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Distressful Symptoms after Radical Cystectomy with Urinary Diversion for Urinary Bladder Cancer: A Swedish Population–Based Study

Objective: To study the excess prevalence of distressful symptoms after radical surgery for urinary bladder cancer. Methods: We included all patients who underwent cystectomy due to bladder cancer before 1996 in Stockholm County. A control group was randomly selected from the general population. Information was collected by means of an anonymous postal questionnaire. Results: Completed questionnaires were returned by 310 (71%) controls and 251 (85%) cystectomized individuals. A 5–fold (reservoir) and 9–fold (conduit) increase in defecation urgency and a 4–fold (reservoir) and 6–fold (conduit) increase in faecal leakage were reported in individuals operated on. Urinary tract infection was increased 3–fold in cystectomized individuals compared with controls, during the previous year 26% of the patients reported a symptomatic infection. The perception of a reduced physical attractiveness due to disease was more than 5–fold increased in the men operated on compared to the controls. The majority, 135 out of 201 (67%), reported that they would have refused alternative bladder–sparing procedures if they decreased the prospects of survival by even as little as 1%. Conclusions: The patient’s situation after cystectomy is considerably impaired due to changed bowel and sexual function, urinary tract infections and a sense of decreased attractiveness. However, most patients are in spite of this unwilling to compromise survival.