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PubMed2004

T1G3 bladder cancer--indications for early cystectomy.

OBJECTIVES: To review our experience with early radical cystectomy in patients with T1G3 Transitional Cell Carcinoma of bladder (TCC). PATIENTS AND METHODS: Thirty patients, who underwent early radical cystectomy over a 10-year period for clinical stage T1G3 TCC bladder, were studied. Of these 21 (70%) had radical cystectomy without treatment with intravesical chemo/immunotherapy. The number of tumours, presence or absence of Carcinoma In-Situ (CIS) and the pathological stage of the cystectomy specimen were recorded in each patient. Disease specific survival was determined in the subgroups using Kaplan-Meier estimates. RESULTS: Seventeen patients underwent radical surgery for a single tumour without concomitant CIS (Group A). The other 13 had multiple tumours with or without concomitant CIS or a single tumour with CIS (Group B). The disease was upstaged after cystectomy in 1 (6%) patient in Group A compared to 7 (55%) in Group B, (p = 0.009). Nine (53%) had pT0 disease in Group A compared to 0% in Group B, (p = 0.0017). The 5-year cancer specific survival rates were 92% in Group A and 82% in Group B. CONCLUSIONS: In patients with multiple T1G3 tumours with or without associated CIS, or in those with single T1G3 tumour with associated CIS the incidence of the disease being already muscle invasive at the time of clinical diagnosis is 55%. Early radical cystectomy should be advocated in this group. Conversely, for a single T1G3 tumour without associated CIS, conservative bladder preserving strategy with immuno-chemotherapy and close surveillance is justified.

Aged↗
PubMed2002

Outcome of radical cystectomy for bladder cancer according to the disease type at presentation.

OBJECTIVE: To examine whether the outcome of cystectomy for invasive transitional cell carcinoma (TCC) of the bladder was influenced by the type of disease at initial presentation. PATIENTS AND METHODS: The charts of 76 patients treated for TCC by radical cystectomy from 1987 to 1997 in our unit were reviewed. The patients were divided into three groups: group 1 comprised 43 patients with primary invasive disease; group 2 included 12 patients with progression of an initial superficial bladder tumour after failure of conservative treatment; and group 3 comprised 21 patients who had a radical cystectomy for superficial TCC, with a high risk of progression after attempts at conservative treatment. The pathological findings on transurethral resection and cystectomy specimens, cancer-specific survival and the time to progression were compared among the three groups. RESULTS: The rate of pT0 in cystectomy specimens was 16%, 41% and 24% in groups 1, 2 and 3, respectively. Under-staging occurred in 24% of cases in group 3. The 10-year cancer-specific survival rates were 48%, 47% and 82% in groups 1, 2 and 3, respectively. The cancer-specific survival rate and progression rate were not significantly different between groups 1 and 2, but were significantly lower/higher in these patients than in group 3 (P < 0.01). CONCLUSIONS: These data suggest that the prognosis of superficial TCC which progresses despite conservative management is no better than that of invasive TCC at initial presentation, despite the closer follow-up received by the former patients. Early identification of this group of patients may improve the cancer-specific survival, as early cystectomy for high-risk superficial TCC yields better results.

Aged↗
PubMed2004

Cystectomy and orthotopic ileal neobladder: the impact on female sexuality.

PURPOSE: January 1986 and September 2003 cystectomy and formation of an ileal neobladder were performed in 86 female patients. In this retrospective study we focused on the impact of orthotopic reconstruction on female sexuality. MATERIALS AND METHODS: To assess female sexuality the standardized self-reporting instrument female sexual function index was mailed to 44 patients who were 70 years or younger at cystectomy with a recurrence-free followup of greater than 1 year, no pelvic irradiation and no concomitant diseases impairing sexual functions. The questionnaire analyzes 6 domains (desire, arousal, lubrication, orgasm, satisfaction and pain) with 19 items. It was returned by 29 patients (65.9%) with a median age of 65.0 years. The indication for cystectomy was benign disease in 8 cases and malignancy in 21. RESULTS: Factors influencing female sexuality were age younger than 60 years, benign disease, partnership at surgery and current partnership. Clean intermittent catheterization, urinary stress incontinence and hormonal therapy did not affect the results. The 11 of 17 patients who remained sexually active after cystectomy even had slight improvement in all female sexual function items. Six patients ceased to be sexually active postoperatively due to erectile dysfunction or partner death. One patient with interstitial cystitis became sexually active following cystectomy due to the loss of pelvic pain. Another 12 patients remained sexually inactive postoperatively. CONCLUSIONS: All aspects of female sexuality may remain unchanged following cystectomy and ileal neobladder formation as long as sexual activity is not ceased due to other reasons. Even fertility can be preserved when the internal genitalia do not have to be removed.

