Laparoscopic radical cystoprostatectomy with bilateral nephroureterectomy: initial report.
OBJECTIVE
To present our experience with laparoscopic radical cystoprostatectomy and bilateral nephroureterectomy for organ-confined, muscle-invasive transitional cell carcinoma (TCC) of the bladder in two patients with dialysis-dependent end-stage renal disease (ESRD).


METHODS
Two men aged 77 and 65 years with organ-confined, muscle-invasive TCC of the urinary bladder and pre-existing dialysis-dependent ESRD underwent laparoscopic bilateral pelvic lymphadenectomy, radical cystoprostatectomy and bilateral nephroureterectomy. Urine spillage was avoided and en bloc urothelial integrity between the bladder and the two renal specimens was maintained throughout the procedure. The intact, entrapped specimens were removed en bloc via a Pfannenstiel incision at the end of the procedure.


RESULTS
The total operative duration was 573 and 660 min, respectively, including repositioning and re-draping between each major step. Blood loss was 350 and 1000 mL, respectively. Both patients tolerated the procedure well and there were no intraoperative complications. The first patient resumed oral intake 3 days after surgery and was discharged home after 5 days. The second patient's course after surgery was complicated by a prolonged adynamic ileus and infection of the catheter placed for continuous ambulatory peritoneal dialysis. He was discharged 28 days after surgery and died from unknown causes at 30 days.


CONCLUSIONS
To our knowledge, this is the first report of radical urotheliectomy, consisting of bilateral pelvic lymph node dissection, radical cystoprostatectomy, and bilateral nephroureterectomy, using entirely intracorporeal laparoscopic techniques.
Berglund
Ryan K
RK
Section of Laparoscopic and Minimally Invasive Surgery, Urological Institute, Cleveland Clinic Foundation, Cleveland, OH 44195, USA.
Matin
Surena F
SF
Desai
Mihir
M
Kaouk
Jihad
J
Gill
Inderbir S
IS
D000368:Aged; D002295:Carcinoma, Transitional Cell / Q000503:physiopathology / Q000601:surgery*; D015653:Cystectomy / Q000379:methods; D006801:Humans; D007676:Kidney Failure, Chronic / Q000503:physiopathology / Q000628:therapy; D010535:Laparoscopy / Q000379:methods*; D008197:Lymph Node Excision / Q000379:methods*; D008297:Male; D009392:Nephrectomy / Q000379:methods; D011468:Prostatectomy / Q000379:methods; D006435:Renal Dialysis / Q000379:methods; D016896:Treatment Outcome; D014513:Ureter / Q000601:surgery; D001749:Urinary Bladder Neoplasms / Q000503:physiopathology / Q000601:surgery*; D013520:Urologic Surgical Procedures / Q000379:methods*