Female urethra-sparing cystectomy and orthotopic bladder replacement.

Abstract

Orthotopic bladder replacement after cystoprostatectomy has long become the method of choice in the treatment of infiltrating bladder cancer in males. Very good quality of life in patients thus treated stimulated the work on a similar approach applicable to females. Twelve females were treated by urethra-sparing cystectomy. The surgical technique preserves not just the urethra itself but also the pelvic floor and relevant innervation. Diurnal continence was achieved in 11 patients, 1 of whom had a so-called hypercontinence with a residual volume of 300 ml. The remaining patient suffered from stress incontinence. The described urethra-sparing radical cystectomy in female patients with a urothelial tumor, with normal pelvic floor and with a low risk of secondary affection of the urethra, permits reconstructing a continent orthotopic neobladder from a detubularized intestinal segment.