Aged↗
PubMed2005

Impact of malpractice caps on use and outcomes of radical cystectomy for bladder cancer: data from the surveillance, epidemiology, and end results program.

PURPOSE: The impact of malpractice awards on insurance premiums and health care delivery generates much concern. To our knowledge no data exist regarding the impact of caps, or upper limits, on awards for noneconomic damages (also termed pain and suffering) on health care delivery patterns or outcomes. We investigated the effect of caps on the use of and outcomes following aggressive surgical treatment (radical cystectomy) in patients with bladder cancer. MATERIALS AND METHODS: We performed a retrospective cohort study of patients with bladder cancer who underwent radical cystectomy, identified from the Surveillance, Epidemiology, and End Results (SEER) Program database. Cystectomy rates and post-cystectomy disease specific survival were compared between SEER regions with and without a cap, while controlling for other variables. RESULTS: A significantly greater proportion of patients with stages III and IV bladder cancer underwent cystectomy in SEER regions with a cap. Cap status was a significant predictor of survival from bladder cancer. CONCLUSIONS: Radical cystectomy for bladder cancer is performed more often even for advanced bladder cancer in geographic regions with a cap with a positive impact on survival. The institution of caps may have beneficial effects on patterns of health care beyond that of merely decreasing insurance premium costs.

Adult↗
PubMed2005

Local recurrence after cystectomy and survival of patients with bladder cancer: a population based study in greater amsterdam.

PURPOSE: We determined retrospectively in a population based study the survival of patients with bladder cancer and the local recurrence rate (LRR) after cystectomy. MATERIALS AND METHODS: All patients with bladder cancer diagnosed between 1988 and 2001 (vital status updated until September 2003) were selected from the Amsterdam Cancer Registry, which covers a population of 2.84 million individuals. For all patients who underwent cystectomy between 1988 and 1997 at 18 participating hospitals information on local recurrence and vital status was collected from the medical records. RESULTS: Five-year relative survival in all 8,321 bladder cancer cases combined was 75%. For clinical stage 0-a this was 99%, decreasing to 85% for stage 0-is and 82% for stage I, and to 44%, 28% and 9% for stages II to IV, respectively. Five-year relative survival after cystectomy was 81%, 44% and 23% for stages II to IV, respectively. The LRR after cystectomy was 19% in all 566 cases and all institutions combined. The LRR increased with higher pT stage and it achieved 11%, 23% and 31% for stages II to IV, respectively. It was slightly lower at oncological centers than at community hospitals (18% vs 20%, not significant). CONCLUSIONS: Survival is higher than the European average but below the value in the United States. Only 1 of 3 stages II-III cases was treated with cystectomy. Relatively high stage specific survival is experienced after cystectomy despite local recurrence in 1 of 5 patients.

Adolescent↗
PubMed2005

Laparoscopic radical cystectomy with extracorporeal urinary diversion: preliminary experience.

AIM: We present our experience with the fi rst eight patients who underwent laparoscopic radical cystectomy with bilateral pelvic lymphadenectomy and extracorporeal urinary diversion. Patients, operative data and the surgical techniques are presented. METHODS: Between June 2003 and April 2004, seven men and one woman with organ-con fi ned muscle-invasive transitional cell carcinoma of the bladder underwent laparoscopic radical cystectomy with urinary diversion. The age range was 41-73 years. Laparoscopic radical cystectomy and bilateral pelvic lymphadenectomy were performed using fi ve ports by a transperitoneal approach. An ileal conduit diversion or ileal W-neobladder was constructed through the site of specimen retrieval. RESULTS: We performed eight radical cystectomies with ileal conduits (six cases) or orthotopic ileal W-neobladders (two cases). Conversion to open surgery was necessary in one due to technical dif fi culty in urethroneobladder anastomosis. Mean operating time was 560 min (range 455-680). Mean estimated blood loss was 675 mL (range 400-1050). Two of the eight patients needed blood transfusion (800 mL each). Mean days to oral intake and ambulation was 4.4 (range 2-6) and 4.1 (range 3-5), respectively. Mean hospital stay was 12.8 days (range 7-28). Mean follow up was 6.1 months (range 4-14). Histopathological examination of the specimens revealed stage T2N0M0 in fi ve cases, T3aN0M0 in one, T3aN1M0 in one and T3bN1M0 in one. No metastases have been detected and all are alive and free of disease. CONCLUSION: Laparoscopic radical cystectomy is feasible, although dif fi cult and technically demanding, and our results are promising. With more experience and improvement of the surgical technique, laparoscopic radical cystectomy with urinary diversion may become an alternative surgical method for treating the selected patients with localized muscle invasive bladder cancer.

