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Radical Cystectomy in Female Patients - Improving Outcomes

  • Urothelial Cancer (S Daneshmand, Section Editor)
  • Published:
Current Urology Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

To review the methods of improving surgical, oncological, and functional outcomes in women with bladder cancer treated with radical cystectomy.

Recent Findings

Οrthotopic urinary diversion (ONB) is a safe option for well-selected women as it combines high rates of daytime and nighttime continence with exceptional oncologic outcomes. It is considered safe even for patients with limited lymph node disease and trigone involvement, as long as a preoperative biopsy of the bladder neck or an intraoperative frozen section analysis of distal urethral margin rules out malignant disease. Nerve-sparing techniques have shown promising results. For well-selected patients with early invasive disease, sparing of internal genitalia has proven to be oncologically safe. Yet, generally accepted and evidence-based oncological and functional follow-up schemes for women after radical cystectomy are still lacking.

Summary

Properly designed prospective studies are needed with adequate number of participants in order to safely conclude about a broader use of pelvic organ-sparing cystectomy.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Ferlay J, Soerjomataram I, Ervik M, et al. GLOBOCAN 2012 v1.0, cancer incidence and mortality worldwide: IARC CancerBase No. 11. International Agency for Research on Cancer: Lyon; 2013.

    Google Scholar 

  2. Torre LA, Bray F, Siegel RL, Ferlay J, Lortet-Tieulent J, Jemal A. Global cancer statistics, 2012. CA Cancer J Clin. 2015;65(2):87–108. https://doi.org/10.3322/caac.21262.

    Article  PubMed  Google Scholar 

  3. Jemal A, Murray T, Ward E, Samuels A, Tiwari RC, Ghafoor A, et al. Cancer statistics, 2005. CA Cancer J Clin. 2005;55(1):10–30.

    Article  PubMed  Google Scholar 

  4. Jemal A, Siegel R, Xu J, Ward E. Cancer statistics, 2010. CA Cancer J Clin. 2010;60(5):277–300. https://doi.org/10.3322/caac.20073.

    Article  PubMed  Google Scholar 

  5. Pelucchi C, Bosetti C, Negri E, Malvezzi M, La Vecchia C. Mechanisms of disease: the epidemiology of bladder cancer. Nat Clin Pract Urol. 2006;3(6):327–40.

    Article  CAS  PubMed  Google Scholar 

  6. Scosyrev E, Noyes K, Feng C, Messing E. Sex and racial differences in bladder cancer presentation and mortality in the US. Cancer. 2009;115(1):68–74. https://doi.org/10.1002/cncr.23986.

    Article  PubMed  Google Scholar 

  7. Siegel RL, Miller KD, Jemal A. Cancer statistics, 2015. CA Cancer J Clin. 2015;65(1):5–29. https://doi.org/10.3322/caac.21254.

    Article  PubMed  Google Scholar 

  8. Fajkovic H, Halpern JA, Cha EK, Bahadori A, Chromecki TF, Karakiewicz PI, et al. Impact of gender on bladder cancer incidence, staging, and prognosis. World J Urol. 2011;29(4):457–63. https://doi.org/10.1007/s00345-011-0709-9.

    Article  PubMed  Google Scholar 

  9. Messer JC, Shariat SF, Dinney CP, Novara G, Fradet Y, Kassouf W, et al. Female gender is associated with a worse survival after radical cystectomy for urothelial carcinoma of the bladder: a competing risk analysis. Urology. 2014;83(4):863–7. https://doi.org/10.1016/j.urology.2013.10.060.

    Article  PubMed  Google Scholar 

  10. Kluth LA, Rieken M, Xylinas E, Kent M, Rink M, Rouprêt M, et al. Gender-specific differences in clinicopathologic outcomes following radical cystectomy: an international multi-institutional study of more than 8000 patients. Eur Urol. 2014;66(5):913–9. https://doi.org/10.1016/j.eururo.2013.11.040.

    Article  PubMed  Google Scholar 

  11. Mungan NA, Kiemeney LA, van Dijck JA, van der Poel HG, Witjes JA. Gender differences in stage distribution of bladder cancer. Urology. 2000;55(3):368–71.

    Article  CAS  PubMed  Google Scholar 

  12. Strope SA, Montie JE. The causal role of cigarette smoking in bladder cancer initiation and progression, and the role of urologists in smoking cessation. J Urol. 2008;180(1):31–7. https://doi.org/10.1016/j.juro.2008.03.045 discussion 37.

    Article  PubMed  Google Scholar 

  13. Brown T, Slack R, Rushton L, British Occupational Cancer Burden Study Group. Occupational cancer in Britain. Urinary tract cancers: bladder and kidney. Br J Cancer. 2012;107(Suppl 1):S76–84. https://doi.org/10.1038/bjc.2012.121.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Samanic CM, Kogevinas M, Silverman DT, Tardón A, Serra C, Malats N, et al. Occupation and bladder cancer in a hospital-based case-control study in Spain. Occup Environ Med. 2008;65(5):347–53.

    Article  CAS  PubMed  Google Scholar 

  15. Jung I, Messing E. Molecular mechanisms and pathways in bladder cancer development and progression. Cancer Control. 2000;7:325–34.

    Article  CAS  PubMed  Google Scholar 

  16. Cole P, Hoover R, Friedell GH. Occupation and cancer of the lower urinary tract. Cancer. 1972;29(5):1250–60.

    Article  CAS  PubMed  Google Scholar 

  17. Hartge P, Harvey EB, Linehan WM, Silverman DT, Sullivan JW, Hoover RN, et al. Unexplained excess risk of bladder cancer in men. J Natl Cancer Inst. 1990;82(20):1636–40.

    Article  CAS  PubMed  Google Scholar 

  18. Afshar N, English DR, Thursfield V, Mitchell PL, Te Marvelde L, Farrugia H, et al. Differences in cancer survival by sex: a population-based study using cancer registry data. Cancer Causes Control. 2018;29(11):1059–69. https://doi.org/10.1007/s10552-018-1079-z.

