The Influence of Urinary Diversion Type on Body Image and Decision Regret Following Radical Cystectomy: A Systematic Review

Abstract

Background and objective: The choice between different urinary diversion types carries distinct implications for physical appearance and psychosocial outcomes. This systematic review aims to synthesize current evidence on how different urinary diversion types influence patients' body image and decision regret.

Methods: In this prospectively registered systematic review (CRD420251079300), we searched MEDLINE, Embase, and Web of Science in June 2025 for studies reporting body image and decision regret outcomes in patients undergoing urinary diversion after radical cystectomy for bladder cancer. Data were synthesized descriptively, and the risk of bias was assessed using the Risk Of Bias in Non-randomized Studies-of Interventions (ROBINS-I) tool.

Key findings and limitations: Of 1837 records screened, 31 studies comprising 5180 patients were included: 24 assessed body image (n = 4552), six decision regret (n = 579), and one both (n = 49). Diversion types comprised orthotopic neobladder (n = 1848), ileal conduit (n = 2970), continent cutaneous diversion (n = 61), cutaneous ureterostomy (n = 206), and ureterosigmoidostomy (n = 95). Most studies evaluated body image using the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire-Bladder Cancer Module (EORTC QLQ-BLM30; 13 studies) or Body Image Scale (seven studies). Decision regret was measured via the Decision Regret Scale (two studies) or custom questionnaires (five studies). Among 17 comparative studies on body image and six on decision regret, most reported favorable body image and lower decision regret in patients with continent versus incontinent urinary diversions. Most studies exhibited moderate to serious risks of bias, primarily due to retrospective designs, missing response data, and incomplete reporting of diversion-specific questionnaire participation.

Conclusions and clinical implications: Urinary diversion choice after radical cystectomy affects body image and decision regret, with continent options generally linked to better psychosocial outcomes. Given the heterogeneity of current evidence, patient-centered counseling, expectation management, and social support are essential to improve long-term satisfaction and quality of life.

Keywords: Bladder cancer; Body image; Decision regret; Incontinent/continent urinary diversion; Urinary diversion.