Williams Cheyenne, Talwar Ruchika, Ramchandani Parvati, Smith Ariana L
Division of Urology, Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
Department of Urology, Vanderbilt University Medical Center, Nashville, TN, USA.
World J Urol. 2025 Sep 17;43(1):559. doi: 10.1007/s00345-025-05918-5.
The effect of radical cystectomy (RC) on female pelvic floor support remains poorly understood; we aim to characterize the prevalence and severity of pelvic organ descent beyond the pubococcygeal line (PCL) in women who have undergone RC.
We retrospectively reviewed charts of women who underwent RC at our institution from 2017 to 2020. Using cross-sectional static imaging we measured pelvic organ position preoperatively, postoperatively, and throughout the surveillance period, as determined by intestinal position in relation to the PCL on sagittal images obtained in the supine position. Imaging review protocol was developed in collaboration with an expert genitourinary radiologist. We also recorded relevant covariates, including age, race/ethnicity, BMI, vaginal parity, pre-cystectomy prolapse, prior hysterectomy, constipation, and chronic cough.
We identified 48 women with ≥ 1 preoperative and ≥ 1 postoperative scan who underwent RC at our institution out of a total of 80 female cystectomies in the study period. The majority underwent ileal conduit (83%) and non-organ sparing RC (81%). Median pelvic organ proximity to the PCL was significantly closer pre-operatively at 2 mm (IQR: -4, 6) below the PCL versus post-operatively at 14 mm (IQR: 9, 20) (p < 0.001). On scans with maximum organ descent, 96% of patients had increased organ descent from baseline. Median time to maximum descent was 9 months (IQR 3.8, 19.1). Patients undergoing continent diversions had greater post-operative descent than those with incontinent diversions. Vaginal deliveries were independently significantly associated with longer pelvic organ descent beyond the PCL (exp. β = 1.87 [95% CI: 1.21, 2.88; p = 0.009]).
We describe the novel use of pre- and post-operative surveillance cross sectional imaging to characterize the natural history of post-RC pelvic floor descent. In our population, 96% of women demonstrate increased pelvic organ descent after RC on supine static imaging. Descent of pelvic floor support is an underappreciated consequence of RC.
根治性膀胱切除术（RC）对女性盆底支持功能的影响仍知之甚少；我们旨在描述接受RC的女性耻骨尾骨线（PCL）以外盆腔器官脱垂的患病率和严重程度。
我们回顾性分析了2017年至2020年在本机构接受RC的女性患者病历。使用横断面静态成像，我们在术前、术后以及整个监测期测量盆腔器官位置，通过仰卧位矢状位图像上肠道与PCL的关系来确定。成像审查方案是与一位泌尿生殖系统专家放射科医生合作制定的。我们还记录了相关协变量，包括年龄、种族/民族、体重指数、阴道分娩次数、膀胱切除术前脱垂情况、既往子宫切除术、便秘和慢性咳嗽。
在研究期间本机构共80例女性膀胱切除术患者中，我们确定了48例术前和术后均有≥1次扫描的接受RC的女性。大多数患者接受回肠导管术（83%）和非保留器官的RC（81%）。盆腔器官与PCL的中位距离术前明显更近，在PCL下方2毫米（四分位间距：-4，6），而术后为14毫米（四分位间距：9，20）（p<0.001）。在器官脱垂最大的扫描中，96%的患者器官脱垂较基线增加。最大脱垂时间的中位数为9个月（四分位间距3.8，19.1）。接受可控改道的患者术后脱垂比不可控改道的患者更严重。阴道分娩与PCL以外盆腔器官脱垂时间延长独立显著相关（指数β=1.87[95%置信区间：1.21，2.88；p=0.009]）。
我们描述了术前和术后监测横断面成像在描述RC后盆底脱垂自然史方面的新用途。在我们的研究人群中，96%的女性仰卧位静态成像显示RC后盆腔器官脱垂增加。盆底支持功能下降是RC一个未得到充分认识的后果。