    Article  PubMed  Google Scholar 

  19. Mungan NA, Aben KK, Schoenberg MP, Visser O, Coebergh JW, Witjes JA, et al. Gender differences in stage-adjusted bladder cancer survival. Urology. 2000;55(6):876–80.

    Article  CAS  PubMed  Google Scholar 

  20. Tracey E, Roder D, Luke C, Bishop J. Bladder cancer survivals in New South Wales, Australia: why do women have poorer survival than men? BJU Int. 2009;104(4):498–504. https://doi.org/10.1111/j.1464-410X.2009.08527.x.

    Article  PubMed  Google Scholar 

  21. Cohn JA, Vekhter B, Lyttle C, Steinberg GD, Large MC. Sex disparities in diagnosis of bladder cancer after initial presentation with hematuria: a nationwide claims-based investigation. Cancer. 2014;120(4):555–61. https://doi.org/10.1002/cncr.28416.

    Article  PubMed  Google Scholar 

  22. Garg T, Pinheiro LC, Atoria CL, Donat SM, Weissman JS, Herr HW, et al. Gender disparities in hematuria evaluation and bladder cancer diagnosis: a population based analysis. J Urol. 2014;192(4):1072–7. https://doi.org/10.1016/j.juro.2014.04.101.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Bassett JC, Alvarez J, Koyama T, Resnick M, You C, Ni S, et al. Gender, race, and variation in the evaluation of microscopic hematuria among Medicare beneficiaries. J Gen Intern Med. 2015;30(4):440–7. https://doi.org/10.1007/s11606-014-3116-2.

    Article  PubMed  Google Scholar 

  24. Lyratzopoulos G, Abel GA, McPhail S, Neal RD, Rubin GP. Gender inequalities in the promptness of diagnosis of bladder and renal cancer after symptomatic presentation: evidence from secondary analysis of an English primary care audit survey. BMJ Open. 2013;3:e002861.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Snyder C, Harlan L, Knopf K, Potosky A, Kaplan R. Patterns of care for the treatment of bladder cancer. J Urol. 2003;169(5):1697–701.

    Article  PubMed  Google Scholar 

  26. Hautmann RE, Gschwend JE, de Petriconi RC, Kron M, Volkmer BG. Cystectomy for transitional cell carcinoma of the bladder: results of a surgery only series in the neobladder era. J Urol. 2006;176(2):486–92 discussion 491-2.

    Article  PubMed  Google Scholar 

  27. Stein JP, Lieskovsky G, Cote R, Groshen S, Feng AC, Boyd S, et al. Radical cystectomy in the treatment of invasive bladder cancer: long-term results in 1,054 patients. J Clin Oncol. 2001;19(3):666–75.

    Article  CAS  PubMed  Google Scholar 

  28. Simon J. Operation for directing the ureteral orifices into the rectum, temporary success, subsequent death, autopsy. Lancet. 1852;2:568–70.

    Article  Google Scholar 

  29. BRICKER EM. Bladder substitution after pelvic evisceration. Surg Clin North Am. 1950;30(5):1511–21.

    Article  CAS  PubMed  Google Scholar 

  30. Hautmann RE, Egghart G, Frohneberg D, Miller K. The ileal neobladder. J Urol. 1988;139(1):39–42.

    Article  CAS  PubMed  Google Scholar 

  31. Hautmann RE, Miller K, Steiner U, Wenderoth U. The ileal neobladder: 6 years of experience with more than 200 patients. J Urol. 1993;150(1):40–5.

    Article  CAS  PubMed  Google Scholar 

  32. Gschwend JE. Bladder substitution. Curr Opin Urol. 2003;13(6):477–82.

    Article  PubMed  Google Scholar 

  33. Stenzl A, Höltl L. Orthotopic bladder reconstruction in women—what we have learned over the last decade. Crit Rev Oncol Hematol. 2003;47(2):147–54.

    Article  PubMed  Google Scholar 

  34. Stenzl A, Colleselli K, Poisel S, Feichtinger H, Pontasch H, Bartsch G. Rationale and technique of nerve sparing radical cystectomy before an orthotopic neobladder procedure in women. J Urol. 1995;154(6):2044–9.

    Article  CAS  PubMed  Google Scholar 

  35. Stenzl A, Draxl H, Posch B, Colleselli K, Falk M, Bartsch G. The risk of urethral tumors in female bladder cancer: can the urethra be used for orthotopic reconstruction of the lower urinary tract? J Urol. 1995;153(3 Pt 2):950–5.

    CAS  PubMed  Google Scholar 

  36. Stein JP, Penson DF, Wu SD, Skinner DG. Pathological guidelines for orthotopic urinary diversion in women with bladder cancer: a review of the literature. J Urol. 2007;178(3 Pt 1):756–60.

    Article  PubMed  Google Scholar 

  37. Stein JP, Penson DF, Lee C, Cai J, Miranda G, Skinner DG. Long-term oncological outcomes in women undergoing radical cystectomy and orthotopic diversion for bladder cancer. J Urol. 2009;181(5):2052–8; discussion 2058-9. https://doi.org/10.1016/j.juro.2009.01.020.

    Article  PubMed  Google Scholar 

  38. • Mischinger J, Abdelhafez MF, Todenhöfer T, Schwentner C, Aufderklamm S, Stenzl A, et al. Quality of life outcomes after radical cystectomy: long-term standardized assessment of Studer Pouch versus I-Pouch. World J Urol. 2015;33(10):1381–7. https://doi.org/10.1007/s00345-014-1461-8 A prospective study reporting on quality of life issues between refluxing and antirefluxing neobladder techniques.

