Extraperitoneal pelvioscopy in lymph node staging of bladder and prostatic cancer

In view of the inadequate accuracy of radiological investigations, surgical lymphadenectomy is generally the last resort to assess lymph node involvement in bladder and prostatic cancers. Extraperitoneal pelvioscopy is a simple and effective method to avoid such invasive surgery, which is always slightly regrettable to perform purely for staging purposes. The investigation is performed with the patient under low spinal anesthesia via a short iliac incision using an instrument derived from the mediastinoscope. It allows biopsies from the external iliac, internal iliac, common iliac and obturator lymph node chains. We analyzed our results of pelvioscopy in 101 patients (36 prostatic and 65 bladder cancers). Extraperitoneal pelvioscopy, unilateral in 78 and bilateral in 23 cases, corrected the conclusions of the radiological assessment in 39% of the prostatic cancer cases and in 28% of the bladder cancer cases. The specificity and positive predictive value is 100%, sensitivity 84%, negative predictive value 93% and over-all reliability 95%. On the basis of the quality of the results and the low morbidity (5 cases of rapidly resolving lymphorrhea, 1 injury to the external iliac vein and 1 obturator nerve lesion), extraperitoneal pelvioscopy can be considered as a useful complement to the preoperative staging of bladder and prostatic cancer.