Pelvic Floor Organ Prolapse After Radical Cystectomy in Patients With Uroepithelial Carcinoma

Abstract

Objective The aim of this study was to identify whether women who undergo a radical cystectomy for uroepithelial carcinoma are at increased risk of pelvic organ prolapse after surgical treatment. Methods A retrospective cohort study compared female subjects who had undergone a radical cystectomy for uroepithelial carcinoma, as identified through an institutional cancer survivor database, with subjects who presented to the Pelvic Health and Continence Clinic with symptoms of either uterovaginal prolapse or urinary incontinence. Demographic data were collected regarding risk factors for prolapse, and study subjects were asked to complete a Pelvic Organ Prolapse Distress Inventory (POPDI-6). Data were collected through retrospective chart review. The primary outcome is difference in the POPDI-6 between the groups. Statistical evaluation of responses was performed, with analysis of variance used to compare the questionnaire scores between groups and correction for risk factors with χ2 tests, with a P value of 0.05 selected for statistical significance. Results There were 36 postcystectomy subjects who responded to the survey, 37 subjects in the prolapse group, and 44 subjects in the incontinence group. With correction for age, body mass index, and number of vaginal deliveries, the postcystectomy group reported significantly lower scores on the POPDI-6 than both the prolapse group (P < 0.0001) and the incontinence group (P = 0.0003). Conclusions Radical cystectomy for uroepithelial carcinoma does not correlate with an increased risk of patient-reported symptoms of pelvic organ prolapse.

Anterior enterocele after cystectomy: case report and review of the literature

“…Wenk and colleagues detected in their study group that the type of urinary diversion, POP-Q stages, and tumor stages did not show significant differences regarding sexual function, QoL, and prolapse complaints in women after RC, whereas a vagina-sparing approach showed significant differences only in two subscales without clinical relevance. This result has also been demonstrated by a study from Lipetskaia et al [ 21 ]. The study quoted the absence of correlation between radical cystectomy for uroepithelial carcinoma with an increased risk of patient-reported symptoms of pelvic organ prolapse.…”

Evaluation of sexual function and vaginal prolapse after radical cystectomy in women: a study to explore an under-evaluated problem

“…The only study using a validated questionnaire to evaluate POP found that 22.9% of the patients reported the sensation of vaginal bulging [ 29 ], whereas this was reported by only 11.4% of our study cohort. These numbers are at odds with the fact that in a study by Swift, when asked, “Do you ever feel or see something bulging out of your vagina?,” 75% of patients with POP could be identified [ 31 ].…”

“…A recent review found that symptoms of POP after RC were systematically assessed in 5 studies, but only 1 used a validated questionnaire and none of the studies included a validated objective measurement of POP [ 7 ]. Two studies did not report cases of postoperative prolapse [ 7 ], whereas 3 studies reported prolapse incidence ranging from 6 to 23% depending on the sample size and the time since RC [ 27 – 29 ]. It has to be mentioned that most studies were performed on women with a neobladder [ 7 ], whereas one study did not state the type of urinary diversion [ 29 ].…”

“…Two studies did not report cases of postoperative prolapse [ 7 ], whereas 3 studies reported prolapse incidence ranging from 6 to 23% depending on the sample size and the time since RC [ 27 – 29 ]. It has to be mentioned that most studies were performed on women with a neobladder [ 7 ], whereas one study did not state the type of urinary diversion [ 29 ]. Another retrospective study reported that 17% of female RC patients were assessed for POP at any postoperative visit and found an incidence of 12% [ 30 ].…”