Gynecologic organ involvement and incidental gynecologic organ neoplasms in female patients with urothelial carcinoma of the bladder undergoing anterior pelvic exenteration in Rajavithi Hospital


  • Keerati Wattanayingcharoenchai Division of Urology, Department of Surgery, Rajavithi Hospital, Bangkok, Thailand
  • Chawawat Gosrisirikul Division of Urology, Department of Surgery, Rajavithi Hospital, Bangkok, Thailand



Female, urothelial carcinoma of bladder, anterior pelvic exenteration, gynecologic organ


Objective: To evaluate the pathological data of the bladder and gynecologic organs obtained from anterior pelvic exenteration and review the incidence of gynecologic organ involvement and primary gynecologic tumor.

Materials and Methods: The clinicopathological data of 70 patients who were diagnosed with bladder transitional cell carcinoma and underwent anterior pelvic exenteration in Rajavithi Hospital between January 2008 and October 2020 were analyzed to examine and determine any correlations.

Results: Thirteen (18.5%) patients had gynecologic organ involvement. This consisted of 4 cases (5.7%) involving the uterus, 7 (10%) involving the vagina, 2 (2.8%) involving the ovaries, and 10 (14.2%) involving the cervix. Female patients with gynecologic organ invasion were more likely to have a high pathological T stage (p < 0.001), and have pre-operative hydronephrosis (p = 0.002). From multivariate logistic regression, pre-operative hydronephrosis was associated with increased risk of gynecologic organ invasion (odds ratio 9.57; 95% confidence interval, 1.86 - 49.18; p = 0.007). There were 23 (32%) female patients incidentally diagnosed with benign gynecologic tumors, specifically 16 (22%) cases of myoma uteri, 7 (10%) of adenomyosis and 4 (2.8%) with ovarian cysts. No patient was diagnosed as having primary gynecologic malignancy.

Conclusions: The incidence of gynecologic organ involvement in female patients who had undergone anterior pelvic exenteration for urothelial carcinoma of the bladder was 18.5%. Pre-operative hydronephrosis was a risk factor associated with increased risk of gynecologic organ involvement. Information from this study may allow better identification of candidates for gynecologic organ sparing surgery.


Antoni S, Ferlay J, Soerjomataram I, Znaor A, Jemal A, Bray F. Bladder Cancer incidence and mortality: a global overview and recent trends. Eur Urol 2017;71:96-108.

Dobruch J, Daneshmand S, Fisch M, Lotan Y, Noon AP, Resnick MJ, et al. Gender and bladder Cancer: a collaborative review of etiology, biology, and outcomes. Eur Urol 2016;69:300-10.

Marshall FF, Treiger BF. Radical cystectomy (anterior exenteration) in the female patient. Urol Clin North Am 1991;18:765-75.

Koie T, Hatakeyama S, Yoneyama T, Hashimoto Y, Kamimura N, Ohyama C. Uterus-, fallopian tube-, ovary, and vagina-sparing cystectomy followed by U-shaped ileal neobladder construction for female bladder cancer patients: oncological and functional outcomes. Urology 2010;75:1499-503.

Djaladat H, Bruins HM, Miranda G, Cai J, Skinner EC, Daneshmand S. Reproductive organ involvement in female patients undergoing radical cystectomy for urothelial bladder cancer. J Urol 2012;188:2134-8.

Salem H, El-Mazny A. A clinicopathologic study of gynecologic organ involvement at radical cystectomy for bladder cancer. Int J Gynecol Obstet 2011;115:188-90.

Chang S, Cole M, Smith Jr J, Cooksin M. Pathologi- cal finding of gynecologic organs obtained at female radical cystectomy. J Urol 2002;168:147-9.

Chen M, Pisters L, Malpica A, Pettaway C, Dinney C. Risk of urethral, vaginal and cervical involvement in patients undergoing radical cystectomy for blad- der cancer: results of a contemporary cystectomy series from M. D. Anderson cancer center. J Urol 1997;157:2120-3.

Huang H, Yan B, Shang M, Liu L, Hao H, Xi Z. Is hysterectomy beneficial in radical cystectomy for female patient with urothelial carcinoma of bladder? A retrospective analysis of consecutive 112 cases from a single institution. BMC Urol 2019;19:28.

Varkarakis IM, Pinggera G, Antoniou N, Constantinides K, Chrisofos M, Deliveliotis C. Pathological review of internal genitalia after anterior exenteration for bladder cancer in women. Evaluating risk factors for female organ involvement. Int Urol Nephrol 2007;39:1015-21.

