Cystectomy In Women Research Articles

Surgical Technique and Fertility Outcomes: A Comprehensive Review of Open and Laparoscopic Cystectomy in Women of Reproductive Age

Surgical Technique and Fertility Outcomes: A Comprehensive Review of Open and Laparoscopic Cystectomy in Women of Reproductive Age

Reproductive organ involvement in women undergoing radical cystectomy for urothelial bladder cancer: a nationwide multicenter study.

Radical cystectomy in women generally includes the removal of the uterus, ovaries, and anterior vaginal wall, but the criteria for reproductive organ sparing are not clear. A total of 2674 patients with bladder cancer were retrospectively reviewed, having undergone cystectomy at this nationwide multicenter from January 2013 to December 2019. We evaluated the incidence of malignancy in reproductive organs in a cohort of 417 women and analyzed the clinicopathological features of reproductive organ involvement. Recurrence-free survival and overall survival were reported using Kaplan-Meier survival curves. Median follow-up was 36.9months. Of the 417 patients with urothelial carcinoma of the bladder, 325 underwent hysterectomy, and 92 had a spared uterus and anterior wall of the vagina. Twenty-nine (8.9%) patients exhibited reproductive organ involvement; this consisted of 22 (6.8%) uteri, 16 (4.9%) vaginas, and two (0.6%) ovaries. Incidental primary reproductive malignancies were found in only two (0.6%) patients. Recurrence-free survival and overall survival were significantly shorter in patients with reproductive organ involvement than in those without. Patients with reproductive organ involvement were more likely to have tumors with ≥ cT3 or sub-localization at the posterior/trigone/bladder neck. The risk of reproductive organ involvement cannot be ignored in women undergoing radical cystectomy for urothelial carcinoma of the bladder, therefore, the eligibility criteria for reproductive organ preservation should be considered carefully.

Evaluation of sexual function and vaginal prolapse after radical cystectomy in women: a study to explore an under-evaluated problem

Introduction and hypothesisThe objective was to evaluate sexual function, vaginal prolapse, and quality of life (QoL) in women after radical cystectomy (RC) using validated questionnaires and pelvic organ prolapse quantification (POP-Q) measurement.MethodsFemale bladder cancer patients who underwent RC at our tertiary care center were included (January 2008 to March 2022). Patients received three validated questionnaires (International Consultation on Incontinence Questionnaire Vaginal Symptoms [ICIQ-VS] Part A, Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire IUGA revised [PISQ], European Organization for Research and Treatment of Cancer Quality of Life Questionnaire [EORTC] C30/BLM30). Patients who consented were examined with vaginal POP-Q measurement.ResultsOut of 322 patients, 193 were still alive, 54 patients were lost to follow-up, and 43 were excluded, resulting in 96 patients who received the questionnaire. Finally, 35 patients were included, of whom 17 patients consented to vaginal examination. Complaints due to vaginal symptoms were low (ICIQ-VS 6.17 + 5.37). Sexual activity was reported by 12 patients (34.3%); 23 patients (65.71%) were not sexually active. No apical prolapse was found in POP-Q measurement; 6 patients (35.3%) had anterior, and 14 patients (82.4%) posterior prolapse; the highest prolapse stage was 2. No significant differences were found regarding POP stages, sexual function, and QoL (all p > 0.05) when comparing continent and incontinent urinary diversions. Comparing the vaginal approach (no sparing vs sparing), significant differences were found in only two PISQ subscales (significantly higher scores after vagina sparing, p = 0.01 and p = 0.02).ConclusionsThe type of urinary diversion, POP-Q stages, and tumor stages did not show significant differences regarding sexual function, QoL, and prolapse complaints in women after RC, whereas a vagina- sparing approach showed significant differences only in two subscales without clinical relevance.

