Retrograde extraperitoneal approach of resection of prostate and bladder to radical cystectomy: 165 cases report

Objective To describe the security and validity of retrograde extraperitoneal approach of resection of prostate and bladder to radical cystectomy. Methods From May 2010 to May 2014, total 165 cases, aged 33–85 years, were treated with retrograde extraperitoneal radical cystectomy. There were 87 cases of Ta–T1,65 cases of T2,and 13 cases of T3–T4;Urinary diversion: 50 cases of Studer orthotopic neobladder, 73 cases of Bricker operation, 42 cases of ureterocutaneostomy. General anesthesia and hip elevation hyperextension were taken, the skin and fascial layers were incised from pubic symphysis to subumbilical incision, extraperitoneal bladder wall and prostate bladder structure were visualized. Pelvic iliac artery lymphadenectomy was performed, followed with bladder artery ligated and incision of pelvic fascia. Both sides of the prostate were dissociated, dorsal vein complex was sutured, prostatic urethra was dissociated and cut off. The indwelling urethral catheter of the apex of the prostate was raised, rectourethral muscle was dissociated and cut off, the bottom and sides of the prostate were dissociated, Denonvillier fascia at the seminal vesicle was incised, the lateral ligament of bladder was separated. LigaSure system was used to cut hemostasis and gradually seperete the prostate and bladder from rectal peritoneum. Regional peritoneum was excised if peritoneal invasion was suspected. Results The amount of operative bleeding was 30–160 ml, average 100 ml; operation time was 45–120 min, average 80 min. Postoperative pathologic results: 157 cases of urothelial carcinoma, 5 cases of adenocarcinoma of bladder, 1 cases of squamous cell carcinoma, and 2 cases of prostate carcinoma invading the bladder; lymph node metastasis was found in 16 cases. The period of follow-up was 3–32 months (median, 13 months). No peritoneal metastasiswas found. Conclusions Ra-dical retrograde extraperitoneal cystectomy is based on a finer knowledge of anatomy and requires accurate dissection. It is safe, effective, and minimally invasive, especially in the neobladder. Key words: Urinary bladder neoplasms; Carcinoma; Radical cystectomy; Retrograde extra-peritoneal approach