Oncologic and functional outcomes of sexual-function preserving cystectomy compared with standard radical cystectomy in men

a systematic review

Virginia Hernandez (Corresponding Author), Estefania Linares Espinos, James Dunn, Steven MacLennan, Thomas Lam, Yuhong Yuan, Eva Compérat, Nigel C Cowan, Georgios Gakis, Thierry Lebret, Antoine G van der Heijden, J.Alfred Witjes, Maria J Ribal

Research output: Contribution to journalArticle

12 Citations (Scopus)
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Abstract

Introduction: Different sexual-function preserving surgical techniques aimed at improving voiding and sexual function in patients undergoing radical cystectomy for bladder cancer have been described. The objective of this systematic review was to determine the effect of sexual function-preserving cystectomy on functional and oncological outcomes.
Materials and Methods: Relevant databases were searched covering the time frame 2000-2015. All publications presenting data on any type of sexual function-preserving cystectomy reporting oncologic and/or functional outcomes with a minimum follow-up of one year were identified. Comparative studies including a minimum of 30 patients and single-arm case series with a minimum of 50 patients were selected. No language restrictions were applied.
Results: Out of 8,517 identified abstracts, 12 studies were eligible for inclusion. Sexual function-preserving cystectomy described included prostate-, capsule-, seminal vesicle and nerve-sparing techniques. Local recurrence ranged from 1.2-61.1% (vs 16.0-55.0% in the control group) and metastatic disease from 0-33.3% (vs 33.0%). No differences were found in comparative studies reporting oncological outcomes. Post-operative potency was significantly better in the sexual function-preserving cystectomy groups in 6 studies comparing sexual function-preserving cystectomy vs radical cystectomy (p<0.05). No major impact on continence was found. Overall, there was moderate to high risk of bias and confounding.
Conclusions: The evidence base for prostate-, capsule- or nerve-sparing cystectomy suggests that these procedures may yield better sexual outcomes than standard cystectomy, without compromising oncological outcomes. However, the overall quality of the evidence was moderate, and hence if offered, patients must be carefully selected, counselled and closely monitored.
Original languageEnglish
Pages (from-to)539.e17-539.e29
Number of pages13
JournalUrologic Oncology
Volume35
Issue number9
Early online date8 May 2017
DOIs
Publication statusPublished - Sep 2017

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Cystectomy
Capsules
Prostate
Seminal Vesicles
Urinary Bladder Neoplasms
Publications
Language
Databases
Recurrence
Control Groups

Keywords

  • cystectomy
  • erectile dysfunction
  • Urinary Bladder Neoplasms
  • urinary incontinence

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Oncologic and functional outcomes of sexual-function preserving cystectomy compared with standard radical cystectomy in men : a systematic review. / Hernandez, Virginia (Corresponding Author); Espinos, Estefania Linares ; Dunn, James ; MacLennan, Steven; Lam, Thomas; Yuan, Yuhong ; Compérat, Eva; Cowan, Nigel C; Gakis, Georgios; Lebret, Thierry; van der Heijden, Antoine G; Witjes, J.Alfred ; Ribal, Maria J.

In: Urologic Oncology, Vol. 35, No. 9, 09.2017, p. 539.e17-539.e29.

Research output: Contribution to journalArticle

Hernandez, V, Espinos, EL, Dunn, J, MacLennan, S, Lam, T, Yuan, Y, Compérat, E, Cowan, NC, Gakis, G, Lebret, T, van der Heijden, AG, Witjes, JA & Ribal, MJ 2017, 'Oncologic and functional outcomes of sexual-function preserving cystectomy compared with standard radical cystectomy in men: a systematic review', Urologic Oncology, vol. 35, no. 9, pp. 539.e17-539.e29. https://doi.org/10.1016/j.urolonc.2017.04.013
Hernandez, Virginia ; Espinos, Estefania Linares ; Dunn, James ; MacLennan, Steven ; Lam, Thomas ; Yuan, Yuhong ; Compérat, Eva ; Cowan, Nigel C ; Gakis, Georgios ; Lebret, Thierry ; van der Heijden, Antoine G ; Witjes, J.Alfred ; Ribal, Maria J. / Oncologic and functional outcomes of sexual-function preserving cystectomy compared with standard radical cystectomy in men : a systematic review. In: Urologic Oncology. 2017 ; Vol. 35, No. 9. pp. 539.e17-539.e29.
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abstract = "Introduction: Different sexual-function preserving surgical techniques aimed at improving voiding and sexual function in patients undergoing radical cystectomy for bladder cancer have been described. The objective of this systematic review was to determine the effect of sexual function-preserving cystectomy on functional and oncological outcomes.Materials and Methods: Relevant databases were searched covering the time frame 2000-2015. All publications presenting data on any type of sexual function-preserving cystectomy reporting oncologic and/or functional outcomes with a minimum follow-up of one year were identified. Comparative studies including a minimum of 30 patients and single-arm case series with a minimum of 50 patients were selected. No language restrictions were applied.Results: Out of 8,517 identified abstracts, 12 studies were eligible for inclusion. Sexual function-preserving cystectomy described included prostate-, capsule-, seminal vesicle and nerve-sparing techniques. Local recurrence ranged from 1.2-61.1{\%} (vs 16.0-55.0{\%} in the control group) and metastatic disease from 0-33.3{\%} (vs 33.0{\%}). No differences were found in comparative studies reporting oncological outcomes. Post-operative potency was significantly better in the sexual function-preserving cystectomy groups in 6 studies comparing sexual function-preserving cystectomy vs radical cystectomy (p<0.05). No major impact on continence was found. Overall, there was moderate to high risk of bias and confounding.Conclusions: The evidence base for prostate-, capsule- or nerve-sparing cystectomy suggests that these procedures may yield better sexual outcomes than standard cystectomy, without compromising oncological outcomes. However, the overall quality of the evidence was moderate, and hence if offered, patients must be carefully selected, counselled and closely monitored.",
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T1 - Oncologic and functional outcomes of sexual-function preserving cystectomy compared with standard radical cystectomy in men

