CODE: 8.4 - Late metastases in postoperative scar after partial cystectomy due to bladder cancer
Article published in Urologia Polska 2006/59/Suplement 1.

authors

Jacek Przybyła, Paweł Wędzikowski, Marek Sosnowski

I Klinika Urologii UM w Łodzi

summary

Introduction. Massive bleeding from urinary bladder seldom requires surgical intervention. Apart from bladder injury, prostatic or bladder neoplasms are the most frequent causes of haemorrhage.

Objectives. The aim of the study is to demonstrate follow-up complications after partial cystectomy due to haemorrhage from a bladder cancer.

Materials and methods. Two patients are presented, who were subjected to partial cystectomy due to bladder tumour and massive haemorrhage which were ineffectively managed conservatively or by transurethral resection out of our Department. In the further course of the disease there were several recurrences of bladder cancer with progression from pT1G1 to pT1G2. Transurethral electroresection and BCG bladder instillation were introduced into the treatment. In the first patient 14 years and in the second 16 years after the primary procedure, a tumour was diagnosed clinically in abdominal integument in the postoperative scar after partial resection. Abdominal CT was performed in both patients and the pathological alterations were confirmed. The patients did not give their consent to suggested cystectomy. Tumour resection was performed with simultaneous hernia mesh implantation. The patients were subjected to systemic chemotherapy.

Results. Transitional cell carcinoma was diagnosed on histopathological examination. Six months after the surgery, neither local recurrence nor postoperative complications were found.

Conclusions. Partial cystectomy due to bladder cancer is a therapeutic method which is less and less often applied because of frequent recurrences and high risk of cancer cells implantation into the wound. Then, the patient is devoid of the chance of full recovery from a malignant disease. Both forms of bladder cancer: superficial and invasive have the risk of cancer cells implantation into the scar if partial cystectomy is applied. Pathological alterations may appear in the scar even after several years.