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Laukhtina E, von Deimling M, Pradere B, Yanagisawa T, Rajwa P, Kawada T, Quhal F, Pallauf M, Bianchi A, Majdoub M, Mostafaei H, Sari Motlagh R, Mori K, Enikeev D, Fisch M, Moschini M, D'Andrea D, Soria F, Albisinni S, Fajkovic H, Rink M, Teoh JYC, Gontero P, Shariat SF. Urinary function in female patients after traditional, organ-sparing and nerve-sparing radical cystectomy for bladder cancer: a systematic review and pooled analysis. BJU Int 2024; 133:246-258. [PMID: 37562831 DOI: 10.1111/bju.16152] [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: 08/12/2023]
Abstract
OBJECTIVES To determine and summarize the available data on urinary, sexual, and health-related quality-of-life (HRQOL) outcomes after traditional radical cystectomy (RC), reproductive organ-preserving RC (ROPRC) and nerve-sparing RC (NSRC) for bladder cancer (BCa) in female patients. METHODS The PubMed, SCOPUS and Web of Science databases were searched to identify studies reporting functional outcomes in female patients undergoing RC and urinary diversion for the treatment of BCa. The outcomes of interest were voiding function (for orthotopic neobladder [ONB]), sexual function and HRQOL. The following independent variables were derived and included in the meta-analysis: pooled rate of daytime and nighttime continence/incontinence, and intermittent self-catheterization (ISC) rates. Analyses were performed separately for traditional, organ- and/or nerve-sparing surgical approaches. RESULTS Fifty-three studies comprising 2740 female patients (1201 traditional RC and 1539 organ-/nerve-sparing RC, and 264 nerve-sparing-alone RC) were eligible for qualitative synthesis; 44 studies comprising 2418 female patients were included in the quantitative synthesis. In women with ONB diversion, the pooled rates of daytime continence after traditional RC, ROPRC and NSRC were 75.2%, 79.3% and 71.2%, respectively. The pooled rate of nighttime continence after traditional RC was 59.5%; this rate increased to 70.7% and 71.7% in women who underwent ROPRC and NSRC, respectively. The pooled rate of ISC after traditional RC with ONB diversion in female patients was 27.6% and decreased to 20.6% and 16.8% in patients undergoing ROPRC and NSRC, respectively. The use of different definitions and questionnaires in the assessment of postoperative sexual and HRQOL outcomes did not allow a systematic comparison. CONCLUSIONS Female organ- and nerve-sparing surgical approaches during RC seem to result in improved voiding function. There is a significant need for well-designed studies exploring sexual and HRQOL outcomes to establish evidence-based management strategies to support a shared decision-making process tailored towards patient expectations and satisfaction. Understanding expected functional, sexual and quality-of-life outcomes is necessary to allow individualized pre- and postoperative counselling and care delivery in female patients planned to undergo RC.
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Affiliation(s)
- Ekaterina Laukhtina
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Markus von Deimling
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Benjamin Pradere
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
- Department of Urology, La Croix Du Sud Hospital, Quint-Fonsegrives, France
| | - Takafumi Yanagisawa
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Pawel Rajwa
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
- Department of Urology, Medical University of Silesia, Zabrze, Poland
| | - Tatsushi Kawada
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
- Department of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Fahad Quhal
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
- Department of Urology, King Fahad Specialist Hospital, Dammam, Saudi Arabia
| | - Maximilian Pallauf
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
- Department of Urology, Paracelsus Medical University Salzburg, University Hospital Salzburg, Salzburg, Austria
| | - Alberto Bianchi
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
- Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Muhammad Majdoub
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
- Department of Urology, Hillel Yaffe Medical Center, Hadera, Israel
| | - Hadi Mostafaei
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
- Research Center for Evidence Based Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Reza Sari Motlagh
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
- Men's Health and Reproductive Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Keiichiro Mori
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Dmitry Enikeev
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Margit Fisch
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Marco Moschini
- Department of Urology and Division of Experimental Oncology, Urological Research Institute, Vita-Salute San Raffaele, Milan, Italy
| | - David D'Andrea
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Francesco Soria
- Division of Urology, Department of Surgical Sciences, San Giovanni Battista Hospital, University of Studies of Torino, Turin, Italy
| | - Simone Albisinni
- Service d'Urologie, Hôpital Erasme, Université Libre de Bruxelles, Bruxelles, Belgium
- Urology Unit, Department of Surgical Sciences, Tor Vergata University Hospital, University of Rome Tor Vergata, Rome, Italy
| | - Harun Fajkovic
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
- Karl Landsteiner Institute of Urology and Andrology, Vienna, Austria
| | - Michael Rink
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jeremy Yuen-Chun Teoh
- S.H. Ho Urology Centre, Department of Surgery, The Chinese University of Hong Kong, Hong Kong, China
| | - Paolo Gontero
- Department of Urology and Division of Experimental Oncology, Urological Research Institute, Vita-Salute San Raffaele, Milan, Italy