    Article  PubMed  Google Scholar 

  39. Schilling D, Gakis G, Sievert KD, Stenzl A. Vordere Exenteration der Frau. Aktuelle Urol. 2015;46(1):72–81. https://doi.org/10.1055/s-0034-1545277.

    Article  CAS  PubMed  Google Scholar 

  40. Gore JL, Lai J, Setodji CM, Litwin MS. Saigal CS; Urologic Diseases in America Project. Mortality increases when radical cystectomy is delayed more than 12 weeks: results from a Surveillance, Epidemiology, and End Results-Medicare analysis. Cancer. 2009;115(5):988–96. https://doi.org/10.1002/cncr.24052.

    Article  PubMed  Google Scholar 

  41. Dalbagni G, Vora K, Kaag M, Cronin A, Bochner B, Donat SM, et al. Clinical outcome in a contemporary series of restaged patients with clinical T1 bladder cancer. Eur Urol. 2009;56(6):903–10. https://doi.org/10.1016/j.eururo.2009.07.005.

    Article  PubMed  PubMed Central  Google Scholar 

  42. Aghazadeh MA, Barocas DA, Salem S, Clark PE, Cookson MS, Davis R, et al. Determining factors for hospital discharge status after radical cystectomy in a large contemporary cohort. J Urol. 2011;185(1):85–9. https://doi.org/10.1016/j.juro.2010.08.016.

    Article  PubMed  Google Scholar 

  43. Lughezzani G, Sun M, Shariat SF, Budäus L, Thuret R, Jeldres C, et al. A population-based competing-risks analysis of the survival of patients treated with radical cystectomy for bladder cancer. Cancer. 2011;117(1):103–9. https://doi.org/10.1002/cncr.25345.

    Article  PubMed  Google Scholar 

  44. Donat SM, Siegrist T, Cronin A, Savage C, Milowsky MI, Herr HW. Radical cystectomy in octogenarians—does morbidity outweigh the potential survival benefits? J Urol. 2010;183(6):2171–7. https://doi.org/10.1016/j.juro.2010.02.015.

    Article  PubMed  Google Scholar 

  45. Koppie TM, Serio AM, Vickers AJ, Vora K, Dalbagni G, Donat SM, et al. Age-adjusted Charlson comorbidity score is associated with treatment decisions and clinical outcomes for patients undergoing radical cystectomy for bladder cancer. Cancer. 2008;112(11):2384–92. https://doi.org/10.1002/cncr.23462.

    Article  PubMed  Google Scholar 

  46. Madersbacher S, Hochreiter W, Burkhard F, Thalmann GN, Danuser H, Markwalder R, et al. Radical cystectomy for bladder cancer today—a homogeneous series without neoadjuvant therapy. J Clin Oncol. 2003;21(4):690–6.

    Article  PubMed  Google Scholar 

  47. Stenzl A, Sherif H, Kuczyk M. Radical cystectomy with orthotopic neobladder for invasive bladder cancer: a critical analysis of long term oncological, functional and quality of life results. Int Braz J Urol. 2010;36(5):537–47.

    Article  PubMed  Google Scholar 

  48. Metcalfe M, Estey E, Jacobsen NE, Voaklander D, Fairey AS. Association between urinary diversion and quality of life after radical cystectomy. Can J Urol. 2013;20(1):6626–31.

    PubMed  Google Scholar 

  49. Cerruto MA, D'Elia C, Siracusano S, Gedeshi X, Mariotto A, Iafrate M, et al. Systematic review and meta-analysis of non RCT’s on health related quality of life after radical cystectomy using validated questionnaires: better results with orthotopic neobladder versus ileal conduit. Eur J Surg Oncol. 2016;42(3):343–60. https://doi.org/10.1016/j.ejso.2015.10.001.

    Article  CAS  PubMed  Google Scholar 

  50. Sogni F, Brausi M, Frea B, Martinengo C, Faggiano F, Tizzani A, et al. Morbidity and quality of life in elderly patients receiving ileal conduit or orthotopic neobladder after radical cystectomy for invasive bladder cancer. Urology. 2008;71(5):919–23. https://doi.org/10.1016/j.urology.2007.11.125.

    Article  PubMed  Google Scholar 

  51. Clark PE, Stein JP, Groshen SG, Cai J, Miranda G, Lieskovsky G, et al. Radical cystectomy in the elderly: comparison of clinical outcomes between younger and older patients. Cancer. 2005;104(1):36–43.

    Article  PubMed  Google Scholar 

  52. Gakis G, Jentzmik F, Schrader M, Stenzl A, Sievert KD. Benefits and risks of orthotopic neobladder reconstruction in female patients. Aktuelle Urol. 2011;42(2):109–14. https://doi.org/10.1055/s-0031-1271413.

    Article  CAS  PubMed  Google Scholar 

  53. Jentzmik F, Schrader AJ, de Petriconi R, Hefty R, Mueller J, Doetterl J, et al. The ileal neobladder in female patients with bladder cancer: long-term clinical, functional, and oncological outcome. World J Urol. 2012;30(6):733–9. https://doi.org/10.1007/s00345-012-0837-x.

    Article  PubMed  Google Scholar 

  54. Fung C, Pandya C, Guancial E, Noyes K, Sahasrabudhe DM, Messing EM, et al. Impact of bladder cancer on health related quality of life in 1,476 older Americans: a cross-sectional study. J Urol. 2014;192(3):690–5. https://doi.org/10.1016/j.juro.2014.03.098.

    Article  PubMed  PubMed Central  Google Scholar 

  55. Marshall FF, Treiger BF. Radical cystectomy (anterior exenteration) in the female patient. Urol Clin North Am. 1991;18(4):765–75.

    CAS  PubMed  Google Scholar 

  56. Granberg CF, Boorjian SA, Crispen PL, Tollefson MK, Farmer SA, Frank I, et al. Functional and oncological outcomes after orthotopic neobladder reconstruction in women. BJU Int. 2008;102(11):1551–5. https://doi.org/10.1111/j.1464-410X.2008.07909.x.

