To oophorectomy or not to oophorectomy: Practice patterns among urologists treating bladder cancer

Classically, radical cystectomy (RC) involves hysterectomy and bilateral salpingo-oophorectomy (BSO). Current understanding of ovarian cancer pathogenesis and effect of premature oophorectomy has lead to a shift within gynecology toward risk-reducing salpingectomy without oophorectomy in the absence of gynecologic malignancy. The purpose of this study was to assess knowledge base and practice patterns of urologic oncologists with regard to management of the gynecological organs at the time of RC.

An anonymous and voluntary electronic survey was distributed to members of the Society of Urologic Oncology (SUO). Demographic data, training, practice setting and duration, experience, rationale for BSO, and knowledge assessment of ovarian cancer pathogenesis/risks associated with BSO was collected.

A total of 159/660 (24%) SUO members responded of whom 110 (69%) were academic urologists and 58 (36%) involved in training urologic oncology fellows. Of all, 75% had performed an ovarian-sparing RC. Furthermore, 14% were aware that salpingectomy alone reduces the risk of ovarian cancer, whereas 95%, 66%, and 26% were aware that BSO increases the risk of osteoporosis, cardiovascular disease, and all-cause mortality, respectively. Reasons for BSO at the time of RC included concern for urothelial carcinoma metastasis (54%), development of future gynecologic pathology (50%), and facilitation of pelvic lymph node dissection (36%).

Many urologic oncologists remain unaware of the benefits of risk-reducing salpingectomy and the risks associated with BSO, identifying a potential area for further education in the urologic community.

Urologic oncology. 2017 Dec 19 [Epub ahead of print]

Rachael D Sussman, Chihun J Han, Daniel Marchalik, Filipe L Carvahlo, Meghan F Davis, Lee A Richter, Stephanie L Wethington, Lambros Stamatakis

Department of Urology, MedStar Georgetown University Hospital, Washington, DC. Electronic address: ., Georgetown University School of Medicine, Washington, DC., Department of Urology, MedStar Washington Hospital Center, Washington, DC., Department of Urology, MedStar Georgetown University Hospital, Washington, DC., National Center for Advanced Pelvic Surgery, MedStar Washington Hospital Center, Washington, DC., Department of Gynecology and Obstetrics-Gynecologic Oncology, The Johns Hopkins Hospital, Baltimore, MD.