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Liu WJ, Campbell RA, Michael PD, Wood A, Haywood SC, Eltemamy M, Kaouk J, Campbell SC, Haber GP, Weight CJ, Remer EM, Almassi N. Clinical Upstaging After Neoadjuvant Chemotherapy Impacting Eligibility for Vaginal-sparing Cystectomy: Identifying Bladder Cancer Patients Who May Benefit From Interim Imaging. Urology 2024; 191:102-109. [PMID: 38908561 DOI: 10.1016/j.urology.2024.06.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Revised: 05/21/2024] [Accepted: 06/11/2024] [Indexed: 06/24/2024]
Abstract
OBJECTIVE Limited data exist on the frequency with which clinical progression during neoadjuvant chemotherapy (NAC) for muscle-invasive bladder cancer (MIBC) impacts eligibility for a vaginal-sparing surgical approach or on the utility of interim imaging assessment. We sought to evaluate the incidence of clinical upstaging following NAC that would render a patient ineligible for a vaginal-sparing cystectomy. METHODS Eighty-nine female patients with non-metastatic MIBC treated with NAC and radical cystectomy (RC) (2012-2023) were retrospectively reviewed. Tumor location(s) was determined from transurethral resection of bladder tumor operative reports. Pre- and post-NAC clinical staging was determined from imaging. Outcomes of interest included clinical upstaging and upstaging to vaginal invasion after NAC. RESULTS 75/89 patients had pre- and post-NAC imaging. Fifty-five had no change in clinical staging, 6 patients were upstaged (4 cT2→cT3, 2 cT3→cT4), and 14 patients were downstaged (13 cT3→cT2, 1 cT4→cT2). Of the 75 patients with pre- and post-NAC imaging, 39 had trigone tumors. Of these, 28 had no change in clinical staging, 2 were upstaged (1 cT2→cT3, 1 cT3→cT4) and 9 were downstaged (8 cT3→cT2, 1 cT4→cT2). Overall, 6/75 (8%) of patients demonstrated clinical upstaging after NAC. 2/39 (5%) of patients with trigone tumors clinically progressed after NAC and both had vaginal invasion (pT4) on final pathology. CONCLUSION Although clinical upstaging after NAC was infrequent, 5% of patients with trigonal MIBC were rendered ineligible for vaginal-sparing cystectomy following NAC due to progression. Interim imaging assessment may identify non-responders and preserve eligibility for vaginal-sparing RC.
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Affiliation(s)
- William J Liu
- Glickman Urologic and Kidney Institute, Cleveland Clinic, Cleveland, OH
| | | | - Patrick D Michael
- Glickman Urologic and Kidney Institute, Cleveland Clinic, Cleveland, OH
| | - Andrew Wood
- Glickman Urologic and Kidney Institute, Cleveland Clinic, Cleveland, OH
| | - Samuel C Haywood
- Glickman Urologic and Kidney Institute, Cleveland Clinic, Cleveland, OH
| | - Mohamed Eltemamy
- Glickman Urologic and Kidney Institute, Cleveland Clinic, Cleveland, OH
| | - Jihad Kaouk
- Glickman Urologic and Kidney Institute, Cleveland Clinic, Cleveland, OH
| | - Steven C Campbell
- Glickman Urologic and Kidney Institute, Cleveland Clinic, Cleveland, OH
| | | | | | - Erick M Remer
- Glickman Urologic and Kidney Institute, Cleveland Clinic, Cleveland, OH; Department of Radiology, Diagnostic Institute, Cleveland Clinic, Cleveland, OH
| | - Nima Almassi
- Glickman Urologic and Kidney Institute, Cleveland Clinic, Cleveland, OH.
