Editing Cystectomy (section)

== Partial cystectomy ==

* '''See [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6737737/ 2019 CUA MIBC Guidelines]'''
* '''For those with solitary lesions of small size and who lack concurrent carcinoma in situ (CIS), results from partial cystectomy are similar to those of radical cystectomy'''
* Patients initially treated with partial cystectomy can be salvaged with radical cystectomy

=== Indications ===

==== AUA ====

* '''2020 AUA Muscle-Invasive Bladder Cancer Guidelines[https://pubmed.ncbi.nlm.nih.gov/28456635/ ★]'''
** '''Partial cystectomy, bilateral pelvic lymphadenectomy and perioperative chemotherapy for cisplatin-eligible patients if they meet the following criteria (6):'''
**# '''Accessible tumor location'''
**# '''Size <3cm'''
**# '''No multi-focal CIS'''
**# '''No hydronephrosis'''
**# '''Adequate bladder function'''
**# '''No residual T1 or higher stage disease'''

==== CUA ====

* '''2019 CUA Muscle-Invasive Bladder Cancer Guidelines[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6737737/ ★]'''
*# '''Dome location'''
*# '''Unifocal'''
*# '''Small tumour <2 cm'''
*# '''Minimal or no CIS'''
*# '''No hydronephrosis'''
*# '''Good bladder capacity'''

=== Technique ===
* '''For cisplatin-eligible patients with MIBC patients that have chosen partial cystectomy and pelvic lymphadenectomy, perioperative chemotherapy should be offered.[https://pubmed.ncbi.nlm.nih.gov/28456635/ ★]'''
** '''Pelvic lymph node dissection should be performed at the time of partial cystectomy[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6737737/ ★]'''
*'''Random bladder biopsies (plus prostatic urethral biopsy) should be performed prior to partial cystectomy to rule out occult disease [i.e. CIS][https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6737737/ ★]'''
*Cystotomy is performed in an area away from the tumor.
* The tumor is then excised including the underlying bladder wall and perivesical fat with a mucosal margin of 1 to 2 cm and confirmation of resection adequacy with frozen section analysis. If necessary, the ureteral orifice or intramural ureter can be excised and a reimplantation performed.
* After excision of the tumor the cystotomy is closed with 2-0 polyglactin suture in 2 or 3 layers, and an instillation of fluid via a Foley catheter is performed to ensure a watertight closure.
* Copious warm water irrigation of the surgical field is performed to minimize the possibility of pelvic seeding.
* A closed suction drain should be placed and the cystotomy closure interrogated with a cystogram on postoperative day 7 before removal of the Foley catheter.

=== Primary adenocarcinoma arising from the urachus ===
*Epidemiology
**Rare
*Pathology
**Tumors are most commonly confined to the dome of the bladder although they may grow by direct extension to involve other areas
*'''Management'''
**'''Complete excision includes the umbilicus, the urachus, and the dome of the bladder with a visual margin free from tumor'''