Patient Reported Bowel-Related Quality of Life After Urinary Diversion for Radiation Injury: A Single Center Prospective Study.

OBJECTIVE: To determine the impact of urinary diversion for severe pelvic radiation injury on bowel-related quality of life. METHODS: This study was a prospective single-institution cohort survey study of patients undergoing urinary diversion for radiation injury from 2017-2024. Surveys were taken preoperatively and at least 6 months postoperatively and included validated bowel-related quality of life questionnaires (Fecal Incontinence QoL Instrument (FIQL) and Fecal Incontinence Severity Index (FISI)). Paired survey responses were analyzed using mixed effect models. RESULTS: A total of 38 participants had paired bowel-related quality of life data with median follow up of 454 days (IQR 371-703). The majority (82%) had prostate cancer radiation. Most patients underwent creation of an ileal conduit (55%). Bowel-related quality of life decreased amongst the full cohort (β=-8.34 [95% Confidence Interval -16.43, -0.26] p=0.043) and with patients with any fecal diversion (-14.15 [-25.30, -3.01] p=0.013). Ileal conduits did not have worsened bowel-related quality of life or fecal incontinence with or without fecal diversion. Compared to ileal conduits, patients with colon conduits (-20.66 [-40.92, -0.40] p=0.046) and right colon pouches (-22.29 [-41.72, -2.85] p=0.026) had worse perioperative changes in bowel-related quality of life and higher rates of fecal incontinence episodes. CONCLUSIONS: Though many health domains demonstrate improvements following urinary diversion for radiation injury, bowel-related quality of life and fecal incontinence may worsen postoperatively especially with patients requiring the use of large bowel in their diversion. This finding is important for counseling patients and for selecting bowel segments in patients whose anatomy affords multiple reconstructive options.