| | - Shahrokh F Shariat
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
- Karl Landsteiner Institute of Urology and Andrology, Vienna, Austria
- Department of Urology, Weill Cornell Medical College, New York, New York, USA
- Department of Urology, University of Texas Southwestern, Dallas, Texas, USA
- Department of Urology, Second Faculty of Medicine, Charles University, Prague, Czech Republic
- Hourani Center for Applied Scientific Research, Al-Ahliyya Amman University, Amman, Jordan
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Chen HX, Huang CP. Oncological and functional outcome of robotic-assisted radical cystectomy with total intracorporeal stentless J-pouch neobladder reconstruction. Int J Med Robot 2023:e2583. [PMID: 37811801 DOI: 10.1002/rcs.2583] [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: 05/24/2023] [Revised: 09/06/2023] [Accepted: 09/18/2023] [Indexed: 10/10/2023]
Abstract
BACKGROUND Robotic-assisted radical cystectomy (RARC) with neobladder reconstruction has gained popularity in recent years. METHODS We conducted a retrospective study of 17 consecutive patients who underwent RARC with totally intracorporeal J-pouch neobladder reconstruction without ureteral stent by a single experienced surgeon to evaluate perioperative, oncological and functional outcomes. RESULTS The median follow-up duration was 32.8 months (range: 17.4-59.0 months), and the 2-year disease-free survival rate was 88.2%. Five out of 12 patients were totally continent, and none required more than one pad per day. The overall complication rate was 41.2%, and hydronephrosis was the most common adverse event. The renal function remained stable, and no long-term renal function impairment was detected. CONCLUSION Our study suggests that RARC with totally intracorporeal J-pouch neobladder reconstruction without ureteral stent is a safe and feasible option for the treatment of muscle-invasive bladder cancer, with good oncological and functional outcomes.
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Affiliation(s)
- Hao Xiang Chen
- Department of Urology, China Medical University Hospital, China Medical University, Taichung, Taiwan
| | - Chi-Ping Huang
- Department of Urology, China Medical University Hospital, China Medical University, Taichung, Taiwan
- School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan
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3
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Abstract
Radical cystectomy is the standard of care for patients with nonmetastatic high-risk bladder cancer. Robotic approach to radical cystectomy has been developed to reduce perioperative morbidities and enhance postoperative recovery while maintaining oncologic control. Classically, radical cystectomy in female patient entails anterior pelvic exenteration with removal of the bladder, uterus, fallopian tubes, ovaries, anterior vaginal wall, and urethra. Pelvic organ-sparing radical cystectomy has been adopted in carefully selected patients to optimize postoperative sexual and urinary function, especially in those undergoing orthotopic urinary diversion. In this article, we describe our techniques of both classical and organ-sparing robot-assisted laparoscopic radical cystectomy in female patients. We also review patient selection criteria, perioperative management, and alternative approaches to improve operative outcomes in female patients.
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Affiliation(s)
- Hong Truong
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Victoria Maxon
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Alvin C Goh
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
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Abstract
Men are at a higher risk of developing bladder cancer, but women present with more advanced disease and have more unfavourable outcomes. Although epidemiologic and genetical studies have underlined the multifactorial aetiology and gender-related differences of bladder cancer, there is lack of evidence-based recommendation for gender-specific management of bladder cancer. We summarize the evidence and most recent findings on gender-specific differences in bladder cancer incidence, diagnosis, treatment and outcome, spotlighting the gender disparities in genetic and hormonal risk factors, pelvic anatomy, diagnostic setting and surgical choices. We reviewed the literature published on PubMed between 1981 and 2018. Males have a threefold to fourfold higher risk of bladder cancer as compared to females; however, women have higher stage-for-stage mortality, being diagnosed with more advanced disease, mostly due to a delay in haematuria evaluation. Numerous studies indicate an increased risk of disease recurrence or progression in women with non-muscle-invasive bladder cancer treated with trans-urethral resection, with or without intravesical chemotherapy or immunotherapy, compared to males. In particular, recent molecular evidence show that there is an excess of female Ta mutant tumours. At the time of radical cystectomy, women have a significantly longer length of hospital stay, operative time, higher blood loss and higher 90-day mortality and perioperative complication rate. Moreover, females are less likely to receive a continent diversion. Future research should guarantee greater inclusion of women in trials and focus on improving the effectiveness of therapies in women, perhaps exploring different therapeutic approaches in men and women. Specific data on functional and oncological outcomes can be analysed to define predictive factors able to guide the surgeon in decisions based on evidence. It is urgently needed to limit gender-related discrepancies in early diagnosis and treatment of bladder cancer. Public awareness and bladder cancer female patients' consciousness on gender inequalities must be similarly uprisen.