New concept in urologic surgery: The total extended genital sparing radical cystectomy in women

The aim of the study was to evaluate genital sparing radical cystectomy surgery in female patients from the point of view of both oncologic and functional outcomes (with emphasis on urinary and sexual outcomes) in a single high-volume center for the treatment of muscular invasive bladder cancer. Between January 2014 and January 2018, 14 female patients underwent radical cystectomy with preservation of genital organs (the entire vagina, uterus, fallopian tubes, ovaries) and orthotopic urinary neobladder (Padua neobladder). Inclusion criteria were recurrent T1G3 tumors; refractory tumors after BCG therapy without associated carcinoma in situ (CIS); T2 or T3a tumors entirely resected at endoscopic transurethral resection of the bladder and not involving urethra/bladder trigone. Exclusion criteria were: T3b or higher bladder cancer, associated CIS and involvement of urethra or bladder trigone. Oncological and histopathological outcomes (Overall Survival - OS, Recurrence Free Survival - RFS), urinary outcomes (day and night incontinence, intermittent catheterization use, Sandvik Score) and sexual outcomes (Female Sexual Function Index 19 FSFI-19) were considered. The average follow-up time was 56 months. Considering oncological outcomes, histologic examination reported urothelial carcinoma in 13/14 patients; 8/13 patients (61.5%) had high grade T1 stage, 3/13 patients (23%) had high grade T2 stage and finally 2/13 patients (15.5%) had high-grade T3 stage. One patient presented with embryonal rhabdomyosarcoma completely excised after surgery (PT2aN0M0). No patient developed local or metastatic recurrence (RFS 100%); OS was 100%. Considering urinary continence outcomes, 12/14 patients retained daytime and nighttime continence (85.5%); 2/14 (14.5%) complained of low stress urinary incontinence daily and nighttime urinary leakage. The Sandvik Score showed complete continence in 7/14 patients (50%); mild degree incontinence in 6/14 patients without use of incontinence devices (43%); moderate degree of incontinence in one patient (7%). The FSFI administered at 1 year from the surgery showed sexual desire in all patients (100%); subjective arousal, achievement of orgasm and sexual satisfaction in 12/14 patients (85.5%); sufficient lubrication in 11/14 patients (78.5%). Only one patient (7%) complained about dyspareunia during sexual intercourse. Our study aims to demonstrate that genital-sparing radical cystectomy is a safe surgery in terms of oncologic outcomes and, most importantly, that it is beneficial in terms of urinary and sexual function. Indeed, patients' quality of life together with their psychological and emotional health should be put on the same level as oncological safety. However, it is a treatment reserved for selected patients who are strongly motivated to preserve fertility and sexual function and thoroughly informed about the benefits and complications of such a procedure.

Initial Preoperative Hemoglobin Level Affects the Rate of Decline in Anti-Müllerian Hormone Levels after Laparoscopic Ovarian Cystectomy in Women with Ovarian Endometriosis.

To determine the factors affecting the decline in ovarian reserve following laparoscopic ovarian cystectomy (LOC) in women with ovarian endometriosis. This retrospective study included 22 women, aged 25-45 years, with regular menstrual cycles who underwent unilateral LOC and were diagnosed with ovarian endometriosis at a university hospital. Blood samples were collected preoperatively and on the third postoperative day to determine the serum anti-Müllerian hormone (AMH) levels for assessment of the decline in ovarian reserve during the early postoperative period. The preoperative hemoglobin level, white blood cell count, and AMH level were associated with changes in the AMH level after unilateral LOC. Among these parameters, only the preoperative hemoglobin level was correlated with the rate of decline in postoperative AMH levels. The preoperative serum AMH level was correlated with the amount of postoperative AMH change but not with its rate of decline. Preoperative hemoglobin levels may be associated with the rate of decline in AMH levels in the early postoperative period after unilateral LOC.

Efficacy of the Mercedes-Benz closure technique for vaginal reconstruction in female robot-assisted radical cystectomy.

Vaginal reconstruction using the posterior vaginal wall is required following radical cystectomy in women with resection of the uterus, adnexa, and anterior vaginal wall. Roll closure and clamshell closure are two widely known techniques. Of these, clamshell closure is recommended because roll closure has a high likelihood of breakdown or a resultant canal that is too narrow for sexual intercourse. In clamshell closure, however, folding the posterior vaginal wall anteriorly can be difficult. Therefore, we devised Mercedes-Benz closure, in which the vaginal wall is sutured from three directions to form a Mercedes-Benz shape, for anastomosis without tension on the vaginal wall. The present study was performed to investigate the efficacy of this alternative surgical technique for vaginal reconstruction. Twenty-six patients who underwent vaginal reconstruction following robot-assisted radical cystectomy were divided into two groups: 15 underwent clamshell closure and 11 underwent Mercedes-Benz closure. The patients' characteristics and surgical outcomes were compared between the two groups. There were no significant differences in clinical characteristics, including age, body mass index, and prior abdominal surgery between the two groups. The median vaginal reconstruction time tended to be longer in the Mercedes-Benz closure group than in the clamshell closure group (35.0 vs. 27.0 min, p=0.102). No complications associated with vaginal reconstruction were identified. The surgical outcomes were comparable between Mercedes-Benz closure and clamshell closure. If vaginal reconstruction with clamshell closure is difficult, Mercedes-Benz closure is a valuable alternative technique.

