Open Access

REVIEW

The role of cystectomy for non-malignant bladder conditions: a review

Julio T. Chong¹, MaryEllen T. Dolat², Adam P. Klausner², Ema Dragoescu³, Lance J. Hampton²

1 Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA
2 Department of Surgery, Division of Urology, Virginia Commonwealth University, Richmond, Virginia, USA
3 Department of Pathology, Virginia Commonwealth University, Richmond, Virginia, USA
Address correspondence to Dr. Adam P. Klausner, Division of Urology, Virginia Commonwealth University School of Medicine, PO Box 980118, Richmond, VA 23298-0118 USA

Canadian Journal of Urology 2014, 21(5), 7433-7441.

Abstract

Introduction: Few studies have adequately addressed the indications, efficacy, and quality-of-life for cystectomy performed for non-malignant bladder conditions. Patients with debilitating non-malignant bladder conditions who have failed all previous conservative therapies may undergo various forms of cystectomy, including partial, simple or radical cystectomy. We provide a review of the current literature and recommendations for cystectomy for various non-malignant bladder conditions.
Materials and methods: A systematic review of MEDLINE was conducted to find prospective and retrospective studies using the keywords "cystectomy", "benign", and "non-malignant". Articles were reviewed and triaged, background articles were added as supplements, leaving a final review of 67 papers.
Results: Data from the final review suggests that common benign indications for cystectomy are interstitial cystitis/painful bladder syndrome (IC/PBS), neurogenic bladder, hemorrhagic/radiation cystitis, infectious diseases of the bladder and miscellaneous conditions of the bladder such as endometriosis and total refractory incontinence. The most common perioperative complications include urinary tract and wound infections. Efficacy of cystectomy in patients with IC/PBS is greater than 80%, while efficacy in patients with neurogenic bladder is greater than 90%. Finally, improved urinary quality-of-life has been demonstrated in patients with neurogenic bladder post-cystectomy.
Conclusion: Cystectomy for non-malignant conditions can be considered for patients who have failed previous conservative therapy. The limited data in existence suggests fertility can be adequately preserved after cystectomy in younger males. The data regarding the forms of urinary diversion suggests no significant advantage between any of the major forms of urinary diversion. Finally, while newer pharmacologics and technological advances are widely used in the treatment of various benign urological conditions, their role in preventing or treating refractory benign bladder conditions have not been fully characterized.

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Keywords

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