    Article  PubMed  Google Scholar 

  57. Stenzl A, Nagele U, Kuczyk M, Sievert KD, Anastasiadis A, Seibold J, et al. Cystectomy - technical considerations in male and female patients. Eur Urol Suppl. 2005;3(3):138-46.

    Article  Google Scholar 

  58. Leissner J, Ghoneim MA, Abol-Enein H, Thüroff JW, Franzaring L, Fisch M, et al. Extended radical lymphadenectomy in patients with urothelial bladder cancer: results of a prospective multicenter study. J Urol. 2004;171(1):139–44.

    Article  CAS  PubMed  Google Scholar 

  59. Dhar NB, Klein EA, Reuther AM, Thalmann GN, Madersbacher S, Studer UE. Outcome after radical cystectomy with limited or extended pelvic lymph node dissection. J Urol. 2008;179(3):873–8; discussion 878. https://doi.org/10.1016/j.juro.2007.10.076.

    Article  PubMed  Google Scholar 

  60. Steven K, Poulsen AL. Radical cystectomy and extended pelvic lymphadenectomy: survival of patients with lymph node metastasis above the bifurcation of the common iliac vessels treated with surgery only. J Urol. 2007;178(4 Pt 1):1218–23 discussion 1223-4.

    Article  PubMed  Google Scholar 

  61. Fleischmann A, Thalmann GN, Markwalder R, Studer UE. Extracapsular extension of pelvic lymph node metastases from urothelial carcinoma of the bladder is an independent prognostic factor. J Clin Oncol. 2005;23(10):2358–65.

    Article  PubMed  Google Scholar 

  62. Herr HW, Faulkner JR, Grossman HB, Natale RB. deVere White R, Sarosdy MF, et al. Surgical factors influence bladder cancer outcomes: a cooperative group report. J Clin Oncol. 2004;22(14):2781–9.

    Article  PubMed  Google Scholar 

  63. Bochner BH, Cho D, Herr HW, Donat M, Kattan MW, Dalbagni G. Prospectively packaged lymph node dissections with radical cystectomy: evaluation of node count variability and node mapping. J Urol. 2004;172(4 Pt 1):1286–90.

    Article  PubMed  Google Scholar 

  64. Koppie TM, Vickers AJ, Vora K, Dalbagni G, Bochner BH. Standardization of pelvic lymphadenectomy performed at radical cystectomy: can we establish a minimum number of lymph nodes that should be removed? Cancer. 2006;107(10):2368–74.

    Article  PubMed  Google Scholar 

  65. Gakis G, Efstathiou J, Lerner SP, Cookson MS, Keegan KA, Guru KA, et al. ICUD-EAU International Consultation on Bladder Cancer 2012: radical cystectomy and bladder preservation for muscle-invasive urothelial carcinoma of the bladder. Eur Urol. 2013;63(1):45–57. https://doi.org/10.1016/j.eururo.2012.08.009.

    Article  PubMed  Google Scholar 

  66. Spitz A, Stein JP, Lieskovsky G, Skinner DG. Orthotopic urinary diversion with preservation of erectile and ejaculatory function in men requiring radical cystectomy for nonurothelial malignancy: a new technique. J Urol. 1999;161(6):1761–4.

    Article  CAS  PubMed  Google Scholar 

  67. Ali-el-Dein B, el-Sobky E, Hohenfellner M, Ghoneim MA. Orthotopic bladder substitution in women: functional evaluation. J Urol. 1999;161(6):1875–80.

    Article  CAS  PubMed  Google Scholar 

  68. Coloby PJ, Kakizoe T, Tobisu K, Sakamoto M. Urethral involvement in female bladder cancer patients: mapping of 47 consecutive cysto-urethrectomy specimens. J Urol. 1994;152(5 Pt 1):1438–42.

    Article  CAS  PubMed  Google Scholar 

  69. Hautmann RE, Paiss T, de Petriconi R. The ileal neobladder in women: 9 years of experience with 18 patients. J Urol. 1996;155(1):76–81.

    Article  CAS  PubMed  Google Scholar 

  70. Blute ML, Gburek BM. Continent orthotopic urinary diversion in female patients: early Mayo Clinic experience. Mayo Clin Proc. 1998;73(6):501–7.

    Article  CAS  PubMed  Google Scholar 

  71. Nandipati KC, Bhat A, Zippe CD. Neurovascular preservation in female orthotopic radical cystectomy significantly improves sexual function. Urology. 2006;67(1):185–6.

    Article  PubMed  Google Scholar 

  72. Koie T, Hatakeyama S, Yoneyama T, Hashimoto Y, Kamimura N, Ohyama C. Uterus-, fallopian tube-, ovary-, and vagina-sparing cystectomy followed by U-shaped ileal neobladder construction for female bladder cancer patients: oncological and functional outcomes. Urology. 2010;75(6):1499–503. https://doi.org/10.1016/j.urology.2009.08.083.

    Article  PubMed  Google Scholar 

  73. Ali-El-Dein B, Mosbah A, Osman Y, El-Tabey N, Abdel-Latif M, Eraky I, et al. Preservation of the internal genital organs during radical cystectomy in selected women with bladder cancer: a report on 15 cases with long term follow-up. Eur J Surg Oncol. 2013;39(4):358–64. https://doi.org/10.1016/j.ejso.2013.02.004.

    Article  CAS  PubMed  Google Scholar 

  74. Chen ME, Pisters LL, Malpica A, Pettaway CA, Dinney CP. 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. 1997;157(6):2120–3.

    Article  CAS  PubMed  Google Scholar 

  75. Groutz A, Gillon G, Konichezky M, Shimonov M, Winkler H, Livne PM, et al. Involvement of internal genitalia in female patients undergoing radical cystectomy for bladder cancer: a clinicopathologic study of 37 cases. Int J Gynecol Cancer. 1999;9(4):302–6.

