ИЛЕОЦИСТОПЛАСТИКА ПРИ ИНВАЗИВНОМ РАКЕ МОЧЕВОГО ПУЗЫРЯ

Objective: to assess the results of surgical treatment of patients with the intestinal urinary bladder, to characterize its early and late postoperative complications, and to develop their correction tactics.  Subjects and methods. The results of treatment in 198 patients who had undergone ileocystoplasty were analyzed.  Results. The developed diagnostic approach and the determined examination periods could reduce the number of late postoperative complications of ileocystoplasty: acute and chronic pyelonephritis from 19.4 to 7.6%, urolithiasis from 17.2 to 1.9%, bladder dysfunction from 25.8 to 7.6%, and metabolic acidosis from 4.3 to 1.9%, and prevent the development of ureterovesical anastomosis stricture.  Conclusion. Radical cystectomy with the ileoplasty using an isolated segment of the ileum in patients with invasive urinary bladder carcinoma has been the operation of choice no longer; it has become an essential surgical adjunct. This method permits overall 5-year survival to be achieved in 69.7% of patients.  Цель исследования — оценка результатов хирургического лечения больных с кишечным мочевым пузырем; характеристика ранних и поздних послеоперационных осложнений; выработка тактики коррекции осложнений.Материалы и методы. Проведен анализ результатов лечения 198 пациентов, которым была проведена кишечная пластика мочевого пузыря. Результаты. Применение разработанной тактики диагностики и сроков обследования позволило снизить число поздних послеоперационных осложнений кишечной пластики мочевого пузыря: острого и хронического пиелонефрита с 19,4 до 7,6%, мочекаменной болезни — с 17,2 до 1,9%, дисфункции мочевого пузыря — с 25,8 до 7,6%, метаболического ацидоза — с 4,3 до 1,9% — и предотвратить развитие стриктуры уретеровезикального анастомоза.Выводы. Радикальная цистэктомия с кишечной пластикой из изолированного сегмента подвздошной кишки у больных инвазивным раком мочевого пузыря перестала быть операцией выбора, превратившись в жизненно необходимое хирургическое пособие. Метод позволяет добиться общей 5-летней выживаемости у 69,7% пациентов.

SPARING CYSTECTOMY IN THE TREATMENT OF BLADDER CANCER WITH UROLOGICAL COMPLICATIONS

Bladder cancer (BC) accounts for 5 to 10% of all cancers and ranks fourth in the prevalence of male cancers. In Russia, its morbidity increases with age and amounts to 8.1—9.6 per 100,000 with the annual increase being 3.34%.Objective: to assess the results of sparing cystectomy (CE) for BC in the presence of urological complications.Subjects and methods. From February 1999 to December 2007, the study consequently included 196 patients receiving surgical treatment for the aggressive form of BC, of whom 101 patients received surgical treatment for CE with intestinal plastic repair. There were 33 (84.6%) males and 6 (15.4%) females. The patients' mean age was 69.4 (range 35-81) years; the duration of the disease averaged 1.4 years (range 6 months to 5 years). The proportion of the males who has undergone sparing CE was 48.5% of the total number of patients. There were no women who had been operated on.Results. Examination of 101 patients with invasive CE revealed that 69 patients had the following types of complications: intractable bleeding, hydronephrosis, acute pyelonephritis, chronic renal failure, progressive cancer intoxication, and acute urinary retention. These patients were determined as having undergone sparing CE. Group 2 comprised 127 patients who had received organ-preserving therapy.Conclusion. Physical examination, instrumental, and X-ray studies established a correlation of the tumor aggression with the severity of urological complications; sparing CE for urological involvement in patients with invasive UBC has an advantage over organ-preserving treatment (33.3% versus 4.7%) in providing 5-year survival. However, the early postoperative mortality from occurring complications was higher in Group 1 than that in Group 2 without radical treatment

SPARING CYSTECTOMY IN THE TREATMENT OF BLADDER CANCER WITH UROLOGICAL COMPLICATIONS

<p>Bladder cancer (BC) accounts for 5 to 10% of all cancers and ranks fourth in the prevalence of male cancers. In Russia, its morbidity increases with age and amounts to 8.1—9.6 per 100,000 with the annual increase being 3.34%.</p><p><strong>Objective: </strong>to assess the results of sparing cystectomy (CE) for BC in the presence of urological complications.</p><p><strong>Subjects and methods. </strong>From February 1999 to December 2007, the study consequently included 196 patients receiving surgical treatment for the aggressive form of BC, of whom 101 patients received surgical treatment for CE with intestinal plastic repair. There were 33 (84.6%) males and 6 (15.4%) females. The patients' mean age was 69.4 (range 35-81) years; the duration of the disease averaged 1.4 years (range 6 months to 5 years). The proportion of the males who has undergone sparing CE was 48.5% of the total number of patients. There were no women who had been operated on.</p><p><strong>Results. </strong>Examination of 101 patients with invasive CE revealed that 69 patients had the following types of complications: intractable bleeding, hydronephrosis, acute pyelonephritis, chronic renal failure, progressive cancer intoxication, and acute urinary retention. These patients were determined as having undergone sparing CE. Group 2 comprised 127 patients who had received organ-preserving therapy.</p><p><strong>Conclusion. </strong>Physical examination, instrumental, and X-ray studies established a correlation of the tumor aggression with the severity of urological complications; sparing CE for urological involvement in patients with invasive UBC has an advantage over organ-preserving treatment (33.3% versus 4.7%) in providing 5-year survival. However, the early postoperative mortality from occurring complications was higher in Group 1 than that in Group 2 without radical treatment.</p

ILEOCYSTOPLASTY IN INVASIVE URINARY BLADDER CARCINOMA

Objective: to assess the results of surgical treatment of patients with the intestinal urinary bladder, to characterize its early and late postoperative complications, and to develop their correction tactics.  Subjects and methods. The results of treatment in 198 patients who had undergone ileocystoplasty were analyzed.  Results. The developed diagnostic approach and the determined examination periods could reduce the number of late postoperative complications of ileocystoplasty: acute and chronic pyelonephritis from 19.4 to 7.6%, urolithiasis from 17.2 to 1.9%, bladder dysfunction from 25.8 to 7.6%, and metabolic acidosis from 4.3 to 1.9%, and prevent the development of ureterovesical anastomosis stricture.  Conclusion. Radical cystectomy with the ileoplasty using an isolated segment of the ileum in patients with invasive urinary bladder carcinoma has been the operation of choice no longer; it has become an essential surgical adjunct. This method permits overall 5-year survival to be achieved in 69.7% of patients.  </p