title: Gynecologic-tract sparing extra peritoneal retrograde radical cystectomy with neobladder.
abstract: OBJECTIVE
  We report on a series of female patients with transitional cell carcinoma of the bladder who underwent extraperitoneal retrograde radical cystectomy sparing the female reproductive organs with neobladder creation.
  
  
  METHODS
  14 female patients between the ages of 45 and 72 years who underwent gynecologic-tract sparing cystectomy (GTSC) with neobladder between 1997 and 2002 were retrospectively reviewed. Our surgical technique is also described. Radical cystectomy is accomplished by a retrograde method sparing the uterus, adnexa, vagina and distal urethra. An orthotopic neobladder was constructed using small bowel or sigmoid colon, brought extraperitoneally, and anastomosed to the distal urethra.
  
  
  RESULTS
  Operating time ranged from 4.5 to six hours with a mean of 5.3 hours. Ten patients were able to void satisfactorily while four required self-catheterization for complete emptying of the bladder. Seven patients were continent day and night and another 7 reported varying degrees of daytime and nighttime incontinence. One patient died of metastases and another of pelvic recurrence. There were no urethral recurrences. Patient satisfaction with the procedure was high.
  
  
  CONCLUSIONS
  Gynecologic-tract sparing cystectomy with orthotopic neobladder is a viable alternative in female patients with muscle invasive traditional cell carcinoma of the bladder, providing oncological safety with improved quality of life. Our extraperitoneal technique, which is an extension of our successful experience with retrograde extraperitoneal radical cystectomy in men, minimizes intraoperative complications and simplifies the management of post-operative morbidity with the neobladder.
authors.affiliation: Department of Urology, Bombay Hospital Institute of Medical Sciences, Mumbai, India. jnkulkarni@hotmail.com
authors.forename: Jagdeesh N
authors.initials: JN
authors.lastname: Kulkarni
authors.forename: S Jamal
authors.initials: SJ
authors.lastname: Rizvi
authors.forename: U Purushotthama
authors.initials: UP
authors.lastname: Acharya
authors.forename: K S Shiva
authors.initials: KS
authors.lastname: Kumar
authors.forename: P
authors.initials: P
authors.lastname: Tiwari
mesh_terms: D000368:Aged; D000714:Anastomosis, Surgical; D002295:Carcinoma, Transitional Cell / Q000601:surgery*; D015653:Cystectomy / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006801:Humans; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome; D001743:Urinary Bladder / Q000601:surgery*; D001749:Urinary Bladder Neoplasms / Q000601:surgery*; D014549:Urinary Incontinence / Q000209:etiology