Preoperative Counseling: A Need for Women Undergoing Radical Cystectomy

Neoadjuvant chemotherapy followed by radical cystectomy is currently the standard of care for muscle-invasive bladder cancer, but radical cystectomy and associated urinary tract reconstruction methods can lead to “long-term quality-of-life impairments in functional independence, urinary and sexual function, social and emotional health, body image, and psychosocial stress are often attributed to the urinary diversion.”

Radical cystectomy is a “big operation for women” that differs from the surgery in men, Mary Beth Westerman, MD, an Associate Clinical Professor in the Department of Urology at the Louisiana State University Health Science Center in New Orleans, said.

“Another difference that we have found between men and women when they have their bladders taken out, is women have higher surgical complications and it’s because really a lot of them are vaginal complications … it’s a different surgery that they’re going through,” Westerman said.

While bladder cancer is more common in men, many women “report receiving inadequate preoperative counseling surrounding sexual health issues” that may result from radical cystectomy and urinary tract reconstruction, according to a study authored by Westerman and colleagues.

The study showed that “sexual dysfunction is prevalent following [radical cystectomy] in women and many desire more preoperative counseling, regardless of disease stage or receipt of chemotherapy,” Westerman and colleagues wrote.

“[Sexual function] has been an area that there’s been a lot of push recently to look at, because we really as urologists have not done a great job of counseling women specifically on what happens if I take out your bladder, and maybe I take out half of your vagina? And how is that going to affect your sexual function, your quality of life, how you feel about yourself?” Westerman said. “And I think we’ve pushed more and in the in the urology community [to address this]. At least there’s been a lot more talk about it and a lot more attention on addressing these issues preoperatively.”

Westerman says it’s critical to offer preoperative counseling for women ahead of the surgery, as it can lead to anatomical and functional changes that patients may not anticipate.

“I think the big thing I take from all of it is, don’t make assumptions about your patients. Your female patients, they might be older, that doesn’t mean they’re not interested in having sex or that that their body image isn’t important to them,” she said. “And I think that the psychologic component in the body image changes is again something we’re starting to understand and talk about a little more.”

Beyond preoperative counseling, Westerman says there’s another avenue for improving women’s outcomes.

“As potentially we can modify our surgical techniques, hopefully we can start decreasing some of those complication rates as well,” Westerman said.

She also suggested a resource that can be shared with women who are undergoing the surgery.

“I direct a lot of my patients to the BCAN, which is the Bladder Cancer Advocacy Network…. They have an excellent website with a lot of resources for patients,” Westerman said. “And I try to send all of them there to do some reading and find other patients on there that they can talk to, reach out to, and kind of find a community, which I think is also empowering for them.”

References

Quality of Life After Radical Cystectomy

What Women Want: Radical Cystectomy and Perioperative Sexual Function Educational Needs