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You C, Cheng L, Fang Q, Qing L, Li Q, Liu S, Wang Y, Li R, Dong Z. Comparative evaluation of reproductive organ-preserving versus standard radical cystectomy in female: a meta-analysis and systematic review of perioperative, oncological, and functional outcomes. Surg Endosc 2024; 38:5041-5052. [PMID: 39009729 DOI: 10.1007/s00464-024-11074-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2024] [Accepted: 07/08/2024] [Indexed: 07/17/2024]
Abstract
BACKGROUND To evaluate the perioperative, oncological, and functional outcomes of reproductive organ-preserving radical cystectomy (ROPRC) compared to standard radical cystectomy (SRC) in the treatment of female bladder cancer. METHODS A systematic search was conducted in November 2023 across several scientific databases. We executed a systematic review and cumulative meta-analysis of the primary outcomes of interest, adhering to the PRISMA and AMSTAR guidelines. The study was registered in PROSPERO (CRD42024501522). RESULTS The meta-analysis included 10 studies with a total of 2015 participants. ROPRC showed a significant reduction in operative time and postoperative fasting period compared to SRC (MD - 45.69, 95% CI - 78.91 ~ - 12.47, p = 0.007, and MD - 0.69, 95% CI - 1.25 ~ - 0.13, p = 0.02, respectively). Functional outcomes, both daytime continence rate (OR 4.94, 95% CI 1.53 ~ 15.91, p = 0.008) and nighttime continence rate (OR 5.91, 95% CI 1.94 ~ 18.01, p = 0.002), and sexual function measured by the Female Sexual Function Index (MD 5.72, 95% CI 0.19 ~ 11.26, p = 0.04), were significantly improved in the ROPRC group. There were no significant differences between ROPRC and SRC in terms of estimated blood loss, length of hospital stay, overall postoperative complications, minor complications or major complications. Oncologically, both procedures showed comparable outcomes with no significant differences in positive surgical margins, tumor recurrence rates, overall survival, cancer-specific survival, recurrence-free survival, or progression-free survival. CONCLUSIONS ROPRC is a viable and effective alternative to SRC in female bladder cancer patients, offering enhanced functional outcomes and similar oncological safety. These findings suggest that ROPRC can improve the quality of life in female bladder cancer patients without compromising the efficacy of cancer treatment.
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Affiliation(s)
- Chengyu You
- Department of Urology, The Second Hospital & Clinical Medical School, Lanzhou University, Lanzhou, 730000, Gansu, China
- Gansu Province Clinical Research Center for Urinary System Disease, Lanzhou, 730030, Gansu, China
| | - Long Cheng
- Department of Urology, The Second Hospital & Clinical Medical School, Lanzhou University, Lanzhou, 730000, Gansu, China
- Gansu Province Clinical Research Center for Urinary System Disease, Lanzhou, 730030, Gansu, China
| | - Qixiang Fang
- Department of Urology, The Second Hospital & Clinical Medical School, Lanzhou University, Lanzhou, 730000, Gansu, China
- Gansu Province Clinical Research Center for Urinary System Disease, Lanzhou, 730030, Gansu, China
| | - Liangliang Qing
- Department of Urology, The Second Hospital & Clinical Medical School, Lanzhou University, Lanzhou, 730000, Gansu, China
- Gansu Province Clinical Research Center for Urinary System Disease, Lanzhou, 730030, Gansu, China
| | - Qingchao Li
- Department of Urology, The Second Hospital & Clinical Medical School, Lanzhou University, Lanzhou, 730000, Gansu, China
- Gansu Province Clinical Research Center for Urinary System Disease, Lanzhou, 730030, Gansu, China
| | - Shuai Liu
- Department of Urology, The Second Hospital & Clinical Medical School, Lanzhou University, Lanzhou, 730000, Gansu, China
- Gansu Province Clinical Research Center for Urinary System Disease, Lanzhou, 730030, Gansu, China
| | - Yanan Wang
- Department of Urology, The Second Hospital & Clinical Medical School, Lanzhou University, Lanzhou, 730000, Gansu, China
- Gansu Province Clinical Research Center for Urinary System Disease, Lanzhou, 730030, Gansu, China
| | - Rongxin Li
- Department of Urology, The Second Hospital & Clinical Medical School, Lanzhou University, Lanzhou, 730000, Gansu, China
- Gansu Province Clinical Research Center for Urinary System Disease, Lanzhou, 730030, Gansu, China
| | - Zhilong Dong
- Department of Urology, The Second Hospital & Clinical Medical School, Lanzhou University, Lanzhou, 730000, Gansu, China.
- Gansu Province Clinical Research Center for Urinary System Disease, Lanzhou, 730030, Gansu, China.
