Incidence and risk factors for postoperative vaginal events following radical cystectomy for bladder cancer: a nationwide population‐based study

Objective To estimate the probability of vaginal events (diagnosis and/or surgery) following radical cystectomy (RC) and explore possible risk factors in a nationwide population‐based observational registry based study. Patients and Methods Women undergoing RC for urinary bladder cancer in Sweden, from 1 January 1997 to 31 December 2019, were identified within national registries. Women with any postoperative vaginal event (PVE), either a diagnosis or surgical repair related to a vaginal complication, were identified using diagnostic and treatment codes. The probability of developing a PVE was estimated based on the cumulative incidence proportion using a competing risk model. Additionally, a multivariable Cox proportional hazards model was used to explore the risk factors for PVEs. Subgroup analysis was performed in patients operated from 2011 to 2019, where additional perioperative variables were registered. Results The study encompassed 1914 women with a median age of 69 years at the time of bladder cancer diagnosis. The 5‐year cumulative risk of PVEs in the entire cohort was 11% (95% confidence interval CI 9.5–12.5%). Subgroup analysis showed that robot‐assisted RC and a body mass index (BMI) >30 kg/m 2 were more often associated with PVEs after RC (hazard ratio HR 2.82, 95% CI 1.81–4.40; and HR 1.71, 95% CI 1.05–2.79, respectively). Conclusions A clinically relevant cumulative incidence of PVEs following RC was identified. An association between robot‐assisted RC or high BMI with increased risk of a PVE indicate the need for further studies on risk assessment of vaginal complications.