`ACUTE SCROTUM`: UNSOLVED DIAGNOSTIC AND THERAPEUTIC PROBLEMS

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MODERN DIAGNOSIS AND TREATMENT OF SUPERFICIAL BLADDER TUMORS

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BLADDER CANCER IMMUNOTHERAPY

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Antireflux Technique of Ureteroileal Implantation Used in the Construction of Artificial Orthotopic Neobladder

Introduction: The optimal technique of ureteroileal implantation used in the construction of artificial orthotopic neobladder still remains unclear and continues to be a subject of lively discussion. The basic aim of the present report is to analyze the long-term functional results after a total cystectomy and the construction of orthotopic neobladder with the implementation of the antireflux serous-lined extramural tunnel technique. Materials and methods: The study comprises a total of 98 patients with bladder cancer (90 men and 8 women, mean age 59±8 years), who underwent total cystectomy with subsequent construction of orthotopic W-shaped ileal neobladder within the period from 1996 to 2016. All ureters were implanted via a subserous extramural tunnel aiming to prevent vesicoureteral reflux. The follow-up included clinical, laboratory, imaging and urodynamic studies for evaluation of the functional and oncological results.Results: The perioperative mortality rate in the whole series was 1.0%, and the percentage of the early and late complications - 17.3% and 22.4%, respectively. 91.8% and 76.5% of the patients remained continent, at day and night, respectively. Late stenosis at the anastomosis site was registered in 5 cases (5.1%), while pouchoureteral reflux was observed in none of the patients. The renal function was stabilized or improved in 94.9% of the reimplanted renal units. The disease progressed in 12 patients: 1 developed local recurrence, and other 11 patients developed distant metastases. The overall and cancer specific survival in the whole series was 67.3% and 79.6%, respectively.Conclusion: The serous-lined extramural tunnel technique offers effective and safe ureteroileal anastomosis, providing nonobstructive unidirectional urinary flow. The results are durable and do not change with time. Therefore, we conclude that this technique should be widely popularized and routinely applied in the construction of continent intestinal urinary reservoirs

Antireflux Technique of Ureteroileal Implantation Used in the Substitution of the Ureter/s/ by Isolated Intestinal Segment

Introduction: Gynecological surgery and pelvic radiotherapy often lead to ureteral damage, requiring subsequent reconstruction of the ureter. Our aim was to analyze the long-term functional results after ureteral substitution by isolated ileal segment. Materials and methods: Within the period 2004 - 2016, we treated a total of 21 women (mean age 54.2 years, from 29 to 68 years) with iatrogenic damage of the ureter: 6 on the right, 8 on the left and 7 - bilateral. These complications occurred after hysterectomy performed for malignant gynecological diseases, with or without adjuvant radiotherapy. In all these cases the length of the ureteral lesion exceeded 10 cm, which necessitated partial or total substitution of the ureter by isolated ileal segment. The antireflux ureteroileal anastomosis was performed by the modified by us serous-lined extramural tunnel technique, initially described and applied until now only during construction of orthotopic urinary reservoirs.Results: Most of the surgeries were performed without serious complications. The follow-up ultrasound and roentgenological examinations confirmed that all reconstructive procedures provide effectively nonobstructive unidirectional flow of the urine. In spite of the good functional results, the oncological results in this patient series were quite unsatisfactory: the malignancy progressed in 9 patients (42.8%), 6 of whom died from the disease in spite of the adjuvant treatment applied. Pelvic recurrences with invasion to the bladder required total cystectomy with subsequent conversion to ileum conduit in 4 of the cases.Conclusions: Ureteral substitution by an isolated ileal segment is a good alternative in case of prolonged stenosis of the ureter, which has occurred as a complication after gynecological and/or radiological therapeutic procedures