ABSTRACT
Objective: To study the recurrence rate of superficial bladder tumors at Cairo university hospitals
Patients and Methods: Sixty-six patients with superficial transitional cell carcinoma who were treated by either Nd: YAG laser therapy [16 patients] or transurethral resection [50 patients] were followed for a mean of 5.5 years
Results: Local tumor recurrence at the same site of the original tumor occurred in 39% of patients while remote recurrence occurred in 33% of patients. The total recurrence rate was 59%. Tumor progression to invasive carcinoma occurred in 7 patients [11%], and 3 patients [4.5%] died of disease-related causes
Conclusion: The treatment of superficial TCC may be done by relatively minor endoscopic procedures, but the disease itself is a serious condition that merits close long-term follow-up
ABSTRACT
Objectives: To evaluate the early and late postoperative complications, upper urinary tract morphology and function and metabolic alterations which may occur after ileal continent orthotopic urinary diversion
Patients and Methods: Between July 1999 and January 2001, 42 male patients were subjected to radical cystoprostatectomy for bladder cancer and orthotopic urinary diversion at the urology departments of Cairo University and Suez Canal University Hospitals. All cases were evaluated clinically, bacteriologically, urodynamically and radiologically during the early and late postoperative periods [at 3 - 6 months and 6 - 18 months, respectively]. The patients were divided into three groups: in Group I [22 cases] a W neobladder was fashioned with the uretero-ileal anastomosis done by creating extramural serosally lined tunnels. In Group II [12 cases] a Camey II pouch was done with ureteroileal anastomosis by direct end-to-end anastomosis in four and by Le Duc technique in eight pouches. In Group III [8 cases] a Kock's pouch was done with the ureters being directly implanted in the afferent loop above the constructed intussusception ileal nipple valve. In all types of reservoirs we used 45 cm of the ileum. Preoperatively all but four ureters were normal. These four ureters were dilated and uretero-ileal anastomosis was done by extramural serosally lined tunnels
Results: In the early follow-up period total diurnal continence was achieved in 72%, 75% and 75% of the patients of Groups I, II and III, respectively, versus 91%, 83% and 88% in the late postoperative period. Nocturnal continence was achieved in 64%, 67% and 63% during the early postoperative period compared to 73%, 75% and 75% in the postoperative period for the three groups, respectively. In the early postoperative period complications occurred in 33% of the patients including ureteroileal leakage [9.5%], a prolonged pouchourethral anastomotic leakage [11.9%], wound dehiscence [4.7%], deep venous thrombosis [2.3%], bronchopneumonia [2.3%] and a prolonged ileus [2.3%]. Late complications occurred in 26.2% of the patients including urethral recurrence, pelvic recurrence and urethroileal anastomotic stricture in 4.8%, 14.2%, 4.8%, respectively and urethral stricture at the bulbomembranous junction in 2.4%. A higher incidence of renal deterioration was detected in cases where the ureters were implanted directly [60%] or in cases where the ureters were implanted by Le Duc technique [30%]. Deterioration was noted in 12.5% of the cases where the ureters were implanted in an intussusception nipple valve and in 4.5% of the renal units where the ureters were implanted in an extramural serosally lined tunnel. At 9 months postoperatively metabolic acidosis occurred in one patient with a Camey II neobladder
Conclusion: A number of early and late postoperative complications were encountered after orthotopic neobladder. Metabolic complications were found in the form of metabolic acidosis in one patient. The lowest incidence of renal deterioration was reported in cases with extramural serosally lined ureteroileal anastomosis