Bhatta Dhar Nivedita, Kessler Thomas M, Mills Robert D, Burkhard Fiona, Studer Urs E
Department of Urology, University of Bern, Bern, Switzerland.
Eur Urol. 2007 Oct;52(4):1006-14. doi: 10.1016/j.eururo.2007.02.048. Epub 2007 Mar 5.
Orthotopic diversion, initially performed solely in men, has now become a viable option in women. Approximately 15 yr ago, at several centres, urethra-sparing cystectomy and orthotopic diversion were initiated in women with bladder cancer. Several studies have since addressed both the oncologic and functional outcomes of this procedure.
We describe our surgical technique of cystectomy and orthotopic urinary diversion in female patients, with an emphasis on how we preserve the neurovascular bundle.
An improved understanding of the anatomic neurovascular and fascial planes related to the rhabdosphincter has facilitated identification of elements needed for orthotopic diversion in female patients. The technique of en bloc anterior exenteration includes the anterior portion of the vagina; however, preservation of the rhabdosphincter and its autonomic nerve supply necessitates specific modifications of the standard operation. The video provides a detailed description of our surgical technique with attention to anatomic details necessary to avoid damage to the proximal urethra and to preserve the autonomic innervation of the rhabdosphincter.
原位改道最初仅在男性中进行，现在已成为女性的一种可行选择。大约15年前，在几个中心，针对患有膀胱癌的女性开展了保留尿道的膀胱切除术和原位改道手术。此后，多项研究探讨了该手术的肿瘤学和功能结果。
我们描述了女性患者膀胱切除术和原位尿流改道的手术技术，重点介绍了我们如何保留神经血管束。
对与横纹括约肌相关的解剖神经血管和筋膜平面的进一步了解，有助于确定女性患者原位改道所需的结构。整块前盆腔脏器清除术包括阴道前部；然而，保留横纹括约肌及其自主神经供应需要对标准手术进行特定修改。该视频详细描述了我们的手术技术，并关注避免损伤近端尿道和保留横纹括约肌自主神经支配所需的解剖细节。