Adult↗
PubMed2006

Radical cystectomy with ileal conduit diversion: early prospective evaluation of the impact of robotic assistance.

OBJECTIVE: To compare the performance of radical cystectomy with ileal conduit diversion by standard methods with that using the assistance of the daVinci robotic system (Intuitive Surgical, Sunnyvale, CA, USA). PATIENTS AND METHODS: From November 2003 to August 2005, we performed 30 radical cystectomies with ileal conduit urinary diversions on patients with bladder cancer. Seven patients (one woman) had a cystectomy with the daVinci system and 23 (nine women) had a standard cystectomy. Data were collected prospectively, including estimated blood loss (EBL), transfusion requirement, operative duration, hospital stay and body mass index (BMI), and compared. RESULTS: The mean EBL and transfusion requirements for standard and daVinci-assisted cases was 1109 and 479 mL (P = 0.002) and 2.7 and 1.6 units (P = 0.14), respectively. Four of seven patients received a transfusion in the robotic group, and 20 of 23 in the standard group (P = 0.084). The mean operative duration was 638 and 507 min (P = 0.005) for the daVinci and standard group, respectively, with respective mean hospital stays of 11 and 13 days (P = 0.52). There was no difference in patient BMI between the groups (P = 0.22). CONCLUSION: The daVinci-assisted cystectomy appears to offer some advantages over standard cystectomy. Larger randomized studies are needed to confirm these findings.

Aged↗
PubMed2000

Long-term risk of salvage cystectomy after radiotherapy for muscle-invasive bladder cancer.

OBJECTIVES: To establish the long-term outcome for muscle-invasive transitional cell carcinoma of the bladder treated by radiotherapy with or without neoadjuvant cisplatin. METHODS: 159 patients with T2-T4a NX M0 bladder cancer were entered into a prospective randomized trial between June 1984 and June 1988. Follow-up was by 3-monthly cystoscopy in the first year, 6-monthly the next 2 years and yearly thereafter. Salvage surgery was performed at the discretion of the participating clinician. RESULTS: Minimum follow-up was 9 (median 11) years, at which time 29 patients (18%) remain alive. Median survival was 24 months with no difference between the treatment groups (chi(2) = 0.08, p = 0.77). Overall cystectomy rate was 24% (radiotherapy alone 20%, combined therapy 28%; p = 0.24). Median time to cystectomy from primary treatment was 12 months; range 56 days to 10 years. The risk of cystectomy was 11, 10 and 7% for the first, second and third years after radiotherapy respectively, and 8% in total after the third year. The proportion of patients alive in each successive year who had required a cystectomy was between 20 and 30% for 5 of the first 8 years after treatment. CONCLUSIONS: Salvage cystectomy is necessary in a quarter of patients after radiotherapy and this can be needed up to 10 years after treatment. During this time, multiple invasive procedures are likely to be performed, resulting in significant patient morbidity and cost. Patients should be fully counselled about the need for prolonged surveillance and the persisting risk of salvage surgery when deciding between primary cystectomy and radiotherapy.

Adult↗
PubMed2006

Recurrence after cystectomy for borderline ovarian tumors: results of a French multicenter study.

