Abstract
Purpose
To assess long-term clinical and oncological outcome in women undergoing radical cystectomy and ileal neobladder reconstruction for invasive bladder cancer.
Methods
From 1995 to 2010, a total of 121 women with clinically organ-confined urothelial carcinoma underwent radical cystectomy with an orthotopic ileal neobladder. Median follow-up was 56 months. Clinical course, functional, pathological, and oncological outcome of these women were analyzed.
Results
Seventy-six patients (62.8%) experienced a complication of some type within 90 days of the procedure. 56 patients (46.3%) experienced minor complications, whereas 20 patients (16.5%) experienced major complications. Pathological subgroups included 70 patients (57.9%) with organ confined, lymph node-negative tumors, 24 (19.8%) with extravesical, lymph node-negative disease and 27 (22.3%) patients with lymph node-positive disease. The 5-year overall survival rate in patients with organ-confined (≤pT2, pN0), locally advanced (≥pT3, pN0), and metastatic disease was 80.2%, 81.9%, and 45.1%, respectively. 4 women (3.3%) experienced a local (pelvic) recurrence. One patient presented with a urethral recurrence (0.8%). Daytime and nighttime urinary continence (0–1 pad) was reported by 82.4 and 76.5%, respectively. Clean intermittent self-catheterization was required by 58.0%. The retrospective study design was the major limitation of the study.
Conclusions
Despite a considerable complication rate, radical cystectomy with orthotopic diversion in female patients with bladder cancer may be considered a standard therapeutic option for selected patients with excellent oncological outcome including a low incidence of local and urethral recurrence.
Similar content being viewed by others
References
Hautmann RE, de Petriconi R, Volkmer BG (2010) Lessons learned from 1,000 neobladders: the 90-day complication rate. J Urol 184:990–994
Stein JP, Penson DF, Lee C et al (2009) Long-term oncological outcomes in women undergoing radical cystectomy and orthotopic diversion for bladder cancer. J Urol 181:2052–2058
Gerber WL (1990) Is urethral sparing at cystectomy a safe procedure? Urology 36:303–304
Stenzl A, Colleselli K, Poisel S (1995) Rationale and technique of nerve sparing radical cystectomy before an orthotopic neobladder procedure in women. J Urol 154:2044–2049
Stenzl A, Colleselli K, Poisel S et al (1996) The use of neobladders in women undergoing cystectomy for transitional-cell cancer. World J Urol 14:15–21
Stein JP, Penson DF, Wu SD et al (2007) Pathological guidelines for orthotopic urinary diversion in women with bladder cancer: a review of the literature. J Urol 178:756–760
Hautmann RE, Paiss T, de Petriconi R (1996) The ileal neobladder in women: 9 years of experience with 18 patients. J Urol 155:76–81
Charlson ME, Pompei P, Ales KL, MacKenzie CR (1987) A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chron Dis 40:373–383
Hautmann RE (2010) Surgery Illustrated-surgical atlas. Ileal neobladder. BJU Int 105:1024–1035
Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240:205–213
May M, Herrmann E, Bolenz C et al (2011) Lymph node density affects cancer-specific survival in patients with lymph node-positive urothelial bladder cancer following radical cystectomy. Eur Urol 59:712–718
Gakis G, Stenzl A (2010) Ileal neobladder and its variants. Eur Urol Suppl 9:735–774
Nieuwenhuijzen JA, de Vries RR, Bex A et al (2008) Urinary diversion after cystectomy: the association of clinical factors, complications and functional results of four different diversions. Eur Urol 53:834–844
Jentzmik F, Schostak M, Stephan C et al (2010) Extraperitoneal radical cystectomy with extraperitonealization of the ileal neobladder: a comparison to the transperitoneal technique. World J Urol 28:457–463
Shabsigh A, Korets R, Vora KC et al (2009) Defining early morbidity of radical cystectomy for patients with bladder cancer using a standardized reporting methology. Eur Urol 55:164–176
Stenzl A, Jarolim L, Coloby P et al (2001) Urethra-sparing cystectomy and orthotopic urinary diversion in women with malignant pelvic tumors. Cancer 92:1864–1871
Akkad T, Gozzi C, Deibl M et al (2006) Tumor recurrence in the remnant urothelium of females undergoing radical cystectomy for transitional cell carcinoma of the bladder: Long-term results from a single center. J Urol 175:1268–1271
Bell CR, Gujral S, Collins CM et al (1999) The fate of the urethra after definitive treatment of invasive transitional cell carcinoma of the urinary bladder. BJU Int 83:607
Stein JP, Esrig D, Freeman JA et al (1998) Prospective pathologic analysis of female cystectomy specimens: risk factors for orthotopic diversion in women. Urology 51:951–955
Chen ME, Pisters LL, Malpica A et al (1997) Risk of urethral, vaginal and cervical involvement in patients undergoing radical cystectomy for bladder cancer: results of a contemporary cystectomy series from M. D. Anderson Cancer Center. J Urol 157:2120–2123
Gakis G, Stenzl A (2011) Radical cystectomy and neobladder in the female. Eur Urol Rev 6:33–36
Stein JP, Cote RJ, Freeman JA et al (1995) Indications for lower urinary tract reconstruction in women after cystectomy for bladder cancer: a pathological review of female cystectomy specimens. J Urol 154:1329–1333
Granberg CF, Boorjian SA, Crispen PL et al (2008) Functional and oncological outcome after orthotopic neobladder reconstruction in women. BJU Int 102:1551–1555
Lee CT, Hafez KS, Sheffield JH et al (2004) Orthotopic bladder substitution in women: nontraditional applications. J Urol 171:1585–1588
Hautmann RE (2003) Urinary diversion: ileal conduit to neobladder. J Urol 169:834–842
Ali-El-Dein B, El-Sobky E, Hohenfellner M, Ghoneim MA (1999) Orthotopic bladder substitution in women: functional evaluation. J Urol 161:1875–1880
Bhatta Dhar N, Kessler TM, Mills RD, Burkhard F, Studer UE (2007) Nerve-sparing radical cystectomy and orthotopic bladder replacement in female patients. Eur Urol 52:1006–1014
Conflict of interest
The authors declare that they have no conflict of interest.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Jentzmik, F., Schrader, A.J., de Petriconi, R. et al. The ileal neobladder in female patients with bladder cancer: long-term clinical, functional, and oncological outcome. World J Urol 30, 733–739 (2012). https://doi.org/10.1007/s00345-012-0837-x
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00345-012-0837-x