Nerve-Sparing Radical Cystectomy and Orthotopic Bladder Replacement in Female Patients

Abstract Objectives 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. Methods We describe our surgical technique of cystectomy and orthotopic urinary diversion in female patients, with an emphasis on how we preserve the neurovascular bundle. Results and Conclusions 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.