Laparoscopic radical cystectomy with intracorporeal heterotopic urinary diversion in a female patient with solitary kidney

32nd Annual EAU Congress, 24-28 March 2017, London, United Kingdom

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Laparoscopic radical cystectomy with intracorporeal heterotopic urinary diversion in a female patient with solitary kidney Eur Urol Suppl 2017; 16(3);e2059

Nosov A., Reva S., Berkut M., Petrov S. N.N.Petrov Research Institute of Oncology, Dept. of Oncourology, Saint-Petersburg, Russia INTRODUCTION & OBJECTIVES: Laparoscopic radical cystectomy (LRC) with intracorporeal urinary diversion has been demonstrated to be feasible, safe and providing operative and functional advantages. According to the guidelines, continent urinary diversion is a preferable strategy. However, only 3% of surgeons performed purely intracorporeal urinary diversion, with no data according to the continent diversion rate. We performed LRC with intracorporeal substitution of the bladder with a heterotopic reservoir using an ileocolic segment with Mitrofanoff continence mechanism. MATERIAL & METHODS: We present the case of a 54-year old women, previously medically fit, with bladder cancer (clinically multiple Tis), who was admitted to our clinic after left side nephroureterecmomy due to renal pelvis cancer pT1N0M0G3. At the distribution, she had been completely asymptomatic. Renal function was slightly impaired (eGRF 63 ml/min). Pre-cystectomy investigation (CT, MRI) showed no regional or distant metastases and imaging showed no bladder lesions. However, urine cytology was positive for malignancy (urothelial tumor cells). Transurethral resection of the suspected malignant area showed multiple carcinoma in situ lesions, including the bladder neck. RESULTS: Taking into account the age, oncological anamnesis, renal function and multiple character of the lesions, we decided to perform laparoscopic radical cystectomy with intracorporeal heterotopic urinary bladder substitution. On 29/JUN/2016, we realized this idea with Mitrofanoff output mechanism. The extirpation step was unremarkable; after extended lymph node dissection, urinary bladder, ovarian, uterus and anterior wall of the vagina were removed. Neobladder formation was performed with the terminal part (20 cm) of ileum and caecum (20 cm) which was sutured using the laparoscopic suturing device (Covidien, 60 mm) between each other. Left side ureterointestinal anastomoses was performed with 5 sutures by Nesbit technique. The output mechanism was created according to Mitrofanoff principle. Pathological examination revealed multiple carcinoma in situ lesions, no muscle invasion or nodal involvement (26 lymph nodes were removed). The postoperative period was favorable; the solitary ureteral stent was removed at p/o day 7. The patient continued to receive follow-up after surgical intervention and demonstrated no evidence of disease or urinary tract disorders (e.g., hydronephrosis or reflux) at a 3-month follow-up examination. She performed self-catheterisations every 3-4 hours with regular evacuation of 150-250 ml of urea. The urodynamic parameters were comparable to those in other women undergoing heterotopic neobladder (cystometric volume 500 ml) reconstruction, and she is continent during daytime and nighttime. CONCLUSIONS: From April 2016 to August 2016, we performed 6 totally laparoscopic radical cystectomies with intracorporeal heterotopic urinary diversion for patients with bladder cancer. We came

Eur Urol Suppl 2017; 16(3);e2059

32nd Annual EAU Congress, 24-28 March 2017, London, United Kingdom

V18

Laparoscopic radical cystectomy with intracorporeal heterotopic urinary diversion in a female patient with solitary kidney Eur Urol Suppl 2017; 16(3);e2060

to a conclusion that this type of minimally invasive surgery is relatively safe, effective, and patients have a good neobladder functional results and an acceptable level of satisfaction.

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