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Affiliation(s)
- Mariangela Mancini
- Urological Clinic, Department of Surgical, Oncological and Gastroenterological Sciences and School of Medicine and Surgery, University of Padova, Padova, Italy
| | - Marialaura Righetto
- Urological Clinic, Department of Surgical, Oncological and Gastroenterological Sciences and School of Medicine and Surgery, University of Padova, Padova, Italy
| | - Giovannella Baggio
- Department of Medicine (DIMED) and School of Medicine and Surgery, University of Padova, Padova, Italy
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Kalampokis N, Grivas N, Ölschläger M, Hassan FN, Gakis G. Radical Cystectomy in Female Patients - Improving Outcomes. Curr Urol Rep 2019; 20:83. [PMID: 31781877 DOI: 10.1007/s11934-019-0951-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
PURPOSE OF REVIEW To review the methods of improving surgical, oncological, and functional outcomes in women with bladder cancer treated with radical cystectomy. RECENT FINDINGS Οrthotopic urinary diversion (ONB) is a safe option for well-selected women as it combines high rates of daytime and nighttime continence with exceptional oncologic outcomes. It is considered safe even for patients with limited lymph node disease and trigone involvement, as long as a preoperative biopsy of the bladder neck or an intraoperative frozen section analysis of distal urethral margin rules out malignant disease. Nerve-sparing techniques have shown promising results. For well-selected patients with early invasive disease, sparing of internal genitalia has proven to be oncologically safe. Yet, generally accepted and evidence-based oncological and functional follow-up schemes for women after radical cystectomy are still lacking. Properly designed prospective studies are needed with adequate number of participants in order to safely conclude about a broader use of pelvic organ-sparing cystectomy.
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Affiliation(s)
| | - Nikolaos Grivas
- Department of Urology, G. Hatzikosta General Hospital, Ioannina, Greece
- Department of Urology, Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Markus Ölschläger
- Department of Urology and Pediatric Urology, University Hospital of Würzburg, Julius Maximillians University, Oberdürrbacher Strasse 6, 97080, Würzburg, Germany
| | - Fahmy Nabil Hassan
- Department of Urology and Pediatric Urology, University Hospital of Würzburg, Julius Maximillians University, Oberdürrbacher Strasse 6, 97080, Würzburg, Germany
| | - Georgios Gakis
- Department of Urology and Pediatric Urology, University Hospital of Würzburg, Julius Maximillians University, Oberdürrbacher Strasse 6, 97080, Würzburg, Germany.
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Wishahi M, Ismail MA, Elganzoury H, Elkholy A, Nour HH, Zayed AS, Eldahshan S. Genital-Sparing Cystectomy versus Standard Urethral-Sparing Cystectomy Followed with Orthotopic Neobladder in Women with Bladder Cancer: Incidence and Causes of Hypercontinence with an Ultrastructure Study of Urethral Smooth Muscles. Open Access Maced J Med Sci 2019; 7:978-981. [PMID: 30976344 PMCID: PMC6454182 DOI: 10.3889/oamjms.2019.206] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2019] [Revised: 03/04/2019] [Accepted: 03/05/2019] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND: Bladder cancer in women is an indication for radical cystectomy (RC) when the tumour is confined muscle-invasive bladder cancer (MIBC) of T2 N0M0, or high risk progressive non-muscle invasive bladder cancer (NMIBC). Radical cystectomy is either genital-sparing cystectomy (GSC) or standard urethra-sparing cystectomy (USC) that is followed with orthotopic ileal neobladder (ONB). Post-operative chronic retention “Hypercontinence” had been reported in different series following URS or GSC and ONB. In long-term follow-up, we evaluated the functional outcome of women who developed hypercontinence after USC or GSC and ONB. AIM: An ultrastructure study of female urethral smooth muscle was done to elucidate the underlying causes of hypercontinence. MATERIAL AND METHODS: Retrospective study was conducted on 71 women who underwent RC and ONB, 45women had undergone USC, and 26 women had GSC, follow-up ranged from 5 to 15 years. Ultrastructure studies were done on 5 urethral biopsy specimens from 5 women who had hypercontinence, and 4 biopsies were from a normal control. RESULTS: Follow-up showed that women who had undergone USC and ONB, 28.88% developed hypercontinence, where in the series of GSC and ONB three women out of 26 developed hypercontinence (7.80%). Three women who had hypercontinence following USC and ONB, they developed stones in the ileal pouch. Ultrastructure study of urethral smooth muscles in women who had hypercontinence showed organized collagen fibrils, absent myelin sheath, and non-detected lymphatic vessels. Normal urethra showed collagen fibrils within the interstitial matrix, preserved myelin sheath of nerve fibres, the presence of lymphatic vessels in the matrix. CONCLUSION: The present study shoes that GSC with ONB leads to the minimal incidence of hypercontinence (7.80%), while standard USC lead to higher incidence (28.88%). Ultrastructure changes of the female urethra who had hypercontinence were fibrotic changes, loss of myelin sheath and minimal vascularity, their findings explains the underlying cause of hypercontinence and support the technique of GSC rather than the standard USC.
