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Wang C, Zhang X. Pelvic organ-preserving radical cystectomy versus standard radical cystectomy in female patients diagnosed with bladder cancer. World J Surg Oncol 2024; 22:218. [PMID: 39182105 PMCID: PMC11344460 DOI: 10.1186/s12957-024-03502-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2024] [Accepted: 08/13/2024] [Indexed: 08/27/2024] Open
Abstract
BACKGROUND Pelvic organ-preserving radical cystectomy (POPRC) has been reported to result in a better postoperative quality of life in female with bladder cancer compared to standard radical cystectomy (SRC). However, its oncological outcomes remain a concern. PATIENTS AND METHODS Female patients with bladder cancer who underwent POPRC or SRC were identified from the Surveillance, Epidemiology, and End Results (SEER) database. Logistic regression was used to identify predictors of POPRC usage. To avoid the potential impact of baseline differences between groups on survival, a 1:2 propensity score matching (PSM) was implemented. After that, Kaplan-Meier curves and Log-rank tests were used to determine the significance of overall survival (OS) differences between patients in the SRC group and POPRC group. Finally, subgroup analysis based on predetermined indicators was performed. RESULTS A total of 2193 patients were included with a median follow-up of 53 months, of whom 233 (10.6%) received POPRC and 1960 (89.4%) received SRC. No definitive predictors of POPRC were identified. Before PSM, POPRC resulted in comparable OS to SRC (HR = 1.09, p = 0.309), while after PSM, POPRC was associated with significantly worse OS (HR = 1.23, p = 0.038). In subgroup analyses, POPRC led to non-inferior OS (HR = 1.18, 95%CI 0.71-1.95, p = 0.531) in patients with non-muscle invasive bladder cancer (NMIBC) and T2 patients (HR = 1.07, p = 0.669), but significantly worse OS in T3 patients (HR = 1.41, p = 0.02). CONCLUSION Currently, patients undergoing POPRC have not undergone strict screening, and candidates for POPRC should have more stringent criteria in the future to achieve satisfactory oncological outcomes. However, flaws in the study make more evidence needed to support our findings.
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Affiliation(s)
- Chuanlin Wang
- Department of Urology, Chongqing University Fuling Hospital, No.2 Gaosuntang Road, Fuling District, Chongqing, 408000, China
| | - Xin Zhang
- Department of Urology, Chongqing University Fuling Hospital, No.2 Gaosuntang Road, Fuling District, Chongqing, 408000, China.
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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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3
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Patel SH, Wang S, Metcalf MR, Gupta N, Gabrielson A, Lee E, Rostom M, Pierorazio P, Smith A, Hahn N, Schoenberg M, Kates M, Hoffman-Censits J, Bivalacqua TJ. Safety and Efficacy of Reproductive Organ-Sparing Radical Cystectomy in Women With Variant Histology and Advanced Stage. Clin Genitourin Cancer 2021; 20:60-68. [PMID: 34896022 DOI: 10.1016/j.clgc.2021.11.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Revised: 11/06/2021] [Accepted: 11/08/2021] [Indexed: 11/03/2022]
Abstract
PURPOSE Muscle invasive bladder cancer surgical management has been historically a radical cystoprostatectomy in males and an anterior exenteration in females. Uterine, ovarian, and vaginal preservation are utilized, but raise concerns regarding risk to oncologic control, especially in variant histopathology or advanced stage. MATERIALS AND METHODS A retrospective single institutional analysis identified radical cystectomies performed in women, including those with variant histology, which were defined as reproductive organ sparing (uterine, vaginal, and ovary sparing) or nonorgan sparing. The Kaplan-Meier method was used for recurrence-free survival (RFS), cancer-specific survival (CSS), and overall survival (OS) in patients with advanced disease. RESULTS From 2000 to 2020, 289 women were identified, 188 underwent reproductive organ-sparing cystectomy. No statistical differences were noted for clinical parameters or presence of variant histology for organ-sparing (ROS) and nonorgan-sparing (non-ROS). Positive margin rates did not differ for ROS and non-ROS; 4.3% vs. 7.9%, P = .19, respectively. Median RFS was not statistically significantly different for ROS vs. non-ROS (26.1 vs. 15.3 months) P = .937 hazard ratio (HR) 1.024. CSS was not statistically different for ROS vs. non-ROS (36.3 vs. 28.6 months), P = .755 HR 0.9. OS was not statistically different for ROS vs. non-ROS (25.8 vs. 23.8 months), P = .5 HR = 1.178. Variant histology did not change survival (HR 1.1, P = .643). CONCLUSION In this analysis, ROS in women with advanced disease did not increase positive margin rates or decrease RFS, CSS, or OS compared to non-ROS. Variant histology did not decrease survival odds. Based on preoperative assessment and intraoperative findings, ROS in patients with variant histology and advanced disease should be considered.
