Pouch Diversion May Lead to Decision Regret in Patients Undergoing Cystectomy

Urinary diversion type was reported to be significantly associated with decision regret 12 months after cystectomy, according to a recent study reported at the 2020 Society of Urologic Oncology (SUO) Annual Meeting.¹

In her presentation at the virtual meeting, Elizabeth A. Green, MD, of Moffitt Cancer Center, Tampa, Florida, explained that there is a paucity of data related to decision regret in patients undergoing cystectomy.

“In the urologic literature, the best-described surgical decision regret is in patients undergoing prostatectomy,” Green said, adding that there is only 1 previous published paper evaluating decision regret in patients undergoing cystectomy.²

For the study from Green et al, patients undergoing cystectomy at Moffitt Cancer Center between 2014 and 2016 were recruited for a prospective quality of life and complication study. Patients were followed for 1 year after undergoing cystectomy. Of the 132 patients included in the study, 21 patients underwent neobladder urinary diversion, 105 underwent ileal conduit, and 6 patients underwent pouch diversion.

Patients completed the following health-related quality of life questionnaires at baseline and at 3, 6, and 12 months post cystectomy:

• Bladder Cancer Index (BCI)

• Body Image Scale (BIS)

• Patient Health Questionnaire-8

• Medical Outcomes Study Sleep Scale

• Medical Outcomes Study Short Form (SF-36).

Additionally, patients completed the Coping Strategy Indicator at baseline and the Decision Regret Scale at 3, 6, and 12 months after surgery.

The investigators found a statistically significant association between urinary diversion type and decision regret on univariate, but not multivariate, analysis, with patients undergoing pouch diversion reporting significantly more regret than patients undergoing neobladder or ileal conduit (P = .048).

Patients undergoing pouch diversion “also had significantly worse SF-36 scores. They had the greatest symptom burden in terms of urinary symptoms, and they also had the most sleep problems and the biggest problems with body image,” Green said.

On univariate analysis, the investigators reported a statistically significant association between pouch diversion and decision regret. No demographic- or cancer-related factors were associated with decision regret.

“Nearly all the self-reported follow-up measures at 12 months after surgery were significantly related to decision regret. The only exception was the sexual function [domain] on the BCI,” Green said.

On multivariate analysis, BIS was found to be the only independent predictor of decision regret 12 months after surgery.

Commenting on the multivariate analysis, Green said, “Due to the limited sample size, particularly in the pouch arm, we were limited in the number of variables we could include in this analysis.”

References:

1. Green G, Fan W, Li R. Factors associated with decision regret in patients undergoing radical cystectomy and urinary diversion. Presented at: 2020 SUO Annual Meeting. December 2-5, 2020; Virtual. Abstract 18

2. Check DK, Leo MC, Banegas MP, et al. Decision regret related to urinary diversion choice among patients treated with cystectomy. J Urol. 2020;203(1):159-163. doi:10.1097/JU.0000000000000512