- Email: [email protected]
541 Hysterectomy and non nerve-sparing cystectomy have a negative impact on functional outcome after orthotopic ileal bladder substitution in female patients
Title
541
Hysterectomy and non nerve-sparing cystectomy have a negative impact on functional outcome after orthotopic ileal bladder substitution in female patients Eur Urol Suppl 2015;14/2;e541
Print! Print!
Gross T., Burkhard F.C., Meierhans Ruf S.D., Meissner C., Ochsner K., Studer U.E. University Hospital Berne, Dept. of Urology, Berne, Switzerland INTRODUCTION & OBJECTIVES: Lower urinary tract symptoms occur in up to 50% of females after orthotopic ileal bladder substitution (BS). Even though the positive effect of nerve-sparing techniques on continence and erectile function is well documented in men, the role of nerve-sparing in females after orthotopic ileal BS remains unclear. As hysterectomy can cause damage to the autonomic nerves that run along the lateral aspect of the cervix, we evaluated whether hysterectomy (prior or simultaneous) and/or attempted nerve-sparing affect functional outcome after orthotopic ileal BS. MATERIAL & METHODS: We retrospectively assessed the postoperative urinary continence status of 73 female cystectomy patients (median age 61.7 y; range 34.7-78.5 y) with orthotopic ileal BS. For the purposes of this study, the patients were divided into 2 groups according to their postoperative continence status: continent (n=43) and incontinent (> 1 pad/day) (n=30). RESULTS: Hysterectomy was performed prior to cystectomy in 16 (22%) of the 73 patients, at the time of cystectomy in 31 (43%); 26 patients did not undergo hysterectomy. Continent patients had a higher rate of preserved uterus (51% vs 13%) and lower rates of preoperative (19% vs 26%) and perioperative hysterectomy (30% vs 60%) than incontinent patients (Graph 1).
file:///S|/IM/EURSUP/2015%20EAU%20Abstracts/content/data/541.html[19/02/2015 08:15:34]
Title
Bilateral Nerve-sparing was attempted in 38 (52%) patients, unilateral nerve-sparing in 31 (43%). Nerve-sparing was not possible in 4 (6%) patients due to complete pelvic exenteration. Continent patients were more likely to have undergone bilateral nerve-sparing surgery (65% vs 33%), and less likely to have had unilateral (33% vs 57%) and no attempted nerve-sparing (2% vs 10%) than incontinent patients (Graph 2).
file:///S|/IM/EURSUP/2015%20EAU%20Abstracts/content/data/541.html[19/02/2015 08:15:34]
Title
CONCLUSIONS: Uterus preservation and/or bilateral nerve-sparing resulted in higher rates of postoperative urinary continence in females undergoing cystectomy and ileal orthotopic BS. If neither of these options is possible from an oncological point of view, other forms of diversion should be considered.
file:///S|/IM/EURSUP/2015%20EAU%20Abstracts/content/data/541.html[19/02/2015 08:15:34]
541
Hysterectomy and non nerve-sparing cystectomy have a negative impact on functional outcome after orthotopic ileal bladder substitution in female patients Eur Urol Suppl 2015;14/2;e541
Print! Print!
Gross T., Burkhard F.C., Meierhans Ruf S.D., Meissner C., Ochsner K., Studer U.E. University Hospital Berne, Dept. of Urology, Berne, Switzerland INTRODUCTION & OBJECTIVES: Lower urinary tract symptoms occur in up to 50% of females after orthotopic ileal bladder substitution (BS). Even though the positive effect of nerve-sparing techniques on continence and erectile function is well documented in men, the role of nerve-sparing in females after orthotopic ileal BS remains unclear. As hysterectomy can cause damage to the autonomic nerves that run along the lateral aspect of the cervix, we evaluated whether hysterectomy (prior or simultaneous) and/or attempted nerve-sparing affect functional outcome after orthotopic ileal BS. MATERIAL & METHODS: We retrospectively assessed the postoperative urinary continence status of 73 female cystectomy patients (median age 61.7 y; range 34.7-78.5 y) with orthotopic ileal BS. For the purposes of this study, the patients were divided into 2 groups according to their postoperative continence status: continent (n=43) and incontinent (> 1 pad/day) (n=30). RESULTS: Hysterectomy was performed prior to cystectomy in 16 (22%) of the 73 patients, at the time of cystectomy in 31 (43%); 26 patients did not undergo hysterectomy. Continent patients had a higher rate of preserved uterus (51% vs 13%) and lower rates of preoperative (19% vs 26%) and perioperative hysterectomy (30% vs 60%) than incontinent patients (Graph 1).
file:///S|/IM/EURSUP/2015%20EAU%20Abstracts/content/data/541.html[19/02/2015 08:15:34]
Title
Bilateral Nerve-sparing was attempted in 38 (52%) patients, unilateral nerve-sparing in 31 (43%). Nerve-sparing was not possible in 4 (6%) patients due to complete pelvic exenteration. Continent patients were more likely to have undergone bilateral nerve-sparing surgery (65% vs 33%), and less likely to have had unilateral (33% vs 57%) and no attempted nerve-sparing (2% vs 10%) than incontinent patients (Graph 2).
file:///S|/IM/EURSUP/2015%20EAU%20Abstracts/content/data/541.html[19/02/2015 08:15:34]
Title
CONCLUSIONS: Uterus preservation and/or bilateral nerve-sparing resulted in higher rates of postoperative urinary continence in females undergoing cystectomy and ileal orthotopic BS. If neither of these options is possible from an oncological point of view, other forms of diversion should be considered.
file:///S|/IM/EURSUP/2015%20EAU%20Abstracts/content/data/541.html[19/02/2015 08:15:34]