Impact of pad wetness on health-related quality of life after radical cystectomy and orthotopic neobladder.

Abstract

Purpose: We aimed to evaluate the impact of day- and night-time pad wetness on 2yrs-QoL after Radical Cystectomy (RC) with Orthotopic Neobladder (ON) from a Randomized Controlled Trial (RCT) aimed at comparing open RC (ORC) and Robot-Assisted RC (RARC) with intracorporeal (i) ON.

Methods: Between January 2018 and September 2020, 116 patients were enrolled. Data from self-assessed questionnaires (EORTC-QLQ-C30 and QLQ-BLM30) were collected. Unmodified HRQoL was defined as a 2yrs Global Health status/QoL increase ≥ 0 (ΔQL ≥ 0) from baseline. Quantitative analysis of continence status was evaluated through 3-day voiding diaries. We previously defined day-time continence as "complete dryness" (0gr pad wetness) and night-time continence as pad wetness ≤ 50gr.

Results: Out of 116 patients enrolled, 88 received ON, and 71 with a minimum 2yrs follow-up were included. Quantitative analysis of day- and night-time urinary continence are reported. Particularly, 44 patients (62%) were completely dry during the day, while 40 patients (57%) experienced night-time pad wetness ≤ 50gr. However, a day pad wetness > 0gr significantly impact on 2yrs unmodified Global Health Status (p = 0.029), while only a night-time pad wetness ≥ 500gr significantly impacts on 2yrs unmodified Global Health Status (p = 0.005).

Conclusion: This study strengthens the need for a strict definition of day-time urinary continence after RC and ON, confirming complete dryness as a main driver of patients' HRQoL. Conversely, nigh-time continence status seems to play a negligible role on subjectively assessed HRQoL.