Retrospective Study Genital Sparing Radical Cystectomy in Women: Oncological and Functional Results

Retrospective Study Genital Sparing Radical Cystectomy in Women: Oncological and Functional Results

Laser Vaporization vs. Cystectomy in Women with Ovarian Endometrioma: A Systematic Review and Meta-analysis [A96

INTRODUCTION: There are still many controversies about managing patients with ovarian endometrioma (OE), discussing recurrence rates, pregnancy rates, and reduction of ovarian reserve (OR). The objective of this study was to compare outcomes after laparoscopic cystectomy versus laser vaporization in women with OE. METHODS: A systematic review and meta-analysis was registered in PROSPERO (CRD42021281781) and was done according to the PRISMA 2020 checklist. Studies (published until October 2021) were identified by searching PubMed, Cochrane Library, Google Scholar, and ClinicalTrials databases (keywords "cystectomy," "laser vaporization," and "endometrioma"). Inclusion criteria: women of reproductive age undergoing surgery for OE larger than 30 mm. Outcomes-risk ratio for recurrence, ovarian reserve, and pregnancy rates. Tools recommended by the Cochrane Society achieved risk of bias assessment. RESULTS: In total, 874 studies were found, and nine studies were included in qualitative synthesis (822 patients). All of the authors compared the efficacy of cystectomy or laser vaporization in reproductive-aged women with OE. Overall risk of bias for randomized trials was 80% “some concerns” and 20% “low,” for cohort studies, 50% “some concerns” and 50% “low.” The primary meta-analysis focused on recurrence rates (four studies included in a meta-analysis) with no statistically significant difference found between these interventions (RR = 0.53, 95%CI: 0.24 to 1.21, P=.13). The next meta-analysis estimated antral follicle count (three studies) which was significantly lower in the cystectomy group (RR=-2.56, 95% CI: -3.71 to -1.42, P<.0001). Pregnancy rates were analyzed in three studies with no statistically significant difference (RR=0.96, 95% CI: 0.81 to 1.14, P=.64). CONCLUSION: There was no statistical difference in recurrence rate and pregnancy rates, butt antral follicle count was higher in the laser vaporization group. Nevertheless, we need more clinical trials for stronger recommendations.

Similar long-term recurrence rates with cystectomy and CO2 laser vaporization for endometrioma: a retrospective study

Research questionIs there a difference in recurrence rate of endometrioma(s) after cystectomy versus CO2 laser vaporization of the cyst wall? DesignThis single-centre retrospective study included 270 patients undergoing laparoscopic surgery for endometriomas between January 2010 and December 2014, stratified according to the surgical technique used. All 270 included patients underwent complete laparoscopic surgery for endometrioma(s): 155 underwent cystectomy, 63 complete CO2 laser vaporization of the cyst wall and 52 a mixed technique. The primary outcome studied was the difference in recurrence rate between the cystectomy group and the CO2 laser vaporization group. ResultsThe mean duration of follow-up was 58 (±34) months. Imaging-based recurrence (any cyst size) was reported in 9.9% of patients (n = 12/121) treated with cystectomy and in 13.3% of patients (n = 6/45) who underwent a vaporization (P = 0.577). The need for reintervention for endometrioma(s) was also similar in both groups, with a rate of 3.2% (n = 5/155) after cystectomy and 4.8% (n = 3/63) after vaporization (P = 0.476). Of 160 women who wanted to conceive immediately after surgery, 73.8% became pregnant (72.6% [77/106] in the cystectomy group and 75.9% [41/54] in the vaporization group [P = 0.310]). Conception occurred mostly by assisted reproductive technology (57.1% [44/77] in the cystectomy group and 70.7% [29/41] in the vaporization group [P = 0.074]). ConclusionsSimilar rates of recurrence for endometrioma(s) were observed after cystectomy versus CO2 laser vaporization. As other studies have suggested that CO2 laser vaporization may be less harmful to the normal ovarian tissue, it can be considered as a safe alternative for cystectomy in women wishing to preserve their reproductive potential.

