Cystectomy with a vaginal sparing approach may be associated with unique complications specific to the female population. The objective of this study was to estimate the incidence of vaginal complications (defined to include vaginal prolapse, vaginal fistula, dyspareunia, and vaginal cuff dehiscence/evisceration) after cystectomy and to determine risk factors for these complications.
Women 65 or older undergoing cystectomy for any indication were identified by procedural codes in the Medicare Limited Data Set 5% sample from January 1st 2011 to December 31st 2017. Patients experiencing a vaginal complication after cystectomy were compared to those who did not. Demographic and biological factors that could increase likelihood of complications were identified and time to development of complications determined. Cumulative incidence was calculated using Kaplan-Meir estimates. Multivariable cause-specific Cox proportional hazards model assessed risk factors for vaginal complications.
481 women undergoing cystectomy were identified during the study period, 37.2% were less than 70 years old. The majority 378 (79%) had bladder cancer and 401 (83.4%) underwent an incontinent conduit or catheterizable channel diversion. Within two years of cystectomy, 93 patients (19.5%) had one or more complications on record. Vaginal cuff dehiscence had the highest cumulative incidence, occurring in 49 patients (10.2%). Over the entire study period (2011-2017), 102 women (21.2%) were diagnosed with a vaginal complication, and 27 (5.6%) received an intervention.
Among women who undergo cystectomy, vaginal complications occur at rates higher than expected with over 20% of women experiencing a complication and over a quarter of those diagnosed undergoing intervention.
The Journal of urology. 2021 Dec 02 [Epub ahead of print]
Lee A Richter, Oyomoare Osazuwa-Peters, Jonathan Routh, Victoria Handa
Departments of Urology and ObGyn, Division of Urogynecology, MedStar/Georgetown University Medical Center, Washington, District of Columbia., Department of Population Health Sciences, Duke University Medical Center, Durham, North Carolina., Department of Surgery, Division of Urology, Duke University Medical Center, Durham, North Carolina., Department of ObGyn, Division of Urogynecology, Johns Hopkins School of Medicine, Baltimore, Maryland.