Health-related quality of life in patients undergoing radical cystectomy with modified single stoma cutaneous ureterostomy, bilateral cutaneous ureterostomy and ileal conduit

Purpose: To compare the clinical outcomes and patients' health-related quality of life (HR-QoL) with modified single stoma cutaneous ureterostomy (MCU), bilateral standard cutaneous ureterostomy (SCU) and ileal conduit (IC) using validated diversion-specific HR-QoL instrument.

Methods: The study included 70 patients who underwent open radical cystectomy with either MCU, SCU, or IC from May 2017 to May 2018. In total 23, 25 and 22 patients were included in each group, respectively, after applying the following exclusion criteria: female, pre- and postoperative radio and chemotherapy, palliative surgery. HR-QoL was evaluated using the European Association of Research and Treatment of Cancer Quality of Life Core Questionnaire (EORTC-QLQ-C30) and Functional Assessment of Cancer Therapy for patients undergoing radical cystectomy (FACT-Bl-Cys).

Results: Global health status per EORTC-QLQ-C30 was the only domain that was found to be statistically better in the IC group compared to MCU (p = 0.007). Higher scores in additional concerns (p = 0.008), functional health domains (p = 0.002), satisfaction from urinary diversion (p = 0.004), and total score (p = 0.027) per FACT-Bl-Cys questionnaire, global health status (p < 0.001), and symptom scale (p = 0.017) per EORTC-QLQ-C30 were observed in IC compered to SCU. Patients with MCU had better scores of functional health (p = 0.012), satisfaction from urinary diversion (p = 0.001), and global health status (p = 0.008) than SCU.

Conclusion: IC is associated with better quality of life scores compared to SCU and similar scores compared to MCU. MCU possesses better scores of HR-QoL domains compared to SCU. Our results suggest that MCU should be preferred in patients requiring SCU and could be considered for patients requiring IC.