Long-Term Oncological Outcomes in Women Undergoing Radical Cystectomy and Orthotopic Diversion for Bladder Cancer

Department of Urology, Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, California 90089, USA.
The Journal of urology (Impact Factor: 4.47). 04/2009; 181(5):2052-8; discussion 2058-9. DOI: 10.1016/j.juro.2009.01.020
Source: PubMed


We compared oncological outcomes in women undergoing radical cystectomy and orthotopic diversion for bladder transitional cell carcinoma.
From 1990 to 2005, 201 women underwent radical cystectomy, including 120 with an orthotopic neobladder. Median followup was 8.6 years. The clinical course, and pathological and oncological outcomes in these 120 women were analyzed and compared to those in 81 women undergoing radical cystectomy and cutaneous diversion during the same period.
Overall 3 of 120 women (2.5%) who received a neobladder died perioperatively. In this group the tumor was pathologically organ confined in 73 patients (61%), extravesical in 18 (15%) and lymph node positive in 29 (24%). Overall 5 and 10-year recurrence-free survival was 62% and 55%, respectively. Five and 10-year recurrence-free survival in patients with organ confined and extravesical disease was similar at 75% and 67%, and 71% and 71%, respectively. Patients with lymph node positive disease had significantly worse 5 and 10-year recurrence-free survival (24% and 19%, respectively). One woman had recurrence in the urethra and 2 (1.7%) had local recurrence. As stratified by pathological subgroups, similar outcomes were observed when comparing women with an orthotopic neobladder to the 81 who underwent cutaneous diversion.
Orthotopic diversion does not compromise the oncological outcome in women after radical cystectomy for bladder transitional cell carcinoma. Excellent local and urethral control may be expected. Women with node positive disease are at highest risk for recurrence. Similar outcomes were observed in women undergoing cutaneous diversion.

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    • "Patients learn to void through simultaneous relaxation of the pelvic muscles with coordinated increase in their intra-abdominal pressure (Valsalva maneuver) [12, 16, 17]. Clean intermittent catheterization (CIC) is required to manage urinary retention or periodically for irrigation of excessive mucous [12, 16, 17]. Patients who are not able to catheterize themselves practice timed voiding (since normal bladder sensation and urge are no longer intact). "
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    ABSTRACT: Bladder cancer is the fifth most commonly diagnosed cancer and the most expensive adult cancer in average healthcare costs incurred per patient in the USA. However, little is known about factors influencing patients' treatment decisions, quality of life, and responses to treatment impairments. The main focus of this paper is to better understand the impact of muscle invasive bladder cancer on patient quality of life and its added implications for primary caregivers and healthcare providers. In this paper, we discuss treatment options, side effects, and challenges that patients and family caregivers face in different phases along the disease trajectory and further identify crucial areas of needed research.
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