Indications and results of total cystectomy to the Luxembourg University Teaching Hospital in Bamako

Abstract

Introduction: Total cystectomy is the gold standard treatment for non-metastatic high-grade infiltrating bladder tumours, as well as for superficial tumours that have resisted treatment with immunotherapy or endovesical chemotherapy. The aim of this study was to determine the indications and results of total cystectomy in the urology department of CHU Le Luxembourg.

Patients and methods: This was a retrospective, descriptive study from January 2017 to December 2022 (6 years), conducted in the urology department of CHU Le Luxembourg, involving 38 patients operated on for total cystectomy.

Results: 38 patients were studied out of 833 operated patients, representing a frequency of 4.6%. The sex ratio was 2.5 in favour of women; the average age was 50.2 ± 13,3 years, with extremes ranging from 27 to 77 years. Total cystectomies were all performed in oncological contexts, including 94.7% MIBC. The risk factor (FDR) by excellency was urinary bilharziasis. Anterior pelvectomy was performed in 71% of cases, and Bricker-type urinary diversion in 63.2%. Squamous cell carcinoma of the bladder, pT3No stage and Grade II were the most common at 71%, 36.8% and 50% respectively. Early postoperative mortality was 18.4%, Grade I and II postoperative complication according to the CLAVIEN-DINDO classification was estimated at 44.7% of cases. There were 5 cases of distant recurrence. At 6 months post-op, 52.6% of patients reported satisfaction. Erectile function was absent in all male subjects. The 3-year survival percentage was 41,6% according to Kaplan-Meier’s estimate.

Conclusion: Total cystectomy is generally performed in oncological contexts, and the decision must be taken promptly, with strict compliance with the RAAC protocol perioperatively. Obtaining healthy excision margins and rigorous postoperative follow-up are the key to prolonged 5-year survival, given the many complications to which these patients are exposed.