Document Detail


Changes in the upper urinary tract after radical cystectomy and urinary diversion: a comparison of antirefluxing and refluxing orthotopic bladder substitutes and the ileal conduit.
MedLine Citation:
PMID:  16406905     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
PURPOSE: We evaluated and compared the effects of different types of urinary diversion on functional and radiographic changes in the upper urinary tract. MATERIALS AND METHODS: We analyzed data on 275 patients who underwent radical cystectomy and urinary diversion for bladder cancer and were observed at least 12 months. Of the patients 197 received an orthotopic bladder substitute, including antirefluxing ureteral anastomoses in 111 (group 1) and refluxing ureteral anastomoses in 86 (group 2). Ileal conduits were created in 78 patients (group 3). Serial serum Cr, radiographic changes in the upper urinary tract after diversion and the number of episodes of APN were compared by diversion method. Mean followup was 52 months (range 12 to 174 months) with no difference among the groups. RESULTS: Compared with group 3 patients in groups 1 and 2 demonstrated a significantly higher incidence of moderate to severe hydronephrosis (p = 0.001) but the incidence was similar between groups 1 and 2 (6.3%, 8.3% and 1.4% of the renal units in groups 1 to 3, respectively). Stabilized postoperative Cr did not differ among the groups. CRF, defined as Cr 3.0 mg/dl or greater, occurred in 2.7% of the patients in group 1 and in 3.5% of those in group 2 but in none in group 3. APN was noted in 3.3%, 4.4% and 0.4% of patients in groups 1 to 3, respectively (p = 0.012). CONCLUSIONS: An ileal conduit with a lower rate of diversion related hydronephrosis, CRF and morbidity associated with APN was superior to orthotopic bladder substitutes. Between the refluxing and antirefluxing types of orthotopic bladder substitutes no significant difference in functional or radiographic changes was noted.
Authors:
Cheryn Song; Taejin Kang; Jun-Hyuk Hong; Choung-Soo Kim; Hanjong Ahn
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Publication Detail:
Type:  Comparative Study; Journal Article    
Journal Detail:
Title:  The Journal of urology     Volume:  175     ISSN:  0022-5347     ISO Abbreviation:  J. Urol.     Publication Date:  2006 Jan 
Date Detail:
Created Date:  2006-01-12     Completed Date:  2006-02-28     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  0376374     Medline TA:  J Urol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  185-9; discussion 189     Citation Subset:  AIM; IM    
Affiliation:
Department of Urology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Aged, 80 and over
Cystectomy*
Female
Humans
Male
Middle Aged
Urinary Bladder Neoplasms / surgery*
Urinary Diversion*

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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