title: Prospective evaluation of health-related quality of life after radical cystectomy: focus on peri- and postoperative complications.
abstract: OBJECTIVE
  To analyse the impact of perioperative complications and complex treatment courses on postoperative health-related quality of life (HRQOL) after radical cystectomy (RC) and continent (ONB) or incontinent (IC) urinary diversion at multiple prospective time points.
  
  
  METHODS
  A total of 121 consecutive patients underwent RC with curative intent between 2013 and 2014. HRQOL was prospectively assessed preoperatively, after 3 and 12 months, using the QLQ-C30 questionnaire. The impact of complex perioperative treatment courses including cases requiring surgical re-interventions was retrospectively assessed using Martin criteria and the Clavien-Dindo scale. Urinary continence was determined using the validated ICIQ-SF questionnaire. Statistical analysis included Kruskal-Wallis ANOVA, Spearman's rank correlation, and ordinal regression models (p < 0.05).
  
  
  RESULTS
  A total of 100 patients underwent further analysis. Physical functioning (PF), role functioning (RF), and global health status (GHS) scores were higher in the ONB subgroup both preoperatively (p < 0.001, 0.010, 0.048) and 3 months after RC (p = 0.003, 0.048, 0.019). Clavien complications ≥III led to reduced PF levels after 3 months (p = 0.050) without effect on GHS (p = 0.825). Operating time and length of critical care monitoring correlated with 3 months pain scores in the ONB subgroup (p = 0.003, 0.009) without affecting GHS (p = 0.603, 0.653). Continent urinary diversion was an independent predictor of increased HRQOL after 3 months (p = 0.021), however, not after 12 months (p = 0.803).
  
  
  CONCLUSIONS
  Patients receiving an IC have lower PF, RF, and GHS scores than those receiving ONB. Perioperative complications and complicated treatment courses can affect HRQOL subdomains but do not significantly impact the GHS. ONB is an independent predictor for better overall HRQOL 3 months, but not 12 months after RC.
authors.affiliation: Department of Urology, Ludwig-Maximilians-University, Marchioninistrasse 15, 81377, Munich, Germany. alexander.kretschmer@med.uni-muenchen.de.|Department of Urological Sciences, The Vancouver Prostate Centre, University of British Columbia, 2660 Oak Street, Vancouver, BC V6H 3Z6, Canada. alexander.kretschmer@med.uni-muenchen.de.
authors.forename: Alexander
authors.identifier: http://orcid.org/0000-0002-6511-4354
authors.initials: A
authors.lastname: Kretschmer
authors.affiliation: Department of Urology, Ludwig-Maximilians-University, Marchioninistrasse 15, 81377, Munich, Germany.
authors.forename: Tobias
authors.initials: T
authors.lastname: Grimm
authors.affiliation: Department of Urology, Ludwig-Maximilians-University, Marchioninistrasse 15, 81377, Munich, Germany.
authors.forename: Alexander
authors.initials: A
authors.lastname: Buchner
authors.affiliation: Department of Urology, Ludwig-Maximilians-University, Marchioninistrasse 15, 81377, Munich, Germany.
authors.forename: Markus
authors.initials: M
authors.lastname: Grabbert
authors.affiliation: Department of Urology, Ludwig-Maximilians-University, Marchioninistrasse 15, 81377, Munich, Germany.
authors.forename: Friedrich
authors.initials: F
authors.lastname: Jokisch
authors.affiliation: Department of Urology, Ludwig-Maximilians-University, Marchioninistrasse 15, 81377, Munich, Germany.
authors.forename: Birte-Swantje
authors.initials: BS
authors.lastname: Schneevoigt
authors.affiliation: Department of Urology, Ludwig-Maximilians-University, Marchioninistrasse 15, 81377, Munich, Germany.
authors.forename: Maria
authors.initials: M
authors.lastname: Apfelbeck
authors.affiliation: Department of Urology, Ludwig-Maximilians-University, Marchioninistrasse 15, 81377, Munich, Germany.
authors.forename: Gerald
authors.initials: G
authors.lastname: Schulz
authors.affiliation: Department of Urology, Ludwig-Maximilians-University, Marchioninistrasse 15, 81377, Munich, Germany.
authors.forename: Christian G
authors.initials: CG
authors.lastname: Stief
authors.affiliation: Department of Urology, Ludwig-Maximilians-University, Marchioninistrasse 15, 81377, Munich, Germany.
authors.forename: Alexander
authors.initials: A
authors.lastname: Karl
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002295:Carcinoma, Transitional Cell / Q000601:surgery*; D015653:Cystectomy; D005260:Female; D006304:Health Status; D006801:Humans; D008197:Lymph Node Excision; D008297:Male; D008875:Middle Aged; D059035:Perioperative Period; D011183:Postoperative Complications / Q000453:epidemiology*; D011446:Prospective Studies; D011788:Quality of Life; D012189:Retrospective Studies; D012380:Role; D011795:Surveys and Questionnaires; D001749:Urinary Bladder Neoplasms / Q000601:surgery*; D014547:Urinary Diversion; D014549:Urinary Incontinence / Q000453:epidemiology*; D016476:Urinary Reservoirs, Continent
keywords: Bladder cancer; Cystectomy; Ileum conduit; Orthotopic neobladder; Quality of life