[Why and how to modify standard cystectomy].

To improve quality of life in postcystectomy patients, we made 150 radical cystectomies with recovery of urethral voiding. Cystectomy was performed by a modified technique in 87 of 135 operated men: transprostatic cystvesiculectomy (n = 11), transprostatic cystectomy (n = 53), supraprostatic cystectomy (n = 23). Indication for this modification was the absence of extravesicular growth of the primary tumor and prostatic cancer. Monitoring of radicalism was carried out by intraoperative urgent histological investigation of the resection line. 74 patients have undergone retrograde cystectomy. Postoperative lethality was 2.3%. 9 month and longer follow up results were studied.

[Long-term results of continent urine derivation on the skin into a de-tubulized small intestinal reservoir]. / Otdalennye rezul'taty kontinentnogo otvedeniia mochi na kozhu v detubuliarizovannyi tonkokishechnyi rezervuar.

Seventy five patients (48 females, 27 males) at the age of 17 to 78 years (mean age 54.6 years) were radically operated on for locally advanced tumors of the small pelvis organs in the Cancer Research Center of Georgia in 1987-2001. The urine was derived continently on the skin into a detubulized small intestinal reservoir. Invagination valvular device was created in 31 patients, non-invagination (the original technique)--in 44. Conversion of ureterocutaneostomas according to the original technique was made 6-7 months after radical operation in 4 of them. The ureters were transplanted using the antireflux (67) and direct (8) methods. 1-10 follow-up data are available for 52 patients. 4 patients with invagination valve developed postoperative and 2 patients delayed (6-9 months) incontinence. In patients with the original valve incontinence was only in one patient. The difference between the results of antireflux and direct transplantation of the ureters was statistically insignificant.

[More effective exenteration of small pelvis organs in colorectal cancer: is it possible?]. / Vozmozhno li uluchshenie éffektivnosti ékzeneratsii organov malogo taza pri kolorektal'nom rake?

21 exenterations of small pelvis organs were performed from 1991 to 2000 for locally-spread cancer of the rectum. Temporary passage feces and urine before radical operation was performed in 6 patients. 10 patients underwent infralevator and 11 patients--supralevator exenteration of small pelvis organs. Continent cypass of urine was carried out in all the patients (in 2--delayed), and of feces--in 8 (in 2--delayed). Substitution of the urinary bladder was performed in 11 patients, formation of reservoir with "dry" urinostoma--in 10.

Is conservative organ-sparing treatment of penile carcinoma justified?

PURPOSE: The results of different conservative organ-sparing methods - radiotherapy, chemotherapy and radiochemotherapy - in the treatment of penile carcinoma were studied. MATERIALS AND METHODS: Conservatively treated 223 patients with penile carcinoma seen in three hospitals between 1959 and 1996 years were studied retrospectively. Among them 155 received radiotherapy, 33 chemotherapy, and 35 radiochemotherapy. RESULTS: The local control was achieved in 135 (60.5%) of 223 patients. The difference in local control rate among these three groups of patients has not reached statistical significance. The efficacy of conservative treatment was highly associated with three factors: tumor size, grade and patient's age. Overall, 24 of 135 patients (17.7%) had local recurrence. Ten patients (4.5%) developed regional metastases. The recurrence rate did not correlate with tumor size and grade and was similar for all treatment modalities. Long-term results of each method were approximatley equal and 5-year survival varied from 78 to 88%. CONCLUSION: Conservative organ-sparing treatment of early-stage penile carcinomas is justified. Failure should be corrected by surgery without compromising survival.

[Exenteration of pelvic organs and its modifications]. / Ekzenteratsiia organov taza i eë modifikatsii.

A classification of modalities of exenteration of pelvic organs is discussed and standards for optimal procedures of surgical rehabilitation are suggested. Different modifications of pelvic organ exenteration involving removal of the urinary bladder were performed in 29 patients with localized and recurrent malignant tumors. Reconstructive procedures matched the exenteration modifications used. Surgical rehabilitation measures included; reinforcing the fundus of the pelvis, formation of an abdominal pouch for urine collection, a low coloanal anastomosis and vaginal reconstruction.

[The choice of urinary diversion in tumors of the small pelvis]. / Vybor metoda derivatsii mochi pri opukholiakh malogo taza.

Two hundred sixty one operations were performed for urinary diversion in 253 patients with localized tumors of the small pelvis in 1953-1994. Urine was diverted through the skin in 224 cases, through the rectal sphincter-29 and the urinary bladder was replaced in 8 cases. Best advantage in the practice of oncology is offered by skin diversion. Puncture nephrostomy should be recommended for temporary diversion and a detubularized ileal pouch-for a permanent one.

[Infrared telethermography in the diagnosis of testicular tumors]. / Infrakrasnaia distantsionnaia termografiia v diagnostike opukholei iaichka.

