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Laparoscopic radical and partial cystectomy  [cached]
Challacombe Ben,Rose Kirsten,Dasgupta Prokar
Journal of Minimal Access Surgery , 2005,
Abstract: Radical cystectomy remains the standard treatment for muscle invasive organ confined bladder carcinoma. Laparoscopic radical cystoprostatectomy (LRC) is an advanced laparoscopic procedure that places significant demands on the patient and the surgeon alike. It is a prolonged procedure which includes several technical steps and requires highly developed laparoscopic skills including intra-corporeal suturing. Here we review the development of the technique, the indications, complications and outcomes. We also examine the potential benefits of robotic-assisted LRC and explore the indications and technique of laparoscopic partial cystectomy.
Radical cystectomy: Analysis of postoperative course  [PDF]
Jeremi? Dimitrije,Vojinov Sa?a,Maru?i? Goran,Levakov Ivan
Vojnosanitetski Pregled , 2010, DOI: 10.2298/vsp1008649j
Abstract: Background/Aim. Radical cystectomy is a method of choice in the therapy of infiltrative bladder cancer. The aim of this research was to analyze postoperative course after radical cystectomy (length of hospitalization, most frequent complications and utilization of antibiotics and transfusions). Methods. We analyzed the records of 82 patients operated on in the Department of Urology, Clinical Center of Vojvodina, in a three-year period. In order to aquire data World Health Organization (WHO) has developed Anatomical Therapeutic Chemical/Defined Daily Dose (ATC/DDD) methodology. Defined daily dose (DDD) is the assumed average maintenance dose per day for a drug use for its main indication. Results. Continent urinary derivation was preformed in 23.15% cases. Postoperative complications occurred in 18.29% of patients. Average blood utilization was 2.19 units. Blood utilization for continent derivations (n = 48) was 4.6 units, and incontinent ones 3.36 units. Totally 159.33 DDD/100 bed days were used. Conclusion. When preforming continent derivation there is a significant increase in blood utilization. Frequency of postoperative complications correlates to those reported in the literature.
P.V. Glybochko,A.N. Ponukalin,Yu.l. Mitryaev,N.G. Galkina
Saratov Journal of Medical Scientific Research , 2008,
Abstract: The type of urinary derivation after radical cystectomy due to urinary bladder carcinoma may greatly influence quality of life of patients. The purpose of this study was to estimate influence of different types of urinary derivation after cystectomy upon lifetime and health-related quality of life of patients with invasive urinary bladder cancer.
Cevdet Kaya,Orhan Koca,Muzaffer O?uz Kele?,Gülhan Y?lmaz
Marmara Medical Journal , 2009,
Abstract: Objective: Bladder cancer is the second most common cancer of the urinary tract. Radical cystectomy and urinary diversion is the gold standard treatment model of invasive bladder cancer.Patient and Methods: We evaluated 71 patients who underwent radical cystectomy, retrospectively according to their demographic properties, pre-operative and post-operative pathologies and method of urinary diversion and the complications between January 2003 and 2008.Results: Mean follow-up was 28.8 months after the operation. The pathologic stage was superficial at 13 patients (18%), T2 at 20 patients (28%), T3 at 25 patients (35%) and T4 at 14 patients (19%). Squamous cell carcinoma was reported in 7 and lymph node metastasis was in 24 patients. Postoperative short-term complications were wound infection in 12, wound eventration at 6, ileus in 3 and urinary leakage form ureteroileal anastomosis in 2 patients. Additionally, loop stenosis in 1 patient and allergic reaction due to urostomy material in 1 patient were noted. 2 patients died at the same time day after the operation.Conclusion: Radical cystectomy is found to be effective treatment modality with low complication rates parallel to the data in the literature.
