Introduction

A significant number of patients after radical cystectomy (RC) suffer from changes in bowel habits and defecation, as we had previously shown. Reports addressing long-term bowel disorders following RC are rare. This cross sectional study evaluates long-term bowel issues in a large cohort with the help of an issue-tailored questionnaire.

Methods

A questionnaire assessing changes in bowel function and its impact on daily life was developed and distributed in collaboration with the German bladder cancer support group. A total of 431 patients after RC were evaluated. Symptoms such as diarrhea, constipation, urge to defecate, sensation of incomplete defecation, flatulence, and impact on quality of life (QoL) were evaluated.

Results

A total of 324 patients were followed ≥1 year, 43% of the patients reported current bowel disorders, 40% life restriction and 60% dissatisfaction. Most frequent bowel symptoms were flatulence (49%), followed by diarrhea (30%) and the sensation of incomplete defecation (23%). The highest prevalence rate of diarrhea is reported in year 3 after surgery: 3 months after surgery 14%, 3-11 months 21%, 12-23 months 18%, 24-35 months 44%, 36-59 months 36%, ≥60 months 27% (p<0.01). Flatulence is also a long-term bowel symptom with a prevalence of 50% ≥1 year vs 37% <1 year after surgery (p=0.0334). The prevalence of the remaining bowel symptoms did not change over time. After 12 months, diarrhea significantly correlated with flatulence, uncontrolled stool loss, urge to defecate, younger age at time of surgery, and the size of bowel segment used for urinary diversion (all p<0.01). Patients suffering from diarrhea report a higher defecation frequency, a lower QoL, a higher dissatisfaction level, a lower energy level (all p<0.01), and a lower health state (p=0.0488).

Conclusions

To our knowledge this is the largest cohort evaluating long-term bowel issues after RC. Diarrhea is a prominent long-term bowel symptom after RC with a high impact on daily life. A better understanding of long-term bowel symptoms can be translated into daily clinical management, such as optimized surgical procedures, post-operative medication/nutrition and patient education.

Funding

None