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Lobo N, Uthayanan L, Uribe-Lewis S, Issa R, Tay A, Thurairaja R, Nair R, Khan MS, Kusuma M, Abou Chedid W, Moschonas D, Woodhams S, Swinn M, Patil K, Perry M. Gynaecological organ involvement in females undergoing radical cystectomy: a multicentre study. BJU Int 2024; 133:474-479. [PMID: 38105508 DOI: 10.1111/bju.16268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2023]
Abstract
OBJECTIVE To report the incidence of malignancy in gynaecological organs removed during radical cystectomy (RC). PATIENTS AND METHODS A retrospective multicentre study of 1600 RCs at three high-volume institutions between January 2009 and March 2022 was performed. Pathological findings in gynaecological organs in female RC specimens were reviewed. Multivariable logistic regression analyses were used to identify predictors of malignant gynaecological organ involvement (GOI) at time of RC. RESULTS Overall, 302 females with a median (interquartile range) age of 68 (61-75) years underwent RC for clinical (c)Ta-T4 bladder cancer. In all, 56 patients (18.5%) received neoadjuvant chemotherapy. Malignant GOI was seen in 20 patients (6.6%); the most common single sites of GOI were the uterus (five patients) and vaginal wall (four), followed by cervix (one), and ovaries (one). Nine patients had involvement of more than one gynaecological organ. No females had a primary gynaecological malignancy detected incidentally at RC. Patients with GOI were more likely to have cT3/T4 stage (P < 0.001), preoperative hydronephrosis (P = 0.004), lymphovascular invasion (P = 0.002), and squamous cell carcinoma (P = 0.005) than those without GOI. On multivariable analysis, cT4 stage was an independent predictor of malignant GOI (odds ratio 88.3, 95% confidence interval 10.1-1214; P < 0.001). CONCLUSION To our knowledge, we present the largest multi-institutional study examining malignant GOI in females with bladder cancer undergoing RC. The rate of GOI at the time of RC is low and associated with higher clinical stage. In the absence of clinical or radiological evidence of sexual organ involvement, our results do not support their routine removal at the time of RC.
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Affiliation(s)
- Niyati Lobo
- Royal Surrey NHS Foundation Trust, Surrey, UK
| | | | | | - Rami Issa
- St George's University Hospitals NHS Foundation Trust, London, UK
| | - Andrea Tay
- St George's University Hospitals NHS Foundation Trust, London, UK
| | | | - Raj Nair
- Guy's and St Thomas' NHS Foundation Trust, London, UK
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Alfred Witjes J, Max Bruins H, Carrión A, Cathomas R, Compérat E, Efstathiou JA, Fietkau R, Gakis G, Lorch A, Martini A, Mertens LS, Meijer RP, Milowsky MI, Neuzillet Y, Panebianco V, Redlef J, Rink M, Rouanne M, Thalmann GN, Sæbjørnsen S, Veskimäe E, van der Heijden AG. European Association of Urology Guidelines on Muscle-invasive and Metastatic Bladder Cancer: Summary of the 2023 Guidelines. Eur Urol 2024; 85:17-31. [PMID: 37858453 DOI: 10.1016/j.eururo.2023.08.016] [Citation(s) in RCA: 44] [Impact Index Per Article: 44.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 08/18/2023] [Indexed: 10/21/2023]
Abstract
CONTEXT We present an overview of the updated 2023 European Association of Urology (EAU) guidelines for muscle-invasive and metastatic bladder cancer (MMIBC). OBJECTIVE To provide practical evidence-based recommendations and consensus statements on the clinical management of MMIBC with a focus on diagnosis and treatment. EVIDENCE ACQUISITION A broad and comprehensive scoping exercise covering all areas of the MMIBC guidelines has been performed annually since 2017. Searches cover the Medline, EMBASE, and Cochrane Libraries databases for yearly guideline updates. A level of evidence and strength of recommendation are assigned. The evidence cutoff date for the 2023 MIBC guidelines was May 4, 2022. EVIDENCE SYNTHESIS Patients should be counselled regarding risk factors for bladder cancer. Pathologists should describe tumour and lymph nodes in detail, including the presence of histological subtypes. The importance of the presence or absence of urothelial carcinoma (UC) in the prostatic urethra is emphasised. Magnetic resonance imaging (MRI) of the bladder is superior to computed tomography (CT) for disease staging, specifically in differentiating T1 from T2 disease, and may lead to a change in