ABSTRACT
Total cystectomy is most frequently performed for bladder malignancy. It has to be accompanied by a method of urinary diversion either through an ileal conduit to an external opening or by implanting the ureters into the sigmoid colon. After abdominal incision, the bladder, lymph glands, and liver are assessed for the extent of disease. The bladder is then dissected out and mobilized, and the ureters secured and divided. Silastic tubes may be inserted into the ends of the ureters to be brought through the ileal loop later, but before this may be placed in a bag to prevent contamination of the wound with urine. Mobilization of the bladder continues together with removal of surrounding lymph glands. The urethra is then exposed and divided and the bladder removed. The urinary diversion procedure is then performed. For an ileal conduit, the left ureter is tunnelled under the colon and brought through the same peritoneal incision as the right ureter. A loop of ileum is selected that is not too close to the ileocaecal valve and long enough to reach the abdominal wall, with sufficient length for stoma formation. It is then separated with its mesentery from the rest of the small bowel and the continuity of the small bowel restored. The proximal end of the loop is closed and the ureters anastomosed. A stoma site is then created and the conduit fixed to the skin.
