How is cystoprostatectomy performed during a radical cystectomy?

Updated: Nov 27, 2016
  • Author: Michael Christopher Large, MD; Chief Editor: Bradley Fields Schwartz, DO, FACS  more...
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Answer

The distal ureters are mobilized, taking care to preserve the periureteral tissue that contains the vasculature; they are ligated at the ureterovesical junction; margins may be sent for frozen section. Some groups forego frozen section analysis, as it has not been shown to alter disease recurrence or systemic progression rates. [19] Bluntly enter Denonvilliers space anterior to the rectum and posterior to the bladder, prostate, and seminal vesicles. For lateral pedicles, the first branch of the anterior division of the internal iliac artery (superior vesical artery) is ligated and divided bilaterally; repeat with the inferior vesical artery.

For the posterior pedicles, in multiple steps, divide the tissue that lies laterally to the bladder, seminal vesicles, and prostate. This can be accomplished with clamps and ties or with the gastrointestinal anastomosis (GIA) stapler. At this point, the bladder and proximal prostate should be mobile. Bluntly open the endopelvic fascia on the lateral edge of the prostate. Turn attention to the apex of the prostate. Partially release the puboprostatic ligaments. Ligate the dorsal venous complex (DVC) proximally and distally. Transect the DVC and control any remaining bleeding with suture ligatures. Transect the urethra, divide the rectourethralis muscle, and remove the bladder, seminal vesicles, and prostate en bloc. If an orthotopic f is planned, frozen sections of the prostatic urethra and prostatic apex are mandatory to exclude disease. Confirm hemostasis. Closed suction drainage of the pelvis is suggested.


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