(UroToday.com) At the 2023 AUA Annual Meeting, Dr. Katie Murray presented on the optimization of care of bladder cancer in women. The topic is broader than just the optimization of care. She notes that there are significant gender disparities that need to be addressed (delays in diagnosis, utilization of neoadjuvant chemotherapy, survival outcomes, clinical trial enrollment), but she will also focus on organ-sparing cystectomy, vaginal wall-sparing cystectomy, and sexual function after cystectomy.
Looking at bladder cancer epidemiology, women are still less likely to be diagnosed with bladder cancer than men, which holds true across all racial backgrounds. Despite this, women continue to be diagnosed at a later stage. In order to help counter this, education and understanding of risks are important.
- Understanding unique risk factors is important
- Outcomes and survival rates lag behind men
- Stage for Stage comparisons
- Referrals need to be equal
- Cystoscopies occur later in women
- It's important to remember that LUTS (lower urinary tract symptoms) in women don't always mean a UTI. This often leads to delay in diagnosis.
Why is it important to understand? Because we need to enhance the quality of care for all genders. Additionally, hormones are different and may be impactful. And obviously, the anatomy is different.
She started by focusing on sexual function after radical cystectomy. Sexual dysfunction is a significant quality-of-life issue and a source of symptom induced distress among patients undergoing radical cystectomy for bladder cancer. sexual dysfunction in women's post radical cystectomy is multifactorial and complex - there are issues with body image, psychosocial issues, damage to the neurovascular bundle, devascularization of the clitoris, removal or slash damage of gynecologic organs. Operative decisions (pelvic organ preservation and nerve sparing) can have a significant impact on sexual function in female patients. in addition organ preservation is oncologically safe in select patients (synchronous vaginal/cervical invasion at the tine of RC is rare – 5-6% of cases).
The AUA guidelines touch on this. When it comes to organ preservation, they recommend that for a standard radical cystectomy in women, the bladder, uterus, fallopian tubes, ovaries, and anterior vaginal wall should be removed. However, they note that clinicians should discuss and consider sexual function-preserving procedures for patients with organ-confined disease and absence of bladder neck or urethral involvement. (Grade C recommendation).
- This is not a strong statement but it at least touches on the topic.
In a study by Gupta et al.1, focused on understanding psychosocial and sexual health concerns among women with bladder cancer, patients received significant feedback about the disconnect between their physician and them on sexual function and goals. Similarly, physicians less often talk to female patients about their baseline sexual activity and post-operative sexual health and dysfunction compared to male patients.
As she notes we can definitely do better! our patients should expect it. Ways to help work toward this include:
- work to make pre op education and expectations clear
- continue to increase access to care
- educate our primary care colleagues
- extrapolate results? instead it's better to include more females in clinical trials
- make “radical” cystectomy a historical term
Presented by: Katie S. Murray, DO, Urologic Oncologist, Department of Urology at NYU Grossman School of Medicine, Chief of Urology Service, Bellevue Hospital Center, New York, NY
Written by: Thenappan (Thenu) Chandrasekar, MD – Urologic Oncologist, Associate Professor of Urology, University of California, Davis @tchandra_uromd @UCDavisUrology on Twitter during the 2023 AUA Meeting, April 28 – May 1, 2023.
References: