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Thiruchelvam N, Ubhayakar G, Mostafid H. The management of hydronephrosis in patients undergoing TURBT. Int Urol Nephrol 2006; 38:483-6. [PMID: 17115297 DOI: 10.1007/s11255-005-4794-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Previous studies have shown the negative prognostic correlation of hydronephrosis in bladder cancer; however, practical uncertainties remain regarding the management of these patients. METHODS We retrospectively reviewed the notes of patients undergoing TURBT over a three year period and recorded the management and outcome of patients with hydronephrosis. RESULTS Six percent with bladder cancer had hydronephrosis. Nearly all the cases had muscle invasive disease. At TURBT, the ureteric orifice was seen in 41%; in the remaining 59% of patients, the ureteric orifice was involved and resected. This resolved the hydronephrosis in only one patient (who had superficial disease). CONCLUSIONS Hydronephrosis in bladder cancer is associated with a poor prognosis. The hydronephrosis does not resolve with resection alone. As awaiting it's resolution may delay definitive treatment, we suggest aggressive management of hydronephrosis from the time of initial diagnosis with ureteric stenting in order to protect renal units and optimize renal function prior to further definitive treatment of bladder cancer.
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Affiliation(s)
- N Thiruchelvam
- Department of Urology, Royal Hampshire County Hospital, Romsey Road, SO22 5DG, Winchester, Hampshire, UK.
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Leibovitch I, Ben-Chaim J, Ramon J, Madjar I, Engelberg IS, Goldwasser B. The significance of ureteral obstruction in invasive transitional cell carcinoma of the urinary bladder. J Surg Oncol 1993; 52:31-5. [PMID: 8441258 DOI: 10.1002/jso.2930520109] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Ureteral obstruction is a frequent complication of transitional cell carcinoma (TCC), known as a poor prognostic sign and indicative of advanced disease. We investigated retrospectively the medical records of 122 consecutive patients who suffered from invasive TCC of the urinary bladder during a 6-year period. Unilateral or bilateral ureteral obstruction was found in 66 patients (54.1%). High stage (T3-T4) and grade (III-IV) tumors were correlated with ureteral obstruction in 89.4% and 83.3% respectively compared to 67.9% and 66.1%, respectively, among patients with normal upper tracts (P < 0.001); 10.6% of the patients with ureteral obstruction had low stage disease, and all of them proved to have involvement of the ureteral orifices on the affected side. The 5-year survival rate of patients with and without ureteral obstruction was 32.2% and 65.9%, respectively (P < 0.001). The presence of ureteral obstruction, particularly in the absence of intravesical involvement of the ureteral orifices, signified a high stage, muscle invasive, and often metastatic tumor in more than 90% of the patients. Ureteral obstruction was an accurate criterion for poor prognostic and was associated with significantly lower, overall and stage-specific, survival rates, despite of radical surgery. We conclude that evidence of ureteral obstruction is an important staging standard and significant prognostic indicator in transitional cell carcinoma of the urinary bladder.
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Affiliation(s)
- I Leibovitch
- Department of Urology, Chaim Sheba Medical Center, Tel Hashomer, Israel
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Parsons JT, Million RR. Role of planned preoperative irradiation in the management of clinical stage B2-C (T3) bladder carcinoma in the 1980s. SEMINARS IN SURGICAL ONCOLOGY 1989; 5:255-65. [PMID: 2672231 DOI: 10.1002/ssu.2980050408] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
In recent years the role of planned preoperative irradiation in the management of clinical stage B2-C (T3) bladder cancer has been questioned by a number of investigators. Much of the confusion regarding the efficacy of combined therapy results from studies that compare the results of treatment of pathological stage B2-C patients treated by cystectomy alone versus clinical stage B2-C patients treated by preoperative irradiation plus cystectomy. Such comparisons are biased because of 1) the exclusion of a large number of pathological stage D patients from cystectomy-alone series and their inclusion in preoperative irradiation plus cystectomy series and 2) the inclusion in the cystectomy-alone series of patients whose clinical stages were less than or equal to T2. The purpose of this paper is to compare the results of treatment in patients with clinical stage B2-C bladder carcinoma following radical cystectomy alone versus preoperative irradiation plus cystectomy. This article reviews the rationale for administering preoperative irradiation, the effect of preoperative irradiation on the pathological specimen (including down-staging, the effect on regional lymph nodes, and radioresponsiveness according to tumor configuration, i.e., papillary vs. solid), the impact of preoperative irradiation on pelvic recurrence and 5-year survival, and the effect of preoperative irradiation on operative and postoperative complications. This paper cites all known literature on the subject in the English language. Data comparing 5-year survival results of radical cystectomy alone versus preoperative irradiation plus cystectomy are analyzed in three different ways: a) retrospective comparisons of historical results, b) comparison of contemporaneous "modern-day" (1960-1980) series comprising 1185 patients who received either radical cystectomy alone or preoperative irradiation plus cystectomy, and c) review of the results of six randomized trials. Preoperative results are also analyzed according to dose level (2,000 cGy versus 4,000 cGy vs. 4,500-5,000 cGy). The data presented indicate that the addition of preoperative irradiation to cystectomy for clinical stage B2-C (T3) bladder cancer adds approximately 15-20 percentage points to the 5-year survival, leading to a survival figure that is approximately half again that achieved by cystectomy alone.