Safety and Efficacy of Reproductive Organ-Sparing Radical Cystectomy in Women With Variant Histology and Advanced Stage

Muscle invasive bladder cancer surgical management has been historically a radical cystoprostatectomy in males and an anterior exenteration in females. Uterine, ovarian, and vaginal preservation are utilized, but raise concerns regarding risk to oncologic control, especially in variant histopathology or advanced stage. A retrospective single institutional analysis identified radical cystectomies performed in women, including those with variant histology, which were defined as reproductive organ sparing (uterine, vaginal, and ovary sparing) or nonorgan sparing. The Kaplan-Meier method was used for recurrence-free survival (RFS), cancer-specific survival (CSS), and overall survival (OS) in patients with advanced disease. From 2000 to 2020, 289 women were identified, 188 underwent reproductive organ-sparing cystectomy. No statistical differences were noted for clinical parameters or presence of variant histology for organ-sparing (ROS) and nonorgan-sparing (non-ROS). Positive margin rates did not differ for ROS and non-ROS; 4.3% vs. 7.9%, P = .19, respectively. Median RFS was not statistically significantly different for ROS vs. non-ROS (26.1 vs. 15.3 months) P=.937 hazard ratio (HR) 1.024. CSS was not statistically different for ROS vs. non-ROS (36.3 vs. 28.6 months), P=.755 HR 0.9. OS was not statistically different for ROS vs. non-ROS (25.8 vs. 23.8 months), P=.5 HR=1.178. Variant histology did not change survival (HR 1.1, P=.643). In this analysis, ROS in women with advanced disease did not increase positive margin rates or decrease RFS, CSS, or OS compared to non-ROS. Variant histology did not decrease survival odds. Based on preoperative assessment and intraoperative findings, ROS in patients with variant histology and advanced disease should be considered.

P122 - Long-term functional results of orthotopic urinary derivation by Studer and VIP after radical cystectomy in women

P122 - Long-term functional results of orthotopic urinary derivation by Studer and VIP after radical cystectomy in women

MP13-03 FEMALE ORGAN SPARING AT THE TIME OF CYSTECTOMY

You have accessJournal of UrologyBladder Cancer: Invasive I (MP13)1 Sep 2021MP13-03 FEMALE ORGAN SPARING AT THE TIME OF CYSTECTOMY Sunil Patel, Shirley Wang, Esther Lee, Natasha Gupta, Andrew Gabrielson, Meredith Metcalf, Phil Pierorazio, Armine Smith, Jeannie Hoffman-Censits, Noah Hahn, Mark Schoenberg, Max Kates, and Trinity Bivalacqua Sunil PatelSunil Patel More articles by this author , Shirley WangShirley Wang More articles by this author , Esther LeeEsther Lee More articles by this author , Natasha GuptaNatasha Gupta More articles by this author , Andrew GabrielsonAndrew Gabrielson More articles by this author , Meredith MetcalfMeredith Metcalf More articles by this author , Phil PierorazioPhil Pierorazio More articles by this author , Armine SmithArmine Smith More articles by this author , Jeannie Hoffman-CensitsJeannie Hoffman-Censits More articles by this author , Noah HahnNoah Hahn More articles by this author , Mark SchoenbergMark Schoenberg More articles by this author , Max KatesMax Kates More articles by this author , and Trinity BivalacquaTrinity Bivalacqua More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000001994.03AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Muscle invasive bladder cancer (MIBC) surgical management has been historically a radical cystoprostatectomy in males and an anterior exenteration in females. Uterine and vaginal preservation are being utilized more often, but often discouraged during cystectomy for oncologic control, especially in adverse histopathology. METHODS: A retrospective single institutional analysis was performed from 2000-2020, identifying cystectomies performed in women. Data was available on 291 women, 188 underwent organ preserving cystectomy, defined as uterine, vaginal, and ovary sparing. Women with prior hysterectomies were included in organ sparing if vaginal and/or ovary sparing was performed. 101 women underwent traditional anterior exenteration. Primary endpoints were recurrence-free (RFS) and overall (OS) survival. RESULTS: No statistically significant differences were noted between the two cohorts in terms of age, race, smoking status, grade, clinical stage, or adverse histology. Non-organ sparing cystectomy was associated with higher pathologic T4 and pathologic nodal positive disease compared to organ sparing (4.8% vs 22.8%, p<0.05) and (16.5% vs 28.7%, p=0.037), respectively. Utilization of an organ sparing approach increased from 2000-2009 to 2010-2020 (55% vs 71%, p=0.03). Positive margin rates for organ sparing vs non-organ sparing were 8/188 (4.3%) vs 8/101 (7.9%), p=0.194, respectively. Median RFS was not statistically significant for organ sparing vs non-organ sparing, 131 months vs 75 months, HR 0.82, p=0.37, respectively. Similarly, OS was not statistically different for organ sparing vs non-organ sparing with median survival being 75 months vs 55 months, HR 0.99, p=0.97, respectively. CONCLUSIONS: In this analysis, organ preservation during time of cystectomy in women for all stages and histopathologic variants, including T3 and T4 disease, did not increase positive margin rates or decrease RFS or OS compared to non-organ preserving cystectomy. In selected patients, organ sparing cystectomy appears to be a viable approach and should be considered. Source of Funding: none © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e243-e243 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Sunil Patel More articles by this author Shirley Wang More articles by this author Esther Lee More articles by this author Natasha Gupta More articles by this author Andrew Gabrielson More articles by this author Meredith Metcalf More articles by this author Phil Pierorazio More articles by this author Armine Smith More articles by this author Jeannie Hoffman-Censits More articles by this author Noah Hahn More articles by this author Mark Schoenberg More articles by this author Max Kates More articles by this author Trinity Bivalacqua More articles by this author Expand All Advertisement Loading ...

