1
|
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.
Collapse
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
| |
Collapse
|
2
|
Comparative performance of the different orthotopic urinary diversions. Curr Opin Urol 2022; 32:554-560. [DOI: 10.1097/mou.0000000000001016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
|
3
|
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.
Collapse
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
| |
Collapse
|
4
|
Richter LA, Egan J, Alagha EC, Handa VL. Vaginal Complications after Radical Cystectomy for Bladder Cancer: A Systematic Review. Urology 2021; 156:e20-e29. [PMID: 34284007 DOI: 10.1016/j.urology.2021.07.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 06/14/2021] [Accepted: 07/05/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVES To summarize the published literature regarding pelvic organ prolapse, dehiscence or evisceration, vaginal fistula, and dyspareunia after radical cystectomy and to describe the management approaches used to treat these conditions. METHODS Ovid MEDLINE, Ovid EMBASE, and Web of Science were systematically searched from January 1, 2001 to January 25, 2021 using a combination of search terms for bladder cancer and radical cystectomy with terms for four categories of vaginal complications (prolapse, fistula, evisceration/dehiscence, and dyspareunia). A total of 229 publications were identified, the final review included 28 publications. RESULTS Neobladder vaginal fistula was evaluated in 17 publications, with an incidence rate of 3 - 6% at higher volume centers, often along the anterior vaginal wall at the location of the neobladder-urethral anastomosis. Sexual function was evaluated in 10 studies, 7 of which utilized validated instruments. Maintaining the anterior vaginal wall and the distal urethra appeared to be associated with improved sexual function. Pelvic organ prolapse was assessed in 5 studies, only 1 used a validated questionnaire and none included a validated objective measure of pelvic organ support. CONCLUSION There is a need for more prospective studies, using standardized instruments and subjective outcome measures to better define the incidence of vaginal complications after radical cystectomy for bladder cancer, and to understand their impact on quality of life measures.
Collapse
Affiliation(s)
- Lee A Richter
- Departments of Urology and Gynecology and Obstetrics, MedStar National Center for Advanced Pelvic Surgery, Georgetown University School of Medicine.
| | - Jillian Egan
- Department of Urology, MedStar Georgetown University Hospital
| | - Emily C Alagha
- Dahlgren Memorial Library, Georgetown University Medical Center
| | - Victoria L Handa
- Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine
| |
Collapse
|
5
|
Zhou X, He P, Ji H, Wang C, Zhang H, Li X, Lang L, Zhou Z, Wu X, Chen Z. Round ligament suspending treatment in orthotopic ileal-neobladder after radical cystectomy in women: a single-centre prospective randomised trial. BJU Int 2020; 128:187-195. [PMID: 33248014 DOI: 10.1111/bju.15306] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To compare the occurrence of emptying dysfunction between surgical techniques for orthotopic neobladder suspended with round ligament (rONB) and the standard procedure (sONB). PATIENTS AND METHODS A prospective randomised controlled trial was performed in a single centre of female patients undergoing creation of an ONB using rONB or sONB. Patients were followed for ≥24 months after ONB. The primary endpoints were significant post-void residual urine volume (sPVR) and need for clean intermittent catheterisation (CIC) at 24 months postoperatively. The secondary endpoints included early and late complications, urodynamic profile, and ONB continence. RESULTS Between January 2011 and October 2017, the trial enrolled 85 patients, of whom 82 were randomised. A total of 41 patients had a rONB and 41 a sONB. At 24 months, 17 of the 37 patients with a sONB and nine of the 39 patients with a rONB had a sPVR. The cumulative risk of a sPVR was significantly lower in the rONB group (23.1%) vs the sONB group (45.9%) (hazard ratio [HR] 0.43, 95% confidence interval [CI], 0.19-0.96; P = 0.040). In all, 15 of the 37 patients with a sONB and four of the 39 patients with a rONB needed CIC. The cumulative risk of requiring CIC was significantly lower in the rONB group (10.3%) vs the sONB group (40.5%) (HR 0.22, 95% CI 0.07-0.67; P = 0.008) at 24 months. Multivariable Cox regression analysis also showed that the rONB type was an independently protective factor for sPVR and CIC. The rates of early (0-90 days) and late complication (>90 days) were 54.1% and 13.5% in the sONB group, and 64.1% and 10.3% in the rONB group, respectively. There were no significant differences in complications, urodynamic profile or ONB continence. A major limitation is the small sample size at a single centre. CONCLUSION Posterior support with round ligament for an ONB significantly improved the emptying of the ONB and resulted in a reduced need for CIC. The surgical modification is a feasible and safe technique without additional complication-related surgeries.
