İnvazif mesane tümörü nedeni ile radikal sistoprostatektomi sonrası üriner diversiyon uygulanan hastalarda postoperatif dönemde meydana gelen metabolik, fizyolojik ve histopatolojik değişiklikler
Postoperative metabolic, physiologic and histopathologic changes in the patients which undergone urinary diversion following radical cystoprostatectomy
Yazar: TEMUÇİN ŞENKUL
Danışman: PROF. DR. YAVUZ ÖNOL
GATA / Haydarpaşa Eğitim Hastanesi  / Üroloji Ana Bilim Dalı
Derece: Tıpta Uzmanlık, 1995
Konu: Üroloji = Urology
Dizin: Hidrolik yapılar = Hydraulic structures ; Mesane neoplazmları = Urinary bladder neoplasms ; Neoplazmlar = Neoplasms ; Postoperatif dönem = Postoperative period ; Prostatektomi = Prostatectomy ; Üreterostomi = Ureterostomy ; Üriner diversiyon = Urinary diversion

Özet:
SUMMARY Postoperative metabolic, physiologic and histopathologic changes in the patients which undergone urinary diversion following radical cystoprostatectomy due to invasive bladder cancer. Between 1986 to 1995, 49 male patients with invasive bladder tumor were treated by urinary diversions following radical pelvic surgery. Of the 49 urinary diversions, 29 were ileal conduit, 16 were orthotopic neobladder and 4 were ureterosigmoidostomy. The patients with ureterosigmoidostomy were excluded because 3 patients did not come to routine follow-ups and 1 patient was undiverted to orthotopic neobladder. Technical properties of the operations, peroperative and early postoperative complications were recorded. The postoperative evaluations included serum electrolytes and blood gas analyzes, histopathologic changes in the mucosa of ileal conduit and neobladder, potency and continence status, urodynamic studies, function of upper urinary tract and tumor progression. Early complication rates were 12,4% and 13,8% in the patients with orthotopic neobladder and ileal conduit, respectively. Late complication rates were 6,2% and 6,8% in the patients with orthotopic neobladder and ileal conduit, respectively. Although, serum chloride levels increased in 13 patients (86%) with orthotopic neobladder, their blood gas analyzes were normal. All patients with ileal conduit had increased serum chloride levels but hyperchloremic metabolic acidosis developed in only 1 patient. The increase of the serum chloride levels was statistically significant in both groups (p<0,05). Daytime continence rate was 93,3% but nighttime continence rate was 46,6% in patients with orthotopic neobladder. Intermittent catheterization was necessary in 2 patients 74programına alındılar. Yine bu gurupta, ortalama sistometrik kapasite 591,8 mi (290-1148 mi) olarak bulundu. Poş yada konduit mukozalarından postoperatif dönemde alman mukoza biyopsilerindeki en önemli histopatolojik değişiklik mukoza kalınlığnda azalma ile eşlik eden atrofı olarak saptandı. Ortotopik mesane uygulanan hastalarda genel sağ kalım oranı %93,75 iken, ileal konduit uygulanan hastalarda %58,6 olarak bulundu. İn vazif mesane kanserinde en etkin tedavinin radikal sistektomi olduğu; hastanın tümör açısından durumu, yaşı ve entellektüalitesi göz önünde bulundurularak uygun diversiyon yönteminin tercih edilmesi gerektiği sonucuna vardık. 73

Abstract:
SUMMARY Postoperative metabolic, physiologic and histopathologic changes in the patients which undergone urinary diversion following radical cystoprostatectomy due to invasive bladder cancer. Between 1986 to 1995, 49 male patients with invasive bladder tumor were treated by urinary diversions following radical pelvic surgery. Of the 49 urinary diversions, 29 were ileal conduit, 16 were orthotopic neobladder and 4 were ureterosigmoidostomy. The patients with ureterosigmoidostomy were excluded because 3 patients did not come to routine follow-ups and 1 patient was undiverted to orthotopic neobladder. Technical properties of the operations, peroperative and early postoperative complications were recorded. The postoperative evaluations included serum electrolytes and blood gas analyzes, histopathologic changes in the mucosa of ileal conduit and neobladder, potency and continence status, urodynamic studies, function of upper urinary tract and tumor progression. Early complication rates were 12,4% and 13,8% in the patients with orthotopic neobladder and ileal conduit, respectively. Late complication rates were 6,2% and 6,8% in the patients with orthotopic neobladder and ileal conduit, respectively. Although, serum chloride levels increased in 13 patients (86%) with orthotopic neobladder, their blood gas analyzes were normal. All patients with ileal conduit had increased serum chloride levels but hyperchloremic metabolic acidosis developed in only 1 patient. The increase of the serum chloride levels was statistically significant in both groups (p<0,05). Daytime continence rate was 93,3% but nighttime continence rate was 46,6% in patients with orthotopic neobladder. Intermittent catheterization was necessary in 2 patients 74because of inability to void or maintain a post- void residual volume of 100 ml. The mean cystometric capacity was 591,8 ml (290 to 1 148 ml). The most common histopathologic change was mucosal atrophy that associated with decrease in mucosal thickness. Overall survival rates were 93,75% and 58,6% in patients with orthotopic neobladder and ileal conduit, respectively. In conclusion, we established that radical cystoprostatectomy is the most effective therapy in invasive bladder cancer and the adequate urinary diversion technique should be preferred in accordance with tumor status, patient's age and intelligence. 75