Vaginal Complications after Radical Cystectomy for Bladder Cancer: A Systematic Review

Richter, Lee A.; Egan, Jillian; Couvillon, Emily; Handa, Victoria L.

doi:10.1016/j.urology.2021.07.001

Cited by 10 publications

(12 citation statements)

References 36 publications

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“…Indeed, a recent Surveillance, Epidemiology and End Results (SEER) study investigating the incidence of secondary ovarian malignancy in women undergoing RC found that, among 1851 women treated with anterior exenteration, only two developed secondary ovarian malignancy [21]. With regards to other gynaecological organs, preservation of the vagina reduces the risk of pelvic organ prolapse, which has a reported incidence of 23% at a mean follow-up of 6.3 years [22]. This is especially important for patients with neobladders, to reduce the risk of urinary retention.…”

Section: Discussionmentioning

confidence: 99%

Gynaecological organ involvement in females undergoing radical cystectomy: a multicentre study

Lobo,

Uthayanan,

Uribe‐Lewis

et al. 2024

BJU International

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ObjectiveTo report the incidence of malignancy in gynaecological organs removed during radical cystectomy (RC).Patients and MethodsA retrospective multicentre study of 1600 RCs at three high‐volume institutions between January 2009 and March 2022 was performed. Pathological findings in gynaecological organs in female RC specimens were reviewed. Multivariable logistic regression analyses were used to identify predictors of malignant gynaecological organ involvement (GOI) at time of RC.ResultsOverall, 302 females with a median (interquartile range) age of 68 (61–75) years underwent RC for clinical (c)Ta–T4 bladder cancer. In all, 56 patients (18.5%) received neoadjuvant chemotherapy. Malignant GOI was seen in 20 patients (6.6%); the most common single sites of GOI were the uterus (five patients) and vaginal wall (four), followed by cervix (one), and ovaries (one). Nine patients had involvement of more than one gynaecological organ. No females had a primary gynaecological malignancy detected incidentally at RC. Patients with GOI were more likely to have cT3/T4 stage (P < 0.001), preoperative hydronephrosis (P = 0.004), lymphovascular invasion (P = 0.002), and squamous cell carcinoma (P = 0.005) than those without GOI. On multivariable analysis, cT4 stage was an independent predictor of malignant GOI (odds ratio 88.3, 95% confidence interval 10.1–1214; P < 0.001).ConclusionTo our knowledge, we present the largest multi‐institutional study examining malignant GOI in females with bladder cancer undergoing RC. The rate of GOI at the time of RC is low and associated with higher clinical stage. In the absence of clinical or radiological evidence of sexual organ involvement, our results do not support their routine removal at the time of RC.

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Section: Discussionmentioning

confidence: 99%

Gynaecological organ involvement in females undergoing radical cystectomy: a multicentre study

Lobo,

Uthayanan,

Uribe‐Lewis

et al. 2024

BJU International

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“…In a recent retrospective evaluation of postoperative functional outcomes among 23 women who underwent ROSRC with intracorporeal urinary diversion for ≤cT2 BC, Lavallee et al [26 ▪ ] demonstrated a cancer specific survival of 91% with 87% of patients returning to sexual activity within 6 months of surgery – all of whom were able to have an orgasm. Although this study highlights the safety of ROSRC and its likely benefit on SF outcomes, the majority of literature evaluating postoperative outcomes following RC have historically failed to assess SF among female patients – emphasizing the importance of large-scale prospective trials and provider education on sexual health counseling [27].…”

Section: Ovarian Preservation and Sexual Functionmentioning

confidence: 90%

Radical cystectomy and women's sexual health – can we do better?

Escott

Avulova

Bree

et al. 2022

Current Opinion in Urology

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Purpose of reviewFemale sexual function after radical cystectomy is a crucial, but historically overlooked component of bladder cancer survivorship. This review focuses on recent studies, which have investigated pelvic health and sexual function after radical cystectomy. We discuss modifiable factors, which may contribute to decreased sexual function after radical cystectomy and techniques, which may lead to improved outcomes.Recent findingsSexual function is important to women and there is a significant desire (and unmet need) for more perioperative counseling and discussion regarding sexual function changes and quality of life impacts. Sexual function may be altered due to a combination of hormonal changes from ovarian removal, anatomic changes from vaginal alteration, and sensation changes due to damage to the neurovascular bundle. Techniques to preserve these structures have been developed.SummarySexual function is an important component of survivorship and increasing attention is being focused on this area. Long term studies with objective measures are needed for to compare various techniques and ensure oncologic safety. Ovarian preservation, anterior vaginal wall preservation, and vaginal estrogen replacement should be carefully considered for most patients.

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“…In a systematic review of vaginal complications after RC for bladder cancer, Richter et al reported that the most common type of vaginal fistula reported is in women undergoing orthotopic diversions occurring between the neobladder and vaginal wall, with reported incidence up to 33% but more consistently ranging from 3%–6% at higher volume centers. 4 The location of neobladder vaginal fistulas most often occurs along the anterior vaginal wall at the location of the neobladder-urethral anastomosis. 5 The fistula rate reported in our study (7%) likely reflects the broad range of surgical locations within the Medicare 5% Limited Data Set, not just high-volume centers.…”

Section: Discussionmentioning

confidence: 99%

Vaginal Complications after Cystectomy: Results from a Medicare Sample

et al. 2022

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Purpose: Cystectomy with a vaginal-sparing approach may be associated with unique complications specific to the female population. The objective of this study was to estimate the incidence of vaginal complications (defined to include vaginal prolapse, vaginal fistula, dyspareunia and vaginal cuff dehiscence/evisceration) after cystectomy and to determine risk factors for these complications. Materials and Methods: Women 65 years or older undergoing cystectomy for any indication were identified by procedural codes in the Medicare Limited Data Set 5% sample from January 1, 2011 to December 31, 2017. Patients experiencing a vaginal complication after cystectomy were compared to those who did not. Demographic and biological factors that could increase likelihood of complications were identified and time to development of complications determined. Cumulative incidence was calculated using cumulative incidence function. Multivariable cause-specific Cox proportional hazards model assessed risk factors for vaginal complications.Results: In all, 481 women undergoing cystectomy were identified during the study period, and 37.2% were younger than 70 years old. The majority (378, 79%) had bladder cancer, and 401 (83.4%) underwent an incontinent conduit or catheterizable channel diversion. Within 2 years of cystectomy, 93 patients (19.5%) had 1 or more complications on record. Vaginal cuff dehiscence had the highest cumulative incidence, occurring in 49 patients (10.2%). Over the entire study period (2011e2017), 102 women (21.2%) were diagnosed with a vaginal complication, and 27 (5.6%) received an intervention. Conclusions: Among women who undergo cystectomy, vaginal complications occur at rates higher than expected with over 20% of women experiencing a complication and over a quarter of those diagnosed undergoing intervention.

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Vaginal Complications after Radical Cystectomy for Bladder Cancer: A Systematic Review

Cited by 10 publications

References 36 publications

Gynaecological organ involvement in females undergoing radical cystectomy: a multicentre study

Gynaecological organ involvement in females undergoing radical cystectomy: a multicentre study

Radical cystectomy and women's sexual health – can we do better?

Vaginal Complications after Cystectomy: Results from a Medicare Sample

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