Reproductive organ sparing cystectomy in women significantly improves continence after orthotopic bladder substitution without affecting oncological outcome

Gross, Tobias; Furrer, Marc; Schorno, Petra; Wüthrich, Patrick Yves; Schneider, Marc Philipp; Thalmann, George; Burkhard, Fiona C. (2018). Reproductive organ sparing cystectomy in women significantly improves continence after orthotopic bladder substitution without affecting oncological outcome. BJU international, 122(2), pp. 227-235. Blackwell Science 10.1111/bju.14191

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OBJECTIVES:
To compare functional and oncological outcomes of reproductive organ-sparing cystectomy (ROSC) compared with standard cystectomy (SC) in women undergoing orthotopic bladder substitution (OBS).

PATIENTS AND METHODS:
Between 1995 and 2016, 121 consecutive women undergoing OBS were prospectively included in this single-centre non-randomized clinical follow-up study comprising an ROSC and an SC group. Urinary continence, the need for intermittent self-catheterization (ISC), lateral standing micturition cystourethrogram (MCUG), urethral pressure profile findings, if available, and oncological outcomes were assessed and compared between ROSC and SC.

RESULTS:
After 12 months, patients who had undergone ROSC with OBS had significantly higher daytime and nighttime continence rates than patients who had undergone SC with OBS (87.5% vs 63.5%; P = 0.027 and 87.5% vs 57.7%; P = 0.008), whereas no significant differences were found between groups in ISC rates (12.5% vs 12.94%; P > 0.99). The degree of attempted nerve-sparing (none, unilateral, bilateral) positively affected continence rates in both groups. No significant differences were found in local recurrence rates (0% vs 9.4%; P = 0.126), 5- and 10-year overall survival rates (80.9% and 80.9% vs 64.9% and 55.7%; P = 0.443) or 5- and 10-year cancer-specific survival rates (84.3% and 84.3% vs 73% and 66.2%; P = 0.431).

CONCLUSION:
Superior continence rates were found for ROSC with an OBS compared with SC, without a negative impact on oncological outcome. ROSC should, therefore, be offered to women receiving an OBS whenever justifiable.

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