    Article  PubMed  Google Scholar 

  76. Chang SS, Cole E, Smith JA Jr, Cookson MS. Pathological findings of gynecologic organs obtained at female radical cystectomy. J Urol. 2002;168(1):147–9.

    Article  PubMed  Google Scholar 

  77. Ali-El-Dein B, Abdel-Latif M, Mosbah A, Eraky I, Shaaban AA, Taha NM, et al. Secondary malignant involvement of gynecologic organs in radical cystectomy specimens in women: is it mandatory to remove these organs routinely? J Urol. 2004;172(3):885–7.

    Article  PubMed  Google Scholar 

  78. Varkarakis IM, Pinggera G, Antoniou N, Constantinides K, Chrisofos M, Deliveliotis C. Pathological review of internal genitalia after anterior exenteration for bladder cancer in women. Evaluating risk factors for female organ involvement. Int Urol Nephrol. 2007;39(4):1015–21.

    Article  PubMed  Google Scholar 

  79. Salem H, El-Mazny A. A clinicopathologic study of gynecologic organ involvement at radical cystectomy for bladder cancer. Int J Gynaecol Obstet. 2011;115(2):188–90. https://doi.org/10.1016/j.ijgo.2011.05.026.

    Article  PubMed  Google Scholar 

  80. Djaladat H, Bruins HM, Miranda G, Cai J, Skinner EC, Daneshmand S. Reproductive organ involvement in female patients undergoing radical cystectomy for urothelial bladder cancer. J Urol. 2012;188(6):2134–8. https://doi.org/10.1016/j.juro.2012.08.024.

    Article  PubMed  Google Scholar 

  81. Dotan ZA, Kavanagh K, Yossepowitch O, Kaag M, Olgac S, Donat M, et al. Positive surgical margins in soft tissue following radical cystectomy for bladder cancer and cancer specific survival. J Urol. 2007;178(6):2308–12 discussion 2313.

    Article  PubMed  Google Scholar 

  82. Schilling D, Horstmann M, Nagele U, Sievert KD, Stenzl A. Cystectomy in women. BJU Int. 2008;102(9 Pt B):1289–95. https://doi.org/10.1111/j.1464-410X.2008.07972.x.

    Article  PubMed  Google Scholar 

  83. Bell CR, Gujral S, Collins CM, Sibley GN, Persad RA. Review. The fate of the urethra after definitive treatment of invasive transitional cell carcinoma of the urinary bladder. BJU Int. 1999;83(6):607–12.

    Article  CAS  PubMed  Google Scholar 

  84. Maralani S, Wood DP Jr, Grignon D, Banerjee M, Sakr W, Pontes JE. Incidence of urethral involvement in female bladder cancer: an anatomic pathologic study. Urology. 1997;50(4):537–41.

    Article  CAS  PubMed  Google Scholar 

  85. Stein JP, Cote RJ, Freeman JA, Esrig D, Elmajian DA, Groshen S, et al. Indications for lower urinary tract reconstruction in women after cystectomy for bladder cancer: a pathological review of female cystectomy specimens. J Urol. 1995;154(4):1329–33.

    Article  CAS  PubMed  Google Scholar 

  86. Kakizoe T, Tobisu K. Transitional cell carcinoma of the urethra in men and women associated with bladder cancer. Jpn J Clin Oncol. 1998;28(6):357–9.

    Article  CAS  PubMed  Google Scholar 

  87. Van Poppel H, Sorgeloose T. Radical cystectomy with or without urethrectomy? Crit Rev Oncol Hematol. 2003;47(2):141–5.

    Article  PubMed  Google Scholar 

  88. Stenzl A, Cowan NC, De Santis M, Kuczyk MA, Merseburger AS, Ribal MJ, et al. Treatment of muscle-invasive and metastatic bladder cancer: update of the EAU guidelines. Eur Urol. 2011;59(6):1009–18. https://doi.org/10.1016/j.eururo.2011.03.023.

    Article  CAS  PubMed  Google Scholar 

  89. Osman Y, Mansour A, El-Tabey N, Abdel-Latif M, Mosbah A, Hekal I, et al. Value of routine frozen section analysis of urethral margin in male patients undergoing radical cystectomy in predicting prostatic involvement. Int Urol Nephrol. 2012;44(6):1721–5. https://doi.org/10.1007/s11255-012-0276-z.

    Article  PubMed  Google Scholar 

  90. Chang SS, Cole E, Cookson MS, Peterson M, Smith JA Jr. Preservation of the anterior vaginal wall during female radical cystectomy with orthotopic urinary diversion: technique and results. J Urol. 2002;168(4 Pt 1):1442–5.

    Article  PubMed  Google Scholar 

  91. Stenzl A, Jarolim L, Coloby P, Golia S, Bartsch G, Babjuk M, et al. Urethra-sparing cystectomy and orthotopic urinary diversion in women with malignant pelvic tumors. Cancer. 2001;92(7):1864–71.

    Article  CAS  PubMed  Google Scholar 

  92. Large MC, Katz MH, Shikanov S, Eggener SE, Steinberg GD. Orthotopic neobladder versus Indiana pouch in women: a comparison of health related quality of life outcomes. J Urol. 2010;183(1):201–6. https://doi.org/10.1016/j.juro.2009.08.148.

    Article  PubMed  Google Scholar 

  93. Lee CT, Hafez KS, Sheffield JH, Joshi DP, Montie JE. Orthotopic bladder substitution in women: nontraditional applications. J Urol. 2004;171(4):1585–8.

    Article  PubMed  Google Scholar 

  94. Abou-Elela A. Outcome of anterior vaginal wall sparing during female radical cystectomy with orthotopic urinary diversion. Eur J Surg Oncol. 2008;34(1):115–21.