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Affiliation(s)
- Sunil H Patel
- The Brady Urological Institute, The Johns Hopkins School of Medicine, Baltimore, MD.
| | - Shirley Wang
- The Brady Urological Institute, The Johns Hopkins School of Medicine, Baltimore, MD
| | | | - Natasha Gupta
- The Brady Urological Institute, The Johns Hopkins School of Medicine, Baltimore, MD
| | - Andrew Gabrielson
- The Brady Urological Institute, The Johns Hopkins School of Medicine, Baltimore, MD
| | - Esther Lee
- The Brady Urological Institute, The Johns Hopkins School of Medicine, Baltimore, MD
| | - Mary Rostom
- The Brady Urological Institute, The Johns Hopkins School of Medicine, Baltimore, MD
| | - Phil Pierorazio
- Division of Urology, University of Pennsylvania, Philadelphia, PA
| | - Armine Smith
- The Brady Urological Institute, The Johns Hopkins School of Medicine, Baltimore, MD
| | - Noah Hahn
- The Brady Urological Institute, The Johns Hopkins School of Medicine, Baltimore, MD; Department of Urology, New York University, New York, NY
| | - Mark Schoenberg
- Department of Urology, Montefiore Medical Center, Einstein School of Medicine, Bronx, NY
| | - Max Kates
- The Brady Urological Institute, The Johns Hopkins School of Medicine, Baltimore, MD
| | - Jean Hoffman-Censits
- The Brady Urological Institute, The Johns Hopkins School of Medicine, Baltimore, MD; Department of Oncology, The Johns Hopkins School of Medicine, Baltimore, MD
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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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5
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Elshabrawy A, Wang H, Satsangi A, Wheeler K, Ramamurthy C, Pruthi D, Kaushik D, Liss M, Gelfond J, Fernandez R, Gore J, Svatek R, Mansour AM. Correlates of refusal of radical cystectomy in patients with muscle-invasive bladder cancer. Urol Oncol 2021; 39:236.e9-236.e20. [PMID: 33423936 DOI: 10.1016/j.urolonc.2020.11.023] [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: 05/28/2020] [Revised: 11/11/2020] [Accepted: 11/13/2020] [Indexed: 11/28/2022]
Abstract
PURPOSE To evaluate factors associated with radical cystectomy (RC) refusal, subsequent treatment decisions, and their influence on overall survival (OS). MATERIALS AND METHODS We queried the National Cancer Database for patients with non-metastatic muscle-invasive bladder cancer (MIBC), cT2-T4M0. Patients who refused recommended RC were further stratified by treatment into chemotherapy, radiation therapy, chemoradiotherapy, and no treatment groups. Patients were excluded from the analysis if surgery was not planned, not recommended; or if survival data were unknown. Multivariate logistic regression modeling was utilized to identify independent predictors of refusing RC. Cox proportional hazards model with propensity score overlap weighting was utilized to identify survival predictors. Kaplan-Meier analysis was utilized to evaluate survival according to treatment. RESULTS A total of 74,159 MIBC patients were identified. Among patients with documented reasons for no surgery, 5.4% refused RC despite physician recommendation. Predictors of refusal on multivariate analysis included female gender (P = 0.016), advancing age ≥80 (vs. <60, P < 0.001), African American race (vs. white, P < 0.001) Medicaid (vs. private insurance, P < 0.001) and advancing T stage (T4 vs. T2, P < 0.001). Patients treated at academic centers were less likely to decline RC (vs. community centers, P < 0.001). Median survival after RC was 40.44 months vs. 12.52 months in refusal group. Undergoing chemoradiation had significantly improved survival in those patients compared to monotherapy or no treatment (hazard ratio 0.25, P < 0.001). Overlap weighted model Identified RC refusal as an independent predictor of poor OS (P < 0.001). CONCLUSIONS Several sociodemographic and clinical factors are associated with refusing radical cystectomy. Such refusal is associated with poor survival outcomes.
