Since continent urinary diversion and bladder substitution after cystoprostatectomy have been offered as alternative to standard urinary diversion, increasing numbers of patients seek to avoid a wet stoma. So since 1988 we have used a pouch constructed from a combination of large and small bowel(Mainz pouch), which offers a low pressure reservoir of adequate capacity, antirefluxing ureteral reimplantation and continent reservoir. Initial applications of the Mainz pouch were for bladder augmentation after subtotal cystectomy and for continent urinary diversion. Current indications have been extended to complete bladder substitution after radical cystectomy with anastomosis of the pouch to the membranous urethra. A total or 15 patients underwent a Mainz pouch procedure ;6 for bladder augmentation, 8 for continent urinary diversion and 1 for total bladder substitution after radical cystectomy. All bladder augmentation cases, 4 of 8 diversion cases and substitution case are completely dry day and night. There are no significant perioperative morbidity and mortality.
Cystectomy ; Humans ; Mortality ; Replantation ; Ureter ; Urethra ; Urinary Bladder ; Urinary Diversion

Radical cystectomy is the most common and effective treatment modality for invasive bladder cancer. However, in case of the elderly patient its application accompanies anxieties over the possible mortality and complications. We purposed to analyze the postoperative mortality and early complication of the elderly patients compared to those of non-elderly patients. We reviewed retrospectively the medical records of 27 elderly patients, over 70 years of age and 61 non-elderly patients, under 69 years of age who were not at high risk anesthesiologically and underwent radical cystectomies with ileal conduits for invasive bladder cancers during last 11 years. We compared mortality, early complications, and postoperative hospital days between two groups. There was no death related to operation in elderly group, but one of the non-elderly group died of sepsis and DIC(disseminated intravascular coagulation) postoperatively Overall early complications were significantly higher in elderly group(P=0.013). But the major complications that were life threatening or required reoperation revealed no significant difference between two groups. There was no significant difference in postoperative hospital days(16.8 days in elderly group, 16.1 days in non-elderly group) between two groups. In conclusion, radical cystectomy can be performed as an effective and safe modality for the treatment of invasive bladder cancer even in elderly patients if only they are not at high risk anesthesiologically.
Aged* ; Anxiety ; Cystectomy* ; Humans ; Medical Records ; Mortality* ; Reoperation ; Retrospective Studies* ; Sepsis ; Urinary Bladder Neoplasms ; Urinary Diversion

A clinical observation was made on 14 patients of bladder tumor who were treated by radical cystectomy with pelvic lymphadenectomy in the Department of Urology, Catholic Medical College during the period from March, 1984 to July, 1986. Metastases to pelvic lymph node were proved histologically in 3 cases among 14 cases. Operative pathologic staging demonstrated an understanding error of 36 per cent, an overstaging error of 28 per cent and an accuracy of 36 per cent. The addition of a meticulous pelvic lymph node dissection did not increase the mortality or morbidity compared to simpler procedures. Results of this study support the early aggressive use of radical cystectomy with pelvic lymphadenectomy and urinary diversion in the management of patients with bladder cancer.
Cystectomy* ; Humans ; Lymph Node Excision* ; Lymph Nodes ; Mortality ; Neoplasm Metastasis ; Urinary Bladder Neoplasms* ; Urinary Bladder* ; Urinary Diversion ; Urology

