Vaginal Dehiscence and Evisceration After Robotic-assisted Radical Cystectomy: A Case Series and Review of the Literature

Lin, Fan-ching; Medendorp, Andrew R.; Kuiken, Michelle Van; Mills, Steven A.; Tarnay, Christopher M.

doi:10.1016/j.urology.2019.09.009

Cited by 15 publications

(27 citation statements)

References 17 publications

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“…Furthermore, our technique may avoid devastating complications such as vaginal dehiscence and evisceration which have been reported after minimally invasive radical cystectomy [24,25].…”

Section: Discussionmentioning

confidence: 98%

Sex-Sparing Robot-Assisted Radical Cystectomy with Intracorporeal Padua Ileal Neobladder in Female: Surgical Technique, Perioperative, Oncologic and Functional Outcomes

Tuderti¹,

Mastroianni

Flammia

et al. 2020

JCM

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Our aim was to illustrate our technique of sex-sparing (SS)-robot-assisted radical cystectomy (RARC) in female patients receiving an intracorporeal neobladder (iN). From January 2013 to June 2018, 11 female patients underwent SS-RARC-iN at a single tertiary referral center. Inclusion criteria were a cT ≤ 2 N0 M0 bladder tumor at baseline imaging (CT or MRI) and an absence of tumors in the bladder neck, trigone and urethra at TURB. Baseline, perioperative, and outcomes at one year were reported. The median operative time was 255 min and the median hospital stay was seven days. Low-grade Clavien complications occurred in four patients (36.3%), while high-grade complications were not observed in any. Seven patients (63.7%) had an organ-confined disease at the pathologic specimen; nodal involvement and positive surgical margins were not detected in any of the cases. At a median follow-up of 28 months (IQR 14–51), no patients developed new onset of chronic kidney disease stage 3b. After one year, daytime and nighttime continence rates were 90.9% and 86.4% respectively. Quality of life as well as physical and emotional functioning improved significantly over time (all p ≤ 0.04), while urinary symptoms and sexual function worsened at three months with a significant recovery taking place at one year (all p ≤ 0.04). Overall, 8 out of 11 patients (72.7%) were sexually active at the 12-month evaluation. In select female patients, SS-RARC-iN is an oncologically sound procedure associated with favorable perioperative and functional outcomes.

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“…Furthermore, our technique may avoid devastating complications such as vaginal dehiscence and evisceration which have been reported after minimally invasive radical cystectomy [24,25].…”

Section: Discussionmentioning

confidence: 98%

Sex-Sparing Robot-Assisted Radical Cystectomy with Intracorporeal Padua Ileal Neobladder in Female: Surgical Technique, Perioperative, Oncologic and Functional Outcomes

Tuderti¹,

Mastroianni

Flammia

et al. 2020

JCM

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“…A Japanese multicenter cohort study reported that 7 of 100 female patients underwent emergency surgery for bowel evisceration as a result of vaginal cuff dehiscence after laparoscopic radical cystectomy 5 . Moreover, several cases of transvaginal bowel evisceration after robot‐assisted radical cystectomy or open pelvic exenteration have also been previously reported 6–8 . However, there have not been too many reports about vaginal cuff dehiscence after laparoscopic radical cystectomy.…”

Section: Discussionmentioning

confidence: 99%

“… 5 Moreover, several cases of transvaginal bowel evisceration after robot‐assisted radical cystectomy or open pelvic exenteration have also been previously reported. 6 , 7 , 8 However, there have not been too many reports about vaginal cuff dehiscence after laparoscopic radical cystectomy.…”

Section: Discussionmentioning

confidence: 99%

Case of vaginal cuff dehiscence and small bowel evisceration after laparoscopic radical cystectomy

et al. 2021

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Introduction Vaginal cuff dehiscence and small bowel evisceration after laparoscopic radical cystectomy, although rare, can be a critical complication. However, little has been reported about it by urologists. Case presentation A 79‐year‐old woman underwent laparoscopic radical cystectomy for invasive bladder carcinoma. Thirteen months postoperatively, she experienced vaginal cuff dehiscence and small bowel evisceration, and underwent emergency surgery. Intraoperatively, we detached the vaginal apex from the surrounding tissue to lengthen it and performed vaginal uterosacral ligament suspension, with no subsequent recurrence. Conclusion Urologists should pay attention to vaginal cuff dehiscence and small bowel evisceration after laparoscopic radical cystectomy in female patients. In this case, the short vaginal length without vaginal uterosacral ligament suspension might have led to vaginal dehiscence.

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“…The literature regarding this rare but potentially devastating complication is quite scarce; however, it is important to report the relatively high percentage (7%) of patients who underwent laparoscopic RC who required emergency surgical reoperation for transvaginal bowel evisceration due to vaginal dehiscence recorded in the study by Kanno et al [44] . The authors, also citing the work by Cronin et al [45] , hypothesized an association between higher incidence of vaginal dehiscence and minimally invasive approach, which could be due to overuse of electrocautery during colpotomy or inadequate suturing caused by difficulty in suturing the bottom of the pelvic floor. Considering also the high median age of these patients (82 years old), according to the authors, a vagina-preserving approach might be one option for older female patients during RC, if possible.…”

Section: Discussionmentioning

confidence: 99%

Surgical and functional outcomes after robot-assisted radical cystectomy in female patients: a systematic review of the literature

Ornaghi¹,

Tafuri²,

Orlando³

et al. 2021

MIS

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Aim:We aimed to review and summarize recent data on surgical and functional outcomes in women undergoing robot-assisted radical cystectomy (RARC) and urinary diversion (UD) for bladder cancer, compared with male and open counterparts. Methods: A systematic review of English-language articles published in the last 15 years was performed on PubMed/Medline database according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Outcomes of interest included peri-and post-operative surgical outcomes [operative time (OT), estimated blood loss (EBL), hospital stay (LOS), complications, and readmission], pathological outcomes [pT stage, lymph node (LN) yield, positive surgical margins (PSMs), and positive LN (pN+)], and functional outcomes [daytime and nighttime continence, sexual activity, need for clean intermittent catheterization (CIC), and quality of life (QoL) evaluation].Results: Overall, eight studies were selected collecting data from 229 female patients undergoing RARC. The median OT was 418 min (range 311-562 min) and the median EBL was 380 mL (range 100-1160 mL). OT and EBL were not significantly different comparing males and females, whereas the robotic approach was found to be Conclusion: RARC and UD in female patients is a feasible procedure with surgical outcomes overlapping with those in the male patient population. Postoperative functional outcomes on continence, sexual function, and QoL are still poorly investigated, although results inherent in the nerve-sparing approach appear promising.

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Vaginal Dehiscence and Evisceration After Robotic-assisted Radical Cystectomy: A Case Series and Review of the Literature

Cited by 15 publications

References 17 publications

Sex-Sparing Robot-Assisted Radical Cystectomy with Intracorporeal Padua Ileal Neobladder in Female: Surgical Technique, Perioperative, Oncologic and Functional Outcomes

Sex-Sparing Robot-Assisted Radical Cystectomy with Intracorporeal Padua Ileal Neobladder in Female: Surgical Technique, Perioperative, Oncologic and Functional Outcomes

Case of vaginal cuff dehiscence and small bowel evisceration after laparoscopic radical cystectomy

Surgical and functional outcomes after robot-assisted radical cystectomy in female patients: a systematic review of the literature

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