Impact of Different Urinary Diversions on Quality of Life after Radical Cystectomy in the Elderly
Abstract:
Introduction: Radical cystectomy with urinary diversion is the standard treatment for invasive or high-risk non invasive bladder cancer. The choice of diversion depends on clinical, surgical, and functional factors and directly influences quality of life (QoL). In the elderly population, few studies have compared the different techniques.
Materials and Methods: We conducted a prospective study between 2021 and 2024 in the urology department of the University Hospital of Casablanca. A total of 99 patients underwent radical cystectomy, of whom 83 completed the SF-36 and Barthel index questionnaires. Two groups were compared: ileal conduit (IC, n=32) and ureterocutaneostomy (UC, n=51). Clinical, operative, and postoperative data were analyzed.
Results: The mean follow-up was longer for patients with ileal conduit than for those with ureterocutaneostomy. UC was associated with shorter operative time and hospital stay, as well as earlier drain removal. Regarding QoL, the ileal conduit was associated with better emotional function, while UC was correlated with more marked fatigue. No significant difference was observed for the other dimensions of QoL between the two groups.
Discussion: These results confirm that the choice of diversion must be individualized. The ileal conduit appears to be a more suitable option for younger patients in good general condition who are concerned about their body image and psychological well-being. Ureterocutaneostomy remains a safer alternative in elderly and frail patients due to its reduced operative risk.
Conclusion: Although no overall difference in QoL was observed, the ileal conduit seems preferable for young and f it patients, while UC should be favored in high-risk elderly patients. The use of QoL questionnaires and informed counseling remain essential to guide therapeutic decision-making.
