ABSTRACT
Objective: To report on the complications following orthotopic ileal W-neobladder with serous lined extramural antireflux ureteral implantation. Patients and Methods The records of 520 patients that had undergone one-stage radical cystectomy and orthotopic ileal neobladder were reviewed retrospectively including the follow-up files. Special attention was directed towards the mortality; morbidity and late complications recorded during the follow-up evaluation. Results Hospital mortality was reported in 5 cases. Eighty-one early complications were observed in 60 patients (11.5); including GIT complications in 13; wound infection in 22 and pouchovaginal fistulae in 3. Out of 520 patients 400 were evaluable (308 men and 92 women). Tumor recurrence was documented in 101 patients (20) including 5 with isolated urethral recurrence (0.9). Late complications included pouch stones in 13; outflow obstruction in 12; mucus retention in 4 and adhesive bowel obstruction in 5. Urinary incontinence was found in 9and 18of patients during the day and night times; respectively. Hypercontinence was documented in 9 females. Upper tract deterioration was observed in 36 out of 785 renal units (4.5) due to anastomotic stricture in 32 and chronic pyelonephritis in 4. Poucho-ureteral reflux was seen in 28 units (3.6). Bacteria were isolated in the urine of 32 of 316 examined patients. Serum creatinine was normal in all but 4 patients and 44 patients (11) suffered from subclinical chemical metabolic acidosis. Conclusion The incidence of complications following ileal W-neobladder is low and amenable to treatment in most of the patients. Furthermore; the technique has proved its efficacy and durability
Subject(s)
Case Reports , Egypt , Ileal Neoplasms , Surgical Procedures, Operative , Urinary Bladder NeoplasmsABSTRACT
Objective To determine the incidence of prostatic adenocarcinoma in bilharzial patients who previously underwent radical cystoprostatectomy for bladder tumors. Patients and Methods From February 1997 to February 1999; 249 male patients with bladder cancer were screened for prostate cancer prior to cystectomy using DRE and total PSA assay; as well as transrectal ultrasound-guided prostatic biopsies. Then the cystoprostatectomy specimens were serially sectioned (every 3 mm) and histologically examined. Results Prostatic adenocarcinoma was detected by ultrasound-guided prostatic needle biopsies in 2 cases; while in 18 it was discovered incidentally after cystoprostatectomy (total 20 patients = 8). Gleason score was 6 in 16 patients; 7 in 3 patients and 8 in the remaining patient. Perineural lymphatic permeation was observed in 4 cases and extracapsular extension in one. Conclusion Compared to previous reports on non-bilharzial patients; the incidence of prostate cancer in the cystoprostatectomy specimens of bilharzial patients was low; and the tumors were clinically insignificant in most of the cases