Pathological findings of gynecologic organs obtained at female radical cystectomy.
OBJECTIVE
Historically anterior pelvic exenteration has been the recommended treatment for invasive urothelial carcinoma in women undergoing radical cystectomy. We evaluated the pathological features of reproductive organs removed during exenteration to determine the incidence of malignant pathology in these organs and the need for removal.


METHODS
We reviewed the records of all patients who underwent radical cystectomy between January 1994 and December 2000. Of these 382 patients, we identified 68 females who underwent radical cystectomy for urothelial carcinoma. We reviewed preoperative, operative and pathological findings, including bladder, lymph nodes, uterine and adnexal pathology, in these female patients.


RESULTS
Median patient age was 64 years (range 35 to 86). Gynecologic organs were present in 40 of the 68 surgical specimens (59%). The reasons for absent gynecologic pathology were previous hysterectomy in 26 cases and the preservation of organs during orthotopic urinary diversion creation in 2. Malignancy was identified in 3 specimens, including invasive urothelial carcinoma in 2 (5%). In these 2 cases invasion was clearly identified intraoperatively. Low grade stromal sarcoma of the uterus was present in 1 specimen (2%).


CONCLUSIONS
In the absence of clinical suspicion radical hysterectomy at cystectomy rarely improves cancer control. Furthermore, secondary malignancies are rare. The functional impact of preserving gynecologic organs is a subject of ongoing study.
Chang
Sam S
SS
Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
Cole
Emily
E
Smith
Joseph A
JA
Cookson
Michael S
MS
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002295:Carcinoma, Transitional Cell / Q000473:pathology / Q000556:secondary* / Q000601:surgery; D015653:Cystectomy; D016889:Endometrial Neoplasms / Q000473:pathology / Q000601:surgery*; D005260:Female; D005833:Genital Neoplasms, Female / Q000473:pathology / Q000556:secondary* / Q000601:surgery; D005836:Genitalia, Female / Q000473:pathology; D006801:Humans; D007044:Hysterectomy; D008875:Middle Aged; D009378:Neoplasms, Multiple Primary / Q000473:pathology / Q000601:surgery*; D010385:Pelvic Exenteration; D018203:Sarcoma, Endometrial Stromal / Q000473:pathology / Q000601:surgery*; D001749:Urinary Bladder Neoplasms / Q000473:pathology / Q000601:surgery*; D016476:Urinary Reservoirs, Continent