Surgical technics in pelvic exenteration and ileal bladder construction

Significant features of our technic include the following: (1) A multidisciplined approach, with physicians in several specialties participating in the preoperative selection and preparation of the patient, and with a urologist and a general surgeon cooperating in the operative procedure and postoperative management. (2) Preservation of the pelvic peritoneum. (3) Availability, but not routine use, of the technic of splitting the symphysis pubis to facilitate the pelvic dissection and complete removal of the urethra in the male patient. (4) Meticulous ureteroileal anastomosis, utilizing two layers of fine sutures, with spatulation of the ureteral end to permit a larger lumen, usually without the use of internal splints. (5) Complete retroperitoneal placement of the ureteroileal anastomoses to prevent tension on and distortion of the anastomoses as well as to permit early detection of leakage of urine should it occur.