Collapse
Affiliation(s)
- Xiaozhou Zhou
- Department of Urology, Urology Institute of PLA, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Peng He
- Department of Urology, Urology Institute of PLA, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Huixiang Ji
- Department of Urology, Urology Institute of PLA, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China.,Center of Urology, Third Affiliated Hospital, Chongqing Medical University, Chongqing, China
| | - Cong Wang
- Department of Urology, Urology Institute of PLA, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Heng Zhang
- Department of Urology, Urology Institute of PLA, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Xuemei Li
- Department of Urology, Urology Institute of PLA, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Lang Lang
- Department of Urology, Urology Institute of PLA, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Zhansong Zhou
- Department of Urology, Urology Institute of PLA, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Xiaojun Wu
- Department of Urology, Urology Institute of PLA, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Zhiwen Chen
- Department of Urology, Urology Institute of PLA, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China.,Southwest Cancer Center, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| |
Collapse
|
6
|
Carlos D, Abraham N, Zhou TC, Hung M. Transvaginal repair of Neobladder Vaginal Fistula with Martius Flap. Int Braz J Urol 2020; 46:864-866. [PMID: 32648433 PMCID: PMC7822384 DOI: 10.1590/s1677-5538.ibju.2018.0154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Accepted: 10/19/2019] [Indexed: 11/22/2022] Open
Abstract
Introduction Neobladder vaginal fistula (NVF) is a known complication after cystectomy and orthotopic diversion in
women, occurring in 3-5% of women. Possible risk factors for fistula formation include compromised tissue vascularity due to surgical dissection and/or radiotherapy, suture line proximity, local tissue recurrence, and injury to the vaginal wall during dissection. The surgical repair of a NVF can be challenging secondary to vaginal shortening, atrophy, local inflammation from chronic exposure to urinary leakage, and the proximity of the neobladder to the anterior vaginal wall. In this video, we present transvaginal repair of a NVF with Martius flap interposition. Materials and Methods This is the case of a 47 year old woman with a history of radical cystectomy and creation of a
Studer pouch secondary to bladder cancer two years prior who subsequently developed a NVF. Evaluation included an office cystoscopy which demonstrated a 3-4mm left-sided neobladder vaginal fistula at the level of the ileal-urethral anastomosis. No pelvic organ prolapse or evidence of bladder cancer recurrence was appreciated. Results A vaginal approach for the NVF repair was performed with a Martius flap interposition. A water-tight closure
was achieved without any intraoperative or immediate postoperative complications. The urethral Foley was removed at 2 weeks and by 4 weeks the patient did not report any urinary leakage. Conclusions Neobladder vaginal fistula is a rare complication following cystectomy and orthotopic urinary diversion
that can be repaired using a transvaginal approach. A Martius flap interposition is important to augment success of the repair. If a transvaginal approach fails a transabdominal approach or conversion to cutaneous diversion may be necessary.
Collapse
Affiliation(s)
- Daniela Carlos
- Montefiore Medical Center/Albert Einstein College of Medicine, NY, USA
| | - Nitya Abraham
- Montefiore Medical Center/Albert Einstein College of Medicine, NY, USA
| | - Tian C Zhou
- Montefiore Medical Center/Albert Einstein College of Medicine, NY, USA
| | - Michael Hung
- Montefiore Medical Center/Albert Einstein College of Medicine, NY, USA
| |
Collapse
|
7
|
Sex-Sparing Robot-Assisted Radical Cystectomy with Intracorporeal Padua Ileal Neobladder in Female: Surgical Technique, Perioperative, Oncologic and Functional Outcomes. J Clin Med 2020; 9:jcm9020577. [PMID: 32093240 PMCID: PMC7073846 DOI: 10.3390/jcm9020577] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Revised: 02/12/2020] [Accepted: 02/14/2020] [Indexed: 12/16/2022] Open
Abstract
Our aim was to illustrate our technique of sex-sparing (SS)-robot-assisted radical cystectomy (RARC) in female patients receiving an intracorporeal neobladder (iN). From January 2013 to June 2018, 11 female patients underwent SS-RARC-iN at a single tertiary referral center. Inclusion criteria were a cT ≤ 2 N0 M0 bladder tumor at baseline imaging (CT or MRI) and an absence of tumors in the bladder neck, trigone and urethra at TURB. Baseline, perioperative, and outcomes at one year were reported. The median operative time was 255 min and the median hospital stay was seven days. Low-grade Clavien complications occurred in four patients (36.3%), while high-grade complications were not observed in any. Seven patients (63.7%) had an organ-confined disease at the pathologic specimen; nodal involvement and positive surgical margins were not detected in any of the cases. At a median follow-up of 28 months (IQR 14–51), no patients developed new onset of chronic kidney disease stage 3b. After one year, daytime and nighttime continence rates were 90.9% and 86.4% respectively. Quality of life as well as physical and emotional functioning improved significantly over time (all p ≤ 0.04), while urinary symptoms and sexual function worsened at three months with a significant recovery taking place at one year (all p ≤ 0.04). Overall, 8 out of 11 patients (72.7%) were sexually active at the 12-month evaluation. In select female patients, SS-RARC-iN is an oncologically sound procedure associated with favorable perioperative and functional outcomes.
Collapse
|
8
|
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.
Collapse
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.
| |
Collapse
|
9
|
Voigt M, Hemal K, Matthews C. Influence of Simple and Radical Cystectomy on Sexual Function and Pelvic Organ Prolapse in Female Patients: A Scoping Review of the Literature. Sex Med Rev 2019; 7:408-415. [DOI: 10.1016/j.sxmr.2019.03.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 02/13/2019] [Accepted: 03/31/2019] [Indexed: 01/27/2023]
|
10
|
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: 1] [Impact Index Per Article: 0.2] [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.
