title: Cystoscopic-assisted partial cystectomy: description of technique and results.
abstract: BACKGROUND
  Partial cystectomy provides oncological results comparable with those of radical cystectomy in selected patients with invasive bladder cancer without the morbidity associated with radical cystectomy and urinary diversion. We describe a novel technique of partial cystectomy that allows accurate identification of tumor margins while minimizing damage to the rest of the bladder.
  
  
  METHODS
  During the study period, 30 patients underwent partial cystectomy for invasive high-grade cancer. In 19 patients, the traditional method of tumor identification was used, ie, identifying the tumor by palpation and cystotomy. In eleven patients, after mobilization of the bladder, flexible cystoscopy was done and the light of the cystoscope was pointed toward one edge of the planned resected ellipse around the tumor, thus avoiding cystotomy.
  
  
  RESULTS
  Patients who underwent partial cystectomy using the novel method were similar in all characteristics to patients operated on using the traditional technique except for tumor diameter which was significantly larger in patients operated on using the novel method (4.3±1.5 cm versus 3.11±1.18 cm, P=0.032). Complications were rare in both types of surgery. The 5-year local recurrence-free survival was marginally superior using the novel method (0.8 versus 0.426, P=0.088). Overall, disease-specific and disease-free survival rates were similar.
  
  
  CONCLUSIONS
  The use of a flexible cystoscope during partial cystectomy is a simple, low-cost maneuver that assists in planning the bladder incision and minimizes injury to the remaining bladder by avoiding the midline cystotomy. Initial oncological results show a trend toward a lower rate of local recurrence compared with the standard method.
authors.affiliation: Department of Urology, Hadassah Hebrew University Hospital, Jerusalem, Israel.
authors.forename: Ofer N
authors.initials: ON
authors.lastname: Gofrit
authors.affiliation: Department of Urology, Hadassah Hebrew University Hospital, Jerusalem, Israel.
authors.forename: Amos
authors.initials: A
authors.lastname: Shapiro
authors.affiliation: Department of Urology, Hadassah Hebrew University Hospital, Jerusalem, Israel.
authors.forename: Ran
authors.initials: R
authors.lastname: Katz
authors.affiliation: Department of Urology, Hadassah Hebrew University Hospital, Jerusalem, Israel.
authors.forename: Mordechai
authors.initials: M
authors.lastname: Duvdevani
authors.affiliation: Department of Urology, Hadassah Hebrew University Hospital, Jerusalem, Israel.
authors.forename: Vladimir
authors.initials: V
authors.lastname: Yutkin
authors.affiliation: Department of Urology, Hadassah Hebrew University Hospital, Jerusalem, Israel.
authors.forename: Ezekiel H
authors.initials: EH
authors.lastname: Landau
authors.affiliation: Department of Surgery, Section of Urology, Montreal, Canada.
authors.forename: Kevin C
authors.initials: KC
authors.lastname: Zorn
authors.affiliation: Department of Urology, Hadassah Hebrew University Hospital, Jerusalem, Israel.
authors.forename: Guy
authors.initials: G
authors.lastname: Hidas
authors.affiliation: Department of Urology, Hadassah Hebrew University Hospital, Jerusalem, Israel.
authors.forename: Dov
authors.initials: D
authors.lastname: Pode
keywords: bladder cancer; cystoscopic-assisted partial cystectomy; partial cystectomy