Cornejo KM, Ricestitt T, Wu C. Updates in staging and reporting of Genitourinary Malignancies. Arch Pathol Lab Med 2020;144:305-19.

NCCN Clinical Practice Guidelines in Oncology. Bladder Cancer. 2017. Available at: Accessed May 1, 2017.

Srilar P, Ramart P, Nualyong C, Soontrapa S, Sujijantararat P, Leewansangtong S, et al. Comparison of 1 year recurrent rate in high-risk of recurrent non-muscle invasive bladder cancer who had received induction course of intravesical BCG after TUR-BT between combination with immediate intravesical mitomycin C and induction course of intravesical BCG alone. Thai J Urol 2012;33:34-42.

Kluth LA, Rieken M, Xylinas E, Kent M, Rink M, Roupret M, et al. Gender-specifc differences in clinicopathologic outcomes following radical cystectomy: an international multi-institutional study of more than 8000 patients. Eur Urol 2013;66:1-7.

Mitra AP, Skinner EC, Schuckman AK, Quinn D, Dorff T, Daneshmand S. Effect of gender on outcomes following radical cystectomy for urothelial carcinoma of the bladder: a critical analysis of 1,994 patients. Urol Oncol 2014;32:52.e1-9.

Rodriguez M, Shoupe D. Surgical Menopause. Endocrinol Metab Clin North Am 2015;44:531-42.

Colditz GA, Hankinson SE, Hunter DJ, Willett WC, Manson JE, Stamfer MJ, et al. The use of oestrogens and progestin and the risk of cancer in post-menopausal women. N Engl J Med 1995;332:1589-93.

Gregg JR, Emeruwa C, Wong J, Barocas DA, Chang SS, Clark PE, et al. Oncologic outcomes after anterior exenteration for muscle invasive bladder cancer in women. J Urol 2016;196:1030-5.

Choi SY, Yoo S, Han JH, Jeong IG, Hong B, Hong JH, et al. Predictors of female genital organ involvement in radical cystectomy for urothelial carcinoma of the bladder: A single-center retrospective analysis of 112 female patients. Int J Surg 2017;47:101-6.

Taylor BL, Matrai CE, Smith AL, Ayangbesan A, Xia L, Golombos DM, et al. Gynecologic Organ Involvement During Radical Cystectomy for Bladder Cancer: Is It Time to Routinely Spare the Ovaries? Clin Genitourin Cancer 2019;17:e209-15.

Montironi R, Lopez-Beltran A. The 2004 WHO classification of bladder tumors: a summary and commentary. Int J Surg Pathol 2005;13:143-53.

Jimenez RE, Gheiler E, Oskanian P, Tiguert R, Sakr W, Wood Jr DP, et al. Grading the invasive component of urothelial carcinoma of the bladder and its relationship with progression free survival. Am J Surg Pathol 2000;24:980-7.

Krüger S, Thorns C, Böhle A, Feller AC. Feller Prognostic significance of a grading system considering tumor heterogeneity in muscle-invasive urothelial carcinoma of the urinary bladder. Int Urol Nephrol 2003;35:169-73.

Ali-El-Dein B, Mosbah A, Osman Y, El-Tabey N, Abdel-Latif M, Eraky I, et al. Preservation of the internal genital organs during radical cystectomy in selected women with bladder cancer: a report on 15 cases with long term follow-up. Eur J Surg Oncol 2013; 39:358-64.

Moursy EES, Eldahshoursy MZ, Gamal WM, Badawy AA. Orthotopic genital sparing radical cystectomy in pre-menopausal women with muscle-invasive bladder carcinoma: a prospective study. Indian J Urol 2016;32:65-70.

Ali-El-Dein B, Abdel-Latif M, Mosbah A, Eraky I, Shaaban AA, Taha NM, et al. Secondary malignant involvement of gynecologic organs in radical cystectomy specimens in women: is it mandatory to remove these organs routinely? J Urol 2004;172:885-7.

Tran L, Antic T, Lastra R. Incidental Gynecologic Tract Neoplasms in Women for Urothelial Carcinoma. Int J Gynecol Pathol 2019;38:97-102.




How to Cite

Wattanayingcharoenchai, K., & Gosrisirikul, C. (2021). Gynecologic organ involvement and incidental gynecologic organ neoplasms in female patients with urothelial carcinoma of the bladder undergoing anterior pelvic exenteration in Rajavithi Hospital. Insight Urology, 42(2), 97–102.



Original article