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Objective To investigate postoperative urinary function recovery after complete robotic assisted radical cystectomy and in situ U-shaped ileal neobladder.Methods Retrospective analysis of 79 cases of local progression bladder cancer (cT2-3 N0-2 Mo) in our hospital from September 2014 to September 2018.79 cases were confirmed by pathology as high-grade uroepithelium cell carcinoma of bladder.Posterior urethra and bladder neck biopsy did not see tumor invasion.The urodynamic examination for all patients before surgery showed no significant decrease in urinary control function.Preoperative International urinary Incontinence Advisory Committee urinary Incontinence Questionnaire summary confirmed that there was no obvious urinary incontinence symptoms.All patients underwent radical bladder resection and in situ Ushaped ileum new bladder surgery.40 cases in the experimental group were treated with complete robot assisted radical bladder resection and in situ U-shaped ileum new bladder.39 cases in control group were treated with laparoscopic surgery.There was no statistically significant difference between the two groups of general data (both P ＞ 0.05).The operation time,bleeding volume,positive rate of postoperative incision,postoperative hospitalization time,new bladder capacity,residual urine volume,maximum urinary flow rate,bladder internal pressure,unilateral ureteral reflux and stenosis incidence,as well as immediate urinary control rate after extraction of catheter and 1,3,6 and 12 months of urinary control recovery were compared.Results 79 cases of this study were successfully completed.The operation time of the two groups [(286.5 ±37.2) min vs.(288.5 ±32.9) min,P =0.801],intraoperative blood loss[(185.1±41.6) ml vs.(189.3 ±54.2) ml,P =0.700].There was no significant difference in the average postoperative hospital stay [(14.3 ± 1.6)d vs.(14.9 ±2.2)d,P =0.168].The margins of the pathological examinations in both groups were negative.New bladder volume after surgery [(300 ± 10) ml vs.(245 ± 10) ml,P ＜ 0.001].Urodynamic examination of residual urine volume [(20 ± 10) ml vs.(50 ± 10) ml,P ＜0.001],maximum urine flow rate [(16 ±4) m1/s vs.(13 ±2) m1/s,P =0.006].Intravesical pressure [(22.5 ±3.0) cmH2Ovs.(17.5 ± 2.5) cmH2O,P ＜ 0.001] (1 cmH2O =0.098 kPa).The two groups of postoperative cystoscopy showed that unilateral ureteral reflux was 5％ (2/40) and 20.5％ (8/39),respectively,and the unilateral ureteral anastomotic stenosis was 2.5％ (1/40) and 15.4％ (6/39) after operation,and the difference was statistically significant (P =0.038,P =0.044).The urine control rate of the observation group and the control group immediately after removal of the catheter was 37.5％ (15/40) and 15.4％ (6/39),respectively.The urine control rate in 1 month was 62.5％ (25/40) and 38.5％ (15/39),respectively.The urine control rate in 3 month was 82.5％ (33/40)and 56.4％ (22/39),the difference was statistically significant (P =0.026,P =0.033,P =0.012).At other follow up time points,there was no significant difference in point-controlled urine rate (P ＞ 0.05).Conclusions Complete robot-assisted radical cystectomy and in situ U-shaped ileal neobladder surgery are more advantageous than standard laparoscopic surgery in time of the early recovery urinary function.
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Objective To study and observe the application effect of debridement adhesive combined with comfeel silver ion dressing in the treatment of wound after the total cystectomy.Methods 90 patients with total cystectomy in Cixi People's Hospital from July 2014 to June 2016 were selected as the research object, and all the patients were randomly divided into control group 45 cases and observation group 45 cases, the control group were treated with conventional treatment of postoperative wound, the observation group were treated with debridement adhesive combined with comfeel silver ion dressing on the treatment of control group, then the infection rates, degree of edema and local comfort, life quality and local microcirculation state before and after the intervention of two groups were respectively analyzed and compared .Results The infection rates of observation group were higher than those of control group, the degree of edema and local comfort, life quality and local microcirculation state after the intervention were all significantly better than those of control group, the difference was all statistically significant ( P <0.05 ).Conclusion The application effect of debridement adhesive combined with comfeel silver ion dressing in the treatment of wound after the total cystectomy is better , and it has active role for the improvement of discomfortableness and microcirculation state.
