Pathological review of internal genitalia after anterior exenteration for bladder cancer in women. Evaluating risk factors for female organ involvement.

To evaluate cancer involvement of internal female genitalia of patients undergoing anterior exenteration for clinically organ confined transitional cell carcinoma of the bladder, and identify potential preoperative risk factors. Charts and anterior exenteration specimens from 54 women with clinically organ confined transitional cell bladder cancer were retrospectively reviewed. Emphasis was given to the presence of internal genitalia involvement and or primary gynecologic pathology. Unsuspected internal genitalia involvement was reported in only three patients (5.7%). The vagina was involved in two cases (3.8%) while the uterus in one (1.9%). In all cases involvement was due to direst extension from bladder tumors of the base and dome respectively. No preoperative variable could predict internal genitalia involvement in a statistical significant manner. Benign pathology of the female reproductive organs was observed in six patients and involved in all cases the uterus (11.5%). Internal genitalia involvement after radical cystectomy for TCC tumors of the bladder is rare (5.8%). Preoperative risk factors could not be identified although all involved genitalia were seen in tumors of the bladder dome and base. Therefore large multi-institutional studies are needed in order to identify preoperative risk factors for internal genitalia involvement in females with bladder cancer.

Ultrasound-guided percutaneous nephrostomy performed by urologists: 10-year experience.

OBJECTIVES: To assess the safety, feasibility, and effectiveness of percutaneous nephrostomy tube (PNT) insertion performed solely by a urologist on an outpatient basis. We present our relevant 10-year experience. METHODS: From 1996 to 2005, 650 PNT insertions were performed in 530 patients (356 men and 174 women), aged 39 to 94 years (mean 67.4). All patients were referred to our outpatient department. PNT placement was performed under local anesthesia by a consultant urologist or registrar during regular work hours or during on-call duty. Early complications within 30 days of PNT insertion were recorded. RESULTS: Primary successful PNT insertion was recorded in 615 (94.6%) of the 650 procedures. Follow-up data up to 30 days were available for 545 PNT placements (83.8%). Of the 650 PNT insertions, 22 (3.3%) major immediate complications were encountered. In 4 patients, laparotomy was performed for surgical exploration of hemorrhage (3 patients) or choleperitoneum, resulting in nephrectomy (1 patient). In 5 (0.8%) of 615 successful PNT procedures, we recorded septicemia, which resulted in 2 deaths. In 1 more case (0.1%), the nephrostomy tube was misplaced into the inferior vena cava. Minor complications within the follow-up period were recorded in 24 (4.5%) of 545 cases. The complication rate did not differ significantly between the consultants and registrars or whether PNT insertion was performed during regular work hours or during on-call duty. CONCLUSIONS: Ultrasound-guided PNT insertion performed solely by a urologist is a safe, feasible, and efficient procedure, regardless of the operator's experience.