Reproductive organ‐sparing cystectomy significantly improves continence in women after orthotopic bladder substitution without affecting oncological outcome

Gross, Tobias; Furrer, Marc A.; Schorno, Petra; Wuethrich, Patrick Y.; Schneider, Marc P.; Thalmann, George N.; Burkhard, Fiona C.

doi:10.1111/bju.14191

Cited by 13 publications

(4 citation statements)

References 22 publications

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“…Finley et al [ 13 ] emphasized that pseudocystocele and urethral kinking are anatomical changes associated with urinary retention after orthotopic bladder substitution. Sparing of the gynecologic organs, such as the round ligament, during radical cystectomy may play a role in continence [ 17 18 ]; however, further prospective comparative studies are needed. Ali-el-Dein et al [ 14 ] reported a low rate of urethral recurrence after radical cystectomy following orthotopic bladder substitution, suggesting the continued use of this type of diversion.…”

Section: Discussionmentioning

confidence: 99%

Gender-related outcomes in robot-assisted radical cystectomy: A multi-institutional study

et al. 2022

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Purpose Robot-assisted radical cystectomy (RARC) optimizes patient recovery and has outcomes comparable with those of open surgery. This study aimed to compare the perioperative and oncologic outcomes of RARC in female and male patients. Materials and Methods A retrospective cohort study of the Korean Robot-Assisted Radical Cystectomy Study Group database from 2007 to 2019 identified 749 patients (111 females and 638 males). Female were matched 1:1 to male by propensity score matching using a logistic regression. We compared perioperative outcomes, oncologic outcomes, and complications between the two groups. Results The female group had comparable perioperative outcomes to the male group in terms of operation time, lymph node yield, positive surgical margin, blood transfusion rate, and hospitalization days. Complication rate and grade were not significantly different between the two groups. The most common complication was infection in female and gastrointestinal complications in male. We compared the 5-year overall, disease-specific, and recurrence-free survival of female and male: 58.2% vs. 68.0% (p=0.495), 75.7% vs. 79.3% (p=0.645), and 40.8% vs. 53.5% (p=0.913), respectively. On multivariable analysis, T stage (>T2), postoperative complications, and positive surgical margin were prognostic factors of poor outcome. Sex was not an independent predictor of the three survivals. Conclusions The current study suggests that RARC in female has comparable perioperative and oncologic outcomes to those in male. The complication rate of RARC in female was comparable to that in male, but the type of complications differed by sex.

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Section: Discussionmentioning

confidence: 99%

Gender-related outcomes in robot-assisted radical cystectomy: A multi-institutional study

et al. 2022

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“…Research in the field of genital-sparing cystectomy (GSC) techniques to improve functional outcomes after cystectomy is gaining prominence [50] . Gross et al [51] and Wishahi et al [52] recently investigated the impact of GSC and subsequent ONB compared with standard RC in maintaining functional outcomes such as urinary continence in women.…”

Section: Discussionmentioning

confidence: 99%

“…The latter showed that GSC with ONB led to a minimal incidence of hypercontinence (7.80%), while standard RC led to a higher incidence (28.88%) [52] . A recent systematic review of the literature regarding OSC techniques showed that preservation of the genital or pelvic organs, in both men and women, yields better sexual outcomes than standard RC without compromising oncologic outcomes; however, the authors emphasized that none of these techniques could be recommended as superior to standard RC, and that large-scale prospective and multi-institutional studies are needed to identify patients suitable for these techniques [50] .…”

Section: Discussionmentioning

confidence: 99%

Surgical and functional outcomes after robot-assisted radical cystectomy in female patients: a systematic review of the literature

Ornaghi¹,

Tafuri²,

Orlando³

et al. 2021

MIS

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Aim:We aimed to review and summarize recent data on surgical and functional outcomes in women undergoing robot-assisted radical cystectomy (RARC) and urinary diversion (UD) for bladder cancer, compared with male and open counterparts. Methods: A systematic review of English-language articles published in the last 15 years was performed on PubMed/Medline database according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Outcomes of interest included peri-and post-operative surgical outcomes [operative time (OT), estimated blood loss (EBL), hospital stay (LOS), complications, and readmission], pathological outcomes [pT stage, lymph node (LN) yield, positive surgical margins (PSMs), and positive LN (pN+)], and functional outcomes [daytime and nighttime continence, sexual activity, need for clean intermittent catheterization (CIC), and quality of life (QoL) evaluation].Results: Overall, eight studies were selected collecting data from 229 female patients undergoing RARC. The median OT was 418 min (range 311-562 min) and the median EBL was 380 mL (range 100-1160 mL). OT and EBL were not significantly different comparing males and females, whereas the robotic approach was found to be Conclusion: RARC and UD in female patients is a feasible procedure with surgical outcomes overlapping with those in the male patient population. Postoperative functional outcomes on continence, sexual function, and QoL are still poorly investigated, although results inherent in the nerve-sparing approach appear promising.

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“…After a constant rise in the number of orthotopic bladder substitution procedures since their introduction in the mid 80s, a plateau was reached at the beginning of this century when nearly 50% of all urinary diversion surgeries performed in high-volume centres worldwide involved © 2020 The Authors BJU International © 2020 BJU International 655 orthotopic bladder substitution [23]. Initially reserved for men, female orthotopic bladder reconstruction was later implemented in clinical routine, with excellent voiding and storage function outcomes in selected patients, especially after widespread utilization of reproductive organ-sparing cystectomy, and therefore became the preferable form of CUD for both sexes [24][25][26]. In the following years, the number of orthotopic bladder substitution surgeries decreased as a result of unsatisfactory results obtained by inexperienced surgeons and the introduction of minimally invasive surgery, in which the orthotopic bladder substitute configuration is a challenge [27].…”

Section: Orthotopic Bladder Substitutionmentioning

confidence: 99%

Continent diversion: five decades of developments and evolution

Stangl

Thalmann

2020

BJU International

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Objective To provide a chronological overview of the evolution of continent urinary diversion (CUD) over the last 50 years and to highlight important milestones. Methods We performed an extensive literature review and analysed different forms of urinary diversion worldwide. After the evaluation of surgical techniques, we assessed the advantages and disadvantages of assorted CUD approaches based on published long‐term follow‐up data. Results A wide variety of surgical options for CUD is available and feasible to date, although consensus among urologists regarding the 'gold standard' is still lacking. Several forms of orthotopic bladder substitutes and continent cutaneous urinary reservoirs have been shown to provide excellent long‐term results. Conclusion The last 50 years of CUD have seen constant evolution and refinement of techniques, but the best surgical approach remains unclear and there is no ‘one‐size‐fits‐all’ option, but rather tailor‐made approaches are necessary to ensure patient satisfaction.

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Reproductive organ‐sparing cystectomy significantly improves continence in women after orthotopic bladder substitution without affecting oncological outcome

Abstract: Superior continence rates were found for ROSC with an OBS compared with SC, without a negative impact on oncological outcome. ROSC should, therefore, be offered to women receiving an OBS whenever justifiable.

Cited by 13 publications

References 22 publications

Gender-related outcomes in robot-assisted radical cystectomy: A multi-institutional study

Gender-related outcomes in robot-assisted radical cystectomy: A multi-institutional study

Surgical and functional outcomes after robot-assisted radical cystectomy in female patients: a systematic review of the literature

Continent diversion: five decades of developments and evolution

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