Purpose: Early rehabilitation (ER) after radical cystectomy (RC) seems to be crucial for quality of life, education and prevention of complications after hospital discharge. We investigated an inpatient ER setting for bladder cancer (BC) patients. Methods: In total, 103 BC patients who underwent ileum neobladder reconstruction were included. The major issues from the patients’ point of view, functional outcome parameters and complications during ER were analysed. A Wilcoxon signed rank test was used to compare body mass index (BMI) and diurnal as well as nocturnal use of urinary pads before and after ER. Results: At the beginning of ER, the median Karnovsky performance scale score was 70% (interquartile range [IQR] 70–90%) and the mean BMI was 25.8 kg/m2 (IQR 21.9–27.9). The 4 most common complaints were urinary incontinence (80.6%), general weakness (73.8%), urinary mucus (49.5%) and mental distress (44.7%). During the programme, 28.2% of patients had a urinary tract infection requiring antibiotics and 15.5% presented a symptomatic acidosis. Median diurnal use of urinary pads significantly decreased during ER (4 vs. 3; p < 0.001). At the end of the ER programme, 76.0, 54.8 and 30.8% of the patients indicated an improvement of their physical capacity, incontinence and psychological distress respectively. Conclusions: Our study demonstrates the need for postoperative rehabilitation after RC. Further investigations should compare outcome parameters to ambulatory and outpatient ER models.

1.
Lee RK, Abol-Enein H, Artibani W, Bochner B, Dalbagni G, Daneshmand S, et al. Urinary diversion after radical cystectomy for bladder cancer: options, patient selection, and outcomes.
BJU Int
. 2014 Jan;113(1):11–23.
2.
Aziz A, May M, Burger M, Palisaar RJ, Trinh QD, Fritsche HM, et al.; PROMETRICS 2011 research group. Prediction of 90-day mortality after radical cystectomy for bladder cancer in a prospective European multicenter cohort.
Eur Urol
. 2014 Jul;66(1):156–63.
3.
Gore JL, Yu HY, Setodji C, Hanley JM, Litwin MS, Saigal CS; Urologic Diseases in America Project. Urinary diversion and morbidity after radical cystectomy for bladder cancer.
Cancer
. 2010 Jan;116(2):331–9.
4.
Roghmann F, Trinh QD, Braun K, von Bodman C, Brock M, Noldus J, et al. Standardized assessment of complications in a contemporary series of European patients undergoing radical cystectomy.
Int J Urol
. 2014 Feb;21(2):143-9.
5.
Buchner A, Grimm T, Schneevoigt BS, Wittmann G, Kretschmer A, Jokisch F, et al. Dramatic impact of blood transfusion on cancer-specific survival after radical cystectomy irrespective of tumor stage.
Scand J Urol
. 2017 Apr;51(2):130–6.
6.
Gerharz EW, Månsson A, Hunt S, Skinner EC, Månsson W. Quality of life after cystectomy and urinary diversion: an evidence based analysis.
J Urol
. 2005 Nov;174(5):1729–36.
7.
Hobisch A, Tosun K, Kinzl J, Kemmler G, Bartsch G, Höltl L, et al. Quality of life after cystectomy and orthotopic neobladder versus ileal conduit urinary diversion.
World J Urol
. 2000 Oct;18(5):338–44.
8.
Huang Y, Pan X, Zhou Q, Huang H, Li L, Cui X, et al. Quality-of-life outcomes and unmet needs between ileal conduit and orthotopic ileal neobladder after radical cystectomy in a Chinese population: a 2-to-1 matched-pair analysis.
BMC Urol
. 2015 Nov;15(1):117.
9.
Schulz GB, Grimm T, Buchner A, Jokisch F, Kretschmer A, Casuscelli J, et al. Surgical High-risk Patients With ASA ≥ 3 Undergoing Radical Cystectomy: Morbidity, Mortality, and Predictors for Major Complications in a High-volume Tertiary Center.
Clin Genitourin Cancer
. 2018 Dec;16(6):e1141–9.
10.
Pearl JA, Patil D, Filson CP, Arya S, Alemozaffar M, Master VA, et al. Patient Frailty and Discharge Disposition Following Radical Cystectomy.
Clin Genitourin Cancer
. 2017 Aug;15(4):e615–21.
11.
Sharma P, Henriksen CH, Zargar-Shoshtari K, Xin R, Poch MA, Pow-Sang JM, et al. Preoperative Patient Reported Mental Health is Associated with High Grade Complications after Radical Cystectomy.
J Urol
. 2016 Jan;195(1):47–52.
12.
Novotny V, Froehner M, Koch R, Zastrow S, Heberling U, Leike S, et al. Age, American Society of Anesthesiologists physical status classification and Charlson score are independent predictors of 90-day mortality after radical cystectomy.
World J Urol
. 2016 Aug;34(8):1123–9.
13.
Henningsohn L, Steven K, Kallestrup EB, Steineck G. Distressful symptoms and well-being after radical cystectomy and orthotopic bladder substitution compared with a matched control population.
J Urol
. 2002 Jul;168(1):168–74.
14.
Karl A, Buchner A, Becker A, Staehler M, Seitz M, Khoder W, et al. A new concept for early recovery after surgery for patients undergoing radical cystectomy for bladder cancer: results of a prospective randomized study.
J Urol
. 2014 Feb;191(2):335–40.
15.
