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Functional and oncological outcomes after orthotopic neobladder reconstruction in women.

Abstract：

OBJECTIVE:To review our experience with orthotopic neobladder reconstruction (ONR) in women, highlighting functional and oncological outcomes, as ONR has been used increasingly for urinary diversion in women after radical cystectomy (RC), largely due to a better understanding of the natural history of urothelial cell carcinoma (UCC) and of the anatomy underlying the female continence mechanism, but defining the safety and long-term efficacy of ONR remain important to expanding its use. PATIENTS AND METHODS:We identified 59 women who had RC with ONR between 1995 and 2006 at the Mayo Clinic. Their records were reviewed for clinicopathological demographics, and functional and oncological outcomes. RESULTS:The median (range) age at surgery of the women was 62 (20-82) years, and the median follow-up was 29.2 (1-141) months. Fifty-three women had RC for malignant disease, including UCC in 47. Five women (8.5%) required resection of the anterior vaginal wall during surgery, while 39 (66%) had concurrent hysterectomy. One patient had a positive surgical margin, at the left distal ureter, on final pathology. Thirteen (22%) patients had perioperative complications, including two (3%) who required reoperation. In addition, three patients (5%) developed a neobladder-vaginal fistula after RC with ONR, requiring surgical repair. At the last follow-up, daytime urinary continence (defined as needing no pads) was reported by 44/49 (90%) patients, while 28/49 (57%) had achieved continence at night. Seventeen (31%) patients required intermittent self-catheterization to facilitate emptying of the neobladder. Fifteen (28%) women had recurrence of disease, at a median of 8 (2-36) months after ONR, including seven (13%) who developed a pelvic recurrence. Twelve (20%) patients died during the follow-up, with four (8%) dying from UCC at a median of 14 (11-65) months after surgery. CONCLUSION:ONR provides a safe and effective option for urinary diversion in women, with oncological and functional outcomes similar to those for men. Thus, the technique remains a preferred option for urinary diversion in appropriately selected women treated with RC.

journal_name

BJU Int

journal_title

BJU international

authors

Granberg CF,Boorjian SA,Crispen PL,Tollefson MK,Farmer SA,Frank I,Blute ML

doi

10.1111/j.1464-410X.2008.07909.x

subject

Has Abstract

pub_date

2008-12-01 00:00:00

pages

1551-5

issue

eissn

1464-4096

issn

1464-410X

pii

BJU7909

journal_volume

102

pub_type

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Functional and oncological outcomes after orthotopic neobladder reconstruction in women.