Worsening Neobladder Incontinence in a Patient on Nivolumab Therapy

A 59-year-old female with a 30 pack-year smoking history presented to the emergency department with hematuria. Cystoscopy and transurethral resection of bladder tumor were performed. Pathology demonstrated high-grade muscle-invasive urothelial carcinoma. Metastatic workup was negative. The patient underwent neoadjuvant cisplatin-based chemotherapy. Radical cystectomy, anterior pelvic exenteration, extended pelvic lymph node dissection, and orthotopic modified Studer ileal neobladder reconstruction were performed. She tolerated the procedure well and was discharged on postoperative day four. Urethral catheter was removed three weeks postoperative. Pathological staging revealed ypT3bN0 disease.