Advertisement

Uterus-, Fallopian Tube-, Ovary-, and Vagina-sparing Cystectomy Followed by U-shaped Ileal Neobladder Construction for Female Bladder Cancer Patients: Oncological and Functional Outcomes

Published:December 07, 2009DOI:https://doi.org/10.1016/j.urology.2009.08.083

      Objectives

      To evaluate oncological outcomes and voiding functions after orthotopic neobladder reconstruction with preservation of gynecologic organs in female bladder cancer patients.

      Methods

      A total of 30 consecutive female patients who underwent radical cystectomy and U-shaped ileal neobladder (constructed using 40 cm of a double-folded ileal loop) substitution were retrospectively analyzed. Of the 30 patients, 29 had urothelial carcinoma and 1 had leiomyosarcoma. Computed tomography was performed every 6 months. Urethroscopic examination was performed at 3-month intervals during the first and second years, and at 6-month intervals thereafter. Pressure flow studies, including urethral pressure profilometry, were performed 3, 6, 9, and 12 months after surgery.

      Results

      During a median follow-up of 35.7 months, 1 patient exhibited local recurrence and 6 patients died of bladder cancer. Maximum neobladder pressure examined 12 months after surgery improved significantly as compared with that examined after 3 months (P <.01). Maximal urethral closure pressure also improved significantly 12 months after surgery as compared with that after 3 months (P <.05). The capacity of the ileal neobladder 3 months after operation was 204 ± 84 mL, and it showed a gradual increase, reaching 311 ± 95 mL at 12 months (P <.01). None of the patients required catheterization for residual urine. Twenty-four patients (80%) remained completely dry day and night, voiding once or twice during the night.

