Investig Clin Urol.  2022 Nov;63(6):612-622. 10.4111/icu.20220220.

Comparison of functional and oncological outcomes between uterus-sparing radical cystectomy and standard radical cystectomy in females: A retrospective study

Affiliations
  • 1Department of Urology, Seoul National University Hospital, Seoul, Korea
  • 2Department of Urology, Seoul National University College of Medicine, Seoul, Korea

Abstract

Purpose
This study aimed to compare the functional and oncological outcomes of females who underwent uterus-sparing radical cystectomy (USRC) and standard radical cystectomy (SRC).
Materials and Methods
Between February 2009 and December 2020, 90 female patients who underwent radical cystectomy with urinary diversion were included in this study, comprising the USRC and SRC groups. Functional outcomes were assessed in 63 patients who only underwent radical cystectomy with neobladder formation. Questionnaire scores, clean intermittent catheterization (CIC) rate, and urinary continence rate were analyzed. Oncological outcomes were assessed in 86 patients, regardless of the urinary diversion type. Overall survival (OS), cancer-specific survival (CSS), and recurrence-free survival (RFS) were compared.
Results
CIC rate was significantly lower in the USRC group than in the SRC group (14.7% vs. 48.0%; p=0.005). The continence rate was significantly higher in the USRC group than in the SRC group (85.3% vs. 40.0%; p=0.001). There were no significant differences in OS (p=0.890), CSS (p=0.700), or RFS (p=0.270) between the two groups. In multivariate analysis, uterine preservation did not significantly increase the hazard ratio (HR) of OS (HR, 0.62; 95% CI, 0.18–2.11; p=0.450), CSS (HR, 0.99; 95% CI, 0.22–4.40; p=0.990), or RFS (HR, 0.46; 95% CI, 0.19–1.11; p=0.840).
Conclusions
USRC resulted in higher continence rates and lower CIC rates than SRC without negatively affecting oncological outcomes. Hence, with thorough deliberation, USRC should be considered for females undergoing radical cystectomy.

Keyword

Bladder cancer; Cystectomy; Females; Hysterectomy; Uterus-sparing
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