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Objective: To investigate the clinical effect of total cystectomy and W-shaped orthotopic ileal neobladder for bladder cancer. Methods: Total cystectomy and W-shaped orthotopic ileal neobladder were performed on 29 male patients and 3 female patients. Atfer the cystectomy, 35-40 cm terminal ileal segment was isolated to make W-shaped orthotopic ileal neobladder. Bilateral uretero-ileal anastomoses were constructed by nipple technique, urethral stump was sutured to the lowest portion of the ileal pouch. Results: All surgeries were completed successfully. Patients were able to void by increasing the abdominal pressure, daytime continence rate was 87.5% and nighttime continence rate was 78.1%. The mean neobladder capacity was 410.6 mL and the mean postvoid residual urine was22.7 mL at 6 months. After the surgery, ileal neobladder leakage occurred in 3 (9.4%) patients, mild ileus occurred in 2 (6.3%) patients, ileo-urethral anastomosis stricture developed in 1(3.1%) patient, and dysuria occurred in 3 (9.4%) patients because of the mucus.HTe complications were treated properly and satisfactory results were obtained. Erection was preserved in 5 of the 9 male patients with normal erectile function, and normal sexual function was preserved in 1 female patient who underwent uterus-sparing cystectomy. HTe mean follow-up was 15 months.One patient died of distant metastasis and pneumonia, while other patients survived without tumor. Conclusion: Total cystectomy and W-shaped orthotopic ileal neobladder have the advantages of voiding through the native urethra, satisfactory continence, low complication rates of upper urinary tract damage and electrolyte imbalance. W-shaped orthotopic ileal neobladder may be considered as the ifrst option of urinary diversion atfer cystectomy. Postoperative management should focus on complications and follow-up.
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Objective To study the therapeutic effects of total cystectomy and internal cyst extirpation for hepatic cystic echinococcosis (HCE).Methods From June 2007 to Mar 2011,118 HCE cases were admitted and underwent surgery including 56 cases treated with internal cyst extirpation,and 62 cases with total cystectomy.Operation time,intraoperative blood loss,postoperative hospital stay,postoperative complications,operative mortality and recurrence rate,re-hospitalization rate,re-operation rate were comparatively studied.Results Compared with internal cyst extirpation patients receiving total cystectomy had less postoperative complications,lower rate of recurrence,re-hospitalization and re-operation,and shorter postoperative hospital stay,although with a longer operation time and more intraoperative blood loss.Conclusions Total cystectomy can reduce postoperative complications,recurrence rate,and shorten postoperative hospital stay.Total cystectomy should be a choice of therapy for the management of HCE.
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Objective To observe clinical curative effect of modified total cystectomy and Mainz Ⅱ neobladder. Methods Seventeen patients with bladder neoplasms were treated with modified total cystectomy and Mainz Ⅱ neobladder for urinary diversion. The paries posterior allantois with intestinum rectum and colon sigmoideum were taken 10 cm respectively, split the mesenterium edges, conduplicated and bilayer sutured from the junction of intestinum rectum and colon sigmoideum, bilateral ureters antireflux anastomosed respectively with colon sigmoideum and rectal papilla, then bilayer sutured paries anterior became Mainz allantois. Results There was no surgical mortality. The operative time was 340 ～ 420 mins (mean, 350 mins).Blood transfusion was 400 ～ 800 ml ( mean 600 ml). The follow-up was 4 ～ 18 months, urine and dejecta were shunt, uresis continence was fine and the operation had fewer severe complications. Conclusion Modified total cystectomy and Mainz Ⅱ neobladder to be an effective method for urinary diversion because of its simple operation, fewer severe complications, good uresis continence and high quality of life.
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Objective To present a modified technique of total cystectomy and ileal neobladder. Methods Radical cystectomy and ileal neobladder were performed for 25 male patients. The dome, the upper part or the lateral walls and the base of the bladder were dissected antegradly. After cutting the ureters, the mobilization was then made retrogradly.For the construction of the reservior, the isolated 40 cm ileal segment was opened along its antimesenteric border and then arranged into a W shape. The wall of ileal pouch was created by side-to-side blanket suture of the incised ileum. The ureters were implanted at the two corners of W shape with antireflux nipple. Results 24 of 25 cases of ileal neobladder have been followed up for 2 to 84 months with a mean of 24 months.The operation took 150 to 310 minutes with a mean of 240 minutes. The intraoperative blood transfusion was 0 to 1200 ml.1 patient died of cancer metastasis. 23 patients have achieved excellent daytime continence,whereas only 14 had nighttime continence. The mean bladder capacity for the entire group was 310 ml. Renal functions of 2 patients were mildly abnormal.Hypokalemia occurred in 2.There was no metabolic acidosis.There were 3 cases of hydroureter or hydronephrosis on one side. 1 calculus of neobladder was discovered on BUS. On voiding cystography, no reflux has been noted in all.And no patient suffered from urethral recurrence. Conclusions The modified total cystectomy and ileal neobladder takes less time and is more feasible.