BACKGROUND: Fertility-sparing surgery for borderline ovarian tumors (BOT) is feasible and effective and does not seem to have a negative effect on survival. Specific data on the effect of cystectomy, and notably on recurrence, are lacking. METHODS: This was a French retrospective multicenter study of 313 women with stage I BOT treated from 1990 to 2000 in 13 specialized gynecological units and 1 cancer center. Diagnosis and staging were based on International Federation of Gynecology and Obstetrics (1989) criteria. Surgery consisted of cystectomy, unilateral salpingo-oophorectomy (USO), or bilateral salpingo-oophorectomy (BSO). RESULTS: After cystectomy, persistent BOT and benign ovarian cysts on the operated ovary were observed in 15% and 65% of patients, respectively. Mean follow-up did not differ among patients receiving the three types of surgery. The recurrences after cystectomy, USO, and BSO treatment were 30.3%, 11%, and 1.7%, respectively (P<.0001). Recurrences were more frequent after cystectomy than after USO (P=.0001) and BSO (P=.0001) and when intraoperative cyst rupture occurred (P=.04). CONCLUSIONS: These results suggest that cystectomy for BOT is associated with a high risk of intraoperative cyst rupture and of recurrence compared with USO or BSO.

Adult↗
PubMed1991

Transitional cell carcinoma of the bladder: patterns of recurrence after cystectomy as determined by CT.

CT scans have been recommended for examination of patients at risk for recurrent transitional cell carcinoma after cystectomy. For CT to be useful in this regard, the location and type of recurrences must be known, so that appropriate scans can be made. Therefore, we retrospectively studied CT scans in 27 postcystectomy patients with recurrent transitional cell carcinoma of the bladder to identify the type and location of the recurrent disease. Recurrence was documented by biopsy in 18 patients and by progression of disease shown on serial CT scans in nine patients. All 27 patients had pelvic CT, and 23 had concomitant abdominal CT. Tumor recurred at the cystectomy site in 10 (37%) of 27 patients, pelvic adenopathy was present in 18 (67%) of 27 patients, and retroperitoneal adenopathy was present in 13 (57%) of 23 patients. Tumor recurrence at the cystectomy site was associated with pelvic adenopathy in seven of 10 patients, and the cystectomy site was the solitary site of disease in the remaining three patients. Conversely, in 11 of 18 patients with pelvic adenopathy no recurrence was seen at the cystectomy site. Combined retroperitoneal and pelvic adenopathy was identified in 11 of 23 patients, but two patients had retroperitoneal lymphadenopathy as their only site of recurrence. Hepatic metastases were seen in seven (30%) of 23 patients; six of these seven patients had metastases elsewhere. In four of five patients in whom underestimation of recurrent disease occurred, the deep pelvis and/or deep perineal space were involved. Our results show that the pelvis is the most common site for recurrence. Cystectomy site or retroperitoneal nodal recurrences are usually accompanied by pelvic adenopathy, but the converse is not as common. Our findings of deep perineal and isolated abdominal recurrences indicate that proper protocol for CT follow-up of the postcystectomy patient should include abdominal scans and scans through the perineum.

Aged↗
PubMed1999

[Clinical study of radical cystectomy and urinary reconstruction in elderly patients with bladder cancer].

We compared the clinical and functional results of radical cystectomy and urinary reconstructions performed on 19 elderly bladder cancer patients over 75 years old to those on 22 younger patients to determine whether age was one of the critical points for the application of this type of surgery. Between January 1992 and January 1998, bladder substitution was performed after cystectomy using either the Hautmann, Studer or Reddy procedure in 9 of the 19 elderly patients. Urinary diversion was performed after cystectomy using ileal conduit and ureterocutaneostomy procedures in the rest of the patients. On the other hand, bladder substitutions were performed in 11; urinary diversions with continent urinary reservoir in 6 and with ileal conduit in 4 of the 22 younger patients. Neither prolongation of the operation time, nor increase in the amount of bleeding or prolongation of the post-operative hospitalization period was observed in any procedure used for elderly patients in comparison with younger ones. In elderly patients, the average operation time of radical cystectomy with bladder substitution was slightly longer than that of total cystectomy with ileal conduit or ureterocutaneostomy. The post-operative hospitalization period in the case of bladder substitution was similar to that for ileal conduit and ureterocutaneostomy with the difference of only 5 days on average. There were no peri-operative deaths, and early post-operative complications were observed in 3 of 9 cases of the bladder substitution, in 4 of 10 cases of ileal conduit or ureterocutaneostomy. Five cases of bladder substitution maintained their comfortable voiding urine comfortably, while 4 had dysuria and/or urinary incontinence. Over all, late complications occurred in 10 of the elderly patients. The rate and types of complications in the elderly patients were not different from those in the younger patients. The cause-specific survival rate and overall survival rates of the elderly patients were similar to those of the younger patients. In conclusion, indication of cystectomy and selection of urinary reconstruction procedure are not dependent on patient's age, Orthotopic urinary reservoir was found to be useful for even an elderly patient.