Diagnostic potential of infrared extracorporeal thermography (IET) was studied in 334 males: 167 with testicular tumors, 42 with acute or chronic epididimitis, 33 with orchitis, 17 with hydrocele and 75 controls. To assess thermography more objectively in large-size testicular tumors and bilateral lesions, a new thermographic criterium T3 was used. IET sensitivity, specificity and efficacy in testicular cancer made up 92.9%, 89.8% and 91.4%, respectively. In view of its safety, high efficacy, noninvasiveness and simplicity this method has perspectives in diagnosis of testicular diseases.

[Organ-preserving treatment in cancer of the penis]. / Organosokhraniaiushchee lechenie pri rake polovogo chlena.

Of 322 patients with squamous cell carcinoma of the penis, conservative therapy was conducted in 162 (50.3%) untreated patients free of metastases to regional lymph nodes. 125, 14 and 23 patients received radiation, drug and drug+radiation treatment, respectively. The efficacy of conservative treatment reached 74.6%, complete regression of the tumor was achieved in 61.1% of the cases. 8 patients with partial response (reduction of the tumor to 1 cm in size) were exposed to cryodestruction of the residual tumor. Thus, in 111 of 162 patients the penis was not amputated. Follow-up results show that within the period 4.5-14 years the disease relapsed in 20 of 111 patients, 4 patients throughout follow-up month 3-6 developed metastases to regional lymph nodes in the absence of recurrent tumor. It is concluded that amputation of the penis in early cancer should be made only in uneffective sparing therapy.

Abdominal reservoirs for continent urinary diversion.

PURPOSE: Abdominal reservoirs with a continent stoma were constructed. MATERIALS AND METHODS: Different types of artificial valves were fashioned. Our original modification for construction of the Kock pouch is described. The main principle of our suggested version is the embedded and plicated valve, foregoing the antireflux afferent loop, with direct ureteral implantation into the reservoir. RESULTS: Of 69 patients 7 died in the postoperative period. Continence was achieved in 58 of the remaining 62 patients (93.5%). All 7 patients with the embedded valve were continent. CONCLUSIONS: The described modifications led to a shorter operating time and simplified certain portions of the operation.

[A detubularized reservoir for the urine made from the small intestine]. / Tonkoskishechnyi detubuliarizirovannyi rezervuar dlia mochi.

In the department of urology of the Georgian Cancer Research Center creation of small intestinal detubularized reservoir for urine was practiced for 4 years (1990-1994). Of a total of 35 patients, 27 underwent cystectomy for bladder cancer, whereas 8 patients with secondary cancer of the bladder and rectum were subjected to exenteration of the small pelvis organs. In 29 patients the reservoir was made using invagination valvular mechanism (in 6 cases according to D. Skinner, in 23 according to an original technique). Non-invagination valvular device according to the authors' technique was used in the other 6 patients (group 3). In postoperative period 3 patients died. A mean follow-up lasted 18 months. With time, the reservoir volume increased with a parallel fall in pressure. Anatomical conditions of the kidneys compared to the baseline conditions have improved, reflux pyelonephritis was absent. Adequate valvular function recovered in group 3. Rejection of invagination valves diminishes the duration of the surgery, makes the operative procedure easier. Introduction of the original non-invagination valvular device proves to reliable sealing and easy catheterization of the reservoir.

[Current methods of surgical rehabilitation of patients with pelvic exenteration]. / Sovremennye vozmozhnosti khirurgicheskoi reabilitatsii bol'nykh posle évistseratsii organov malogo taza.

An original procedure for supravesical urinary diversion to a small intestine pouch, intended to facilitate urination following pelvic exenteration, is suggested. Post-operative complications are minimized due to formation of a "dry" urinostomy, reduced pressure in the pouch and absence of reflux-pyelonephritis. If required, urine flow can be channeled to the pouch by connecting the sigmoid colon to the anal canal. Said procedure offers optimal advantage of rehabilitation as far as urine channeling is concerned.

Continent urinary diversion (Gotsadze Pouch) after pelvic exenteration for gynaecological malignancies.

The problem of urinary diversion is of major importance in patients requiring pelvic exenteration for advanced gynaecological malignancies. Eight patients underwent pelvic exenteration (4-total and 4-anterior) at the Georgian Oncologic Centre, 7 of them for recurrent cervical carcinoma after combined treatment and 1--for primary advanced cervical carcinoma. The original surgical technique for construction of detubalarized ileal reservoir with continent umbilical stoma (Gotsadze Pouch) is described. Six patients underwent this type of urinary diversion with successful results. Urination is patient-controlled via self-catheterization every 5 to 6 hours. The results obtained by operation can be considered as optimal for their functional and rehabilitational properties.

[The results of the diversion of urine into a large-intestine reservoir]. / Rezul'taty derivatsii mochi v tolstokishechnyi rezervuar.

