The author had experienced 3 cases of ureterosigmoidostomy with sigmoid pouch and colostomy above as urinary diversion after total cystectomy in patients having advanced bladder carcinoma. The postoperative complications such as electrolyte imbalance, infection or hydronephrosis were not remarkable in these cases, which have been frequently encountered in ureterosigmoidostomy alone. The patients had been well in urination without significant frequency, residual urine or incontinence.
Colon, Sigmoid* ; Colostomy ; Cystectomy ; Humans ; Hydronephrosis ; Postoperative Complications ; Urinary Bladder ; Urinary Bladder Neoplasms ; Urinary Diversion ; Urination

Radical cystectomy is the golden standard treatment for muscle-invasive bladder cancer. Urinary diversion is the prerequisite procedure after cystectomy and various type of urinary diversion has been introduced. Urinary diversion carries surgical morbidities, postoperative complications in terms of urinary function and sexual function, and issues for quality of life, which are important considerations for selecting urinary diversion. Ileal conduit urinary diversion and orthotopic bladder substitution have been regarded as the representative urinary diversion after radical cystectomy. There have been great efforts to compare the functional outcomes and quality of life between these two types of urinary diversion. Although orthotopic bladder substitution seems to a more natural and desirable urinary diversion, the currently available evidence is insufficient to draw a conclusion that orthotopic bladder is an absolutely superior form of urinary diversion. However, the vast majority of studies demonstrated that orthotopic neobladder urinary diversion shows at least equal or a marginally better quality of life scores compared to ileal conduit diversion. The favorable outcomes of orthotopic neobladder would be more pronounced especially when considering relatively young and healthy patients.
Cystectomy ; Humans ; Postoperative Complications ; Quality of Life* ; Urinary Bladder Neoplasms* ; Urinary Bladder* ; Urinary Diversion

Under specific circumstances the appendix vermiformis may be an appropriate organ for replacement of a large ureteral defect or efferent loop in continent urinary diversion. Since 1995 we have applied the appendix in ureteral substitution (3 cases) and continent urinary diversion (3 cases). Primary diagnoses included complete lower ureteral stricture due to urinary tuberculosis (3 cases), invasive bladder tumor (1 case), areflexic neurogenic bladder (1 case), and contracted bladder (1 case). In all patients who have been replaced the ureter with appendix, clinical symptoms were markedly improved and degree of hydronephrosis decreased. Other patients with continent urinary diversion using appendix achieved dryness and low postoperative complications. we anticipate that the appendix will be used more commonly in the future as a ureteral substitute or continent urinary diversion as more urologists become more comfortable with it through its use in various reconstructive procedures.
Appendix* ; Constriction, Pathologic ; Diagnosis ; Humans ; Hydronephrosis ; Postoperative Complications ; Tuberculosis ; Ureter ; Urinary Bladder ; Urinary Bladder Neoplasms ; Urinary Bladder, Neurogenic ; Urinary Diversion

PURPOSE: We analyzed the perioperative and early oncological outcomes following radical cystectomy with using the laparoscopic method, and we compared these findings with those of the conventional open method. MATERIALS AND METHODS: Between January 2003 and December 2006, we performed laparoscopic radical cystectomy(LRC) with an extracorporeal ileal conduit for treating bladder cancer in 22 patients, and the results of the LRC were compared with those of open radical cystectomy(ORC) in 20 cases. The surgical results such as the operation time, the estimated blood loss(EBL), the transfusion rate, the hospital stay, the complications and the oncological results were reviewed retrospectively and then analyzed via the Mann-Whitney U test. RESULTS: There were no significant differences of demographic data between the two groups. The pathologic reports showed a transitional cell type in all cases. For the LRC and ORC groups, the mean operation time for cystectomy was 186.5 min(150-240) vs 192.4 min(150-240), respectively (p=0.276), the EBL was 228.18ml(150-380) vs 995.0ml(400-1,200), respectively(p<0.01), the transfusion rate was 15.7% vs 85.0%, respectively, the hospital stay was 11.2 days vs 12.4 days, respectively(p=0.67), the intraoperative complications was 3/22 cases(13.6%) vs 9/20 cases(45.0%), respectively. The pathologic surgical margins were all negative. The surgical and pathologic parameters of the LRC group showed no significant differences compared to those of the ORC group, except for the EBL and transfusion rate. CONCLUSIONS: LRC resulted in less blood loss, a lower transfusion rate and earlier, more rapid recovery than did ORC. In our opinion, lararoscopic surgery is a feasible treatment for bladder cancer.
Cystectomy* ; Humans ; Intraoperative Complications ; Laparoscopy ; Length of Stay ; Retrospective Studies ; Urinary Bladder Neoplasms ; Urinary Diversion*