Age Factors↗
PubMed2000

[Radical cystectomy in the treatment of cancer of the bladder].

OBJECTIVE: To analyze retrospectively the efficacy of radical cystectomy alone in the treatment of transitional cell carcinoma of the bladder. METHODS: 125 patients who underwent radical cystectomy were evaluated. The mean follow-up was 62 months. At the time of the study, 65 patients were alive (3 with bladder tumor and 1 with a second primary) and 60 patients had died (50 from bladder cancer and 10 from other causes). Nine patients were lost to follow-up. The Kaplan-Meier method was used for the survival analysis and the log-rank test for the comparison of the variables. RESULTS: The overall survival at 5 years was 50% and the cancer-specific survival was 56%. By tumor stage, the cancer-specific survival at 3 and 5 years were respectively: 83% and 85% for pT1, 78% and 70% for pT2, 52% and 42% for pT3, 24% and 12% for pT4 and 14% for pN+ (p < 0.0001). No differences were found between stages pT2a (73% and 68%) and pT2b (71% and 53%) (p = 0.2). The survival was significantly higher in patients with no residual tumor in the cystectomy specimen (pT0) (93% and 83%) than in those with residual tumor (60% and 53%) (p = 0.03). CONCLUSIONS: Radical cystectomy alone in the treatment of transitional cell carcinoma of the bladder was found to be effective in patients with tumor stage pT2. It is less effective in patients with tumor in the advanced stages (pT3 or pT4) or lymph node invasion. Radical cystectomy is an overtreatment in patients with no residual tumor in the cystectomy specimen.

Carcinoma, Transitional Cell↗
PubMed2000

[Results of radical cystectomy for management of invasive bladder cancer with special reference to prognostic factors and quality of life depending on the type of urinary diversion].

Bladder cancer is one of the main problems in urology in terms of diagnosis and treatment, due to its high incidence, high recurrence rate, and difficulties in prognosis of its natural history. According to Polish epidemiological reports, bladder cancer was the fifth cause of death due to malignant diseases in 1993 (1.2% in females and 4.0% in males). Radical cystectomy remained for over forty years the main method of treatment in cases of invasive bladder cancer. Improvements in postoperative care, surgical techniques and methods of urine diversion made cystectomy a widely performed, low mortality procedure. The analysis of prognostic factors with their influence on survival is helpful in patient qualification and prognosis of long-term outcome. The objective was to study retrospectively the results of radical cystectomy in cases of invasive bladder cancer with an emphasis on negative prognostic factors affecting survival. An evaluation of the quality of life (QL) depending on urine diversion method was performed. The material consisted of 95 patients (77 males and 8 females, mean age 59.6) who underwent cystectomy at the Department of Urology, Pomeranian Academy of Medicine, between 1989 and 1998. In 46 cases (48.4%) the Bricker's ileal conduit was performed. Ileal neobladders were created in 24 cases (25.2%) and in 25 patients (26.3%) other types of urine diversion were used. Among 37 survivals (38.6%) 20 patients were evaluated by means of physical examination, abdominal ultrasonography, laboratory parameters, blood gas analysis, urine culture, and QL questionnaires. Median follow-up time was 17.4 months. Survival curves were calculated according to the Kaplan-Meier's method. Statistical significance was established using Cox and Cox-Mantel tests. Histopathologic examination revealed transitional cell carcinoma in 97.8% of the bladders. Basing on the pathologic stage, patients were assigned to 2 groups: organ confined disease (pT2-3a, 41.3%) and perivesical or adjacent organ involvement (pT3b-4, 58.7%). The tumor was graded G1, G2 and G3 in 3.4%, 22.5%, and 74.1%, respectively. Pelvic lymph node involvement was histologically confirmed in 31 patients (35.2%). Different forms of adjuvant or neoadjuvant therapy, e.g. radiotherapy, systemic chemotherapy, intra-arterial chemotherapy, electrochemotherapy were used in 28 patients. In the postoperative period 7.3% of patients died. The negative factors with significant prognostic value were identified as non organ-confined tumors pT3b-T4 (p = 0.00002), lymph node involvement pN+ (p = 0.0001), and high grade tumors G3 (p = 0.01). All these parameters were responsible for the high death rate during 500 days postoperatively. The patient's age or preoperative hydronephrosis did not influence the overall survival. The 5-year survival for organ confined and remaining tumors was 44.1% and 11.6%, respectively (Tab. 1). Overall 5-year survival rate was 22%. The highest mortality and the highest risk of cancer-related death occurred during the first year from operation (Fig. 1 and 2). QL was evaluated basing on a specific questionnaire completed by 20 patients. The quality of life was similar in all groups of urine diversion (ileal conduit, neobladder, simple diversion), but some differences concerning general health status were revealed. Patients with Bricker's ileal conduit rated their present health status worse than the other groups. Patients with continent urinary diversion presented the best emotional status and lowest rate of disturbances in self care, professional, social and leisure activities. Surprisingly, high QL in patients with simple urine diversion (ureterocutaneostomy or nephrostomy) suggests a good adaptation to the so created difficult situation. Radical cystectomy is the best method of treatment in invasive bladder cancer, although it offers a poor chance of curing the patient. Eventually, only one-fifth of the patients survive 5 years. Half of the deaths occur during the first year from surgery. The best candidates for radical cystectomy are patients with low or medium grade organ confined tumors. In other cases this is just a palliative procedure, thereby justifying the selection of simple methods of urine diversion.

