SPARING CYSTECTOMY IN THE TREATMENT OF BLADDER CANCER WITH UROLOGICAL COMPLICATIONS

Bladder cancer (BC) accounts for 5 to 10% of all cancers and ranks fourth in the prevalence of male cancers. In Russia, its morbidity increases with age and amounts to 8.1—9.6 per 100,000 with the annual increase being 3.34%.

Objective: to assess the results of sparing cystectomy (CE) for BC in the presence of urological complications.

Subjects and methods. From February 1999 to December 2007, the study consequently included 196 patients receiving surgical treatment for the aggressive form of BC, of whom 101 patients received surgical treatment for CE with intestinal plastic repair. There were 33 (84.6%) males and 6 (15.4%) females. The patients' mean age was 69.4 (range 35-81) years; the duration of the disease averaged 1.4 years (range 6 months to 5 years). The proportion of the males who has undergone sparing CE was 48.5% of the total number of patients. There were no women who had been operated on.

Results. Examination of 101 patients with invasive CE revealed that 69 patients had the following types of complications: intractable bleeding, hydronephrosis, acute pyelonephritis, chronic renal failure, progressive cancer intoxication, and acute urinary retention. These patients were determined as having undergone sparing CE. Group 2 comprised 127 patients who had received organ-preserving therapy.

Conclusion. Physical examination, instrumental, and X-ray studies established a correlation of the tumor aggression with the severity of urological complications; sparing CE for urological involvement in patients with invasive UBC has an advantage over organ-preserving treatment (33.3% versus 4.7%) in providing 5-year survival. However, the early postoperative mortality from occurring complications was higher in Group 1 than that in Group 2 without radical treatment.

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