    Article  CAS  PubMed  Google Scholar 

  95. Anderson CB, Cookson MS, Chang SS, Clark PE, Smith JA Jr, Kaufman MR. Voiding function in women with orthotopic neobladder urinary diversion. J Urol. 2012;188(1):200–4. https://doi.org/10.1016/j.juro.2012.03.004.

    Article  PubMed  Google Scholar 

  96. Gross T, Meierhans Ruf SD, Meissner C, Ochsner K, Studer UE. Orthotopic ileal bladder substitution in women: factors influencing urinary incontinence and hypercontinence. Eur Urol. 2015;68(4):664–71. https://doi.org/10.1016/j.eururo.2015.05.015.

    Article  PubMed  Google Scholar 

  97. Rouanne M, Legrand G, Neuzillet Y, Ghoneim T, Cour F, Letang N, et al. Long-term women-reported quality of life after radical cystectomy and orthotopic ileal neobladder reconstruction. Ann Surg Oncol. 2014;21(4):1398–404. https://doi.org/10.1245/s10434-013-3458-8.

    Article  PubMed  Google Scholar 

  98. Zahran MH, El-Hefnawy AS, Zidan EM, El-Bilsha MA, Taha DE, Ali-El-Dein B. Health-related quality of life after radical cystectomy and neobladder reconstruction in women: impact of voiding and continence status. Int J Urol. 2014;21(9):887–92. https://doi.org/10.1111/iju.12452.

    Article  PubMed  Google Scholar 

  99. Bhatta Dhar N, Kessler TM, Mills RD, Burkhard F, Studer UE. Nerve-sparing radical cystectomy and orthotopic bladder replacement in female patients. Eur Urol. 2007;52(4):1006–14.

    Article  PubMed  Google Scholar 

  100. Turner WH, Danuser H, Moehrle K, Studer UE. The effect of nerve sparing cystectomy technique on postoperative continence after orthotopic bladder substitution. J Urol. 1997;158(6):2118–22.

    Article  CAS  PubMed  Google Scholar 

  101. Hübner WA, Trigo-Rocha F, Plas EG, Tanagho EA. Urethral function after cystectomy: a canine in vivo experiment. Urol Res. 1993;21(1):45–8.

    Article  PubMed  Google Scholar 

  102. Strasser H, Ninkovic M, Hess M, Bartsch G, Stenzl A. Anatomic and functional studies of the male and female urethral sphincter. World J Urol. 2000;18(5):324–9.

    Article  CAS  PubMed  Google Scholar 

  103. Aboseif SR, Borirakchanyavat S, Lue TF, Carroll PR. Continence mechanism of the ileal neobladder in women: a urodynamics study. World J Urol. 1998;16(6):400–4.

    Article  CAS  PubMed  Google Scholar 

  104. Ali-El-Dein B, Gomha M, Ghoneim MA. Critical evaluation of the problem of chronic urinary retention after orthotopic bladder substitution in women. J Urol. 2002;168(2):587–92.

    Article  PubMed  Google Scholar 

  105. Ali-el-Dein B, Shaaban AA, Abu-Eideh RH, el-Azab M, Ashamallah A, Ghoneim MA. Surgical complications following radical cystectomy and orthotopic neobladders in women. J Urol. 2008;180(1):206–10. https://doi.org/10.1016/j.juro.2008.03.080 discussion 210.

    Article  PubMed  Google Scholar 

  106. Bartsch G, Daneshmand S, Skinner EC, Syan S, Skinner DG, Penson DF. Urinary functional outcomes in female neobladder patients. World J Urol. 2014;32(1):221–8. https://doi.org/10.1007/s00345-013-1219-8.

    Article  PubMed  Google Scholar 

  107. Stenzl A, Colleselli K, Bartsch G. Update of urethra-sparing approaches in cystectomy in women. World J Urol. 1997;15(2):134–8.

    Article  CAS  PubMed  Google Scholar 

  108. Ghoneim MA. Orthotopic bladder substitution in women following cystectomy for bladder cancer. Urol Clin North Am. 1997;24(1):225–39.

    Article  CAS  PubMed  Google Scholar 

  109. Henningsohn L, Wijkström H, Steven K, Pedersen J, Ahlstrand C, Aus G, et al. Relative importance of sources of symptom-induced distress in urinary bladder cancer survivors. Eur Urol. 2003;43(6):651–62.

    Article  PubMed  Google Scholar 

  110. Kulaksizoglu H, Toktas G, Kulaksizoglu IB, Aglamis E, Unlüer E. When should quality of life be measured after radical cystectomy? Eur Urol. 2002;42(4):350–5.

    Article  PubMed  Google Scholar 

  111. Henningsohn L, Steven K, Kallestrup EB, Steineck G. Distressful symptoms and well-being after radical cystectomy and orthotopic bladder substitution compared with a matched control population. J Urol. 2002;168:168–74 discussion 174-5.

    Article  PubMed  Google Scholar 

  112. Salonia A, Zanni G, Gallina A, Briganti A, Saccà A, Suardi N, et al. Unsuccessful investigation of preoperative sexual health issues in the prostate cancer “couple”: results of a real-life psychometric survey at a major tertiary academic center. J Sex Med. 2009;6(12):3347–55. https://doi.org/10.1111/j.1743-6109.2009.01483.x.

    Article  PubMed  Google Scholar 

  113. Pederzoli F, Campbell JD, Matsui H, Sopko NA, Bivalacqua TJ. Surgical factors associated with male and female sexual dysfunction after radical cystectomy: what do we know and how can we improve outcomes? Sex Med Rev. 2018;6(3):469–81. https://doi.org/10.1016/j.sxmr.2017.11.003.

    Article  PubMed  Google Scholar 

  114. Volkmer BG, Gschwend JE, Herkommer K, Simon J, Küfer R, Hautmann RE. Cystectomy and orthotopic ileal neobladder: the impact on female sexuality. J Urol. 2004;172(6 Pt 1):2353–7.

