[Bladder replacement and cancer of the bladder].
Urothelial tumours which infiltrate the vesical muscle or more superficial tumours which resist localised treatment (resection+/-BCG or mytomicin C) should be considered for excision. Excision is successful in female cystectomy and in male radical cystoprostatectomy. For local tumours of the bladder (<T3), this treatment allows for a specific survival of 5 years at 90 % to be obtained. After the excision of the bladder, several types of urinary diversions may be proposed. The replacement neo-bladder by ilioplasty (orthotopic replacement) should be chosen when possible (conservation of the urether). Numerous techniques were proposed. The ilieum would appear to be the segment of the intestine best adapted for this use and of a short segment is preferable (less than 50 cm). For the creation of the neo-bladder it is necessary that the established surgical rules are followed carefully. Pre-operative preparation and post-operative treatment have become easier but must be well respected. Patients have a check-up every 6 months for the first 3 years, then annually, in order to detect possible local or secondary relapses. The correct functioning of the neo-bladder should be verified regularly in order to ensure that the bladder is emptied properly. Continence returns through auto-exercise.
Lebret
T
T
Service d'urologie, hôpital Foch, Suresnes, France. t.lebret@hopital-foch.org, lebret@worldnet.fr
D015653:Cystectomy; D006801:Humans; D001749:Urinary Bladder Neoplasms / Q000601:surgery*; D014547:Urinary Diversion