treatment approach in patients at high risk of an invasive tumour. Imaging of the upper urinary tract, lymph nodes, and distant metastasis is performed with CT or MRI; the additional value of flurodeoxyglucose positron emission tomography/CT still needs to be determined. Frail and comorbid patients should be evaluated by a multidisciplinary team. Postoperative histology remains the most important prognostic variable, while circulating tumour DNA appears to be an interesting predictive marker. Neoadjuvant systemic therapy remains cisplatin-based. In motivated and selected women and men, sexual organ-preserving cystectomy results in better functional outcomes without compromising oncological outcomes. Robotic and open cystectomy have comparable outcomes and should be combined with (extended) lymph node dissection. The diversion type is an individual choice after taking patient and tumour characteristics into account. Radical cystectomy remains a highly complex procedure with considerable morbidity and risk of mortality, although lower rates are observed for higher hospital volumes (>20 cases/yr). With proper patient selection, trimodal therapy (chemoradiation) has comparable outcomes to radical cystectomy. Adjuvant chemotherapy after surgery improves disease-specific survival and overall survival (OS) in patients with high-risk disease who did not receive neoadjuvant treatment, and is strongly recommended. There is a weak recommendation for adjuvant nivolumab, as OS data are not yet available. Health-related quality of life should be assessed using validated questionnaires at baseline and after treatment. Surveillance is needed to monitor for recurrent cancer and functional outcomes. Recurrences detected on follow-up seem to have better prognosis than symptomatic recurrences. CONCLUSIONS This summary of the 2023 EAU guidelines provides updated information on the diagnosis and treatment of MMIBC for incorporation into clinical practice. PATIENT SUMMARY The European Association of Urology guidelines panel on muscle-invasive and metastatic bladder cancer has released an updated version of the guideline containing information on diagnosis and treatment of this disease. Recommendations are based on studies published up to May 4, 2022. Surgical removal of the bladder and bladder preservation are discussed, as well as updates on the use of chemotherapy and immunotherapy in localised and metastatic disease.
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Affiliation(s)
- J Alfred Witjes
- Department of Urology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
| | - Harman Max Bruins
- Department of Urology, Zuyderland Medisch Centrum, Sittard/Heerlen, The Netherlands
| | - Albert Carrión
- Department of Urology, Vall Hebron Hospital, Autonomous University of Barcelona, Barcelona, Spain
| | - Richard Cathomas
- Department of Medical Oncology, Kantonsspital Graubünden, Chur, Switzerland
| | - Eva Compérat
- Department of Pathology, Medical University Vienna General Hospital, Vienna, Austria
| | - Jason A Efstathiou
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA, USA
| | - Rainer Fietkau
- Department of Radiation Therapy, University of Erlangen, Erlangen, Germany
| | - Georgios Gakis
- Department of Urology and Pediatric Urology, University of Würzburg, Würzburg, Germany
| | - Anja Lorch
- Department of Medical Oncology and Hematology, University Hospital Zürich, Zürich, Switzerland
| | - Alberto Martini
- Department of Urology, Institut Universitaire du Cancer-Toulouse-Oncopole, Toulouse, France; Department of Urology, MD Anderson Cancer Center, Houston, TX, USA
| | - Laura S Mertens
- Department of Urology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Richard P Meijer
- Department of Oncological Urology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Matthew I Milowsky
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA
| | - Yann Neuzillet
- Department of Urology, Foch Hospital, University of Versailles-Saint-Quentin-en-Yvelines, Suresnes, France
| | - Valeria Panebianco
- Department of Radiological Sciences, Oncology and Pathology, Sapienza University of Rome, Rome, Italy
| | - John Redlef
- Patient Representative, European Association of Urology Guidelines Office, Arnhem, The Netherlands
| | - Michael Rink
- Department of Urology, Marienkrankenhaus Hamburg, Hamburg, Germany
| | - Mathieu Rouanne
- Department of Urology, Foch Hospital, University of Versailles-Saint-Quentin-en-Yvelines, Suresnes, France
