Pathological Guidelines for Orthotopic Urinary Diversion in Women With Bladder Cancer: A Review of the Literature

Abstract

Orthotopic urinary diversion can be performed safely in appropriately selected women with bladder cancer. Excellent oncological outcomes can be expected with a minimal risk of urethral recurrence. Preoperative bladder neck involvement is an important risk factor for urethral involvement but not an absolute contraindication to orthotopic diversion should intraoperative frozen section of the proximal urethra be without evidence of malignancy.

Bladder cancer survivals in New South Wales, Australia: why do women have poorer survival than men?

“…After the 1990s, orthotic urinary diversion or neobladders were developed for women. According to Baniel [13], bladder reconstruction was not performed in women until the mid-1990s because it was assumed that surgical intervention at the bladder neck area might render them incontinent; it was also thought that women were more prone to urethral involvement than men and would have a high recurrence rate if the urethra was spared [13][14][15]. Bladder neck tumour involvement in women is no longer considered a contraindication to this procedure as long as the proximal urethra is tumour free.…”

“…Bladder neck tumour involvement in women is no longer considered a contraindication to this procedure as long as the proximal urethra is tumour free. One would expect that less extensive surgical sparing in women may, in fact, provide a survival advantage, but this is clearly not the case [15].…”

Management of the urethra in urothelial bladder cancer

“…1 Several other studies have confirmed similarly low rates of urethral involvement in both male and female cystectomy specimens. [3][4][5][6] The overall incidence of UR following cystectomy is approximately 8% to 10%. 1 In men, incidence ranges from 4% to 7.9%.…”

“…[7][8][9][10] Women seem to have at least comparable UR rates in contemporary series, ranging from 4.7% to 12%. 5,11,12 Interestingly, recurrence rates have also been shown to vary by type of diversion performed. In patients with cutaneous urinary diversions, recurrence rates range from 2.1% to 11.1%, while in those with orthotopic bladder substitutions, recurrence rates are slightly lower at 0.5% to 4.3%.…”

“…11 This has been postulated to be due to the shorter length of remnant urothelium, or due to the process of aging resulting in cranial migration of metaplastic squamous cell mucosa in the urethra, which may have a protective effect. 5 …”