Luckily, my physical appearance looks intact”: A qualitative study of men's experiences of radical surgery for lower urinary tract tumors

Aim: This study examined how middle-aged and older men diagnosed with lower urinary tract cancer in China are supported by physicians and nurses in the physical and survival changes associated with the need for prostate or other sex organ removal and urinary tract reconstruction surgery. The following research questions were addressed: (a) how do middle-aged and older men who undergo radical surgery for lower urinary tract tumors, including removal of the bladder or prostate for urinary tract reconstruction, and (b) how does cancer treatment affect their body image and socialization?

Design: This study utilized a constructivist qualitative research design and the Braun and Clarke six-step thematic analysis. Method: From May 2023 to September 2023, in-depth interviews were conducted with 10 men diagnosed with lower urinary tract tumors. In this qualitative study, data analysis was conducted concurrently with data construction, recognizing that the process of analyzing and making sense of data should begin with the interviews. We explicitly frame the discussion of these findings within a theory of concretization influenced by Armstrong's model of symptom experience, which is consistent with exploring the patient's symptom experience to generate meaningful experiences and applying them to the construction of a clinical recovery model.

Results:Three overarching themes were identified that contained related sub-themes: (1) the "distress of physical change," (2) "coping with stressful events," and (3) "constructing external connections." Common to all three themes was that patients felt like they were on an upward spiral staircase, reflecting on their past, on their current body, on adapting to life in their "new body" after surgery, and on reconstructing their relationship with their surroundings.

Conclusion: Participants reflected on their state of life in the face of altered sexual and urinary function as a result of the diagnosis of a lower urinary tract tumor and radical tumor resection. The study participants were generally satisfied with the outcome of the radical tumor surgery, as was effectively listening to the doctors' and nurses' recommendations for postoperative voiding training. The patients were grateful for the preciousness of life and continued to live a high quality life after surgery, revitalized and living a colorful life with the support of friends and family.

Impact: This study shows the dynamics from receiving a cancer diagnosis and cancer treatment to making surgical decisions and postoperative rehab. The primary finding of this patient's symptom experience was from the perspective of middle-aged and older men who are throughout the stages of urethral reconstruction and rehabilitation after radical surgery for lower urinary tract tumors. The findings suggest that advanced care professionals in the field of urology can provide personalized rehabilitation guidance and psychological support by focusing on the patient's symptoms and symptom experience, and provide a whole-course management program to promote recovery and treatment satisfaction in the prehospital, preoperative, intraoperative, postoperative, and home settings.