Gynecologic-tract sparing extra peritoneal retrograde radical cystectomy with neobladder

Abstract

Objective: We report on a series of female patients with transitional cell carcinoma of the bladder who underwent extraperitoneal retrograde radical cystectomy sparing the female reproductive organs with neobladder creation. Materials and Methods: 14 female patients between the ages of 45 and 72 years who underwent gynecologic-tract sparing cystectomy (GTSC) with neobladder between 1997 and 2002 were retrospectively reviewed. Our surgical technique is also described. Radical cystectomy is accomplished by a retrograde method sparing the uterus, adnexa, vagina and distal urethra. An orthotopic neobladder was constructed using small bowel or sigmoid colon, brought extraperitoneally, and anastomosed to the distal urethra. Results: Operating time ranged from 4.5 to six hours with a mean of 5.3 hours. Ten patients were able to void satisfactorily while four required self-catheterization for complete emptying of the bladder. Seven patients were continent day and night and another 7 reported varying degrees of daytime and nighttime incontinence. One patient died of metastases and another of pelvic recurrence. There were no urethral recurrences. Patient satisfaction with the procedure was high. Conclusions: Gynecologic-tract sparing cystectomy with orthotopic neobladder is a viable alternative in female patients with muscle invasive traditional cell carcinoma of the bladder, providing oncological safety with improved quality of life. Our extraperitoneal technique, which is an extension of our successful experience with retrograde extraperitoneal radical with the neobladder.

Perioperative morbidity of radical cystectomy: A review

“…[6263] In women, we have recently used this technique for sparing the gynecological tract effectively to reduce POM and to improve quality of life [Figure 2]. [64]…”

Systematic review of the oncological and functional outcomes of pelvic organ‐preserving radical cystectomy (RC) compared with standard RC in women who undergo curative surgery and orthotopic neobladder substitution for bladder cancer

“…). In all, 11 937 articles were identified and screened; of these, 16 articles were eligible for full‐text screening and 15 met the inclusion criteria .…”

Primary and secondary malignant involvement of gynaecological organs at radical cystectomy for bladder cancer: Review of literature and retrospective analysis of 360 cases

“…Studies concerning genital-sparing radical cystectomy (Table IV) are few and their limitations included: limited sample size (Horenblas et al 2001;Menon et al 2004;Moinzadeh et al 2005); retrospective (Kulkarni et al 2008;Koie et al 2010;Salem and El-Mazny 2011); limited long-term follow-up (Horenblas et al 2001;Moinzadeh et al 2005;Game et al 2007); incomplete functional and oncological outcome (Fossa et al 1977;Francis and Gikas 1992) and lastly, cases with non-orthotopic diversion (Horenblas et al 2001;Menon et al 2004;Moinzadeh et al 2005;Game et al 2007). …”