Radical Cystectomy and Ileal Orthotopic Bladder Substitution after Radical Retropubic Prostatectomy: Functional and Oncological Results

Abstract

Men with good functional results following radical retropubic prostatectomy (RRP) and requiring radical cystectomy (RC) for subsequent bladder carcinoma seldom receive orthotopic bladder substitution. Four patients aged 62- 72 years (median 67 years), who had undergone RRP for prostate cancer of stage pT2bN0M0 Gleason score 6 (n = 1), pT2cN0M0 Gleason score 5 and 6 (n = 2) and pT3bN0M0 Gleason score 7 (n = 1) 27 to 104 months before, developed urothelial bladder carcinoma treated with RC and ileal orthotopic bladder substitution. After radical prostatectomy three were continent and one had grade I stress incontinence, and three achieved intercourse with intracavernous alprostadil injections. Follow-up after RC ranged between 27 and 42 months (median 29 months). At the 24-month follow-up visit after RC daily urinary continence was total (0 pad) in one patient, two used one pad for mild leakage, and one was incontinent following endoscopic incision of anastomotic stricture. One patient died of progression of bladder carcinoma, while the other three are alive without evidence of disease. The three surviving patients continued to have sexual intercourse with intracavernous alprostadil injections. Men with previous RRP have a reasonable chance of maintaining a satisfactory functional outcome following RC and ileal orthotopic bladder substitution.

Postoperative Quality of Life in Patients with Ileal Neobladder at Short-, Intermediate- and Long-Term Follow-Up

“…This result could be explained anyway on the basis of some general points that we think are of utmost importance: the satisfaction of the patients for the neobladder, the progressive adaptation to new life habits and surely the improving prognosis with time due to a negative follow-up, which plays a fundamental role. Selli et al [8] assessed the functional outcomes in 4 patients who had previously undergone radical prostatectomy for prostate cancer and after radical cystectomy for urothelial neoplasm; they concluded that in these patients there is a reasonable chance of maintaining a satisfactory functional. Yoneda et al [9], using anyway non-validated instruments, report functional results about QoL of patients with an orthotopic neobladder showing how surgery can have a minor impact on a patient's life focusing in particular on their social, emotional and psychological conditions.…”