Perineal-abdominal cystourethrectomy with pelvic node dissection: a new 2-stage procedure for selected cases.

An ileal conduit diversion followed 7 to 14 days later by cystourethrectomy with pelvic node dissection was done on 20 patients with carcinoma of the bladder. Two types of patients were selected for this operation: 1) those with an advanced stage of carcinoma involving the bladder neck, prostatic urethra or prostate, primarily cases suspected of having focal metastatic disease in the urethra, and 2) patients who had had a previous pelvic operation with resultant dense adhesions and scarring. The cystourethrectomy with pelvic node dissection is begun perineally. After the specimen, consisting of the urethra, part of the urogenital diaphragm, seminal vesicles, prostate and bladder is dissected, mobilized and, finally, pushed into the pelvis the perineum is closed and the operation is completed abdominanlly through a Pfannenstiel incision.