達文西機器手臂膀胱根除手術併女性骨盆器官保留之術後探討
李宗叡、黃志平、張兆祥、吳錫金
中國醫藥大學附設醫院 泌尿部
Outcomes of the pelvic organ-preserving robotic radical cystectomy with neobladder in female patients-single center experience
Tzung-Ruei Li, Chi-Ping, Huang, Chao-Hsiang, Chang, His-Chin, Wu
Department of Urology, China Medical University Hospital, Taichung, Taiwan
Purpose:
Radical cystectomy (RC) is the golden standard for muscle invasive urothelial carcinoma. Standard RC includes the female organs removal. However, vagina, uterus and ligaments could provide suspension pelvic floor and further give neobladder support, which might improve functional status. We would like to share the cases and the compare the outcomes.
Materials and Methods:
This retrospective study recruited 8 patients from 2014 to 2020, who underwent robotic radical cystectomy with neobladder in either intracorporeal or extracorporeal methods. We made the analysis of the characteristics, peri-operative, oncological and functional, especially continence outcomes.
Results:
Among the 8 patients, 5 patients received female organ-sparing, and 3 patients received standard cystectomy. The mean age was 60 (37-68). Mean BMI was 23.65 (15.4-30.6). 1, 1, 5, and 1 patients belonged to clinical T1, T2, T3 and T4 respectively. 6 of the 8 patients receive neoadjuvant treatment, and 4 of them had response. Further 1, 1,3 and 3 patients belonged to pathological Tx, CIS, T1 and
T3 respectively. Hospital stays were 18 and 19.8 days, organ-sparing and no-sparing groups respectively. Only one patient received standard RC had recurrence, with lymph node positive in the pathology, and the others were recurrence-free, with the median follow up 17.5 months. 2 out of 3 patients in RC needed self-catherization or Foley indwelling. All patients received organ-sparing RC removed Foley for irrigation after about 25 days (19-29) after surgery. 2 out of 5 patients in organ-sparing RC had complication of ureteral stricture with long-term DJ indwelling. Although stress urine incontinence happened in all organ-sparing RC, only 2 out of 5 had daytime urine incontinence with 2 pads use, and 3 out of 5 had night urine incontinence with 2-3 pads use. There was also one patient had maintained acceptable sexual function, based on female sexual function index (FSFI).
Conclusions:
The patients received female pelvic organ-preserving robotic radical cystectomy with neobladder are in limited number. However, the preliminary result showed no inferiority in oncological outcomes, but meanwhile seemed to have functional outcomes for urine continence. The female patients could be considered organ-preserving RC under certain condition with well-experienced surgeon.