Urinary diversion in women following radical cystectomy: single center comparison and update on outcomes

Introduction & Objectives: Radical cystectomy remains the primary treatment for highgrade,invasive bladder cancer. Over the past twenty years, the various options for lowerurinary tract reconstruction in women have clearly evolved. The clinical outcomes ofincontinent cutaneous (IC), continent cutaneous (CC), and orthotopic neobladders (ON)for females following radical cystectomy are reviewed.Material & Methods: From July 1971 to December 2004, 327 females, ages 23 to91 years old (median age 67) with primary Transitional Cell Carcinoma of the bladderunderwent radical cystectomy and urinary diversion. Urinary diversion was performedby means of ON in 115, CC diversion in 121, and IC diversion by means of ileal conduitin 91 patients. Data were analyzed according to histologic grade and pathologicstage, presence of carcinoma in situ, multifocal carcinoma, lymphovascular invasion,lymph node density, early and late complications, pre-operative radiation, overall andrecurrence-free survival.Results: Median follow-up for the entire cohort is 12.2 years (range: 8 days to 33.6 years).All patients receiving pre-operative radiation therapy underwent continent diversions(71% IC vs. 29% CC vs. 0% ON; p < .0001). Furthermore, although higher grade tumorswere more commonly seen in the cutaneous diversion groups (89% vs 75%; p=0.001)the presence of multifocal tumor, carcinoma in situ, or advanced patient age (> 65 yearsold) did not have an influence the type of diversion performed. There were no significantdifferences in pathological stage, presence of lymphovascular invasion, margin status,lymph node density, early complication rate, and operative mortality between the threegroups. Despite a higher late complication rate with orthotopic diversions (p < .0001),the type of diversion did not have a statistically significant impact on overall survival orrecurrence.Conclusions: Orthotopic diversion is an appropriate form of urinary diversion in carefullyselected women with bladder cancer. When comparing various forms of reconstruction,there are no apparent pathological differences and the survival data are similar. From anoncological perspective, women undergoing an orthotopic diversion are not compromisedwith this form of diversion. Further functional studies addressing quality of life issues andcontinence status are needed to validate these clinical outcomes