Health-related quality of life after radical cystectomy with different urinary diversions. What we know so far?

Introduction. Muscle-invasive bladder cancer (MIBC) is a highly aggressive malignancy, with radical cystectomy (RC) remaining the gold standard of treatment. Following RC, urinary diversion (UD) is required, with various surgical options available, including ureterocutaneostomy (UCS), ileal conduit (IC), and orthotopic neobladder (ONB). Despite advances in surgical techniques, the five-year overall survival rates remain poor, and preserving health-related quality of life (HRQoL) has become a critical goal in patient-centered care. Objective. This review aims to synthesize the available evidence regarding HRQoL outcomes associated with different types of urinary diversion in patients undergoing RC for MIBC, to identify current knowledge gaps, and to highlight directions for future research. Methods. A comprehensive review of PubMed literature from the late 1990s to the present was conducted, evaluating studies assessing HRQoL across various UD types. Key findings from both retrospective and prospective analyses, as well as meta-analyses, were summarized and critically appraised, with particular focus on validated HRQoL assessment tools and reported patient outcomes. Results. Although early studies suggested superior HRQoL outcomes in ONB patients, subsequent research has provided conflicting results, with several studies reporting no significant differences between UD types. Variability in patient selection, surgical expertise, follow-up duration, and the use of diverse HRQoL instruments complicates direct comparisons. Furthermore, while numerous questionnaires (e.g., EORTC BLM30, FACT-Bl-Cys, IONB-PRO) are available, the absence of a universally accepted standard hinders consistent assessment. Conclusions. Currently, no definitive conclusions can be drawn regarding the optimal UD type based solely on HRQoL outcomes. Further high-quality, prospective studies with standardized methodologies are urgently needed to better understand the long-term impact of different UD approaches and to guide evidence-based, patient-centered surgical decisions in MIBC management.