Benefits and Complications during the Stay at an Early Rehabilitation Facility after Radical Cystectomy and Orthotopic Ileum Neobladder Reconstruction

Abstract

Purpose: Early rehabilitation (ER) after radical cystectomy (RC) seems to be crucial for quality of life, education and prevention of complications after hospital discharge. We investigated an inpatient ER setting for bladder cancer (BC) patients. Methods: In total, 103 BC patients who underwent ileum neobladder reconstruction were included. The major issues from the patients’ point of view, functional outcome parameters and complications during ER were analysed. A Wilcoxon signed rank test was used to compare body mass index (BMI) and diurnal as well as nocturnal use of urinary pads before and after ER. Results: At the beginning of ER, the median Karnovsky performance scale score was 70% (interquartile range [IQR] 70–90%) and the mean BMI was 25.8 kg/m² (IQR 21.9–27.9). The 4 most common complaints were urinary incontinence (80.6%), general weakness (73.8%), urinary mucus (49.5%) and mental distress (44.7%). During the programme, 28.2% of patients had a urinary tract infection requiring antibiotics and 15.5% presented a symptomatic acidosis. Median diurnal use of urinary pads significantly decreased during ER (4 vs. 3; p < 0.001). At the end of the ER programme, 76.0, 54.8 and 30.8% of the patients indicated an improvement of their physical capacity, incontinence and psychological distress respectively. Conclusions: Our study demonstrates the need for postoperative rehabilitation after RC. Further investigations should compare outcome parameters to ambulatory and outpatient ER models.