Antegrade extraperitoneal approach to radical cystectomy and ileal neobladder

We describe a new operative technique for the surgical treatment of bladder cancer.

Male patients with invasive bladder cancer were managed by radical cystoprostatectomy using a technically different approach than the conventional method. The main feature of this method includes a small vertical incision between pubis and umbilicus, keeping the abdominal peritoneum closed during the surgery. Reperitonealization is done at completion to isolate the urinary anastomoses from the bowel anastomoses.

Seventy-six consecutive patients with bladder cancer underwent this operation. The mean operation time was 4 h 30 min and the mean hospital stay was 11 days. No mortality was seen in the early postoperative period. Only one patient developed serious bowel distension. Two patients developed pneumonia. Wound infection was seen in two patients. Two patients experienced hydronephrosis in the late period of follow-up. Four patients developed pelvic lymphocele. There was no evidence of postoperative electrolyte loss in any of the patients. Three patients developed abdominal hernia and this was corrected with surgical treatment. Urodynamic evaluation of 15 patients showed a low capacity reservoir. All patients were continent during the daytime.

This technique keeps the abdominal peritoneum closed during radical cystoprostatectomy, preventing the patients from complications, such as infection, water and electrolyte imbalances. The technique also decreases the recovery time.