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Affiliation(s)
- J T Parsons
- Department of Radiation Oncology, University of Florida College of Medicine, Gainesville
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Parsons JT, Million RR. Planned preoperative irradiation in the management of clinical stage B2-C (T3) bladder carcinoma. Int J Radiat Oncol Biol Phys 1988; 14:797-810. [PMID: 3280534 DOI: 10.1016/0360-3016(88)90102-2] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
In recent years the role of planned preoperative irradiation in the management of clinical Stage B2-C (T3) bladder cancer has been questioned by a number of investigators. Much of the confusion regarding the efficacy of combined therapy results from studies that compare the results of treatment of pathological Stage B2-C patients treated by cystectomy alone versus clinical Stage B2-C patients treated by preoperative irradiation plus cystectomy. Such comparisons are biased because of (1) the exclusion of a large number of Stage D patients from cystectomy-alone series and their inclusion in preoperative irradiation plus cystectomy series and (2) the inclusion in the cystectomy-alone series of patients whose clinical stages were less than or equal to T2. The purpose of this paper is to compare the results of treatment in patients with clinical Stage B2-C bladder carcinoma following radical cystectomy alone versus preoperative irradiation plus cystectomy. This article reviews the rationale for administering preoperative irradiation, the effect of preoperative irradiation on the pathological specimen (including down-staging, the effect on regional lymph nodes, and radioresponsiveness according to tumor configuration, i.e., papillary vs. solid), the impact of preoperative irradiation on pelvic recurrence and 5-year survival, and the effect of preoperative irradiation on operative and postoperative complications. This paper cites all known literature on the subject in the English language. Data comparing 5-year survival results between radical cystectomy alone versus preoperative irradiation plus cystectomy are analyzed in three different ways: (a) retrospective comparisons of historical results, (b) review of the results of 6 randomized trials, and (c) comparison of concomitantly treated "modern-day" (1960-1980) series treated by either radical cystectomy alone versus preoperative irradiation plus cystectomy in 1185 patients. Preoperative results are also analyzed according to dose level (2000 rad versus 4000 rad versus 4500-5000 rad). The data presented indicate that the addition of preoperative irradiation to cystectomy for clinical Stage B2-C (T3) bladder cancer adds approximately 15 to 20 percentage points to the 5-year survival, leading to a survival figure that is approximately half-again that achieved by cystectomy alone.
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Affiliation(s)
- J T Parsons
- Department of Radiation Oncology, University of Florida College of Medicine, Gainesville
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Borkowski A, Krzeski T, Kazoń M, Gajl D, Niemierko M, Rachwał-Sochacka L, Borówka A, Zachwiej M, Miecznikowski A. Supracystic urine diversion in patients with bladder carcinoma treated by cystectomy preceded by "short radiotherapy" (2000 R). Int Urol Nephrol 1981; 13:363-9. [PMID: 7343538 DOI: 10.1007/bf02081937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
The authors assessed the results of supracystic urine diversion in 50 patients treated by cystectomy for bladder carcinoma who had "short radiotherapy" (2000 R) before the operation. It was found that preoperative radiotherapy caused no difficulties during subsequent cystectomy and the observed postoperative complications should be related rather to the surgical technique. It seems that indications to urine diversion by the method of Goodwin or Coffey should be considered with greater caution. In patients past the age of 65 years and those with more advanced neoplasms (T-3, T-4) bilateral ureterocutaneostomy should be performed more frequently for suprapubic urine diversion.
