Radical cystectomy and urinary diversion in women: techniques, outcomes, and challenges—a narrative review

Deimling, Markus von; Laukhtina, Ekaterina; Pradère, Benjamin; Pallauf, Maximilian; Klemm, Jakob; Fisch, Margit; Shariat, Shahrokh F.; Rink, Michael

doi:10.21037/tau-22-463

Cited by 11 publications

(7 citation statements)

References 127 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Well-designed studies in this field are necessary to further improve the outcomes of women treated with RC, with an overarching aim to close the gender gap in managing women with BC. 23 Due to our current investigation, we must strongly agree with this conclusion.…”

Section: Discussionsupporting

confidence: 56%

Prospective evaluation of sexual health following radical cystectomy due to bladder cancer

Nolting,

Nitzsche,

Kiss

et al. 2024

Sexual Medicine

View full text Add to dashboard Cite

Background There is a lack of data concerning sexual health following open radical cystectomy (RC), especially in elderly patients and women. Aim To describe sexual health and its impact on general health as well as survival in patients undergoing standard open RC for the treatment of bladder cancer (BC). Due to limited data, subgroup analysis for elderly patients and women was performed. Methods A prospective noninterventional clinical study was performed evaluating sexual health in RC with any kind of urinary diversion due to BC with a follow-up of 12 months after RC. The study was approved by the local ethics review board (A 2021-0175) and was registered at the German Clinical Trial Register (DRKS00026255). Assessment of sexual health was done with the following validated questionnaires: EORTC QLQ-C30 (for quality of life; European Organisation for Research and Treatment of Cancer), EORTC SH22 (for sexual health), and IIEF-5 (5-item International Index of Erectile Function). Outcomes The standard measurements of EORTC QLQ-C30, EORTC SH22, and IIEF-5 as well as overall survival. Results Thirty-two patients participated in the study with a mean age of 71.5 years (SD, 9.7): 25 (78.1%) were male and 7 (21.9%) were female. Overall there is a heterogenic picture for sexual health in the study population, but sexual satisfaction is significantly higher prior to surgery while the importance of a sex life stays high and stable. Interestingly, the general health score is significantly correlated to sexual satisfaction (Pearson’s correlation; r = 0.522, P = .002) preoperatively but not following surgery: r = 0.103 (P = .665) after 3 months, r = 0.478 (P = .052) after 6 months, r = 0.276 (P = .302) after 9 months, and r = 0.337 (P = .202) after 12 months. The importance of a sex life is still essential for the patients, especially when recovering from RC; nearly the same can be reported for elderly patients. Unfortunately, the data for women are too limited to report robust results. Clinical Implications Evaluation, advice, and monitoring of sexual health must be integrated into clinical practice, particularly in women. Strengths and Limitations At least to our knowledge, this is the first systematic prospective evaluation of sexual health in patients with BC receiving RC. Due to the small sample size, there is a risk of selection bias. Conclusion Sexual health is important for patients with BC receiving RC, and it is an essential part of quality of life, especially in elderly patients.

show abstract

Section: Discussionsupporting

confidence: 56%

Prospective evaluation of sexual health following radical cystectomy due to bladder cancer

Nolting,

Nitzsche,

Kiss

et al. 2024

Sexual Medicine

View full text Add to dashboard Cite

show abstract

“…The vast majority of the included studies did not systematically assess baseline and postoperative sexual function [67]. According to current data, it is not possible to estimate the true impact of RC on sexual function and its postoperative recovery in women.…”

