Impact of the level of muscle invasion in organ-confined bladder cancer.

OBJECTIVE: We evaluated whether there is a survival difference between patients having pT2a and pT2b invasive bladder carcinomas without nodal involvement and distant metastases. PATIENTS AND METHODS: Three hundred and thirty-six patients with invasive carcinomas of the bladder underwent radical cystectomy. Seventy-five patients with organ-confined disease were evaluated. The pathological stage was used as predictor of survival. Kaplan-Meier method and log-rank test were used to evaluate survival rates. Cox proportional-hazard models were used to identify whether pathological stage, grade, diversion type, age, and gender affect the outcome. RESULTS: Thirty-five patients were in the pT2aN0 group with a mean age of 57.8 +/- 1.4 (range 37-76) years, and 40 patients were in the pT2bN0 group with a mean age of 59.5 +/- 1.1 (range 37-76) years. There were 2 female patients. The mean follow-up period was 27.41 +/- 20.5 (range 3-80) months. The disease-specific 5-year survival rate of the pT2N0 cases was 80.3%. The disease-specific 5-year survival rates for the pT2aN0 and pT2bN0 patients were 84.3 and 66.0%, respectively. The disease-specific mean survival times of pT2aN0 and pT2bN0 cases were 76.2 +/- 4.7 and 56.3 +/- 7.7 months, respectively. There was no statistically significant survival difference between pT2aN0 and pT2bN0 patients by log-rank test (p = 0.1767). According to the Cox multivariate regression analysis, stage, grade, diversion type, age, and gender were not predictive of the survival in patients with organ-confined bladder cancer (p > 0.05). CONCLUSIONS: The level of muscle invasion in organ-confined bladder cancer does not have an influence on the patient survival. Also stage, grade, diversion type, age, and gender are not predictive of survival in patients with organ-confined muscle-invasive bladder cancer.

Giant renal calculus in a solitary functioning kidney.

We report a case of giant renal calculus 230 x 140 mm in size and weighing 1,350 g in a solitary functioning kidney treated by nephrolithotomy. A 47-year-old man presented with right lumbar pain, abdominal mass and microscopic hematuria. Physical examination revealed a stony hard mass on the right side of the abdomen, extending from the subcostal region to the iliac crest. A giant renal calculus in his right kidney and atrophic nonfunctioning left kidney was diagnosed by ultrasonography, IVP and CT scan. Right nephrolithotomy was performed. Analysis revealed a calcium phosphate stone. This case is the largest and the heaviest stone reported in the literature in a solitary functioning kidney.

Erection- and ejaculation-preserving cystectomy with orthotopic urinary diversion: is it feasible?

Nerve-sparing techniques to preserve sexual function in men undergoing cystoprostatectomy have been documented by different centers. We evaluated the results of the first 4 erection- and ejaculation-preserving cystectomies performed in our department. The ages of patients ranged between 36 and 43 years. In all cases, patients wished to maintain sexual function. Of the cases, 3 patients had pT1 G3 transitional cell carcinoma (TCC) refractory to treatment and one had pT2a adenocarcinoma of the bladder. Extirpation of the bladder and anterior proximal prostate en bloc with preservation of the vasa deferentia, seminal vesicles, posterior prostate, and neurovascular bundles was performed after pelvic lymphadenectomy. W-ileal neobladder was performed by using 40 cm of ileum. All patients had erections at the third month. Of the cases, 2 patients had antegrade ejaculation. The ejaculate volumes were 0.8 and 1.2 mL in patients with antegrade ejaculation. Patients in the other cases had retrograde ejaculation. All patients were continent day and night. We started clean intermittent catheterization in 1 case because of residual urine. There were no local recurrences. One patient with TCC died because of systemic disease in the postoperative 32nd month. The most important drawback of potent cases in cystectomy decision is erectile dysfunction after radical cystectomy. This drawback causes delay of the operation and sometimes mortality. As was the case in other reports, our limited number of cases in this study demonstrated that erection and ejaculation could be preserved in selected groups of patients.