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Brannan W, Fuselier HA, Ochsner M, Randrup ER. Critical evaluation of 1-stage cystectomy--reducing morbidity and mortality. J Urol 1981; 125:640-2. [PMID: 7230334 DOI: 10.1016/s0022-5347(17)55146-0] [Citation(s) in RCA: 25] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Although it is a major surgical effort removal of the bladder can be done with reasonable safety. In our opinion cystectomy and urinary diversion by an ileal conduit can be performed as a conjoined procedure without need for staging to reduce risks. Mortality up to 3 months postoperatively was 3.9 per cent and the major complication rate for surviving patients was 18.6 per cent. Minor complications occurred in 28.7 per cent of all patients but were treated easily. We did not note increased morbidity after radical cystectomy compared to other types of cystectomy. A higher complication rate was noted in patients who had undergone preoperative radiation treatment, and wound infection rate was higher in patients with neurogenic bladder dysfunction and chronic cystitis. The advantages of 1-stage compared to 2-stage cystectomy would include the fact that it eliminates the need for a second operation, saves considerable expense by virtue of shortened hospitalization and an earlier resumption of the patient's productivity, achieves early removal of the malignancy, decreases the chances of infection by avoiding a second laparotomy in the presence of a stoma and allows better exposure in the absence of previous ureteroileal anastomoses.
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Sullivan JW, Grabstald H, Whitmore WF. Complications of ureteroileal conduit with radical cystectomy: review of 336 cases. J Urol 1980; 124:797-801. [PMID: 7441828 DOI: 10.1016/s0022-5347(17)55669-4] [Citation(s) in RCA: 111] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Review of complications of the ileal conduit in patients undergoing radical cystectomy for bladder cancer showed a statistically significant increase in renal calculi, ureteral obstruction, acute and chronic pyelonephritis and deterioration of renal function by 60 months postoperatively. Ureteroileal fistulas occurred in 3.3 per cent, stomal stenosis in 5.1 per cent, intestinal fistulas in 5.4 per cent, severe intestinal obstruction in 6 per cent and abdominal wound infection or dehiscence in 20.2 per cent of the cases. The over-all operative mortality was 13.7 per cent, with 8 per cent of the deaths attributed to complications from the ileal conduit. Comparison of colonic conduits to ileal conduits as a means of urinary diversion with radical cystectomy for bladder cancer demonstrated no convincing evidence of its superiority.
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Abstract
Pne hundred and fifty-one patients with transitional cell carcinoma of the bladder who were evaluated by conventional means preoperatively underwent a radical cystectomy. They were then classified according to the highest known pathological stage, first site of postoperative metastasis and the temporal relationship of the cystectomy to the appearance of the metastasis. Fifty patients developed metastases, 80% of which were proven histologically. Thirty-nine of fifty patients (78%) who developed metastases did so within a year of cystectomy. Extent of local tumor was directly related to the incidence of positive pelvic nodes. Metastases occurred most commonly in lung and bone. Soft tissues of the pelvis were involved in thirteen (16%) of the patients who developed metastatic carcinoma and those patients with positive pelvic nodes were more likely to have these kinds of recurrent disease. These evaluations suggest that the metastases must be present at cystectomy or as a result of it. The data imply the existence of appreciable heterogeneity among patients and/or their invasive bladder carcinoma. Disseminated but silent metastases suggest that a relationship between the primary tumor and the occurrence of metastatic disease may exist. Knowledge of this relationship is very important in planning subsequent therapeutic strategies.
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Abstract
This is the first report of a 4-year prospective trial of integrated irradiation and cystectomy in the management of advanced bladder carcinoma. Patients are treated sequentially with staging laparotomy and urinary diversion, highdose preoperative irradiation (5,000 rad/30 treatments/42 days), and total cystectomy. Twenty-eight consecutive patients have been entered into the study; all had Grade III or IV tumor or clinical evidence of invasion (Jewett Stage B1-D1). Local control has been achieved in 21 of 22 patients, and the 4-year actuarial survival is 54%. The initial staging procedure not only defines inoperable patients, but also allows completion of urinary diversion prior to small bowel irradiation with fewer anastomotic problems. Acute and chronic complications have been minimal, and there have been no treatment-related deaths.
