No urinary diversion is universally superior after radical cystectomy; the most appropriate option depends on patient priorities rather than surgical preference alone. The orthotopic neobladder is associated with higher global quality of life and better psychosocial outcomes, largely due to preservation of body image and sexual function. The ileal conduit provides more stable urinary function and simpler daily management, reducing the burden of incontinence and self-care demands. These outcomes represent a clear functional trade-off, not a superiority hierarchy between diversion types. Shared decision-making is essential—selection should incorporate age, comorbidities, lifestyle expectations, and the patient’s willingness and ability to manage long-term self-care requirements. Radical cystectomy (RC) requires urinary diversion, commonly orthotopic neobladder (ONB) or ileal conduit (IC). While ONB preserves natural voiding, IC is technically simpler. This study aimed to compare long-term (>12 mo) quality of life (QoL) outcomes between ONB and IC to aid preoperative shared decision-making. Following PRISMA guidelines, we searched PubMed, Cochrane Library, and Google Scholar up to September 15, 2025. We included studies comparing ONB and IC in adults with follow-up >12 mo. Heterogeneity was explored using meta-regression. The Newcastle-Ottawa Scale assessed bias, and Review Manager v5.4 was used for analysis. Nineteen studies involving 2379 patients were analyzed. For all assessment tools used (EORTC QLQ-C30, FACT-BL, SF-36, and Bladder Cancer Index BCI), higher scores indicate better QoL or function. Pooled analysis showed that ONB was associated with higher global health status (EORTC QLQ-C30: mean difference MD = −9.42, p = 0.009; negative value indicates higher score in ONB) and functional well-being (FACT-BL −2.60, p = 0.010). Conversely, the IC group demonstrated higher scores in urinary outcomes (BCI Urinary: MD = 22.81, p = 0.02; positive value indicates higher score in IC). Heterogeneity among studies was moderate to high. Meta-regression indicated geographic location and tumor characteristics influenced heterogeneity. Limitations include observational design and potential selection bias. ONB reconstruction is associated with higher overall QoL scores, while IC is associated with higher urinary scores. These findings represent clinical trade-offs rather than superiority. Surgical selection should be individualized, balancing patient preference for body image against the risk of functional management challenge.
Mediana et al. (Thu,) studied this question.