Follow-Up Of Patients Undergone Radical Cystectomy With Ureterosigmoidostomy

Objective To sum up the effectiveness of radical cystectomy in the treatment of bladder cancer and the methods of preventing and treating complications of ureterosigmoidostomy.Methods To follow up 68 patients who had undergone radical cystectomy with ureterosigmoidostomy at department of urology affiliated hospital of Qingdao medical college Qingdao university from April 1984 to April 2003 and the clinical materials of these cases were summed up.68 patients were in this group, male 49cases, female 19cases;ages: 36~83 years old, average age: 60.33±16.50 years old. 59 of these cases were transitional cell carcinoma, 6 of them were adenocarcinoma, 2 were squamous cell carcinoma and 1 were malignant Schwann's cell tumor. 15 of these cases had metastatic tumor to the lymph node. All of the cases have been performed radical cystectomy, 59 of them have been performed pelvic lymph node dissection. The urinary diversion technique of all cases were ureterosigmoidostomy.Radical cystectomy consisted of the removal the bladder with the prostate and seminal vesicle in the male and the uterus and adnexae, anterior vaginal wall, whole urethra in the female. Pelvic lymph node dissection consisted of removing internal, external and common iliac nodes, the obturator nodes, the pressacral nodes.Ureterosigmoidostomy employed the submucosal tunneling technque(Leadbetter's) which implanted two ureters separated under mucous membrane of sigmoid. The length of the submucosal tunnels were 5cm in order to antireflux.All patients must be followed up strictly after operation and take routinely medicines of sodium bicarbonate in order to preventing hyperchloremic metabolic acidosis.Results 51 of 68 patients who had undergone radical cystectomy with ureterosigmoidostomy were followed up, the rate of follow up is 75%. Survival rates: The 1-year survival rate of these patients is 54.9%, the 2-year survival rate is 37.3%, the 3-year survival rate of the is 19.6%, the 4-year survival rate is 15.7%, the 5-year survival rate is 11.8%. Complications: 3 of 51-patients had fever caused by urinary tract reflux infections(pyelonephritis);2 occurred hyperchloremic metabolic acidosis;1 complicated left kidney stones;1 suffered renal failure. 31 of 51 patients have been dead, 2 of them because of operation;24 because of advanced stage of tumor;1 because of infections and renal failure;4 because of other diseases. 41 of these 51 patients were inquiried for micturition, the rates of bothpoor continent during the day and nocturnal enuresis are 7.3%.Conclusions The survival times of the patients who had undergone radical cystectomy with ureterosigmoidostomy have closely relation with the stage and grade of carcinoma and the situation of metastatic tumor to the lymph node. No evidences showed that the survival times are related with ureterosigmoidostomy.Though ureterosigmoidostomies have some complications such as hyperchloremic metabolic acidosis, urinary tract influx infections, pyelonephritis, renal impairment, etc, and the high risk of developing colonic neoplasms, they have a lot of merits such as continent, without external appliances and cutaneous stomas, and so on. The patients are able to lead a relatively normal life.Ureterosigmoidostomy may serve as an alternative to other types of continent urinary diversion after radical cystectomy, especially for those patients whose expectant lives are shorter.