Orthotopic neobladder in irradiated patients

Abstract

Salvage cystectomy for the treatment of transitional cell carcinoma following radical external beam radiation therapy is a considerable surgical undertaking. The resulting fibrosis secondary to radiation causes welding of tissue planes, making surgical dissection more difficult. As the experience of urologists has increased over the last few decades, the high operative mortality seen in early experiences with salvage cystectomy has lessened. To define the nature and risk of complications associated with the type of urinary diversion we analyzed the clinical course of 77 patients. The urinary diversion chosen was the ileal conduit in 56 patients and cutaneous ureterostomy in 16. In accordance with literature, continent reservoirs were very limited due to a higher complication rate. Although continent cutaneous diversion, according to the Indiana pouch technique, may be performed safely in highly irradiated patients, orthotopic bladder replacement should still be considered critically.