(5) The bladder is drained suprapubically, as well as by an indwelling
urethral catheter. Penrose drains may also be placed in the wounds.
a. General. This operation involves the total or radical excision of the urinary
bladder. The extent and nature of the excision depends on the extent and nature of the
pathological area. Total excision is usually carried out if the malignancy has not
infiltrated the entire bladder or shown evidence of extension or distant metastasis and if
the patient is in condition to withstand the procedure with hope of an appreciable period
of relief. More conservative measures may be taken when the tumor is hopelessly
advanced or when the pathological area is limited. If a radical procedure is to be done,
combined abdominal and perineal approaches may be made.
b. Operative Procedure (Suprapubic Approach).
The bladder is approached as for cystostomy.
(2) Deep retractors and laparotomy pads are used to retract the peritoneum.
Long tissue forceps, stick sponges, and long scissors are used for dissection. Long
hemostats or right-angled clamps are placed across the major vessels and ureters.
Suture ligatures number 2-0 chromic gut are placed and the structures divided. Large
pedicle or intestinal clamps are placed across the urachus and its vessels anterior to the
bladder. The structures are ligated and divided by sharp dissection.
(3) In the male, the bladder is lifted up, using long Allis forceps. The
peritoneum is dissected free from the bladder. The bladder is retracted to expose the
vesicle neck. The bladder is dissected from the prostate and the vas deferens ligated.
A large pedicle or intestinal clamp is placed across the urethra which is ligated with
number 2-0 chromic sutures. The urethra is divided and the specimen removed.
(4) The seminal vesicles are removed with the bladder. Ureteral transplant
is performed if not done previously.
(5) Penrose drains are placed in the suprapubic wound, which is closed in
layers with #0 chromic interrupted sutures. Silver wire or nylon tension sutures may be
placed. The skin is sutured with silk number 3-0 or steel wire gauge 35. The abdominal
and perineal wounds are dressed.
In the female, cystectomy will depend on the extent and nature of the
pathological lesion. A vaginal approach may be used and then, via the
abdominal approach, lymphadenectomy and pelvic exenteration completed.