Long-term Health-related Quality of Life (HRQOL) After Radical Cystectomy and Urinary Diversion - A Propensity Score-matched Analysis

Published:March 06, 2022DOI:



      Radical cystectomy (RC) and urinary diversion by ileal conduit (IC) or ileal orthotopic neobladder (ONB) is the standard-of-care for surgical treatment of muscle-invasive bladder cancer. Yet, it is unclear how urinary diversion affects the patient's health-related quality of life (HRQOL) in the longer-term.


      HRQOL was assessed preoperatively, 3mo postoperatively and then annually until a maximum follow-up of 48 months using the validated EORTC QLQ-C30- as well as the bladder cancer-specific FACT-BL- and QLQ-BLM30-questionnaires. A propensity-score matching for the variables “age,” “ASA-classification,” “cardiovascular co-morbidity,” “sex” as well as “tumor stage,” and “preoperative physical functioning score” was performed. Hypothetical predictors for decreased general HRQOL were analyzed using multivariable logistic regression models.


      After propensity-score matching, 246 patients were analyzed. HRQOL assessment revealed significant differences regarding preoperative QLQ-C30 symptoms which diminished during the postoperative time course. Similarly, we did not find significant differences based on bladder cancer-specific FACT-BL and QLQ-BLM HRQOL assessment including body image (48 months: 29.6.4 [IC] vs. 40.7 [ONB]; P = .733). Regarding general HRQOL, we found increased global health status scores for ONB throughout the whole observational period without reaching statistical significance (48 months: 55.0 [IC] vs. 70.1 [ONB]; P = .079). In multivariate analysis, cardiovascular comorbidity was an independent predictor of impaired HRQOL 24 months (HR 2.20; CI95% 1.02-5.72, P = .044) and 36 months (HR 6.84; CI95% 1.61-29.14, P = .009) postoperatively.


      We did not observe significant differences in bladder-specific as well as generic HRQOL in the longer-term and consequently, the type of urinary diversion was not an independent predictor of good general HRQOL in a follow-up period of 4 years.


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      1. J.A. Witjes (Chair), HM B, R. Cathomas, et al. Muscle-invasive and Metastatic Bladder Cancer. Edn. presented at the EAU Annual Congress Milan 2021. Arnhem, The Netherlands: EAU Guidelines Office; 2021.