Extent of lymphadenectomy in radical cystectomy for bladder cancer
M Hammad Ather, Sadaf Fatima, Orhun Sinanoglu
World Journal of Surgical Oncology , 2005, DOI: 10.1186/1477-7819-3-43
Abstract: A Pubmed search was carried out for the literature published over the last 15 years using bladder cancer, radical cystectomy, survival, lymphadenectomy and complications as the key words. We have discussed the extent of lymphadenectomy on survival and its anatomical basis to determine the optimal number of lymph nodes to be removed and the concept of node density.Evidence from contemporary literature indicate significantly increased survival rates after cystectomy in patients with bladder cancer diagnosed with stages III or IV disease who have had relatively more lymph nodes examined, suggesting that even some patients with higher stage disease may benefit from extended pelvic lymphadenectomy at the time of cystectomy. Studies also indicate that more extensive lymphadenectomy significantly improved the prognosis of patients with bladder cancer, not only by providing prognostic information but perhaps it is also due to its inherent therapeutic value.Extended lymph node dissection improves local control and survival. However, in the absence of controlled randomized trial this remains a dubitable issue.Bladder cancer is the second most common tumor of the urogenital tract with transitional cell carcinoma comprising of about 90% of all primary bladder malignancies [1]. Most of these tumors are superficial at initial presentation, limited to the mucosa, sub-mucosa or lamina propria. In superficial cancers, recurrence rates after initial treatment are 50–80% with progression to muscle invasive disease in 10–25% cases, whereas in muscle invasive disease there is 50% risk of loco-regional and distant metastasis.The transitional cell carcinomas (TCC) originates in the bladder mucosa, progressively invading the lamina propria and more sequentially involves muscularis propria, perivesical fat and contiguous pelvic structures with increasing incidence of lymph node involvement during progression [2,3].Radical cystectomy is the corner stone of treatment for invasive bladder canc
Cystectomy with orthotopic reconstruction following radical retropubic prostatectomy
Miotto Jr, Ari;Dall'Oglio, Marcos;Srougi, Miguel;
International braz j urol , 2004, DOI: 10.1590/S1677-55382004000200009
Abstract: the development of infiltrative bladder carcinoma in patients previously treated with radical prostatectomy due to prostate adenocarcinoma represents a challenging perspective. radical cystectomy remains the best option for invasive bladder cancer, however, there are few reports about the best approach to such individuals. nevertheless, despite possible technical difficulties found during surgery, the orthotopic urinary shunt is a reasonable option in selected cases.
Laparoscopic partial cystectomy in bladder cancer: initial experience
Mariano, Mirandolino B.;Tefilli, Marcos V.;
International braz j urol , 2004, DOI: 10.1590/S1677-55382004000300003
Abstract: proposal: the authors present their initial experience with a selected group of patients who underwent laparoscopic partial cystectomy for treating bladder cancer. materials and methods: in the period from june 1997 to april 2000, 6 patients, aged between 38 and 76 years, having transitional cell carcinoma of the bladder, were identified as candidates to partial cystectomy. the procedure employed consisted in laparoscopic partial cystectomy and lymphadenectomy with exclusive intracorporeal suture technique. results: the proposed procedure was completed in all cases. mean surgical time was 205 minutes and mean blood loss was 200 ml. there were no significant complications during both intra- and post-operative period. two patients (33%) presented urinary extravasation of less than 50 ml, with spontaneous resolution. mean hospitalization period was 4 days (2 to 6). the histological analysis of the resected specimens revealed transitional cell carcinoma, stage pt1g3 in case 1, pt2ag2 in cases 2 to 4, pt2bg2 in case 5 and pt3ag3 in case 6. the resection margins, as well as lymph nodes, were free of neoplasia. one patient developed local and metastatic disease, and was treated with salvage chemotherapy. no other case of local or systemic recurrence was observed with a mean follow-up of 30 months. conclusions: laparoscopic partial cystectomy can be an alternative surgical method for treating selected cases of patients with transitional cell carcinoma of the bladder.
