The Role of Radical Cystectomy with Orthotopic Neobladder Reconstruction in Patients Developing Bladder Cancer after Prior Radical Prostatectomy, Radiation Therapy, or BPH Surgery.

Abstract

Introduction: Current evidence suggests that prior prostatic interventions, such as prostatectomy, radiation, or transurethral surgery, may increase the risk of incontinence in patients undergoing radical cystectomy (RC) with ileal orthotopic neobladder reconstruction. We aimed to evaluate the short- and long-term complications, functional outcomes of neobladder reconstruction in patients undergoing RC after prior prostatic procedures.

Methods: We analyzed patients who underwent RC after prior prostatic intervention in our department from 2013 to 2022. A comparison was made between patients receiving neobladder reconstruction (ONB) versus ileal conduit, including propensity score matching for age and preoperative continence.

Results: We included 79 patients who underwent RC for bladder cancer after prior prostatic intervention. Of them, 43 (54%) patients had previously undergone BPH surgery, 29 (37%) radical prostatectomy, and 7 (9%) prostate radiation therapy. An ileal conduit was performed in 62 (78%) cases. Patients presented similar baseline characteristics, perioperative complications, and quality of life after RC. Accordingly, after propensity-score-matching patients with ONB after prior prostatic intervention and patients who received ONB without prior prostatic intervention did not differ significantly in their baseline characteristics, perioperative complications, and quality of life. Overall, 24% of patients without prior intervention reported incontinence, compared to 53% with prior prostatic intervention.

Conclusion: Neobladder reconstruction remains to be a feasible option in patients undergoing RC after prior prostatic intervention.