T2 - a systematic review

AU - Hernandez, Virginia

AU - Espinos, Estefania Linares

AU - Dunn, James

AU - MacLennan, Steven

AU - Lam, Thomas

AU - Yuan, Yuhong

AU - Compérat, Eva

AU - Cowan, Nigel C

AU - Gakis, Georgios

AU - Lebret, Thierry

AU - van der Heijden, Antoine G

AU - Witjes, J.Alfred

AU - Ribal, Maria J

N1 - Copyright © 2017 Elsevier Inc. All rights reserved.

PY - 2017/9

Y1 - 2017/9

N2 - Introduction: Different sexual-function preserving surgical techniques aimed at improving voiding and sexual function in patients undergoing radical cystectomy for bladder cancer have been described. The objective of this systematic review was to determine the effect of sexual function-preserving cystectomy on functional and oncological outcomes.Materials and Methods: Relevant databases were searched covering the time frame 2000-2015. All publications presenting data on any type of sexual function-preserving cystectomy reporting oncologic and/or functional outcomes with a minimum follow-up of one year were identified. Comparative studies including a minimum of 30 patients and single-arm case series with a minimum of 50 patients were selected. No language restrictions were applied.Results: Out of 8,517 identified abstracts, 12 studies were eligible for inclusion. Sexual function-preserving cystectomy described included prostate-, capsule-, seminal vesicle and nerve-sparing techniques. Local recurrence ranged from 1.2-61.1% (vs 16.0-55.0% in the control group) and metastatic disease from 0-33.3% (vs 33.0%). No differences were found in comparative studies reporting oncological outcomes. Post-operative potency was significantly better in the sexual function-preserving cystectomy groups in 6 studies comparing sexual function-preserving cystectomy vs radical cystectomy (p<0.05). No major impact on continence was found. Overall, there was moderate to high risk of bias and confounding.Conclusions: The evidence base for prostate-, capsule- or nerve-sparing cystectomy suggests that these procedures may yield better sexual outcomes than standard cystectomy, without compromising oncological outcomes. However, the overall quality of the evidence was moderate, and hence if offered, patients must be carefully selected, counselled and closely monitored.

AB - Introduction: Different sexual-function preserving surgical techniques aimed at improving voiding and sexual function in patients undergoing radical cystectomy for bladder cancer have been described. The objective of this systematic review was to determine the effect of sexual function-preserving cystectomy on functional and oncological outcomes.Materials and Methods: Relevant databases were searched covering the time frame 2000-2015. All publications presenting data on any type of sexual function-preserving cystectomy reporting oncologic and/or functional outcomes with a minimum follow-up of one year were identified. Comparative studies including a minimum of 30 patients and single-arm case series with a minimum of 50 patients were selected. No language restrictions were applied.Results: Out of 8,517 identified abstracts, 12 studies were eligible for inclusion. Sexual function-preserving cystectomy described included prostate-, capsule-, seminal vesicle and nerve-sparing techniques. Local recurrence ranged from 1.2-61.1% (vs 16.0-55.0% in the control group) and metastatic disease from 0-33.3% (vs 33.0%). No differences were found in comparative studies reporting oncological outcomes. Post-operative potency was significantly better in the sexual function-preserving cystectomy groups in 6 studies comparing sexual function-preserving cystectomy vs radical cystectomy (p<0.05). No major impact on continence was found. Overall, there was moderate to high risk of bias and confounding.Conclusions: The evidence base for prostate-, capsule- or nerve-sparing cystectomy suggests that these procedures may yield better sexual outcomes than standard cystectomy, without compromising oncological outcomes. However, the overall quality of the evidence was moderate, and hence if offered, patients must be carefully selected, counselled and closely monitored.

KW - cystectomy

KW - erectile dysfunction

KW - Urinary Bladder Neoplasms

KW - urinary incontinence

U2 - 10.1016/j.urolonc.2017.04.013

DO - 10.1016/j.urolonc.2017.04.013

M3 - Article

VL - 35

SP - 539.e17-539.e29

JO - Urologic Oncology

JF - Urologic Oncology

SN - 1078-1439

IS - 9

ER -