Vaginal reconstruction with a greater omentum - pedicled flap combined with a vicryl mesh after anterior pelvic excentration surgical approach with cyto - histological follow-up

The aim of this study was to evaluate a new technique of vaginal reconstruction following anterior pelvic exenteration with clinical and cyto-histological follow up. Between March 2000 and November 2002, ten sexually active female patients underwent vaginal reconstruction after radical cystectomy that required en-bloc removal of the anterior vaginal wall, with a pedicle flap of greater omentum combined with a vicryl mesh. The mean operative time of the reconstructive procedure was 50 minutes. There were no complications regarding the reconstructive procedure. On the follow up, the neovagina accepted two fingers easily and showed pink colored smooth lining. Seven patients reported a successful attempted sexual intercourse. The combined cytological and histological follow up was very reliable and beneficial in the detection of complete healing, postoperative infections, hormonal activity of the flap and recurrence of malignancy

prognostic index [BPI] for bilharzial related invasive bladder cancer

This study was done on 180 patients with histopathologically proven invasive bladder cancer associated with bilharziasis. They were subjected to radical cystectomy or anterior pelvic excentration. After surgery, the patients were regularly followed up for a minimum of two years. Squamous cell carcinoma was the commonest type and most of the tumors were grade II. One hundred and seventy-three patients had their tumors operable, while seven patients were inoperable. Five operative related mortalities were recorded. Free and overall survival rates of the whole group of the patients were 31.44 + 5.9% and 32.5 + 6.8%, respectively. Tumor pathologic stage, grade and nodal affection were the only significant factors that affected the survival. These three prognostic indices were used to design a model to predict an individual patientgyptians risk factor for recurrence. Then, the patients were assigned to one of four risk groups according to the score achieved in this prognostic index [0 = low risk, 1 = intermediate risk and 2 or 3 = higher risk]. These four risk groups had distinctly different rates of disease free survival, being 91.7%, 53%, 13% and 7% for low risk, intermediate risk and higher risk groups, respectively