Outcome of anterior vaginal wall sparing during female radical cystectomy with orthotopic urinary diversion.

Objective: Orthotopic urinary reconstruction has been shown to be a viable option in women undergoing radical cystectomy and is currently the diversion of choice in many institutions. We evaluated the technique of vaginal wall preservation during female radical cystectomy and orthotopic neobladder construction.

Methods: Thirty female patients underwent radical cystectomy with bilateral pelvic lymphadenectomy and orthotopic urinary diversion from January 2001 to December 2006. We reviewed perioperative early and late complications, postoperative care, follow-up, pathological and functional results.

Results: Early complications included prolonged ileus in 4 patients, urinary tract infection in 2, deep venous thrombosis in 2, wound infection in 2 and prolonged urine leak in 1. Late complications requiring rehospitalization or reoperation included small bowel obstruction, requiring surgical exploration in 1 patient, an ileal pouch calculus requiring endoscopic removal in another patient and a unilateral ureteroileal stenosis treated by antegrade dilatation and stenting in the third patient. Pathological specimens revealed a negative posterior bladder wall and urethral margins in all cases. At a median follow-up of 18 months daytime and nighttime continence was 100% and 93%, respectively. All but 2 patients voided spontaneously. One patient had local recurrence of bladder carcinoma.

Conclusions: With strict selection criteria, anterior vaginal wall preservation in female radical cystectomy with orthotopic neobladder substitution is technically feasible, maintains vaginal length and support, has excellent functional results, acceptable complication rate and can achieve negative margins. Long-term evaluation is needed for better assessment of the impact on functional outcomes and cancer control.