Sacrocolpopexy with polypropylene tape as valuable surgical modification during cystectomy with orthotopic ileal bladder: functional results

Functional Outcomes of Orthotopic Neobladder in Women

PURPOSE OF REVIEW

This review paper summarizes the available literature on the evolution of surgical approach to radical cystectomy in female bladder cancer patients and its impact on functional outcomes in orthotopic neobladder.

RECENT FINDINGS

Traditionally, radical cystectomy in female bladder cancer patients has been maximally extirpative with pelvic exenteration. Recently, new techniques which include pelvic organ-sparing, nerve-sparing and vaginal-sparing have demonstrated improved rates of urinary incontinence and retention. Additional techniques include prophylactic apical suspension which reduces the likelihood of pelvic organ prolapse, a risk factor for voiding dysfunction in the setting of orthotopic neobladder. Surgical management of bladder cancer in female patients has evolved to include surgical approaches which center quality of life and functional outcomes that are unique to female patients who have undergone radical cystectomy with ileal neobladder and can be optimized based on considerations regarding an approach that limits pelvic floor and pelvic nerve disruption.

Radical cystectomy in the female patient: The pelvic floor, sexual function, and patient/provider education

Radical cystectomy in women results in numerous deleterious anatomic impacts to the pelvic floor that can result in sexual dysfunction, pelvic organ prolapse, and other disorders of pelvic floor function. A comprehensive understanding of this relationship and the quality-of-life impacts of radical cystectomy in women is important. This narrative review provides an overview of female pelvic floor disorders in the setting of radical cystectomy, with focus on present understanding of related anatomy, incidence, and prevention strategies, as well as the importance of both provider and patient education.

Urodynamic Parameters and Continence Outcomes in Asymptomatic Patients with Ileal Orthotopic Neobladder: A Systematic Review and Metanalysis

INTRODUCTION

The orthotopic neobladder is the type of urinary diversion (UD) that most closely resembles the original bladder. However, in the literature the urodynamic aspects are scarcely analysed.

OBJECTIVE

To provide the first systematic review (SR) on the urodynamic (UDS) outcomes of the ileal orthotopic neobladders (ONB). Continence outcomes are also presented.

METHODS

A PubMed, Embase and Cochrane CENTRAL search for peer-reviewed studies on ONB published between January 2001-December 2022 was performed according to the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) statement.

RESULTS AND CONCLUSION

Fifty-nine manuscripts were eligible for inclusion in this SR. A great heterogeneity of data was encountered. Concerning UDS parameters, the pooled mean was 406.2 mL (95% CI: 378.9-433.4 mL) for maximal (entero)cystometric capacity (MCC) and 21.4 cmH2O (95% CI: 17.5-25.4 cmH2O) for Pressure ONB at MCC. Postvoid-residual ranged between 4.9 and 101.6 mL. The 12-mo rates of day and night-time continence were 84.2% (95% CI: 78.7-89.1%) and 61.7% (95% CI: 51.9-71.1%), respectively.Despite data heterogeneity, the ileal ONB seems to guarantee UDS parameters that resemble those of the native bladder. Although acceptable rates of daytime continence are reported the issue of high rates of night-time incontinence remains unsolved. Adequately designed prospective trials adopting standardised postoperative care, terminology and methods of outcome evaluation as well as of conduction of the UDS in the setting of ONB are necessary to obtain homogeneous follow-up data and to establish UDS guidelines for this setting.

Influence of Simple and Radical Cystectomy on Sexual Function and Pelvic Organ Prolapse in Female Patients: A Scoping Review of the Literature

INTRODUCTION

Despite the high risk for sexual dysfunction and pelvic organ prolapse after cystectomy and urinary diversion, a paucity of data and attention to these issues exists in women. This is in stark contrast to the attention paid to male sexual function undergoing similar urologic procedures. As survivorship from bladder cancer improves, appropriate assessment and treatment of these quality of life conditions are needed. Whereas consideration of surgical approach and technique on male outcomes is widespread, female outcomes are lacking in comparison.

AIM

This scoping review evaluates sexual function and postoperative vaginal support in women undergoing cystectomy for benign and malignant diseases of the bladder.

METHODS

This article reviews current evidence regarding sexual function and pelvic organ prolapse in women undergoing cystectomy and the potential impact of choice of urinary diversion on these outcomes.

MAIN OUTCOME MEASURE

We conducted a systematic literature review of sexual dysfunction and pelvic organ prolapse after cystectomy and urinary diversion.

RESULTS

73 relevant articles were reviewed regarding sexual dysfunction and pelvic organ prolapse after cystectomy. This review discusses key quality-of-life outcomes, the role of surgical approach, the importance of evaluation and counseling, and future directions in the field.

CONCLUSION

Our internal review highlights the urgent need to raise awareness among providers regarding the adverse impact of cystectomy on these important quality-of-life issues. Voigt M, Hemal K, Matthews C. Influence of Simple and Radical Cystectomy on Sexual Function and Pelvic Organ Prolapse in Female Patients: A Scoping Review of the Literature. Sex Med Rev 2019;7:408-415.

Treatment of Pelvic Floor Disorders Following Neobladder

Radical cystectomy remains the gold standard treatment for organ-confined high-grade recurrent or muscle-invasive bladder cancer. Orthotopic neobladder urinary diversion following cystectomy represents an option for patients wishing for continent urinary diversion. Female patients who undergo radical cystectomy with orthotopic bladder substitution are at risk for developing both common and neobladder-specific disorders of the pelvic floor, including urinary incontinence, hypercontinence, vaginal prolapse, and neobladder-vaginal fistula. Each of these sequelae can have significant impact on the patient's quality of life. Due to the increased frequency of orthotopic neobladder creation in women, subspecialty urologists are more likely to confront such pelvic floor disorders in bladder cancer survivors. This review presents the most current information on the treatment of pelvic floor disorders after orthotopic bladder substitution.