Supra-ampullar cystectomy and ileal neobladder.
OBJECTIVE
This article describes both the open and laparoscopic operative techniques of supra-ampullar cystectomy (SAC).


METHODS
Both open (photographs and drawings) and laparoscopic (attached DVD) SAC are explained step by step.


RESULTS
Between May 1984 and December 2005, 31 patients with bladder tumour underwent SAC with ileal orthotopic neobladder (2 Camey I, 26 Camey II, and 3 Y). Three patients underwent laparoscopy. Preoperatively, 26 patients had superficial high-risk transitional cell carcinoma (TCC). Median follow-up was 95.0 mo (range: 5-260 mo). The 10-yr cause-specific survival rate was 76.7%. Two patients had local recurrence. Potency was preserved in 28 patients (90.3%); 15 patients (48.3%) also maintained antegrade ejaculation, allowing procreation in 3 cases. In one patient the Camey I neobladder was converted into an ileal conduit (high postvoid residual, recurrent pyelonephritis). None of the remaining patients had daytime incontinence, eight had nightime urinary incontinence, and six performed intermittent self-catheterisation.


CONCLUSIONS
SAC with detubularised ileal orthotopic neobladder allows preservation of sexual function and maintenance of urinary continence in most patients, without compromising oncologic outcome. The key element is the very strict and careful preoperative selection of the patients.
Terrone
Carlo
C
Divisione di Urologia, Università del Piemonte Orientale, Ospedale Maggiore della Carità, Novara, Italy. carlo.terrone@med.unipmn.it <carlo.terrone@med.unipmn.it>
Porpiglia
Francesco
F
Cracco
Cecilia
C
Tarabuzzi
Roberto
R
Cossu
Marco
M
Renard
Julien
J
Scarpa
Roberto Mario
RM
Rocca Rossetti
Salvatore
S
D000328:Adult; D000368:Aged; D002295:Carcinoma, Transitional Cell / Q000473:pathology / Q000503:physiopathology / Q000601:surgery; D039021:Colonic Pouches; D015653:Cystectomy / Q000379:methods*; D005500:Follow-Up Studies; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D010410:Penile Erection / Q000502:physiology; D012189:Retrospective Studies; D016896:Treatment Outcome; D001749:Urinary Bladder Neoplasms / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D014563:Urodynamics