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