Comparison of quality of life and sexual function after ileal vs. sigmoid orthotopic neobladder reconstruction following nerves, vas deferens, and seminal vesicle-sparing radical cystectomy: A prospective randomized study.

INTRODUCTION

Radical cystectomy with orthotopic urinary diversion is a standard treatment for muscle-invasive bladder cancer. However, the impact of different bowel segments used for neobladder reconstruction on postoperative quality of life and sexual function remains underexplored. This prospective randomized study compared the outcomes of orthotopic ileal neobladders (INB) and sigmoid neobladders following nerve-sparing, vas deferens-sparing, seminal vesicle-sparing, and partial prostate-sparing radical cystectomy.

MATERIALS AND

METHODS

Seventy-nine sexually active male patients with histopathologically confirmed T2 or high-grade T1 (T1G3) bladder cancer were randomized to INB (n = 38) or sigmoid neobladders (n = 41) reconstruction. All procedures were performed by a single urologist. Quality of life and sexual function were assessed using the European Organization for Research and Treatment of Cancer Quality-of-Life Core Questionnaire, version 3 and International Index of Erectile Function-15 (validated Hindi versions), respectively, preoperatively and at 1, 3, 6, 12, and 18 months postoperatively. Data were analyzed using SPSS version 23.0, and mean differences were calculated with 95% confidence intervals.

RESULTS

Baseline demographic and pathological characteristics were comparable between groups. European Organization for Research and Treatment of Cancer Quality-of-Life Core Questionnaire, version 3 scores showed progressive improvement over time, with no significant difference in global health or overall functional recovery between INB and sigmoid neobladders groups at 18 months. However, International Index of Erectile Function-15 analysis revealed significantly better preservation of erectile function, orgasmic function, sexual desire, and intercourse satisfaction in the INB group, indicating superior early sexual rehabilitation.

CONCLUSION

Both orthotopic neobladders provide comparable long-term quality of life outcomes. Nevertheless, the INB offers better postoperative sexual function recovery, supporting its preference in suitable male patients undergoing nerve-sparing radical cystectomy.