Health-related quality of life after radical cystectomy for bladder cancer in elderly patients with ileal orthotopic neobladder, ureterocutaneostomy or ileal conduit: cross-sectional study using validated questionnaires

Purpose The most appropriate form of urinary diversion (UD) after radical cystectomy remains controversial. In this study, we aimed to compare the health-related quality of life questionnaire results of patients who underwent orthotopic neobladder (ONB), ureterocutaneostomy (UC) and ileal conduit (IC) diversion. Materials A total of 92 patients, including 42 out of 65 IC patients, 11 out of 15 ONB patients, and 39 out of 59 UC patients, completed the SF-36 and Barthel index quality of life questionnaires. Results The mean follow-up periods were 11.7 +/- 13.5 months for UC patients, 24.2 +/- 20.8 months for IC patients, and 34.3 +/- 25 months for ONB patients. The drain removal times were 5.7 +/- 2.3 days in the UC group, 7 +/- 2.8 days in the IC group, and 10.9 +/- 9.2 days in the ONB group, with both the follow-up and drain removal periods being shorter in the UC group (P < 0.001; P = 0.002). Significant differences were noted in quality of life scores, particularly for emotional function (P = 0.016) and fatigue (P = 0.001), with the ONB group having higher emotional function scores and the UC group having higher fatigue scores than the other groups did. Conclusion Although there was no significant difference in terms of quality of life among the three methods, according to our results, we concluded that ONB should be performed in healthy, young, fit patients, especially those with body image expectations, and that UC should be performed in high-risk elderly patients. Although the selection of UD is based on individual considerations and the experience of the physician, quality of life questionnaires and patient counseling have critical importance.