European urology open science · 2026
Quality of Life After Radical Cystectomy: Meta-analysis of Neobladder and Ileal Conduit Outcomes Across Multiple Assessment Tools.
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Mediana Ervita, Hamid Agus R A H, Rahman Fakhri, Mochtar Chaidir A, Umbas Rainy, Abol-Enein Hassan
Аннотация
BACKGROUND AND OBJECTIVE: Radical cystectomy (RC) requires urinary diversion, commonly orthotopic neobladder (ONB) or ileal conduit (IC). While ONB preserves natural voiding, IC is technically simpler. This study aimed to compare long-term (>12 mo) quality of life (QoL) outcomes between ONB and IC to aid preoperative shared decision-making.
METHODS: Following PRISMA guidelines, we searched PubMed, Cochrane Library, and Google Scholar up to September 15, 2025. We included studies comparing ONB and IC in adults with follow-up >12 mo. Heterogeneity was explored using meta-regression. The Newcastle-Ottawa Scale assessed bias, and Review Manager v5.4 was used for analysis.
KEY FINDINGS AND LIMITATIONS: Nineteen studies involving 2379 patients were analyzed. For all assessment tools used (EORTC QLQ-C30, FACT-BL, SF-36, and Bladder Cancer Index [BCI]), higher scores indicate better QoL or function. Pooled analysis showed that ONB was associated with higher global health status (EORTC QLQ-C30: mean difference [MD] = -9.42, p = 0.009; negative value indicates higher score in ONB) and functional well-being (FACT-BL -2.60, p = 0.010). Conversely, the IC group demonstrated higher scores in urinary outcomes (BCI Urinary: MD = 22.81, p = 0.02; positive value indicates higher score in IC). Heterogeneity among studies was moderate to high. Meta-regression indicated geographic location and tumor characteristics influenced heterogeneity. Limitations include observational design and potential selection bias.
CONCLUSIONS AND CLINICAL IMPLICATIONS: ONB reconstruction is associated with higher overall QoL scores, while IC is associated with higher urinary scores. These findings represent clinical trade-offs rather than superiority. Surgical selection should be individualized, balancing patient preference for body image against the risk of functional management challenge.
METHODS: Following PRISMA guidelines, we searched PubMed, Cochrane Library, and Google Scholar up to September 15, 2025. We included studies comparing ONB and IC in adults with follow-up >12 mo. Heterogeneity was explored using meta-regression. The Newcastle-Ottawa Scale assessed bias, and Review Manager v5.4 was used for analysis.
KEY FINDINGS AND LIMITATIONS: Nineteen studies involving 2379 patients were analyzed. For all assessment tools used (EORTC QLQ-C30, FACT-BL, SF-36, and Bladder Cancer Index [BCI]), higher scores indicate better QoL or function. Pooled analysis showed that ONB was associated with higher global health status (EORTC QLQ-C30: mean difference [MD] = -9.42, p = 0.009; negative value indicates higher score in ONB) and functional well-being (FACT-BL -2.60, p = 0.010). Conversely, the IC group demonstrated higher scores in urinary outcomes (BCI Urinary: MD = 22.81, p = 0.02; positive value indicates higher score in IC). Heterogeneity among studies was moderate to high. Meta-regression indicated geographic location and tumor characteristics influenced heterogeneity. Limitations include observational design and potential selection bias.
CONCLUSIONS AND CLINICAL IMPLICATIONS: ONB reconstruction is associated with higher overall QoL scores, while IC is associated with higher urinary scores. These findings represent clinical trade-offs rather than superiority. Surgical selection should be individualized, balancing patient preference for body image against the risk of functional management challenge.