Radical cystectomy and orthotopic neobladder in fit octogenarians| JOURNAL OF GERONTOLOGY AND GERIATRICS

Abstract

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 nighttime,
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.