Partial cystectomy
For tumours involving the bladder cranial to the trigone, partial
cystectomy was required for this portion of the tumour as it is not
consistently covered by the interstitial HDR-BT system described below.
Through a Pfannenstiel incision the bladder was opened. While surgery
sought to achieve a microscopically tumour-free (“R0”) margin
cranially, a deliberate macroscopically incomplete (“R2”) resection
was intended at the trigone/bladder neck. Surgery avoided dissection to
the level of the prostate, in the knowledge that this area could be
reliably treated by HDR-BT and in order to prevent the genitourinary
sequelae of radical surgery at the bladder neck. Ureteric reimplantation
was not required. Regional lymph nodes were sampled as part of the
procedure.