Functional and Oncological Outcomes of Female Pelvic Organ-preserving Robot-assisted Radical Cystectomy

Etienne Lavallée; Zach Dovey; Prachee Pathak; Linda Dey; Lotta Renström Koskela; Arad Hosseini; Nikhil Waingankar; Reza Mehrazin; John Sfakianos; Abolfazl Hosseini; Peter Wiklund

doi:10.1016/j.euros.2021.11.010

Functional and Oncological Outcomes of Female Pelvic Organ-preserving Robot-assisted Radical Cystectomy

Eur Urol Open Sci. 2021 Dec 27:36:34-40. doi: 10.1016/j.euros.2021.11.010. eCollection 2022 Feb.

Authors

Etienne Lavallée^{1

2}, Zach Dovey¹, Prachee Pathak¹, Linda Dey^{3

4}, Lotta Renström Koskela^{3

4}, Arad Hosseini³, Nikhil Waingankar¹, Reza Mehrazin¹, John Sfakianos¹, Abolfazl Hosseini^{3

4}, Peter Wiklund^{1

3

4}

Affiliations

¹ Department of Urology, Icahn School of Medicine at Mount Sinai Hospital, New York, NY, USA.
² Department of Surgery, Faculty of Medicine, Laval University, Québec, Canada.
³ Department of Pelvic Cancer, Karolinska University Hospital, Stockholm, Sweden.
⁴ Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.

Abstract

Background: For females undergoing cystectomy and urinary diversion, decreases in sexual and urinary functions can have a significant impact on quality of life. Pelvic organ-preserving (POP) radical cystectomy (RC) has been proposed as an approach to improve postoperative functional outcomes.

Objective: To evaluate postoperative functional outcomes of a robotic approach for female POP RC with intracorporeal urinary diversion.

Design setting and participants: This was a multicenter retrospective study evaluating sexual, urinary, and oncological outcomes for sexually active females undergoing POP robot-assisted RC for ≤T2 bladder cancer. Exclusion criteria included multifocal, trigonal, or locally advanced tumors.

Surgical procedure: We describe a step-by-step technique for POP robot-assisted RC with intracorporeal urinary diversion.

Measurements: The primary outcome of the study was evaluation of sexual and urinary functions following surgery. Oncological outcomes were evaluated as a secondary endpoint.

Results and limitations: Our study included 23 females who underwent POP robot-assisted RC between 2008 and 2020 with intracorporeal neobladder (87%) or ileal conduit (13%) reconstruction. The median follow-up was 20 mo. A postoperative sexual function questionnaire was completed by 15 patients (65%). Of those, 13 (87%) resumed sexual activity at a median of 6 mo after surgery. Of the patients with a neobladder, 14 (70%) achieved daytime continence and 16 (80%) achieved nighttime continence. Cancer-specific and overall survival were both 91%. The results are limited by their retrospective nature.

Conclusions: POP robot-assisted RC with orthotopic neobladder allows a majority of female patients to return to sexual activity after surgery. This approach should be considered for selected sexually active women.

Patient summary: We evaluated 23 women with bladder cancer who underwent surgical removal of the bladder with preservation of their reproductive organs. Following this surgery, a majority of patients resumed sexual activity. For selected patients, this technique can be performed without compromising cancer control.

Keywords: Bladder cancer; Cystectomy; Female cystectomy; Neobladder; Sexual function; Urinary diversion; Urinary function.