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