Is Reproductive Organ-Sparing and Nerve-Sparing Radical Cystectomy Underused? - European Medical Journal

Is Reproductive Organ-Sparing and Nerve-Sparing Radical Cystectomy Underused?

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REPRODUCTIVE organ-sparing (ROS) and nerve-sparing radical cystectomy (RC) may be underused in the treatment of females with bladder cancer, according to a survey among urologic oncologists in the USA. Most respondents reported they routinely perform a hysterectomy, without sparing the neurovascular bundle in premenopausal patients with organ-confined disease. Researchers stated that “RC techniques for patients with organ-confined disease, despite evidence that ROS and nerve-sparing techniques are oncologically safe and can optimise functional outcomes in select patients.” 

In total, 101 urologic oncologists who belonged to the Society of Urologic Oncology (SUO) and had performed a RC in a female completed survey questions regarding their operative approach in premenopausal women. Of the respondents, 83.2% were fellowship-trained in urologic oncology, 80.2% were in academic practice, 9.9% were female, and their median time in practice was of 9 years. Furthermore, they had performed a median of 5.5 RC in females in the year prior to the survey.  

Results showed that 79.2% routinely resected the cervix or uterus in pre-menopausal patients with non-muscle invasive bladder cancer who had failed intravesical therapy or clinically localised T2 muscle-invasive bladder cancer. Further, 67.3% stated they routinely resect the neurovascular bundle, 18.8% stated they routinely resect a portion of the vagina, and 48.5% said they routinely resect ovaries in this patient group. Results also showed that 20.8% never spare the neurovascular bundle, 17.8% never spare the uterus or cervix, 5.9% never spare the ovaries, and 1.0% never spare a portion of the vagina in the same patient group. Researchers did not note associations between these outcomes and sex, age, urologic oncology fellowship training, academic practice, or years in practice.  

Further results of the survey showed that 70.3% of respondents were less likely to spare the uterus or cervix when treating post-menopausal patients with organ-confined disease, 69.3% were less likely to spare the ovaries, 43.6% were less likely to spare the neurovascular bundle, and 22.8% were less likely to spare a portion of the vagina when performing a RC in a postmenopausal patient. Only 41.6% of respondents stated that the type of urinary diversion influenced their decision on performing a ROS or nerve-sparing RC.  

Researchers concluded that “future efforts should improve provider training in and education about ROS and nerve-sparing RC to improve postoperative outcomes among female patients.” 

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