ORTHOTOPIC BLADDER SUBSTITUTION IN WOMEN FOLLOWING CYSTECTOMY FOR BLADDER CANCER - 11/09/11
Résumé |
As a result of the evolution of low-pressure reservoirs derived from various segments of the intestines,10 orthotopic bladder substitution is now a feasible option. The procedure has gained an increasing popularity in men for whom cystectomy was indicated.5, 8, 11, 15 The employment of such procedures in women was lagging, however, because total urethrectomy was considered an integral part of the radical operation. Furthermore, the chances of continence in a woman in whom the bladder neck was removed during cystectomy was questionable. The first clinical attempt was reported by Tscholl et al16 in 1987. Although their one female patient became continent, the authors were skeptical and stated that “from this case, one should not infer that the proximal urethra can ensure continence on its own.”
Three studies provided the scientific basis and paved the way for orthotopic substitution in selected cases in women. The functional study by Hubner et al9 outlined that the continuity of bladder and urethra in the dog is not required for the function of the urethral closure mechanism. The anatomic study by Colleselli and associates4 showed that the preservation of the musculature of the lower two thirds of urethra together with its nerve supply is important for urinary continence in women. Finally, the pathologic studies of Stenzl and coworkers14 identified the subpopulation of patients in whom the urethra may be preserved without an increased risk of local tumor recurrences.
As a result, an increasing number of clinical experiences with orthotopic bladder substitution in women were reported by several groups with uniformly good functional results.7, 12 The author's first case was carried out late in 1994. Since then, the procedure has been employed for another 32 patients.
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| Address reprint requests to Mohamed A. Ghoneim, MD, MD (HON), Department of Urology, University of Mansoura, Mansoura, Egypt |
Vol 24 - N° 1
P. 225-239 - février 1997 Retour au numéro
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- SANDWICH THERAPY
- Stevan B. Streem
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