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Objective To report the modified surgical technique currently used for the construction of an orthotopic ileal neobladder.So as to improve the vesical function of urinary storage and urination after total cystectomy. Methods Radical cystectomy and ileal neobladder with double “U” shape were performed in 20 patients with transitional cell carcinoma. After the detubularized ileal segment approximately 40 cm in length was arranged in a U configuration,the two medial borders of the U-shaped open segment were oversewn with a single layer seromuscular continuous 2-0 polyglycolic acid suture.The bottom of the U was folded over between the two ends of the U.Thus a spherical pouch, the neobladder, was fashioned. During that period, the neobladder anastomosed to the urethra.The ureters were implanted according to the improved stitching method. Results The operative time to form a neobladder was (90?15)min.Follow-up turned out that no perioperative or early postoperative mortality was observed, and no severe early complications occurred. The mean postoperative follow-up time was 25 (range,6 to 48) months.All the 20 cases achieved excellent continence except for 6 cases with temporary incontinence at night.Dysuria occurred in 1 case,and hydronephrosis on the left was found in 1 case.Six months later, the mean bladder capacity was 340 ml (range,250 to 450 ml). Conclusions The construction of an ileal neobladder using a smaller part of ileum that has been completely detubularized and fashioned by double U shape is easy and agreeable to perform.This mode of operation has low complication rates, achieves adequate capacity at low pressure, and provides satisfactory continence rates.
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PURPOSE: Multifocal development of transitional cell carcinoma in the urinary tract is well recognized. We reviewed the urethral recurrence following cystectomy for transitional cell carcinoma of the bladder and determined the factors influencing this recurrence. MATERIALS AND METHODS: From January 1984 to December 1996, 97 patients underwent total cystectomy in our hospital and 59 men were able to be followed up for transitional cell carcinoma of the bladder. The incidence of the urethral recurrence after cystectomy and its relationship to some factors including tumor stage, grade, number, shape, and location of the bladder cancer were evaluated. RESULTS: Of the 59 patients, nine(15.3%) had secondary urethral cancer which was more common in high stage & grade, multiple, sessile tumors and that involved the trigone, bladder neck or prostate. CONCLUSIONS: A proper evaluation of patients at high risk for subsequent development of cancer in the urethra after cystectomy appears to be important to determine whether or not preserve the urethra and to avoid unnecessary urethrectomy during the total cystectomy.
Subject(s)
Humans , Male , Carcinoma, Transitional Cell , Cystectomy , Incidence , Neck , Prostate , Recurrence , Urethra , Urethral Neoplasms , Urinary Bladder Neoplasms , Urinary Bladder , Urinary TractABSTRACT
Between Jan. 1971 and Dec. 1985, 102 consecutive patients underwent total cystectomy and urinary diversion for primary carcinoma of the bladder. Among the patients, planned radiation therapy (2,000 rad. for 5 days) followed by operation was done in 18 patients, therapeutic dose of radiation was given postoperatively in 8 patients and 76 patients underwent operation only The postoperative mortality rate was 3.9%. Early complications occurred in 30% of the 102 patients and included wound infection, urine leak, bowel obstruction and medical complication. An increased late complication incidence was noted among 26 patients receiving pre- or postoperative radiation (50%) compared with those not receiving radiation (32%). Staging errors by CT scanning occurred in 37% of patients, overstaging in 8 (33%) and understaging in 1 (4%). Survival was evaluated in 45 patients and the overall 5-yesr survival rate for patients with transitional cell carcinoma was 38%.
Subject(s)
Humans , Carcinoma, Transitional Cell , Cystectomy , Incidence , Mortality , Survival Rate , Tomography, X-Ray Computed , Urinary Bladder Neoplasms , Urinary Bladder , Urinary Diversion , Wound InfectionABSTRACT
A total of 26 consecutive patients underwent total cystectomy and ileal conduit for bladder cancer, 6 patients without preoperative radiation therapy, 16 patients after planned preoperative radiation therapy and 4 patients with postoperative radiation therapy. The operative death was none. Early complications occurred in 38% and included wound infection, wound disruption, parastromal dermatitis, acute pyelonephritis, intestinal obstruction and urine leak. Late complications included stromal stenosis, intestinal obstruction, acute pyelonephritis, enterocutaneous fistula, peritonitis and ureteroileal stricture. Errors in clinical staging of bladder carcinoma occurred in about 38% of patients. The pathologic stage was higher (clinical understaging) in 6 (23%), and lower (clinical overstaging) in 4 (15%). Deaths during follow-up were 7 patients and the average survival period was 15 months, with a range of 6 to 38 months.
