Radical cystectomy (anterior exenteration) in female patients

Abstract

Introduction: Radical cystectomy or anterior exenteration, is the treatment of choice for infiltrative bladder tumours in female patients. Radical cystectomy consists in ileo-pelvic lymphodissection + extirpation of: a), urinary bladder + urethra, b). uterus, ovary, uterine tubes, c). anterior vaginal wall. Materials and Methods: From the radical 1.200 cystectomies performed between 1975-1998, to women, 164 anterior pelvectomies have been made. The female patient in a dorsal decubitus position with the elevator located under the ombilicus. After checking the bladder lesions, liver, ileopelvic and para-aortic adenopathies, the peritoneum is incised at the level of the iliac vessels and the urethers are dissected up to the juxta-vesical level, where are divided. The ligature / cross-sectioning of the lombo-ovarian ligaments and round ligament is practised. The ileo-pelvin lymphodissection is practised. The incision of the recto-vaginal peritoneum is followed by the decollation of vagina from the rectum. The ligature of the vascular pedicles and cross-sectioning, follows. The posterior vaginal wall is transversally incised. Anteriorely the pubo-vesical ligaments and the dorsal vein of the clitoris are ligated and cross-sectioned. Laterally, the lateral walls of the vagina are incised. The urethra is isolated and divided. The operation is ending by the suture of the vaginal anterior wall. Results and Conclusions: Female radical cystectomy may be performed with an acceptable low rate of morbidity and mortality. The operation is the election procedure for multifocal cancer and / or infiltrative in the urinary bladder.