Genital-sparing cystectomy versus standard urethral-sparing cystectomy followed with orthotopic neobladder in women with bladder cancer: Incidence and causes of hypercontinence with an ultrastructure study of urethral smooth muscles

Theodor Bilharz Research Institute

Bibliographic Information

Authors: Wishahi M.; Ismail M.A.; Elganzoury H.; Elkholy A.; Nour H.H.; Zayed A.S.; Eldahshan S.

Journal: Open Access Macedonian Journal of Medical Sciences

Publisher: Open Access Macedonian Journal of Medical Sciences

Publication Date: 27 March 2019

Volume / Issue: Volume 7 / Issue 6

Pages: 978–981

ISSN: 18579655

DOI: 10.3889/oamjms.2019.206

Scopus: View on Scopus

Document Type: Article

Access: All Open Access; Gold Open Access; Green Open Access

Authors and Affiliations

Wishahi M., Department of Urology, Theodor Bilharz Research Institute, Cairo, Egypt; Ismail M.A., Department of Urology, Theodor Bilharz Research Institute, Cairo, Egypt; Elganzoury H., Department of Urology, Theodor Bilharz Research Institute, Cairo, Egypt; Elkholy A., Department of Urology, Theodor Bilharz Research Institute, Cairo, Egypt; Nour H.H., Department of Urology, Theodor Bilharz Research Institute, Cairo, Egypt; Zayed A.S., Department of Urology, Theodor Bilharz Research Institute, Cairo, Egypt; Eldahshan S., Department of Urology, Theodor Bilharz Research Institute, Cairo, Egypt

Abstract

BACKGROUND: Bladder cancer in women is an indication for radical cystectomy (RC) when the tumour is confined muscle-invasive bladder cancer (MIBC) of T2 N0M0, or high risk progressive non-muscle invasive bladder cancer (NMIBC). Radical cystectomy is either genital-sparing cystectomy (GSC) or standard urethra-sparing cystectomy (USC) that is followed with orthotopic ileal neobladder (ONB). Post-operative chronic retention “Hypercontinence” had been reported in different series following URS or GSC and ONB. In long-term follow-up, we evaluated the functional outcome of women who developed hypercontinence after USC or GSC and ONB. AIM: An ultrastructure study of female urethral smooth muscle was done to elucidate the underlying causes of hypercontinence. MATERIAL AND METHODS: Retrospective study was conducted on 71 women who underwent RC and ONB, 45women had undergone USC, and 26 women had GSC, follow-up ranged from 5 to 15 years. Ultrastructure studies were done on 5 urethral biopsy specimens from 5 women who had hypercontinence, and 4 biopsies were from a normal control. RESULTS: Follow-up showed that women who had undergone USC and ONB, 28.88% developed hypercontinence, where in the series of GSC and ONB three women out of 26 developed hypercontinence (7.80%). Three women who had hypercontinence following USC and ONB, they developed stones in the ileal pouch. Ultrastructure study of urethral smooth muscles in women who had hypercontinence showed organized collagen fibrils, absent myelin sheath, and non-detected lymphatic vessels. Normal urethra showed collagen fibrils within the interstitial matrix, preserved myelin sheath of nerve fibres, the presence of lymphatic vessels in the matrix. CONCLUSION: The present study shoes that GSC with ONB leads to the minimal incidence of hypercontinence (7.80%), while standard USC lead to higher incidence (28.88%). Ultrastructure changes of the female urethra who had hypercontinence were fibrotic changes, loss of myelin sheath and minimal vascularity, their findings explains the underlying cause of hypercontinence and support the technique of GSC rather than the standard USC. © 2019 Mohamed Wishahi, Mohamed A. Ismail, Hossam Elganzoury, Amr Elkholy, Hani H. Nour, Ahmed S. Zayed, Samir Eldahshan.

Keywords

Bladder cancer; Chronic retention; Cystectomy; Female urethra; Neobladder; Ultrastructure; Urinary diversion; adult; aged; Article; cancer incidence; collagen fibril; computer assisted tomography; conservative treatment; cystoscopy; female; follow up; genital sparing cystectomy; human; human tissue; hypercontinence; lymph vessel; major clinical study; myelin sheath; retrospective study; smooth muscle; transmission electron microscopy; ureter catheterization; urethra; urethral sparing cystectomy; urinary dysfunction; urine retention

Citation Information

Scopus Citations: 4

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