Female reproductive organ-sparing (ROS) and nerve-sparing radical cystectomy (RC) techniques have been shown to be oncologically safe and to improve sexual function outcomes among select patients with organ-confined disease. We sought to characterize practice patterns regarding female ROS and nerve-sparing RC among US urologists.
We conducted a cross-sectional survey of members of the Society of Urologic Oncology to assess provider-reported frequency of ROS and nerve-sparing RC in premenopausal and postmenopausal patients with non-muscle-invasive bladder cancer that failed intravesical therapy or clinically localized muscle-invasive bladder cancer.
Among 101 urologists, 80 (79.2%) reported that they routinely resect the uterus/cervix, 68 (67.3%) the neurovascular bundle, 49 (48.5%) the ovaries, and 19 (18.8%) a portion of the vagina when performing RC in premenopausal patients with organ-confined disease. When asked about changes to approach in postmenopausal patients, 71 participants (70.3%) reported that they were less likely to spare the uterus/cervix, 44 (43.6%) were less likely to spare the neurovascular bundle, 70 (69.3%) were less likely to spare the ovaries, and 23 (22.8%) were less likely to spare a portion of the vagina.
We identified significant gaps in adoption of female ROS and nerve-sparing RC techniques for patients with organ-confined disease, despite evidence that ROS and nerve-sparing techniques are oncologically safe and can optimize functional outcomes in select patients. Future efforts should improve provider training in and education about ROS and nerve-sparing RC to improve postoperative outcomes among female patients.
Clinical genitourinary cancer. 2023 Jan 26 [Epub ahead of print]
Natasha Gupta, Lauren Kucirka, Alice Semerjian, Phillip M Pierorazio, Stacy Loeb, Trinity J Bivalacqua
Department of Urology and Population Health, New York University and Manhattan Veterans Affairs, New York City, NY. Electronic address: ., Division of Maternal Fetal Medicine, Department of Gynecology and Obstetrics, University of North Carolina at Chapel Hill, Chapel Hill, NC., Trinity Health IHA, Ann Arbor, MI., Department of Urology, University of Pennsylvania, Philadelphia, PA., Department of Urology and Population Health, New York University and Manhattan Veterans Affairs, New York City, NY.