Abstract
IntroductionRadical cystectomy is the standard treatment for patients with invasive bladder cancer and for those with superficial bladder cancer who did not respond to conservative TUR and intravesical therapy. Many diversions are available after radical cystectomy; the most attractive for the patients is orthotopic diversion due to better quality of life associated with this diversion. ObjectiveTo evaluate the long-term outcomes beyond 1 year, both functional and oncological, in male patients treated with radical cystectomy and orthotopic diversion for invasive bladder cancer. Patients and methodsThis is a retrospective study done at Cairo university hospitals. A total of 44 male patients underwent radical cystectomy and orthotopic diversion (W-pouch) for invasive bladder cancer with minimum follow up 1 year. Assessment included; neobladder function, renal pattern and function, ureteroenteric anastomotic stricture or reflux, survival, recurrence, erectile function, urolithiasis, and urinary tract infection.The tools used to assess the complications during each visit included; history including voiding diary and IIEF questionnaire, examination including PR, laboratory investigations including urine analysis and kidney function tests, pH (acidosis) and bicarbonates and radiological investigation including ultrasound, chest X-ray, CT abdomen and pelvis. ResultsThe mean follow up was 88 months (range 12–138). Stones developed post-operatively in four patients (two of them were pouch stones and the other two were renal stones), incision hernia developed in two patients (4.5%), uretero enteric anastomotic stricture in two patients (4.5%), recurrent UTI was recorded in 10 cases (23%), uremia and dialysis in 9.2% of cases, metastasis was recorded as follows: local 2%, distant 11.5% and both 4.5% and the mortality rate was 19% (over all survival was 81%).Nocturnal incontinence 29.5% (13 patients), stress incontinence 9.5% (4 patients), urge incontinence 9.5% (4 patients), total incontinence 4.5% (23 patients); while the remaining 21 patients (47.5%) were continent day and night.Erectile dysfunction developed post-operatively in 35 cases (80.5%). ConclusionLong term follow-up for patients with radical cystectomy and orthotopic diversion is associated with high complication rate. Long term follow up for those patients is needed to verify the causes of complications and how to prevent them.
Highlights
Radical cystectomy is the standard treatment for patients with invasive bladder cancer and for those with superficial bladder cancer who did not respond to conservative TUR and intravesical therapy
Stones developed post-operatively in four patients, incision hernia developed in two patients (4.5%), uretero enteric anastomotic stricture in two patients (4.5%), recurrent urinary tract infection (UTI) was recorded in 10 cases (23%), uremia and dialysis in 9.2% of cases, metastasis was recorded as follows: local 2%, distant 11.5% and both 4.5% and the mortality rate was 19%
Long term follow-up for patients with radical cystectomy and orthotopic diversion is associated with high complication rate
Summary
Radical cystectomy is the standard treatment for patients with invasive bladder cancer and for those with superficial bladder cancer who did not respond to conservative TUR and intravesical therapy. Objective: To evaluate the long-term outcomes beyond 1 year, both functional and oncological, in male patients treated with radical cystectomy and orthotopic diversion for invasive bladder cancer. A total of 44 male patients underwent radical cystectomy and orthotopic diversion (W-pouch) for invasive bladder cancer with minimum follow up 1 year. At the National Cancer Institute (NCI), Cairo, urinary bladder cancer constitutes 30.3% of all cancers, 40.6% of male cancers, and 14.3% of female cancers [2]. According to the International Agency for Research on Cancer (IARC) statistical study, Egypt ranked first among Northern African and Arabian African countries in urinary bladder cancer incidence and mortality rates in both males and females [3]. This study was done to evaluate long-term outcomes, both functional and oncological, in male patients treated with radical cystectomy and orthotopic diversion for invasive bladder cancer at Cairo university hospitals
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