Ovarian reserve in women with endometriosis under total cystectomy compared to partial cystectomy: A randomized clinical trial.

Background The standard procedure for ovarian endometriosis is laparoscopic excision of ovarian cysts and complete removal of the cyst capsule using the striping technique. Owing to the possibility of reducing ovarian reserve, and in some cases, the premature ovarian failure, the safety remains to be known.Objective To compare the ovarian reserve in women with endometriosis who underwent total cystectomy with partial cystectomy.Materials and Methods In this randomized clinical trial, 56 women with endometriosis who were referred to the Research and Clinical Center for Infertility and Shahid Sadoughi Hospital, Yazd, Iran between January and February 2020 were randomly assigned into two groups (n = 25/each); group I (total cystectomy) and group II (partial cystectomy). To assess the ovarian reserves, the anti-Müllerian hormone (AMH) level before and three months after surgery was measured and compared between the two groups.ResultsNo significant difference was observed in the AMH levels before and after surgery (p = 0.52, p = 0.32, respectively). However, the mean reduction of AMH in total cystectomy group was significantly higher than the partial cystectomy (p = 0.001).ConclusionCystectomy in women with endometriosis reduces ovarian reserve and can help maintain some ovarian reserve by performing partial instead of total cystectomy.

This Month in Adult Urology

This Month in Adult Urology

Function of the orthotopic urinary reservoir formed from the ileocecal angle in the long term after radical cystectomy in women

Objective: to study the long-term functional results of creating an orthotopic urinary reservoir from the ileocecal angle in comparison with the Studer technique of creating a urinary reservoir after radical cystectomy in women. Materials and methods. From 2004 to 2018 radical cystectomy for bladder cancer was performed in 120 women. In 71 (59.2 %) patients, an orthotopic urinary reservoir was formed: 48 (67.6 %) from the ileum, 23 (32.4 %) from segments of the colon. This study included 11 patients who had a reservoir formed from the ileocecal angle, including by their own modification, and 13 patients who had a reservoir forme by Studer. The average age of the patients was 62.6 ± 2.6 (29—82) years. The average follow-up time was 77.1 ± 10.5 (19—184) months. The presence and degree of urinary incontinence was assessed using a questionnaire and a Pad test. 12 months or more after the operation, a complex urodynamic study was performed. Results. The overall 5-year survival rate was 92.3 %: in the Studergroup it was 90.9 %, in the ileocecal angle group it was 100 % (p = 0.317). In the general population of patients, 37.5 % were completely continent. Women after plastic surgery by Studer retained urine better than after plastic surgery by ileocecal angle (46.2 % vs 27.3 %), the difference was only for mild urinary incontinence, which was more common in the ileocecal angle group. The frequency of severe urinary incontinence in both groups was the same. Nocturnal urinary incontinence was more common in patients in the Studer group (46.2 %). In the group of patients with ileocecal angle plastic surgery, there was no chronic urinary retention requiring intermittent catheterization, and in the group of Studer plastic surgery — in 1 (7.7 %) case. Analysis of urodynamic parameters revealed the presence of a greater physiological capacity of the urinary reservoir in the group of patients after plastic surgery according to Studer (p = 0.043). In the group of patients with ileocecal angle plastic surgery, higher values of the maximum pressure of the reservoir wall, “leakage pressure” and maximum expulsion pressure are observed, possibly associated with a more pronounced muscle layer of the intestinal segment used. Conclusion . The functional results of the orthotopic reservoir formedfrom the ileocecal angle are comparable to the results of urine derivation using the classical Studer method. Complex urodynamic study showed a direct influence of various characteristics of the reservoir on the nature and degree of urination disorders in patients.