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Affiliation(s)
| | - Hanzhang Wang
- Department of Urology, UT Health San Antonio, San Antonio, TX
| | - Arpan Satsangi
- Department of Urology, UT Health San Antonio, San Antonio, TX
| | - Karen Wheeler
- Department of Urology, UT Health San Antonio, San Antonio, TX
| | | | - Deepak Pruthi
- Department of Urology, UT Health San Antonio, San Antonio, TX; UT Health San Antonio/MD Anderson Mays Cancer Center, San Antonio, TX
| | - Dharam Kaushik
- Department of Urology, UT Health San Antonio, San Antonio, TX; UT Health San Antonio/MD Anderson Mays Cancer Center, San Antonio, TX
| | - Michael Liss
- Department of Urology, UT Health San Antonio, San Antonio, TX; UT Health San Antonio/MD Anderson Mays Cancer Center, San Antonio, TX
| | - Jonathan Gelfond
- Department of Population Health Sciences, UT Health San Antonio, San Antonio, TX
| | - Roman Fernandez
- Department of Population Health Sciences, UT Health San Antonio, San Antonio, TX
| | - John Gore
- Department of Urology, University of Washington, Seattle, WA
| | - Robert Svatek
- Department of Urology, UT Health San Antonio, San Antonio, TX; UT Health San Antonio/MD Anderson Mays Cancer Center, San Antonio, TX
| | - Ahmed M Mansour
- Department of Urology, UT Health San Antonio, San Antonio, TX; UT Health San Antonio/MD Anderson Mays Cancer Center, San Antonio, TX; Urology and Nephrology Center, Mansoura University, Egypt.
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Bessa A, Martin R, Häggström C, Enting D, Amery S, Khan MS, Cahill F, Wylie H, Broadhead S, Chatterton K, Malde S, Nair R, Thurairaja R, Kumar P, Haire A, Green S, Northover M, Briggs K, Van Hemelrijck M. Unmet needs in sexual health in bladder cancer patients: a systematic review of the evidence. BMC Urol 2020; 20:64. [PMID: 32493286 PMCID: PMC7268732 DOI: 10.1186/s12894-020-00634-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 05/22/2020] [Indexed: 02/06/2023] Open
Abstract
Background Bladder cancer (BC) treatment can have a detrimental effect on the sexual organs of patients and yet assessment of sexual health needs has been greatly overlooked for these patients compared to those who have undergone other cancer therapies. Methods This review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines in July 2019. Studies were identified by conducting searches for Medline (using the PubMed interface), the Cochrane Central Register of Controlled Trials (CENTRAL) and Ovid Gateway (Embase and Ovid) using a list of defined search terms. Results 15 out of 37 studies included men only, 10 studies women only and 11 both sexes. Most participants were aged 50 to 65 years. Most studies (n = 34) focused on muscle invasive BC and only three on non-muscle invasive BC. Measurements of sexual dysfunction, including erection, ejaculation, firmness and desire, were the most commonly used measurements to report sexual health in men. In women, lubrification/dryness, desire, orgasm and dyspareunia were the most commonly reported. Twenty-one studies evaluated sexual dysfunction based on validated questionnaires, two with a non-validated questionnaire and through interviewing participants. Conclusion While recognition of the importance of the inclusion of psychometric measurements to assess sexual health is growing, there is a lack of consistent measures to assess sexual health in BC. With the focus on QoL arising in cancer survivorship, further studies are needed to develop, standardize and implement use of sexual health questionnaires with appropriate psychometrics and social measures to evaluate QoL in BC patients. Trial registration “PROSPERO does not currently accept registrations for scoping reviews, literature reviews or mapping reviews. PROSPERO is therefore unable to accept your application or provide a registration number. This decision should not stop you from submitting your project for publication to a journal.”
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Affiliation(s)
- Agustina Bessa
- King's College London, School of Cancer and Pharmaceutical Studies, Translational Oncology & Urology Research (TOUR), TOUR, Guy's Hospital, 3rd Floor Bermondsey Wing, London, SE1 9RT, UK.
