Bahlburg Henning, Reicherz Alina, Reike Moritz, Bach Peter, Butea-Bocu Marius Cristian, Tully Karl Heinrich, Roghmann Florian, Noldus Joachim, Müller Guido
Department of Urology, Marien Hospital Herne, Ruhr-University Bochum, Hölkeskampring 40, 44625, Herne, Germany.
Center for Urological Rehabilitation, Kliniken Hartenstein, Bad Wildungen, Germany.
J Cancer Surviv. 2025 Jun;19(3):1102-1110. doi: 10.1007/s11764-024-01535-0. Epub 2024 Jan 30.
This study aims to evaluate survival, health-related quality of life (HRQoL), psychosocial distress, and functional outcomes after radical cystectomy (RC) and urinary diversion for ileal neobladder (INB) or ileal conduit (IC) in a contemporary German cohort of bladder cancer patients.
Patients undergoing inpatient rehabilitation after RC between April 2018 and December 2019 in one high-volume rehabilitation center were surveyed regarding HRQoL, psychosocial distress, and functional outcomes until two years after RC.
Eight-hundred forty-two patients (683 male, 159 female; 395 INB, 447 IC) were included. Patients with an IC suffered more often from locally advanced disease (≥ pT3; 41.4% vs. 24.1%, p < 0.001) and lymph node metastases (19.9% vs. 11.8%, p = 0.002), resulting in worse probability of survival (p < 0.001). Global HRQoL improved steadily during follow-up, but significant differences in subscales persisted between cohorts. Multivariable regression analysis identified IC, male sex, and patient age ≤ 59 years as independent predictors for persistent high psychosocial distress. Almost 42% of female patients reported severe urinary incontinence two years after RC. Most men reported severely diminished erectile function, even after nerve-sparing surgery.
Global HRQoL two years after RC is comparable to the general German population. Female patients should be informed about worse continence rates. Conversely, men should be educated about erectile dysfunction. Aftercare should include psycho-oncologic counseling, especially for patients at risk.
Patients should be counseled on long-term functional outcomes and persistent psychosocial distress after RC. Closer cooperation between urologists and psycho-oncologists is needed.
本研究旨在评估当代德国膀胱癌患者行根治性膀胱切除术（RC）及回肠新膀胱术（INB）或回肠膀胱术（IC）后的生存率、健康相关生活质量（HRQoL）、心理社会困扰及功能结局。
对2018年4月至2019年12月期间在一家大型康复中心接受RC术后住院康复的患者进行调查，了解其HRQoL、心理社会困扰及功能结局，随访至RC术后两年。
纳入842例患者（男性683例，女性159例；395例行INB，447例行IC）。行IC的患者更常患有局部晚期疾病（≥pT3；41.4%对24.1%，p<0.001）和淋巴结转移（19.9%对11.8%，p=0.002），导致生存率更差（p<0.001）。随访期间总体HRQoL稳步改善，但各亚组之间仍存在显著差异。多变量回归分析确定IC、男性性别及患者年龄≤59岁是持续性高心理社会困扰的独立预测因素。近42%的女性患者在RC术后两年报告有严重尿失禁。大多数男性报告勃起功能严重减退，即使在保留神经的手术后也是如此。
RC术后两年的总体HRQoL与德国普通人群相当。应告知女性患者尿失禁发生率更高。相反，应向男性患者宣传勃起功能障碍相关知识。术后护理应包括心理肿瘤咨询，尤其是对有风险的患者。
应向患者咨询RC术后的长期功能结局及持续性心理社会困扰。泌尿外科医生和心理肿瘤学家需要更密切的合作。
