CLINICAL ARTICLE A clinicopathologic study of gynecologic organ involvement at radical cystectomy for bladder cancer Hosni Salem a , Akmal El-Mazny b, ⁎ a Department of Urosurgery, Faculty of Medicine, Cairo University, Cairo, Egypt b Department of Obstetrics and Gynecology, Faculty of Medicine, Cairo University, Cairo, Egypt abstract article info Article history: Received 18 February 2011 Received in revised form 19 May 2011 Accepted 28 July 2011 Keywords: Anterior pelvic exenteration Bladder cancer Female genitalia Radical cystectomy Objective: To report the clinicopathologic analysis of women who underwent radical cystectomy for bladder cancer in Egypt from 1997 to 2005. Methods: Clinicopathologic data for 250 women who underwent radical cystectomy for bladder cancer at 3 centers in Cairo were retrospectively reviewed from hospital charts and pathology sheet records. Cystectomy specimens were evaluated pathologically for involvement of internal genitalia. Results: The uterus was not available for histopathologic examination in 11 specimens; 1 ovary was absent from 18 specimens; and both ovaries were absent from 2 specimens. Uterine involvement was observed in 1 case of transitional cell carcinoma. Benign uterine pathology was detected in 25 cases. All patients had normal ovaries, and the vagina was involved in 11 cases. There was urethral involvement in 10% of patients. Of the 50 patients available for follow-up, 11 had 1 ovary preserved and 2 had the uterus plus both ovaries preserved. None of them experienced late ovarian or uterine recurrence. Conclusion: Involvement of female internal genitalia in bladder cancer is uncommon. Thus, preservation of these organs in young women undergoing radical cystectomy should be considered in selected cases after careful preoperative assessment. © 2011 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved. 1. Introduction Radical cystectomy is the treatment of choice for muscle-invasive bladder cancer in both sexes [1]. The principle of radical cancer surgery includes resection of adjacent organs when there is a relatively high risk of synchronous or metasynchronous involvement. In women, radical cystectomy implies cystectomy, bilateral pelvic lymphade- nectomy, hysterectomy, bilateral salpingo-oophorectomy, and resec- tion of the upper third of the anterior vaginal wall; consequently, the operation is also termed anterior pelvic exenteration [2]. Involvement of the internal genitalia in women with bladder cancer must be investigated. The data in the literature are scarce, and only a small number of published autopsy studies have included women [2,3]. Furthermore, very few cases of ovarian metastasis due to transitional cell carcinoma (TCC) of the bladder have been reported [4–6]. The aim of the present study was to report the clinicopathologic analysis of women who underwent radical cystectomy for bladder cancer at 3 centers in Cairo, Egypt. 2. Materials and methods Between 1997 and 2005, 250 women underwent open radical cystectomy for bladder cancer at 3 centers located in Cairo: Kasr El- Aini Hospital; French Teaching Hospital; and the National Cancer Institute. All women were diagnosed, treated, and followed-up at these centers. Initial evaluation included diagnostic cystoscopic biopsy or transurethral resection of bladder tumor. Staging was carried out via bimanual examination under anesthesia, chest X-ray, intravenous pyelography, computerized tomography (CT), and bone scan. No patients underwent preoperative radiation or chemotherapy. After approval was obtained from the local Scientific Research Committee, clinicopathologic data for all 250 patients were retrospec- tively collected from hospital charts and pathologic sheet records. Histopathologic evaluation was routinely performed by at least 2 experienced pathologists. Cystectomy specimens were studied for histologic type, grade, site, stage, and involvement of internal genitalia (ovaries, uterus, and vagina); staging was determined according to the 1997 TNM staging system [7]. Clinical data included age at time of surgery, operative details, type of diversion, and postoperative follow-up. Radical cystectomy included cystectomy, urethrectomy, bilat- eral pelvic lymphadenectomy, hysterectomy, bilateral salpingo- oophorectomy, and resection of the upper third of the anterior vaginal wall. The urethra was preserved in 60 cases—in which orthotopic urinary diversion was offered. The uterus was absent in 9 cases (previous hysterectomy) and preserved in 2 cases, and the ovary was absent on 1 side in 18 cases (previous unilateral oophorectomy or unilateral preservation) and preserved on both sides in 2 cases. Fifty patients were available for follow-up—of whom 11 had 1 ovary preserved, 11 had the anterior vaginal wall preserved, and 2 had the uterus, both ovaries, and the vagina preserved. International Journal of Gynecology and Obstetrics 115 (2011) 188–190 ⁎ Corresponding author at: Department of Obstetrics and Gynecology, Faculty of Medicine, Cairo University, Cairo 12411, Egypt. Tel.: + 20 101454576; fax: + 20 223643554. E-mail address: dr_akmalelmazny@yahoo.com (A. El-Mazny). 0020-7292/$ – see front matter © 2011 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved. doi:10.1016/j.ijgo.2011.05.026 Contents lists available at ScienceDirect International Journal of Gynecology and Obstetrics journal homepage: www.elsevier.com/locate/ijgo