Introduction

Comparability of current literature regarding the impact of stress urinary incontinence (SUI) outcomes after radical cystectomy (RC) and orthotopic ileal neoblader (ONB) on health-related quality of life (HRQOL) is impaired since definitions of continence vary and are usually based on subjective patient reports on pad usage. In addition, previous studies analysed women only, focused on particular subdivisions of HRQOL, or did not analyse the impact of assistive devices such as condom catheters and clean intermittent self-catheterization. In the current study, we correlate objectified and detailed continence outcomes with HRQOL after ONB.

Methods

Questionnaires were sent to 244 patients who underwent RC with ONB diversion between 2004 and 2015, and information about the current continence status was retrieved. To objectify postoperative urine loss, daytime and nocturnal pad tests were performed. Continence was also assessed using the validated ICIQ-SF score. Continence was defined as need of up to one safety pad and urine loss of <10g per pad test. HRQOL was assessed using the validated EORTC QLQ-C30 score. Statistical analysis included Fisher test, Mann-Whitney-U test, Spearman rank correlation, and binary regression models (p<0.05).

Results

178 patients (73.0%) answered the QLQ-C30 questionnaires and were included in the study. Median follow-up was 61 months. Median daytime pad use was 1 and median daily urine loss based on pad testing was 4.0g, leading to a daytime continence rate of 48.5%. The mean daily urine loss based on 24hrs pad testing correlated significantly with decreased physical functioning (R=-0.355, p<0.001), and global health status (R=-0.282, p<0.001). Continence success had a significant impact on postoperative global health status (p=0.017). In addition, we found a significantly decreased global health status for patients using a condom catheter (p=0.049) and patients suffering from pollacisuria (p=0.001). Patients who had performed pelvic floor muscle training had a significantly better global health status (p=0.035). In multivariate analysis, only ICIQ-SF score (p=0.001, OR=0.805) and need for condom catheters (p=0.015, OR=0.123) were independent predictors for worse HRQOL outcomes based on global health status. A history of pelvic floor muscle training was an independent predictor of increased HRQOL (p=0.009, OR=10.459).

Conclusions

This is the first study to correlate objective continence outcomes with HRQOL after RC and ONB. Need of condom catheters and increased ICIQ-SF scores are independent predictors for worse HRQOL outcomes. Furthermore, we show significant beneficial effects of pelvic floor muscle training on patients HRQOL.

Funding

none