Assessment of bowel disorders following radial cystectomy and urinary diversion for muscle-invasive transitional cell carcinoma of the bladder.

Abstract

347 Background: Articles reporting and specifying bowel disorders after radical cystectomy as long-term complications are sparse. However, numerous patients report on bowel function alteration and/or defecation disorders or even stool incontinence. For better qualification and quantification we present our data of a large cohort of patients evaluated with a newly developed questionnaire. Methods: For this purpose a novel non validated questionnaire was developed. The questionnaire was sent to 253 patients who had been treated with radical cystectomy between 2006 and 2012 to assess possible changes in bowel function and its impact on health related quality of life. Of those, 89 patients reported on their current status. Questions were related to their overall satisfaction as well as to their quality and severity of bowel disorders following pelvic surgery for bladder cancer. Results: In total 40 (44.9%) patients reported of a persistent change in bowel function after surgery. Most frequent were constipation (28.9%), diarrhea (18.4%) or both (21.1%) followed by flatulence (31.6%). Patients who experienced bowel function alteration but who are still satisfied reported predominantly of constipation (35.3%) and flatulence (41.2%) but not diarrhea. Twenty-three (25.8%) patients are currently not satisfied with their bowel function. Of those, 82.6% complaint about frequent flatulence, 75% report on softer stools, 65.2% have irritable bowel symptoms, 26.1% experience faecal incontinence and 73.9% are affected by serious life restrictions due to bowel disorder. Defecation frequency increased significantly (p<0.001). There is a significant reduction in life quality (p=0.004), medical condition (p=0.008) and energy level (p=0.035). A significant correlation could be found for higher T-stage (p<0.05) and positive lymph nodes (p<0.03). No differences could be observed between patients who received ileal-conduit vs. orthotopic neobladder or MAINZ I pouch urinary diversion. Conclusions: Long-term bowel disorders after cystectomy are an underestimated issue. A better understanding might lead to modifications of surgical procedures.