Læknablaðið : fylgirit - 01.06.2009, Blaðsíða 20

27TH CONGR SCAND ASSOC UROL
F Y L G I R I T 6 1
ileum and the ileocecal valve was used for a modified ileocecal
pouch with an umbilical stoma.
Material and methods: after cystectomy a pouch was formed
of 30cm ileum and 8-10cm ascending colon. Detubularization
and reconfirmation to a pouch was performed. The ureters were
implanted in a spatulated end-side fashion preferably into the
colon. The efferent limb was constructed out of 5-7 cm terminal
ileum. The efferent limb was stapled and tapered over a 12 F red
rubber catheter. Inverting non-resorbable Lembert sutures were
used to secure and additionally narrow the ileum. The ileocecal
valve was also inverted with non-resorbable Lembert sutures.
After rotating the pouch 180° counter clockwise the efferent limb
reached to the umbilicus.
84 patients were operated. 64 patients (51 females,13 males)
had muscle invasive urothelial cancer, 12 were converted from
an ileal conduit or an ureteral stoma and 8 patients had non
malignant disease (post irradiation, contracted bladder....).
9 patients had their stoma implanted into the right lower
abdominal quadrant, 75 had an umbilical stoma. Median follow-
up was 5 years.
Results: 82/84 patients were completely dry during catheter
intervals. Patients had to catheterize the pouch 0.8 x per night
to stay dry. Daytime interval between cath was 4.2 h, night time
4.6 h.
Specific complications included revision of the umbilicus in 6
patients due to catheterisation difficulties, leakage of the pouch
in 2 pat., and ureteral stenosis in 5 patients. Functional capacity
of the pouch was 550 ml (320-740 ml), cystometric capacity at
10 cm H20 490 ml (300-640 ml). Maximum pressure was 27 cm
H,0 and median pressure 18 cm H,0, maximum pressure in the
efferent limb was 72 cm H,0 and median pressure 45 cm H,0.
Conclusions: The principle of an efferent limb according to the
Indiana pouch was used. The ileocecal valve, a tapered efferent
ileum, an inverted and narrowed ICV and the isoperisaltic
bowel movement in the terminal ileum all add to a continent and
reliable stoma. Long durability of the catheterizable ileum, few
complications with stenosis at the umbilicus-ileal anastomosis
and a low pressure reservoir lead to high patient satisfaction
also in the long run.
33 Urostomy and quality of life in patients with lower
urinary tract dysfunction
A Schultz1, B Boye1,0 Jonsson2, P Thind3, W Mánsson4
1Rikslwspitalet, Oslo, Norway, 2Sahlgrenska University Hospital, Coteborg,
Sweden, 3Rigshospitalet, Copenhagen, Denmark, 4Lund University Hospital,
Sweden
alexander.schultz@rikshospitalet.no
Aim of investigation: To evaluate whether urostomy improves
quality of life in patients with disabling lower urinary tract
dysfunction and the cost of surgery in terms of complications
and hospital stay.
Material and methods: Fifty two consecutive patients
undergoing urinary diversion were included in a prospective
study. The patients completed the generic quality of life
instrument WHOQOL-BREF, and a bladder/urostomy specific
quality of life instrument preoperatively, and 6 and 12 months
after surgery. Complications and hospital stay were registered.
Results: There was no mortality related to the surgery. The
patients improved in all domains but social relationship on the
generic quality of life instrument (p<0.05) and in all domains on
the disease specific quality of life instrument (p<0.0005) from
baseline to 12 months follow up.
The improvement was reported during the first 6 months, with
no further improvement thereafter.
For the question on future perspective, improvement from
5.2 to 1.4 (1 indicating „satisfaction" and 7 indicating „worst
possible") was seen. Hospital stay was 14 days. Early and late
complications required open surgery in 12 patients (23%). Out
of 41 patients who had GFR determination both preoperatively
and a year after surgery, 3 had reduction in GFR of >25%.
Conclusion: Urostomy improves both general and disease
specific quality of life in patients with disabling lower urinary
tract dysfunction. However, the risk of complications is not
negligible.
34 Extended lymph node dissection in patients
with urothelial carcinoma of the bladder: Can it make a
difference?
T Davidsson* 1, M Holmer1, P-O Bendahl2, S Gudjonsson1, W Mánsson1, F
Liedberg3'
’Department of Urology and 2Department ofOncology, Lund University
Hospital, Lund, 3Departmcnt ofUrology, Vcixjö County Hospital, Viixjö, Sweden
thomas.davidsson@skane.se
Aim: Extended and limited lymph node dissections, performed
during radical cystectomy, were analyzed, with regard to impact
on survival and time to recurrence in bladder cancer patients.
Methods: 170 patients who underwent radical cystectomy for
urothelial carcinoma between January 1997 and December 2005
were analyzed. 69 of the patients were subjected to limited
lymph node dissection and 101 patients underwent extended
lymph dissection.
Results: Pathological pT3 and pT4a tumors were more common
in the extended (48%) than in the limited dissection group
(33%). The median numbers of lymph nodes removed were 37
and 8. Lymph node metastases were found in 38% and 17%,
respectively. No differences in survival or time to recurrence
were found between the groups. However, in a multivariate
analysis adjusting for tumor stage, lymph node status, age, sex,
and adjuvant chemotherapy there was an improved survival
(HR 0.47, 95% CI 0.25-0.88; p = 0.018) and time to recurrence
(HR 0.42, 95% CI 0.23-0.79; p = 0.007) in the patients with
extended lymph node dissections. Subgroup analyses showed a
longer time to recurrence (HR 0.45, 95% CI 0.22-0.93; p = 0.032)
in patients with non-organ-confined disease who underwent
extended lymph node dissection.
Conclusions: Extended lymph node dissection was related
to improved disease-specific survival and prolonged time to
recurrence in radical cystectomy patients. These results should
20 LÆKNAblaðið 2009/95