Do all those organs need to come out? Radical cystectomy is a tough operation. It’s not just removal of the bladder: in men, it includes removing the prostate and seminal vesicles, and in women, it includes removing the anterior vaginal wall, ovaries, uterus, fallopian tubes and urethra.

“This surgery profoundly alters the anatomy and functionality of the genitourinary system,” says Armine Smith, M.D., Director of Urologic Oncology at Sibley Memorial Hospital. “It causes sexual dysfunction in a large number of men and women, and urinary incontinence in those who choose to have an orthotopic replacement of their native bladder.”

Do all those organs need to come out? Investigators at the Brady and the Johns Hopkins Greenberg Bladder Cancer Institute are studying organ preservation during cystectomy. The hope, says Smith, “is to dramatically improve quality of life after surgery for both men and women.”

In a prospective, randomized-controlled study, Smith, with urologists Max Kates, M.D., and Sunil Patel, M.D., will look at preserving the prostate in men with bladder cancer who need radical cystectomy.  The research, Smith says, “will show the extent of the benefit of this surgical modification and allow us to answer the question of who is the best candidate for this type of surgery.”

There is an organ-sparing radical cystectomy for women, as well. “It is a modified surgical technique that preserves some or all gynecologic organs and the urethra,” says Smith. “Preserving these structures improves pelvic support, the endocrine milieu, and sexual function by maintaining vaginal anatomy and minimizing disruption of nerve pathways – but organ and nerve preservation in women is even less studied than in men!”

Smith, who also leads the Women’s Bladder Cancer Program, is taking a multifaceted approach to improving this operation for women. It includes:

• Creating MRI-guided functional maps of the pelvis to allow better nerve preservation during cystectomy, “in collaboration with the pioneers of multiparametric pelvic MRI at the National Cancer Institute, Baris Turkbey, M.D., and Peter Choyke, M.D.,” and
• Designing 3D training models to improve surgical techniques and organ preservation (with Brady urologist Ahmed Ghazi, M.B.B.Ch., M.D.).

“These innovations may revolutionize how we care for women with bladder cancer.”