Nerve‐sparing radical cystectomy has a beneficial impact on urinary continence after orthotopic bladder substitution, which becomes even more apparent over time

Furrer, Marc A.; Studer, Urs E.; Gross, Tobias; Burkhard, Fiona C.; Thalmann, George N.; Nguyen, Daniel Truong Phat

doi:10.1111/bju.14123

Cited by 30 publications

(58 citation statements)

References 35 publications

(57 reference statements)

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“…Pre‐operative continence and sexual function were poorly described. There were no pre‐operative incontinence and sexual dysfunction in 2 9,10 and 4 4,8,15,16 studies. Furthermore, participants of two included studies had comparative pre‐operative sexual function between NS and NNS group 9,10 …”

Section: Resultsmentioning

confidence: 86%

“…Age of included participants was comparable between the two groups in most of the studies, except for one article which included more younger participants in NS group 13 . As for tumor stage, most of the included studies were comparable between the two groups, only one had more favorable pathological T stage in NS group 8 . There was also no significant difference in post‐operative N stage compared with NNS group in three studies which reported this characteristic 4,8,14 (Table 2).…”

Section: Resultsmentioning

confidence: 93%

“…As displayed in Table 1, four of the 6 prospective studies get a 7‐8 NOS, which means most of our included prospective studies with high quality and low risk of bias. Sample sizes of the included studies ranged from 25 10 to 180 8 (total: 921 participants, 549 in the NS group vs 372 in the NNS group). Additionally, sample sizes of prospective studies ranged from 55 to 180, and the only two studies with sample size higher than 100 were both prospective studies.…”

Section: Resultsmentioning

confidence: 99%

“…According to a previous systematic review, the NS RC does not show superior effect both on daytime continence and nocturnal continence compared with the standard RC 5 . However, some studies reveal the NS RC could significantly improve urinary continence after surgery, recently 8,9 . Furthermore, concern remains regarding the impact of NS RC on oncological outcomes.…”

Section: Introductionmentioning

confidence: 99%

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Effect of neurovascular bundle sparing radical cystectomy on post‐operative continence and sexual function: A systematic review and meta‐analysis

Xiong

Qiu

et al. 2020

Andrology

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Background It is unclear whether the neurovascular bundle (NVB) sparing could improve post‐operative urinary continence and potency. Furthermore, concern remains regarding the impact of nerve‐sparing (NS) radical cystectomy (RC) on oncological outcomes. Objectives The primary objective of this meta‐analysis was to evaluate whether in men undergoing NS RC could improve post‐operative urinary continence and potency. The secondary objective was to assess whether NS RC could compromise the oncological control. Materials and methods A systematic search of the PubMed and Web of Science was performed in February 2020, yielding 1446 unique records. A total of 13 comparative cohort studies were included. Risk of bias in each study was assessed separately by two authors using the Newcastle‐Ottawa Scale (NOS). Results Data from 921 participants in 12 studies were synthesized in the present meta‐analysis. Meta‐analysis revealed that NS compared with non–nerve sparing (NNS) results in improved post‐operative potency, daytime continence, and nocturnal continence. RRs were 9.35 (P < .00001) in potency, 1.11 (P = .045) in daytime continence, and 1.33 (P = .002) in nocturnal continence, respectively. Furthermore, no differences were found in the included studies reporting oncological outcomes. RRs were 0.88 (P = .61) in local and/or distant recurrence between two groups. A sensitivity analysis of prospective studies indicated consistent results. Discussion and conclusion This meta‐analysis indicates that NS RC can improve post‐operative potency, and daytime and nocturnal urinary continence, without compromising oncological control, compared with NNS RC in men.

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Section: Resultsmentioning

confidence: 86%

Section: Resultsmentioning

confidence: 93%

Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Effect of neurovascular bundle sparing radical cystectomy on post‐operative continence and sexual function: A systematic review and meta‐analysis

Xiong

Qiu

et al. 2020

Andrology

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“…Increased nighttime diuresis and shift of free water into the concentrated urine may further attribute to incontinence. In a more recent study evaluating no vs unilateral vs bilateral nerve sparing, any degree of nerve sparing was associated with both day-and nighttime continence, which became even more apparent over time [7].…”

Section: Introductionmentioning

confidence: 93%

Management of Incontinence After Orthotopic Bladder Substitution Post-Radical Cystectomy

Schneider

Burkhard

2019

Curr Bladder Dysfunct Rep

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Purpose of Review Incontinence after orthotopic bladder substitution (OBS) post-radical cystectomy can be devastating for the patient and its treatment a challenge for the physician. The aim of this narrative review was to summarize the available evidence on treatment options for incontinence after OBS and to facilitate deciding on treatment strategies. Recent Findings Despite good continence rates after OBS, incontinence remains an issue and treatment poses a challenge for which limited evidence exists. Summary Treatment of incontinence therapy after orthotopic bladder substitution (OBS) post-radical cystectomy currently remains a challenge with limited evidence to aid treatment decisions. After a sound patient assessment and exclusion of anatomical or underlying problems, conservative management including pelvic floor muscle training is generally considered the first line of therapy. Drugs can be used as second-line therapy in specific cases, before refraining to third-line surgical options.

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Oncological and functional outcomes of organ‐preserving cystectomy versus standard radical cystectomy: A systematic review and meta‐analysis

et al. 2022

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Introduction: Radical cystectomy (RC) is historically considered the gold standard treatment for muscle invasive and high-risk non-muscle invasive bladder cancer.However, this technique leaves the majority of patients of both sexes with poor sexual and urinary function. Organ-sparing cystectomy (OSC) techniques are emerging as an alternative to the standard procedure to preserve these functions, without compromising the oncological outcomes. We present a systematic review and metaanalysis of the published literature.Methods: MEDLINE, Embase and Web of Science were systematically searched for eligible studies on 6 April 2021. Primary outcomes studied were both oncological outcomes, specifically overall recurrence, and functional outcomes, specifically sexual function, and daytime and nighttime continence. Odds ratios (OR) with 95% confidence intervals (95% CI) were calculated. The PROSPERO registration reference number was CRD42018118897.Results: From 13 894 identified abstracts, 19 studies (1886 male and 305 female patients) were eligible for inclusion in this review. These studies included patients who underwent either whole prostate, prostate capsule, seminal vesicle, nerve, uterus, ovary, vagina and fallopian tube sparing techniques. Four studies included only female patients.Thirteen studies reported oncological outcomes, and overall recurrence rate was similar between the two groups (five studies; OR 0.73; 95% CI 0.38-1.40, p = 0.34).Thirteen studies reported on male sexual function. In men, OSC had significantly

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Nerve‐sparing radical cystectomy has a beneficial impact on urinary continence after orthotopic bladder substitution, which becomes even more apparent over time

Abstract: Nerve-sparing during RC and OBS was associated with better long-term continence outcomes. This becomes more apparent as the patients age with their OBS. We advocate a NS RC whenever an OBS is considered.

Cited by 30 publications

References 35 publications

Effect of neurovascular bundle sparing radical cystectomy on post‐operative continence and sexual function: A systematic review and meta‐analysis

Effect of neurovascular bundle sparing radical cystectomy on post‐operative continence and sexual function: A systematic review and meta‐analysis

Management of Incontinence After Orthotopic Bladder Substitution Post-Radical Cystectomy

Oncological and functional outcomes of organ‐preserving cystectomy versus standard radical cystectomy: A systematic review and meta‐analysis

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