Collapse
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
| |
Collapse
|
11
|
The Feasibility and Safety of Reproductive Organ Preserving Radical Cystectomy for Elderly Female Patients With Muscle-Invasive Bladder Cancer: A Retrospective Propensity Score-matched Study. Urology 2018; 125:138-145. [PMID: 30445122 DOI: 10.1016/j.urology.2018.09.035] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Revised: 09/06/2018] [Accepted: 09/18/2018] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To evaluate the feasibility and safety of reproductive organ preserving radical cystectomy (ROPRC) compared to radical cystectomy (RC) for elderly female patients with muscle-invasive bladder cancer. METHODS We retrospectively studied 135 elderly female patients (aged ≥75 years) who underwent RC followed by cutaneous ureterostomies at our center between January 1, 2007 and December 31, 2017. Eighty-four patients treated with RC, and 51 patients treated with ROPRC, were grouped into 45 pairs. Patient demographics, extensive peri-operative, and oncological data were then recorded and evaluated. RESULTS In the matched group, the incidence of short-term and long-term complications in the ROPRC group were lower than the RC group (18.0% vs 28.0%, P = .035; 12.0% vs 22.0%, P = .030). Furthermore, operative time was shorter, estimated blood loss was lower, and bowel recovery was quicker in the ROPRC group (207.5 minutes vs 267.9 minutes, P < .001; 500 mL vs 600 mL, P = .024; 3.0 days vs 4.0 days, P < .001, respectively) compared to the RC group. The recurrence free survival (P = .658), overall survival (P = .604), and cancer-specific survival (P = .361) were all equivalent when compared between the 2 groups with a median follow-up period of 34.0 and 38.0 months, respectively. The surgical approach (RC vs ROPRC) was an independent risk factor for short-term complications (P = .045), duration of operative time (P < .001), estimated blood loss (P = .004), and bowel recovery (P < .001). CONCLUSION This propensity score-matched cohort study showed that ROPRC was both feasible and safe for elderly female patients with muscle-invasive bladder cancer compared to RC, and also had comparable oncological outcomes after a lengthy follow-up period.
Collapse
|
12
|
Shim JS, Seo HK, Ku JH, Jeong BC, Hong B, Kang SH. Oncologic, Perioperative Outcomes of Female Radical Cystectomy: Results from a Multicenter Study in Korea. Cancer Res Treat 2018; 51:1064-1072. [PMID: 30376708 PMCID: PMC6639238 DOI: 10.4143/crt.2018.515] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2018] [Accepted: 10/29/2018] [Indexed: 11/21/2022] Open
Abstract
PURPOSE The lower incidence of bladder cancer among women has led to a lack of information on female radical cystectomy (RC). This study aimed to analyze the characteristics related with female RC in a cohort from multiple academic institutions. MATERIALS AND METHODS This was a retrospective review of 384 female patients who underwent RC for bladder cancer. Epidemiologic, perioperative variables including urologic referral periodwith consequent pathologic stage distributions were assessed. The changes in surgical techniques over time were illustrated. Also, we evaluated recurrence-free survival (RFS) at 2 and 5 years and overall survival (OS) at 5 years with stage-specific analyses using the Kaplan-Meier method. RESULTS The mean follow-up time was 35 months (interquartile rage [IQR], 9 to 55). The average time to urologic referral with initial symptoms was 5.5 (IQR, 1 to 6) months and over 20% of patients visited clinics after 6 months. In subsequent stage distributions according to referral period, T2 or higher stage distributions were abruptly increased after 1 year. Overall 2-year/5-year RFS rates were 0.72/0.57 and 5-year OS was 0.61. Notable surgical descriptions were as follows: 91% of patients underwent open RC; 80% of patients underwent an ileal conduit; and 83% of patients received anterior exenteration. However, the proportions of robotic surgery, orthotopic neobladder and organ sparing cystectomy have increased recen-tly. CONCLUSION We identified the general characteristics and changes in pattern of female RC. Our results also suggest that women are susceptible to delays in referral to an urologist and are at greater risk for worse prognosis.
Collapse
Affiliation(s)
- Ji Sung Shim
- Department of Urology, Korea University School of Medicine, Seoul, Korea
| | - Ho Kyung Seo
- Department of Urology, National Cancer Center, Goyang, Korea
| | - Ja Hyeon Ku
- Department of Urology, Seoul National University School of Medicine, Seoul, Korea
| | - Byong Chang Jeong
- Department of Urology, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Bumsik Hong
- Department of Urology, Asan Medical Center, University of Ulsan, College of Medicine, Seoul, Korea
| | - Seok Ho Kang
- Department of Urology, Korea University School of Medicine, Seoul, Korea
| |
Collapse
|
13
|
Avulova S, Chang SS. Role and Indications of Organ-Sparing "Radical" Cystectomy: The Importance of Careful Patient Selection and Counseling. Urol Clin North Am 2018; 45:199-214. [PMID: 29650136 DOI: 10.1016/j.ucl.2017.12.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Organ-sparing cystectomy remains an operation for a highly selected patient population that can offer similar oncologic outcomes but improved sexual function in men and women. Occult prostate cancer in men may occur even with screening but the majority is of clinical insignificance. Paramount to patient selection are oncologic concerns, but preoperative sexual function, age, performance status, and postoperative expectations must also be evaluated during patient selection. Improved diagnostic and surveillance tools may facilitate and improve patient selection in the future.