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Affiliation(s)
- Mohamed Wishahi
- Department of Urology, Theodor Bilharz Research Institute, Cairo, Egypt
| | - Mohamed A Ismail
- Department of Urology, Theodor Bilharz Research Institute, Cairo, Egypt
| | - Hossam Elganzoury
- Department of Urology, Theodor Bilharz Research Institute, Cairo, Egypt
| | - Amr Elkholy
- Department of Urology, Theodor Bilharz Research Institute, Cairo, Egypt
| | - Hani H Nour
- Department of Urology, Theodor Bilharz Research Institute, Cairo, Egypt
| | - Ahmed S Zayed
- Department of Urology, Theodor Bilharz Research Institute, Cairo, Egypt
| | - Samir Eldahshan
- Department of Urology, Theodor Bilharz Research Institute, Cairo, Egypt
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7
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Negro C, Destefanis P, Bosio A, Bisconti A, De Maria C, Carchedi M, Buffardi A, Rolle L, Fontana D. Riparazione Trans-Vaginale di Fistola Neovescico-Vaginale. Urologia 2018. [DOI: 10.1177/0391560310077016s03] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction Neobladder vaginal fistula is a known complication after cystectomy and orthotopic neobladder in women. The exact incidence is still unknown, even if in some of the largest series is reported in about 5% of female patients. We present our personal experience with a case of neobladder vaginal fistula. Methods A fifty-year old woman affected by T2G3 bladder cancer underwent radical cystectomy and orthotopic neobladder in December 2007. Definitive pathological examination revealed pT3aN0G3 urothelial cancer with squamous aspects. Two cycles of neoadjuvant chemotherapy were administered before cystectomy. Three weeks after cystectomy, a retrograde cystography revealed a fistula between vagina and neobladder. At first, the patient was treated conservatively, keeping the urethral catheter for two months. Cystographies, repeated every month, recorded a reduction in size of the fistula but not the complete closure. A surgical correction was planned. Preoperative cystoscopy showed the neobladder opening of the fistula on the posterior wall. Then a transvaginal approach with fistula excision and a two layer cross suture were performed. Results At the cystography performed 1 month after surgical repair no fistula was detected, and the patient was completely dry. At 3 months follow-up the patient was completely dry. Conclusion The development of a neobladder-vaginal fistula is a significant, even if infrequent, complication after cystectomy. In our case, we performed a transvaginal approach without tissue interposition, with good results. Such procedure is easy and effective and, in our opinion, can be tempted as first line surgical treatment.
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Affiliation(s)
- C.L.A. Negro
- Divisione Universitaria di Urologia 2 - Ospedale San Giovanni Battista “Molinette” - Torino
| | - P. Destefanis
- Divisione Universitaria di Urologia 2 - Ospedale San Giovanni Battista “Molinette” - Torino
| | - A. Bosio
- Divisione Universitaria di Urologia 2 - Ospedale San Giovanni Battista “Molinette” - Torino
| | - A. Bisconti
- Divisione Universitaria di Urologia 2 - Ospedale San Giovanni Battista “Molinette” - Torino
| | - C. De Maria
- Divisione Universitaria di Urologia 2 - Ospedale San Giovanni Battista “Molinette” - Torino
| | - M. Carchedi
- Divisione Universitaria di Urologia 2 - Ospedale San Giovanni Battista “Molinette” - Torino
| | - A. Buffardi
- Divisione Universitaria di Urologia 2 - Ospedale San Giovanni Battista “Molinette” - Torino
| | - L. Rolle
- Divisione Universitaria di Urologia 2 - Ospedale San Giovanni Battista “Molinette” - Torino
| | - D. Fontana
- Divisione Universitaria di Urologia 2 - Ospedale San Giovanni Battista “Molinette” - Torino
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Chronic urinary retention after radical cystectomy and orthotopic neobladder in women: Risk factors and relation to time. Urol Oncol 2017; 35:671.e11-671.e16. [DOI: 10.1016/j.urolonc.2017.07.032] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2017] [Revised: 06/19/2017] [Accepted: 07/31/2017] [Indexed: 11/18/2022]
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Smith AB, Crowell K, Woods ME, Wallen EM, Pruthi RS, Nielsen ME, Lee CT. Functional Outcomes Following Radical Cystectomy in Women with Bladder Cancer: A Systematic Review. Eur Urol Focus 2017; 3:136-143. [DOI: 10.1016/j.euf.2016.05.005] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Revised: 04/12/2016] [Accepted: 05/21/2016] [Indexed: 10/21/2022]
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De Sutter T, Akand M, Albersen M, Everaerts W, Van Cleynenbreugel B, De Ridder D, Goethuys H, Moris L, Milenkovic U, Van Poppel H, Van Der Aa F, Joniau S. The N-shaped orthotopic ileal neobladder: functional outcomes and complication rates in 119 patients. SPRINGERPLUS 2016; 5:646. [PMID: 27330912 PMCID: PMC4870512 DOI: 10.1186/s40064-016-2287-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Accepted: 05/05/2016] [Indexed: 11/16/2022]
Abstract
Background We report our long-term experience with 119 cases of N-shaped orthotopic ileal neobladder. Methods Between March 1996 and July 2013, a total of 119 patients (102 men, 17 women) underwent cystectomy with creation of an N-shaped orthotopic ileal neobladder. The Clavien–Dindo classification score was used for grading early (<3 months postoperative), late, and pouch-related and non-pouch-related complications. Daytime and nighttime continence were evaluated for male and female patients separately, with patients subdivided in three groups: completely continent, use of ≤1 pad, and use of >1 pad. Results Median follow-up was 75 months (range 3–204). Early complications (15 major, 54 minor) occurred in 39.5 % of 119 patients whereas 53.1 % presented with late complications (56 major, 39 minor; 111 patients evaluated). Urinary infection and outlet obstruction were both the most frequent early and late pouch-related complications; early non-pouch-related complications were mainly infectious and gastrointestinal, and the most common late non-pouch-related problem was wound herniation. At 12 months, 96 and 60 % of the men and 84.6 and 66.7 % of the women respectively achieved daytime and nighttime continence. Conclusion Complication rates of the N-shaped orthotopic ileal neobladder were relatively high, probably because of meticulous recording and follow-up. Daytime continence rates were better than nighttime rates. N-shaped orthotopic ileal neobladder can be a good option for urinary diversion in selected patients who undergo radical cystectomy.
