Radical cystectomy, though a morbid operation, remains the standard of care for muscle invasive bladder cancer. As with other major surgeries, the patient regret regarding the decision to undergo radical cystectomy and urinary diversion has been observed, but factors associated with decision regret have not been fully characterized.

132 cystectomy patients were accrued to a prospective quality of life (QOL) and complication study between 2014 to 2016 and followed for 1 year after surgery. Study patients completed a series of questionnaires including the Bladder Cancer Index (BCI), Body Image Scale (BIS), Patient Health Questionnaire-8 (PHQ-8), Medical Outcomes Study Sleep Scale (MOS-Sleep) and Medical Outcomes Study Short Form (SF-36) prior to cystectomy and at 3, 6 and 12 months after surgery. The Coping Strategy Indicator (CSI) was collected at baseline and the Decision Regret Scale (DRS) was collected at 3, 6, and 12 months after surgery.

Baseline sexual function was worse in patients with an ileal conduit (IC) than those with a neobladder (NB) or catheterizable pouch (p=0.009, Table 1). Pouch patients had more depressive symptoms than IC or NB patients (P=0.042). There were no differences in other baseline measures between groups.

Decision regret was different by diversion type 12 months after surgery. Pouch patients endorsed the most regret followed by NB and IC patients (P=0.048). Pouch patients had lower urinary BCI (P<0.001), body image (P=0.002), SF-36 physical scores (P=0.002), and more sleep problems (P=0.018) than those with NB or IC.

Other factors associated with decision regret included lower 12 month SF-36 (P=0.004), urinary BCI (P=0.001), and bowel BCI (P=0.020), and higher scores on PHQ-8 (P=0.002), MOS-Sleep problem index 1 (P<0.001), and BIS (P<0.001, Table 2). There was no association between baseline measures and decision regret. Body image was the only independent predictor of decision regret.

Urinary diversion type was significantly associated with decision regret 12 months after cystectomy. Baseline factors were not associated with regret but deficits in several patient-reported outcome measures (PROMs) at 12 months were associated with decision regret. Body image was the only independent predictor of decision regret. Patients who received a catheterizable pouch had worse follow-up quality of life and the highest decision regret, but comprised a small number in the overall study cohort.