Retrograde radical cystectomy. Advantages of our "vesico-rectal tunnel" method

Abstract

The facilitation of dissecting the vesical pedicles and undisturbed preservation of the membranous urethra were investigated during radical cystectomy using the retrograde technique. First, just as with radical prostatectomy, the prostate and the rectum were separated by blunt digital dissection. After the deep dorsal vein complex and the urethra were cut, the bladder and the rectum were also separated in a retrograde manner towards the Denonvillier's fascia. Then the peritoneum was opened and its lowest part was incised above the cul-de-sac. A tunnel was made beginning at the cut-end of the urethra to the cul-de-sac. Consequently, the bladder was lifted up by hand inserted this "vesico-rectal tunnel" and the bilateral remaining lateral pedicles were ligated and transsected without difficulty. Fourteen patients underwent radical cystectomy using this technique. Among them, the average operating time and blood loss in 4 patients received retrograde radical cystectomy accompanied with ileal conduit were 5 hours 15 minutes and 1606 ml, respectively. These in 9 patients received retrograde radical cystectomy followed by bowel orthotopic urinary reservoir were 7 hours and 6 minutes and 1086 ml, respectively. Another patient received ureterocutaneoustomy. Creating a "vesico-rectal tunnel" during radical cystectomy primarily by the retrograde extraperitoneal technique can afford to preserve the urethral sphincter and to ligate the pedicles easily. This method is fundamentally familiar to us because retrograde radical prostatectomy is now widely adopted and it may help to reduce the operating time even when there is a shortage of manpower.