Collapse
Affiliation(s)
- Svetlana Avulova
- Department of Urologic Surgery, Vanderbilt University Medical Center, A1302 Medical Center North, Nashville, TN 37203, USA.
| | - Sam S Chang
- Department of Urologic Surgery, Vanderbilt University Medical Center, A1302 Medical Center North, Nashville, TN 37203, USA
| |
Collapse
|
14
|
Nayak AL, Cagiannos I, Lavallée LT, Morash C, Hickling D, Mallick R, Breau RH. Urinary function following radical cystectomy and orthotopic neobladder urinary reconstruction. Can Urol Assoc J 2018; 12:181-186. [PMID: 29485037 DOI: 10.5489/cuaj.4877] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION An orthotopic neobladder urinary diversion aims to minimize the physical and psychological effects of radical cystectomy through avoidance of a stoma and maintenance of urethral voiding. Neobladder function reported in the literature ranges widely due to differences in patient selection and method of assessment. The objective of the study was to characterize functional outcomes of consecutive patients treated at a tertiary care hospital. METHODS A historical cohort of patients who underwent radical cystectomy with a neobladder diversion performed at The Ottawa Hospital between January 2006 and December 2014 were reviewed. Outcomes of interest were urinary continence, use of clean intermittent catheterization (CIC), post-void residual volume, and uroflowmetry at three, six, and 12 months following cystectomy. RESULTS During the study period, 158 neobladder diversions were performed. The mean age of patients was 63.1 years (standard deviation [SD] 8.1), and 81.7% were male. Significant daytime incontinence (>1 pad) three months following surgery was common (65%), but decreased to 8.6% by 12 months. Nighttime incontinence was also common at three months (54%) and improved at 12 months (20%). While no appreciable differences between men and women were observed for continence, more women performed CIC at 12 months post-surgery (59% of women; 9% of men; relative risk [RR] 0.15; 95% confidence interval [CI] 0.07-0.30). Among patients who did not catheterize, uroflowmetry and post-void residual volume parameters were stable between three and 12 months postoperative. CONCLUSIONS Daytime and nighttime incontinence is common in neobladder patients following surgery, but improves considerably with time. Correspondingly, many female neobladder patients at our institution use CIC.
Collapse
Affiliation(s)
- Ameeta L Nayak
- The Ottawa Hospital Research Institute; University of Ottawa, Ottawa, ON, Canada
| | - Ilias Cagiannos
- Division of Urology, Department of Surgery; University of Ottawa, Ottawa, ON, Canada
| | - Luke T Lavallée
- Division of Urology, Department of Surgery; University of Ottawa, Ottawa, ON, Canada
| | - Chris Morash
- Division of Urology, Department of Surgery; University of Ottawa, Ottawa, ON, Canada
| | - Duane Hickling
- Division of Urology, Department of Surgery; University of Ottawa, Ottawa, ON, Canada
| | - Ranjeeta Mallick
- The Ottawa Hospital Research Institute; University of Ottawa, Ottawa, ON, Canada
| | - Rodney H Breau
- Division of Urology, Department of Surgery; University of Ottawa, Ottawa, ON, Canada
| |
Collapse
|
15
|
|
16
|
Abstract
Orthotopic neobladder is a viable option for women undergoing cystectomy for bladder cancer, with excellent oncologic outcomes and a low incidence of urethral recurrence. Careful patient selection is important, as is developing a clear understanding by the patient and her family in what to expect with an orthotopic diversion. Surgical technique is also important in optimizing functional outcomes, such as continence, sexual function, and decreased rate of vaginal fistula formation, and urinary retention.
Collapse
Affiliation(s)
- Dimitar V Zlatev
- Department of Urology, Stanford University School of Medicine, Stanford University Hospital and Clinics, 300 Pasteur Drive, Room S287, Stanford, CA 94304, USA
| | - Eila C Skinner
- Department of Urology, Stanford University School of Medicine, Stanford University Hospital and Clinics, 300 Pasteur Drive, Room S287, Stanford, CA 94304, USA.
| |
Collapse
|
17
|
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]
|
18
|
Pichler R, Fritz J, Heidegger I, Oberaigner W, Horninger W, Hochleitner M. Gender-related Outcome in Bladder Cancer Patients undergoing Radical Cystectomy. J Cancer 2017; 8:3567-3574. [PMID: 29151942 PMCID: PMC5687172 DOI: 10.7150/jca.21130] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Accepted: 08/29/2017] [Indexed: 12/27/2022] Open
Abstract
Background: The impact of gender on oncological outcome after radical cystectomy (RC) is not fully understood yet. The aim of the study was to evaluate gender-related differences in histopathological parameters and prognosis of patients with bladder cancer undergoing RC. Methods: A retrospective analysis of a 10-year single-center cystectomy database was performed. Kaplan-Meier survival and Cox-regression analyses with sex-specific interactions were performed to determine the impact of gender on recurrence-free survival (RFS), cancer-specific survival (CSS), and overall survival (OS), in addition to established clinicopathological factors. Results: 259 patients (212 [81.8%] men and 47 [18.2%] women) were enrolled. Although women had a greater propensity for extravesical (≥pT3) disease (53.2% vs. 33.9%, p=0.03) and heterotopic urinary diversion (72.3% vs. 49.5%, p=0.006), gender did not independently predict RFS, CSS or OS on multivariate analysis. Extravesical tumor disease was the sole independent predictor concerning RFS (hazard ratio [HR]=4.70; p<0.001), CCS (HR=2.77; p=0.013), and OS (HR=1.93; p=0.041). Orthotopic urinary diversion (HR=0.36; p=0.002) had an independent effect only on RFS. Rates of 5-year RFS (73.7% vs. 48.3%; p=0.001), CSS (72.5% vs. 44.9%; p<0.001) and OS (62.6% vs. 37.8%; p<0.001) were higher in orthotopic versus heterotopic diversions. Conclusion: In our series, women presented with more advanced tumors and higher rates of heterotopic urinary diversions, but their survival outcome was not significantly inferior to that of men. Extravesical disease was independently related to poorer survival after RC.
