Immediate Salvage Radical Cystectomy for Massive Hematuria in Mus cle-Invasive Bladder Cancer: Feasibility, Safety, and Oncologic Outcomes
Abstract:
Objective: This study aimed to evaluate the feasibility, safety, and clinical and oncological efficacy of immediate salvage radical cystectomy in patients with muscle-invasive bladder cancer (MIBC) presenting with massive hema turia and acute anemia (Hb < 8 g/dL).
Materials and Methods: A prospective cohort of 15 patients underwent immediate open radical cystectomy with pelvic lymphadenectomy at the Urology Department of Casablanca University Hospital between January 2022 and December 2024. Preoperative clinical and demographic data, surgical parameters, and postoperative out comes were analyzed. Functional status was assessed using the Karnofsky Performance Scale, ASA classification, Charlson Comorbidity Index, and Clavien-Dindo classification. Oncologic outcomes, including soft tissue surgical margins (STSMs) and cancer-specific survival, were evaluated. Follow-up included clinical, biochemical, and im aging assessments.
Results: All patients were male, with a mean age of 62.8 years and a mean BMI of 28.3. The mean Charlson In dex was 3.6, and the median Karnofsky score was 65.6. Preoperative imaging revealed cT4 (13%), cT3b (47%), and cT3a (40%) disease, with 27% showing lymph node involvement. The mean operative time was 282 minutes, and the mean blood loss was 520 mL. All patients required transfusions (mean: 4.2 units preoperatively, 2.1 units postoperatively). Histopathology showed 93.3% high-grade transitional cell carcinoma and 6.66% squamous cell carcinoma. Positive surgical margins were observed in 20% of cases, with 6.66% STSMs positive. The cancer-spe cific survival rate was 60% at a median follow-up of 26 months.
Conclusion: Immediate salvage radical cystectomy is a feasible and safe intervention for MIBC with massive he maturia, providing life-saving hemostatic control and satisfactory oncologic outcomes. Despite limitations such as a small sample size and short follow-up, this approach is critical for high-risk patients. Further studies are needed to validate these findings.
