title: Reconstructive option after radical mutilating surgery in children with genitourinary rhabdomyosarcoma: When sparing the bladder is not an option.
abstract: To present versatile surgical reconstructive techniques and their outcomes in pediatric patients with genitourinary rhabdomyosarcoma.
  
  
  
  We retrospectively analyzed the oncological and urological outcomes of seven patients treated between 1992 and 2014 according to the Cooperative Weichteilsarkom Studiengruppe protocols. Intergroup Rhabdomyosarcoma Study staging: local, six patients; and IV, one patient.
  
  
  
  embryonal, five patients; unclassified, one patient; triton tumor one patient. Surgical treatment included: cystectomy, uterectomy and partial vaginectomy, one patient; radical cystectomy, two patients; cystectomy, one patient; cystectomy with partial prostatectomy, one patient; partial cystectomy, one patient; and partial prostatectomy, one patient.
  
  
  
  All patients were alive in complete remission at last follow up. In four cases, ileal conduit with ureteral reimplantation with serous-lined extramural tunnel (Abol-Enein technique) was carried out, which was followed by conversion into ileal continent bladder with continent appendiceal stoma for clean intermittent catheterization in three patients. In one boy, partial cystectomy and continent reconstruction was carried out during a single surgical procedure. One child with incontinent urinary diversion is still awaiting a continence solution. One child after partial prostatectomy is continent without any voiding disturbances.
  
  
  
  The timing and extent of radical surgery for treatment of genitourinary rhabdomyosarcoma depend on the local anatomical conditions, and the response to previous chemo- and radiotherapy. Cystectomy followed by various reconstructive techniques still remains an important option in the local treatment.
authors.affiliation: Department of Surgery and Urology for Children and Adolescents, Medical University of Gdansk, Gdansk, Poland.
authors.forename: Leszek
authors.initials: L
authors.lastname: Komasara
authors.affiliation: Department of Pediatrics, Hematology and Oncology, Medical University of Gdansk, Gdansk, Poland.
authors.forename: Joanna
authors.initials: J
authors.lastname: Stefanowicz
authors.affiliation: Department of Surgery and Urology for Children and Adolescents, Medical University of Gdansk, Gdansk, Poland.
authors.forename: Anna
authors.initials: A
authors.lastname: Bryks-Laszkowska
authors.affiliation: Department of Surgery and Urology for Children and Adolescents, Medical University of Gdansk, Gdansk, Poland.
authors.forename: Andrzej
authors.initials: A
authors.lastname: Gołębiewski
authors.affiliation: Department of Surgery and Urology for Children and Adolescents, Medical University of Gdansk, Gdansk, Poland.
authors.forename: Piotr
authors.initials: P
authors.lastname: Czauderna
mesh_terms: D002648:Child; D015653:Cystectomy; D006801:Humans; D008297:Male; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000601:surgery; D019651:Plastic Surgery Procedures; D012208:Rhabdomyosarcoma / Q000601:surgery*; D001749:Urinary Bladder Neoplasms / Q000601:surgery*; D014547:Urinary Diversion; D016476:Urinary Reservoirs, Continent
keywords: bladder/prostate tumors; cystectomy; genito/urinary tract; reconstructive surgery; rhabdomyosarcoma