Introduction and Objectives: Bladder cancer is characterized by gender-dependent disparities. To further address this issue, we analysed a prospective, multicentre cystectomy registry. Methods: An online database was developed that included patient demographics, intra/perioperative data, surgical data and in-house complications. Results: Four hundred fifty-eight patients (112 [24.5%] women and 346 [75.5%] men) were analysed. Men and women were comparable regarding age (mean 68 years), body mass index (mean 26.5) and the mean Charlson score (4.8). Women had more advanced tumour-stages (pT3/pT4; women: 57.1%; men: 48.1%). The rate of incontinent urinary diversion was higher in women (83.1%) than in men (60.2%) and in a multivariate analysis, the strongest predictors were M+ status (OR 11.2), female gender (OR 6.9) and age (OR 6.5). Women had a higher intraoperative blood transfusion rate. The overall rate of in-house complications was similar in both genders (men: 32.0%, women: 32.6%). Severe (Clavien-Dindo grade >2) medical (women: 6.3%; men: 5.2%) and surgical (women: 21.5%; men: 14.4%) in-house complications, however, were more frequent in women. Conclusions: This multicentre registry demonstrates several gender-related differences in patients undergoing radical cystectomy. The higher transfusion rate, the rare use of orthotopic bladder substitutes and the higher in-house complication rate underline the higher complexity of this procedure in women.

1.
Fajkovic H, Halpern JA, Cha EK, Bahadori A, Chromecki TF, Karakiewicz PI, et al: Impact of gender on bladder cancer incidence, staging, and prognosis. World J Urol 2011;29:457-463.
2.
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;69:300-310.
3.
Wolff I, Brookman-May S, May M: Sex difference in presentation and outcomes of bladder cancer: biological reality or statistical fluke? Curr Opin Urol 2015;25:418-426.
4.
Siegel RL, Miller KD, Jemal A: Cancer statistics, 2015. CA Cancer J Clin 2015;65:5-29.
5.
Mungan NA, Kiemeney LA, van Dijck JA, van der Poel HG, Witjes JA: Gender differences in stage distribution of bladder cancer. Urology 2000;55:368-371.
6.
Stenzl A, Cowan NC, De Santis M, et al: Treatment of muscle-invasive and metastatic bladder cancer: update of the EAU guidelines. Eur Urol 2011;59:1009-1018.
7.
Gakis G, Efstathiou J, Lerner SP, Cookson MS, Keegan KA, Guru KA, Shipley WU, Heidenreich A, Schoenberg MP, Sagaloswky AI, Soloway MS, Stenzl A; International Consultation on Urologic Disease-European Association of Urology Consultation on Bladder Cancer 2012: ICUD-EAU International Consultation on Bladder Cancer 2012: radical cystectomy and bladder preservation for muscle-invasive urothelial carcinoma of the bladder. Eur Urol 2013;63:45-57.
8.
Froehner M, Brausi MA, Herr HW, Muto G, Studer UE: Complications following radical cystectomy for bladder cancer in the elderly. Eur Urol 2009;56:443-454.
9.
Lee KL, Freiha F, Presti JC Jr, Gill HS: Gender differences in radical cystectomy: complications and blood loss. Urology 2004;63:1095-1099.
10.
Novara G, De Marco V, Aragona M, Boscolo-Berto R, Cavalleri S, Artibani W, Ficarra V: Complications and mortality after radical cystectomy for bladder transitional cell cancer. J Urol 2009;182:914-921.
11.
Kluth LA, Rieken M, Xylinas E, Kent M, Rink M, Roupret M, et al: Gender-specific differences in clinicopathologic outcomes following radical cystectomy: an international multi-institutional study of more than 8000 patients. Eur Urol 2014;66:913-919.
12.
Scosyrev E, Noyes K, Feng C, Messing E: Sex and racial differences in bladder cancer presentation and mortality in the US. Cancer 2009;115:68-74.
13.
Waldhoer T, Berger I, Haidinger G, Zielonke N, Madersbacher S: Sex differences of ≥ pT1 bladder cancer survival in Austria: a descriptive, long-term, nation-wide analysis based on 27,773 patients. Urol Int 2015;94:383-389.
14.
Scosyrev E, Trivedi D, Messing E: Female bladder cancer: incidence, treatment, and outcome. Curr Opin Urol 2010;20:404-408.
15.
Svatek RS, et al: Evidence-based gender related outcomes after radical cystectomy: results of a large multicenter study. J Urol 2009;181:629.
16.
Mitra AP, Skinner EC, Schuckman AK, Quinn DI, Dorff TB, 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-e9.
17.
Garg T, Pinheiro LC, Atoria CL, Donat SM, Weissman JS, Herr HW, Elkin EB: Gender disparities in hematuria evaluation and bladder cancer diagnosis: a population based analysis. J Urol 2014;192:1072-1077.
18.
Henning A, et al: Do differences in clinical symptoms and referral patterns contribute to the gender gap in bladder cancer? BJU Int 2013;112:66-73.
19.
Aziz A, Madersbacher S, Otto W, Mayr R, Comploj E, Pycha A, et al: Comparative analysis of gender-related differences in symptoms and referral patterns prior to initial diagnosis of urothelial carcinoma of the bladder: a prospective cohort study. Urol Int 2015;94:37-44.
20.
Siegrist T, Savage C, Shabsigh A, Cronin A, Donat SM: Analysis of gender differences in early perioperative complications following radical cystectomy at a tertiary cancer center using a standardized reporting methodology. Urol Oncol 2010;28:112-117.
21.
Lavallee LT, Schramm D, Witiuk K, Mallick R, Fergusson D, Morash C, Cagiannos I, Breau RH: Peri-operative morbidity associated with radical cystectomy in a multicenter database of community and academic hospitals. PLoS One 2014;9:e111281.
22.
Gore JL, Litwin MS; Urologic Diseases in America Project: Quality of care in bladder cancer: trends in urinary diversion following radical cystectomy. World J Urol 2009;27:45-50.
23.
Gore JL, Saigal CS, Hanley JM, Schonlau M, Litwin MS; Urologic Diseases in America Project: Variations in reconstruction after radical cystectomy. Cancer 2006;107:729-737.
24.
Kim SP, Shah ND, Weight CJ, Thompson RH, Wang JK, Karnes RJ, Han LC, Ziegenfuss JY, Frank I, Tollefson MK, Boorjian SA: Population-based trends in urinary diversion among patients undergoing radical cystectomy for bladder cancer. BJU Int 2013;112:478-484.
25.
Schmid M, Rink M, Traumann M, Bastian PJ, Bartsch G, Ellinger J, et al: Evidence from the ‘PROspective MulticEnTer Radical Cystectomy Series 2011 (PROMETRICS 2011)' study: how are preoperative patient characteristics associated with urinary diversion type after radical cystectomy for bladder cancer? Ann Surg Oncol 2015;22:1032-1042.
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