Techniques of Urological Reconstruction

Abstract

Locally recurrent cancer or, less commonly, a bulky, primary tumor arising adjacent to the urologic organs, requires an extended operation for salvage. During surgery for colorectal carcinoma (CRC), or pelvic surgery, a carcinomatous infiltration of adjacent urological organs is found in 5–10% of all cases [1]. However, this rate increases to ~50% in T4 and even higher rates for rectal carcinomas, as it is only partially covered by the visceral peritoneum, and to ~80% in recurrent carcinomas [2]. In these advanced cases in particular, an inherent surgical problem is the impossibility of distinguishing between inflammation and malignant infiltration of the adjacent organs during surgery [3]. Total pelvic exenteration (PE) and its modifications are surgical options for treating locally advanced rectal cancer. Total PE may involve en bloc removal of the rectum, bladder, prostate, or ureters, since it is essential to create clear margins if the procedure is to be curative. As a result, patients often require double stomas, which severely compromise quality of life (QoL) despite achieving acceptable locoregional control.