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Survival up to 5-15 years in young women following genital sparing radical cystectomy and neobladder: oncological outcome and quality of life. Single-surgeon and single-institution experience.

Wishahi M, Elganozoury H - Cent European J Urol (2015)

Bottom Line: Oncological outcome for 5-15 years was good; continence and sexual function were good.This procedure should be considered when surgical approach appears to be feasible.The limitation of our findings is the small sample size of this case series.

View Article: PubMed Central - PubMed

Affiliation: Theodor Bilharz Research Institute, Cairo, Egypt.

ABSTRACT

Introduction: This is an observational retrospective study utilising long term patient follow-up for 15 years to determine the survival and quality of life in women (age range 20-54 years) after having been treated for carcinoma of the bladder by radical cystectomy with preservation of genital organs.

Material and methods: The study included 13 female patients with urothelial carcinoma of the bladder treated with genital sparing radical cystectomy during the period of 1995 until 2006. They had orthotopic ileal neobladder. Follow-up included recurrence-free survival, metastases-free survival, overall survival, continence, and sexual function.

Results: Genital sparing cystectomy was done in 13 women. Seven women were between the ages of 20-37, and 6 women were aged 38-54. Overall survival of 10-15 years was 61.53%, survival from 5 to 9 years was 38.46%. The procedure was done in 9 women with a muscle-invasive tumor of stage T2- T3a. Non-muscle invasive T1 tumor was present in four patients. Quality of life was assessed by continence, which was good in 10/13 patients. Three women needed CIC. Sexual function was tested by female sexual function index >20-30 and was scored at 84.61%.

Conclusions: The study provides evidence of safety and efficacy of radical cystectomy with sparing of genital organs in women aged 20 to 54 with urothelial carcinoma of the bladder. Oncological outcome for 5-15 years was good; continence and sexual function were good. This procedure should be considered when surgical approach appears to be feasible. The limitation of our findings is the small sample size of this case series.

No MeSH data available.


Related in: MedlinePlus

Final view of the procedure of female genital sparing cystectomy with construction of U shaped orthotopic ileal neobladder. It illustrates the anchoring sutures between the uterus and the pre–sacral fascia, as well as the anchoring sutures of the horns of the U shaped ileal neobladder to the psoas muscle fascia.N: neobladder, UR: uterus, U: urethra, V: vagina, O: ovary, F: fallopian tube, Sc: sacrum, PS: psoas muscle fascia; NUA: neobladder urethral anastomosis.
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Figure 0002: Final view of the procedure of female genital sparing cystectomy with construction of U shaped orthotopic ileal neobladder. It illustrates the anchoring sutures between the uterus and the pre–sacral fascia, as well as the anchoring sutures of the horns of the U shaped ileal neobladder to the psoas muscle fascia.N: neobladder, UR: uterus, U: urethra, V: vagina, O: ovary, F: fallopian tube, Sc: sacrum, PS: psoas muscle fascia; NUA: neobladder urethral anastomosis.

Mentions: Patients underwent urethro–cystoscopy to localise the urethro–vesical– junction (UVJ). To identify the UVJ during cystectomy, a cystoscopic injection needle was used and guided by the Alberan bridge and 30° optical telescope to inject 0.5 ml methylene blue solution in the positions 12, 3, 6, 9 in the region of the UVJ. An indwelling urethral catheter was passed to the bladder and filled with 10 ml saline solution. An infra–umbilical incision was done, lymphadenectomy on both sides included iliac lymph nodes below the bifurcation of the common iliac vessels to the end of the external iliac vessels as well as obturator lymph nodes with clearance of the obturator fossa. The ureter was identified and followed down to the crossing of the superior vesical vessels that were ligated and divided close to the bladder wall. Further down, the inferior vesical vessels were ligated and divided close to the bladder wall. The ureters were divided at the level of the uretero–vesical junction. Lateral ligaments of the bladder were divided close to the bladder wall. The bladder was turned interiorly to get access to the vesico–uterine peritoneal reflection that was opened and sharp dissection was performed to reach the posterior bladder, trigonal area. Opening the vesico–uterine and vesico–vaginal spaces with sharp dissection would separate the posterior bladder wall from the anterior vaginal wall (Figure 1). The blue colour of the methylene blue previously injected in position 6, 3, 9 of the UVJ would be the landmarks where the bladder would be removed in the posterior level. The bladder was pushed posteriorly and careful dissection was made in the retro–pubic space to reach the anterior portion of the UVJ (Figure 1). The bladder was separated from the UVL after application of a vascular clamp following deflation of the balloon catheter. The ileal neobladder was constructed as a U shaped detubularised pouch. The ureters were anastomosed to the ileal pouch by the direct dipping technique. The ileal pouch was anastomosed to the urethra with four interrupted 3/0 polyglycolic acid sutures. The two ureters were drained externally via two ureteral stents, the bladder was drained with an 18 F silicone Catheter, which was anchored to the anterior abdominal wall with a Harris stitch to guard against slipping of the indwelling catheter if the balloon was accidently deflated, and to avoid pressure on the anastomotic site between the ileal pouch and the urethra. The uterus was fixed to the peri–sacral periosteal fascia and the two horns of the U shaped ileal neobladder were anchored to the iliopsoas fascia on either sides. These fixation steps were done to prevent anterior angulation of the neobladder with subsequent acute angulation of the neobladder–urethral anastomosis that may lead to hypercontinence (Figure 2).


