Distal preservation and retrograde resection of the anterior vaginal wall in female robot-assisted radical cystectomy.

INTRODUCTION: In many cases of female radical cystectomy for bladder cancer, the procedure involves simultaneous removal of the uterus, fallopian tubes, ovaries, anterior vaginal wall, and urethra. After this procedure, rare complications like vaginal dehiscence and evisceration may occur. We herein describe this article surgical technique involving preservation of the distal anterior vaginal wall to maintain pelvic floor strength and retrograde resection of the proximal anterior vaginal wall.

MATERIALS AND SURGICAL TECHNIQUE: The presented case was a 61-year-old woman who had a bladder tumor. After undergoing a transurethral resection, the pathology revealed muscle-invasive squamous cell bladder cancer. Consequently, she received a robot-assisted radical cystectomy (RARC) without neoadjuvant chemotherapy. Before opening the vaginal wall, the urethra, including the external urethral meatus, was dissected along its entire length. Next, a transverse incision was made in the anterior vaginal wall at the level of bladder neck, and the wall was resected retrogradely toward the anterior vaginal fornix while preserving the distal anterior vaginal wall. The opened vaginal wall was closed in a tubular shape.

DISCUSSION: Preservation of the distal anterior vaginal wall and retrograde anterior vaginal wall resection can be safely performed in female RARC and may reduce the risk of vaginal dehiscence by minimizing the vaginal wall defect.