Nerve-sparing radical cystectomy and orthotopic bladder replacement in female patients.
OBJECTIVE
Orthotopic diversion, initially performed solely in men, has now become a viable option in women. Approximately 15 yr ago, at several centres, urethra-sparing cystectomy and orthotopic diversion were initiated in women with bladder cancer. Several studies have since addressed both the oncologic and functional outcomes of this procedure.


METHODS
We describe our surgical technique of cystectomy and orthotopic urinary diversion in female patients, with an emphasis on how we preserve the neurovascular bundle.


CONCLUSIONS
An improved understanding of the anatomic neurovascular and fascial planes related to the rhabdosphincter has facilitated identification of elements needed for orthotopic diversion in female patients. The technique of en bloc anterior exenteration includes the anterior portion of the vagina; however, preservation of the rhabdosphincter and its autonomic nerve supply necessitates specific modifications of the standard operation. The video provides a detailed description of our surgical technique with attention to anatomic details necessary to avoid damage to the proximal urethra and to preserve the autonomic innervation of the rhabdosphincter.
Bhatta Dhar
Nivedita
N
Department of Urology, University of Bern, Bern, Switzerland.
Kessler
Thomas M
TM
Mills
Robert D
RD
Burkhard
Fiona
F
Studer
Urs E
UE
D015653:Cystectomy / Q000379:methods*; D005260:Female; D006801:Humans; D007082:Ileum / Q000637:transplantation*; D008197:Lymph Node Excision; D014182:Transplantation, Autologous; D001743:Urinary Bladder / Q000294:innervation*; D001749:Urinary Bladder Neoplasms / Q000601:surgery*; D014599:Uterus / Q000601:surgery