Radical cystectomy for infiltrative bladder tumour in male patients

Abstract

Introduction: Radical cystectomy represents the elective treatment of infiltrative bladder tumour consisting in the ileo-pelvic lymphodissection followed by the urinary bladder, prostata and seminal vesicles extirpation. Materials and methods: In the Urology Department of "Fundeni" Hospital - Bucharest over 1,200 radical cystectomies have been performed. The technique consists in the isolation / cross-sectioning the urethers in the urinary juxta-vesical region, followed by bilateral ileo-pelvic lymphodissection, the lymphatic tissue being removed from the common iliac vessels, external iliac vessels (up to the inguinal arcade), internal iliac vessels and obturator fossa liberation with the obturator nerve and ligature / cross-section of the obturator vessels. It follows the peritoneal incision between the bladder and the rectum with the decollation of the urinary bladder, prostata, seminal vesicles from the rectum. The tiered ligature of the vascular pedicles is performed. The latero-prostatic endopelvic fascia is incised. Ligature / cross-section of the pubo-urethral ligaments, dorsal venous plexus and the urethra at the apex of the prostate is performed. Results: On a statistic analysis made in 1988, in 630 radical cystectomies, the global death rate was 16,6%. The death rate has been reduced to 0% in cohorts of selected patients (51 patients with cystectomy Ă subtitution cystoplasty). Conclusions: Radical cystectomy represent the optimum modality of treatment for infiltrative bladder tumours. From a “formidable operation for a formidable illness" - Scott, it has become in the hands of some skilled surgeons, an operation of routine with exceptional results.