[Orthotopic substitutive cystoplasty in women. Technical modifications in anterior exenteration: results in 9 cases]. / Plastia de sustitución vesical ortotópica en la mujer. Modificaciones técnicas en la exenteración anterior: resultado en 9 casos.

ABSTRACT

OBJECTIVE: The results obtained in 9 female patients who underwent bladder substitution after a modified anterior pelvic exenteration are presented. METHODS: From 1994 to 1999, 9 women underwent bladder substitution after a modified anterior pelvic exenteration that preserved the two distal thirds of the urethra, the pubourethral ligaments and endo-pelvic fascia and limited laterovaginal dissection to preserve the innervation of the striated sphincter for continence. RESULTS: The bladder capacity was 332.9 +/- 35.6 ml and urinary flow was 17.7 +/- 2.9 ml/sec. Seven patients are completely continent and two patients have stress incontinence grade II. None of the patients had difficulty with bladder emptying. Fistula (one case) and diarrhea (one case) were the most important complications. CONCLUSIONS: Our approach is based on a better understanding of the anatomical mechanisms of female continence and the viability of the remaining urethra from the oncologic perspective. This technique achieves a high level of patient satisfaction and quality of life.