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Related Experiment Videos

Laparoscopic radical cystoprostatectomy with bilateral nephroureterectomy: initial report.

Ryan K Berglund1, Surena F Matin, Mihir Desai

  • 1Section of Laparoscopic and Minimally Invasive Surgery, Urological Institute, Cleveland Clinic Foundation, Cleveland, OH 44195, USA.

BJU International
|December 13, 2005
PubMed
Summary

This study reports the first entirely laparoscopic radical urotheliectomy for bladder cancer in patients with end-stage renal disease (ESRD). The complex procedure involved radical cystoprostatectomy and bilateral nephroureterectomy, demonstrating feasibility in select ESRD patients.

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Area of Science:

  • Urology
  • Surgical Oncology
  • Nephrology

Background:

  • Organ-confined, muscle-invasive transitional cell carcinoma (TCC) of the bladder presents treatment challenges, particularly in patients with end-stage renal disease (ESRD).
  • Radical cystoprostatectomy and bilateral nephroureterectomy are standard treatments for advanced bladder cancer, but their application in ESRD patients requires careful consideration.

Purpose of the Study:

  • To describe the surgical experience and outcomes of laparoscopic radical cystoprostatectomy and bilateral nephroureterectomy in two patients with dialysis-dependent ESRD.
  • To evaluate the feasibility and safety of a minimally invasive approach for radical urotheliectomy in this specific patient population.

Main Methods:

  • Two male patients (aged 77 and 65) with muscle-invasive TCC and ESRD underwent a staged laparoscopic procedure.

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  • The surgery included bilateral pelvic lymphadenectomy, radical cystoprostatectomy, and bilateral nephroureterectomy, with meticulous attention to maintaining urothelial integrity.
  • Specimens were removed en bloc through a Pfannenstiel incision.

    • Main Results:

    • The laparoscopic radical urotheliectomy was technically successful in both patients, with no intraoperative complications.
    • Operative times were lengthy (573 and 660 minutes) with significant blood loss (350 and 1000 mL).
    • One patient experienced a prolonged ileus and catheter infection, while the other had a shorter recovery.

    Conclusions:

    • This case series represents the first report of an entirely intracorporeal laparoscopic radical urotheliectomy (including pelvic lymph node dissection, cystoprostatectomy, and nephroureterectomy) in patients with ESRD.
    • Laparoscopic radical urotheliectomy may be a feasible option for carefully selected ESRD patients with muscle-invasive bladder cancer.
    • Further research is warranted to establish the long-term oncological and functional outcomes.