ABSTRACT
Objective To evaluate the urodynamic parameters of W shape orthotopic ileal neobladder during a 36-month follow-up post-operatively.Methods Forty-five consecutive patients underwent radical cystectomy and W shape ileal neobladder substitution for muscle-invasive bladder cancer were recruited.Follow-up and urodynamic evaluation were performed at 12 and 36 months after surgery.Cystourethrography,ultrasonography,IVU and renal function test were performed during the follow-up.Results Of the 45 patients,3 were dead during the follow-up because of cancer-related causes.When comparing to the 12-and 36-month urodynamic parameters,Qmax,MCC,compliance,end-filling pressure,peak flow pressure and PVR respectively were 15.6 ± 2.3 ml/s and 14.9 ± 1.9 ml/s,588.0 ± 264.6 ml and 561.0 ±197.4 ml,27.6±8.4 ml/cm H2O and 29.5 ±1.7 ml/cm H2O,24.4 ±5.2 cm H2O and 33.0 ±6.8 cmH2O,60.7 ±18.0 cm H2O and 79.9 ±28.2 cm H2O,83.5±24.4 ml and 80.4 ±26.8 ml.At early and late evaluation,daytime continence rate was 90％ and 94％,night continence rate was 48％ and 74％.Conclusions Orthotopic W shape ileal neobladder was proven to maintain an adequate capacity and low pressure during a 36-month period of follow-up.The urodynamic results support this urinary diversion as a valid treatment option for muscle-invasive bladder cancer.
ABSTRACT
Objective To discuss the long term clinical effect of ileal orthotropic neobladder.Methods From 1991 to 1998,79 patients,mean age 55(41～75)years,male 74,female 6,were followed up.The serum creatinine and urea,electrolytes,blood routine,B ultrasonic scan of the neobladder residual urine and IVU or MRU of the patients were followed up.The max transverse diameter of renal pelvis and the max verticaI/level diameter of neobladder were measured in 5,10 to 14,15 years of postoperative when IVU or MRU.All results of different time were compared by the multiple comparisons.The local or distant cancer recurrence and the complications of the operation Were evaluated. Results Sixty-four cases,58 male,6 famle,were long term followed up:mean time was 167 (range,121～216)months.Seven cases died of other diseases.Seven cases had pelvic recarrence.Two cases had urethral recurrence.Three cases died of tumor metastasis.One case had ureter recurrence.Forty-eight patients were alive more than 10 years.The value of the serum creatinine,urea,electrolytes and bloods routine of the patients were normal after 5,10 to 14 and 15 vears postoperative (P＞0.05).The max transverse diameter of the renal pelvis in 5,10 to 14 and 15 years Dostoperative were 14.0 mm,14.1 mm and 13.7 mm,respectively,P＞0.05.The max vertical/level diameter of the neobladder in 5,10 to 14,15 years of postoperative were 110.4 mm/90.4 mm,111.5 mm/95.3mm and 127.0 mm/97.0 mm,respectively,P＞0.05.The residual urine of 5 cases was more than 50 ml and had not increased during follow up.Eight cases with neobladder stone were cured by the intracavitary lithothrypsis.Two cases with uretheral stricture were cured by the intracavitary therapy.Twelve cases of 14 cases with inguinal hernia were cured by reoperation,2 cases accepted conservative treatment.Only 17 cases had no complication involve of the cancer and the operation. Conclusion The upper urinary tract and neobladder of the ileal orthotopic neobladder could be stable for long time,the cure rate of tumor is satisfactory and the lifetime follow up is necessary.
ABSTRACT
Objective To evaluate the expression of endothelial Per-ARNT-Sim domain protein-1(EPAS-1)/hypoxia-inducible factor-2?(HIF-2?) and its relationship with vascular endothelial growth factor (VEGF) in bladder transitional cell carcinoma (BTCC). Methods The expression of EPAS-1/HIF-2? and VEGF by immunohistochemical staining was examined in 60 cases of BTCC (Grade Ⅰ in 28 cases,Grade Ⅱ in 12,Grade Ⅲ in 20) and 8 subjects with normal urothelium. Of the 60 cases 29 had superficial (≤pT 1) bladder cancer and 31 had invasive (≥pT 2 bladder cancer).?2 test was used to assess the relationship between EPAS-1/HIF-2? and VEGF expression versus tumor grade and stage. Results The expressions of EPAS-1/HIF-2? and VEGF were negative in all normal bladder tissue but high in BTCC.Of the 60 cases,34 (56.6%) were positive and 26 ( 43.4%) were negative for EPAS1/HIF-2?.Four cases (14.3%) of Grade Ⅰ,11 (91.7%) of Grade Ⅱ and 19 (95.0%) of Grade Ⅲ were positive for EPAS-1/HIF-2?. Positive staining was seen in 5 (17.2%) of the superficial and 29 (93.5%) of the invasive cancer cases.EPAS-1/HIF-2? positivity was correlated with high histological grade (r=0.862,P