Radical cystectomy in eldery.

BACKGROUND/AIM: Radical cystectomy is the method of choice for the treatment of muscle invasive bladder cancer. This major surgery is associated with many complications, especially in older patients. The aim of this study was to analyze preoperative comorbidity, and intraoperative and postoperative complicatons in patients older than 75 years. METHODS: This clinical, retrospective study included 46 patients over 75 years, who underwent radical cystectomy. Indications for surgery, and complications during and after the surgery were followed up. RESULTS: Preoperatively, anemia caused by hematuria was registered in 76% of the patients. In 52% of the patients urine derivation was performed by ileal conduit, in 35% by ureterocutaneostomy and in 13% orthotopic ileal neobladder was created. The average duration of surgery was 190 (120-300) min. A total of 76% of the patients were treated by blood supstitution intraoperatively, average 630 (310-1230) mL. Concerning pathological stage of transitional cell carcinoma of urinary bladder, 26% of the patients had T2, 4% T3a, 52% T3b, and 14% T4a stage. In one case, planocellular carcinoma was diagnosed by patohistological examination, and in 2 cases prostate carcinoma was incidentally found. The average duration of hospitalization was 16 (8-35) days. CONCLUSION: The main reason for cystectomy in patients over 70-and 80 years was gross hematuria caused by bladder cancer, with consecutive anemia which could not be solved using endoscopic treat- ment or blood supstitution. As expected, a prolonged stay in hospital after cystectomy, and a higher rate of complications were recorded in this population.

Living unrelated donor kidney transplantation--a fourteen-year experience.

BACKGROUND: In countries without a national organization for retrieval and distribution of organs of the deceased donors, problem of organ shortage is still not resolved. In order to increase the number of kidney transplantations we started with the program of living unrelated - spousal donors. The aim of this study was to compare treatment outcome and renal graft function in patients receiving the graft from spousal and those receiving ghe graft from living related donors. METHOD: We retrospectively identified 14 patients who received renal allograft from spousal donors between 1996 and 2009 (group I). The control group consisted of 14 patients who got graft from related donor retrieved from the database and matched than with respect to sex, age, kidney disease, immunological and viral pretransplant status, the initial method of the end stage renal disease treatment and ABO compatibility. In the follow-up period of 41 +/- 38 months we recorded immunosuppressive therapy, surgical complications, episodes of acute rejection, CMV infection and graft function, assessed by serum creatinine levels at the beginning and in the end of the follow-up period. All patients had pretransplant negative cross-match. In ABO incompatible patients pretransplant isoagglutinine titer was zero. RESULTS: The patients with a spousal donor had worse HLA matching. There were no significant differences between the groups in surgical, infective, immunological complications and graft function. Two patients from the group I returned to hemodialysis after 82 and 22 months due to serious comorbidities. CONCLUSION: In spite of the worse HLA matching, graft survival and function of renal grafts from spousal donors were as good as those retrieved from related donors.

[On 10-year experience in the use of direct and antireflux techniques of anastomosis of ureter and orthotopic intestinal neobladder after radical cystectomy].

BACKGROUND/AIM: Today, radical cystectomy is the method of choice in treatment of muscle invasive bladder carcinoma in stage T2-T4a, No-Nx, Mo, and orthotopic derivation is for patients the most comfortable derivation of urin. From 1888 when Tizzoni and Foggi performed the first orthotopic derivation on animals, and 1913 when Lemoin declared the first orthotopic derivation in humans there has been a constant improvement and modification of orthotopic urinary diversion after radical cystectomy which significantly decrease the number and severity of postoperative complications. The aim of this study was to compare complications regarding the direct and antireflux ureter-neobladder anastomosis. METHODS: This retrospective study included 79 selected patients operated over the last ten years having medical records available. Previously, we excluded the patients with prior radiation therapy, systemic illness, diabetes mellitus, previous history of calculosis and metabolic disorders etc. Hautmann orthotopic technique was used in almost 70% of the patients. We analyzed complications regarding direct and antireflux ureter-neobladder anastomosis with a median follow-up period of 4.72 years. We followed-up the appearance of unilateral and bilateral hydronephrosis, forming of renal stones in the patients without previous history of renal calculosis, and renal insuficiency caused by stenosis on the site of anastomosis. We used the Kolmogorov Smirnov test, Mann-Whitney U test, Student's ttest i chi2 test for statistic analysis. RESULTS: The median age of the patients was 68.2 years. Totally 88.61% of the patients were male and 11.39% were female. The direct anastomotic technique secundum Wallace was used in 43.03% of the operated patients and antireflux technique secundum Le Duc in 56.97%s. Renal deterioration caused by stenosis on the site of the ureter-neobladder anastomosis was statistically significantly higher in the antireflux anastomosis compared to direct anastomosis (chi2= 4.71, p = 0.0299). No one of the patients with direct anastomosis had poucho-ureteral reflux higher grade than gr III. CONCLUSION: In our study, complication as renal deterioration as a result of stenosis on the site of the ureter anastomosis was significantly more common in the group of patients exposed to antireflux technique.