Radical cystectomy and orthotopic neobladder in fit octogenarians

B. Calò 1, E. Carvalho-Dias 2, R. Autorino 3

1 Urology and Renal Transplantation Unit, Department of Medical and Surgical Sciences, University of Foggia, Italy; 2 Urology Department, Hospital de Braga ICVS, University of Minho, Braga, Portugal; 3 Division of Urology, Department of Surgery, VCU Health, Richmond, VA, USA

Background and aims. Octogenarians are usually considered poor candidates to orthotopic neobladder after radical cystectomy. Herein we report our experience with feasibility, efficacy and safety of orthotopic neobladder in octogenarians.

Patients and methods. Two 83 year-old patients with muscle invasive urothelial carcinoma were considered eligible for orthotopic neobladder after radical cystectomy. Their cognitive status was excellent; no serious comorbidities. Follow-up consisted of chest/abdomen computed tomography every six months for three years, then yearly. Urinary continence was assessed recording day-time and night-time used-pad and International Consultation on Incontinence Questionnaire (ICIQ).

Results. Final pathology was high-grade urothelial carcinoma (pT2N0) in patient A and high-grade urothelial carcinoma with neuroendocrine component (pT3N1) plus prostate adenocarcinoma Gleason 3+3 (pT2a) in patient B. No complication occurred. However, patient B progressed (bone metastases) after 3 months and died 7 months after surgery due to the aggressive behaviour of the neuroendocrine tumor. Patient B presented 74 months after surgery with a 3.5 tumor of the left renal pelvis. He refused further surgical treatment and died 13 months later due to metastatic disease. Patient A scored 12 at 3 month ICIQ as he needed 1 pad day-time and 1 night-time but experienced progressive improvement up to full day-time continence and safety liner night-time, scoring 2 at 1-year ICIQ. Early functional outcome was good in patient B who was continent day-time but used 1 pad night-time. His ICIQ score was 6.

Conclusions. Age is not an absolute contraindication to neobladder construction providing adequate cognitive status and absence of major comorbidities.

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