Evaluation of Bowel Function Following Radical Cystectomy and Urinary Diversion Using Two Validated Questionnaires: What Are the Effects on Quality of Life? - Beyond the Abstract

Changes in bowel function are an important contributor to health-related quality of life (QOL) after radical cystectomy (RC) and urinary diversion. While several bladder cancer-specific QOL measures exist, few specifically address constipation symptoms with even fewer stratifying symptoms after surgery or by type of diversion.


In this study, we prospectively evaluated both short- and long-term constipation outcomes in both continent and incontinent urinary diversions and integrated patients’ quality of life, using two validated questionnaires. We specifically used the Patient Assessment of Constipation Symptoms (PAC−SYM) and Patient Assessment of Constipation Quality of Life (PAC-QOL) questionnaires, given the granularity and detail inherent within these surveys. This is especially important to help providers targets specific symptoms of patients. For example, PAC-SYM can be subdivided into abdominal symptoms (pain, bloating, cramping), rectal symptoms (bleeding, burning, incomplete sensation), and stool symptoms (straining, hardness). PAC-QOL integrates patient satisfaction with bowel movements and treatment.

We sampled 198 patients who underwent open RC and completed 255 questionnaires between 2017-2018 with a median follow-up of 1.7 years. Constipation symptoms were worst at 3-month follow-up but significantly improved over time, especially after one year. Patients reported they were most bothered by their stool-related symptoms. On multivariable linear regression analysis, younger patients (<70 years old) and those who received an ileal conduit had significantly improved bowel function symptoms.

Our results revealed constipation symptoms and bowel function-related QOL after RC and urinary diversion is prevalent but dynamic with improvement over time. Our study raises insight into the importance of managing bowel function not only in the immediate post-operative setting but long term as well.

Written by: Kian Asanad, MD,1 and Siamak Daneshmand, MD2

  1. USC Institute of Urology, USC/Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, California
  2. Comprehensive Cancer Center, University of Southern California, Los Angeles, California

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