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Serous-lined Extramural Tunnel 방법의 Ileal W-neobladder의 종양학적, 기능적 결과

The Oncologic and Functional Results of the Ileal W-neobladder with a Serous-lined Extramural Tunnel

대한비뇨기과학회지 2008년 49권 9호 p.797 ~ 803
박홍주 ( Park Hong-Zoo ) - 울산대학교 의과대학 서울아산병원 비뇨기과학교실

김청수 ( Kim Choung-Soo ) - 울산대학교 의과대학 서울아산병원 비뇨기과학교실
유창희 ( Yoo Chang-Hee ) - 한림대학교 의과대학 비뇨기과학교실

Abstract


Purpose: We wanted to analyze the oncologic and functional outcomes of radical cystectomy and creation of an orthotopic ileal neobladder with a serous-lined extramural tunnel.

Materials and Methods: There were 110 patients and 101 patients were male(mean age: 58.7 years, age range: 35-78 years). All these patients underwent radical cystectomy and creation of a ileal W-shaped neobladder with a serous-lined extramural tunnel, and all the procedures were done by one surgeon. The median period of follow-up was 28.9(range: 6-95) months. The Assessing the patients’ clinical history, physical examinations, complete laboratory tests, CT scans and bone scans were performed postoperatively for the evaluation of recurrence and complications. The voiding patterns of 77 patients of the 110 patients were surveyed.

Results: Five-year-overall survival was 56% and the median survival period was 66.1 months. The tumor recurrence rate was 39.1%(43 patients) and 21(19.1%) patients died due to progression of cancer. The daytime and nighttime urinary continence rates at postoperative 1 year were 87% and 79%, respectively. Sixty three(81%) patients among the 77 patients had no voiding problems after the procedures. Nine patients still had severe incontinence and 5 patients still suffered from voiding difficulty. Renal functional deterioration developed in 3 patients(2.8%); however, no patients were on dialysis. Acute pyelonephritis was observed in 12 patients and recurrent pyelonephritis occurred in 6 patients. Ureter-ileal anastomosis site stricture was occurred in 5 renal units. No reflux from the ileal bladder into the ureter was observed.

Conclusions: Radical cystectomy and an orthotopic ileal neobladder using a serous-lined extramural tunnel for patients with invasive bladder cancer were effective and durable procedures in terms of the oncologic and functional outcomes.

키워드

Bladder cancer;Serous-lined extramural tunnel;Orthotopic bladder substitution;Complications
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