Collapse
Affiliation(s)
| | - Josef Fritz
- Department of Medical Statistics, Informatics and Health Economics
| | | | - Wilhelm Oberaigner
- Department of Clinical Epidemiology of the Tyrolean State Hospitals Ltd, Cancer Registry of Tyrol.,Department of Public Health, Health Services Research and HTA, UMIT - University for Health Sciences, Medical Informatics and Technology, Hall in Tyrol, Austria
| | | | - Margarethe Hochleitner
- Women's Health Centre and Coordination Centre for Equality, Affirmative Action for Women and Gender Research, Medical University of Innsbruck, A-6020 Innsbruck, Austria
| |
Collapse
|
19
|
Veskimäe E, Neuzillet Y, Rouanne M, MacLennan S, Lam TBL, Yuan Y, Compérat E, Cowan NC, Gakis G, van der Heijden AG, Ribal MJ, Witjes JA, Lebrét T. Systematic review of the oncological and functional outcomes of pelvic organ-preserving radical cystectomy (RC) compared with standard RC in women who undergo curative surgery and orthotopic neobladder substitution for bladder cancer. BJU Int 2017; 120:12-24. [PMID: 28220653 DOI: 10.1111/bju.13819] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
CONTEXT Pelvic organ-preserving radical cystectomy (POPRC) for women may improve postoperative sexual and urinary functions without compromising the oncological outcome compared with standard radical cystectomy (RC). OBJECTIVE To determine the effect of POPRC on sexual, oncological and urinary outcomes compared with RC in women who undergo standard curative surgery and orthotopic neobladder substitution for bladder cancer. EVIDENCE ACQUISITION Medline, Embase, Cochrane controlled trials databases and clinicaltrial.gov were systematically searched for all relevant publications. Women with bladder cancer who underwent POPRC or standard RC and orthotopic neobladder substitution with curative intent were included. Prospective and retrospective comparative studies and single-arm case series were included. The primary outcomes were sexual function at 6-12 months after surgery and oncological outcomes including disease recurrence and overall survival (OS) at >2 years. Secondary outcomes included urinary continence at 6-12 months. Risk of bias (RoB) assessment was performed using standard Cochrane review methodology including additional domains based on confounder assessment. EVIDENCE SYNTHESIS The searches yielded 11 941 discrete articles, of which 15 articles reporting on 15 studies recruiting a total of 874 patients were eligible for inclusion. Three papers had a matched-pair study design and the rest of the studies were mainly small, retrospective case series. Sexual outcomes were reported in seven studies with 167/194 patients (86%) having resumed sexual activity within 6 months postoperatively, with median (range) patients' sexual satisfaction score of 88.5 (80-100)%. Survival outcomes were reported in seven studies on 197 patients, with a mean follow-up of between 12 and 132 months. At 3 and 5 years, cancer-specific survival was 70-100% and OS was 65-100%. In all, 11 studies reported continence outcomes. Overall, the daytime and night-time continence rates were 58-100% and 42-100%, respectively. Overall, the self-catheterisation rate was 9.5-78%. Due to poor reporting and large heterogeneity between studies, instead of subgroup-analysis, a narrative synthesis approach was used. The overall RoB was high across all studies. CONCLUSION For well-selected patients, POPRC with orthotopic neobladder may potentially be comparable to standard RC for oncological outcomes, whilst improving sexual and urinary function outcomes. However, in women undergoing RC, oncological and functional data regarding POPRC remain immature and require further evaluation in a prospective comparative setting.
Collapse
Affiliation(s)
- Erik Veskimäe
- Department of Urology, Tampere University Hospital, Tampere, Finland
| | - Yann Neuzillet
- Department of Urology, Hospital Foch, University of Versailles Saint-Quentin-en-Yvelines, Suresnes, France
| | - Mathieu Rouanne
- Department of Urology, Hospital Foch, University of Versailles Saint-Quentin-en-Yvelines, Suresnes, France
| | | | - Thomas B L Lam
- Academic Urology Unit, University of Aberdeen, Aberdeen, UK
| | - Yuhong Yuan
- Department of Medicine, Health Science Centre McMaster University, Hamilton, ON, Canada
| | - Eva Compérat
- Department of Pathology, Hôpital Tenon, UPMC Paris VI, Paris, France
| | - Nigel C Cowan
- Department of Radiology, Queen Alexandra Hospital, Portsmouth, UK
| | - Georgios Gakis
- Department of Urology, Eberhard-Karls University, Tübingen, Germany
| | | | - Maria J Ribal
- Department of Urology, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | | | - Thierry Lebrét
- Department of Urology, Hospital Foch, University of Versailles Saint-Quentin-en-Yvelines, Suresnes, France
| |
Collapse
|
20
|
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]
|
21
|
Kretschmer A, Grimm T, Buchner A, Grimm J, Grabbert M, Jokisch F, Schneevoigt BS, Apfelbeck M, Schulz G, Bauer RM, Stief CG, Karl A. Prognostic Features for Objectively Defined Urinary Continence after Radical Cystectomy and Ileal Orthotopic Neobladder in a Contemporary Cohort. J Urol 2016; 197:210-215. [PMID: 27506691 DOI: 10.1016/j.juro.2016.08.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/02/2016] [Indexed: 11/26/2022]
Abstract
PURPOSE We objectively quantified daytime and nocturnal continence rates, and defined predictive features for favorable continence outcomes after radical cystectomy and orthotopic ileal neobladder creation. MATERIALS AND METHODS At 1 institution 1,012 cystectomies were performed between 2004 and 2015. Questionnaires evaluating the continence status were sent to 244 patients. To objectify postoperative urine loss daytime and nocturnal pad tests were performed. Continence was defined as the need for up to 1 safety pad and urine loss 10 gm or less per test. Predefined associative features were tested for an influence on continence outcomes. Statistical analysis was done with the Fisher exact and Mann-Whitney U tests, and linear logistic regression models. Significance was considered at p <0.05. RESULTS A total of 188 patients (77.0%) returned the questionnaires. Median followup was 61 months. Median daytime pad use was 1 pad per day (range 0 to 9). Median daily urine loss based on standardized pad testing was 8 gm (range 0 to 2,400). During the night a median of 1 pad (range 0 to 7) was used and median nocturnal urine loss was 28.5 gm (range 0 to 1,220). The continence rate was 54.3% during the day and 36.3% at night. On multivariate analysis good preoperative ECOG (Eastern Cooperative Oncology Group) status (OR 2.987, p = 0.010), retained sensation of bladder filling (OR 6.462, p = 0.003) and preoperative coronary heart disease (OR 0.036, p = 0.002) were independent predictors of daytime success. Based on preoperative risk factors a simple predictive score for daytime continence was created (AUC 0.725, p <0.001). CONCLUSIONS Continence rates after orthotopic ileal neobladder creation are lower than previously described when objective continence definitions are applied. Patients with good performance status, without coronary heart disease and with retained sensation of orthotopic ileal neobladder filling have better daytime continence outcomes.