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Affiliation(s)
- Thomas De Sutter
- Department of Urology, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium
| | - Murat Akand
- Department of Urology, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium ; Department of Urology, School of Medicine, Selcuk University, Konya, Turkey
| | - Maarten Albersen
- Department of Urology, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium
| | - Wouter Everaerts
- Department of Urology, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium
| | | | - Dirk De Ridder
- Department of Urology, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium
| | - Hans Goethuys
- Department of Urology, Ziekenhuis Oost-Limburg, Genk, Belgium
| | - Lisa Moris
- Department of Urology, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium
| | - Uros Milenkovic
- Department of Urology, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium
| | - Hendrik Van Poppel
- Department of Urology, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium
| | - Frank Van Der Aa
- Department of Urology, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium
| | - Steven Joniau
- Department of Urology, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium
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12
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Patient Selection, Operative Technique, and Contemporary Outcomes of Continent Catheterizable Diversion: the Indiana Pouch. CURRENT BLADDER DYSFUNCTION REPORTS 2014. [DOI: 10.1007/s11884-014-0265-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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13
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Goldmark E, Ginsberg D. Evaluation, Treatment and Management of Urinary Incontinence in Patients with Orthotopic Neobladder. CURRENT BLADDER DYSFUNCTION REPORTS 2014. [DOI: 10.1007/s11884-014-0236-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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14
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Lee RK, Abol-Enein H, Artibani W, Bochner B, Dalbagni G, Daneshmand S, Fradet Y, Hautmann RE, Lee CT, Lerner SP, Pycha A, Sievert KD, Stenzl A, Thalmann G, Shariat SF. Urinary diversion after radical cystectomy for bladder cancer: options, patient selection, and outcomes. BJU Int 2014; 113:11-23. [PMID: 24330062 DOI: 10.1111/bju.12121] [Citation(s) in RCA: 212] [Impact Index Per Article: 21.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
CONTEXT The urinary reconstructive options available after radical cystectomy (RC) for bladder cancer are discussed, as are the criteria for selection of the most appropriate diversion, and the outcomes and complications associated with different diversion options. OBJECTIVE To critically review the peer-reviewed literature on the function and oncological outcomes, complications, and factors influencing choice of procedure with urinary diversion after RC for bladder carcinoma. EVIDENCE ACQUISITION A Medline search was conducted to identify original articles, review articles, and editorials on urinary diversion in patients treated with RC. Searches were limited to the English language. Keywords included: 'bladder cancer', 'cystectomy', 'diversion', 'neobladder', and 'conduit'. The articles with the highest level of evidence were selected and reviewed, with the consensus of all of the authors of this paper. EVIDENCE SYNTHESIS Both continent and incontinent diversions are available for urinary reconstruction after RC. In appropriately selected patients, an orthotopic neobladder permits the elimination of an external stoma and preservation of body image without compromising cancer control. However, the patient must be fully educated and committed to the labour-intensive rehabilitation process. He must also be able to perform self-catheterisation if necessary. When involvement of the urinary outflow tract by tumour prevents the use of an orthotopic neobladder, a continent cutaneous reservoir may still offer the opportunity for continence albeit one that requires obligate self-catheterisation. For patients who are not candidates for continent diversion, the ileal loop remains an acceptable and reliable option. CONCLUSIONS Both continent and incontinent diversions are available for urinary reconstruction after RC. Orthotopic neobladders optimally preserve body image, while continent cutaneous diversions represent a reasonable alternative. Ileal conduits represent the fastest, easiest, least complication-prone, and most commonly performed urinary diversion.
