Bladder cancer with obstructive uremia: oncologic outcome after definitive surgical management.
OBJECTIVE
To report the surgical and oncologic outcomes of patients with bladder cancer who present with obstructive uremia.


METHODS
A total of 61 patients presented to our institute with obstructive oliguria or anuria concomitant with bladder cancer. The mean serum creatinine at presentation was 11.4 +/- 5.1 mg%. After stabilization of kidney function following nephrostomy drainage, only 38 patients were eligible for radical cystectomy. Analysis of the intraoperative findings, early postoperative course, definitive histopathologic findings, and long-term functional and oncologic outcome was performed. The mean follow-up period was 16.2 +/- 8.1 months (range 8 to 134).


RESULTS
Radical cystectomy with bilateral iliac lymphadenectomy was feasible in 26 patients, palliative cystectomy in 10, and ileal conduit only without cystectomy in 2. The postoperative morbidity was minimal and treated conservatively. Bladder cancer causing uremia was invasive in 94.5%, and was pathologic Stage T4 in 30.5% of cases. At the mean follow-up, treatment failure was observed in 26 patients (68.4%), with only 12 patients living free of disease and a mean serum creatinine of 1.4 +/- 0.7 mg%. Although none of the preoperative variables proved to be predictive of the oncologic outcome, significant correlation was found between the tumor stage and grade, as well as lymph node involvement, and treatment failure.


CONCLUSIONS
Although bladder cancer causing obstructive uremia is almost always muscle invasive, with a large proportion of patients presenting with locally advanced disease, an adequate number of these patients could achieve long-term disease-free survival.
El-Tabey
Nasr A
NA
Urology and Nephrology Center, Mansoura University, Mansoura, Egypt.
Osman
Yasser
Y
Mosbah
Ahmed
A
Mohsen
Tarek
T
Abol-Enein
Hassan
H
D000328:Adult; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009846:Oliguria / Q000209:etiology / Q000601:surgery; D012189:Retrospective Studies; D014511:Uremia / Q000209:etiology / Q000601:surgery*; D001748:Urinary Bladder Neck Obstruction / Q000209:etiology / Q000601:surgery*; D001749:Urinary Bladder Neoplasms / Q000150:complications / Q000601:surgery*