May be indicated in a very select population:
- Solitary tumour at the dome
- Solitary tumour within diverticulum
- No CIS or multifocal disease
- Adequate bladder function
Requirements:
- Well counselled patient
- Mapping biopsies of rest of bladder prior
Radical cystectomy will always be the safest operation in terms of oncological outcome.
Will need ongoing surveillance a la TMT with cystoscopy and cytology 3 – 4 x / year, and salvage cystectomy may be more difficult with poorer outcomes.
AUA – should do bilateral PLND and still offer ‘perioperative’ chemotherapy.
Technique for partial cystectomy at dome / urachal adenocarcinoma:
En bloc resection of entire tumour with surrounding detrusor, perivesical fat and peritoneum
- Counselling and set up to be prepared for radical cystectomy
- Consider cystoscopy first and scoring margin with diathermy
- Lower midline incision from umbilicus down, open rectus fascia and develop Retzius
- Open peritoneum and take urachus proximally between ties, leaving a clamp on
- Lateral peritoneal wings down to bladder
- Mobilise bladder laterally and ensure mobility
- Open bladder anteriorly away from tumour and visually confirm location
- Excise with 2 cm margin
- Close bladder in 2 layers with Allis forceps and 3-0 PDS over an 18 fr 2-way IDC
- Node dissection – obturator/internal iliac
- Drain and closure