Journals / Türk Üroloji Dergisi/Turkish Journal of Urology / 2005 / Cilt: 31 - Sayı: 3
Long term follow-up results of our 10-year ileal loop series and comparison of ureteroileal anastomosis techniques (Bricker and Wallace)
- Pages
- 318–323
- DOI
- —
Abstract
Introduction: Bladder cancer is the second most frequent cancer of the genitourinary system. Radical cystectomy maintains its position as the gold standard in the treatment of local invasive bladder cancer. The ileal loop introduced by Seiffert and popularized by Bricker has been used for half a century, and it is still considered a standard form of urinary diversion following cystectomy for bladder cancer. The purpose of this study was to evaluate the long-term follow-up results of patients in whom radical cystectomy and ileal loop had been performed within the last 10 years in our clinic because of local invasive bladder tumors, and to compare two anastomosis techniques used in ureteroileal anastomoses. Materials and Methods: Follow-up data of 74 patients in whom radical cystectomy and ileal loop had been performed in our clinic between 1994 and 2004 were retrospectively examined. Complications seen within the postoperative 30 days were recorded as early complications, and complications seen in later periods were recorded as late complications. Early and late postoperative complication rates for the entire patient groups were determined. Group 1 included 60 patients in whom Bricker technique had been applied as the ureteroileal anastomosis technique and Group 2 included 14 patients in whom Wallace technique had been applied. These two groups were compared in terms of age, mean follow-up period, pathological stages, and ureteral complications as stricture and leakage in anastomosis. Results: The mean age of patients was 60.7±9.68 years (28-80), and average follow-up period was 17.6±19.11 months (1-96). Pathologically, 70 of the patients (94.6%) had transitional-cell cancer, 3 (4%) had adenocancer, and 1 (1.4%) had squamous-cell cancer. In six patients out of 74 (8.8%) prostate adenocancer was determined incidentally. During follow-up 14 of the patients were lost. While early complications were seen in 17.5% of the patients, the most frequent early complication was evisceration (12.2%). Late complications were seen in 32.4% of the patients. The most frequent complications in late period were hydronephrosis and ureteral anastomosis stricture (10.8%). Two groups with Bricker and Wallace type ureteroileal anastomosis were similar in terms of age, gender, and the distribution of pathological stages. Anastomosis stricture was seen in 8 patients and urine leakage from the anastomosis in 2 out of 60 patients in the Bricker technique group. Anastomosis stricture and urine leakage were observed in none of the patients in Group 2. Conclusion: Wallace technique can be preferred as the ureteroileal anastomosis method in ileal loop diversion after radical cystectomy, since it has lower complication rates when compared to Bricker technique.
Özet
Bu çalışmanın amacı; son 10 yıl içinde kliniğimizde lokal invaziv mesane tümörü nedeniyle radikal sistektomi ve ileal loop uygulanan hastaların uzun dönem takip sonuçlarını değerlendirmek ve üreteroileal anastomoz için kullanılan iki anastomoz tekniğini istenmeyen yan etkiler açısından karşılaştırmaktır. 1994-2004 yılları arasında kliniğimizde radikal sistektomi ve ileal loop uygulanan 74 hastanın takip bilgileri retrospektif olarak incelendi. Hastaların ameliyat sonrası erken ve geç dönemde gelişen istenmeyen yan etkilerin oranları tespit edildi. Hastalar uygulanan üreteroileal anastomoz tekniğine göre iki gruba ayrıldı. Bu iki grup yaş, ortalama takip süresi, patolojik evre ve anastomoz darlığı, anastomoz kaçağı gibi üreteral istenmeyen yan etkiler açısından karşılaştırıldı. Hastaların %17.5'inde erken istenmeyen yan etkiler görülürken, en sık görülen erken istenmeyen yan etki eviserasyon (%12.2) idi. Hastaların %32.4'ünde geç istenmeyen yan etkiler görüldü. Geç dönemde en sık görülen istenmeyen yan etki hidronefroz ve üreteral anastomoz darlığı (%10.8) idi. Bricker ve Wallace tipi üreteroileal anastomoz yapılan iki grup, ortalama takip süresi, yaş, cinsiyet ve patolojik evrelerin dağılımı açısından benzerdi. Bricker tekniği uygulanan 60 hastanın 8'inde anastomoz darlığı, 2 tanesinde de anastomozdan idrar kaçağı tespit edildi. Wallace tekniği uygulanan 14 hastanın hiçbirinde anastomoz darlığı ve idrar kaçağı tespit edilmedi. Radikal sistektomi sonrası ileal loop diversiyonu uygulanan hastalarda üreteroileal anastomoz yöntemi olarak Wallace tekniği, Bricker tekniği ile karşılaştırıldığında daha düşük istenmeyen yan etki oranlarına sahip olması nedeniyle tercih edilebilir.