Health-related quality of life after radical cystectomy and ileal orthotopic neobladder: effect of detailed continence outcomes



To objectively quantify continence rates and to correlate continence outcomes with health-related quality of life (HRQOL) after radical cystectomy and orthotopic ileal neobladder (ONB).


Questionnaires were sent to 244 patients who underwent radical cystectomy with ONB between 2004 and 2015, and information about the current continence status was retrieved. To objectify postoperative urine loss, daytime and nocturnal pad tests were performed. Continence was defined as need of up to one safety pad. HRQOL was assessed using EORTC QLQ-C30 scoring with global health status being the primary endpoint. Statistical analysis included Fisher’s test, Mann–Whitney U test, Pearson’s rank correlation, and binary regression models (p < 0.05).


178 patients (73.0%) answered the QLQ-C30 questionnaires and were included in the study. Median follow-up was 61 months. Median daytime pad use was 1 and median daily urine loss based on pad testing was 4.0 g, leading to a daytime continence rate of 48.5%. Continence had a significant impact on postoperative HRQOL (p = 0.017). ICIQ-SF score (p = 0.001, OR = 0.805) and need for condom catheter during nighttime (p = 0.015, OR = 0.123) were independent predictors for worse HRQOL outcomes based on global health status. A history of pelvic floor muscle training was an independent predictor of increased HRQOL (p = 0.009, OR = 10.459).


Need of condom urinals and higher ICIQ-SF scores are independent predictors for worse HRQOL outcomes. We show significant beneficial effects of pelvic floor muscle training on patients' HRQOL.

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Fig. 1



Body mass index


Confidence interval


Clean intermittent self-catheterization


Eastern Cooperative Oncology Group


European Organization for Research and Treatment of Cancer


Health-related quality of life


International consultation on incontinence questionnaire short form


Odds ratio


Orthotopic ileal neobladder


Pelvic floor muscle training


  1. 1.

    Siegel R, Ma J, Zou Z, Jemal A (2014) Cancer statistics, 2014. CA Cancer J Clin 64(1):9–29.

    Article  PubMed  Google Scholar 

  2. 2.

    Witjes JA, Comperat E, Cowan NC, De Santis M, Gakis G, Lebret T et al (2014) EAU guidelines on muscle-invasive and metastatic bladder cancer: summary of the 2013 guidelines. Eur Urol 65(4):778–792.

    Article  PubMed  Google Scholar 

  3. 3.

    Studer UE, Burkhard FC, Schumacher M, Kessler TM, Thoeny H, Fleischmann A et al (2006) Twenty years experience with an ileal orthotopic low pressure bladder substitute–lessons to be learned. J Urol 176(1):161–166.

    Article  PubMed  Google Scholar 

  4. 4.

    Todenhofer T, Stenzl A, Schwentner C (2013) Optimal use and outcomes of orthotopic neobladder reconstruction in men and women. Curr Opin Urol 23(5):479–486.

    Article  PubMed  Google Scholar 

  5. 5.

    Kretschmer A, Grimm T, Buchner A, Grimm J, Grabbert M, Jokisch F et al (2017) Prognostic features for objectively defined urinary continence after radical cystectomy and ileal orthotopic neobladder in a contemporary cohort. J Urol 197(1):210–215.

    Article  PubMed  Google Scholar 

  6. 6.

    Zahran MH, El-Hefnawy AS, Zidan EM, El-Bilsha MA, Taha DE, Ali-El-Dein B (2014) Health-related quality of life after radical cystectomy and neobladder reconstruction in women: impact of voiding and continence status. Int J Urol 21(9):887–892.

    Article  PubMed  Google Scholar 

  7. 7.

    Takenaka A, Hara I, Soga H, Sakai I, Terakawa T, Muramaki M et al (2010) Assessment of long-term quality of life in patients with orthotopic neobladder followed for more than 5 years. Int Urol Nephrol 43(3):749–754.

    Article  PubMed  Google Scholar 

  8. 8.

    Imbimbo C, Mirone V, Siracusano S, Niero M, Cerruto MA, Lonardi C et al (2015) Quality of life assessment with orthotopic ileal neobladder reconstruction after radical cystectomy: results from a prospective italian multicenter observational study. Urology 86(5):974–980.

    Article  PubMed  Google Scholar 

  9. 9.

    Hautmann RE, Egghart G, Frohneberg D, Miller K (1988) The ileal neobladder. J Urol 139(1):39–42

    CAS  Article  Google Scholar 

  10. 10.

    Avery K, Donovan J, Peters TJ, Shaw C, Gotoh M, Abrams P (2004) ICIQ: a brief and robust measure for evaluating the symptoms and impact of urinary incontinence. Neurourol Urodyn 23(4):322–330.

    Article  PubMed  Google Scholar 

  11. 11.

    Aaronson NK, Ahmedzai S, Bergman B, Bullinger M, Cull A, Duez NJ et al (1993) The European Organization for Research and Treatment of Cancer QLQ-C30: a quality-of-life instrument for use in international clinical trials in oncology. J Natl Cancer Inst 85(5):365–376

    CAS  Article  Google Scholar 

  12. 12.

    Fayers PM (2001) Interpreting quality of life data: population-based reference data for the EORTC QLQ-C30. Eur J Cancer 37(11):1331–1334

    CAS  Article  Google Scholar 

  13. 13.

    Snyder CF, Blackford AL, Okuyama T, Akechi T, Yamashita H, Toyama T et al (2013) Using the EORTC-QLQ-C30 in clinical practice for patient management: identifying scores requiring a clinician’s attention. Qual Life Res 22(10):2685–2691.

    Article  PubMed  Google Scholar 

  14. 14.

    Cerruto MA, D’Elia C, Siracusano S, Gedeshi X, Mariotto A, Iafrate M et al (2015) Systematic review and meta-analysis of non RCT’s on health related quality of life after radical cystectomy using validated questionnaires: Better results with orthotopic neobladder versus ileal conduit. Eur J Surg Oncol.

    Article  PubMed  Google Scholar 

  15. 15.

    Kretschmer A, Grimm T, Buchner A, Stief CG, Karl A (2016) Prognostic features for quality of life after radical cystectomy and orthotopic neobladder. Int Braz J Urol 42(6):1109–1120.

    Article  PubMed  PubMed Central  Google Scholar 

  16. 16.

    Goode PS, Burgio KL, Johnson TM 2nd, Clay OJ, Roth DL, Markland AD et al (2011) Behavioral therapy with or without biofeedback and pelvic floor electrical stimulation for persistent postprostatectomy incontinence: a randomized controlled trial. JAMA 305(2):151–159.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  17. 17.

    Fernandez RA, Garcia-Hermoso A, Solera-Martinez M, Correa MT, Morales AF, Martinez-Vizcaino V (2015) Improvement of continence rate with pelvic floor muscle training post-prostatectomy: a meta-analysis of randomized controlled trials. Urol Int 94(2):125–132.

    Article  PubMed  Google Scholar 

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Author information




TG Project development, Data Collection, Manuscript writing. JG Project development, Data Collection. AB Project development, Data Collection. GS Project development, Data Collection. FJ Data Collection, Manuscript writing. CGS Project development. AK Project development. AK Project development, Statistical analysis, Manuscript writing.

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Correspondence to Tobias Grimm.

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Grimm, T., Grimm, J., Buchner, A. et al. Health-related quality of life after radical cystectomy and ileal orthotopic neobladder: effect of detailed continence outcomes. World J Urol 37, 2385–2392 (2019).

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  • Cystectomy
  • Urinary incontinence
  • Ileal neobladder
  • Bladder cancer
  • Quality of life