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Thomas Flaig, MD
Thomas Flaig, MD
Posted: Thursday, November 10, 2022
Sexuality-preserving cystectomy techniques have been proposed to improve functional outcomes for select patients with bladder cancer. However, there are limited data on how successful women have been in becoming pregnant after such surgical procedures. In BMC Urology, Costantino Leonardo, MD, PhD, of La Sapienza University of Rome, and colleagues shared a case presentation of a 43-year-old woman with a Padua ileal orthotopic neobladder after robot-assisted sexuality-preserving cystectomy throughout her pregnancy and birth. Their results indicate this surgical technique may prove to be a useful option for some motivated young patients with muscle-invasive bladder cancer, although collaboration of gynecologists, urologists, radiologists, anesthesiologists, and neonatologists would be necessary.
“With the spread of sexuality-preserving techniques and minimally invasive surgery, the number of pregnancies and deliveries in patients with [a] history of radical cystectomy and urinary diversion is expected to increase,” said the authors. “Despite the number of possible complications, management of this particular setting of patients, that require close surveillance, is possible by relying on a multidisciplinary team.”
Throughout the featured patient’s pregnancy (and others cited by the researchers), the most common complication observed was ureterohydronephrosis because of ureteral compression and recurrent urinary tract infections. The patient also experienced displacement of the neobladder from the growing uterus during pregnancy. Other reported conditions were related to neobladder emptying and ureteral compression in the second trimester, as well as bowel movement abnormalities from adhesions and altered anatomy.
A caesarean section was performed with a higher incision to reduce the risk of neobladder or ureteral injury. Researchers also cited the possibility of temporarily interrupting the internal iliac artery flow from the use of balloon catheters. Reported necessities and suggestions for future procedures and patient care include maintaining bladder catheters and nephrostomy tubes until after uterus involution as well as frequent genitourinary ultrasounds and urinalysis.
Disclosure: The study authors reported no conflicts of interest.
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