Radical cystectomy with orthotopic neobladder reconstruction following prior radical prostatectomy

Purpose

To review the perioperative and follow-up outcomes of patients undergoing radical cystectomy with orthotopic neobladder reconstruction for bladder cancer after prior radical prostatectomy (RP) for prostate cancer.

Methods

A retrospective review of more than 1,900 patients treated with radical cystectomy at USC between 1990 and 2011 was conducted. Fifty-six patients were identified who were previously treated with RP for prostate cancer. Twenty-four of these patients (43?%) underwent orthotopic neobladder reconstruction. Perioperative data and follow-up including postoperative continence were analyzed.

Results

The median age at cystectomy for these 24 patients was 68?years (range 55?C89). The types of neobladder reconstruction were Kock neobladder in 3, Sigmoid reservoir in 1, Studer neobladder in 12, and T-pouch ileal neobladder in 8 patients. There were no major intraoperative complications. Of 19 patients eligible for evaluation of post-cystectomy urinary control, 11 patients (57.9?%) with good continence (0?C1 pad/day) after RP regained preoperative level of urinary control after cystectomy within 1?year. The continence rate of 13 post-RP patients with good continence was 84.6?%. Among the 4 patients who received adjuvant radiotherapy after RP, 1 regained good continence. One with poor continence after prostatectomy had an artificial urethral sphincter (AUS) placed 2?months after cystectomy, and 2 with fair and poor continence after prostatectomy had an AUS placed at the time of cystectomy.

Conclusions

Patients undergoing radical cystectomy after prior RP pose a challenge to urologists. Those who are continent post-RP have a fair chance of regaining good urinary control with neobladder reconstruction. Adjuvant radiotherapy for prostate cancer may have a negative impact on continence with neobladder reconstruction.