Subject(s)
Humans , Constriction, Pathologic , Cystectomy , Dermatitis , Follow-Up Studies , Intestinal Fistula , Intestinal Obstruction , Peritonitis , Pyelonephritis , Urinary Bladder Neoplasms , Urinary Bladder , Urinary Diversion , Wound Infection , Wounds and InjuriesABSTRACT
Between Jan, 1971 and July, 1977, 28 consecutive patients underwent total cystectomy and ureteroileocutaneostomy for carcinoma of the bladder in the Department of Urology. Keimyung University Medical College and Hospital, and survival was valuated in 25 patients who had been followed for at least 5 years. 1. Patients ranged in age from 31 years to 72 years, with an average of 53.6 years with peak incidence in the 6th decade and the male to female ratio was 3:1. 2. Preoperative irradiation and pelvic lymphadenectomy were not performed. 3. Operative mortality was 7.1 percent. 4. Early complications included wound infection. wound dehiscence, ileus, intestinal obstruction, pulmonary embolism, rectal injury, spontaneously pneumothorax, hydropneumothroax, renal failure, and hepatic coma. Late complications included parastromal dermatitis, stromal ulceration, recurrent stromal bleeding, fecal fistula, intestinal obstruction and hydronephrosis. 5. The over all 5-year survival rate was 32 percent. The over all 5-year survival rate for patients with transitional cell carcinoma wag 33.3 percent, for squamous cell carcinoma 25 percent, and for adenocarcinoma 33.3 percent. 6. The 5-year survival rate for patients with superficial (A and B1) transitional cell tumor was 80 percent, for B2 and C tumor 11 percent and for D 25 percent. 7. The 5-year survival rate for patients with grade II tumor wag 57 percent, for grade III 17 percent, and for grade IV 20 percent.
Subject(s)
Female , Humans , Male , Adenocarcinoma , Carcinoma, Squamous Cell , Carcinoma, Transitional Cell , Cystectomy , Dermatitis , Hemorrhage , Hepatic Encephalopathy , Hydronephrosis , Ileus , Incidence , Intestinal Fistula , Intestinal Obstruction , Lymph Node Excision , Mortality , Pneumothorax , Pulmonary Embolism , Renal Insufficiency , Survival Rate , Ulcer , Urinary Bladder Neoplasms , Urinary Bladder , Urology , Wound Infection , Wounds and InjuriesABSTRACT
A retrospective analysis of 9 patients of bladder tumor who underwent total cystectomy in the Department of Urology. Kyung Hee University Hospital, during the period from May, 1977 to April, 1981. The results were as follows: 1. The age of the patients ranged from 52 to 65 years, the average age 59.8 years, and male to female ratio was 7 to 2. 2. Hematuria was the most commonly found in 9 patients, frequency in 5 patients, and dysuria in 3 patients. 3. Errors in clinical staging were also common-1 case was overstaged, 3 cases understaged, 3 cases corresponded and 2 casts inadequate for the clinical staging, but the pathologic grade proved to be equal that estimated from the 2 cases of transurethral biopsy. 4. There were 8 cases of total cystectomy and 1 case of radical cystectomy, the methods of urinary diversion and remodeling of urinary tract were ileal conduit in 6 cases, bilateral cutaneous ureterostomy in 3 cases. 5. Operative death was none but the complications were followed by total cystectomy and urinary diversion in 8 cases as wound disruption, pneumonia, atelectasis, irritation dermatitis, vaginal vault bleeding, pyelonephritis, stromal stricture, stricture of ureteroileal anastomosis site and delayed wound healing.
Subject(s)
Female , Humans , Male , Biopsy , Constriction, Pathologic , Cystectomy , Dermatitis , Dysuria , Hematuria , Hemorrhage , Pneumonia , Pulmonary Atelectasis , Pyelonephritis , Retrospective Studies , Ureterostomy , Urinary Bladder Neoplasms , Urinary Bladder , Urinary Diversion , Urinary Tract , Urology , Wound Healing , Wounds and InjuriesABSTRACT
Clinical observation was made on 18 cases of total cystectomy who had been admitted to the Department of Urology, Chonnam University Medical School from November 1966 to August 1976. The results were as follows: 1. The age of the patients ranged from 27 to 67 years, most common in sixth decade. Male patients were more common than female ones. 2. The underlying diseases for total cystectomy were bladder tumors in 15 cases, urethral carcinoma in 1, prostatic carcinoma in 1 and prostatic sarcoma in 1. 3. The methods of urinary diversion and remodeling of the urinary tract were ileal conduit in 9 cases, cutaneous ureterostomy in 2, cutaneous transureteroureterostomy in 1, rectal bladder in 3, ureterosigmoidourethrostomy in 2 and ureteroileourethrostomy in 1. 4. Complication was followed immediately as hematoma in cystectomized site, pulmonary edema, severe metabolic acidosis, mechanical ileus, prolonged paralytic ileus, wound disruption, conduit bleeding, stricture of ureteroileal anastomosis site and uncontrolled hiccup and later as incisional hernia, ileal invaginstion and stomal stricture, in 10 cases. 5. There were two operative death (11%) 3 and 4 days postoperatively, respectively.