PURPOSE: We tried to investigate the clinical impact of Ki-67 (MIB-1) expression on the oncological and survival outcomes in patients with bladder cancer (BCa) after the radical cystectomy. MATERIALS AND METHODS: We retrospectively analyzed the data of 230 patients who were treated by radical cystectomy for BCa. Multivariate Cox-proportional hazards models and logistic regression tests were performed to evaluate the prognostic value of each variable. RESULTS: The patients with positive Ki-67 expression showed significant worse clinical characteristics and pathologic outcomes than negative Ki-67 group. Furthermore, the patients with Ki-67 expression showed significant worse recurrence (p=0.018) and cancer-specific mortality free survival (p=0.019) than negative Ki-67 group. The overall survival was also revealed to be inferior in Ki-67 positive group than Ki-67 negative group but the statistical significance was marginal (p=0.062). Subsequent multivariate Cox analyses showed that Ki-67 was independent predictor for disease recurrence after surgery (hazard ratio, 3.142; 95% CI, 1.287–7.671; p=0.012). CONCLUSIONS: In our study, high Ki-67 expression was significantly related with worse clinical outcomes after radical cystectomy in the patients with BCa. Further prospective and basic researches are needed to validate the true prognostic value of Ki-67.
Cystectomy* ; Humans ; Logistic Models ; Mortality ; Prognosis* ; Proportional Hazards Models ; Prospective Studies ; Recurrence ; Retrospective Studies ; Urinary Bladder Neoplasms* ; Urinary Bladder*

A continent ileal reservoir procedure has been performed on 30 patients at our hospital since Jan. 1987. Twenty eight patients underwent simultaneous total cystectomy and this procedure for bladder tumor, 2 patients underwent a reservoir procedure only for a neurogenic bladder or a urethral stricture. There was no operative mortality. There was 4 early complications resulting directly from this kind of diversion : urinary leakage from ureteroileal anastomosis site in 1 that required reanastomosis, incontinence due to incompetent efferent valve and urinary reflex of afferent valve in 2. The end result in 30 patients indicates that the continent ileal reservoir provides a urine storage function with adequate capacity and without incontinence and reflux. Most patients appreciate better quality of life by not having collecting device. Although this procedure is more difficult, time consuming and complication prone more than ileal conduit, overall result is considered to be satisfactory.
Colonic Pouches* ; Cystectomy ; Humans ; Mortality ; Quality of Life ; Reflex ; Urethral Stricture ; Urinary Bladder Neoplasms ; Urinary Bladder, Neurogenic ; Urinary Diversion

Complications have been evaluated retrospectively in 190 cases with surgical procedures involving the ureter at the Department of Urology, Kyungpook National University Hospital during the period from January. 1972 to December, 1981. Wound infections occurred in 6.8 per cent, being the most commonly encountered, acute pyelonephritis and urine leakage in 5.3 per cent, respectively, wound dehiscence in 2.1 per cent, gross hematuria in 1.6 per cent, respiratory failure in 1.1 per cent, and etc. The overall complication rate was 23.2 per cent (44 of 1190 cases) and mortality rate was 1.6 per cent (3 of 190 cases). Complications occurred in 16 (13.6 per cent) of 106ureterolithotomies. 4 (13.8 per cent) of 29 cystoectopic stone manipulations, 6 (13.6per cent) of 19 nephroureterectomies. 4 (33.3 per cent) of 12 ureteroneocystostomies,6 (66.7 per cent) of 9 ileal conduits with total cystectomy, 2 of 3 cutaneous ureterotomies, and 1 of 3 ureteroureteroetomies. The most common complication of ureterolithotomy was wound infection, developed in 6 (5.7 per cent) cases. The complication rate of ureterolithotomy for patients with moderate to severe hydroureteronephrosis on IVP was higher than that for patients with normal finding or mild hydroureteronephrosis. Simple ureterolithotomy had a low complication rate of 9.0 per cent, but ureterolithotomy combined simultaneously with other surgery had a higher rate 50.0 of per cent. Ureteral surgery excluding ureterolithotomy showed a high complication rate of 45.4 per cent. Thus, these findings indicate that complication rate of ureteral surgery at our hospital is still relatively high, and suggest that every effort should be gone not only into preoperative and postoperative management of the patient, but also into improvement in surgical technique for ureteral surgery.
Cystectomy ; Gyeongsangbuk-do ; Hematuria ; Humans ; Mortality ; Pyelonephritis ; Respiratory Insufficiency ; Retrospective Studies ; Ureter* ; Urinary Diversion ; Urology ; Wound Infection ; Wounds and Injuries