Anemia, Hemolytic, Autoimmune ; Carcinoma, Transitional Cell/complications* ; Humans ; Urinary Bladder Neoplasms/complications*

Since January 2003, two male patients, 60 and 47 years old, with muscle-invasive, organ-confined, transitional cell carcinomas of the urinary bladder underwent laparoscopic radical cystoprostatectomy with extracorporeal ileal conduit urinary diversion (LRCEIC). The surgical time was 8.5 hours in the first patient and 10 hours in the second. The respective blood losses were 350 and 380ml. In the first patient, ambulation resumed on day 2, bowel sounds on day 3 and oral intake on day 4, with a hospital stay of 8 days. In the second patient, due to inadvertent rectal injury, which was discovered on day 3, ambulation, bowel sounds and oral intake could not be determined. A pathological examination revealed a pT1N0M0 transitional cell carcinoma of the bladder, with the surgical margins negative for cancer, in the first patient, and a pT3bN1M0, with the surgical margins positive for cancer, in the second. Immediate postoperative complications included rectal injury and ileus in the second patient. With further experience and refinement in the operative technique, it is believe that LRCEIC can be performed safely and efficaciously in selected muscle-invasive bladder cancers.
Carcinoma, Transitional Cell ; Cystectomy* ; Humans ; Ileus ; Laparoscopy ; Length of Stay ; Male ; Middle Aged ; Operative Time ; Postoperative Complications ; Urinary Bladder ; Urinary Bladder Neoplasms ; Urinary Diversion* ; Walking

PURPOSE: During laparoscopic partial cystectomy (LPC), lesion identification is essential to help to determine the appropriate bladder incisions required to maintain adequate resection margins. The inability to use tactile senses makes it difficult for surgeons to locate lesions during laparoscopic surgery. Endoscopic India ink marking techniques are often used in laparoscopic gastroenterological surgery. We present our experience with performing LPC with India ink during the surgical resection of various bladder lesions. MATERIALS AND METHODS: LPC with cystoscopic fine needle tattooing was performed on 10 patients at our institute. Tattooing was performed at 1- to 2-cm intervals approximately 1 cm away from the outer margin of the lesion with enough depth (the deep muscle layer) under cystoscopic guidance. LPC was performed by the transperitoneal approach. The clinical courses and pathologic results were analyzed. RESULTS: All LPC with cystoscopic tattooing cases were performed successfully. The mean patient age was 39.1 years. The mean operative time was 130.5 minutes, and the mean estimated blood loss was 93 ml. The mean hospital stay was 13.1 days, and the mean duration of indwelling Foley catheterization was 10.7 days. There were no significant intraoperative or postoperative complications except 1 case of delayed urinary leak and 1 case of delayed wound healing. The pathological diagnosis included 1 urachal cancer, 1 urachal remnant, 4 urachal cysts, 2 pheochromocytomas, and 2 inflammatory masses. All specimens showed adequate surgical margins. CONCLUSIONS: Cystoscopic tattooing in LPC is a simple and effective technique to assist in locating pathological bladder lesions intraoperatively. This technique can help to determine appropriate resection margins during LPC without incurring additional complicated procedures.
Carbon ; Cystectomy ; Cystoscopy ; Humans ; India ; Ink ; Laparoscopy ; Length of Stay ; Muscles ; Needles ; Operative Time ; Pheochromocytoma ; Postoperative Complications ; Tattooing ; Urachal Cyst ; Urinary Bladder ; Urinary Bladder Neoplasms ; Urinary Catheterization ; Wound Healing

