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.