Radical cystectomy with extended lymphadenectomy in the presence of a pelvic kidney

The pelvic kidney represents the most common form of congenital renal ectopia. Because of its location, variable vasculature, and short ureteral length, the presence of a pelvic kidney in a patient undergoing radical cystectomy and pelvic lymphadenectomy creates unique technical challenges for the urologic surgeon. We describe a patient with a right pelvic kidney and invasive bladder cancer for whom radical cystectomy with extended pelvic iliac lymph node dissection and ileal conduit was performed.     

Radical laparoscopic cystectomy

Radical laparoscopic cystectomy is being adopted by most groups with proven experience in laparoscopic surgery, especially by those who have already completed the learning curves in radical laparoscopic prostatectomy. It is still considered a highly complex technique, which has not yet been mastered in many Urology Units. In this article, we review the surgical technique and available literature on this approach, with special emphasis on its indications, advantages and most frequent morbidity.     

Radical cystectomy with ileoneocystoplasty

There were examined 32 patients with cancer of bladder, to whom radical cystectomy with ileoneocystoplasty in the author's modification was performed. Operative intervention was done for the transitional cell carcinoma of bladder in T2-T4 stage. The method of the bladder formation using resection of the ileum segment 40-60 cm in length was adduced. The intestinal segment was transsected along the side opposite to mesentery, the transplant was placed in U-like fashion, the posterior wall of bladder was formed sewing together medial edges, anastomosis between bladder and ureter was performed. In 17 patients postoperative complications had occurred, mainly of septic-purulent character. Postoperative mortality was 9.4%. Radical cystectomy with ileoneocystoplasty is an effective method of medico-social rehabilitation of patients, which secures restoration of urodynamics of upper urinary ways and urination.     

Radical cystectomy: minimizing operative blood loss with a "stapling technique"

We describe our experience with a surgical technique using the multiple fire Endo-GIA-30-3.5 stapler to control the vascular pedicles during radical cystectomy. This technique was performed in 16 radical cystectomies, including three pelvic anterior exenterations for female invasive bladder carcinoma, and compared with 23 cases treated with the conventional method. It was associated with a significant decrease in the intraoperative and postoperative blood loss and a shorter operative time.     

Radical cystectomy and adjuvant chemotherapy

Seventy-one radical cystectomies were performed at the University of Tennessee from June, 1976, through December, 1983. The operative mortality rate was 1.5 per cent. The early and late complication rate was 21 and 15 per cent, respectively. Single agent cisplatin was used as adjuvant chemotherapy in patients at high risk for development of metastatic disease and did not alter the poor survival of this group of patients.     

Radical cystectomy in regionally advanced bladder cancer.

The distinction pathologically of invasive tumors confined to the muscularis propria from those that penetrate the bladder wall and invade the perivesical fat or adjacent organs is a critical prognostic determinant. Nodal metastases are evident in approximately one half of patients with tumors pathologically staged as P3b or greater. Five-year survival rates after radical cystectomy with or without preoperative irradiation for stage P3b tumors range from 17% to 46%. Long-term survival is the exception when bladder cancer invades the pelvic sidewall or adjacent structures, yet cystectomy can provide palliation and accurate staging and can be considered in the context of combination therapy. Supravesical diversion can provide palliation when there is nodal disease above the bifurcation or pelvic fixation. The optimal role of adjuvant chemotherapy in the treatment of regionally advanced bladder cancer is yet to be defined. Tannock has delineated the many serious pitfalls inherent in interpreting nonrandomized trials of new therapies (see also his article elsewhere in this issue). Randomized trials are currently under way to determine if survival can be improved with adjuvant or neoadjuvant chemotherapy and the most efficacious timing of chemotherapy administration. Clinicians should generally resist the tendency to treat all patients with these regimens until it is clear that we are truly improving the outcome of therapy and the quality of life for our patients.     

Radical cystectomy in septuagenarian patients with bladder cancer

Introduction: Clinical results of radical cystectomy performed on elderly bladder cancer patients over 70 years old were assessed to determine whether age is one of the critical points for the application of this type of surgery. Materials: From January 1992 to December 2002, 41 radical cystectomy performed in septuagenarian population were compared with 197 performed in patients less than 70 years of age. Results: The early and late complication rate for septuagenarians was 29.7% and 12%, compared with 26.9% and 9.6% for patients younger than 70 years respectively. The overall mortality rate for septuagenarians was 4.9%, compared with 8.6% for patients younger than 70 years. There was no significant difference between the two groups with regard to pathologic stage or length of hospital stay. The 5-year overall survival rate for septuagenarians was 53% compared with 59% for patients younger than 70 years. Conclusions: When indicated after adequate preoperative assessment and optimization of the patient, radical cystectomy is a safe procedure in the septuagenarians and patient should not be denied surgery dependent on chronologic age.