title: Hybrid procedure using perineal and abdominal approaches for radical prostatocystectomy: initial experience with 16 select cases.
abstract: OBJECTIVE
  To validate the feasibility and implications of a hybrid procedure using perineal and abdominal approaches for a radical prostatocystectomy.
  
  
  METHODS
  Between March 2007 and May 2012, we performed 16 prostatocystectomy and simultaneous urethrectomy under a hybrid procedure using perineal and abdominal approach for advanced bladder cancer. The hybrid procedure was selected in each case, because of prostatic urethra involvement in 13 and prior treatment in 3 (irradiation, radical retropubic prostatectomy, and sigmoidectomy, respectively). Two surgical teams, one responsible for the perineal approach and the other for the abdominal portion, performed the operation.
  
  
  RESULTS
  The median operation time for the prostatocystectomy procedure was 207 minutes and median intraoperative blood loss was 1665 ml. The en bloc removal of the specimen was perfectly performed and no intraoperative difficulties and intraoperative complications such as rectal injury were recognized in all cases. As for postoperative complications associated with the exaggerated lithotomy position, neurologic complications and rhabdomyolysis which could be treated conservately were found in 1 case. Although 5 patients died from distant metastasis, local recurrence was not seen in any of the 16 patients during the follow-up period.
  
  
  CONCLUSIONS
  The hybrid procedure using perineal and abdominal approach for radical prostatocystectomy is a well-organized procedure that can provide good visualization of the surgical structure around the prostate, leading to a reduction in or prevention of local recurrence and surgical complications even in the selected patient.
authors: Department of Urology, Shimane University School of Medicine, 89-1 Enya-cho, 693-8501 Izumo, Japan.
authors: Yozo
authors: Y
authors: Mitsui
authors: Hiroaki
authors: H
authors: Yasumoto
authors: Haruki
authors: H
authors: Anjiki
authors: Chiaki
authors: C
authors: Koike
authors: Naoko
authors: N
authors: Arichi
authors: Takeo
authors: T
authors: Hiraoka
authors: Masahiro
authors: M
authors: Sumura
authors: Satoshi
authors: S
authors: Honda
authors: Mikio
authors: M
authors: Igawa
authors: Hiroaki
authors: H
authors: Shiina
keywords: Bladder cancer; Perineal; Prepubic; Radical cystectomy; Urethrectomy
references: Urol Int. 2009;82(3):306-11
references: 19440019
references: Urology. 1979 Oct;14(4):348-51
references: 494461
references: J Clin Oncol. 2003 Feb 15;21(4):690-6
references: 12586807
references: BJU Int. 2011 Sep;108(6):882-7
references: 21166749
references: BJU Int. 2007 Feb;99(2):465
references: 17313436
references: BJU Int. 2010 Jul;106(1):44-8
references: 20067449
references: J Urol. 1980 Jan;123(1):32-4
references: 7351717
references: J Urol. 2006 Jun;175(6):2054-7
references: 16697802
references: J Clin Oncol. 2001 Feb 1;19(3):666-75
references: 11157016
references: Eur Urol. 2003 May;43(5):489-94
references: 12705992
references: J Urol. 2008 Jul;180(1):121-7
references: 18485392
references: BJU Int. 2011 Sep;108(6 Pt 2):962-8
references: 21917098
references: BJU Int. 2012 Mar;109(6):846-54
references: 21812902
references: J Urol. 1978 May;119(5):601-4
references: 660728
references: J Urol. 2000 Aug;164(2):360-3
references: 10893585
references: Int Urol Nephrol. 2007;39(3):829-31
references: 17063371
references: BJU Int. 2011 Aug;108(4):539-45
references: 21166753
references: J Urol. 1998 Oct;160(4):1376-8
references: 9751357
references: BJU Int. 2011 Feb;107(4):628-35
references: 20883479
references: Urology. 2011 Apr;77(4):976-9
references: 21296400
references: World J Urol. 2002 May;20(1):68-71
references: 12088195
references: Urology. 2006 Apr;67(4):746-50
references: 16566991
references: J Urol. 1997 Jun;157(6):2227-9
references: 9146622