Detailed functional results after bladder-preserving surgery and high-dose-rate brachytherapy in pediatric bladder/prostate rhabdomyosarcoma

Abstract

Purpose: In pediatric bladder/prostate-rhabdomyosarcoma, the rate of bladder preservation after neoadjuvant chemotherapy is high, with an excellent oncological outcome. Information about functional urological long-term outcomes is rare.

Methods: Data of all patients who had undergone bladder-preserving surgery with or without brachytherapy at our institution between 2009 and 2020 were analyzed retrospectively. Detailed urological function was assessed focusing on age-related continence, bladder capacity and urodynamic findings.

Results: We identified 40 patients, median age at surgery of 27 months (range 9-191), and 32 patients additionally received postoperative high-dose-rate brachytherapy. The median follow-up was 32.5 months (range 6-125). The bladder capacity increased from median 66.7% (21.1-180) of expected bladder capacity related to age 3 months after surgery to 87.4% (58.1-181.8) 9 months after surgery. In the group of aged > 6-year-old, continence was 94% (83% with brachytherapy, 100% without brachytherapy). Erectile function was normal in 92% (90% with brachytherapy, 100% without brachytherapy). Bladder capacity was more than 65% expected bladder capacity related to age in 70% (60% with brachytherapy, 86% without brachytherapy). 65% of all patients need neither anticholinergic drugs nor low-dose antibiotics (63% with brachytherapy, 71% without brachytherapy).

Conclusions: Bladder preservation with good functional outcome can be achieved in localized bladder/prostate-rhabdomyosarcoma. In selected cases, supportive brachytherapy additionally contributes to an improvement in the oncological outcome with calculable risks for bladder and erectile function. Careful urological aftercare should be a fixed priority after oncological follow-ups.

Keywords: Bladder reconstruction; Bladder sparing surgery; Bladder-preserving surgery; Brachytherapy; Functional outcome; Pediatrics; Rhabdomyosarcoma; Urodynamics.

Fig. 1

BC in relation to EBCA (BC/(30 × [age + 1])*100) at last follow-up. The dotted line indicates the limit below which children are considered to have decreased bladder capacity compared to estimated bladder capacity for their age (65% EBCA).) There was no significant difference between the groups (BPS + BT: 72.8% (21–200) vs. BPS: 78.7% (50.9–254.1); p = 0.601, Mann–Whitney U test)

Fig. 2

Median rate of BC related to EBCA. The dotted line is the limit below which children are considered to have decreased bladder capacity compared to estimated bladder capacity for their age (65% EBCA). There was an initial increase from median 66.7% (21.05–180) after 3 months to 79.1% (34.1–254.1) after 6 months, and to 87.4% (58.1–181.8) 9 months after surgery. Then it decreased again to 82.4% (41.0–134.2) 12 months after surgery and to 79.6% (36.8–200.0) 18 months and to 74.0% (44.2–126.7) > 24 months after surgery. The variation of the median values was not significant (p = 0.41, Kruskal–Wallis test). There was no significant difference between the two groups (graphs not shown)

Fig. 3

Compliance of patients with UD. Black line with dots—100% EBACom, gray line with dots—65% EABCom. Triangles show patients of BPS + BT group, Squares show patients of BPS group. Most patients improve at time with anticholinergic drugs. Deterioration of Pt. 35 was due to lack of drug adherence