        • Thalmann GN
        • Markwalder R
        • Shahin O
        • et al.
        Primary T1G3 bladder cancer: organ preserving approach or immediate cystectomy?.
        J Urol. 2004 Jul; 172: 70-75
        • Studer UE
        • Burkhard FC
        • Schumacher M
        • et al.
        Twenty years experience with an ileal orthotopic low pressure bladder substitute–lessons to be learned.
        J Urol. 2006 Jul; 176: 161-166
        • Hautmann RE
        • Volkmer BG
        • Schumacher MC
        • et al.
        Long-term results of standard procedures in urology: the ileal neobladder.
        World J Urol. 2006 Aug; 24: 305-314
        • Smith AB
        • Jaeger B
        • Pinheiro LC
        • et al.
        Impact of bladder cancer on health-related quality of life.
        BJU Int. 2018 Apr; 121: 549-557
        • Cerruto MA
        • D'Elia C
        • Siracusano S
        • et al.
        Systematic review and meta-analysis of non RCT's on health related quality of life after radical cystectomy using validated questionnaires: Better results with orthotopic neobladder versus ileal conduit.
        Eur J Surg Oncol. 2016 Mar; 42: 343-360
        • Kretschmer A
        • Grimm T
        • Buchner A
        • et al.
        Midterm health-related quality of life after radical cystectomy: a propensity score-matched analysis.
        Eur Urol Focus. 2020 Jul 15; 6: 704-710
        • Elbadry MS
        • Ali AI
        • Hassan A
        • et al.
        The relationship between type of urinary diversion and quality of life after radical cystectomy: Ileal conduit versus orthotopic bladder.
        BJUI Compass. 2020; 1: 133-138
        • Tostivint V
        • Verhoest G
        • Cabarrou B
        • et al.
        Quality of life and functional outcomes after radical cystectomy with ileal orthotopic neobladder replacement for bladder cancer: a multicentre observational study.
        World J Urol. 2020 Oct 16; 39 (PMID: 33067727): 2525-2530
        • Ding H
        • Fan N
        • Ning Z
        • et al.
        Trimodal therapy vs. radical cystectomy for muscle-invasive bladder cancer: a meta-analysis.
        Front Oncol. 2020; 10564779
        • Aaronson NK
        • Ahmedzai S
        • Bergman B
        • et al.
        The European Organization for Research and Treatment of Cancer QLQ-C30: a quality-of-life instrument for use in international clinical trials in oncology.
        J Natl Cancer Inst. 1993 Mar 3; 85: 365-376
        • Fayers PM.
        Interpreting quality of life data: population-based reference data for the EORTC QLQ-C30.
        Eur J Cancer. 2001 Jul; 37: 1331-1334
        • Månsson A
        • Davidsson T
        • Hunt S
        • et al.
        The quality of life in men after radical cystectomy with a continent cutaneous diversion or orthotopic bladder substitution: is there a difference?.
        BJU Int. 2002 Sep; 90: 386-390
        • Degboe A
        • Ivanescu C
        • Rohay JM
        • et al.
        Validity and performance of the Functional Assessment of Cancer Therapy-Bladder (FACT-Bl) among advanced urothelial cancer patients.
        Support Care Cancer. 2019 Nov; 27: 4189-4198
        • Dindo D
        • Demartines N
        • Clavien PA.
        Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey.
        Ann Surg. 2004 Aug; 240: 205-213
        • Karl A
        • Buchner A
        • Becker A
        • et al.
        A new concept for early recovery after surgery for patients undergoing radical cystectomy for bladder cancer: results of a prospective randomized study.
        J Urol. 2014 Feb; 191: 335-340
        • Kretschmer A
        • Grimm T
        • Buchner A
        • et al.
        Prognostic features for objectively defined urinary continence after radical cystectomy and ileal orthotopic neobladder in a contemporary cohort.
        J Urol. 2017 Jan; 197: 210-215
        • Ziegelmueller BK
        • Jokisch JF
        • Buchner A
        • et al.
        Long-term follow-up and oncological outcome of patients undergoing radical cystectomy for bladder cancer following an enhanced recovery after surgery (eras) protocol: results of a large randomized, prospective, single-center study.
        Urol Int. 2020; 104: 55-61
        • Snyder CF
        • Blackford AL
        • Okuyama T
        • et al.
        Using the EORTC-QLQ-C30 in clinical practice for patient management: identifying scores requiring a clinician's attention.
        Qual Life Res. 2013 Dec; 22: 2685-2691
        • Stein JP
        • Lieskovsky G
        • Cote R
        • et al.
        Radical cystectomy in the treatment of invasive bladder cancer: long-term results in 1,054 patients.
        J Clin Oncol. 2001 Feb 1; 19: 666-675
        • Tamalunas A
        • Volz Y
        • Schlenker BA
        • et al.
        Is it safe to offer radical cystectomy to patients above 85 years of Age? A long-term follow-up in a single-center institution.
        Urol Int. 2020; 104: 975-981
        • Hobisch A
        • Tosun K
        • Kinzl J
        • et al.
        Quality of life after cystectomy and orthotopic neobladder versus ileal conduit urinary diversion.
        World J Urol. 2000 Oct; 18: 338-344
        • Singh V
        • Yadav R
        • Sinha RJ
        • et al.
        Prospective comparison of quality-of-life outcomes between ileal conduit urinary diversion and orthotopic neobladder reconstruction after radical cystectomy: a statistical model.
        BJU Int. 2014 May; 113: 726-732
        • D''Agostino D
        • Racioppi M
        • Pugliese D
        • et al.
        Postoperative quality of life in patients with ileal neobladder at short-, intermediate- and long-term follow-up.
        Urol Int. 2016; 97: 54-60
        • Erber B
        • Schrader M
        • Miller K
        • et al.
        Morbidity and quality of life in bladder cancer patients following cystectomy and urinary diversion: a single-institution comparison of ileal conduit versus orthotopic neobladder.
        ISRN Urol. 2012; 2012342796
        • Philip J
        • Manikandan R
        • Venugopal S
        • et al.
        Orthotopic neobladder versus ileal conduit urinary diversion after cystectomy–a quality-of-life based comparison.
        Ann R Coll Surg Engl. 2009 Oct; 91: 565-569
        • Hedgepeth RC
        • Gilbert SM
        • He C
        • et al.
        Body image and bladder cancer specific quality of life in patients with ileal conduit and neobladder urinary diversions.
        Urology. 2010 Sep; 76: 671-675