Investigators have identified important gaps in urological oncologists’ adoption of female reproductive organ-sparing and nerve-sparing radical cystectomy, despite the oncologic safety of these approaches, according to a recent report.
Investigators asked members of the Society of Urologic Oncology how frequently they would spare organs and nerves in a hypothetical premenopausal woman with clinically localized T2 muscle invasive-bladder cancer or nonmuscle-invasive bladder cancer that failed intravesical therapy. Among the 101 urologic oncologists surveyed, 79.2% reported that in such cases they routinely resected the uterus or cervix, 67.3% routinely resected the neurovascular bundle, 48.5% routinely resected the ovaries, and 18.8% routinely resected a portion of the vagina. Another 17.8% of respondents reported that they never spare the uterus or cervix, 20.8% never spare the neurovascular bundle, 5.9% never spare the ovaries, and 1.0% never spare a portion of the vagina. Only 41.6% reported that the type of urinary diversion influenced their decision to perform reproductive organ- or nerve-sparing radical cystectomy.
When asked how they would alter management for a postmenopausal patient, 70.3% of respondents reported that they would be less likely to spare the uterus/cervix, 43.6% less likely to spare the neurovascular bundle, 69.3% less likely to spare the ovaries, and 22.8% less likely to spare a portion of the vagina.
These practices did not vary by provider characteristics or clinical experience, Natasha Gupta, MD, of NYU Langone Health in New York, New York, and colleagues reported in Clinical Genitourinary Cancer. Yet guidelines from the American Urological Association support consideration of female reproductive organ- and nerve-sparing radical cystectomy in select patients with organ-confined disease. Published rates of uterine or cervical involvement at the time of surgery are less than 10% and rates of ovarian involvement are less than 5%, the investigators noted.
According to Dr Gupta’s team, the potential benefits of female reproductive organ-sparing and nerve-sparing radical cystectomy include fertility preservation, better urinary control in patients receiving a neobladder, retention of pelvic floor support and sexual function, and avoidance of surgical menopause.
“Future efforts should be directed towards improving training in and education about indications for [reproductive organ-sparing] and nerve-sparing [radical cystectomy] techniques among urologists to optimize postoperative functional and overall health outcomes among female patients with bladder cancer undergoing [radical cystectomy].”
Gupta N, Kucirka L, Semerjian A, Pierorazio PM, Loeb S, Bivalacqua TJ. Practice patterns regarding female reproductive organ-sparing and nerve-sparing radical cystectomy among urologic oncologists in the United States. Clin Genitourin Cancer. Published online January 26, 2023. doi:10.1016/j.clgc.2023.01.010