A 62 year old woman presented with a single episode of gross haematuria. Cystoscopy revealed a solid tumour in the dome, 2 cm in diameter, well away from ureteric orifices. TURBT was done. Histology is grade II transitional cell carcinoma with detrusor invasion. Mucosal biopsies from remain areas are normal. CECT abdomen and pelvis and Chest x-ray show to evidence of dissemination. The appropriate definitive treatment is: (AIPG 2009)
|B||Simple cystectomy with ureterosigmoidostomy|
|D||None of the above|
a. Radical cystoprostatectomy in the male patient and anterior exenteration in the female patient, coupled with en bloc pelvic lymphadenectomy, remain the standard surgical approaches to muscle-invasive bladder carcinoma in the absence of metastatic disease.
b. Patients with significant medical comorbidity or evidence of metastatic disease are better served by alternative management approaches.
c. A critical technical point to observe in performing nerve-sparing cystoprostatectomy is that the prostatic pedicles should be ligated so as to preserve the soft tissue adjacent to the tips of the seminal vesicles.
e. Preservation of the urethra during anterior exenteration has offered the opportunity for orthotopic reconstruction to female patients with bladder cancer.
f. Local recurrence is rare.
g. Continence in orthotopically reconstructed female patients is excellent and comparable to what is observed in similarly treated male patients.
h. The morbidity associated with this surgical procedure falls into three general categories:
i. complications associated with preexisting or comorbid conditions,
ii. complications stemming from removal of the bladder and adjacent structures, and
iii. complications resulting from use of segments of the gastrointestinal tract for the purpose of urinary tract reconstruction or diversion after radical cystectomy.