Uterus-, fallopian tube-, ovary-, and vagina-sparing cystectomy followed by U-shaped ileal neobladder construction for female bladder cancer patients: oncological and functional outcomes.
OBJECTIVE
To evaluate oncological outcomes and voiding functions after orthotopic neobladder reconstruction with preservation of gynecologic organs in female bladder cancer patients.


METHODS
A total of 30 consecutive female patients who underwent radical cystectomy and U-shaped ileal neobladder (constructed using 40 cm of a double-folded ileal loop) substitution were retrospectively analyzed. Of the 30 patients, 29 had urothelial carcinoma and 1 had leiomyosarcoma. Computed tomography was performed every 6 months. Urethroscopic examination was performed at 3-month intervals during the first and second years, and at 6-month intervals thereafter. Pressure flow studies, including urethral pressure profilometry, were performed 3, 6, 9, and 12 months after surgery.


RESULTS
During a median follow-up of 35.7 months, 1 patient exhibited local recurrence and 6 patients died of bladder cancer. Maximum neobladder pressure examined 12 months after surgery improved significantly as compared with that examined after 3 months (P<.01). Maximal urethral closure pressure also improved significantly 12 months after surgery as compared with that after 3 months (P<.05). The capacity of the ileal neobladder 3 months after operation was 204+/-84 mL, and it showed a gradual increase, reaching 311+/-95 mL at 12 months (P<.01). None of the patients required catheterization for residual urine. Twenty-four patients (80%) remained completely dry day and night, voiding once or twice during the night.


CONCLUSIONS
Orthotopic neobladder reconstruction with preservation of gynecologic organs is feasible for female bladder cancer patients. Although the follow-up period was not long, the present technique provided acceptable oncological outcome and voiding function.
Koie
Takuya
T
Department of Urology, Hirosaki University, Graduate School of Medicine, Hirosaki, Japan.
Hatakeyama
Shingo
S
Yoneyama
Takahiro
T
Hashimoto
Yasuhiro
Y
Kamimura
Noritaka
N
Ohyama
Chikara
C
D000368:Aged; D000369:Aged, 80 and over; D002295:Carcinoma, Transitional Cell / Q000473:pathology / Q000601:surgery*; D015331:Cohort Studies; D015653:Cystectomy / Q000009:adverse effects / Q000379:methods*; D005187:Fallopian Tubes / Q000601:surgery; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D005836:Genitalia, Female / Q000601:surgery; D006801:Humans; D007150:Immunohistochemistry; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods; D009367:Neoplasm Staging; D010053:Ovary / Q000601:surgery; D011183:Postoperative Complications / Q000503:physiopathology; D011788:Quality of Life; D019651:Plastic Surgery Procedures / Q000009:adverse effects / Q000379:methods; D020127:Recovery of Function; D012189:Retrospective Studies; D018570:Risk Assessment; D016896:Treatment Outcome; D001749:Urinary Bladder Neoplasms / Q000473:pathology / Q000601:surgery*; D016476:Urinary Reservoirs, Continent; D014554:Urination / Q000502:physiology*; D014563:Urodynamics