#10. Bladder Tumour Methods of Urine Diversion After Cystectomy

Question 1

What is the Incidence of Bladder Cancer?

Answer 1

{Bladder Cancer = Carcinoma Vesicae Urinae}

• 6th Most Common Oncological Disease in Men
• 2nd Most Common for Urological Neoplasms
• Male : Female = 2.5 : 1
• Diagnosed AFTER 70 Years of Age

Question 2

What are the Risk Factors?

Answer 2

• Smoking = 2-4x
• Family History = 1.8x
• Exposure to Carcinoma = Aniline Dyes / Arsenic / Iron / Aluminium
• Chronic Inflammation of Bladder Mucosa = Bladder Stones / Drainage of Urine / Urethral Catheters / Schistiomiasis
• Drugs = Phenacetin / Cyclophosphamide

Question 3

What are the Histological Types of BC? Which one is the Most Common?

Answer 3

• Transitional Cell = 90% (MOST Common!)
• Squamous Cell = 1 - 7%
• Adenocarcinomas = 2%

Question 4

According to T Category, what are the Non Muscle Invasive Bladder Cancers?

Answer 4

• Tis
• Ta
• T1
• Muscle Invasive = T2 - T4

Question 5

What is the Most Important Symptom of Bladder Cancer?

Answer 5

Macroscopic Painless Haematuria

Question 6

What are the Methods of Diagnosis and which of them is considered the Gold Standard? Why?

Answer 6

• Identifying Causes of Haematuria
• Cytology Urine Test
• Cytoscopy w/ Biopsy = GOLD STANDARD!

Question 7

What Classifications are used to Determine Tumour Grading?

Answer 7

1) 1973 Classification
- Well-Differentiated
- Moderately-Differentiated
- Poorly Differentiated

2) 2004 Classification
- G1 / G2 Low Grade
- G2 / G3 High Grade

Question 8

Is a Low-Grade Tumour more Aggressive?

Answer 8

NO, because they’re WELL-DIFFERENTIATED

Question 9

What is the Therapeutic Approach for Non Muscle Invasive Bladder Cancer?

Answer 9

INTRAVESICAL THERAPY

1) Chemotherapy = Mitomycin / Epirubicin AFTER Transurethral Resection

2) BCG Vaccine = Calgevax

Question 10

Which Types of Intravesical Therapy can be Administered Immediately After Surgical Treatment?

Answer 10

Intravesical CHEMICAL Therapy can be administered immediately after Surgical Treatment

Question 11

In Male Radical Cystectomy, what is the Surgical Resection Scope?

Answer 11

REMOVAL OF:

• Bladder
• Prostate
• Seminal Vesicles
• Distal Ureters
• Regional Lymph Nodes

FEMALE
- Bladder
- Entire Urethra
- Adjacent Vagina
- Uterus
- Distal Ureters
- Regional Lymph Nodes

Question 12

What are the Urinary Diversion Methods after Radical Cystectomy?

Answer 12

1) INCONTINENT
- Nephrostomy
- Ureterocutaneostomy
- Bucker Operation

2) CONTINENT
- Implanting Ureter into Colon
- Orthotopic Bladder Replacement

Question 13

What are the Complications after Orthotopic Bladder Replacement?

Answer 13

• Urine Retention
• Infections
• Stone Formations