Defecation disturbances after cystectomy for urinary bladder cancer.
OBJECTIVE
• To describe and compare long-term defecation disturbances in patients who had undergone a cystectomy due to urinary bladder cancer with non-continent urostomies, continent reservoirs and orthotopic neobladder urinary diversions.


METHODS
• During their follow-up we attempted to contact all men and women aged 30-80 years who had undergone cystectomy and urinary diversion at seven Swedish hospitals. • During a qualitative phase we identified defecation disturbances as a distressful symptom and included this item in a study-specific questionnaire together with free-hand comments. The patients completed the questionnaire at home. • Outcome variables were dichotomized and the results are presented as relative risks with 95% confidence interval.


RESULTS
• The questionnaire was returned from 452 (92%) of 491 identified patients. Up to 30% reported problems with the physiological emptying process of stool (bowel movement, sensory rectal function, awareness of need for defecation, motoric rectal and anal function, straining ability). • A sense of decreased straining capacity was reported by 20% of the men and women with non-continent urostomy and 14% and 8% of those with continent reservoirs and orthotopic neobladders, respectively.


CONCLUSIONS
• Of the cystectomized individuals 30% reported problems with the physiological emptying process of stool (bowel movement, sensory rectal function, awareness of need for defecation, motoric rectal and anal function, straining ability). • Those wanting to improve the situation for bladder cancer survivors may consider communicating before surgery the possibility of stool-emptying problems, and asking about them after surgery.
Division of Clinical Cancer Epidemiology, Department of Oncology and Pathology, Karolinska Institutet, Karolinska University Hospital-Huddinge, Stockholm, Sweden. helena.thulin@ki.se
Helena
H
Thulin
Ulrika
U
Kreicbergs
Erik
E
Onelöv
Christer
C
Ahlstrand
Malcolm
M
Carringer
Sten
S
Holmäng
Börje
B
Ljungberg
Per-Uno
PU
Malmström
David
D
Robinsson
Hans
H
Wijkström
N Peter
NP
Wiklund
Gunnar
G
Steineck
Lars
L
Henningsohn
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015653:Cystectomy / Q000009:adverse effects*; D003672:Defecation / Q000502:physiology*; D004812:Epidemiologic Methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology / Q000503:physiopathology*; D011788:Quality of Life; D001749:Urinary Bladder Neoplasms / Q000601:surgery*; D014547:Urinary Diversion / Q000009:adverse effects*; D016476:Urinary Reservoirs, Continent / Q000009:adverse effects*