الفهرس 
AcknowledgmentOnly 14 pages are availabe for public view
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Abstract
Bladder cancer is the most common malignancy of the urinary tract and accounts for about 3.2% of all cancer worldwide where it remains the seventh most commonly diagnosed malignancy in the male population.
Radical cystectomy with pelvic lymph node dissection with appropriate urinary diversion remains the mainstay of surgical treatment for muscle invasive bladder cancer and for high risk non-muscle invasive disease. Urinary diversion is a complex surgery which has an impact on different aspects of health-related quality of life including physical, psychosocial, sexual, day-life activities and distress related to the body image.
Although ileal conduit is considered the standard method for incontinent urinary diversion, unilateral cutaneous ureterostomy with separate stomas may represent a good alternative to ileal conduit in poor communities where specialized medical care is not widespread available without significantly affecting quality of life and long-term outcomes. We conducted this study to test this assumption.
The aim of our study was comparing the outcomes and quality of life between patients underwent radical cystectomy with ileal conduit and those underwent radical cystectomy with unilateral cutaneous ureterostomy with separate stomas at Assiut university hospital.
We examined prospectively a cohort of bladder cancer patients (32 patients) who underwent radical cystectomy, and according to type of urinary diversion, they were divided into two groups (16 patients in each group),
group A is unilateral cutaneous ureterostomy with separate stomas and group B is ileal conduit. The type of urinary diversion was left to the surgeon preference and intraoperative circumstances.
Regarding the demographics, preoperative data and medical co-morbidities of the patients, no difference was found between the two groups.
Also, there was no significant difference between the two groups regarding the total operative time, estimated blood loss, number of transfused blood units and perioperative complications.
Although the total operative time was nearly equal between the two groups, the shunt time was longer in group B in comparison to group A and was statistically significant (p-value <0.001).
Regarding the rate of febrile urinary tract infection, we found that there was statistically significant difference between the two groups (p-value 0.017) with higher rates in the cutaneous ureterostomy group. However, there was no significant difference between the two groups regarding the renal function.
Before six months follow up, seven patients experienced high grade complications; six of them died, and these seven patients were excluded from further analysis. from the remaining 25 survived patients, 14 patients belong to group B and 11 patients belong to group A.
from ileal conduit group, six patients showed ureteroenteric stricture with median time to detect 12 months. Most of these patients presented either by infected hydronephrosis or oliguria and raised serum creatinine or both. The initial management was percutaneous nephrostomy tube insertion as an emergency.
Using the FACT-BL questionnaire, we found that the quality of life was better in the group of ileal conduit with a statistically significant difference (p-value 0.025). The median total score was 78 (56-103) in ileal conduit compared to 65.5 (52-92) in unilateral cutaneous ureterostomy.
Finally, we can summarize that selection of the best type of urinary diversion for each patient is still a controversial topic considering that many patients in the ileal conduit group underwent multiple surgical re-interventions due to sudden rise in the serum creatinine that mostly resulted from lack of medical care and irregular follow up as usually seen in most developing countries. So, we can claim that unilateral cutaneous ureterostomy with separate stomas may represent a good alternative to ileal conduit in such communities.