Urethra-sparing cystectomy and orthotopic urinary diversion in women with malignant pelvic tumors

BACKGROUND. To the authors' knowledge, few data exist regarding the functio nal and oncologic outcome of pelvic tumors in women with urethra-sparing cy stectomy and orthotopic urinary diversion to the urethra. PATIENTS AND METHODS. The combined data of 102 women age 28-79 (mean, 59 yr s) years who underwent a urethra-sparing cystectomy and orthotopic urinary diversion for either primary bladder cancer (96 patients), carcinoma of the uterine cervix (2 patients), carcinoma of the vagina (1 patient), primary fallopian tube carcinoma (1 patient), uterine sarcoma (1 patient), or recta l carcinoma (1 patient) were reviewed. The histology of the 96 primary blad der tumors was 81 transitional cell carcinomas (TCC), 8 adenocarcinomas, 5 squamous cell carcinomas, 1 small cell carcinoma, and 1 unclassified. Follo w-up ranged from 1.5-100 months (mean, 26 mos; median, 24 mos). In all pati ents, the bladder neck and up to 1 cm in length of the adjacent urethra wer e removed with the bladder. An ileal orthotopic neobladder procedure was pe rformed if staging biopsies of the bladder neck and intraoperative frozen s ection of the urethral margin revealed no tumor. RESULTS. There was no perioperative mortality, and an early and late compli cation rate requiring secondary intervention in 5 (5%) and 12 (12%) patient s. With 88 of 102 patients alive and 83 of 102 patients disease free, a dis ease-specific survival of 74% and a disease-free survival of 63% was estima ted at 5 years. No pelvic recurrence was seen in 81 patients with TCC. Thre e pelvic recurrences occurred, two tumors of the inner genitalia and one ad enocarcinoma of the bladder, none of them in the area of the urethra or its supplying autonomic nerves. Daytime continence was 82%; nocturnal continen ce was 72%. Twelve (12%) patients were unable to empty their bladders compl etely and needed some form of catheterization. CONCLUSIONS. The functional and oncologic outcome of female patients with a n orthotopic urinary diversion to a remnant urethra was found to be compara ble to that found in large studies on males. An orthotopic neobladder prove d to be an oncologically safe option for women with pelvic tumors and was f ound to provide quality of life when there was adherence to previously defi ned selection criteria. (C) 2001 American Cancer Society.