Survival up to 5-15 years in young women following genital sparing radical cystectomy and neobladder: oncological outcome and quality of life. Single-surgeon and single-institution experience.

Wishahi M, Elganozoury H - Cent European J Urol (2015)

Final view of the procedure of female genital sparing cystectomy with construction of U shaped orthotopic ileal neobladder. It illustrates the anchoring sutures between the uterus and the pre–sacral fascia, as well as the anchoring sutures of the horns of the U shaped ileal neobladder to the psoas muscle fascia.N: neobladder, UR: uterus, U: urethra, V: vagina, O: ovary, F: fallopian tube, Sc: sacrum, PS: psoas muscle fascia; NUA: neobladder urethral anastomosis.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4526600&req=5

Figure 0002: Final view of the procedure of female genital sparing cystectomy with construction of U shaped orthotopic ileal neobladder. It illustrates the anchoring sutures between the uterus and the pre–sacral fascia, as well as the anchoring sutures of the horns of the U shaped ileal neobladder to the psoas muscle fascia.N: neobladder, UR: uterus, U: urethra, V: vagina, O: ovary, F: fallopian tube, Sc: sacrum, PS: psoas muscle fascia; NUA: neobladder urethral anastomosis.
Mentions: Patients underwent urethro–cystoscopy to localise the urethro–vesical– junction (UVJ). To identify the UVJ during cystectomy, a cystoscopic injection needle was used and guided by the Alberan bridge and 30° optical telescope to inject 0.5 ml methylene blue solution in the positions 12, 3, 6, 9 in the region of the UVJ. An indwelling urethral catheter was passed to the bladder and filled with 10 ml saline solution. An infra–umbilical incision was done, lymphadenectomy on both sides included iliac lymph nodes below the bifurcation of the common iliac vessels to the end of the external iliac vessels as well as obturator lymph nodes with clearance of the obturator fossa. The ureter was identified and followed down to the crossing of the superior vesical vessels that were ligated and divided close to the bladder wall. Further down, the inferior vesical vessels were ligated and divided close to the bladder wall. The ureters were divided at the level of the uretero–vesical junction. Lateral ligaments of the bladder were divided close to the bladder wall. The bladder was turned interiorly to get access to the vesico–uterine peritoneal reflection that was opened and sharp dissection was performed to reach the posterior bladder, trigonal area. Opening the vesico–uterine and vesico–vaginal spaces with sharp dissection would separate the posterior bladder wall from the anterior vaginal wall (Figure 1). The blue colour of the methylene blue previously injected in position 6, 3, 9 of the UVJ would be the landmarks where the bladder would be removed in the posterior level. The bladder was pushed posteriorly and careful dissection was made in the retro–pubic space to reach the anterior portion of the UVJ (Figure 1). The bladder was separated from the UVL after application of a vascular clamp following deflation of the balloon catheter. The ileal neobladder was constructed as a U shaped detubularised pouch. The ureters were anastomosed to the ileal pouch by the direct dipping technique. The ileal pouch was anastomosed to the urethra with four interrupted 3/0 polyglycolic acid sutures. The two ureters were drained externally via two ureteral stents, the bladder was drained with an 18 F silicone Catheter, which was anchored to the anterior abdominal wall with a Harris stitch to guard against slipping of the indwelling catheter if the balloon was accidently deflated, and to avoid pressure on the anastomotic site between the ileal pouch and the urethra. The uterus was fixed to the peri–sacral periosteal fascia and the two horns of the U shaped ileal neobladder were anchored to the iliopsoas fascia on either sides. These fixation steps were done to prevent anterior angulation of the neobladder with subsequent acute angulation of the neobladder–urethral anastomosis that may lead to hypercontinence (Figure 2).

Bottom Line: Oncological outcome for 5-15 years was good; continence and sexual function were good.This procedure should be considered when surgical approach appears to be feasible.The limitation of our findings is the small sample size of this case series.

View Article: PubMed Central - PubMed

Affiliation: Theodor Bilharz Research Institute, Cairo, Egypt.

ABSTRACT

Introduction: This is an observational retrospective study utilising long term patient follow-up for 15 years to determine the survival and quality of life in women (age range 20-54 years) after having been treated for carcinoma of the bladder by radical cystectomy with preservation of genital organs.

Material and methods: The study included 13 female patients with urothelial carcinoma of the bladder treated with genital sparing radical cystectomy during the period of 1995 until 2006. They had orthotopic ileal neobladder. Follow-up included recurrence-free survival, metastases-free survival, overall survival, continence, and sexual function.

Results: Genital sparing cystectomy was done in 13 women. Seven women were between the ages of 20-37, and 6 women were aged 38-54. Overall survival of 10-15 years was 61.53%, survival from 5 to 9 years was 38.46%. The procedure was done in 9 women with a muscle-invasive tumor of stage T2- T3a. Non-muscle invasive T1 tumor was present in four patients. Quality of life was assessed by continence, which was good in 10/13 patients. Three women needed CIC. Sexual function was tested by female sexual function index >20-30 and was scored at 84.61%.

Conclusions: The study provides evidence of safety and efficacy of radical cystectomy with sparing of genital organs in women aged 20 to 54 with urothelial carcinoma of the bladder. Oncological outcome for 5-15 years was good; continence and sexual function were good. This procedure should be considered when surgical approach appears to be feasible. The limitation of our findings is the small sample size of this case series.

No MeSH data available.


Related in: MedlinePlus