Bladder Cancer
Conditions
Keywords
Bladder Cancer, Orthotopic diversion, Wallace, sub-serous extramural tunnel.
Brief summary
there are many techniques for uretero-ileal anastomosis some of them are antirefluxing for protection of the upper urinary tract with many complications including strictures and pyelonephritis with difficult technical issues and long operation time so a modified technique combining the 2 ureter by wallace technique and implanted them in a single trough in the neobladder making the surgery easier and shorter. this technique was done after informed consent in 45 patients with muscle invasive bladder cancer candidate for radical cystectomy and ileal neobladder diversion
Detailed description
This was a prospective study conducted from 2014 to 2017 in Ain shams university, 73 patients were enrolled from outpatient clinic diagnosed with muscle invasive bladder cancer and candidate for radical cystectomy and orthotopic urinary diversion, 45 patients were included according to patient's acceptance and the inclusion and exclusion criteria. After having a written informed consent, all selected patients were assessed by detailed history and physical examination, contrast enhanced pelvi-abdominal Computed tomography (CT) scan (for patients with serum creatinine \<1.5 mg/dl). Laboratory investigations in the form of complete blood count, coagulation profile, electrolytes, renal and liver function tests. Bowel preparation was done to all patients one or two days before operation. Cases were diverted using a U-shaped pouch with uretero-ileal anastomosis done in a single trough combining the extramural serous-lined tunnel and Wallace techniques.
Interventions
PROCEDUREuretero ileal anastomosis in single trough
Sponsors
Ain Shams University
Study design
Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
TREATMENT
Masking
NONE
Intervention model description
the new technique was observed in a group of patients for effectiveness and complications.
Eligibility
Sex/Gender
ALL
Age
40 Years to 70 Years
Healthy volunteers
No
Inclusion criteria
The inclusion criteria: * Patients with invasive bladder cancer (T2, T3). * good performance status * patients with serum creatinine ≤ 2 mg/dL * prostatic urethra free of tumor. * willing to adhere to the follow up regimen. The
Exclusion criteria
* patients not fit for surgical intervention. * patients with renal or hepatic dysfunction. * male patients with positive urethral biopsy or diffuse CIS. * female patients with bladder neck or vaginal involvement. * concomitant pathological condition in the distal ureters necessitating the excision of a significant segment that hinders proper fashioning of uretero-ileal anastomosis. * Cases with markedly dilated ureters.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| the rate of vesicoureteral reflux (VUR) | after 6 months and after one year | the incidence of occurrence of reflux in the patients was assessed |
| the incidence of anastomotic stricture | after 6 months and after one year | the incidence of occurrence of uretero ileal stricture in the patients was recorded |
| the post operative changes in the mean serum creatinine level | after 6 months and after one year | the change in mean serum creatinine level of the patients was assessed |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| the incidence of pyelonephritis | after 6 months and after one year | — |
| the incidence of urinary incontinence | after 6 months and after one year | — |
| the mean operative time of urinary diversion | at the time of the operation | the time elapsing from bowel selection till the beginning of wound closure |
Outcome results
None listed