[Radical cystectomy. Bladder substitution (in women)].
OBJECTIVE
To report our experience with a series of 10 patients undergoing radical cystectomy with bladder substitution. We were supported by a better knowledge of the female continence anatomical mechanisms and the demonstration of the oncological viability of the urethral remnant.


METHODS
From 1994 to 2002 10 women underwent radical cystectomy with bladder substitution by means of a modified anterior pelvic exanteration; technical modifications to achieve continence preservation are based on: preservation of the distal 2/3 of urethra, pubourethral ligaments and endopelvic fascia, and limitation of lateral vaginal dissection to avoid damage to the striated sphincter innervation. To avoid the neocystocele effect the vagina is fixed to the uterosacral ligaments and to the sacral promontory.


RESULTS
Bladder capacity is 332.9 +/- 35.6 ml with a flow of 17.7 ml/sec. Complete continence wax achieved in 8 patients, the remainder 2 present grade II urinary stress incontinence. All of them empty their neobladder satisfactorily; only one patient needed a bladder re-education program. One bladder fistula and diarrhoea in one patient are the complications to be highlighted.


CONCLUSIONS
The results obtained with orthotopic neobladder in females, achieving a high satisfaction level and quality of life, stimulate us to continue with this technique.
Martínez-Sagarra Oceja
José María
JM
Servicio de Urología, Hospital Universitario Rio Hortega, Valladolid, España.
Amón Sesmero
José Heriberto
JH
Conde Redondo
Consuelo
C
Estébanez Zarranz
Javier
J
Robles Samaniego
Alberto
A
Rodriguez Toves
Antonio
A
Alonso Fernández
Daniel
D
Amo García
Angel
A
D000368:Aged; D015653:Cystectomy / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D001749:Urinary Bladder Neoplasms / Q000601:surgery*; D013520:Urologic Surgical Procedures / Q000379:methods