Cystectomy for bladder cancer with derivation of the urine into the colon was performed in 35 patients (30 males and 5 females). Postoperative lethality was 11.4% (4 patients). The best outcomes in cases of partial and/or complete failure of the ileocecal valve were obtained when forming the invaginate in the stomal ileum. Examination following the surgery was conducted in 31 patients. Of them, preoperative passage from the upper urinary tracts was impaired in 22 (71%) because of the tumor spread into the ostium urethritis. Postoperative defect from the upper urinary tracts was recorded in 7 (22.6%) patients, while normal function of the kidney was registered in 24 out of 31 patients (77.4%). A complete retention of the urine was achieved in 27 of 31 patients (87.1%). With time, the capacity of the colon reservoir increased up to 750 +/- 57.9 ml to the end of the second postoperative year. The right part of the colon, cecum or ascending colon as well as the proximal third of the transverse colon as the reservoir served satisfactorily.

[The causes of mortality following cystectomy for bladder tumor]. / Prichiny letal'nosti posle tsistéktomii po povodu opukholi mochevogo puzyria.

The analysis of the treatment results is given for 183 patients with bladder cancer following cystectomy under various methods of urine derivation. Ureterocutaneostomy, Brickers operation, ureteral implantation into an isolated segment of the sigmoid, ureteral implantation into the colonic reservoir with controlled evacuation, radical cystectomy with ureteral implantation into an isolated rectal bladder with formation of sigmostoma, ureterosigmoanastomosis were performed in 94, 15, 10, 35, 12 and 17 patients, respectively. As shown by the follow-up available for 151 patients, 55 patients died of the tumor progression, 22 of renal complications, 11 of other causes. Within 2 postoperative years the disease progression and renal failure caused death in 65 (73.9%) out of 88 patients. The least lethality due to renal failure (3.2%) was recorded in patients with colonic reservoir.

[The quality of life of patients after cystectomy for cancer]. / Kachestvo zhizni bol'nykh posle tsistéktomii po povodu raka.

Quality of life was assessed in 60 cystectomized patients with bladder cancer versus method of urine derivation. Surgery had been ended with formation of "wet" stoma in 39 cases (ureterocutaneostomy--in 30 patients and operation after Bricker--in 9) whereas in 21 cases "dry" stoma had been formed with derivation of the urine into large bowel reservoir assuring controlled voiding. Only as few as 9 (23.1%) "wet" stoma patients retained the pretreatment activity as compared to 100% of those in the other treatment group. One-third of the "wet" stoma patients were unsatisfied with functional results of surgery and preferred formation of the reservoir which assured controlled voiding and allowed freedom from urinal.

[The lack of knowledgeability of men about testicular tumors as a cause for the late diagnosis of this disease]. / Plokhaia osvedomlennost' muzhchin ob opukholiakh iaichka kak prichina pozdnei diagnostiki étogo zabolevaniia.

Five hundred and sixty-two males, aged 15-50 years, were questionnaired to assess their knowledge about testicular cancer, its early symptoms, treatment and role of self-examination in early diagnosis of tumor. Only 25 (4.5%) respondents answered all 9 questions correctly whereas 93 (16.6i%) failed completely. On the average, each respondent gave a correct answer to four questions out of nine. The study pointed to very poor knowledge about testicular cancer among young males. This calls for making educational effort to improve the situation.

[Ways toward improvement of the results of cystectomy in bladder cancer]. / Puti uluchsheniia rezul'tatov tsistéktomii pri rake mochevogo puzyria.

Cystectomy with derivation of urine into large bowel reservoir was performed in 35 cases of bladder cancer including five females. Four patients (11.4%) died postoperatively. In patients with partial or complete ileocecal valve failure, the best functional results were obtained with formation of intussusceptum in the area of the ileum stoma. The reservoir volume increased with time, reaching 750 +/- 57.9 ml by the end of the second year. Within the same period, pressure in the totally filled reservoir decreased from 32 +/- 1.7 to 18 +/- 4.3 un. Postoperative monitoring of anatomic structure of the kidneys showed improvement in urine passage. Wide integration of the procedure discussed with practice will improve results of bladder cancer treatment.

[The results of cystectomy in bladder cancer]. / Rezul'taty tsistéktomii pri rake mochevogo puzyria.

Long-term results were assessed in 173 bladder cancer patients subjected to cystectomy. Twenty-eight (16.2%) patients died postoperatively. End results were evaluated in 142 patients. The patients were followed up for 1-17 years. Within that period, 50 patients (35.2%) died of tumor progression whereas 20--from renal failure (14.1%). Overall three- and five-year survival was 54.8 +/- 5.1 and 50.0 +/- 5.6%, respectively. Treatment results were studied versus stage, histologic pattern, type of treatment, tumor growth pattern and age. A significant correlation was established for stage and effectiveness of cystectomy only.