The majority of the blood supply to the bladder is derived from the obturator artery.
The inferior gluteal artery sends no branches to the bladder.
The bladder cannot be mobilized substantially because of its tenuous blood supply.
The inferior vesical artery arises from the posterior trunk of the internal iliac artery.
The superior vesical artery arises from the anterior trunk of the internal iliac artery.
It is difficult to perform through a standard cystoscope.
It is useful for biopsy of large bladder tumors.
It allows for better tissue procurement without coagulation defects when compared with standard loop resection.
It requires suprapubic pressure if the lesion is located on the trigone.
It is most amenable to lesions on the inside of the bladder neck.
Tumor base larger than 2â•¯cm
a cathartic such as GoLYTELY.
a clear liquid diet.
Median umbilical ligament
Node of Cloquet
Bifurcation of the common iliac artery
0.1% to 0.2%
15% to 17%
5% to 7%
1% to 3%
9% to 11%
29% to 37%
4% to 18%
0.5% to 4%
19% to 28%
38% to 48%
It is necessary to split the glans to remove all of the transitional cell epithelium at the meatus.
The bulbar urethral arteries should be preserved throughout the dissection.
The dissection is much easier if carried out several weeks after radical cystectomy.
Drainage is not recommended after urethrectomy.
When a urethrectomy is performed, the best position for the patient is the exaggerated lithotomy.
Orthotopic bladder substitution can rarely be used in the female patient because of the risk of urethral recurrence.
Incidence of urethral involvement in female patients has been shown to be consistently above 15%.
Intraoperative frozen section is the best way to determine whether the urethra is suitable for orthotopic reconstruction.
Female patients have a much higher incidence of urethral involvement than do male patients.
Tumor involvement at the bladder neck always signifies urethral involvement.
bilateral pelvic lymphadenectomy.
pain and incomplete emptying in patients with prior supravesical diversions.
pyocystis in a neurogenic bladder.
hemorrhagic cystitis resulting from cyclophosphamide.
colovesical fistula after urinary diversion.
Possibility of using surveillance cystoscopy
Preservation of bladder and sexual function
More accurate staging
Lower recurrence rates of tumor
Tumor within a bladder diverticulum
Multifocal tumor associated with multifocal carcinoma in situ (CIS)
Grade 1 transitional cell carcinoma
Tumor location at the dome of the bladder
The lateral extent of the dissection is the genitofemoral nerve.
Extended lymphadenectomy improves survival in patients with limited lymph node metastases.
Extended lymphadenectomy improves survival in N0 patients.
En bloc resection yields fewer lymph nodes than dissecting separate packets.
Extended dissection to the aortic bifurcation is associated with increased incidence of lymphocele.
superior gluteal artery.
medial umbilical ligament.
inferior epigastric artery.
internal pudendal artery.
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