Quality of life after radical treatment for invasive bladder cancer.

Considerable effort has been put into improving the quality of life after radical therapy for bladder cancer, though it has proved difficult to demonstrate conclusively that these aims have been achieved. There can be little doubt that the impact of a cystectomy is substantial but that it can be lessened by the use of continent and orthotopic diversion. Quality-of-life studies have, however, shown the remarkable ability of patients to adapt well to the more commonly used incontinent ileal conduit. Chemoradiation appears to have little impact on bladder function for about three-quarters of all patients and this effect will likely be lessened in the future by the use of partial bladder irradiation or better targeting using fiducial markers. Both radical surgery and chemoradiation can perturb bowel function but this may be reduced by choosing less functionally critical portions of bowel for diversion or by better targeted pelvic nodal radiation. Male sexual function is profoundly affected by both treatment approaches although conformal radiation or nerve-sparing cystectomy may help in the future. Female sexual function has never been fully examined but the impact of both approaches is likely very high.