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Surgical Techniques in Bladder Cancer
Diversion of the urine into the sigmoid colon, ureterosigmoidostomy, Discussion
is not commonly performed in Europe due to the options discussed The technique and technology involved in TURBT are constantly
above. It is a useful technique in developing countries where stoma evolving, and the ‘incise and scatter’ technique that is considered the
bags and catheters are not readily available. Patients are usually ‘gold standard’ of treatment needs to be questioned.
continent, passing a faecal slurry. There are metabolic consequences
and there is a risk of malignancy at the anastomosis site, which seems Meticulous attention to good-quality resection is paramount and
to become significant after 10 years. should be combined with early re-resection where appropriate.
Surgeons should be aware of the evolution of their speciality and
Pelvic Lymph-node Dissection continue to strive to improve their technique using the technology
A radical pelvic lymph-node dissection is regarded as standard practice and knowledge available to them, rather than being satisfied with a
during radical cystectomy. Standard lymphadenectomy involves the flawed technique described decades ago.
skeletalisation of the iliac vessels to the level of the iliac bifurcation.
Extended lymphadencetomy increases the amount of tissue taken, up to Minimally invasive techniques in radical cystectomy will continue to
the level of the aortic bifurcation. Retrospective studies have reported develop, with increasing use of robotic surgery. The use of orthotopic
improved survival in these patients.
36
Localisation studies have shown, bladder reconstruction is likely to be offered to a larger number of
prospectively and retrospectively, that if pelvic nodes are clear, nodes patients as surgeon confidence and patient education improve.
outside the pelvis will be negative.
37
There is a morbidity associated with Radical pelvic lymph-node dissection is a mainstay of radical
lymph-node dissection, ranging from lymphocele in the post-operative treatment, although the extent of the dissection needs to be
period through to significant limb lymphoedema. Further studies are balanced between the associated morbidity and the potential
required to finalise a standard template for dissection. oncological benefit. n
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