| | - George N Thalmann
- Department of Urology, Inselspital, University Hospital Bern, Bern, Switzerland
| | - Sæbjørn Sæbjørnsen
- Patient Representative, European Association of Urology Guidelines Office, Arnhem, The Netherlands
| | - Erik Veskimäe
- Department of Urology, Tampere University Hospital, Tampere, Finland
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D’Andrea VD, Melnick K, Yim K, Ernandez J, Onochie N, Clinton TN, Steele GS, Preston MA, Kibel AS, Mossanen M. Evidence-Based Analysis of the Critical Steps of Radical Cystectomy for Bladder Cancer. J Clin Med 2023; 12:6845. [PMID: 37959309 PMCID: PMC10647807 DOI: 10.3390/jcm12216845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 10/21/2023] [Accepted: 10/28/2023] [Indexed: 11/15/2023] Open
Abstract
Radical cystectomy (RC) is an integral part of the management of patients with advanced-stage bladder cancer. This major oncologic operation is prone to complications resulting in morbidity and mortality. We analyzed the critical steps of open RC, performed an evidence-based review of these steps, and discussed our experience and approach. We conducted a literature review of the open RC technique, identified the critical steps that consistently appeared across different sources, and organized these steps into a framework. PubMed was queried with the critical steps as keywords for relevant articles published from 1 January 2013 to 1 August 2023. We utilized this query to conduct a systematic review of the literature using the outcomes of overall survival and 90-day complication rate. We developed the "Summary for the 10 Critical Operative Steps of Radical Cystectomy", a concise guide to the approach to open RC. When available, an evidence-based analysis of each critical step was performed. We also included additional components of cystectomy optimization such as pre-habilitation in the preoperative phase, standard versus extended lymphadenectomy, the vaginal-sparing approach to female radical cystectomy, patient-reported outcomes following urinary diversion, the use of a mesh for stoma formation, and the use of the ERAS protocol for postoperative care. An evidence-based assessment of RC may help provide valuable information to optimize surgical techniques and patient outcomes.
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Affiliation(s)
- Vincent D. D’Andrea
- Division of Urology, Department of Surgery, Harvard Medical School, Brigham & Women’s Hospital, Boston, MA 02115, USA; (V.D.D.)
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA 02115, USA
| | - Kevin Melnick
- Division of Urology, Department of Surgery, Harvard Medical School, Brigham & Women’s Hospital, Boston, MA 02115, USA; (V.D.D.)
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA 02115, USA
| | - Kendrick Yim
- Division of Urology, Department of Surgery, Harvard Medical School, Brigham & Women’s Hospital, Boston, MA 02115, USA; (V.D.D.)
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA 02115, USA
| | - John Ernandez
- Division of Urology, Department of Surgery, Harvard Medical School, Brigham & Women’s Hospital, Boston, MA 02115, USA; (V.D.D.)
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA 02115, USA
| | - Nnamdi Onochie
- Division of Urology, Department of Surgery, Harvard Medical School, Brigham & Women’s Hospital, Boston, MA 02115, USA; (V.D.D.)
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA 02115, USA
| | - Timothy N. Clinton
- Division of Urology, Department of Surgery, Harvard Medical School, Brigham & Women’s Hospital, Boston, MA 02115, USA; (V.D.D.)
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA 02115, USA
| | - Graeme S. Steele
- Division of Urology, Department of Surgery, Harvard Medical School, Brigham & Women’s Hospital, Boston, MA 02115, USA; (V.D.D.)
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA 02115, USA
| | - Mark A. Preston
- Division of Urology, Department of Surgery, Harvard Medical School, Brigham & Women’s Hospital, Boston, MA 02115, USA; (V.D.D.)
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA 02115, USA
| | - Adam S. Kibel
- Division of Urology, Department of Surgery, Harvard Medical School, Brigham & Women’s Hospital, Boston, MA 02115, USA; (V.D.D.)
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA 02115, USA
| | - Matthew Mossanen
- Division of Urology, Department of Surgery, Harvard Medical School, Brigham & Women’s Hospital, Boston, MA 02115, USA; (V.D.D.)
