title: Supra-ampullar cystectomy and ileal neobladder.
abstract: 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.
authors.affiliation: Divisione di Urologia, Università del Piemonte Orientale, Ospedale Maggiore della Carità, Novara, Italy. carlo.terrone@med.unipmn.it <carlo.terrone@med.unipmn.it>
authors.forename: Carlo
authors.initials: C
authors.lastname: Terrone
authors.forename: Francesco
authors.initials: F
authors.lastname: Porpiglia
authors.forename: Cecilia
authors.initials: C
authors.lastname: Cracco
authors.forename: Roberto
authors.initials: R
authors.lastname: Tarabuzzi
authors.forename: Marco
authors.initials: M
authors.lastname: Cossu
authors.forename: Julien
authors.initials: J
authors.lastname: Renard
authors.forename: Roberto Mario
authors.initials: RM
authors.lastname: Scarpa
authors.forename: Salvatore
authors.initials: S
authors.lastname: Rocca Rossetti
mesh_terms: 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