title: Long-term bowel disorders following radial cystectomy: an underestimated issue?
abstract: OBJECTIVE
  Patients after radical cystectomy (RC) frequently complain about bowel disorders (BDs). Reports addressing related long-term complications are sparse. This cross-sectional study assessed changes in bowel habits (BH) after RC.
  
  
  METHODS
  A total of 89 patients with a minimum follow-up ≥1 year after surgery were evaluated with a questionnaire. Patients with BD prior to surgery were excluded. Symptoms such as diarrhea, constipation, bloating/flatulence, incomplete defecation, uncontrolled stool loss, and impact on quality of life (QoL) were assessed.
  
  
  RESULTS
  A total of 46.1 % of patients reported changes in BH; however, only 25.8 % reported experiencing related dissatisfaction. Primary causes of dissatisfaction were diarrhea and uncontrolled stool loss. The most common complaints were bloating/flatulence and the feeling of incomplete defecation, but these symptoms did not necessarily lead to dissatisfaction or impairment in quality of life. No difference was identified between an orthotopic neobladder and ileal conduit, and even patients without bowel surgery were affected. QoL, health status, and energy level were significantly decreased in unsatisfied patients.
  
  
  CONCLUSIONS
  About 25 % of patients complain about BDs after RC. More prospective studies assessing symptoms, comorbidities, and dietary habits are necessary to address this issue and to identify strategies for follow-up recommendations.
authors.affiliation: Department of Urology and Urologic-Oncology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
authors.forename: Mario W
authors.initials: MW
authors.lastname: Kramer
authors.affiliation: Department of Urology and Urologic-Oncology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
authors.forename: Christoph A
authors.initials: CA
authors.lastname: von Klot
authors.affiliation: Department of Urology and Urologic-Oncology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
authors.forename: Mohammad
authors.initials: M
authors.lastname: Kabbani
authors.affiliation: Department of Urology and Urologic-Oncology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
authors.forename: Abdul-Rahman
authors.initials: AR
authors.lastname: Kabbani
authors.affiliation: Department of Urology and Urologic-Oncology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
authors.forename: Hossein
authors.initials: H
authors.lastname: Tezval
authors.affiliation: Department of Urology and Urologic-Oncology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
authors.forename: Inga
authors.initials: I
authors.lastname: Peters
authors.affiliation: Department of Urology and Urologic-Oncology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
authors.forename: Thomas R W
authors.initials: TR
authors.lastname: Herrmann
authors.affiliation: Department of Urology and Urologic-Oncology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
authors.forename: Markus A
authors.initials: MA
authors.lastname: Kuczyk
authors.affiliation: Department of Urology and Urologic-Oncology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany. merseburger.axel@mh-hannover.de.
authors.forename: Axel S
authors.initials: AS
authors.lastname: Merseburger
mesh_terms: D000368:Aged; D003430:Cross-Sectional Studies; D015653:Cystectomy / Q000009:adverse effects*; D005247:Feeding Behavior; D005260:Female; D005500:Follow-Up Studies; D005858:Germany / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D007410:Intestinal Diseases / Q000453:epidemiology / Q000209:etiology* / Q000523:psychology; D008297:Male; D011446:Prospective Studies; D011788:Quality of Life; D011795:Surveys and Questionnaires; D001749:Urinary Bladder Neoplasms / Q000601:surgery
keywords: Bladder cancer; Bowel disorder; Diarrhea; Quality of life; Radical cystectomy; Uncontrolled stool loss; Urinary diversion