    Article  PubMed  Google Scholar 

  115. Rosen R, Brown C, Heiman J, Leiblum S, Meston C, Shabsigh R. The Female Sexual Function Index (FSFI): a multidimensional self-report instrument for the assessment of female sexual function. J Sex Marital Ther. 2000;26(2):191–208.

    Article  CAS  PubMed  Google Scholar 

  116. Zippe CD, Raina R, Shah AD, Massanyi EZ, Agarwal A, Ulchaker J, et al. Female sexual dysfunction after radical cystectomy: a new outcome measure. Urology. 2004;63(6):1153–7.

    Article  PubMed  Google Scholar 

  117. Booth BB, Rasmussen A, Jensen JB. Evaluating sexual function in women after radical cystectomy as treatment for bladder cancer. Scand J Urol. 2015;49(6):463–7. https://doi.org/10.3109/21681805.2015.1055589.

    Article  CAS  PubMed  Google Scholar 

  118. Zahran MH, Fahmy O, El-Hefnawy AS, Ali-El-Dein B. Female sexual dysfunction post radical cystectomy and urinary diversion. Climacteric. 2016;19(6):546–50.

    Article  CAS  PubMed  Google Scholar 

  119. Berman L, Berman J, Felder S, Pollets D, Chhabra S, Miles M, et al. Seeking help for sexual function complaints: what gynecologists need to know about the female patient’s experience. Fertil Steril. 2003;79(3):572–6.

    Article  PubMed  Google Scholar 

  120. Zippe CD, Nandipati KC, Agarwal A, Raina R. Female sexual dysfunction after pelvic surgery: the impact of surgical modifications. BJU Int. 2005;96(7):959–63.

    Article  PubMed  Google Scholar 

  121. Bhatt A, Nandipati K, Dhar N, Ulchaker J, Jones S, Rackley R, et al. Neurovascular preservation in orthotopic cystectomy: impact on female sexual function. Urology. 2006;67(4):742–5.

    Article  PubMed  Google Scholar 

  122. Bouman MB, van Zeijl MC, Buncamper ME, Meijerink WJ, van Bodegraven AA, Mullender MG. Intestinal vaginoplasty revisited: a review of surgical techniques, complications, and sexual function. J Sex Med. 2014;11(7):1835–47. https://doi.org/10.1111/jsm.12538.

    Article  PubMed  Google Scholar 

  123. Schover LR, von Eschenbach AC. Sexual function and female radical cystectomy: a case series. J Urol. 1985;134(3):465–8.

    Article  CAS  PubMed  Google Scholar 

  124. Chen YB, Cheng TJ, Lin HH, Yang YS. Spatial W-plasty full-thickness skin graft for neovaginal reconstruction. Plast Reconstr Surg. 1994;94(5):727–31.

    Article  CAS  PubMed  Google Scholar 

  125. McCraw JB, Massey FM, Shanklin KD, Horton CE. Vaginal reconstruction with gracilis myocutaneous flaps. Plast Reconstr Surg. 1976;58(2):176–83.

    Article  CAS  PubMed  Google Scholar 

  126. Li X, Wang W, Zhu G, He W, Gou X. Risk factors, follow-up, and treatment of urethral recurrence following radical cystectomy and urinary diversion for bladder cancer: a meta-analysis of 9498 patients. Oncotarget. 2017;9(2):2782–96. https://doi.org/10.18632/oncotarget.23451.

    Article  PubMed  PubMed Central  Google Scholar 

  127. Stein JP, Ginsberg DA, Skinner DG. Indications and technique of the orthotopic neobladder in women. Urol Clin North Am. 2002;29(3):725–34.

    Article  PubMed  Google Scholar 

  128. Ali-el-Dein B, Abdel-Latif M, Ashamallah A, Abdel-Rahim M, Ghoneim M. Local urethral recurrence after radical cystectomy and orthotopic bladder substitution in women: a prospective study. J Urol. 2004;171(1):275–8.

    Article  PubMed  Google Scholar 

  129. Hassan JM, Cookson MS, Smith JA Jr, Chang SS. Urethral recurrence in patients following orthotopic urinary diversion. J Urol. 2004;172(4 Pt 1):1338–41.

    Article  PubMed  Google Scholar 

  130. Boorjian SA, Kim SP, Weight CJ, Cheville JC, Thapa P, Frank I. Risk factors and outcomes of urethral recurrence following radical cystectomy. Eur Urol. 2011;60(6):1266–72. https://doi.org/10.1016/j.eururo.2011.08.030.

    Article  PubMed  Google Scholar 

  131. • Gakis G, Ali-El-Dein B, Babjuk M, Hrbacek J, Macek P, Burkhard FC, et al. Urethral recurrence in women with orthotopic bladder substitutes: a multi-institutional study. Urol Oncol. 2015;33(5):204.e17–23. https://doi.org/10.1016/j.urolonc.2015.01.020 The largest series to date on oncological outcomes after radical cystectomy with ileal neobladder in women.

    Article  Google Scholar 

  132. Huguet J. Diagnosis and treatment of urethral recurrence after radical cystectomy in the male. Actas Urol Esp. 2012;36(1):42–7. https://doi.org/10.1016/j.acuro.2011.06.009.

    Article  CAS  PubMed  Google Scholar 

  133. Stein JP, Clark P, Miranda G, Cai J, Groshen S, Skinner DG. Urethral tumor recurrence following cystectomy and urinary diversion: clinical and pathological characteristics in 768 male patients. J Urol. 2005;173(4):1163–8.

    Article  PubMed  Google Scholar 

  134. Varol C, Thalmann GN, Burkhard FC, Studer UE. Treatment of urethral recurrence following radical cystectomy and ileal bladder substitution. J Urol. 2004;172(3):937–42.