World Medical A; World Medical Association. World Medical Association Declaration of Helsinki: ethical principles for medical research involving human subjects.
JAMA
. 2013 Nov;310(20):2191–4.
16.
Aghazadeh MA, Barocas DA, Salem S, Clark PE, Cookson MS, Davis R, et al. Determining factors for hospital discharge status after radical cystectomy in a large contemporary cohort.
J Urol
. 2011 Jan;185(1):85–9.
17.
Perimenis P, Koliopanou E. Postoperative management and rehabilitation of patients receiving an ileal orthotopic bladder substitution.
Urol Nurs
. 2004 Oct;24(5):383–6.
18.
Jensen BT, Petersen AK, Jensen JB, Laustsen S, Borre M. Efficacy of a multiprofessional rehabilitation programme in radical cystectomy pathways: a prospective randomized controlled trial.
Scand J Urol
. 2015 Apr;49(2):133–41.
19.
Porserud A, Sherif A, Tollbäck A. The effects of a physical exercise programme after radical cystectomy for urinary bladder cancer. A pilot randomized controlled trial.
Clin Rehabil
. 2014 May;28(5):451–9.
20.
Jensen BT, Jensen JB, Laustsen S, Petersen AK, Søndergaard I, Borre M. Multidisciplinary rehabilitation can impact on health-related quality of life outcome in radical cystectomy: secondary reported outcome of a randomized controlled trial.
J Multidiscip Healthc
. 2014 Jul;7:301–11.
21.
Jensen BT, Laustsen S, Jensen JB, Borre M, Petersen AK. Exercise-based pre-habilitation is feasible and effective in radical cystectomy pathways-secondary results from a randomized controlled trial.
Support Care Cancer
. 2016 Aug;24(8):3325–31.
22.
Evers PD, Logan JE, Sills V, Chin AI. Karnofsky performance status predicts overall survival, cancer-specific survival, and progression-free survival following radical cystectomy for urothelial carcinoma.
World J Urol
. 2014 Apr;32(2):385–91.
23.
Kretschmer A, Grimm T, Buchner A, Grimm J, Grabbert M, Jokisch F, et al. Prognostic Features for Objectively Defined Urinary Continence after Radical Cystectomy and Ileal Orthotopic Neobladder in a Contemporary Cohort.
J Urol
. 2017 Jan;197(1):210–5.
24.
Hautmann RE, Abol-Enein H, Davidsson T, Gudjonsson S, Hautmann SH, Holm HV, et al.; International Consultation on Urologic Disease-European Association of Urology Consultation on Bladder Cancer 2012. ICUD-EAU International Consultation on Bladder Cancer 2012: urinary diversion.
Eur Urol
. 2013 Jan;63(1):67–80.
25.
Nieuwenhuijzen JA, de Vries RR, Bex A, van der Poel HG, Meinhardt W, Antonini N, et al. Urinary diversions after cystectomy: the association of clinical factors, complications and functional results of four different diversions.
Eur Urol
. 2008 Apr;53(4):834–42.
26.
Perimenis P, Burkhard FC, Kessler TM, Gramann T, Studer UE. Ileal orthotopic bladder substitute combined with an afferent tubular segment: long-term upper urinary tract changes and voiding pattern.
Eur Urol
. 2004 Nov;46(5):604–9.
27.
Grimm T, Grimm J, Buchner A, Schulz G, Jokisch F, Stief CG, et al. Health-related quality of life after radical cystectomy and ileal orthotopic neobladder: effect of detailed continence outcomes.
World J Urol
. 2019 Jan. .
28.
Liedberg F, Ahlgren G, Baseckas G, Gudjonsson S, Håkansson U, Lindquist S, et al. Long-term functional outcomes after radical cystectomy with ileal bladder substitute: does the definition of continence matter?
Scand J Urol
. 2017 Feb;51(1):44–9.
29.
Clifford TG, Shah SH, Bazargani ST, Miranda G, Cai J, Wayne K, et al. Prospective Evaluation of Continence Following Radical Cystectomy and Orthotopic Urinary Diversion Using a Validated Questionnaire.
J Urol
. 2016 Dec;196(6):1685–91.
30.
Månsson A, Colleen S, Hermerén G, Johnson G. Which patients will benefit from psychosocial intervention after cystectomy for bladder cancer?
Br J Urol
. 1997 Jul;80(1):50–7.
31.
Gregg JR, Cookson MS, Phillips S, Salem S, Chang SS, Clark PE, et al. Effect of preoperative nutritional deficiency on mortality after radical cystectomy for bladder cancer.
J Urol
. 2011 Jan;185(1):90–6.
32.
Johnson DC, Riggs SB, Nielsen ME, Matthews JE, Woods ME, Wallen EM, et al. Nutritional predictors of complications following radical cystectomy.
World J Urol
. 2015 Aug;33(8):1129–37.
33.
Miyake M, Morizawa Y, Hori S, Marugami N, Shimada K, Gotoh D, et al. Clinical impact of postoperative loss in psoas major muscle and nutrition index after radical cystectomy for patients with urothelial carcinoma of the bladder.
BMC Cancer
. 2017 Mar;17(1):237.
34.
Mano R, Baniel J, Goldberg H, Stabholz Y, Kedar D, Yossepowitch O. Urinary tract infections in patients with orthotopic neobladder.
Urol Oncol
. 2014 Jan;32(1):50.e9–14.
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