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2009, Number 6

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Cir Cir 2009; 77 (6)

Trece años de experiencia en el manejo de cáncer vesical con neovejiga ortotópica de Studer

Martínez-Cornelio A, Hernández-Toriz N, Quintero-Becerra J, Flores-López D, Moreno-Palacios J, Vázquez-Martínez E

Language: Spanish
References: 30
Page: 443-450
PDF size: 157.57 Kb.


ABSTRACT

Background: We present the results of patients submitted to a Studer type urinary orthotopic derivation after radical cystectomy. Methods: The files of patients with bladder cancer submitted to a radical cystectomy plus the procedure of the ileal neobladder were reviewed in our hospital from January 1992 until December 2004. Patients were divided into two groups: group A¾60 years old or younger and group B¾›60 years old. Results: From 306 patients submitted to a radial cystectomy with urinary derivation, there were 42 patients (13.7%) included whose derivation was a Studer type neobladder. There were 34 (80.9 %) men and 8 (19.1%) women, with an average age of 60 years. Average surgical time was 7 h with an average blood loss of 1600 ml requiring transfer to intensive care unit (ICU) in 55% of the cases. The most frequent early complication was metabolic acidosis that was present in 28 (66%) patients. The most severe complication was ileal-ureter urinary leak, which was present in 7 (16.6 %) patients. Among the most frequent late complications are the day- and night-time urinary incontinence often related to urinary infections and intestinal occlusion. Overall 5-year survival was 71%, cancer-specific mortality was 15% and surgical-related mortality was 7.3%. Conclusions: The performance of procedures with orthotopic neobladders is actually feasible in experienced hospital centers and is a valuable alternative to urinary heterotopic derivation with ileal conduit. Postoperative patient management and regular follow-up is of major importance.


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