Section: Discussionmentioning

confidence: 99%

Urinary function in female patients after traditional, organ‐sparing and nerve‐sparing radical cystectomy for bladder cancer: a systematic review and pooled analysis

et al. 2023

Self Cite

View full text Add to dashboard Cite

ObjectivesRadical cystectomy (RC) has detrimental effects on the urinary, sexual, and reproductive systems. Approaches to mitigate a decline in postoperative functional quality of life include organ‐preserving and nerve‐sparing variations of RC; however, high‐quality data on gender‐specific outcomes in women remain scarce. We aimed to determine and summarize available data on the urinary, sexual, and health‐related quality of life (HRQOL) outcomes after traditional, reproductive organ preserving (ROPRC) and nerve‐sparing RC (NSRC) for bladder cancer (BCa) in female patients.Evidence AcquisitionThe PubMed, SCOPUS, and Web of Science databases were searched to identify studies reporting on functional outcomes in female patients undergoing RC and urinary diversion for the treatment of BCa. The outcomes of interest were voiding function (for orthotopic neobladder), sexual function, and HRQOL. The following independent variables were derived and included in the meta‐analysis: pooled rate of daytime and nighttime continence/incontinence and intermittent self‐catheterization (ISC) rate. Analyses were performed separately for traditional, organ‐ and/or nerve‐sparing surgical approaches.Evidence SynthesisFifty‐three studies comprising 2,740 female patients (1,201 underwent traditional; 1,539 ‐ organ‐/NS‐sparing, or 264 ‐ NS alone RC) were eligible for qualitative synthesis; 44 studies comprising 2,418 female patients were included in the quantitative synthesis. In women with orthotopic neobladder (ONB) diversion, the pooled rates of daytime continence after traditional, ROPRC and NSRC were 75.2%, 79.3%, and 71.2%, respectively. The pooled rate of nighttime continence after traditional RC was 59.5%; this rate increased to 70.7% and 71.7% in women who underwent ROPRC and NSRC, respectively. The pooled rate of ISC after traditional RC with ONB diversion in female patients was 27.6% and decreased to 20.6% and 16.8% in patients undergoing ROPRC and NSRC, respectively. The use of different definitions and questionnaires in the assessment of postoperative sexual and HRQOL outcomes did not allow a systematic comparison.ConclusionsFemale organ‐ and nerve‐sparing surgical approaches during RC seem to result in improved voiding function. There is a significant need for well‐designed studies exploring sexual and HRQOL outcomes to establish evidence‐based management strategies to support shared decision‐making process tailored toward patient expectations and satisfaction. Understanding expected functional, sexual, and quality of life outcomes is necessary to allow individualized pre‐and postoperative counseling and care delivery in female patients planned for RC.

show abstract

“…The significantly higher decrease in CUD use in male patients may reflect an existing gender gap in UD care. Despite the feasibility of neobladder and continent cutaneous pouches in female patients, CUDs have persistently been underutilized among female patients [8]. This suggests that the proportion of CUDs was already low in 2005, leaving limited room for further decrease.…”

Section: Figmentioning

confidence: 99%

Continent diversion is losing its momentum: a nationwide trend analysis from Germany 2005–2021

Klemm,

Fisch,

Laukhtina

et al. 2023

BJU International

Self Cite

View full text Add to dashboard Cite

from this study were typically brief with a median word count of 177. This may not be long enough to comprehensively explain certain ED topics such as the risks and benefits of different treatment options. Despite this, three of the four AI chatbots provided web-linked citations for users to read more on the related ED query.Finally, AI chatbot responses scored low on actionability. It may be reassuring that AI chatbots do not give individualised medical advice, which can potentially harm patients. AI chatbots often provide disclaimers that they are not medical professionals and urge users to seek one. Actionability scores can be improved if chatbots integrated tables, visual aids, and explicit steps to help patients find a provider that could directly address their medical questions.

show abstract

Radical cystectomy and urinary diversion in women: techniques, outcomes, and challenges—a narrative review

Cited by 11 publications

References 127 publications

Prospective evaluation of sexual health following radical cystectomy due to bladder cancer

Prospective evaluation of sexual health following radical cystectomy due to bladder cancer

Urinary function in female patients after traditional, organ‐sparing and nerve‐sparing radical cystectomy for bladder cancer: a systematic review and pooled analysis

Continent diversion is losing its momentum: a nationwide trend analysis from Germany 2005–2021

Contact Info

Product

Resources

About