Bladder cancer remains a commonly diagnosed malignancy worldwide, bringing huge economic burden and high morbidity for patients. Assessment of prognostic significance of lymphovascular invasion (LVI) is a critical issue in the surgical management of bladder cancer after transurethral resection or radical cystectomy. A systematic search of PubMed, Embase and Cochrane Library was performed up to Oct 10, 2014 to identify eligible studies. Outcomes of interest were collected from studies comparing overall survival (OS), cancer specific survival (CSS) and recurrence free survival (RFS) in patients with the LVI. Results of studies were pooled, and combined hazard ratios (HRs) with corresponding 95% confidence intervals (CIs) for survival were used as the effect size estimation. Funnel plots were done to show the publication bias, while the forest plots and subgroup analyses were used to limit the heterogeneity. A total of 20 studies (10 663 patients) met the eligibility criteria and were included for this meta-analysis. Our pooled results showed that there were significant differences in OS (pooled HR, 1.71; 95%CI, 1.52-1.92; P<0.00001), CSS (pooled HR, 2.25; 95% CI, 1.80-2.81; P<0.00001) and RFS (pooled HR, 1.91; 95% CI, 1.57-2.32; P<0.00001) between the patients with LVI and the patients without LVI. There were significant heterogeneities observed in the studies concerning the relationship between LVI and CSS, RFS. There was no clear evidence of publication bias. When tumor stage was beyond T3, LVI lost its predictive value for CSS and RFS. For the patients who had negative lymph nodes, LVI was still an adverse predictor. Our pooled results demonstrate that LVI indicates poor prognosis of patients with bladder cancer after surgical procedures, and it can be of particular importance in clinical practice. However, these results need to be further confirmed by more adequately designed prospective studies.
Carcinoma, Squamous Cell ; diagnosis ; mortality ; pathology ; surgery ; Cystectomy ; mortality ; Female ; Humans ; Lymph Nodes ; Lymphatic Metastasis ; Male ; Neoplasm Invasiveness ; Neoplasm Staging ; Prognosis ; Survival Analysis ; Urinary Bladder Neoplasms ; diagnosis ; mortality ; pathology ; surgery ; Urothelium ; pathology ; surgery

PURPOSE: It is well established that muscle-invasive urothelial carcinoma (UC) has a marked propensity for divergent differentiation, a fact that has significant diagnostic, prognostic, and therapeutic implications. This work is designed to assess the impact of different histopathologic variants of bladder cancer on morbidity and mortality in patients undergoing radical cystectomy (RC) as compared to the impact in patients with conventional UC. MATERIALS AND METHODS: We reviewed records of 201 patients treated with RC and pelvic lymph node dissections. Demographics as well as clinico-pathologic parameters, including histopathological variant, tumor stage, and nodal status, were reviewed. Multivariate analyses were used to evaluate these parameters for overall survival (OS). Kaplan-Meier curves for overall and cancer-specific survival were plotted. RESULTS: The majority of patients were male (84%), and the mean age was 61+/-13.1 years (range, 27-87 years). The mean follow-up was 67 months (range, 6-132 months). A histological variant of UC tumor was found in 19 patients (11%). The OS was 55%, and the cancer-specific survival was 35%. The histopathologic variance showed significant impact on morbidity and mortality (p=0.02 and p=0.05, respectively). Patients with divergent histopathology of bladder tumor have poorer survival than do those with UC in a multivariate analysis. CONCLUSIONS: The pathologic stages at RC and lymph node involvement are predictors for OS. Because of its aggressive nature, histopathologic variance is an independent risk factor determining the outcome in terms of both morbidity and mortality.
Cystectomy* ; Demography ; Follow-Up Studies ; Humans ; Lymph Node Excision ; Lymph Nodes ; Male ; Mortality ; Multivariate Analysis ; Neoplasms, Glandular and Epithelial ; Risk Factors ; Urinary Bladder Neoplasms

