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Paper Information

Title: 

"RADICAL CYSTECTOMY IN FEMALE: IS REMOVAL OF INTERNAL GENITAL ORGANS NECESSARY?"

Type: PAPER
Author(s): SHARIFI AGHDAS FARZANEH,GHADERIAN NASSRIN*
 
 *
 
Name of Seminar: CONGREH ANJOMAN UROLOGY IRAN
Type of Seminar:  CONGRESS
Sponsor:  ANJOMAN OROLOGY
Date:  2005Volume 8
 
 
Abstract: 

PROPOSE: BLADDER CARCINOMA IS THE EIGHTH MOST COMMON CANCER IN FEMALE. RADICAL CYSTECTOMY IS KNOWN THE STANDARD SURGICAL APPROACH IN THE TREATMENT OF INVASIVE BLADDER CANCER. IN THE RECENT YEARS THERE HAVE BEEN A FEW REPORTS WHICH HAVE PUT THE REMOVAL OF INTERNAL GENITAL ORGANS IN DOUBT. THIS STUDY WAS DONE TO ANSWER THIS QUESTION IF POSSIBLE.
METHODS & MATERIALS: WE REVIEWED THE MEDICAL RECORDS OF 33 FEMALE PATIENTS WHO UNDERWENT RADICAL CYSTECTOMY WITH URINARY DIVERSIONS IN UROLOGY DEPARTMENT OF 3 HOSPITALS AFFILIATED TO SHAHID BEHESHTI UNIVERSITY SINCE APRIL 1987 TO APRIL 2003. MEDIAN AGE WAS 60 (33-77 RANGE) YEARS. GROSS HEMATURIA WAS THE MAIN COMPLAINT. OBVIOUS RISK FACTOR WAS FOUND IN ONLY TWO (CIGARETTE SMOKING AND BLADDER STONE). INTRAVESICAL SITE OF TUMOR WAS IN TRIGONE AND AROUND URETERAL ORIFICES IN THE MAJORITY. EXTERNAL URINARY AND ORTHO TOPIC URINARY DIVERSION WAS USED IN 27 AND 6 RESPECTIVELY. HISTOPATHOLOGIC REPORT WAS T.C.C. IN 24 (73%), S.C.C. IN 3 (9%), MIXED IN 3 (9%), ADENOCARCINOMA IN 2 (6%) AND PARAGANGLIOMA IN 1 (3%). PATHOLOGIC STAGE WAS ORGAN–CONFINED (T1, T2, T3A) IN 19 (58%) AND BEYOND THE BLADDER (T3B, T4A, B) IN 14 (42%). INTERNAL GENITALIA WERE INVOLVED IN 10 OUT OF 33 (30%). (SOME WITH MULTIPLE SYNCHRONOUS INVOLVEMENTS). VAGINA WAS INVOLVED IN 7, CERVIX IN 5, UTERUS IN 3 AND OVARY IN 1. MAJOR OPERATIVE COMPLICATIONS, OCCURRED IN 12 (36%) CONSISTING: THROMBOPHLEBITIS 2, C.V.A2, M.I1, TACHYARRHYTHMIA 1, PULMONARY EMBOLI 1, ASPIRATION–PNEUMONIA 1, ANASTOMOTIC BOWEL LEAKAGE 1, RECTAL PERFORATION AND COLOSTOMY 1, URINARY FISTULA TO VAGINA IN 1, UPPER TRACT OBSTRUCTION AND PCN IN 1. PERI-OPERATIVE MORTALITY OCCURRED IN 3 (9%). MEDIAN FOLLOW-UP TIME IS 33.5 (3-131) MONTHS. WE HAVE NO INFORMATION ABOUT 12 PATIENTS. FROM 18 ACCESSIBLE PATIENTS, 10 ARE ALIVE.
DISCUSSION & CONCLUSION: THERE HAVE BEEN A FEW REPORTS IN RECENT YEARS ABOUT THE NECESSITY OF REMOVAL OF GENITAL ORGANS DURING RADICAL CYSTECTOMY. IN OUR STUDY GENITAL ORGANS WERE FREE OF TUMOR IN 70% WHICH IS CONSIDERABLE. ALTHOUGH WE COULDN’T FIND ANY SPECIAL PROGNOSTIC FACTOR IN ORDER TO DECIDE TO REMOVE THE INTERNAL GENIAL ORGANS DURING SURGERY. ALSO THE HIGH RATE OF MAJOR COMPLICATIONS IS NOTEWORTHY IN ORDER TO GIVE A BETTER PERIOPERATIVE MEDICAL CARE.

 
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