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Affiliation(s)
- Richard K Lee
- James Buchanan Brady Foundation, Department of Urology and Division of Medical Oncology, Weill Cornell Medical College, New York-Presbyterian Hospital, New York, NY, USA
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Rouanne M, Legrand G, Neuzillet Y, Ghoneim T, Cour F, Letang N, Yonneau L, Hervé JM, Botto H, Lebret T. Long-Term Women-Reported Quality of Life After Radical Cystectomy and Orthotopic Ileal Neobladder Reconstruction. Ann Surg Oncol 2014; 21:1398-404. [DOI: 10.1245/s10434-013-3458-8] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2013] [Indexed: 01/08/2023]
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16
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Pichler R, Zangerl F, Leonhartsberger N, Stöhr B, Horninger W, Steiner H. Orthotopic bladder replacement in women: Focus on functional results of a retrospective, single-centre study. Scand J Urol 2013; 47:295-301. [DOI: 10.3109/00365599.2012.738429] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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17
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Clifton MM, Tollefson MK. Anatomic basis of radical cystectomy and orthotopic urinary diversion in female patients. Clin Anat 2012. [DOI: 10.1002/ca.22189] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Miyake H, Furukawa J, Muramaki M, Inoue T, Fujisawa M. Health related quality of life after radical cystectomy: Comparative study between orthotopic sigmoid versus ileal neobladders. Eur J Surg Oncol 2012; 38:1089-94. [DOI: 10.1016/j.ejso.2012.07.117] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2012] [Revised: 06/13/2012] [Accepted: 07/19/2012] [Indexed: 11/16/2022] Open
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19
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Muscle invasive bladder cancer: from diagnosis to survivorship. Adv Urol 2012; 2012:142135. [PMID: 22924038 PMCID: PMC3424737 DOI: 10.1155/2012/142135] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2012] [Accepted: 05/16/2012] [Indexed: 11/17/2022] Open
Abstract
Bladder cancer is the fifth most commonly diagnosed cancer and the most expensive adult cancer in average healthcare costs incurred per patient in the USA. However, little is known about factors influencing patients' treatment decisions, quality of life, and responses to treatment impairments. The main focus of this paper is to better understand the impact of muscle invasive bladder cancer on patient quality of life and its added implications for primary caregivers and healthcare providers. In this paper, we discuss treatment options, side effects, and challenges that patients and family caregivers face in different phases along the disease trajectory and further identify crucial areas of needed research.
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Anderson CB, Cookson MS, Chang SS, Clark PE, Smith JA, Kaufman MR. Voiding Function in Women with Orthotopic Neobladder Urinary Diversion. J Urol 2012; 188:200-4. [DOI: 10.1016/j.juro.2012.03.004] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2011] [Indexed: 10/28/2022]
Affiliation(s)
| | - Michael S. Cookson
- Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Sam S. Chang
- Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Peter E. Clark
- Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Joseph A. Smith
- Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Melissa R. Kaufman
- Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
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Jentzmik F, Schrader AJ, de Petriconi R, Hefty R, Mueller J, Doetterl J, Eickhoff A, Schrader M. The ileal neobladder in female patients with bladder cancer: long-term clinical, functional, and oncological outcome. World J Urol 2012; 30:733-9. [DOI: 10.1007/s00345-012-0837-x] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2011] [Accepted: 01/30/2012] [Indexed: 10/14/2022] Open
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Kübler H, Gschwend JE. Ileal neobladder in women with bladder cancer: cancer control and functional aspects. Curr Opin Urol 2012; 21:478-82. [PMID: 21897260 DOI: 10.1097/mou.0b013e32834b31c4] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
PURPOSE OF REVIEW Radical cystectomy and urinary diversion is the accepted standard of care for invasive bladder cancer. Although orthotopic neobladder is the preferred method of urinary diversion in men, less experience is available for women. Recent studies and reports on this subject are summarized and reviewed. RECENT FINDINGS Urethra-sparing cystectomy in women and orthotopic urinary diversion can be performed safely in appropriately selected women with invasive bladder cancer. Excellent oncological outcomes can be expected with a minimal risk of urethral recurrence in case of negative frozen section of the proximal urethra. Orthotopic neobladder diversion offers excellent clinical and functional results, and should be the diversion of choice in most women following cystectomy. Female sexual dysfunction can be avoided in patients who received neurovascular preservation, although quality of life declined in women who had undergone non-nerve-sparing radical cystectomy. SUMMARY Urethra-sparing cystectomy does not compromise the oncologic outcome in women with bladder cancer. The excellent functional outcome and voiding pattern with orthotopic urinary diversion argues in favor of this technique as the preferred method for lower urinary tract reconstruction after radical cystectomy. Nerve-sparing radical cystectomy preserves female sexual function and improves quality of life.
