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Cystectomy – Technical Considerations in Male and Female Patients

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Presentation on theme: "Cystectomy – Technical Considerations in Male and Female Patients"— Presentation transcript:

1 Cystectomy – Technical Considerations in Male and Female Patients
Arnulf Stenzl, Udo Nagele, Markus Kuczyk, Karl-Dietrich Sievert, Aristotelis Anastasiadis, Joerg Seibold, Stefan Corvin  EAU Update Series  Volume 3, Issue 3, Pages (September 2005) DOI: /j.euus Copyright © 2005 Elsevier B.V. Terms and Conditions

2 Fig. 1 Extent of pelvic lymphadenectomy in malignant disease of Urinary bladder (adapted from Rohen/Yokochi, Color Atlas of Anatomy: A Photographic Study of the Human Body; I. Gaku-Shoin, 1984). EAU Update Series 2005 3, DOI: ( /j.euus ) Copyright © 2005 Elsevier B.V. Terms and Conditions

3 Fig. 2 Sympathetic nerve fibres crossing the left common iliac artery (U: left ureter, CIA: left common iliac artery). EAU Update Series 2005 3, DOI: ( /j.euus ) Copyright © 2005 Elsevier B.V. Terms and Conditions

4 Fig. 3 Stepwise dissection and ligation of the lateral vesicle petical. EAU Update Series 2005 3, DOI: ( /j.euus ) Copyright © 2005 Elsevier B.V. Terms and Conditions

5 Fig. 4 Dissection of the genitorectal space.
EAU Update Series 2005 3, DOI: ( /j.euus ) Copyright © 2005 Elsevier B.V. Terms and Conditions

6 Fig. 5 Shape and location of the urethral rhabdosphincter in correlation to the prostate. EAU Update Series 2005 3, DOI: ( /j.euus ) Copyright © 2005 Elsevier B.V. Terms and Conditions

7 Fig. 6 Dissection of the rhabdosphincter should start midway between the bladder neck and the prostatic apex. EAU Update Series 2005 3, DOI: ( /j.euus ) Copyright © 2005 Elsevier B.V. Terms and Conditions

8 Fig. 7 In order to preserve the autonomic nerves the seminal vesicles must be carefully peeled out from their surrounding tissue (SV: right seminal vesicle). EAU Update Series 2005 3, DOI: ( /j.euus ) Copyright © 2005 Elsevier B.V. Terms and Conditions

9 Fig. 8 Extent of lymphadenctomy in female patients with bladder confined disease: the interrupted line marks the cranial limit of dissection on the right side (AIC: common iliac artery, VIE: external iliac vein, AVS: superior vesical artery). EAU Update Series 2005 3, DOI: ( /j.euus ) Copyright © 2005 Elsevier B.V. Terms and Conditions

10 Fig. 9 Schematic (a) and intraoperative (b) delineation of the incision of the anterior vaginal wall. EAU Update Series 2005 3, DOI: ( /j.euus ) Copyright © 2005 Elsevier B.V. Terms and Conditions

11 Fig. 10 Schematic (a) and intraoperative (b) situation after radical cystectomy: transverse (clam) reconstruction of the vagina and placement of urethral sutures for an orthotopic neobladder. EAU Update Series 2005 3, DOI: ( /j.euus ) Copyright © 2005 Elsevier B.V. Terms and Conditions

12 Fig. 11 Schematic (a) and intraoperative (b) delineation of proximal urethral dissection. For an explanation see text. EAU Update Series 2005 3, DOI: ( /j.euus ) Copyright © 2005 Elsevier B.V. Terms and Conditions

13 Fig. 12 After dissection of the urethra the whole cystectomy specimen is just attached to the proximal urethra. EAU Update Series 2005 3, DOI: ( /j.euus ) Copyright © 2005 Elsevier B.V. Terms and Conditions

14 Fig. 13 Intraoperative inspection (on a separate table) to ensure removal of the entire bladder neck and a small segment of the urethra. EAU Update Series 2005 3, DOI: ( /j.euus ) Copyright © 2005 Elsevier B.V. Terms and Conditions

15 Fig. 14 Schematic drawing (a) and anatomic specimen (b) delineating the autonomic nerves to the bladder neck and urethra. EAU Update Series 2005 3, DOI: ( /j.euus ) Copyright © 2005 Elsevier B.V. Terms and Conditions


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