Endoscopic transurethral resection of bilharzial ulcers in the urinary bladder. Single-center experience with 1000 patients

Objective To report on the results of endoscopic transurethral resection of chonic bilharzial ulcers of the urinary bladder at the Assiut University Hospital; Assiut; Egypt. Patients and Methods Between June 1995 and April 2001; 1000 patients (87.3males and 12.7females) with chronic bilharzial ulcers (78de novo and 22recurrent ulcers after previous open partial cystectomy) were treated by endoscopic transurethral electroresection (TUR) at our department. Single ulcers were diagnosed in 612 (61.2); double ulcers in 261 (26.1) and multiple ulcers in 127 (12.7) patients. Ulcers of a moderate diameter (1-2 cm) were present in 505 (50.5) patients. Electroresection was done until healthy fibers of the detrusor muscle or even the prevesical fat was reached. Results The mean duration of the resection was 19.8 minutes. Extraperitoneal bladder perforation was recorded in 11 patients (1.1). In all these patients conservation was successful. Intraperitoneal bladder perforation was recorded in 16 patients (1.6). In six out of these patients conservation was successful; while peritoneal drainage was necessary in the remaining cases. Conservative management was successful in 5 cases (0.5) of secondary haemorrhage. Hospitalization was one day in 920 patients (92). After six months 862 patients (86.2) were available for follow up. 745 (86.4) were symptom-free and 794 (92.1) reported complete healing of the resected ulcer at follow-up cystoscopy. Conclusion Endoscopic transurethral electroresection is a satisfactory modality for the treatment of bilharzial ulcers of the urinary bladder

Charleston Pouch with in-situ appendix and concealed umbilical stoma

Objectives : To evaluate the functional outcome of the Charleston pouch procedure as a continent catheterizable urinary reservoir using an unaltered in-situ appendix with a triangular skin flap at its umbilical stoma with few modifications to the original technique. Patients and Methods: Between February 1999 and October 2002; 34 patients (31 males and 3 females) were studied at the Urology Department; Assiut University Hospital; Assiut; Egypt. The indications for urinary diversion were radical cystectomy for invasive carcinoma of the bilharzial bladder in 27 males and three females; and incontinent epispadias in four male patients. The age of the patients ranged between 18 and 60 years (mean 48.1 6.1 years). Mean follow up was 30 4.2 months (range 11-40 months). The evaluation during the follow-up period included clinical; laboratory; imaging and urodynamic studies to evaluate the functional outcome. Results: All patients are continent (day and night). No stomal stenosis was recorded. Laboratory investigations were within normal. The upper urinary tract remained unchanged in all patients. Pouchometry revealed that the Charleston pouch is a low-pressure (4 -21 cm H2O) reservoir with a good capacity (average 750 ml). Cancer recurrence was recorded in 3 patients at 12; 27 and 32 months. Conclusions: The Charleston pouch with in-situ appendix is an efficient versatile technique for the creation of a catheterizable continent cutaneous urinary reservoir. The umbilical stoma with triangular skin flap provides excellent cosmetic results