      Conclusions

      Orthotopic neobladder reconstruction with preservation of gynecologic organs is feasible for female bladder cancer patients. Although the follow-up period was not long, the present technique provided acceptable oncological outcome and voiding function.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Urology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Stein J.P.
        • Lieskovsky G.
        • Cote R.
        • et al.
        Radical cystectomy in the treatment of invasive bladder cancer: long-term results in 1,054 patients.
        J Clin Oncol. 2001; 19: 666-675
        • Marshall F.F.
        • Treiger B.F.
        Radical cystectomy (anterior exenteration) in the female patient.
        Urol Clin North Am. 1991; 18: 765-775
        • Nandipati K.C.
        • Bhat A.
        • Zippe C.D.
        Neurovascular preservation in female orthotopic radical cystectomy significantly improves sexual function.
        Urology. 2006; 67: 185-186
        • Hautmann R.E.
        • Paiss T.
        • de Petriconi R.
        The ileal neobladder in women: 9 years of experience with 18 patients.
        J Urol. 1996; 155: 76-81
        • Shimogaki H.
        • Okada H.
        • Fujisawa M.
        • et al.
        Long-term experience with orthotopic reconstruction of the lower urinary tract in women.
        J Urol. 1999; 161: 573-577
        • Mills R.D.
        • Studer U.E.
        Female orthotopic bladder substitution: a good operation in the right circumstances.
        J Urol. 2000; 163: 1501-1504
        • Ali-El-Dein B.
        • Abdel-Latif M.
        • Mosbah A.
        • et al.
        Secondary malignant involvement of gynecological organs at radical cystectomy specimens in women: is it mandatory to remove these organs routinely?.
        J Urol. 2004; 172: 885-887
        • Stenzl A.
        • Jarolim L.
        • Coloby P.
        • et al.
        Urethra-sparing cystectomy and orthotopic urinary.
        Cancer. 2001; 92: 1864-1871
        • Chang S.S.
        • Cole E.
        • Cookson M.S.
        • et al.
        Preservation of the anterior vaginal wall during female radical cystectomy with orthotopic urinary diversion: technique and results.
        J Urol. 2002; 168: 1442-1445
        • Lee C.T.
        • Hafez K.S.
        • Sheffield J.H.
        • et al.
        Orthotopic bladder substitution in women: nontraditional applications.
        J Urol. 2004; 171: 1585-1588
        • Abou-Elela A.
        Outcome of anterior vaginal wall sparing during female radical cystectomy with orthotopic urinary diversion.
        J Cancer Surg. 2008; 34: 115-121
        • Blute M.L.
        • Gburek B.M.
        Continent orthotopic urinary diversion in female patients: early Mayo Clinic experience.
        Mayo Clin Proc. 1998; 73: 501-507
        • Greene F.L.
        • Page D.L.
        • Fleming I.D.
        • et al.
        AJCC Cancer Staging Manual. 6th ed. Springer-Verlag, New York, NY2002: 317-322
        • Koie T.
        • Yamamoto H.
        • Okamoto A.
        • et al.
        Feasibility and efficacy of gemcitabine and carboplatin neoadjuvant chemotherapy in muscle-invasive bladder cancer.
        J Clin Oncol. 2009; 27: e16100
        • Koie T.
        • Hatakeyama S.
        • Yoneyama T.
        • et al.
        Experience and functional outcome of modified ileal neobladder in 95 patients.
        Int J Urol. 2006; 13: 1175-1179
        • Ali-El-Dein B.
        • Gomha M.
        • Ghoneim M.A.
        Critical evaluation of the problem of chronic urinary retention after orthotopic bladder substitution in women.
        J Urol. 2002; 168: 587-592
        • Westney O.L.
        • Pisters L.L.
        • Pettaway C.A.
        • et al.
        Presentation, methods of diagnosis and therapy for pelvic recurrence following radical cystectomy for transitional cell carcinoma of the bladder.
        J Urol. 1998; 159: 792-795
        • Mondaini N.
        • Giubilei G.
        • Rosaria M.
        • et al.
        Recurrence of vaginal implantation of transitional cell carcinoma of the urinary tract.
        Gynecol Oncol. 2005; 97: 669-670
        • Groutz A.
        • Gillon G.
        • Konichezky M.
        • et al.
        Involvement of internal genitalia in female patients undergoing radical cystectomy for bladder cancer: a clinicopathological study of 37 cases.
        Int Gynecol Cancer. 1999; 9: 302-306
        • Chen M.E.
        • Pisters L.L.
        • Malpica A.
        • et al.
        Risk of urethral, vaginal and cervical involvement in patients undergoing radical cystectomy for bladder cancer: results of a contemporary cystectomy series from MD Anderson Cancer Center.
        J Urol. 1997; 157: 2120-2123
        • Varkarakis I.M.
        • Pinggera G.
        • Antoniou N.
        • et al.
        Pathological review of internal genitalia after anterior exenteration for bladder cancer in women.
        Int Urol Nephrol. 2007; 39: 1015-1021
        • Strasser H.
        • Ninkovic M.
        • Hess M.
        • et al.
        Anatomic and functional studies of the male and female urethral sphincter.
        World J Urol. 2000; 18: 324-329
        • Kessler T.M.
        • Studer U.E.
        • Burkhard F.C.
        Increased proximal urethral sensory threshold after radical pelvic surgery in women.
        Neurourol Urodyn. 2007; 26: 208-212
        • Gosling J.A.
        • Dixon J.S.
        • Critchley H.O.
        • et al.
        A comparative study of the human external sphincter and periurethral levator ani muscles.
        Br J Urol. 1981; 53: 35-41
        • Colleselli A.
        • Stenzl A.
        • Eder R.
        • et al.
        The female urethral sphincter: a morphological and topographical study.
        J Urol. 1998; 160: 49-54
        • Nagele U.
        • Kuczyk M.
        • Anastasiadis A.G.
        • et al.
        Radical cystectomy and orthotopic bladder replacement in females.
        Eur Urol. 2006; 50: 249-257
        • Dhar N.B.
        • Kessler T.M.
        • Mills R.D.
        • et al.
        Nerve-sparing radical cystectomy and orthotopic bladder replacement in female patients.
        Eur Urol. 2007; 52: 1006-1014

      Linked Article

      • Editorial Comment
        UrologyVol. 75Issue 6
        • Preview
          The surgical tenets of radical cystectomy were established years ago on the basis of our knowledge of the progression patterns of invasive bladder cancer. Early experience with less aggressive approaches made it clear that wide local excision of the bladder and its surrounding tissues, along with a thorough pelvic lymph node dissection, provides the optimal means to achieve local and regional cancer control. Because local recurrence after radical cystectomy is associated with fatal outcome, every attempt must be made to achieve cancer control.
        • Full-Text
        • PDF