A Prospective Analysis of Patient-reported Health-related Quality of Life Outcomes Following Urinary Diversion for Pelvic Radiation-related Injury.

OBJECTIVE

To define the long-term impacts on health-related quality of life (HRQoL) of patients undergoing urinary diversion for radiation-induced urologic injuries.

METHODS

We conducted a single-center, prospective study of patients undergoing urinary diversion for radiation-related urologic injury from 2017 to 2024. HRQoL was assessed pre- and postoperatively with paired surveys (at early, 6-12 months, and late, most recent) using 3 validated surveys: Patient-Reported Outcomes Measurement Information System (PROMIS) Global Health v1.1, Genitourinary Pain Index (GUPI), and Decision Regret Scale (DRS). Changes in PROMIS and GUPI scores were evaluated by surgery type and DRS scores were analyzed using Kruskal-Wallis test.

RESULTS

Fifty-five patients were enrolled with >1 year follow-up and 47 patients were included with paired pre- and postoperative surveys. The median follow-up was 47.7 months (IQR 27.3-60). Survey completion rates were 92% (PROMIS), 68% (GUPI), and 89% (DRS). Patients experienced significant improvements in all domains of the PROMIS score, which were sustained from early to late follow-up; GUPI scores showed significant improvement at both postoperative time points for pain, QoL, and urinary symptoms (P<.001). Mean DRS were low for all patients; 12.6/100 points (SD 14.5, range:0-25) at the early postoperative follow-up and 10.4/100 points (SD 11.5, range:0-20) at the late follow-up with no difference between diversion types.

CONCLUSION

Despite the morbidity of urinary diversion after radiation-induced pelvic injury, our study demonstrates significant sustained improvements in multiple patient-reported outcome measures in this high-risk population.