Assessment of the Quality-of-life and Functional Outcomes in Patients Undergoing Cystectomy and Urinary Diversion for the Management of Radiation-induced Refractory Benign Disease

ObjectiveTo investigate the impact of cystectomy for the treatment of refractory benign disease secondary to radiation therapy on the health-related quality of life (HRQOL).MethodsA retrospective review was performed on patients undergoing cystectomy for the management of treatment-refractory disease secondary to radiation therapy. Overall, 29 patients underwent cystectomy for refractory fistulas (n = 12, 41.4%), radiation cystitis (n = 12, 41.4%), pelvic pain (n = 4, 13.8%), or incontinence (n = 1, 3.4%) from 2004 to 2013. Preoperative and postoperative HRQOL were measured using a modified version of the Short Form version 2 (SF-36v2).ResultsA total of 19 patients (65.5%) reported a 30-day postoperative complication, of which 80% were Clavien grade I or II. Nineteen (65.5%) of the patients completed the SF-36v2 survey. Low scores were noted in the preoperative setting in the physical and mental health domains of these patients, especially in the role limitations due to health and emotional problems. Clinically meaningful improvements were noted in all the physical and mental health domains after cystectomy. Significant improvements were found in certain domains, namely in the level of pain control, general health, role limitations due to emotional problems, and social functioning (all P <.01).ConclusionTreatment-refractory disease from radiation therapy significantly impairs patients' HRQOL. Although cystectomy with urinary diversion is associated with perioperative complication risks, cystectomies can be safely performed in this high-risk population and significantly improve patients' physical and mental HRQOL. Further studies are needed to characterize the role of cystectomy in treatment-refractory disease from radiation therapy.