (IP) urinary diversions are all offered after radical cystectomy and the literature is conflicting regarding the optimal method of urinary diversion.

Further, most quality of life studies comparing various diversion types are relatively short- term, less than 12 months. Dr. Gellhaus and colleagues sought to evaluate health- related quality of life following radical cystectomy with urinary diversion by IC, NB and IP in a large cohort with long-term (greater than 10 year) follow- up.

The authors performed a retrospective review of a single- institution radical cystectomy database. They identified 300 living patients with greater than 5 years follow up and sent the validated, disease specific health- related quality of life survey, the Bladder Cancer Index (BCI) instrument. ANOVA analysis was used to compare baseline characteristics and ANCOVA was used to adjust for age, gender, surgeon, age at time of surgery, and total follow up time. A separate sub- analysis of patients with <65 and >65 years was conducted.

28 patients (42.7%) completed the BCI survey. Urinary function was better for patients with IC and IP (p= 0.0002). IP had lower sexual function scores relative to IC and NB (p= 0.0387). Age stratification revealed some differences in males, with urinary function better in males >65 years who received an IC (p= 0.0086). Urinary function was better in males <65 with IC and UP than NB (p=0.0074). In females >65 years, bowel bother and function were significantly better for IC than for IP (p= 0.0453 and p= 0.0168).

This represents a unique study with long- term follow up in patients with three types of urinary diversion, including the largest group of patients undergoing urinary diversion with an Indiana pouch. The authors conclude that type of urinary diversion significantly affects health related quality of life outcomes after radical cystectomy. Quality of life outcomes were significantly different according to gender and age at surgery.


Presented By: Paul Gellhau, MD

Written By: Simone Vernez; Medical Student, Department of Urology, University of California, Irvine at the 2016 AUA Annual Meeting - May 6 - 10, 2016 – San Diego, California, USA