| | | | - Christel Häggström
- King's College London, School of Cancer and Pharmaceutical Studies, Translational Oncology & Urology Research (TOUR), TOUR, Guy's Hospital, 3rd Floor Bermondsey Wing, London, SE1 9RT, UK.,Department of Surgical Sciences, Uppsala University, Uppsala, Sweden.,Department of Biobank Research, Umeå University, Umeå, Sweden
| | - Deborah Enting
- King's College London, School of Cancer and Pharmaceutical Studies, Translational Oncology & Urology Research (TOUR), TOUR, Guy's Hospital, 3rd Floor Bermondsey Wing, London, SE1 9RT, UK.,Department of Oncology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Suzanne Amery
- Department of Urology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | | | - Fidelma Cahill
- King's College London, School of Cancer and Pharmaceutical Studies, Translational Oncology & Urology Research (TOUR), TOUR, Guy's Hospital, 3rd Floor Bermondsey Wing, London, SE1 9RT, UK
| | - Harriet Wylie
- King's College London, School of Cancer and Pharmaceutical Studies, Translational Oncology & Urology Research (TOUR), TOUR, Guy's Hospital, 3rd Floor Bermondsey Wing, London, SE1 9RT, UK
| | - Samantha Broadhead
- Department of Urology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Kathryn Chatterton
- Department of Urology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Sachin Malde
- Department of Urology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Rajesh Nair
- Department of Urology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Ramesh Thurairaja
- Department of Urology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | | | - Anna Haire
- King's College London, School of Cancer and Pharmaceutical Studies, Translational Oncology & Urology Research (TOUR), TOUR, Guy's Hospital, 3rd Floor Bermondsey Wing, London, SE1 9RT, UK
| | - Saran Green
- King's College London, School of Cancer and Pharmaceutical Studies, Translational Oncology & Urology Research (TOUR), TOUR, Guy's Hospital, 3rd Floor Bermondsey Wing, London, SE1 9RT, UK
| | - Margaret Northover
- Department of Urology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Karen Briggs
- Department of Urology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Mieke Van Hemelrijck
- King's College London, School of Cancer and Pharmaceutical Studies, Translational Oncology & Urology Research (TOUR), TOUR, Guy's Hospital, 3rd Floor Bermondsey Wing, London, SE1 9RT, UK
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7
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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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8
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Whittum M, Hussein AA, Ahmed YE, Khan H, Krasowski C, Huben NB, May PR, Terakawa T, Li Q, Guru KA. Gynecological organ involvement at robot-assisted radical cystectomy in females: Is anterior exenteration necessary? Can Urol Assoc J 2018; 12:E398-E402. [PMID: 29787373 DOI: 10.5489/cuaj.5086] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION We aimed to investigate patient and disease variables associated with gynecological organ invasion in females with bladder cancer at the time of robot-assisted radical cystectomy (RARC). METHODS We conducted a retrospective review of female patients who underwent robot-assisted anterior pelvic exenteration (RAAE) between 2005 and 2016. Patients were divided into two groups: those with gynecological organ involvement at RAAE and those without. Data were reviewed for perioperative and pathological outcomes. Kaplan-Meier method was used to depict survival outcomes. Multivariable stepwise regression analysis was performed to identify predictors of gynecological organ involvement. RESULTS A total of 118 female patients were identified; 17 (14%) showed evidence of gynecological organ invasion at RAAE. Patients with gynecological organ invasion had more lymphovascular invasion at transurethral resection of bladder tumour (TURBT) (82% vs. 46%; p=0.006), trigonal tumours at TURBT (59% vs. 18%; p=0.001), multifocal disease (65% vs. 33%; p=0.01), pN+ (71% vs. 22%; p<0.001), positive surgical margins (24% vs. 4%; p=0.02), and they less commonly demonstrated pure urothelial carcinoma at TURBT (18% vs. 66%; p<0.001). On multivariate analysis, significant predictors of gynecological organ invasion were pN positive disease (odds ratio [OR] 6.48; 95% confidence interval [CI] 1.64-25.51; p=0.008), trigonal tumour location (OR 5.72; 95% CI 1.39-23.61; p=0.02), and presence of variant histology (OR18.52; 95% CI 3.32-103.4; p=0.001). CONCLUSIONS Patients with trigonal tumours, variant histology, and nodal involvement are more likely to have gynecological organs invasion at RAAE. This information may help improve counselling of patients and better identify candidates for gynecological organ-sparing cystectomy.
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Affiliation(s)
- Michelle Whittum
- Department of Urology, Roswell Park Cancer Institute, Buffalo, NY, United States
| | - Ahmed Aly Hussein
- Department of Urology, Roswell Park Cancer Institute, Buffalo, NY, United States
| | - Youssef E Ahmed
- Department of Urology, Roswell Park Cancer Institute, Buffalo, NY, United States
| | - Hijab Khan
- Department of Urology, Roswell Park Cancer Institute, Buffalo, NY, United States
| | - Collin Krasowski
- Department of Urology, Roswell Park Cancer Institute, Buffalo, NY, United States
| | - Neil B Huben
- Department of Urology, Roswell Park Cancer Institute, Buffalo, NY, United States
| | - Paul R May
- Department of Urology, Roswell Park Cancer Institute, Buffalo, NY, United States
| | - Tomoaki Terakawa
- Department of Urology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Qiang Li
- Department of Urology, Roswell Park Cancer Institute, Buffalo, NY, United States
| | - Khurshid A Guru
- Department of Urology, Roswell Park Cancer Institute, Buffalo, NY, United States
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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.
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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
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