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Radical cystectomy with construction of Bricker bladder

General

A radical cystectomy is standard treatment of muscle-infiltrating urothelial cancer of the bladder. This operation is also relevant for certain high risk groups of superficial cancer. 

Construction of Bricker bladder (cutaneous uretero-ileostomy ad modum Bricker) may be performed with open surgery or robot-assisted laparoscopy.

A segment of ileum about 25 cm long is used for bladder substitution. The ureters are anastomosized to the oral end of the ileum segment. The anal end is prepared as an abdominal stoma (incontinent), usually in the right iliac fossa. The urine will continually drain from the stoma and collect into a urostomy bag. An ideal stoma is about 2 cm high. This allows for easy attachment of the stoma bag and also keep urine from seeping out on the skin under the bag, causing skin problems. This can in turn also cause the bag to fall off.

Indications for radical cystectomy

  • T1 tumor with deep invasion of lamina propria
  • T1 tumor with accompanying carcinoma in situ
  • Extensive T1 tumors
  • Recurring T1 tumors
  • Muscle infiltrating urothelial cancer in the bladder without detectable nodal metastasis 

Goal

  • Curative treatment
  • Palliative treatment for local problems from the bladder and where there are bone or nodal metastases

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