title: Oncological and functional outcomes of radical cystectomy and orthotopic bladder replacement in women.
abstract: OBJECTIVE
  To report oncological and functional results in women undergoing radical cystectomy and orthotopic bladder replacement.
  
  
  METHODS
  The charts of all women undergoing bladder replacement after radical cystectomy at UCSF through April 2008 were reviewed. Pathologic characteristics, survival (overall and disease-specific), and urinary functional outcomes are reported. Survival was estimated using Kaplan-Meier methods, and Cox proportional hazards regression analyses were performed to determine factors associated with incontinence, retention, and mortality.
  
  
  RESULTS
  Fifty-six women with a mean follow-up of 35 months were analyzed. The cancer recurrence rate was 32%. Kaplan-Meier estimated 5-year recurrence-free, cancer-specific, and overall survival were 54%, 57%, and 47%, respectively. Pathologic lymph node status (HR 14.2, P <.001) and age at diagnosis (HR 1.7, P = .04) were the only clinical or pathologic characteristics significantly associated with survival. The overall continence rate (no pads) was 57%. Hypercontinence occurred in 24% of patients.
  
  
  CONCLUSIONS
  With careful patient selection and usage of urethral frozen section, rates of local recurrence are low. Overall rates of incontinence (43%) and hypercontinence (24%) are similar to those previously reported. When pathologically organ-confined, women have an excellent disease-specific survival. Orthotopic bladder replacement is a safe and effective form of urinary diversion after radical cystectomy in women.
authors.affiliation: Department of Urology, UCSF, Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco, CA 94143, USA. yangg2@urology.ucsf.edu
authors.forename: Glen
authors.initials: G
authors.lastname: Yang
authors.forename: Jared M
authors.initials: JM
authors.lastname: Whitson
authors.forename: Benjamin N
authors.initials: BN
authors.lastname: Breyer
authors.forename: Badrinath R
authors.initials: BR
authors.lastname: Konety
authors.forename: Peter R
authors.initials: PR
authors.lastname: Carroll
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D015653:Cystectomy / Q000379:methods*; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008197:Lymph Node Excision; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D011183:Postoperative Complications / Q000453:epidemiology; D016016:Proportional Hazards Models; D020127:Recovery of Function; D012189:Retrospective Studies; D016896:Treatment Outcome; D001749:Urinary Bladder Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D014547:Urinary Diversion / Q000379:methods; D014549:Urinary Incontinence / Q000453:epidemiology; D016476:Urinary Reservoirs, Continent