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Upper urinary tract involvement after cystectomy and ileal conduit diversion for primary bladder carcinoma
Y Tsuji1, H Nakamura, A Ariyoshi
1Department of Urology, School of Medicine, Fukuoka University, Japan.
European Urology
|January 1, 1996
Summary
Malignant recurrence after cystectomy and ileal conduit diversion can occur up to 10 years later, progressing rapidly. Benign strictures develop sooner but advance slowly, necessitating annual imaging for proper follow-up.
Area of Science:
- Urology
- Oncology
- Radiology
Background:
- Cystectomy with ileal conduit urinary diversion is a standard treatment for bladder cancer.
- Monitoring for upper tract recurrence and anastomotic complications is crucial for patient outcomes.
Purpose of the Study:
- To differentiate radiographic characteristics of recurrent malignant upper tract lesions from benign ureteroileal anastomosis strictures.
- To establish optimal follow-up protocols after cystectomy and ileal conduit diversion.
Main Methods:
- A 20-year retrospective study of 61 patients undergoing cystectomy and ileal conduit diversion.
- Routine excretory urography at 1, 3, 6, 12 months post-surgery, then annually.
Main Results:
- Malignant ureteral obstruction occurred in 8.2% of patients, with delayed onset (mean 69 months) and rapid renal function loss.
- Benign ureteroileal anastomotic strictures developed in 18.0%, typically within 2 years, with slower progression of renal dysfunction.
- All patients were asymptomatic prior to imaging detection.
Conclusions:
- Cancer recurrence can manifest late (up to 10 years post-cystectomy) and progresses rapidly.
- Benign anastomotic strictures usually appear within 2 years and progress slowly.
- Annual excretory urography and/or renal ultrasonography are recommended for long-term follow-up.