CODE: 8.4 - Conditions of supravesical urinary diversion choice in patients after radical cystectomy performed due to invasive bladder cancer
Article published in Urologia Polska 2006/59/Suplement 1.

authors

Krzysztof Bar, Radosław Starownik, Jerzy Michalak, Dariusz Borowiec, Robert Klijer, Waldemar Białek

Katedra i Klinika Urologii i Onkologii Urologicznej AM w Lublinie

summary

Introduction. Urinary diversion is integrally associated with radical cystectomy. The most commonly used is ileal conduit, which is well known and proved to be effective, easy to do, but its performance frequently is influenced by the degree of advancement of neoplasmic process.

Objectives. The authors introduced retrospectively the conditions of supravesical urinary diversion choice in patients subjected to radical cystectomy due to invasive bladder cancer.

Materials and methods. There were 62 radical cystectomies performed due to advanced cancer of urinary bladder in 56 men and in 6 women, aged from 45 till 77 years (average 61.9 years) from October 2000 till June 2005. In 52 patients (83.9 %) ileal conduit was applied as urinary diversion. In 7 cases (11.3 %) orthotopic intestinal neobladder by Studer method was carried out. In 3 patients (4.8 %) ureters were implanted into sigmoid colon (ureterosigmoideostomia Mainz II). The patients' demographic data, predominant symptoms, time of their duration as well as kind of treatment before radical cystectomy were put to analysis. The results of radiographic investigations were also estimated (USG, CT) as well as the histopathologic examination done before and after radical treatment, and also intraoperative image of the disease.

Results. Radical treatment almost in half of the patients (43.5%) was introduced in 1 to 6 months (4.1 months in average) from the moment of first symptoms occurrence. Patients from country-sides were usually treated conservatively for 36 to 48 months (43.6 months average). Leading symptoms causing application to the doctor were: haematuria (90.3%) as well as dysuria (77.4%). Before radical cystectomy all patients were subjected to the diagnostic TUR. During operation regional nodes were estimated macroscopically as well as perivesical tissues. In 20 cases (32.3%) enlargement of the lymphatic nodes was stated in the neighborhood of obturatory fossa, and additionally in 32 (51.6%) reaction in perivesical tissues. In histopathologic research carried out preoperatively the presence of ca uroepitheliale was stated in 52 patients (87,2%). In 8 cases (12.8%) the following tumours were affirmed: adenocarcinoma - 3 (4.8%), ca in situ - 2 (3.2%) and paraganglioma - 1 (1.6%). Degree of advancement before radical treatment of tumours: T2G2 - appeared in 35 (56.5%) patients, T2G3 - in 14 (22.6%), T1G2-3 - in 7 (11.3%). Histopathologic surgical research showed in 55 (88,8%) patients ca uroepitheliale, among them T2G2-3 - 13 (20.9%), T3G2-3 - 16 (25.9%), T4G2-3 - 20 (32.3%). Different tumours occured in 7 cases (11.2%). In histopathologic surgical research in 13 (21%) patients metastasis to the lymphatic nodes were stated and in 37 (59.7%) the presence of tumour beyond the bladder.

Conclusions. 1. The average period which went by from the occurrence of first symptoms of bladder cancer to carry out the radical cystectomy was 4,1 months in patients from municipal centres and as much as 43,6 months from country-sides. 2. Most of the patients at the moment of qualification to radical treatment were chosen to carry out intestinal insertion as a way of urine diversion. 3. Tumours stage as well as the patient's state of mind (the lack of co-operation and understanding of low-pressure intestinal bladder) were the causes of choice of the kind of urinary diversion.