Orthotopic bladder replacement to the urethra following salvage radical cystoprostatectomy in men with failed radiation therapy.
OBJECTIVE
Salvage cystoprostatectomy has evolved as a safe and potentially curative treatment option for patients with radiation recurrent bladder cancer. Although orthotopic bladder replacement remains the preferred form of urinary diversion, there is minimal information about its role in salvage cystectomy series. We describe our limited experience in this regard.


METHODS
We evaluated the operative characteristics and outcome of two patients with muscle invasive transitional cell carcinoma (TCC) of the urinary bladder after failed high-dose radiation therapy (mean 6,490 cGy). Both patients underwent salvage cystoprostatectomy with Studer-type ileal neobladder reconstruction. Existing literature on the topic is reviewed.


RESULTS
Final histopathology showed pT3 N0 M0 TCC urinary bladder with no recent evidence of tumor recurrence. There was no mortality or major perioperative complication. Mean surgery time was 590 minutes, and mean blood loss was 1,600 mL, with 3.5 U of packed cell transfusion per patient. Mean length of stay was 15 days. Postoperative complications included urinary tract infection in both cases. Prolonged urinary leakage, metabolic derangements, and loose stools were seen in one case. At a mean follow-up of 17 months, both patients have well-preserved upper tracts, normal renal function, good capacity neobladders, and satisfactory postvoid emptying. Both patients are fully continent.


CONCLUSIONS
Salvage cystoprostatectomy with orthotopic bladder replacement is a safe and effective management option in a select group of radiation recurrent bladder cancer patients.
Department of Surgery, The Aga Khan University Hospital, Karachi, Pakistan.
F
F
Abbas
S R
SR
Biyabani
J
J
Talati
D000328:Adult; D015653:Cystectomy; D006801:Humans; D008297:Male; D011468:Prostatectomy; D017211:Treatment Failure; D014521:Urethra / Q000601:surgery*; D001749:Urinary Bladder Neoplasms / Q000532:radiotherapy / Q000601:surgery*; D014547:Urinary Diversion