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Experimental and Therapeutic Medicine Oct 2021This study was designed with an aim to share our experience of primary pelvic exenterations. The study included 23 patients with different types of pelvic cancer...
This study was designed with an aim to share our experience of primary pelvic exenterations. The study included 23 patients with different types of pelvic cancer enrolled at a single institution between November 2011 and July 2020. The patient mean age was 55 years (range, 43-72 years) and the oncological indications included: Stage IVa cervical cancer (11 cases, 48.9%), stage IVa endometrial cancer (1 case, 4.3%), stage IVa vaginal cancer (6 cases, 26%), stage IIIb bladder cancer (3 cases, 13%), stage IIIc rectal cancer (1 case, 4.3%) and undifferentiated pelvic sarcoma (1 case, 4.3%). Total, anterior, and posterior pelvic exenterations were performed on 34.4, 56.5 and 13% of cases, respectively. Related to levator ani muscle, 13 (56.5%) pelvic exenterations were supralevatorian, 10 (43.5%) infralevatorian, and 5 (21.7%) were infralevatorian with vulvectomy. No major intraoperative complications occurred. Seven patients (30.5%) developed early complications, 4 of them (17.4%) required reoperation and 1 (4.3%) perioperative death caused by a pulmonary embolism was recorded. Only 1 patient experienced a late complication, a urostomy stenosis. Over a median follow-up period of 35 months, 8 (34.8%) patients died. The median overall survival (OS) was 33 months (range, 1-96 months). The 2-year and 5-year survival rates were 72 and 66%, respectively. Primary pelvic exenteration may be related with various postoperative complications, without high perioperative morality and with long-term survival.
PubMed: 34434274
DOI: 10.3892/etm.2021.10494 -
International Journal of Surgery Case... Nov 2021Bladder exstrophy is a rare congenital anomaly while, bladder adenocarcinoma mucinous type is a rare type of bladder cancer, with aggressive behavior and inadequate...
INTRODUCTION
Bladder exstrophy is a rare congenital anomaly while, bladder adenocarcinoma mucinous type is a rare type of bladder cancer, with aggressive behavior and inadequate response to radiation and chemotherapy. In extremely rare cases, untreated bladder exstrophy could transform into bladder mucinous adenocarcinoma.
CASE PRESENTATION
We report a case of a 41-year-old male with untreated bladder exstrophy that transformed into mucinous adenocarcinoma. The patient also had epispadias and a right inguinal hernia. Joint procedures were conducted to perform radical cystectomy, total penectomy and W-Pouch continent urostomy, inguinal hernia repair, osteotomy, and keystone and scrotal flap by split-thickness skin graft (STSG) for wound closure. The patient progressed well after surgery, two months after initial procedure, nephrostomies were conducted due to pouches stenosis. Due to the government's limited transportation and lockdown policy, as the Covid-19 pandemic occurred, the patient could not come to the hospital for routine follow-up and died nine-month after surgery.
CLINICAL DISCUSSION
Bladder exstrophy is one of the risk factors of bladder cancer. Transformation of bladder exstrophy into mucinous adenocarcinoma is extremely rare, as the case is the first case to be discovered in Indonesia. Surgery, followed with a strict follow-up regime, is mainstay of treatment in this type of malignancy.
CONCLUSION
Adenocarcinoma of mucinous type is a scarce type of bladder exstrophy malignancies. A multidiscipline approach is mandatory in these cases. Strict and regular follow up are suggested for these cases.
PubMed: 34717273
DOI: 10.1016/j.ijscr.2021.106493 -
Wound Management & Prevention Aug 2020An ileal conduit for urinary diversion after radical cystectomy is a common surgical procedure for muscle-invasive bladder cancer. Mucocutaneous separation, one of...
UNLABELLED
An ileal conduit for urinary diversion after radical cystectomy is a common surgical procedure for muscle-invasive bladder cancer. Mucocutaneous separation, one of several potential complications following surgery, can cause life-threatening sepsis and may have long-term consequences such as stomal stenosis or retraction. However, there are few reports describing the treatment of mucocutaneous separation.
PURPOSE
The purpose of this case study was to report the outcome of a team-based, integrated conservative treatment of a 46-year-old patient with a complex mucocutaneous separation.
CASE STUDY
Abdominal distension, fever, and progressive oliguria developed in the patient 6 days after radical cystectomy and ileal conduit surgery. Gastrointestinal decompression, parenteral nutrition, urinary diversion, and antibiotic therapy were initiated. Fifteen (15) days postoperatively, peristomal ulcers and mucocutaneous separation were observed. After 16 days of treatment with hydrocolloid powder, a silver-containing hydrofiber dressing, and meticulous pouching techniques, the wounds were healed. No additional peristomal lesions developed or surgical procedures were required for repairing the stoma, and no adverse reactions were seen.
CONCLUSION
Comprehensive treatment provided by an ostomy care team facilitated the recovery and healing of a patient who had a complicated mucocutaneous separation of his urostomy.
Topics: Cystectomy; Humans; Male; Middle Aged; Oliguria; Postoperative Complications; Urinary Diversion; Wound Healing
PubMed: 32732439
DOI: No ID Found