Salvage radical cystoprostatectomy and orthotopic urinary diversion following radiation failure

Purpose: Salvage surgery followed by lower urinary tract reconstruction is a viable therapeutic option for patients in whom definitive radiation therapy for localized bladder or prostate cancer has failed. Improvements in surgical technique and postoperative care have significantly improved overall outcome. An enhanced understanding of the rhabdoid sphincteric mechanism responsible for maintaining urinary continence following cystoprostatectomy has helped make the orthotopic neobladder the procedure of choice for patients requiring lower urinary tract reconstruction. We describe our experience with salvage surgery and orthotopic bladder substitution following failed radical radiation therapy. Materials and Methods: We evaluated the complications of 18 patients in whom definitive radiation therapy (total minimum dose 60 Gy. or greater) for bladder or prostate cancer had failed. All patients underwent a salvage procedure with creation of an orthotopic neobladder. Results: Operative characteristics, postoperative outcomes and postoperative complications related or unrelated to urinary reconstruction were similar between irradiated and nonirradiated patients. Good day and night continence following surgery was reported by 67 and 56% of irradiated patients, respectively. Patients with poor postoperative continence were successfully treated with the placement of an artificial urinary sphincter. Conclusions: Salvage surgery with orthotopic urinary reconstruction is a safe, effective procedure that provides a functional lower urinary tract in patients in whom definitive pelvic radiation therapy has failed.