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Affiliation(s)
- Hubert Kübler
- Department of Urology, Technische Universität München, Munich, Germany
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23
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Orthotopic bladder substitution following radical cystectomy in women: Comparative study between sigmoid and ileal neobladders. Urol Oncol 2012; 30:38-43. [DOI: 10.1016/j.urolonc.2009.11.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2009] [Revised: 10/18/2009] [Accepted: 11/04/2009] [Indexed: 11/21/2022]
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24
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Koie T, Hatakeyama S, Yoneyama T, Hashimoto Y, Kamimura N, Ohyama C. Uterus-, Fallopian Tube-, Ovary-, and Vagina-sparing Cystectomy Followed by U-shaped Ileal Neobladder Construction for Female Bladder Cancer Patients: Oncological and Functional Outcomes. Urology 2010; 75:1499-503. [DOI: 10.1016/j.urology.2009.08.083] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2009] [Revised: 07/30/2009] [Accepted: 08/07/2009] [Indexed: 10/20/2022]
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25
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Quality of life following incontinent cutaneous and orthotopic urinary diversions. Curr Treat Options Oncol 2010; 10:275-86. [PMID: 19763836 DOI: 10.1007/s11864-009-0110-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
The quality of life (QOL) of patients requiring urinary diversion remains an important issue within the field of Urology. The majority of this population has undergone cystectomy as treatment for malignant disease. In the initial phases of treatment counseling, the patient is focused on the eradication of their tumor. However, it is the urinary diversion that will have a lasting functional impact on the patient every day for the rest of their lives. The selection of an appropriate diversion, then, is critical to long-term satisfaction with the surgical treatment. Patients must be fully counseled in all types of urinary diversion and should have ready access to all options. Reported differences in QOL between diversion populations are difficult to interpret in view of limitations in the methodology of study designs and apparent selection bias. Ultimately, as a community, urologists cannot definitively say that one class of urinary diversion is superior to another. Instead, we must empower the patient in their own decision making with an accurate impression of diversion recovery, required education and training, and related side-effects and complications. The choice of urinary diversion still remains a very personal decision to be made between the patient, family members, friends, and the physician.
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Abstract
Standardized operating techniques and surgeons' experiences have contributed to the development of complex urinary diversion systems over the last two decades. Patients' desires and comorbidity risks, such as kidney or bowel dysfunction, as well as their mental and manual abilities need to be taken into account. Careful preoperative decision making is essential if patients are to accept the chosen urinary diversion system and improve their quality of life. Ileal and ileocecal orthotopic neobladders have proven to be effective and comfortable for long-time use, thus stimulating decisions for orthotopic bladder substitution despite the risk of incontinence episodes, especially during the night. Catheterization of continent reservoirs connected to the umbilicus (e.g., ileocecal reservoirs, Mainz pouch I) are widely accepted as an alternative diversion procedure if the urethra and/or sphincter region have to be removed. The patient's desire to avoid a wet stoma and achieve a cosmetically "unchanged" body image is met by these urinary diversion techniques. The surgeon's experience and the patient's mental and general health status must be considered in order to meet the increased complexity of these specific urinary diversions. Nevertheless, elderly patients often tend to prefer an ileal conduit as the easiest solution for urinary diversion. Therefore, even in experienced urological departments, the percentage of patients with orthotopic or self-catheterizable bladder substitution ranges between 30% and 66%, while the ileal conduit is selected in up to 64% of cases after cystectomy. The future of laparoscopic cystectomy has just begun and will affect future techniques of urinary diversion.
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27
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Granberg CF, Boorjian SA, Crispen PL, Tollefson MK, Farmer SA, Frank I, Blute ML. Functional and oncological outcomes after orthotopic neobladder reconstruction in women. BJU Int 2008; 102:1551-5. [DOI: 10.1111/j.1464-410x.2008.07909.x] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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29
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30
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Zattoni F, Zanin M. La cistectomia ieri come oggi? Urologia 2008. [DOI: 10.1177/039156030807500214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- F. Zattoni
- Cattedra e Divisione clinicizzata di Urologia, Università di Verona
| | - M. Zanin
- Cattedra e Divisione clinicizzata di Urologia, Università di Verona
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Stein JP, Penson DF, Wu SD, Skinner DG. Pathological Guidelines for Orthotopic Urinary Diversion in Women With Bladder Cancer: A Review of the Literature. J Urol 2007; 178:756-60. [PMID: 17631333 DOI: 10.1016/j.juro.2007.05.013] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2006] [Indexed: 10/23/2022]
Abstract
PURPOSE Before the early 1990s total urethrectomy at radical cystectomy for bladder cancer in women was considered the standard of care. As our understanding of the natural history of urethral urothelial carcinoma in women has improved, neobladders have been increasingly created in carefully selected women with bladder cancer. We reviewed the literature regarding the incidence of urethral involvement, the risk factors for urethral involvement and the incidence of urethral recurrence in women undergoing orthotopic urinary diversion for bladder cancer. MATERIALS AND METHODS A comprehensive literature review was performed regarding the natural history of urethral tumor involvement by urothelial carcinoma, risk factors and the incidence of urethral recurrence following radical cystectomy and orthotopic diversion in women with bladder cancer. RESULTS Urethral tumor involvement occurs in approximately 12% of female patients with bladder cancer undergoing radical cystectomy for high grade, invasive urothelial carcinoma. Preoperative involvement of the bladder neck or anterior vaginal wall with urothelial carcinoma is an important risk factor for urethral tumor involvement. Intraoperative frozen section analysis of the proximal urethra is an appropriate and reliable method of identifying female candidates for orthotopic diversion. The rate of secondary tumor recurrence in the retained urethra of women following radical cystectomy and orthotopic urinary diversion is low but the condition requires long-term followup. CONCLUSIONS Orthotopic urinary diversion can be performed safely in appropriately selected women with bladder cancer. Excellent oncological outcomes can be expected with a minimal risk of urethral recurrence. Preoperative bladder neck involvement is an important risk factor for urethral involvement but not an absolute contraindication to orthotopic diversion should intraoperative frozen section of the proximal urethra be without evidence of malignancy.