Fertility Outcome after CO2 Laser Vaporization versus Cystectomy in Women with Ovarian Endometrioma: A Comparative Study

To assess the postoperative likelihood of conception in patients with endometriomas managed by either CO2 laser vaporization or cystectomy. A retrospective study with prospective recording of data. University hospital. One hundred and forty-two patients with symptomatic endometriomas. Patients underwent a standardized laparoscopic stripping technique (Group 1) or cyst vaporization with CO2 fiber laser (Group 2). Patients wishing to become pregnant were allowed to attempt a spontaneous conception after surgery. If spontaneous conception failed, patients were referred for in vitro fertilization (IVF). The primary objective was to compare pregnancy rates between the 2 groups. The secondary objective was the identification of independent predictors of pregnancy. Thirty-nine women in Group 1 (53.4%) and 39 women in Group 2 (56.5%) desired to conceive after surgery. Three patients (7.7%) in Group 1 became pregnant following donor-IVF and were excluded. Pregnancies were recorded in 72.2% of patients treated with cystectomy and in 74.3% of those managed with CO2 fiber laser (p = .83). Twenty patients (55.6%) in Group 1 and 14 patients (35.9%) in Group 2 conceived spontaneously (p = .08). Among patients who failed spontaneous conception, 21 patients (28%) achieved pregnancy through IVF (Group 1: n = 6, 16.7%; Group 2: n = 15, 38.5%; p = .08). Twenty patients (26.7%) never became pregnant. Age at the time of surgery (odds ratio (OR) = 0.86; 95% Confidence intervals (CI): 0.78-0.96, p = .002) and duration of infertility (OR=0.80; 95% CI: 0.69-0.92, p = .006) were identified as independent indicators for pregnancy. CO2laser-treated endometrioma is associated withpregnancy ratesequalto those observed after cystectomy and favorable IVF outcomes. The one step CO2fiber laser technique may represent a viable alternative to cystectomy.

Long-term functional results of orthotopic urinary derivation by Studer and VIP after radical cystectomy in women

Introduction. The feasibility of reconstructing an orthotopic urinary reservoir after radical cystectomy (RCE) in women is still debatable. This is due to the peculiarities of the physiology and anatomy of the female lower urinary tract and an increased risk of developing urinary incontinence or urinary retention after surgery.Purpose of the study. Studying long-term functional results of creating an orthotopic urinary reservoir by VIP in comparison with the technique of creating a urinary reservoir by Studer after RCE in women.Materials and methods. The study included 32 women who underwent RCE with the formation of an orthotopic urinary reservoir by to Studer — 13 patients and a «spherical» reservoir in the VIP — 19 modification. At the time of surgery, the age of patients was 61.1±1.9 years (29 ‒ 82). The average follow-up time was 77.5±7.8 months (17 ‒ 157, median 82). The patients who underwent a more complex type of plastic were younger than the patients operated on by the Studer method (p = 0.014). The groups did not differ statistically in other parameters.Results. The overall five-year survival rate in the Studer group was 90.9%, and in the VIP group — 94.7% (p = 0.596). 59.4% of patients were completely continent. Women after plastic surgery by VIP held urine better (68.4% vs 46.2%). The incidence of mild urinary incontinence was higher after Studer surgery. The incidence of severe urinary incontinence was the same in both groups. Nighttime urinary incontinence was the same in both groups. Intermittent catheterization was used more often by patients after VIP plastic surgery than after Studer surgery (21% vs 7.7%). In urodynamic studies, it was shown that the lower physiological capacity of the reservoir according to Studer due to more intense peristalsis of the reservoir wall, which causes involuntary leaking of urine, hyperperistalsis of the reservoir and a higher frequency of urinary incontinence causes more complete emptying in patients less residual urine, less need for self-catheterization. In the group of patients with plastic surgery according to VIP, a high physiological capacity of the reservoir with a lower pressure of the walls of the reservoir during the filling phase was recorded. This is manifested by a lower incidence of urinary incontinence, and, at the same time, a more significant amount of residual urine and a higher need for patients for self-catheterization.Conclusion. The formation of an orthotopic urinary reservoir with favourable long-term results is possible in women after RCE. The most beneficial in terms of the quality of daily held urine is the VIP modification, which is characterized by sufficiently high capacity and low intraluminal pressure. However, with this method of surgery, the risk of hypercontinence increases, which requires periodic catheterization. A complex urodynamic study made it possible to show the direct effect of various characteristics of the reservoir on the nature and degree of impaired urination of patients.

