When the patient develops an aggressive cancer which was invading into the bladder wall, it was required to remove the whole bladder as well as nearby lymph nodes. In male patients, the operation may also involve removing of the prostate gland. In female patients, the uterus, fallopian tubes and ovaries were generally removed. Patients without a bladder can still produce the urine. In some patients a “neobladder” will be built by using their own intestines. This procedure was called as Radical Cystectomy with NeoBladder.
OPEN RADICAL CYSTECTOMY WITH NEOBLADDER:
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This procedure will closely mimics the storage and function of a urinary bladder.
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In this procedure, a small part of the small intestine was made into a pouch or reservoir, which was connected to the urethra.
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The ureters was repositioned to drain into this provided pouch. With the Indiana Pouch, the descending flow of the urine from kidneys to the pouch will helps to prevent urine back up, this helps to guard the kidneys from the infection.
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Urine will be pass from the kidney, then to the ureters, after to the pouch, and by the urethra in a similar manner to the normal passing of the urine.
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There will be a very low risk of the cancer recurrence in the urethra, & patients were able to pass catheter in the urethra to empty this pouch if it was necessary.
LAPROSCOPIC RADICAL CYSTECTOMY WITH NEOBLADDER:
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We used the ligasure system, plastic and metal clips, harmonic scalpel, bipolar scissors to dissector cut the tissue & ligation of vessels.
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After identification of the ureters, start with the dissection of the bladder base, posterior surface of the prostate and seminal vesicles.
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After dissection of Retzius space, incise the pelvic fascia & then followed by dissection of the prostate apex & dissection of the urethra. Obturator, presacral, external, internal, para-aortic, common iliac and paracaval lymph nodes are all dissected for the pathological analysis. The specimen is removed into a silicon bag.
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In females, the method will be started from the dissection of the uterus ligaments & peritoneum in the Douglas cavity. The bladder, uterus, along with urethra, adnexa with anterior vaginal wall & lymph nodes, was also been removed transvaginally.
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Urinary diversions were done via a minilaparotomy procedure with the left ureter carried to the right side under a sigmoid colon mesentery. Ileal neobladders were formed according to the procedure. A 14F drain will be left in the abdominal cavity after the surgery was done.