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Affiliation(s)
- John P Stein
- Department of Urology, University of Southern California, Norris Comprehensive Cancer Center, Los Angeles, California 90089, USA
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32
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Burkhard FC, Kessler TM, Mills R, Studer UE. Continent urinary diversion. Crit Rev Oncol Hematol 2006; 57:255-64. [PMID: 16325414 DOI: 10.1016/j.critrevonc.2005.06.008] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2005] [Revised: 05/30/2005] [Accepted: 06/03/2005] [Indexed: 11/22/2022] Open
Abstract
During the last decade continent urinary diversion, especially orthotopic bladder substitution has become increasingly popular following radical cystectomy for bladder cancer. In general, if sphincter sparing surgery is possible, orthotopic bladder substitution is performed, if not then continent catheterisable reservoirs are a viable option. Strict patient selection criteria and improved surgical technique have had a positive influence on outcome, not only on survival but also on quality of life issues. It is becoming increasingly obvious, that a nerve sparing surgical technique not only improves sexual function but also continence. In addition, the length of the intestinal segment has an influence on continence and the degree of metabolic consequences, which are discussed in detail. Postoperative surveillance and instruction of patients is of utmost value for good functional results. Overall patient satisfaction and quality of life seem comparable in the various types of continent urinary diversions, and improved when compared to a urinary stoma. Continent urinary diversion offers a good quality of life with few long-term complications and should be considered the treatment of choice in the majority of patients, independent of sex.
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Affiliation(s)
- Fiona C Burkhard
- Department of Urology, University of Bern, 3010 Bern, Switzerland
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Tunuguntla HSGR, Manoharan M, Gousse AE. Management of neobladder-vaginal fistula and stress incontinence following radical cystectomy in women: a review. World J Urol 2005; 23:231-5. [PMID: 16160880 DOI: 10.1007/s00345-005-0013-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2004] [Accepted: 02/16/2005] [Indexed: 10/25/2022] Open
Abstract
Contemporary literature regarding the management of neobladder-vaginal fistula and stress urinary incontinence following radical cystectomy and neobladder reconstruction in women is reviewed in this article. Neobladder-vaginal fistula is uncommon but mandates meticulous repair. Compared to the native bladder, the wall of the neobladder is much thinner that may render it vulnerable to fistulization. Preservation of the anterior vaginal wall during radical cystectomy decreases the likelihood of pouch-vaginal fistula. Omental flap interposition between the vaginal stump and neobladder at cystectomy may not always prevent fistulization if anterior vaginal wall is violated or overlapping suture lines are not avoided. Surgery for intractable stress incontinence following neobladder reconstruction is fraught with severe complications and requires judicious use of allograft pubovaginal slingplasty possibly with bone anchors. Martius flap interposition appears to play a crucial role in improving the outcome following transvaginal repair of the neobladder-vaginal fistula in multiple non-overlapping layers.
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Affiliation(s)
- Hari S G R Tunuguntla
- Division of Female Urology, Voiding Dysfunction and Reconstructive Urology, Department of Urology, School of Medicine, University of Miami, FL 33136, USA.
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Kessler TM, Burkhard FC, Studer UE. Clinical Indications and Outcomes with Nerve-sparing Cystectomy in Patients with Bladder Cancer. Urol Clin North Am 2005; 32:165-75. [PMID: 15862614 DOI: 10.1016/j.ucl.2005.02.005] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The autonomic sympathetic and parasympathetic nerve fibers from the pelvic plexus pass through the dorsomedial pedicle of the bladder ending as the paraprostatic neurovascular bundle or paravaginal plexus before supplying the urogenital diaphragm, sphincter, and erectile organs. Preservation of the autonomic innervation is important for sexual, lower urinary tract, and bowel function. Oncologic outcome is not compromised by a nerve-sparing cystectomy if adequate selection criteria are applied. During pelvic lymphadenectomy nerve sparing is not impaired as long as the dissection is performed on the lateral, not medial side of the ureters, where the nerves lie. Nerve-sparing radical cystectomy preserves sexual function and, in the case of orthotopic bladder substitution, better continence, and decreased catheterization rates (especially in women) are achieved. Therefore, under the proper circumstances, nerve-sparing radical cystectomy is to be strongly recommended.
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Affiliation(s)
- Thomas M Kessler
- Department of Urology, University of Bern, CH-3010 Bern, Switzerland
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