Bacillus Calmette-Guérin Perfusion Treatment via Cutaneous Ureterostomy for Carcinoma in Situ of the Upper Urinary Tract

Introduction: Bacillus Calmette-Guérin instillation is an established therapy for the treatment of carcinoma in situ of the upper urinary tract. Case Presentation: A 72-year-old woman underwent radical cystectomy with cutaneous ureterostomy for invasive bladder cancer with carcinoma in situ of both ureters. For the treatment of upper urinary tract carcinoma in situ, an infusion of 40 mg bacillus Calmette-Guérin through each ureterostomy was performed once weekly for 5 times. Urine cytology of the left upper urinary tract became negative, with a recurrence-free survival of 4 months. On the other hand, the right upper urinary tract became temporarily negative but turned positive after 3 months. Conclusion: Bacillus Calmette-Guérin perfusion therapy via cutaneous ureterostomy is considered as one of the useful therapies for carcinoma in situ of the upper urinary tract. Furthermore, there are several factors to be discussed, including the treatment duration, dosage and secondary therapeutic options.

The Application of Skin Expander in Subcontaneous Cystoplasty: A Novel Method to Solve the Dysfunction of Bladder

The patients of neurogenic bladder or radical cystectomy suffered much of the bladder dysfunction, leading mass wealth losses and misfortune of individual and society. We designed a new method to solve the problem: subcontaneous cystoplasty. Three skin expanders were buried around the abdominal ureter exit after cutaneous ureterostomy, then the inner skin bag were constructed by the expanded skin. The subcutaneous tunnel connected to the urine bag were pressed outside by belt to control the voiding. Skin urethra bulge, controlling the direction of the urination, located at the terminal of subcutaneous tunnel. Patients can put pressure to the subcontaneous urine bag to exhaust the urine. It may affect the appearance, but it can avoid many defects caused by ileocolic-cystoplasty, and may help neurogenic patients get ride of external urine bags.

The Application of Skin Expander in Subcontaneous Cystoplasty: A Novel Method to Solve the Dysfunction of Bladder

The patients of neurogenic bladder or radical cystectomy suffered much of the bladder dysfunction, leading mass wealth losses and misfortune of individual and society. We designed a new method to solve the problem: subcontaneous cystoplasty. Three skin expanders were buried around the abdominal ureter exit after cutaneous ureterostomy, then the inner skin bag were constructed by the expanded skin. The subcutaneous tunnel connected to the urine bag were pressed outside by belt to control the voiding. Skin urethra bulge, controlling the direction of the urination, located at the terminal of subcutaneous tunnel. Patients can put pressure to the subcontaneous urine bag to exhaust the urine. It may affect the appearance, but it can avoid many defects caused by ileocolic-cystoplasty, and may help neurogenic patients get ride of external urine bags.

Quality of Life and Renal Functional Status In Patients With Cutaneous Ureterostomy and Ileal Conduit Urinary Diversion after Radical Cystectomy

Introduction: Radical cystoprostetectomy in male patients and anterior pelvic exenteration in female patients coupled with en-block pelvic lymphadenectomy and urinary reconstruction or diversion remains the gold standard surgical approach to muscle invasive bladder cancer in the absence of metastatic disease. In Bangladesh, commonly performed urinary diversions are Cutaneous ureterostomy and Ileal conduit. Types of urinary diversion have a great impact on different aspects of quality of life (QoL) as well as post -operative renal function. Aims and Objectives: This study was designed to compare the Quality of Life and Renal Function in between Cutaneous ureterostomy and Ileal conduit urinary diversion after radical cystectomy. Methodology: This was a hospital based Quasi Experimental study in which patients were selected by purposive sampling and, conducted from July, 2017 to September, 2018 in the department of Urology Bangabandhu Sheikh Mujib Medical University. This study was performed among the patients with muscle invasive bladder cancer treated by radical cystectomy with cutaneous ureterostomy or Ileal conduit fulfilling the exclusion and inclusion criteria. Total 34 patients were taken for the study, among them 17 for cutaneous ureterostomy and, 17 for Ileal Conduit Group. Quality of Life was assessed through EORTC-QLQ-C30 questionnaire both pre and post operatively (3 months after operation). Renal function was assessed before and 1st POD, 7thPOD, one month and three months after operation by measuring eGFR. Result: Mean age of the patients was 59.00 ± 8.60 years and 53.35 ± 8.43years in group- A (Cutaneous ureterostomy) and group-B (Ileal conduit) respectively. Three months after operation, overall QoL in all scales were improved in both group but, more improvements were noted in group-B than group-A which were statistically significant (p<0.05). The mean pre-operative eGFR was significantly lower in group-A than group-B (p<0.001). Three months after operation, statistically significant differences in eGFR, were observed within, and in between two groups (p<0.05). Percentage of eGFR changed (renal function deterioration) were significantly more in group-A than group-B (p=0.001). Conclusion: Quality of life, after radical cystectomy with ileal conduit is better than cutaneous ureterostomy and, post- operative renal function deterioration significantly less in ileal conduit group than cutaneous ureterostomy group. So, ileal conduit is an appropriate option of urinary diversion for the patient those who permit prolong operative procedure. Bangladesh Journal of Urology, Vol. 23, No. 2, July 2020 p.142-150