SALVAGE RADICAL CYSTOPROSTATECTOMY AND ORTHOTOPIC URINARY-DIVERSION FOLLOWING RADIATION FAILURE

Purpose: Salvage surgery followed by lower urinary tract reconstructio n is a viable therapeutic option for patients in whom definitive radia tion therapy for localized bladder or prostate cancer has failed. Impr ovements in surgical technique and postoperative care have significant ly improved overall outcome. An enhanced understanding of the rhabdoid sphincteric mechanism responsible for maintaining urinary continence following cystoprostatectomy has helped make the orthotopic neobladder the procedure of choice for patients requiring lower urinary tract re construction. We describe our experience with salvage surgery and orth otopic bladder substitution following failed radical radiation therapy . Materials and Methods: We evaluated the complications of 18 patients in whom definitive radiation therapy (total minimum dose 60 Gy. or gr eater) for bladder or prostate cancer had failed. All patients underwe nt a salvage procedure with creation of an orthotopic neobladder. Resu lts: Operative characteristics, postoperative outcomes and postoperati ve complications related or unrelated to urinary reconstruction were s imilar between irradiated and nonirradiated patients. Good day and nig ht continence following surgery was reported by 67 and 56% of irradiat ed patients, respectively. Patients with poor postoperative continence were successfully treated with the placement of an artificial urinary sphincter. Conclusions: Salvage surgery with orthotopic urinary recon struction is a safe, effective procedure that provides a functional lo wer urinary tract in patients in whom definitive pelvic radiation ther apy has failed.