The ileal neobladder in female patients with bladder cancer: long-term clinical, functional, and oncological outcome.
OBJECTIVE
To assess long-term clinical and oncological outcome in women undergoing radical cystectomy and ileal neobladder reconstruction for invasive bladder cancer.


METHODS
From 1995 to 2010, a total of 121 women with clinically organ-confined urothelial carcinoma underwent radical cystectomy with an orthotopic ileal neobladder. Median follow-up was 56 months. Clinical course, functional, pathological, and oncological outcome of these women were analyzed.


RESULTS
Seventy-six patients (62.8%) experienced a complication of some type within 90 days of the procedure. 56 patients (46.3%) experienced minor complications, whereas 20 patients (16.5%) experienced major complications. Pathological subgroups included 70 patients (57.9%) with organ confined, lymph node-negative tumors, 24 (19.8%) with extravesical, lymph node-negative disease and 27 (22.3%) patients with lymph node-positive disease. The 5-year overall survival rate in patients with organ-confined (≤pT2, pN0), locally advanced (≥pT3, pN0), and metastatic disease was 80.2%, 81.9%, and 45.1%, respectively. 4 women (3.3%) experienced a local (pelvic) recurrence. One patient presented with a urethral recurrence (0.8%). Daytime and nighttime urinary continence (0-1 pad) was reported by 82.4 and 76.5%, respectively. Clean intermittent self-catheterization was required by 58.0%. The retrospective study design was the major limitation of the study.


CONCLUSIONS
Despite a considerable complication rate, radical cystectomy with orthotopic diversion in female patients with bladder cancer may be considered a standard therapeutic option for selected patients with excellent oncological outcome including a low incidence of local and urethral recurrence.
Department of Urology, University Hospital Ulm, Prittwitzstrasse 43, 89075 Ulm, Germany. florian.jentzmik@uniklinik-ulm.de
Florian
F
Jentzmik
Andres J
AJ
Schrader
Robert
R
de Petriconi
Robert
R
Hefty
Johannes
J
Mueller
Johannes
J
Doetterl
Alexander
A
Eickhoff
Mark
M
Schrader
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002295:Carcinoma, Transitional Cell / Q000401:mortality / Q000601:surgery*; D015653:Cystectomy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007082:Ileum / Q000601:surgery*; D015994:Incidence; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome; D001743:Urinary Bladder / Q000502:physiology* / Q000601:surgery; D001749:Urinary Bladder Neoplasms / Q000401:mortality / Q000601:surgery*; D014547:Urinary Diversion / Q000379:methods*; D014549:Urinary Incontinence / Q000453:epidemiology; D016476:Urinary Reservoirs, Continent