Purpose: Urinary diversion is an alternative treatment for conditions such
as radiation and interstitial cystitis, neurogenic bladder and severe incon
tinence. The subsequent complication rate may reach 60% due to the retained
nonfunctional bladder. The subsequent cystectomy rate may be as high as 20
% because of pyocystis, hematuria, pelvic pain and rarely bladder cancer. W
e describe simple cystectomy involving bladder removal without the adjacent
structures, avoiding deep pelvic dissection.
Materials and Methods: Ileal conduit or continent diversion and simple cyst
ectomy were performed for crippling bladder symptoms secondary to neurogeni
c bladder, pelvic radiation, hematuria and/or severe incontinence in 12 wom
en and 7 men with a mean age of 63 years. We performed urinary diversion an
d simple cystectomy only when all conservative means of treatment had faile
d. The majority of patients had multiple co-morbidities, previous surgeries
and pelvic radiation. An average of 5 conservative procedures (range 2 to
10) had been done before simple cystectomy. None of these patients had urot
helial malignancy. Simple cystectomy was done concomitantly with urinary di
version in 13 cases and later as a separate procedure in 6 due to complicat
ions of a retained nonfunctional bladder.
Results: Mean followup was 15 months. No mortality was associated with surg
ery. For simple cystectomy only mean operative time was 30 minutes and mean
estimated blood loss was 300 cc. Median time from symptom presentation to
cystectomy was 35 months and mean hospital stay was 7 days. In all cases sy
mptoms were dramatically alleviated. No morbidity was directly attributable
to simple cystectomy.
Conclusions: Simple cystectomy is well tolerated and should be performed at
urinary diversion to avoid later complications of the retained bladder. Te
chnically this procedure is not demanding and is relatively easy to perform
even after previous pelvic radiation.