Carcinoma, Transitional Cell↗
PubMed1992

[Cystectomy in bladder cancer patients].

Within the last 12 years, 125 patients have been subjected to cystectomy which makes up 18.0% of the total of 691 surgical patients. The majority of patients were at T3 (64) or T2 stage (50) whereas T1 and T4 tumors were observed in 8 and 3 cases, respectively. Four patterns of urine derivation were used after cystectomy: ureterosigmoid anastomosis--in 8 patients, one-stage cystectomy with ileocystoplasty--23, double-stage cystectomy with ileocystoplasty--48 and ureterocutaneostomy--in 46 cases. Ileocystoplasty proved the best procedure for urine derivation. Depending on patient condition, it may follow cystectomy immediately or be carried out in 2 stages: cystectomy with ureterocutaneostomy followed by ileocystoplasty 2-4 months after the first operation.

Adenocarcinoma↗
PubMed2003

[Cystectomy with preservation of the prostate in the treatment of bladder tumours: anatomical basis, surgical techniques, indications and results].

OBJECTIVE: To evaluate cystectomy with preservation of the prostate in the treatment of bladder tumours. MATERIAL AND METHODS: A review of the literature (Medline, key words: cancer, bladder, cystectomy, prostate, urinary incontinence, sexual impotence) was performed. Three cystectomy techniques with preservation of the prostate were recently described; their anatomical basis, surgical techniques and indications are reported. Their morbidity and oncological and functional results were then studied and compared to contemporary total cystectomy series. RESULTS: The morbidity is not worsened. The functional results were globally improved, especially in terms of erectile function. In terms of cancer control, local recurrences were not more frequent, but metastatic recurrence rates appeared to be higher. CONCLUSION: Compared to total cystectomy, cystectomy with preservation of the prostate is not associated with increased morbidity, improves functional results, but does not appear to ensure an equivalent level of cancer control.

Cystectomy↗
PubMed2004

[Prostate-sparing cystectomy: long-term functional and oncological results in a series of 25 cases].

