A Study on Complications of Cystectomies and Urinary Diversions

Hong, Jin Wook; Yoon, Jong Byung

Abstract

From October 1974 to September 1984, 64 consecutive patients of bladder and urethral cancer were treated by cystectomy and urinary diversion at the Department of Urology, Pusan National University Hospital. Comparative study was made between enteric diversion and ureterocutaneostomy, and several surgical mo. dality of cystectomy. The results obtained were as follows. l. The modes of cystectomy were simple cystectomy in 5 cases (7.8%), total cystectomy in 48 cases (75.0%), radical cystectomy in 10 cases (15.6%) and pelvic exenteration in 1 cases (1.6%). 2. The causes of cystectomy with urinary diversion were primary bladder cancer in 60 cases (93.8%), urethral carcinoma in 2 cases (3.1%) and metastatic bladder cancer in 2 cases (3.1%). 3. The methods of urinary. diversion were ileal conduit in 38 cases (59.4%) , ileocecal conduit in 5 cases (7.8%), tube in double stoma ureterocutaneostomy in 7 cases (10.9%) and tubeless single stoma ureterocutaneostomy in 14 cases (21.9%). 4. Age distribution was from 4 to 79 years and average was 56.3 years. Male to female ratio was 7:l. 5. Most frequent urinary diversion was enteric in 6th decade and ureterocutaneostomy in 7th decade. 6. Average operation time was 360 minutes in enteric diversion with total cystectomy and 272 minutes in ureterocutaneostomy with total cystectomy. 7. High stage (>=pT2) was 76.5% in enteric diversion and 81.O% in ureterocutaneostomy. High grade (II or III) was 67.6% in enteric diversion and 81.0% in ureterocutaneostomy. 8. Early complication rates were 50.0% in ileal conduit, 60.0% in ileocecal conduit, 42.9% in tube in double stoma ureterocutaneostomy, and 35.7% in tubeless single stoma ureterocutaneostomy. Late complication rates were 52.4% in ileal couuit, 40.0% ileocecal conduit and 33.3% in tubeless single stoma ureterocutaneostomy. 9. Local recurrence of tumor was observed in 80.0% of simple cystectomy cases but recurrence was not in total or radical cystectomy. Conclusively, total or radical cystectomy is treatment of choice in invasive bladder tumor rather than simple cystectomy. And single stoma ureterocutaneostomy may be useful method of urinary diversion inhigh stage, high grade, aged and poor risk patient if stomal control is male carefully.