Laparoscopic radical cystectomy combined with bilateral nephroureterectomy and specimen extraction through the vagina

Radical cystectomy is the gold standard for muscle-invasive urothelial carcinoma of the bladder because this operation provides excellent local cancer control. Laparoscopic radical cystectomy with different urinary diversions has been reported since 1992 and proposed as an alternative to open radical cystectomy. However, the reconstruction part of the operation is time-consuming and challenging. For a patient already under dialysis, concomitant radical cystectomy with bilateral nephroureterectomy could obviate the need to create urinary diversion and treat upper urinary tract tumors at the same time. Generally the specimen has to be removed through a mini-laparotomy. But for female patients, specimen extraction through the vagina has been reported to be safe and efficient. Thus, patients with multiple comorbidities can benefit from the avoidance of mini-laparotomy. Herein, we present a 65-year-old female with invasive urothelial carcinoma of the urinary bladder and end-stage renal disease who underwent laparoscopic radical cystectomy combined with bilateral nephroureterectomy, where the specimen was extracted transvaginally.