Collapse
Affiliation(s)
- Alexander Kretschmer
- Department of Urology, Ludwig-Maximilians-University Munich, Germany; Department of Urological Sciences, University of British Columbia, Vancouver, British Columbia, Canada.
| | - Tobias Grimm
- Department of Urology, Ludwig-Maximilians-University Munich, Germany
| | - Alexander Buchner
- Department of Urology, Ludwig-Maximilians-University Munich, Germany
| | - Julia Grimm
- Department of Urology, Ludwig-Maximilians-University Munich, Germany
| | - Markus Grabbert
- Department of Urology, Ludwig-Maximilians-University Munich, Germany
| | - Friedrich Jokisch
- Department of Urology, Ludwig-Maximilians-University Munich, Germany
| | | | - Maria Apfelbeck
- Department of Urology, Ludwig-Maximilians-University Munich, Germany
| | - Gerald Schulz
- Department of Urology, Ludwig-Maximilians-University Munich, Germany
| | - Ricarda M Bauer
- Department of Urology, Ludwig-Maximilians-University Munich, Germany
| | - Christian G Stief
- Department of Urology, Ludwig-Maximilians-University Munich, Germany
| | - Alexander Karl
- Department of Urology, Ludwig-Maximilians-University Munich, Germany
| |
Collapse
|
22
|
Bailey GC, Blackburne A, Ziegelmann MJ, Lightner DJ. Outcomes of Surgical Management in Patients with Stress Urinary Incontinence and/or Neovesicovaginal Fistula after Orthotopic Neobladder Diversion. J Urol 2016; 196:1478-1483. [PMID: 27288693 DOI: 10.1016/j.juro.2016.06.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/01/2016] [Indexed: 11/26/2022]
Abstract
PURPOSE To our knowledge there are no guidelines for the evaluation and management of incontinence in women with an orthotopic neobladder. We propose a treatment algorithm based on our experience with treating this patient population. MATERIALS AND METHODS We identified women in whom orthotopic neobladder diversion and surgery for incontinence were performed from January 1, 1995 to January 1, 2014. Charts were reviewed for management, outcomes and complications within 30 days of surgery. RESULTS At this institution 12 women with orthotopic neobladder diversion were treated with surgery for incontinence between 1995 and 2014. Six women (50%) had an undiagnosed neovesicovaginal fistula, of whom 3 (50%) underwent successful fistula repair. A total of 12 bulking agent injections were performed in 6 women (50%). The outcomes were continued dryness after 1 injection (8%), transient improvement after 9 (75%), immediate failure after 1 (8%) and secondary fistula development after 1 (8%). Four transobturator slings and 4 pubovaginal slings were placed in a total of 6 patients (50%), of whom 1 (17%) was dry and 1 (17%) was improved. At a median followup of 22.9 months (IQR 11.1-46.4) 6 women (50%) were dry or improved and 6 (50%) had no improvement in leakage. Of the 6 (50%) women who were dry or improved 2 (17%) achieved planned intermittent catheterization after surgery and 2 (17%) underwent ileal conduit conversion. CONCLUSIONS Bulking agents have low long-term efficacy and carry the risk of fistula formation. The efficacy of tension-free sling placement is low and continence requires an obstructing sling. Counseling should include acceptance of multiple procedures, which may be necessary to achieve continence, and consideration of conduit diversion.