OBJECTIVE: To decrease the risk of erectile dysfunction and incontinence by performing prostate-sparing cystectomy for bladder cancer; and to evaluate the oncological results by comparing them to those of radical cystectomy. MATERIALS AND METHODS: Since 1994, 141 men have undergone cystectomy for bladder cancer. Twenty five patients with a mean age of 57 years (range: 47-75 years) underwent prostate-sparing cystectomy. The exclusion criteria were: contraindication to bladder replacement, invasion of the prostatic urethra, and associated prostatic adenocarcinoma. TURP was performed preoperatively to evaluate the prostatic urethra. All patients had a PSA < 4 ng/ml or negative prostatic needle biopsies. The Ditrovie and IIEF scores were used to evaluate the quality of voiding and erectile function. RESULTS: The mean follow-up was 53.4 months (median: 46 months). The overall 5-year survival regardless of stage was 66%. Seven patients (28%) died, all from their cancer. Six patients (24%) developed a pelvic recurrence, 2 patients (8%) developed an urethral recurrence (1 had a multifocal lesion, and 1 had CIS) treated by TURP and 6 patients (24%) developed distant metastases. Among the patients with pelvic recurrence, 4 (66%) presented a multifocal tumour. One patient developed prostatic adenocarcinoma after 36 months, which was treated by external beam radiotherapy. At 1 year, 100% of patients reported normal daytime continence and 19 out of 22 patients (86.4%) were continent at night and had to get up 1 to 3 times per night. At 1 year, 10 out of 22 patients (45.4%) had normal erections, 9 (40.9%) reported impaired erectile function but allowing sexual intercourse, and 3 had major erectile dysfunction (13.6%). At 3 years, 93.7% of patients had normal daytime continence; 75% of patients were continent at night, 37.5% of patients reported normal erections, 37.5% of patients reported partial erections and 25% of patients reported major erectile dysfunction. CONCLUSION: Prostate-sparing cystectomy for the treatment of invasive bladder cancer improves continence, sexual function and quality of life of patients, with poorer oncological results to those of radical cystectomy in terms of pelvic recurrence. Rigorous patient selection should improve these results.

Aged↗
PubMed1993

[Radical cystectomy in the therapy of bladder tumors].

Between January 1970 and December 1992, 100 patients (95 males and 5 females) underwent radical cystectomy for bladder cancer. Their mean age was 54.9 years (range, 34-74 years). Indications for radical surgery were multiple superficial tumors (pTa, pT1) in 24 patients and muscle invasive bladder cancer (pT2, pT3b) in 76 patients. Patients with invasive bladder cancer had received elective pre-operative radiotherapy (40 Gy in 20 pts, 20 Gy in 18 pts). Seven patients had undergone salvage cystectomy after full-dose irradiation (60 Gy); 20 pts received pre-operative (neo-adjuvant) chemotherapy (M-VAC or CMV combination) and 11 pts had had no therapy before cystectomy. In 5 pts urinary diversion was performed in advance; in 95 pts cystectomy and urinary diversion were done at the same time. The following methods of urinary diversion were used: ureteroileostomy (Wallace's modification) in 80 pts, Mainz pouch I (ileal conduit with intermittent catheterization) in 6 pts, Mainz pouch with ileourethral anastomosis in 3 pts, ureterosigmoidostomy in 5 pts and Mainz pouch II (continent rectosigmoidal reservoir) in 6 pts. Post-cystectomy mortality was 8.0%. Long-term survival (Kaplan-Meier) following cystectomy was 15-20% of pts with invasive bladder cancer and 30-40% of pts with superficial bladder cancer.

Adult↗
PubMed1996

Upper urinary tract involvement after cystectomy and ileal conduit diversion for primary bladder carcinoma.

OBJECTIVES: To design a proper follow-up for cystectomy and ileal conduit urinary diversion for primary bladder transitional carcinoma, we compared the radiographic characteristics of recurrent malignant upper tract lesions with those of benign ureteroileal anastomosis strictures. METHODS: Over a 20-year period, we followed 61 patients who underwent cystectomy and ileal conduit diversion at our hospitals for a minimum period of 3 years. Excretory urography was performed routinely at 1, 3, 6 and 12 months after cystectomy and once yearly thereafter. RESULTS: Five patients (8.2%) developed malignant ureteral obstruction (4 had metachronous upper tract tumors, and 1 patient had retroperitoneal lymph node metastasis which compressed the ureter). Eleven patients (18.0%) developed benign ureteroileal anastomotic stricture. The interval between cystectomy and initial detection of the malignant and benign upper tract lesion ranged between 34 and 118 months (mean 69 months) and between 1 and 20 months (mean 5.1 months), respectively. In all patients with malignant upper tract obstruction, a complete loss of renal function occurred within 10 months after the detection. Conversely, a progressive renal dysfunction was observed in patients with benign ureteroileal anastomotic stricture. All patients were asymptomatic before the detection of lesions on excretory pyelography. CONCLUSIONS: Our results suggest that cancer recurrence can occur even 10 years after cystectomy, typically progressing very rapidly within 1 year. A benign ureteroileal anastomotic stricture, on the other hand, tends to occur within 2 years but advances slowly. Consequently, a proper follow-up necessitates annual excretory urography and/or renal ultrasonography in all patients with ileal conduit urinary diversion after cystectomy.

Adult↗