Simultaneous laparoscopic nephroureterectomy and cystectomy: a preliminary report
Barros, Rodrigo;Frota, Rodrigo;Stein, Robert J.;Turna, Burak;Gill, Inderbir S.;Desai, Mihir M.;
International braz j urol , 2008, DOI: 10.1590/S1677-55382008000400003
Abstract: purpose: patients with muscle-invasive bladder cancer and concomitant upper urinary tract tumors may be candidates for simultaneous cystectomy and nephroureterectomy. other clinical conditions such as dialysis-dependent end-stage renal disease and non-functioning kidney are also indications for simultaneous removal of the bladder and kidney. in the present study, we report our laparoscopic experience with simultaneous laparoscopic radical cystectomy (lrc) and nephroureterectomy. materials and methods: between august 2000 and june 2007, 8 patients underwent simultaneous laparoscopic radical nephroureterectomy (lnu) (unilateral-6, bilateral-2) and radical cystectomy at our institution. demographic data, pathologic features, surgical technique and outcomes were retrospectively analyzed. results: the laparoscopic approach was technically successful in all 8 cases (7 males and 1 female) without the need for open conversion. median total operative time, including lnu, lrc, pelvic lymphadenectomy and urinary diversion, was 9 hours (range 8-12). median estimated blood loss and hospital stay were 755 ml (range 300-2000) and 7.5 days (range 4-90), respectively. there were no intraoperative complications but only 1 major and 2 minor postoperative complications. the overall and cancer specific survival rates were 37.5% and 87.5% respectively at a median follow-up of 9 months (range 1-45). conclusions: laparoscopic nephroureterectomy with concomitant cystectomy is technically feasible. greater number of patients with a longer follow-up is required to confirm our results.
Laparoscopic partial cystectomy for urachal and bladder cancer
Colombo Jr., Jose R.;Desai, Mihir;Canes, David;Frota, Rodrigo;Haber, Georges-Pascal;Moinzadeh, Alireza;Tuerk, Ingolf;Desai, Mahesh R.;Gill, Inderbir S.;
Clinics , 2008, DOI: 10.1590/S1807-59322008000600004
Abstract: purpose: to report our initial experiences with laparoscopic partial cystectomy for urachal and bladder malignancy. materials and methods: between march 2002 and october 2004, laparoscopic partial cystectomy was performed in 6 cases at 3 institutions; 3 cases were urachal adenocarcinomas and the remaining 3 cases were bladder transitional cell carcinomas. all patients were male, with a median age of 55 years (45-72 years). gross hematuria was the presenting symptom in all patients, and diagnosis was established with trans-urethral resection bladder tumor in 2 patients and by means of cystoscopic biopsy in the remaining 4 patients. laparoscopic partial cystectomy was performed using the transperitoneal approach under cystoscopic guidance. in each case, the surgical specimen was removed intact entrapped in an impermeable bag. one patient with para-ureteral diverticulum transitional cell carcinoma required concomitant ureteral reimplantation. results: all six procedures were completed laparoscopically without open conversion. the median operating time was 110 minutes (90-220) with a median estimated blood loss of 70 ml (50-100). frozen section evaluations of bladder margins were routinely obtained and were negative for cancer in all cases. the median hospital stay was 2.5 days (2-4) and the duration of catheterization was 7 days. there were no intraoperative or postoperative complications. final histopathology confirmed urachal adenocarcinoma in 3 cases and bladder transitional cell carcinoma in 3 cases. at a median follow-up of 28.5 months (range: 26 to 44 months), there was no evidence of recurrent disease as evidenced by radiologic or cystoscopic evaluation. conclusions: laparoscopic partial cystectomy in carefully selected patients with urachal and bladder cancer is feasible and safe, offering a promising and minimally invasive alternative for these patients.
Cystectomy with orthotopic reconstruction following radical retropubic prostatectomy  [cached]
Miotto Jr Ari,Dall'Oglio Marcos,Srougi Miguel
International braz j urol , 2004,
Abstract: The development of infiltrative bladder carcinoma in patients previously treated with radical prostatectomy due to prostate adenocarcinoma represents a challenging perspective. Radical cystectomy remains the best option for invasive bladder cancer, however, there are few reports about the best approach to such individuals. Nevertheless, despite possible technical difficulties found during surgery, the orthotopic urinary shunt is a reasonable option in selected cases.
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