الفهرس 
Acknowledgement
Treatment of Bladder CancerOnly 14 pages are availabe for public view
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Abstract
• Radical cystectomy is still accompanied by high and significant complication rates on either the early or long terms. Some of these complications may be life threatening.
• Patients’ age, tumor type & stage, number of excised lymph nodes, degree of lymph node involvement or type of urinary diversion had no significant difference regarding morbidity and mortality.
• Although many techniques of urinary diversion exist, no one technique is considered superior, since each type of diversion may have some peculiar advantages but it still has its inherited disadvantages. Thus, each type of diversion should be individualized.
Recommendations
Based on the statistically significant results of the current study and review of literature, we recommend the following :
1. Selection of patients candidate for radical cystectomy should be careful and cautious in order to gain the maximum benefit out of this very major surgery.
2. Radical cystectomy is still valid for elderly patients harboring MIBC so long they are fit for surgery.
3. Long term follow up for patients after radical cystectomy is a must for early detection of complications and/or tumor recurrence.
4. Bladder cancer still represents an actual challenge for both surgeons and patients. Hence, researches should continue aiming at obtaining better and properly innovative treatment options.
Summary
Summary
Bladder cancer (BCa) is the second most prevalent genitourinary malignancy. It accounts for 3% of all malignancies and it stands behind 2.1% of all cancer deaths. BCa is treated according to histopathological state of tumor. Radical cystectomy (RC) is the gold standard treatment of muscle invasive bladder cancer (MIBC) or high risk non-muscle invasive bladder cancer (NMIBC).
Urinary diversion after RC is a must to reroute urine flow from its normal pathway. There are several techniques to divert urine including ileal neobladder, continent cutaneous reservoir, ureterosigmoidostomy, ileal conduit and cutaneous ureterostomy.
Despite the major improvement in surgical technique and perioperative care, RC remains a major operative procedure with a significant morbidity and mortality. Complications after radical cystectomy can be divided into early (within the first 90 days) and late (after 90 days). Implementation of enhanced recovery after surgery (ERAS) protocol can decrease perioperative complications and shorten length of stay.
This case series study was carried out encompassing post RC patients who presented to Assiut Urology and Nephrology University Hospital with complications or for mere follow up. The primary outcome was to assess the postoperative complications.
Ultimately, the current study enrolled 60 patients were from 60 patients.
According to the modified Clavian Dindo classification, a total of fifty four (90%) patients developed complications of which high-grade (3-5) complications occurred in 25 (41%) patients. Six (10%) patients died within the first 90 days postoperatively and the overall mortality rate was 23.3% (14 patients). The disease recurred in 14 (23.3%) patients; the lung was the most common site of recurrence followed by the pelvic lymph nodes. Thromboembolism was more prominent in patients with ileal neobladder. Otherwise, there was no significant statistical difference among patients with different types of diversion regarding complications, recurrence or death. Many variables didn’t affect morbidity, recurrence or mortality rates including the age, number of retrieved lymph nodes, lymph node tumor involvement and histopathological stage of tumor.
So candidates of radical cystectomy must be carefully selected regardless of their age. and long term follow up after radical cystectomy to early discover recurrence and complications is a must.