Radical cystectomy in women: Impact of the robot-assisted versus open approach on surgical outcomes

ObjectivesTo perform a comparison of complications following open versus robot-assisted radical cystectomy (RC) among women who undergo the procedure. Studies comparing robotic to open RC have been mixed without a clear delineation of which patients benefit the most from one modality vs. the other, leading to continued debate. Patients and methodsThis was a retrospective study of women who underwent either open or robotic RC at the MD Anderson Cancer Center from 1/2014 to 6/2018. Co-morbidities, pathologic data, and complications were assessed with descriptive statistics, along with uni- and multivariable logistic regression. Results122 women underwent either open (n = 76) or robotic (n = 46) RC. Open RC was associated with greater intraoperative blood loss (median EBL 775 ml vs. 300 ml, P < 0.001). In both uni- and multivariable analyses, open RC was associated with a greater odds of intraoperative transfusion compared to robotic RC (odds ratio 6.49, 95% CI 2.85–14.78, P < 0.001). Women undergoing open RC were also at greater odds of receiving 4 or more units of packed red blood cells (odds ratio 5.46 (1.75–17.02), P = 0.003). Robotic RC conferred a higher median lymph node yield (27 vs. 20 nodes, P, <0.001) and operative times (median 513 min vs. 391.5 min, P < 0.001). There were no differences in margin positivity, length of stay, or readmission rates at 30 and 90 days. ConclusionsRobotic RC was associated with a significantly lower risk of transfusion and EBL, and a higher median lymph node yield and operative time. Unique anatomic considerations may in part be responsible for these findings.

Long-term results of radical cystectomy in women with bladder cancer

Long-term results of radical cystectomy in women with bladder cancer

Anatomical description of the umbilical arteries and impact of their ligation on pelvic and perineal vascular supply after cystectomy in women.

In radical cystectomy, the surgeon generally ligates the umbilical artery at its origin. This artery may give rise to several arteries that supply the sexual organs. Our aim was to evaluate pelvic and perineal devascularisation in women after total cystectomy. We carried out a prospective anatomical and radiological study. We performed bilateral pelvic dissections of fresh adult female cadavers to identify the dividing branches of the umbilical artery. In parallel, we examined and compared the pre- and postoperative imaging investigations [magnetic resonance imaging (MRI) angiography] in patients undergoing cystectomy for benign disease to quantify the loss of pelvic vascularisation on the postoperative images by identifying the occluded arteries. The anatomical study together with the radiological study visualised 35 umbilical arteries (n = 70) with their branching patterns and collateral arteries. The uterine artery originated from the umbilical artery in more than 75% of cases (n = 54) of the internal pudendal artery in 34% (n = 24) and the vaginal artery in 43% (n = 30). The postoperative MRI angiograms showed pelvic devascularisation in four patients. Devascularisation was dependent on the level of surgical ligation. In the four patients with loss of pelvic vascular supply, the umbilical artery had been ligated at its origin. The umbilical artery gives rise to various branches that supply the pelvis and perineum. If the surgeon ligates the umbilical artery at its origin during total cystectomy, there is a significant risk of pelvic and perineal devascularisation.