Impact of pad wetness on health-related quality of life after radical cystectomy and orthotopic neobladder

• Published in: World journal of urology Vol. 43; no. 1; p. 548
• Main Authors: Mastroianni, Riccardo, Iannuzzi, Andrea, Ragusa, Alberto, Tuderti, Gabriele, Anceschi, Umberto, Bove, Alfredo Maria, Brassetti, Aldo, D’Annunzio, Simone, Ferriero, Mariaconsiglia, Misuraca, Leonardo, Guaglianone, Salvatore, Papalia, Rocco, Simone, Giuseppe
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 10.09.2025; Springer Nature B.V
• Subjects: Aged; Bladder cancer; Chemotherapy; Clinical outcomes; Cystectomy - methods; Diaries; Female; Global health; Hemoglobin; Humans; Incontinence Pads; Intubation; Male; Medicine; Medicine & Public Health; Middle Aged; Mortality; Nephrology; Nighttime; Oncology; Patients; Postoperative Complications - epidemiology; Public health; Quality of Life; Robotic surgery; Statistical analysis; Urinary Bladder Neoplasms - surgery; Urinary Incontinence - etiology; Urinary Reservoirs, Continent; Urological surgery; Urology; Pad wetness; HRQoL; Neobladder; Radical cystectomy; RARC
• ISSN: 1433-8726; 0724-4983; 1433-8726
• DOI: 10.1007/s00345-025-05930-9

Purpose We aimed to evaluate the impact of day- and night-time pad wetness on 2yrs-QoL after Radical Cystectomy (RC) with Orthotopic Neobladder (ON) from a Randomized Controlled Trial (RCT) aimed at comparing open RC (ORC) and Robot-Assisted RC (RARC) with intracorporeal (i) ON. Methods Between January 2018 and September 2020, 116 patients were enrolled. Data from self-assessed questionnaires (EORTC-QLQ-C30 and QLQ-BLM30) were collected. Unmodified HRQoL was defined as a 2yrs Global Health status/QoL increase ≥ 0 (ΔQL ≥ 0) from baseline. Quantitative analysis of continence status was evaluated through 3-day voiding diaries. We previously defined day-time continence as “complete dryness” (0gr pad wetness) and night-time continence as pad wetness ≤ 50gr. Results Out of 116 patients enrolled, 88 received ON, and 71 with a minimum 2yrs follow-up were included. Quantitative analysis of day- and night-time urinary continence are reported. Particularly, 44 patients (62%) were completely dry during the day, while 40 patients (57%) experienced night-time pad wetness ≤ 50gr. However, a day pad wetness > 0gr significantly impact on 2yrs unmodified Global Health Status ( p  = 0.029), while only a night-time pad wetness ≥ 500gr significantly impacts on 2yrs unmodified Global Health Status ( p  = 0.005). Conclusion This study strengthens the need for a strict definition of day-time urinary continence after RC and ON, confirming complete dryness as a main driver of patients’ HRQoL. Conversely, nigh-time continence status seems to play a negligible role on subjectively assessed HRQoL.