Collapse
|
23
|
The Long-Term Follow-Up and Complications Associated with Urinary Diversion in the Cancer Survivor. CURRENT BLADDER DYSFUNCTION REPORTS 2016. [DOI: 10.1007/s11884-016-0359-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
|
24
|
|
25
|
|
26
|
Flack CK, Monn MF, Kaimakliotis HZ, Koch MO. Functional and Clinicopathologic Outcomes Using a Modified Vescica Ileale Padovana Technique. Bladder Cancer 2015; 1:73-79. [PMID: 30561444 PMCID: PMC6218179 DOI: 10.3233/blc-140002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To evaluate the clinicopathologic and functional outcomes of a modified Vescica ileale Padovana (VIP) neobladder technique. METHODS Data for 160 patients at a single institution who underwent radical cystectomy and orthotopic VIP neobladder creation between 1998 and 2013 were analyzed. Modified VIP technique involved longitudinal opening of the small bowel close to the anterior mesenteric border instead of along the true anti-mesentery. This allowed for creation of a dependent neourethral funnel and a large serosal surface for ureteral anastomosis, distant from any suture lines. RESULTS Mean age for the entire cohort was 59.5, with 9% female and 64% with muscle invasive disease prior to cystectomy. Within 30 days of surgery, 16 patients (10%) developed a Clavien grade 3-4 complication and there were no deaths. Ninety-six percent reported minor or no daytime urinary leakage at 12 months, and 70% reported minor or no nighttime urinary leakage. Two- and five-year overall survival rates were 84.2% and 72.6% , respectively. Seven patients developed a ureteral stricture (4%), three (2%) had bladder neck contractures, two (1%) experienced urethral recurrence, and there were no vesicovaginal fistulas. CONCLUSIONS This modified VIP neobladder technique achieves favorable functional, survival, and recurrence outcomes similar to other published orthotopic continent diversions. Its near spheroidal shape lowers internal pressure, allowing for improved continence at physiologic filling capacity, and its offset bowel opening helps prevent unnecessary stretch to the native urethra, even in large individuals. The widened uretero-enteric anastomosis site distant from bowel suture lines contributes to decreased stricture rates and its placement on the dome of the neobladder facilitates endoscopic access should strictures occur. Finally, lack of posterior overlapping suture lines also mitigates the risk of fistulae formation in females should anterior vaginal wall excision or entry be unavoidable.
Collapse
Affiliation(s)
- Chandra K. Flack
- Indiana University School of Medicine, Department of Urology, Indianapolis, IN, USA
| | - M. Francesca Monn
- Indiana University School of Medicine, Department of Urology, Indianapolis, IN, USA
| | | | - Michael O. Koch
- Indiana University School of Medicine, Department of Urology, Indianapolis, IN, USA
| |
Collapse
|
27
|
Sacrocolpopexy with polypropylene tape as valuable surgical modification during cystectomy with orthotopic ileal bladder: functional results. BIOMED RESEARCH INTERNATIONAL 2015; 2015:306191. [PMID: 25789311 PMCID: PMC4350582 DOI: 10.1155/2015/306191] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/24/2014] [Revised: 11/06/2014] [Accepted: 11/06/2014] [Indexed: 11/23/2022]
Abstract
Introduction. Urinary diversion is very often associated with urinary retention and urinary incontinence. In this study, a surgical modification during cystectomy with orthotopic ileal neobladder is presented. Material and Methods. Female patients enrolled in the study (n-24) were subjected to sacrocolpopexy during the operation. Apart from oncological control, the follow-up consisted of 1-hour inlay test and questionnaires (UDI-6 and IIQ-7) in the 3rd, 6th, and 12th month after the operation. In the 12th month after the surgery, the urodynamic pressure-flow test was performed. Outcomes were compared with the control group (n-18) in which sacrocolpopexy was not implemented. Results. The study group was characterised by reduced urinary retention and improved continence. Conclusion. Sacrocolpopexy during cystectomy with orthotopic ileal bladder is a valuable surgical method which provides patients with a better quality of life.
Collapse
|
28
|
Abstract
BACKGROUND Quality of life after anterior or total exenteration is determined, among other factors, by the type of urinary diversion. There are two different types of urinary diversion: incontinent diversion (ureterocutaneostomy, ileal conduit, and colonic conduit) and continent diversions (continent cutaneous pouch, orthotopic neobladder, and rectal reservoir). RESULTS Invasive bladder cancer and advanced or recurrent gynecological tumors are the main indications for continent urinary diversion in women. In patients with non-irradiated bladder cancer, an orthotopic neobladder (except those with tumor invasion of the bladder neck or urethra) or a rectal reservoir is an option. In patients who had received preoperative radiotherapy, non-irradiated bowel segments should be used for urinary diversion (e.g., the transverse colon). In patients with planned postoperative radiation, the urinary diversion should be outside the radiation field. CONCLUSION Advantages and disadvantages of all types of urinary diversion should be objectively discussed with the patient. Especially exenteration for advanced or recurrent gynecological cancers should be performed in centers with a multidisciplinary team (gynecologist, urologist, radiotherapist, and in cases with complete exenteration the gastrointestinal surgeon).
