THE USE OF NEOBLADDERS IN WOMEN UNDERGOING CYSTECTOMY FOR TRANSITIONAL-CELL CANCER

Recent studies have provided us with new insights into the natural his tory of female bladder cancer as well as the behaviour of the isolated urethra after cystectomy. Based on more than 16 years of experience w ith orthotopic lower urinary tract reconstruction to the urethra in me n, a similar approach was attempted in women with transitional-cell ca ncer of the bladder. Refinements in the technique of cystectomy and su bsequent intestinourethral anastomosis based on anatomical, histologic al, and clinical studies are described that should improve postoperati ve results in women undergoing anterior exenteration and creation of a n orthotopic neobladder to the urethra. Our findings in a series of 11 patients are presented and compared with data from other institutions . Improved postoperative continence and micturition without compromise of the oncological outcome may be a result of preservation of the ent ire lateral vaginal walls, nerve-sparing dissection of the bladder nec k and proximal urethra, removal of 1 cm of proximal urethra en bloc wi th the cystectomy specimen, and a J-omentum flap or an additional atta chment of the anastomosed intestinal pouch to surrounding pelvic struc tures. Taken together, our average of 90% daytime and 73% nighttime co ntinence, 90% spontaneous residual-free micturition, and 100% patient satisfaction without compromise of the surgical oncological outcome se ems to justify the creation of an orthotopic neobladder in selected wo men with bladder cancer.