Abstract
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.
Highlights
Radical cystectomy (RC) with urinary diversion is the standard treatment for patients with muscle-invasive (MI) and high-risk non-muscle-invasive (NMI) urothelial carcinoma of the bladder and can offer an orthotopic neobladder (ON) diversion if technically and oncologically feasible [1]
In this paper we describe surgical steps of sex-robot-assisted radical cystectomy (RARC) in female patients, highlighting differences with the standard technique and anatomical details of preservation of the inferior hypogastric plexus (IHP) and we report perioperative, pathologic, and functional outcomes
According to EORTC-QLQ-BLM30 questionnaire, specific for bladder cancer (BCa), urinary symptoms item worsened at 3-monthwith a significant recovery at 1-year (p = 0.02); if matching baseline vs 1-year scores, values are comparable (p = 0.08) (Supplementary Table S2, Figure 2)
Summary
Bladder cancer (BCa) is more frequent among men, it remains the 17th most common cancer in women worldwide, with approximately 74,000 new diagnosed cases each year [2]. The standard surgical procedure is represented by anterior pelvic exenteration including the removal of the bladder, ovaries, uterus, and anterior vaginal wall [1]. In this setting, when an ON is performed, the procedure can be associated with a considerable rate of voiding symptoms [4,5]. Sexual dysfunction derived from such a highly demolitive surgical procedure is a key concern, especially in younger patients due to a significant impact on health-related quality of life (HRQoL) [6]
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