    Article  PubMed  Google Scholar 

  135. Nieder AM, Sved PD, Gomez P, Kim SS, Manoharan M, Soloway MS. Urethral recurrence after cystoprostatectomy: implications for urinary diversion and monitoring. Urology. 2004;64(5):950–4.

    Article  PubMed  Google Scholar 

  136. Yoshimine S, Kikuchi E, Matsumoto K, Ide H, Miyajima A, Nakagawa K, et al. The clinical significance of urine cytology after a radical cystectomy for urothelial cancer. Int J Urol. 2010;17(6):527–32. https://doi.org/10.1111/j.1442-2042.2010.02516.x.

    Article  PubMed  Google Scholar 

  137. Cho KS, Seo JW, Park SJ, Lee YH, Choi YD, Cho NH, et al. The risk factor for urethral recurrence after radical cystectomy in patients with transitional cell carcinoma of the bladder. Urol Int. 2009;82(3):306–11. https://doi.org/10.1159/000209363.

    Article  PubMed  Google Scholar 

  138. Nelles JL, Konety BR, Saigal C, Pace J, Lai J. Urethrectomy following cystectomy for bladder cancer in men: practice patterns and impact on survival. J Urol. 2008;180(5):1933–6. https://doi.org/10.1016/j.juro.2008.07.039 discussion 1936-7.

    Article  PubMed  PubMed Central  Google Scholar 

  139. Huguet-Pérez J, Palou J, Millán-Rodríguez F, Salvador-Bayarri J, Villavicencio-Mavrich H, Vicente-Rodríguez J. Upper tract transitional cell carcinoma following cystectomy for bladder cancer. Eur Urol. 2001;40(3):318–23.

    Article  PubMed  Google Scholar 

  140. Gakis G, Schilling D, Perner S, Schwentner C, Sievert KD, Stenzl A. Sequential resection of malignant ureteral margins at radical cystectomy: a critical assessment of the value of frozen section analysis. World J Urol. 2011;29(4):451–6. https://doi.org/10.1007/s00345-010-0581-z.

    Article  PubMed  Google Scholar 

  141. Meissner C, Giannarini G, Schumacher MC, Thoeny H, Studer UE, Burkhard FC. The efficiency of excretory urography to detect upper urinary tract tumors after cystectomy for urothelial cancer. J Urol. 2007;178(6):2287–90.

    Article  PubMed  Google Scholar 

  142. Tollefson MK, Blute ML, Farmer SA, Frank I. Significance of distal ureteral margin at radical cystectomy for urothelial carcinoma. J Urol. 2010;183(1):81–6. https://doi.org/10.1016/j.juro.2009.08.158.

    Article  PubMed  Google Scholar 

  143. Sanderson KM, Cai J, Miranda G, Skinner DG, Stein JP. Upper tract urothelial recurrence following radical cystectomy for transitional cell carcinoma of the bladder: an analysis of 1,069 patients with 10-year followup. J Urol. 2007;177(6):2088–94.

    Article  PubMed  Google Scholar 

  144. Schoenberg MP, Carter HB, Epstein JI. Ureteral frozen section analysis during cystectomy: a reassessment. J Urol. 1996;155(4):1218–20.

    Article  CAS  PubMed  Google Scholar 

  145. Soloway MS, Myers GH Jr, Burdick JF, Malmgren RA. Ileal conduit exfoliative cytology in the diagnosis of recurrent cancer. J Urol. 1972;107(5):835–9.

    Article  CAS  PubMed  Google Scholar 

  146. Raj GV, Bochner BH, Serio AM, Vickers A, Donat SM, Herr H, et al. Natural history of positive urinary cytology after radical cystectomy. J Urol. 2006;176(5):2000–5 discussion 2005.

    Article  PubMed  Google Scholar 

  147. Slaton JW, Swanson DA, Grossman HB, Dinney CP. A stage specific approach to tumor surveillance after radical cystectomy for transitional cell carcinoma of the bladder. J Urol. 1999;162(3 Pt 1):710–4.

    Article  CAS  PubMed  Google Scholar 

  148. Brien JC, Shariat SF, Herman MP, Ng CK, Scherr DS, Scoll B, et al. Preoperative hydronephrosis, ureteroscopic biopsy grade and urinary cytology can improve prediction of advanced upper tract urothelial carcinoma. J Urol. 2010;184(1):69–73. https://doi.org/10.1016/j.juro.2010.03.030.

    Article  PubMed  Google Scholar 

  149. Fujisawa M, Nakamura I, Yamanaka N, Gotoh A, Hara I, Okada H, et al. Changes in calcium metabolism and bone demineralization after orthotopic intestinal neobladder creation. J Urol. 2000;163(4):1108–11 quiz 1295.

    Article  CAS  PubMed  Google Scholar 

  150. Hautmann RE, Abol-Enein H, Davidsson T, Gudjonsson S, Hautmann SH, Holm HV, et al. International Consultation on Urologic Disease-European Association of Urology Consultation on Bladder Cancer 2012. ICUD-EAU International Consultation on Bladder Cancer 2012: urinary diversion. Eur Urol. 2013;63(1):67–80. https://doi.org/10.1016/j.eururo.2012.08.050.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Urology, G. Hatzikosta General Hospital, Ioannina, Greece

    Nikolaos Kalampokis & Nikolaos Grivas

  2. Department of Urology, Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands

    Nikolaos Grivas

  3. Department of Urology and Pediatric Urology, University Hospital of Würzburg, Julius Maximillians University, Oberdürrbacher Strasse 6, 97080, Würzburg, Germany

    Markus Ölschläger, Fahmy Nabil Hassan & Georgios Gakis

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Kalampokis, N., Grivas, N., Ölschläger, M. et al. Radical Cystectomy in Female Patients - Improving Outcomes. Curr Urol Rep 20, 83 (2019). https://doi.org/10.1007/s11934-019-0951-z

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