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA 02115, USA
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Faulk A, Avulova S, Bree KK, Baak-Kukreja J, Westerman ME. Pelvic Organ Preservation in Non-muscle-invasive Bladder Cancer: Less Is More. Eur Urol Focus 2023:S2405-4569(23)00103-7. [PMID: 37142535 DOI: 10.1016/j.euf.2023.04.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 03/20/2023] [Accepted: 04/21/2023] [Indexed: 05/06/2023]
Abstract
Radical cystectomy (RC) is a treatment option for high-risk non-muscle-invasive bladder cancer (NMIBC) but is associated with high morbidity and a negative impact on quality of life. Reproductive or pelvic organ-sparing cystectomy (ROSC) techniques have emerged as a potential strategy to mitigate some potential effects of standard RC. Here we discuss current knowledge regarding oncological, functional, and sexual function outcomes associated with ROSC and their applicability in NMIBC. These outcomes can be used to make informed clinical decisions regarding cystectomy technique in appropriately staged and selected patients with NMIBC. PATIENT SUMMARY: We reviewed results for bladder cancer control, urinary function, and sexual function after removal of the bladder with and without techniques to spare reproductive or pelvic organs. We found evidence of better sexual function outcomes with a sparing approach without compromise of cancer control. Further studies are needed to assess urinary function and pelvic floor-related outcomes.
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Affiliation(s)
- Anne Faulk
- School of Medicine, LSU Health Science Center-New Orleans, New Orleans, LA, USA
| | | | - Kelly K Bree
- Department of Urology, MD Anderson Cancer Center, Houston, TX, USA
| | | | - Mary E Westerman
- Department of Urology, LSU Health Science Center-New Orleans, New Orleans, LA, USA; Department of Surgery, East Jefferson General Hospital, Metairie, LA, USA.
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Gupta N, Kucirka L, Semerjian A, Pierorazio PM, Loeb S, Bivalacqua TJ. Practice Patterns Regarding Female Reproductive Organ-Sparing and Nerve-Sparing Radical Cystectomy Among Urologic Oncologists in the United States. Clin Genitourin Cancer 2023:S1558-7673(23)00032-0. [PMID: 36801170 DOI: 10.1016/j.clgc.2023.01.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 01/16/2023] [Accepted: 01/22/2023] [Indexed: 01/27/2023]
Abstract
BACKGROUND Female reproductive organ-sparing (ROS) and nerve-sparing radical cystectomy (RC) techniques have been shown to be oncologically safe and to improve sexual function outcomes among select patients with organ-confined disease. We sought to characterize practice patterns regarding female ROS and nerve-sparing RC among US urologists. PATIENTS AND METHODS We conducted a cross-sectional survey of members of the Society of Urologic Oncology to assess provider-reported frequency of ROS and nerve-sparing RC in premenopausal and postmenopausal patients with non-muscle-invasive bladder cancer that failed intravesical therapy or clinically localized muscle-invasive bladder cancer. RESULTS Among 101 urologists, 80 (79.2%) reported that they routinely resect the uterus/cervix, 68 (67.3%) the neurovascular bundle, 49 (48.5%) the ovaries, and 19 (18.8%) a portion of the vagina when performing RC in premenopausal patients with organ-confined disease. When asked about changes to approach in postmenopausal patients, 71 participants (70.3%) reported that they were less likely to spare the uterus/cervix, 44 (43.6%) were less likely to spare the neurovascular bundle, 70 (69.3%) were less likely to spare the ovaries, and 23 (22.8%) were less likely to spare a portion of the vagina. CONCLUSION We identified significant gaps in adoption of female ROS and nerve-sparing RC techniques for patients with organ-confined disease, despite evidence that ROS and nerve-sparing techniques are oncologically safe and can optimize functional outcomes in select patients. Future efforts should improve provider training in and education about ROS and nerve-sparing RC to improve postoperative outcomes among female patients.
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Affiliation(s)
- Natasha Gupta
- Department of Urology and Population Health, New York University and Manhattan Veterans Affairs, New York City, NY.
| | - Lauren Kucirka
- Division of Maternal Fetal Medicine, Department of Gynecology and Obstetrics, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | | | | | - Stacy Loeb
- Department of Urology and Population Health, New York University and Manhattan Veterans Affairs, New York City, NY
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