Collapse
|
29
|
|
30
|
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]
|
31
|
Carmel ME, Goldman HB, Moore CK, Rackley RR, Vasavada SP. Transvaginal neobladder vaginal fistula repair after radical cystectomy with orthotopic urinary diversion in women. Neurourol Urodyn 2014; 35:90-4. [DOI: 10.1002/nau.22687] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2014] [Accepted: 09/02/2014] [Indexed: 11/08/2022]
|
32
|
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]
|
33
|
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]
|
34
|
Urinary functional outcomes in female neobladder patients. World J Urol 2013; 32:221-8. [DOI: 10.1007/s00345-013-1219-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2013] [Accepted: 11/25/2013] [Indexed: 11/12/2022] Open
|
35
|
Kaufman MR. Management of Stress Urinary Incontinence in the Neobladder Patient. CURRENT BLADDER DYSFUNCTION REPORTS 2013. [DOI: 10.1007/s11884-013-0207-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
36
|
|
37
|
Ahmadi H, Skinner EC, Simma-Chiang V, Miranda G, Cai J, Penson DF, Daneshmand S. Urinary Functional Outcome Following Radical Cystoprostatectomy and Ileal Neobladder Reconstruction in Male Patients. J Urol 2013; 189:1782-8. [DOI: 10.1016/j.juro.2012.11.078] [Citation(s) in RCA: 74] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/08/2012] [Indexed: 11/30/2022]
Affiliation(s)
- Hamed Ahmadi
- Institute of Urology, USC/Norris Comprehensive Cancer Center, Los Angeles, California
| | - Eila C. Skinner
- Department of Urology, Stanford University, Stanford, California
| | - Vannita Simma-Chiang
- Institute of Urology, USC/Norris Comprehensive Cancer Center, Los Angeles, California
| | - Gus Miranda
- Institute of Urology, USC/Norris Comprehensive Cancer Center, Los Angeles, California
| | - Jie Cai
- Institute of Urology, USC/Norris Comprehensive Cancer Center, Los Angeles, California
| | - David F. Penson
- Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Siamak Daneshmand
- Institute of Urology, USC/Norris Comprehensive Cancer Center, Los Angeles, California
| |
Collapse
|
38
|
Ali-El-Dein B, Mosbah A, Osman Y, El-Tabey N, Abdel-latif M, Eraky I, Shaaban A. Preservation of the internal genital organs during radical cystectomy in selected women with bladder cancer: A report on 15 cases with long term follow-up. Eur J Surg Oncol 2013; 39:358-64. [DOI: 10.1016/j.ejso.2013.02.004] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2012] [Revised: 12/30/2012] [Accepted: 02/01/2013] [Indexed: 10/27/2022] Open
|
39
|
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]
|
40
|
Hautmann RE, Abol-Enein H, Davidsson T, Gudjonsson S, Hautmann SH, Holm HV, Lee CT, Liedberg F, Madersbacher S, Manoharan M, Mansson W, Mills RD, Penson DF, Skinner EC, Stein R, Studer UE, Thueroff JW, Turner WH, Volkmer BG, Xu A. ICUD-EAU International Consultation on Bladder Cancer 2012: Urinary Diversion. Eur Urol 2013; 63:67-80. [DOI: 10.1016/j.eururo.2012.08.050] [Citation(s) in RCA: 201] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2012] [Accepted: 08/27/2012] [Indexed: 11/25/2022]
|
41
|
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]
|
42
|
Perugia ileal neobladder: functional results and complications. World J Urol 2012; 30:747-52. [DOI: 10.1007/s00345-012-0985-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2012] [Accepted: 11/03/2012] [Indexed: 10/27/2022] Open
|
43
|
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
| |
Collapse
|
44
|
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
|
45
|
Vaginal repair of neobladder–vaginal fistula: a case report and review of the literature. Int Urogynecol J 2012; 24:175-8. [PMID: 22237787 DOI: 10.1007/s00192-011-1636-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2011] [Accepted: 12/19/2011] [Indexed: 10/14/2022]
|
46
|
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]
|
47
|
|
48
|
Yang G, Whitson JM, Breyer BN, Konety BR, Carroll PR. Oncological and functional outcomes of radical cystectomy and orthotopic bladder replacement in women. Urology 2011; 77:878-83. [PMID: 21215428 DOI: 10.1016/j.urology.2010.08.065] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2010] [Revised: 08/08/2010] [Accepted: 08/21/2010] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To report oncological and functional results in women undergoing radical cystectomy and orthotopic bladder replacement. MATERIALS AND METHODS The charts of all women undergoing bladder replacement after radical cystectomy at UCSF through April 2008 were reviewed. Pathologic characteristics, survival (overall and disease-specific), and urinary functional outcomes are reported. Survival was estimated using Kaplan-Meier methods, and Cox proportional hazards regression analyses were performed to determine factors associated with incontinence, retention, and mortality. RESULTS Fifty-six women with a mean follow-up of 35 months were analyzed. The cancer recurrence rate was 32%. Kaplan-Meier estimated 5-year recurrence-free, cancer-specific, and overall survival were 54%, 57%, and 47%, respectively. Pathologic lymph node status (HR 14.2, P <.001) and age at diagnosis (HR 1.7, P = .04) were the only clinical or pathologic characteristics significantly associated with survival. The overall continence rate (no pads) was 57%. Hypercontinence occurred in 24% of patients. CONCLUSIONS With careful patient selection and usage of urethral frozen section, rates of local recurrence are low. Overall rates of incontinence (43%) and hypercontinence (24%) are similar to those previously reported. When pathologically organ-confined, women have an excellent disease-specific survival. Orthotopic bladder replacement is a safe and effective form of urinary diversion after radical cystectomy in women.
Collapse
Affiliation(s)
- Glen Yang
- Department of Urology, UCSF, Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco, CA 94143, USA.
| | | | | | | | | |
Collapse
|
49
|
Sigel CS, Park KJ, Fine SW, Lin O. Urothelial carcinoma involving vaginal specimens from patients with neobladder: A potential pitfall in diagnostic cytopathology. Diagn Cytopathol 2010; 40:168-72. [DOI: 10.1002/dc.21600] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2010] [Accepted: 10/16/2010] [Indexed: 11/11/2022]
|
50
|
Kassouf W, Hautmann RE, Bochner BH, Lerner SP, Colombo R, Zlotta A, Studer UE. A Critical Analysis of Orthotopic Bladder Substitutes in Adult Patients with Bladder Cancer: Is There a Perfect Solution? Eur Urol 2010; 58:374-83. [DOI: 10.1016/j.eururo.2010.05.023] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2010] [Accepted: 05/12/2010] [Indexed: 10/19/2022]
|