PURPOSE: Radical cystectomy with urinary tract reconstruction currently remains the standard treatment for invasive bladder cancer, and adjuvant chemotherapy is usually considered for patients with a clinical stage >T2 or nodal metastasis. The aim of this study was to assess the safety of adjuvant chemotherapy in patients with orthotopic bladder substitution in comparison to ileal conduit. MATERIALS AND METHODS: We retrospectively analyzed the patients who underwent radical cystectomy and urinary diversion between 1990 and 2005. The patients who underwent adjuvant chemotherapy were stratified into two groups: those who had orthotopic bladder substitution and those who had ileal conduit. The chemotherapy regimen, renal function change, complications from adjuvant chemotherapy and other relevant data were analyzed. RESULTS: Overall, 341 patients had radical cystectomy, 89 had adjuvant chemotherapy, 28 had orthotopic bladder substitution and 61 had ileal conduit. The patient characteristics, including age, stage and follow-up, were similar in both groups. In all, 42% of patients had grade 1 toxicity, 16% had grade 2, 14% had grade 3 and 0% had grade 4. No patients had serious organ toxicity and none died. There were no significant differences in the chemotherapy toxicity and renal function change among the two groups. CONCLUSIONS: Adjuvant chemotherapy is safe and well tolerated by patients with either orthotopic bladder substitution or ileal conduit. There was no increased morbidity or mortality due to adjuvant chemotherapy in the patients who had orthotopic bladder substitution. Hence, orthotopic bladder substitution should not be denied to those patients with bladder cancer and who might require adjuvant chemotherapy.
Chemotherapy, Adjuvant* ; Cystectomy ; Drug Therapy ; Follow-Up Studies ; Humans ; Mortality ; Neoplasm Metastasis ; Retrospective Studies ; Urinary Bladder Neoplasms ; Urinary Bladder* ; Urinary Diversion* ; Urinary Tract

Five hundred forty three patients with transitional cell carcinoma managed at Seoul National University Hospital during a 20 year period between 1965 and 1984 art analyzed retrospectively. We selected 108 patients with stage A tumor for analysis of recurrence by excluding 95 patient with a prior history of bladder cancer, 14 patients whose initial treatment were a total cystectomy, 12 patients whose disease progressed in stage within 3 years following treatment, 58 patients followed up less than 3 years and 65 patients lost to follow up from 352 patients with stage A tumor. The over-all recurrent rate within the first 3 years following resection of stage A tumor was 70%. The influence of the tumor size, number and grade on recurrence was examined. Disease-free status by 36 months according to the tumor size 1cm or smaller, 1-2cm, 3-4cm, 5cm or larger was 57%, 31%, 17% and 7% respectively. All differences were statistically significant. There was no significant difference of recurrence rate between 1 tumor and 2 tumors, but 3 or more tumors showed significantly higher recurrence rate than 2 or less tumors. There was no significant difference of recurrent rate among grade I, Fade II , grade III tumors combined. Total cystectomies without pelvic lymphadenectomy or preoperative irradiation were performed in 110 patients and 77 patients were adequately followed up. Five-year survival rate of stage A, B, C, D was 87%, 26%, 11%, and 0% respectively. Operative mortality among patients undergoing total cystectomy was 4.5%. Metastases were found in the lymph node, adjacent organs and bone in the order of frequency. Only one patient with stage D tumor on initial presentation survived more than 5 years and the average survival length of stage D was 8 months.
Carcinoma, Transitional Cell ; Cystectomy ; Humans ; Lost to Follow-Up ; Lymph Node Excision ; Lymph Nodes ; Mortality ; Neoplasm Metastasis ; Recurrence ; Retrospective Studies ; Seoul ; Survival Rate ; Urinary Bladder Neoplasms* ; Urinary Bladder*