Some post-cystectomy symptoms persist for 3 months

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New research suggests that post-surgery symptoms may last for at least 3 months in cystectomy patients and worsen over time in some cases, posing unique management challenges for urologists.

Pain, anxiety, and depression; constipation; diarrhea; nausea; and sleep disturbances were all common, researchers found. Patients may also suffer from difficulties with social functioning and walking. The findings were presented at the 2016 American College of Surgeons Clinical Congress in Washington.

Dr. Smith"The percentage of patients who experienced constipation throughout the 3-month time period was surprising, as was the percentage with sleep [disturbance] and fatigue persisting over 3 months," said study co-author Angela B. Smith, MD, assistant professor of urology at the University of North Carolina at Chapel Hill.

The good news, she told Urology Times, is that the study findings will help urologic surgeons provide patients with more accurate information about symptoms.

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"Fear of the unknown can be a big challenge for patients, so it can be helpful to know that there is an endpoint in sight with regard to certain symptoms,” she said.

"In general, patients take quite a long time to recover," Dr. Smith said. "We know that there are a number of postoperative symptoms like nausea, vomiting, GI distress, fatigue, and sleep disturbances. But we really don't have a good sense of how many experience each symptom and at what time points."

In her practice, she said, patients often ask about when they'll experience symptoms and when they'll improve. But, she said, "I didn't have a good answer to guide them."

For the new study, Dr. Smith and colleagues administered a phone survey to 27 patients who underwent cystectomy in 2014 and 2015. The patients answered questions weekly for 30 days and biweekly for the rest of the time up to 12 weeks. The participants completed a median of seven calls.

Some patients reported pain throughout the entire 3 months, with the highest level (29%) at week 2.

"Then they had a steep drop-off at 3 weeks," Dr. Smith said. This was expected, as patients begin to recover over time, she said.

Next: Decreased appetite seen in early weeks

Decreased appetite seen in early weeks

The highest percentages of patients reporting nausea were at week 2 (23%) and weeks 4 and 10 (32% and 25%, respectively). Up to 60% of the patients had significantly decreased appetite and bloating in the early weeks after their procedures, Dr. Smith said.

"By 3 months, only 5% are describing decreased appetite,” she said.

These specific study findings are helpful, Dr. Smith said, because patients are especially anxious about decreased appetite. Their stress may be allayed when they're told that it's likely to improve over several weeks, she said.

Up to 36% reported diarrhea in the first 2 weeks, while constipation affected 25% to 33% early on, Dr. Smith said. Constipation lingered for some-generally, 25% to 35% of the patients-for the entire 3 months, she said, although the severity decreased over time.

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Sleep disturbances also lingered for some patients for the entire 12 weeks, affecting the highest percentage of patients (41%) in the first week. Depression and anxiety also lingered and reached their highest level (affecting 36% of patients) in the first month.

Sixty-five percent of patients reported urinary leakage at week 3, up from 45% at week 2, suggesting that week 3 may be the best time to intervene, Dr. Smith said.

Disruptions in social functioning and walking were most common in the first 2 weeks.

Why are these patients experiencing so many problems?

"These patients undergo a bowel resection, and many of these symptoms are similarly experienced in patients undergoing GI surgery. However, I think that some of the symptoms are amplified in urologic surgeries. We're adding urine to the system, and that can create metabolic disturbances leading to dehydration and differences in taste perception and appetite,” Dr. Smith said.

Enhanced recovery protocols try to eliminate symptoms through medications and other strategies. "While many of these strategies do help, they're not so effective as to eliminate the symptoms altogether,” she said.