Editing Cystectomy (section)

===== Campbell’s =====
* '''Males'''
** '''Absolute (2):'''
**# '''Positive urethral margin'''
**#* '''If a frozen section of the urethral margin is positive, an orthotopic neobladder is contraindicated'''
**#** '''When an orthotopic neobladder is to be constructed, frozen sections need to be done at the level of the urethral section margin in males and females. Conversion to a cutaneous diversion with immediate urethrectomy is mandatory if the frozen sections turn out to be positive§'''
**#* '''While preoperative evaluation of the prostatic urethra via transurethral biopsy can be performed''' (TUR biopsies of the prostate, preferably at the 5- and 7-o’clock positions lateral to the verumontanum, at the time of TURBT of the primary bladder tumor) to further characterize the risk of urethral recurrence and help dictate intraoperative management of the distal urethra and choice of urinary diversion, '''the sensitivity and specificity of transurethral biopsy is moderate with a relatively low positive predicate value compared to final cystoprostatectomy specimens'''.
**# '''Presence of CIS or urothelial carcinoma in the prostatic urethra, glands or stroma [different than CUA Guidelines]'''
** '''Relative (1):'''
**# '''Patients that undergo other types of diversions (incontinent, continent cutaneous), even when no poor prognostic factors are present because the risk of urethral recurrence is always present'''
* '''Females'''
** Unless indicated, a complete urethrectomy can be omitted at the time of cystectomy allowing for orthotopic bladder substitution in women
** '''Absolute (3):'''
**# '''Positive urethral margin'''
**#* Frozen-section analysis of the distal urethra has demonstrated high correlation with final urethral margin and should be performed in all women in which orthotopic bladder substitution is being considered
**# '''Tumour involving bladder neck'''
**#* Although tumor presence at the bladder neck is significantly associated with urethral involvement, ≈60% of patients with tumors in this location will not have a tumor in the urethra on final pathology and therefore controversy exists with regard to an absolute need for complete urethrectomy in this setting
**# '''T4 tumors involving the urethra and/or vagina [different than CUA Guidelines]'''