Comparison of three types of continent urinary diversions in a single center.

The results including the complication and continence rates for 3 types of continent urinary diversion were evaluated. From 1992 to 1998 we performed 58 continent urinary diversions after radical cystectomy for invasive transitional cell carcinoma (TCC) of the urinary bladder. All three types of continent diversions and ileal loop procedures were discussed and patient preferences were determined. The patient preference rate for continent urinary diversion was 96.6%, and half of these patients wanted to be completely dry. Mean age of the patients was 58.2 years. Of the 58 patients, 9 (15.5%) had a Kock pouch, 15 (25.8%) had a Kock neobladder and 34 (58.6%) had sigmoidorectal pouch (Mainz-II pouch). Early and late complication rates of the three different continent diversions were evaluated. The number of complications, such as urine leakage, pyelonephritis, hydronephrosis, reflux and stone formation, were similar in all three types of diversions. Two (5.9%) Mainz pouch II patients who had stopped oral alkalinization demonstrated severe hyperchloremic acidosis. Spontaneous pouch rupture occurred in 1 of the Kock pouches. Reoperation rates were higher with the Kock pouch and Kock neobladder cases. Daytime continence rates for the Kock pouch, Kock neobladder and Mainz II pouch were 77.7%, 86.7% and 100% respectively. Even though complete dryness may not be achieved in every patient, orthotopic bladder substitution appears to be the best choice after radical cystectomy. Although it carries the risk of life-long oral alkalinization therapy, the Mainz pouch II is associated with an excellent continence rate and may be a good alternative for patients who desire to be dry.

Large pelvic schwannoma causing bilateral hydronephrosis.

Schwannoma is a tumor originating from neural sheath schwann cells. We report here a case of benign retroperitoneal schwannoma that caused bilateral ureterohydronephrosis. The retroperitoneal localization in the present case is unusual. The tumor was 21 x 18 x 11 cm in dimension and reached from the prostate to the umbilical level. Even though the patient had bilateral hydronephrosis, the renal function tests results were in the normal range. Complete surgical excision was achieved by anterior laparotomy. Histological and immunohistochemical studies confirmed the diagnosis. At 6 months follow-up there was no evidence of recurrence and renal function test results were normal.

Outcome of the treatment of invasive non-transitional cell carcinoma.

BACKGROUND: We evaluated the treatment outcomes of non-transitional cell carcinoma (non-TCC) cases after radical cystectomy. METHODS: Radical cystectomy was performed in 259 invasive bladder cancer patients in our department and of these, 59 (22.7%) were non-TCC. Primary squamous cell carcinomas (SCC), adenocarcinomas and undifferentiated cancers (UC) were grouped as non-TCC of the bladder. Of the 59 non-TCC; 32 SCC, 20 UC, five adenocarcinoma and two sarcomatoid tumor cases were demonstrated. RESULTS: The 5-year disease-specific survival rate of TCC and non-TCC cases were 48.9 and 28.2%, respectively (P = 0.0016). The 5-year disease-specific survival rates of SCC and UC were 25.1 and 23.4%, respectively. The median survival time of SCC, UC and adenocarcinoma cases were 19, 12 and 6 months, respectively (P = 0.4579). The disease-specific survival rates of TCC and non-TCC cases at stage pT2NoMo were 79.1 and 27.2%, respectively (P = 0.0000). The median survival time of SCC, UC and adenocarcinoma cases were 19, 12 and 13.3 months, respectively, for the same stage. The survival time of TCC, SCC and UC cases at stage pT3NoMo were 23, 26 and 45 months, respectively (P = 0.2307). The median survival time at stages pT2-3N1Mo for the same groups were 18, 16 and 11 months, respectively (P = 0.0939). CONCLUSION: The study presented here demonstrates that both TCC and non-TCC cases have poor survival rates in locally advanced disease and that at the pT2NoMo stage the prognosis of non-TCC cases is poor when compared with TCC cases.