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Månsson W, Colleen S, Stigsson L. Four methods of uretero-intestinal anastomosis in urinary conduit diversion. A comparative study of early and late complications and the influence of radiotherapy. SCANDINAVIAN JOURNAL OF UROLOGY AND NEPHROLOGY 1979; 13:191-9. [PMID: 482870 DOI: 10.3109/00365597909181176] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Kishev SV. Perineal-abdominal cystourethrectomy with pelvic node dissection: a new 2-stage procedure for selected cases. J Urol 1978; 119:601-4. [PMID: 660728 DOI: 10.1016/s0022-5347(17)57562-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
An ileal conduit diversion followed 7 to 14 days later by cystourethrectomy with pelvic node dissection was done on 20 patients with carcinoma of the bladder. Two types of patients were selected for this operation: 1) those with an advanced stage of carcinoma involving the bladder neck, prostatic urethra or prostate, primarily cases suspected of having focal metastatic disease in the urethra, and 2) patients who had had a previous pelvic operation with resultant dense adhesions and scarring. The cystourethrectomy with pelvic node dissection is begun perineally. After the specimen, consisting of the urethra, part of the urogenital diaphragm, seminal vesicles, prostate and bladder is dissected, mobilized and, finally, pushed into the pelvis the perineum is closed and the operation is completed abdominanlly through a Pfannenstiel incision.
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Byström J. Early and late complications of ileal condiut urinary diversion. SCANDINAVIAN JOURNAL OF UROLOGY AND NEPHROLOGY 1978; 12:233-7. [PMID: 725544 DOI: 10.3109/00365597809179723] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
The early and late complications of cutaneous uretero-ileostomy in 61 patients are reported. Only complications attributable to the urinary diversion procedure are detailed. The early complications included intestinal obstruction in 4 cases, enterocutaneous fistula in 4, urinary fistula in 6 and wound disruption in 3 cases The surgical mortality was 6.6%. The predominant late complications were uretero-ileal obstruction with progressive hydronephrosis in 14 patients, 8 of whom underwent re-operation. Stomal problems arose in 6 patients and stone in the urinary tract in 5 patients. Full preoperative irradiation and isolated anastomosis between the ureters and the ileal segment increased the frequency of these late complications. Some measures are discussed which may reduce this fairly high complication rate.
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Greiner R, Skaleric C, Veraguth P. The prognostic significance of ureteral obstruction in carcinoma of the bladder. Int J Radiat Oncol Biol Phys 1977; 2:1095-100. [PMID: 599060 DOI: 10.1016/0360-3016(77)90115-8] [Citation(s) in RCA: 31] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Galleher EP, Young JD, Campbell EW, Wizenberg MJ, Jacobs JA, Millstein DI. Pre-cystectomy radiation for carcinoma of the bladder: 17-year experience. J Urol 1977; 118:179-83. [PMID: 875216 DOI: 10.1016/s0022-5347(17)57941-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Our experience with pre-cystectomy radiation for carcinoma of the bladder from July 1959 through June 1976 is presented. Pre-cystectomy radiation would appear to be beneficial in the management of patients with invasive bladder cancer. There is an impressive improvement in survival rates in those patients demonstrating reduction in staging after radiation. Our experience correlates well with other comparative series. Based on this 17-year experience guide lines are outlines for the subsequent management of patients with bladder cancer.
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Bredin HC, Prout GR. One-stage radical cystectomy for bladder carcinoma: operative mortality, cost/benefit analysis. J Urol 1977; 117:447-51. [PMID: 403302 DOI: 10.1016/s0022-5347(17)58495-5] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
An analysis of cystectomies performed between September 1, 1969 and December 31, 1974 was conducted to determine the rates of morbidity (59 per cent) and operative mortality (4.1 per cent). Comparison of these figures for single operations with data published form other sources concerning staging of the therapeutic procedures suggests that there is no benefit for the patient relative to surgical morbidity or mortality if the latter course is followed. Conversely, prolongation of hospital experience, multiple operations, absence from productive activity and increased health care cost are associated with the staged procedures. Application of cost-benefit analysis suggests that this experience may act as a model to evaluate competing forms of therapy involving other disorders. When costs are not equivalent and benefits are the same the more expensive form of therapy should not be offered except for unusual circumstances.
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Johnson DE, Lamy SM. Complications of a single stage radical cystectomy and ileal conduit diversion: review of 214 cases. J Urol 1977; 117:171-3. [PMID: 833960 DOI: 10.1016/s0022-5347(17)58385-8] [Citation(s) in RCA: 88] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Single stage radical cystectomy and ileal conduit diversion were performed on 214 patients for treatment of bladder carcinoma. The over-all operative mortality rate was only 3.3 per cent. Early complications occurred in 27.6 per cent of the patients and late complications were noted in 41.1 per cent of the patients followed 6 months or longer. We refute recent arguments for staged procedures as a necessity for reducing operative mortality and morbidity.
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