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- Title
Cistectomia radicală retrogradă extraperitoneală.
- Authors
Glück, G.; Domnişor, Liliana; Neagoe, L.; Stoica, R.; Andrei, R.; Filip, A.
- Abstract
Introduction. Radical cystectomy is the main therapeutical procedure for the treatment of invasive bladder tumors. The standard technique requires a transperitoneal approach. In order to reduce morbidity, we have studied the results of extraperitoneal radical retrograde cystectomy with primary ligature of the dorsal vein complex. Surgical technique. Median suprapubic incision of about 15 cm in length. Entering the Retzius space, the peritoneum is dissected off the pelvic walls and the iliac vessels, after cutting the vas deferens. Standard lymph node dissection is performed, ligation and section of the superior vesical artery, isolation and downwards dissection of the ureters to the bladder. The endopelvic fascia is incised laterally to the prostate and the dorsal venous complex is ligated and sectioned. The urethra is sectioned at the apex of the prostate. Ligation and sectioning of the lateral prostatic pedicles, isolation of the seminal vesicles and ligation/ sectioning of the bladder pedicles are performed. The bladder, en-bloc with the prostate and seminal vesicles is dissected off the peritoneum. The urachus can be dissected up to the umbilicus, where it is sectioned. Sectioning of the ureters with frozen section examination of the margins. Results. During December 2009 - September 2010 we performed this procedure on 22 male patients, mean age 65.5 years (54-77). Tumor stadialization: T1 (2), T2 (14), T3 (3), T4 (3); N+ (3); U+ (4). Comorbidities: heart failure (2), hypertension (6), major bundle branch block (3), systemic atherosclerosis (5), aortoiliac l thrombosis (2), thrombosed aortic aneurism (1), common iliac artery aneurism thrombosis (1), chronic bronchitis (1), operated laryngeal cancer (1), stroke (1). We performed the following urinary diversions: orthotopic bladder substitution (6: 5 Camey, 1 Studer), Bricker (2), cutaneous ureterostomy (14). Pelvic lymph nodes dissection: standard 18cases, extensive 1, limited 3 cases. There were not intraoperative complications. Immediate postoperative complications: prolonged lymphatic drainage (2), acute renal failure (1), mean time for radical cystectomy: 2 hours, blood loss: 300-500 ml, mean hospitalization: 15.2 days (7- 25), cutaneous ureterostomy: 13.6 days, Bricker diversion: 12 days, orthotopic bladder substi-tution: 20.6 days. Conclusions. The radical extraperitoneal cystectomy technique maintains the integrity of the peritoneal bag, with early resuming of bowel function; reduces postoperative complications and hospitalization. Extraperitoneal ureterointestinal anastomosis avoids complications related to the procedure. Parietal incision with preservation of the peritoneum decreases the incidence of eventrations.
- Subjects
BLADDER tumors; LIGATURE (Surgery); URETHRA; SEMINAL vesicles; COMORBIDITY; URETERS; TUMOR treatment
- Publication
Romanian Journal of Urology, 2011, Vol 10, Issue 1, p14
- ISSN
1223-0650
- Publication type
Article