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Hassan Farsi, Anmar Nassir , Hesham Saada, Rami Salawi

Radical Cystectomy and Orthotopic Ileal W- Neobladder : Functional Results and Early Experience. Hassan Farsi, Anmar Nassir , Hesham Saada, Rami Salawi . Bladder caner. 63,210 new cases Male to female 3:1 All cancer cases Men 4 th common cancer 6.6% Women

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Hassan Farsi, Anmar Nassir , Hesham Saada, Rami Salawi

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  1. Radical Cystectomyand OrthotopicIleal W- Neobladder : Functional Results and Early Experience Hassan Farsi, Anmar Nassir, Hesham Saada, Rami Salawi

  2. Bladder caner • 63,210 new cases • Male to female 3:1 • All cancer cases • Men • 4th common cancer 6.6% • Women • 9thcommon cancer 2.4% % • Age • middle-aged and elderly people.

  3. Bladder Cancer - Pathology • TCC • >90% • SCC • 5-7% • chronic irritation • stones, foleycatheter • Schistosomiasis] • ADENOCARCINOMA • 1-2% • urachal carcinoma, • cystitis glandularis • Rule out metastatic source. • STAGING • Superficial versus Infiltrating Tumor • Localized versus Locally Extensive or Metastatic

  4. INDICATIONS of RADICAL CYSTECTOMY • Muscle-invasive bladder cancer • Recurrent T1 disease or CIS unresponsive to intra-vesical chemotherapy • Palliative procedure when the symptoms of the disease are severe • Severe hematuria • Severe frequency

  5. Indications of Urinary Diversion • Dangerous bladder • Bladder cancer • Pelvic Malignancy • Useless bladder • Neurogenic • Contracted (T.B,B.Irrad) • Vesicle fistula • Absent bladder • Congenital anomalies (Ectopia) Abol-enein,H 2000

  6. Goals of Continent Urinary Diversion • Construction of a complaint reservoir Detubularisation and Double folding • Protection of the upper tracts • Controlled reservoir emptying (continence) Abol-enein,H 2000

  7. Ideal Orthotopic Bladder Substitute • Technical simplicity • Constructed from a minimal bowel length • Complaint • Protects the upper tract. • Continent. • Minimal metabolic and nutritional consequences Abol-enein,H 2000

  8. REFLUXING OR ANTIREFLUXING ANASTOMOSIS • Considerable controversy • Potential advantage of anti reflux as long as it does not add a risk of obstruction. • Ghoneim, 2002 • No Explicit evidence of its necessity • Anti refluxing Uretero-intestinal anastomosis in low pressure high capacity reservoir is unnecessary. • Prospective controlled randomized study is required • Pantuk,2000 & Hohnfeller,2002

  9. Aim of The Work To assess our experience and results of patients undergoing: Radical Cystectomy and Orthotopic Neobladder Reconstruction

  10. MATERIALES & METHODS

  11. Patient

  12. Method

  13. Patient selection (Exclusion criteria)

  14. Radical Cystectomy & W-Neobladder. SLEMT 5cm two long chimney with direct anastomosis Radical Cystectomy & W-Neobladder.

  15. Post Operative Evaluation • Histopathologcal examination of the Cystectomy specimens • Follow up evaluation on regular intervals • Renal profiles • CBC • UA and Cx • U/S and /or IVU • Pouchogram • when indicated • CT • Bone scan • Endoscopy • AUG

  16. RESULTS

  17. TUMOR CHARACTERISTICS(HISTOPATHOLOGY RESULTS)

  18. Age Distribution

  19. Early Complications

  20. Renal and electrolytes profiles Anti Reflux Refluxing

  21. Continence Status

  22. Voiding pattern

  23. Late Complications

  24. Radiographic Evaluation

  25. Preoperative Bladder tumour

  26. I V U

  27. Pouchogrphy+VCUGSLEMT

  28. Pouchogrphy + VCUG + IVU 5cm Two Long Chimney With Direct Anastomosis

  29. Early Post Op Urethroileal Leakage 2 wk More Foleys catheter drainage 3 wk post operative

  30. Early Post OpBroken Unrecognized External Ureteral Stent SLEMT EASY CYSTOSCOPY+ STENT REMOVAL EASY LOCALIZATION OF BOTH URETERAL ORIFICE

  31. Early Post OpBroken External Ureteral Stent 5cm Two Long Chimney With Direct Anastomosis Antegrade insertion of Guide wire then Cystoscopy and URS and removal of DJ Stent

  32. Uretero-Ileal AnastomosisStricture

  33. Reflux 5cm two long chimney with direct anastomosis

  34. Conclusions • Radical Cystectomy, followed by the construction of orthotopic W-shaped ilealNeobladder results in a near-normal-functioning orthotopic reservoir that can be safely offered to Suitable patients. • Well designed Prospective controlled randomized study regarding refluxing and anti-refluxing anastomosisis required.

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