title: [Management of invasive carcinoma of bladder and abdominal aortic aneurysm (AAA); technique of radical total cystectomy and simultaneous AAA repair].
abstract: BACKGROUND
  There is no consensus on the optimal surgical treatment for patients with concomitant invasive carcinoma of bladder and abdominal aortic aneurysm (AAA). We experienced two patients who were treated successfully with simultaneous radical cystectomy and AAA repair. The techniques required for the combined procedure and case reports are discussed.
  
  
  METHODS
  The goal of the one-stage operation was to minimize the risk of graft infection without compromising postoperative morbidity and mortality secondary to carcinoma of bladder. Initially pelvic lymph node dissection and radical cystectomy were performed. We preferred retrograde cyctoprostatectomy because most of the cystectomy procedure can be performed without opening the peritoneal cavity and the extent of the retroperitoneal dissection can be minimal. A single-stoma ureterocutaneostomy was preferable urinary diversion. Urinary diversions which utilize intestine such as ileal conduit or ileal urinary reservoir may cause contamination of a graft with bowel content and should be avoided. Before or after urinary diversion, aneurysmal resection and a bifurcated graft replacement were performed. The replaced graft was wrapped with the aneurysmal wall. The major omentum was mobilized and fixed in front of the graft, thereby serving as a protective barrier of the graft. A Dacron graft which was sealed with rifampicin-bonding gelatin was used to further reduce the risk of graft infection.
  
  
  RESULTS
  Two male patients were treated with the one stage radical cystectomy and AAA repair. Single-stoma ureterocutaneostomy and bilateral ureterocutaneostomy were selected as a urinary diversion. No major postoperative complications, except for paralytic ileus in one case, were observed.
  
  
  CONCLUSIONS
  Our experience and reports of others indicate that radical cystectomy and simultaneous AAA repair can be safely performed with less morbidity than staged operations for the management of concomitant invasive carcinoma of bladder and AAA.
authors.affiliation: Department of Urology, Tokyo Medical and Dental University School of Medicine.
authors.forename: T
authors.initials: T
authors.lastname: Tsujii
authors.forename: T
authors.initials: T
authors.lastname: Iwai
authors.forename: K
authors.initials: K
authors.lastname: Kihara
authors.forename: A
authors.initials: A
authors.lastname: Tosaka
authors.forename: S
authors.initials: S
authors.lastname: Kawakami
authors.forename: H
authors.initials: H
authors.lastname: Masuda
authors.forename: M
authors.initials: M
authors.lastname: Wakui
authors.forename: H
authors.initials: H
authors.lastname: Oshima
mesh_terms: D000368:Aged; D017544:Aortic Aneurysm, Abdominal / Q000150:complications / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation / Q000379:methods*; D002295:Carcinoma, Transitional Cell / Q000150:complications / Q000601:surgery*; D015653:Cystectomy; D006801:Humans; D008197:Lymph Node Excision; D008297:Male; D001749:Urinary Bladder Neoplasms / Q000150:complications / Q000601:surgery*; D014547:Urinary Diversion