title: Oncological and functional outcome of radical cystectomy in patients with bladder cancer and obstructive uropathy.
abstract: OBJECTIVE
  We present our experience with the perioperative, functional and oncological outcomes of radical cystectomy in patients with bladder cancer and obstructive uremia.
  
  
  METHODS
  From 1998 to June 2006, 58 patients with bladder cancer, and concomitant obstructive uropathy and azotemia presented to our institution. Mean +/- SD serum creatinine at presentation was 9.2 +/- 4.5 mg% (range 2.4 to 16.5). Radical cystectomy, bilateral pelvic lymphadenectomy and urinary diversion were performed after stabilizing renal function with and without percutaneous nephrostomy in 28 and 8 patients, respectively. Various preoperative variables were evaluated for predicting long-term treatment failure and renal deterioration. Mean followup was 34 months.
  
  
  RESULTS
  Mean serum creatinine at surgery was 1.85 mg%. An ileal conduit was used in 32 patients and cutaneous ureterostomy was used in 4. One patient died of chest infection in the perioperative period. All patients had muscle invasive disease, while 15 had positive lymph nodes. At the mean followup 15 patients (41.6%) were free of disease and 21 had treatment failure. Of the factors evaluated pathological tumor stage, grade and lymph node involvement predicted the long-term oncological outcome, while serum creatinine greater than 2.5 mg% at surgery and ileal conduit diversion predicted long-term renal deterioration.
  
  
  CONCLUSIONS
  Patients with bladder cancer who have obstructive uremia usually present with locally advanced disease. Radical cystectomy is not associated with additional morbidity, provided that patients are adequately prepared before surgery by optimizing renal function. An adequate number of these patients achieve long-term disease-free survival after radical cystectomy. As the urinary diversion of choice, an ileal conduit appears to be safe in patients with serum creatinine less than 2.5 mg% at surgery.
authors: Department of Urology, All India Institute of Medical Sciences, New Delhi, India. narmadagupta@hotmail.com
authors: Narmada P
authors: NP
authors: Gupta
authors: Surendra B
authors: SB
authors: Kolla
authors: A
authors: A
authors: Seth
authors: Ashok K
authors: AK
authors: Hemal
authors: Prem N
authors: PN
authors: Dogra
authors: R
authors: R
authors: Kumar
mesh_terms: D000328:Adult; D000368:Aged; D000465:Algorithms; D002295:Carcinoma, Transitional Cell / Q000473:pathology / Q000601:surgery*; D003404:Creatinine / Q000097:blood; D015653:Cystectomy; D018450:Disease Progression; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008197:Lymph Node Excision; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness / Q000473:pathology; D009367:Neoplasm Staging; D009403:Nephrostomy, Percutaneous; D011379:Prognosis; D012307:Risk Factors; D014511:Uremia / Q000473:pathology / Q000601:surgery; D014517:Ureteral Obstruction / Q000473:pathology / Q000601:surgery; D014519:Ureterostomy; D001743:Urinary Bladder / Q000473:pathology; D001749:Urinary Bladder Neoplasms / Q000473:pathology / Q000601:surgery*; D014547:Urinary Diversion
chemical_list: D003404:Creatinine