Presentation Authors: Kian Asanad*, Azadeh Nazemi, Saum Ghodoussipour, Nima Nassiri, Daniel Zainfeld, Kevin Wayne, Jie Cai, Gus Miranda, Anne K. Schuckman, Hooman Djaladat, Siamak Daneshmand, Los Angeles, CA
Introduction: Bowel dysfunction can have a significant impact on quality of life. Little is known regarding bowel function following radical cystectomy (RC) and various forms of urinary diversion. We sought to prospectively assess both short- and long-term constipation symptoms and their impact on quality of life in patients who underwent RC with three different types of urinary diversions: orthotopic ileal neobladder (NB), continent cutaneous diversion (CCD), and ileal conduit (IC).
Methods: The validated Patient Assessment of Constipation Symptoms (PAC-SYM) and Patient Assessment of Constipation Quality of Life (PAC-QOL) questionnaires were administered to all patients at follow-up greater than 30 days from surgery. PAC-SYM is a 12-item questionnaire, divided into three symptom subscales (abdominal, rectal, and stool), is scored on a 5-point Likert Scale (range 0-4: absent-very severe). PAC-QOL is a 5-item questionnaire that evaluates patient satisfaction with bowel function (higher scores correspond to better quality of life). Patients with a history of inflammatory bowel disease or those who underwent subsequent colorectal surgeries were excluded. Clinical and pathological characteristics were prospectively recorded in an IRB approved bladder cancer database. Using multivariable linear regression analyses, we determined significant predictors of improving bowel function and quality of life scores.
Results: A total of 198 patients completed 254 PAC-SYM and PAC-QOL questionnaires with a median follow-up time of 1.7 years (IQR: 0.7-3.0 years). NB, CCD, and IC were performed in 78%, 5.5%, and 16.5% of patients, respectively. Median PAC-SYM scores were highest at 6-12 months after surgery. These improved significantly over time to a median overall score of 4 with scores of 1, 0, and 2 for abdominal, rectal, and stool subgroups, respectively. A similar trend was seen with improving PAC-QOL scores to a median of 12 (range 8-14). On multivariable analysis, we found that patients < 70 years old (b -2.1, p=0.004), with follow-up >1 year (b -4.8, p=0.001), and who received an IC (b -2.4, p=0.02) had significantly lower PAC-SYM scores. Patients who received CCD trended towards an improved PAC-QOL score (b 2.1, p=0.05).
Conclusions: Patients have few constipation symptoms and are overall satisfied with their bowel function at long-term follow-up after RC. While patients with IC have significantly fewer constipation symptoms compared to those with NB or CCD, all patients had significant improvement one year after surgery.