Impact of protocolized intravesical instillation after TURBT on men's sexual quality of life:a retrospective cohort study.

OBJECTIVE: To determine whether protocolized intravesical gemcitabine instillation after transurethral resection of bladder tumor (TURBT) is associated with men's sexual quality of life, assessed using the Sexual Life Quality Questionnaire (SLQQ), compared with a single immediate postoperative instillation. METHODS: We conducted a retrospective cohort study of 244 men with non-muscle-invasive bladder cancer undergoing TURBT between January 2021 and May 2024. Patients received either protocolized intravesical gemcitabine (weekly for 8 weeks, then monthly for 6 months) or a single immediate postoperative instillation. The primary outcome was the 8-month SLQQ score. Secondary outcomes included the International Index of Erectile Function-5 (IIEF-5) and urinary symptom-related quality-of-life (QOL) score. Between-group comparisons, difference-in-differences (DID), correlation analyses, multivariable regression, and multiple-imputation sensitivity analyses were performed. RESULTS: Baseline SLQQ scores were comparable between groups. At 8 months, the protocol cohort had significantly lower SLQQ scores than controls (21.78 ± 8.77 vs. 37.13 ± 8.56; mean difference -15.35, 95% CI -17.54 to -13.16; Cohen's d=-1.77; P<0.001). The decline in SLQQ was greater in the protocol cohort (DID -15.27, 95% CI -18.18 to -12.36). Postoperative IIEF-5 was strongly correlated with SLQQ (r=0.938), whereas urinary symptom-related QOL showed a weak negative correlation (r=-0.232). Sensitivity analyses consistently demonstrated an approximately 15-point between-group difference after adjustment for baseline SLQQ and additional imputed clinical covariates. CONCLUSIONS: Protocolized intravesical gemcitabine following TURBT was associated with poorer postoperative sexual quality of life. This association remained robust across multiple sensitivity analyses, supporting routine sexual-health assessment during NMIBC survivorship.