Ortotopic bladder reconstruction in patients with locally advanced bladder cancer

Katica Pavlović¹, Dino Zalihić¹, Davor Tomić¹ Ivan Gilja²
¹Universty Clinical Hospital Mostar, Department of Urology, Mostar, Bosnia and Herzegovina
²Clinical Hospital „Sveti Duh“ Zagreb,Croatia

Corresponding author: Katica Pavlović, MD, Department of Urology, University Clinical Hospital Mostar, Kralja Tvrtka bb, 88000 Mostar, Bosnia and Herzegovina. Tel. +387 63 390 423. E-mail: katicapavlovic555@gmail.com

Orthotopic blader reconstruction has become the standard procedure, as well as, the prefered method of urinary diversion after cystectomy for localized bladder carcinoma. Locally advanced bladder cancer implies a patohistological finding pT3b-Pt4a N1-3 deep muscle invasion, extension into perivesical fat, stromal invasion of the prostatae and node – positiv disease.
Objective: The aim of this study was to determine and show results after surgical treatmen locally advanced bladder cancer with ortotopic diversion. Key research is to try to answer the question „Should continent diversion be preformed in patients with locally advenced bladder cancer? “

The study was conducted retrospectively, in the period for the 5 years. The data were collected from the medical history and protocol of the Department of Urology, Clinical Hospital „Sveti Duh„ Zagreb, Croatia. A total of 93 outpatients who are treatment with ortotopic diversion were included in the study. The following parameters were analysed: age, gende, patohistological analysis (urothelial, non urothelial cancer) oncological terapy, 5-year overall survival rate after operativ treatment.

Five-year results include 93 patients out of which 81 were male and 12 were women. According to the patohistologic analysis made, 86 urothelial and 12 non-urothelial carcinomas were confirme. In patients with radical cystectomy 5-years survival rate is only 25-35% for patients with stage pT3-4, N+M0.
Five-years survival rate in patient with combination of surgical and adjuvant chemotherapy were; alive 41 patients (44, 0%), patient which are use adjuvant chemotherapy after surgica treatment 13(34, 1%), died 52 patients (56, 6%), with adjuvant chemoterapy 10 patients (19,2%). Five-year overall survival was 53, 6% with immidiate therapy versus 47,7% with deffered treatment. Tumor recurrence rate after radical cystectomy was 13 %.

The clinical behavior of the tumor in patients with locally advenced bladder carcinoma is unpredictable.

Key words: locally advanced bladder cancer, ortotopic diversion, chaemotherapy