title: A modified single mini-incision complete urinary tract exenteration for urothelial carcinoma in dialysis patients.
abstract: OBJECTIVE
  To present our experience with single mini-incision complete urinary tract exenteration (CUTE) for female dialysis patients suffering from urothelial carcinoma (UC).
  
  
  METHODS
  Institutional review board approval was obtained. From 2005 through 2012, 14 female dialysis patients with UC underwent single mini-incision CUTE, in combination with radical hysterectomy and bilateral salpingo-oophorectomy. All were placed in the modified dorsal lithotomy position without repositioning. An infraumbilical midline mini-incision was made. Bilateral nephroureterectomy was first performed entirely extraperitoneally, followed by radical cystectomy with removal of the uterus and ovaries transperitoneally.
  
  
  RESULTS
  All procedures were done successfully without major complications. The median operative time was 242.5 minutes, and estimated blood loss was 500 mL. The median time to oral intake was 2 postoperative days; the median hospital stay was 11 days. Ten patients remained cancer-free at a median follow-up of 46.5 months; six patients were confirmed as having preoperatively undetectable UC or renal cell carcinoma, even after reviewing preoperative computed tomography.
  
  
  CONCLUSIONS
  This modified technique provides a time-saving complete urinary tract extirpation to eliminate preoperatively undetectable malignancy, reduce metachronous recurrences, and avert perioperative complications associated with pneumoperitoneum and repositioning. Good cancer control and early convalescence can mutually be achieved in experienced hands.
authors.affiliation: Division of Urology, Department of Surgery, Kaohsiung Veterans General Hospital, 386 Ta-Chung 1st Road, Kaohsiung 813, Taiwan ; Division of Urology, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan.
authors.forename: I-Hsuan
authors.initials: IH
authors.lastname: Chen
authors.affiliation: Division of Urology, Department of Surgery, Kaohsiung Veterans General Hospital, 386 Ta-Chung 1st Road, Kaohsiung 813, Taiwan.
authors.forename: Jen-Tai
authors.initials: JT
authors.lastname: Lin
authors.affiliation: Division of Urology, Department of Surgery, Kaohsiung Veterans General Hospital, 386 Ta-Chung 1st Road, Kaohsiung 813, Taiwan.
authors.forename: Jeng-Yu
authors.initials: JY
authors.lastname: Tsai
authors.affiliation: Division of Urology, Department of Surgery, Kaohsiung Veterans General Hospital, 386 Ta-Chung 1st Road, Kaohsiung 813, Taiwan ; School of Medicine, National Yang-Ming University, Taipei 112, Taiwan.
authors.forename: Tony
authors.initials: T
authors.lastname: Wu
authors.affiliation: Division of Urology, Department of Surgery, Kaohsiung Veterans General Hospital, 386 Ta-Chung 1st Road, Kaohsiung 813, Taiwan ; Division of Urology, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan ; School of Medicine, National Yang-Ming University, Taipei 112, Taiwan ; Department of Pharmacy, Tajen University, Pingtung 90741, Taiwan.
authors.forename: Chia-Cheng
authors.initials: CC
authors.lastname: Yu
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002295:Carcinoma, Transitional Cell / Q000209:etiology / Q000517:prevention & control*; D003956:Dialysis; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications / Q000628:therapy*; D007680:Kidney Neoplasms / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control*; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods*; D010385:Pelvic Exenteration / Q000379:methods*; D012189:Retrospective Studies; D016896:Treatment Outcome; D014551:Urinary Tract / Q000601:surgery*; D013520:Urologic Surgical Procedures / Q000379:methods