Managing persistent and symptomatic urachal anomalies requires wide surgical excision of all anomalous tissue with a cuff of bladder tissue via the open approach. We report 7 cases with complete laparoscopic removal of symptomatic urachal remnants with or without a cuff of bladder tissue. We expected that this technique would be less invasive and have lower morbidity. We report on the feasibility of this approach, including efficacy and outcomes. Eight patients with a mean age of 36.5 years who had symptomatic urachal diseases underwent laparoscopic excision between July 2004 and July 2012. With the use of four ports, the urachal remnant was dissected transperitoneally and then removed via the umbilicus port. The clinical results of laparoscopic urachal remnant excision as a minimally invasive surgery, the perioperative records, and pathologic results were evaluated. There were no intraoperative or postoperative complications. Mean surgery time was 2.7 hours. Mean hospital stay was 14.6 days. The patients with bladder cuff resection had a long admission and Foley catheterization period (mean, 14.4 and 11 days). Pathological evaluations were 6 cases of infected urachal cysts, 1 case of infected urachal sinus, and 1 case of urachal adenocarcinoma. We found no postoperative complications including any symptom recurrence or voiding difficulty during a mean follow-up of 46.3 months. The perioperative surgical outcomes achieved infection control and symptomatic relief and additionally good cosmesis. Complete laparoscopic removal of symptomatic urachal remnants with or without a cuff of bladder tissue seems to be a safe, effective, and better cosmetic alternative with the advantages of a minimally invasive approach.
Adenocarcinoma ; Cosmetics ; Follow-Up Studies ; Humans ; Infection Control ; Laparoscopy ; Length of Stay ; Postoperative Complications ; Recurrence ; Surgical Procedures, Minimally Invasive ; Umbilicus ; Urachal Cyst ; Urinary Bladder ; Urinary Bladder Neoplasms ; Urinary Catheterization

AIMTo determine the incidence of adenocarcinoma of the prostate for patients undergoing radical cystoprostatectomy for bladder cancer in Taiwan.

METHODSA total of 248 patients in Taiwan who were histologically confirmed for transitional cell carcinoma of the bladder underwent cystoprostatectomy. Histopathologic evaluation of the prostate specimens sectioned at 5 mm intervals was performed.

RESULTSOf the 248 patients, 10 (4.03%) were found to have prostate cancer. Of the 10 cases of unsuspected prostate cancer, eight proved to be at stage T1 or T2, and two at T3 and T4, respectively. This rate of incidentally found prostate cancer amongst our bladder cancer patients appeared to be lower than that found in bladder cancer patients in similar studies in USA.

CONCLUSIONAlthough the incidence of incidental prostate cancer in patients in Taiwan with bladder cancer is not high compared with that in Western countries, we suggest that digital rectal examination and prostate-specific antigen (PSA) are important screening tools for men with bladder cancer, especially for those aged 60 years and older in Taiwan.

Carcinoma, Transitional Cell ; pathology ; surgery ; Humans ; Male ; Neoplasm Staging ; Prostatectomy ; Prostatic Neoplasms ; complications ; surgery ; Urinary Bladder Neoplasms ; complications ; pathology ; surgery

PURPOSE: We aimed to ascertain the effects of performing extended pelvic lymph node dissection (PLND) on the duration of surgery, morbidity, and the number of lymph nodes removed when the dissection was performed before or after radical cystectomy (RC). MATERIALS AND METHODS: We used the database of our previous prospective multicenter study. A total of 118 patients underwent RC and extended PLND. Of the 118 patients, 48 (40.7%) underwent extended PLND before RC (group 1) and 70 (59.3%) underwent extended PLND after RC (group 2). The two groups were compared for extended PLND time, RC time, and total operation times, per operative morbidity, and the total numbers of lymph nodes removed. RESULTS: Clinical and pathologic characteristics were comparable in the two groups (p>0.05). The mean RC time and mean total operation times were significantly shorter in group 1 than in group 2 (p<0.001). The mean number of lymph nodes removed was 27.31+/-10.36 in group 1 and 30.87+/-8.3 in group 2 (p=0.041). Only at the presacral region was the mean number of lymph nodes removed significantly fewer in group 1 than in group 2 (p=0.001). Intraoperative and postoperative complications and drain withdrawal time were similar in both groups (p=0.058, p=0.391, p=0.613, respectively). CONCLUSIONS: When extended PLND was performed before RC, the duration of RC and consequently the total duration of the operation were significantly shorter than when extended PLND was performed after RC. Practitioners may consider performing extended PLND before RC and rechecking the presacral area for additional lymph nodes after RC, particularly in elderly patients with high co-morbidity for whom the duration of surgery matters.
Aged ; Cystectomy ; Humans ; Lymph Node Excision ; Lymph Nodes ; Postoperative Complications ; Prospective Studies ; Urinary Bladder Neoplasms