title: Radical cystectomy with orthotopic neobladder reconstruction following prior radical prostatectomy.
abstract: OBJECTIVE
  To review the perioperative and follow-up outcomes of patients undergoing radical cystectomy with orthotopic neobladder reconstruction for bladder cancer after prior radical prostatectomy (RP) for prostate cancer.
  
  
  METHODS
  A retrospective review of more than 1,900 patients treated with radical cystectomy at USC between 1990 and 2011 was conducted. Fifty-six patients were identified who were previously treated with RP for prostate cancer. Twenty-four of these patients (43 %) underwent orthotopic neobladder reconstruction. Perioperative data and follow-up including postoperative continence were analyzed.
  
  
  RESULTS
  The median age at cystectomy for these 24 patients was 68 years (range 55-89). The types of neobladder reconstruction were Kock neobladder in 3, Sigmoid reservoir in 1, Studer neobladder in 12, and T-pouch ileal neobladder in 8 patients. There were no major intraoperative complications. Of 19 patients eligible for evaluation of post-cystectomy urinary control, 11 patients (57.9 %) with good continence (0-1 pad/day) after RP regained preoperative level of urinary control after cystectomy within 1 year. The continence rate of 13 post-RP patients with good continence was 84.6 %. Among the 4 patients who received adjuvant radiotherapy after RP, 1 regained good continence. One with poor continence after prostatectomy had an artificial urethral sphincter (AUS) placed 2 months after cystectomy, and 2 with fair and poor continence after prostatectomy had an AUS placed at the time of cystectomy.
  
  
  CONCLUSIONS
  Patients undergoing radical cystectomy after prior RP pose a challenge to urologists. Those who are continent post-RP have a fair chance of regaining good urinary control with neobladder reconstruction. Adjuvant radiotherapy for prostate cancer may have a negative impact on continence with neobladder reconstruction.
authors.affiliation: USC Institute of Urology, Keck School of Medicine, University of Southern California, 1441 Eastlake Ave, Suite 7416, Los Angeles, CA 90089, USA.
authors.forename: Eric Yi-Hsiu
authors.initials: EY
authors.lastname: Huang
authors.forename: Eila C
authors.initials: EC
authors.lastname: Skinner
authors.forename: Stuart D
authors.initials: SD
authors.lastname: Boyd
authors.forename: Jie
authors.initials: J
authors.lastname: Cai
authors.forename: Gus
authors.initials: G
authors.lastname: Miranda
authors.forename: Siamak
authors.initials: S
authors.lastname: Daneshmand
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015653:Cystectomy / Q000379:methods*; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000601:surgery; D019651:Plastic Surgery Procedures / Q000379:methods; D012189:Retrospective Studies; D016896:Treatment Outcome; D001743:Urinary Bladder / Q000502:physiology / Q000601:surgery; D001749:Urinary Bladder Neoplasms / Q000601:surgery*; D014547:Urinary Diversion / Q000379:methods*; D014549:Urinary Incontinence / Q000453:epidemiology; D016476:Urinary Reservoirs, Continent