The use of intestines in reconstructive operations in patients with invasive bladder carcinoma
Article published in Urologia Polska 2008/61/Supl. 1.

authors

Krzysztof Pliszek, Jan Kawecki, Ryszard Zbroński, Paweł Pawlaczek, Henryk Augustyniak, Piotr Bryniarski, Mieczysław Fryczkowski, Zofia Salska, Wiesław Duda, Andrzej Paradysz

Oddział Urologii, Szpital Wojewódzki w Bielsku-Białej
Oddział Urologii, Szpital im. E. Michałowskiego w Katowicach
Katedra i Klinika Urologii w Zabrzu Śląskiego Uniwersytetu Medycznego

summary

Introduction.

Usage of intestine after cystectomy in patients with bladder cancer became the standard technique of urinary diversion. Diversity ascertain operative technique as well as principles of qualifications are dependent on general and local condition of patient and preference of surgeon.

Objectives.

Analysis of results of this operations performed in years 2000 – 2007 in patients with bladder cancer is the purpose of this work.

Material and methodology.

Analysis was performed for group of 333 patients that underwent cystectomy with urinary diversion. Among this group were 135 patients (40.5%) with continent urinary diversion and 198 patients (59.5%) with ileal conduit. Among these there were 284 (85%) men and 49 (15%) women. Patients in different age groups are represented as follows: age under 40 – 6 (2%), age 41-50 – 35 ( 10,5%), age 51-60 – 115 (34.5%), age 61-70 – 138 (41.3%), over age of 71 – 39 (11.7%). Local stage of cancer based

on histological examination of specimen after cystectomy is represented as follows: pTx, pTis, p T1 – 38 (11.4%) cases, pT2 – 114 (34.2%), pT3 – 129 (38.7%), pT4 – 52 (15.6%). Lymph

node metastases were present in 68 (37.5%) cases with T3, T4 and in 11 (7.2%) cases with lower stages, collectively in 79 (23.7%) of cases. Distant metastases were present in 2 (0.6%)

cases. Cellulary grade differentiations G1 was found in 34 (10.2%), G2 – 139 (41.8%), G3 – 160 (48%) cases. In 27 (8%) patients in different periods prior to cystectomy X-ray therapy

was performed.

Results.

Postoperative mortality was 0.6% (2 cases). Serious short-term complications requiring surgical intervention, Intensive Care Unit treatment or urgent

intervention of physician of other speciality (eg. CI, pneumothorax, gastrointestinal bleeding, illeus) have taken place at 37 (11%) cases. Most frequent complications requiring

surgical treatment resulted from extended paralytic or obstructed illeus, intestinal fistula ( in the place of intestinal junction) – 9 cases (2.7%), eventeration – 2 cases (0.67%)

or leakiness of uretero-intestinal junction 2 cases (0.67%). Remaining complications were related to wounds healing disturbances, renal failure, extend lymphorrhea,

immunological disturbances and electrolyte / protein equilibrium disorders after multihour procedure confused with moderate to significant loss of blood.

Conclusions.

1. Low number of serious complications (11%) and postoperative mortality (0.6%) in often heavy burden, senile patients allows to consider procedure of

cystectomy with various type of ileal diversions as safe. 2. Estimate of comfort and quality of life after procedure by patients is good equally in “physical” and mental aspect. 3.

Estimation of long-term results is uncertain, by reason of lack of follow-up of patient from different regions of country in departments where the procedure was performed.