The impact of the type of urinary diversion, after radical cystectomy for bladder cancer, on quality of life

The aim of this study was to review the quality of life (QOL) of patients who underwent urinary diversion after a radical cystectomy for bladder cancer. Bladder cancer is the fourth most common cancer among US males and the eighth most common cancer among US females. The radical cystectomy is the gold standard treatment for certain types of bladder cancer, and provides the best chances for survival. Body image, emotional distress, functional, and social activities have become important factors to consider for improving the QOL after surgery. It is generally expected that patients who have undergone continent diversion, after a radical cystectomy, have a better long-term QOL than patients who do not undergo continent diversion. Numerous studies on the QOL after cystectomy have been reported on different methods used for reconstructing the urinary tract. Some studies have shown that the QOL is preserved to a higher degree after orthotopic bladder substitution compared to an ileal conduit urinary diversion. However, in most studies, the type of urinary diversion was not associated with differences in the QOL because most patients adjusted to their new condition without significant inconvenience. However, there have been no randomized controlled studies that have investigated the QOL after a radical cystectomy, although such studies are likely difficult to perform. Furthermore, only a few investigators have used validated instruments for the measurement and comparison of data. Moreover, small study samples have limited the statistical power of the data reported. Therefore, it is with some surprise and disappointment that the published evidence does not support an advantage of one type of reconstruction procedure over others with regard to the QOL. This review emphasizes the importance of performing well designed studies in the future. By understanding these issues more completely, patients could be counseled prior to treatment and make more informed decisions on the most appropriate form of therapy for this serious life-altering disease. Increased awareness regarding the QOL may increase our understanding of the impact of bladder cancer and the management options on patient QOL.