Radical Cystectomy And Urinary Diversion In The Treatment Of Bladder Carcinoma (Analysis Of 105 Cases)

Objective: To investigate the effectiveness of radical cystectomy in patients with bladder cancer, analyze prognosis affecting factors after surgery and compare the post-surgery complications of different urinary diversion surgery.Patients and methods: 143 patients who underwent radical cystectomy for bladder cancer in shandong provincial hospital from January 1996 to January 2006 are enrolled in our study. There are 115 male and 28 female with male:female of 4.3:1. The average age is 59.3(28-77). 105 patients are available to be followed up with the follow-up rate 73.4%.1-year,3-year and 5-year survival rate as well as peri-operational mortality are obtained to evaluate the effectiveness and safety of radical cystectomy in patients with bladder cancer.According to the local infiltrating depth of the tumor, our cases were divided into superficial group(40 cases) and invasion group(65 cases). According to pathology grade of the tumor, the cases were divided into low-grade group(Grade I,Grade II) 56 cases and high-grade group(GradeIII) 42 cases. According to the number of the tumor, the cases were divided into single group(30 cases) and multiple group(75 cases). Through analyzing and comparing the difference of 5-year survival rate between superficial group and invasion group, low-grade group and high-grade group as well as single group and multiple group, we investigated prognosis affecting factors after radical cystectomy. Besides, according to the type of urinary diversion, the cases were divided into ileal conduit group(13 cases), colonic conduit group(41 casses), rectal conduit group(38 cases), ureterocutaneostomy group(10 cases) and Kock neobladder group(3 cases) and the post surgery complication were analyzed and compared and the effect of different types of urinary diversion was evaluated.Result: Of the 143 patients, 105 were followed up. The follow-up rate is 73.4%. The 1-year, 3-year and 5-year survival rate after the surgery are 92.8%(77/83),61.8%(42/68),42.9%(15/35) respectively. The 5-year survival rate of superficial group is 60.0%(12/20) which is higher than invasion group 20.0%(3/15) (p<0.025). The 5-year survival rate of low-grade group and high-grade group are 61.1%(11/18) and 23.5%(4/17) respectively (p<0.05). While, the 5-year survival rate of single group and multiple group are 50.0%(6/12) and 39.1%(9/23) respectively which seems to have no statistical difference(p>0.5).The incidence of the urinary, diversion related complications: (1)short-term comlications: acute pyelonephritis 12.4%(13/105),ileus 9.5%(10/105),leakage of urine through bowel-ureter stoma 2.9%(3/105),intestinal fistula 1.9%(2/105),ansa interstinalis necrosis 1.9%(2/105). (2)long-term comlications: renal inadequacy 11.4%(12/105),stenosis of bowel-ureter stoma 8.6%(9/105),urinary lithiasis 7.6%(8/105),hyperchlorine acidosis 6.7%(7/105),urine reflux 5.7%(6/105),stenosis of abdominal stoma 4.8%(5/105), peristomal hernia 4.8%(5/105),bleeding of urethral 1.9%(2/105).Comparison of different types of urinary diversion on complications: (1)ureterocutaneostomy group: stenosis of abdominal stoma 30.0%(3/10), acute pyelonephritis 30.0%(3/10),renal inadequacy 20.0%(2/10). (2)ileal conduit group:ileus 23.1%(3/13),stenosis of bowel-ureter stoma 15.4%(2/13),acute pyelonephritis 7.7%(l/13),renal inadequacy 7.7%(1/13). (3)colonic conduit group: ileus 17.1%(7/41),acute pyelonephritis 12.2%(5/41),stenosis of bowel-ureter stoma 9.8%(4/41),renal inadequacy 9.8%(4/41),hyperchlorine acidosis 9.8%(4/41),urinary lithiasis 9.8%(4/41),intestinal fistula 4.9%(2/41),ansa interstinalis necrosis 4.9%(2/105),peristomal hernia 4.9%(2/41),leakage of urine through bowel-ureter stoma 7.3%(3/41),urine reflux 4.9%(2/41),bleeding of urethral 2.4%(1/41). (4)rectal conduit group: renal inadequacy 13.2%(5/38),hyperchlorine acidosis 10.5%(4/38),acute pyelonephritis 10.5%(4/38),peristomal hernia 7.9%(3/38),stenosis of bowel-ureter stoma 7.9%(3/38),urine reflux 7.9%(3/38),urinary lithiasis 7.9%(3/38),stenosis of abdominal stoma 5.7%(2/38),bleeding of urethral 2.6%(1/38). (5)Kock neobladder group: urine reflux 33.3%(1/3),urinary lithiasis 33.3%(1/3).Conclusion: Radical cystectomy is a safe and effective procedure for the treatment of bladder cancer especially invasion bladder cancer. The prognosis of the patients after surgery seems to be related with the clinical phase and pathological grade. Each type of urinary diversion has its advantages and disadvantages. Stenosis of abdominal stoma, acute pyelonephritis, renal inadequacy are more common in ureterocutaneostomy group. Ileus, stenosis of bowel-ureter stoma, upper urinary tract infection, renal inadequacy are the main complications of ileal conduit group. In colonic conduit group ileus and acute pyelonephritis are common, while, compared with ileal conduit group, there seems to be no stastical difference. The incidence of renal inadequacy and acute pyelonephritis is higher in rectal conduit group, which may be contributed to the high pressure in the rectal conduit. Hyperchlorine acidosis is also common in rectal group,which may be due to selective absorption of chloridion by rectal mucosa. Urine reflux and The effect of ileal conduit,clonic conduit and rectal bladder is satisfying. Urine reflux and urinary lithiasis are common in Kock neobladder group.