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Re: Defecation Disturbances After Cystectomy for Urinary Bladder Cancer
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BLADDER, PENIS AND URETHRAL CANCER, AND BASIC PRINCIPLES OF ONCOLOGY
a relatively high rate of radiation exposure. It appears that selective ureteral cytologies are necessary to evaluate patients with upper tract filling defects and to monitor those at high risk for upper tract tumors. David P. Wood, M.D.
This is a large multi-institutional study that attempted to assess the accuracy of urinary cytology to detect aggressive urothelial cancers in the upper tracts. Records of 326 patients who had undergone radical nephroureterectomy or distal ureterectomy without history of bladder cancer were reviewed, and urinary cytology was not predictive of either muscle invasive disease or high grade urothelial lesions. The authors conclude that markers other than cytology are needed to correlate better with grade and stage of upper tract lesions. Richard K. Babayan, M.D.
Re: Defecation Disturbances After Cystectomy for Urinary Bladder Cancer H. Thulin, U. Kreicbergs, E. Onelöv, C. Ahlstrand, M. Carringer, S. Holmäng, B. Ljungberg, P. U. Malmström, D. Robinsson, H. Wijkström, N. P. Wiklund, G. Steineck and L. Henningsohn Division of Clinical Cancer Epidemiology, Department of Oncology and Pathology, Karolinska Institutet, Karolinska University Hospital-Huddinge, Stockholm, Sweden BJU Int 2011; 108: 196 –203.
Objective: To describe and compare long-term defecation disturbances in patients who had undergone a cystectomy due to urinary bladder cancer with non-continent urostomies, continent reservoirs and orthotopic neobladder urinary diversions. Patients and Methods: During their follow-up we attempted to contact all men and women aged 30 – 80 years who had undergone cystectomy and urinary diversion at seven Swedish hospitals. During a qualitative phase we identified defecation disturbances as a distressful symptom and included this item in a study-specific questionnaire together with free-hand comments. The patients completed the questionnaire at home. Outcome variables were dichotomized and the results are presented as relative risks with 95% confidence interval. Results: The questionnaire was returned from 452 (92%) of 491 identified patients. Up to 30% reported problems with the physiological emptying process of stool (bowel movement, sensory rectal function, awareness of need for defecation, motoric rectal and anal function, straining ability). A sense of decreased straining capacity was reported by 20% of the men and women with non-continent urostomy and 14% and 8% of those with continent reservoirs and orthotopic neobladders, respectively. Conclusions: Of the cystectomized individuals 30% reported problems with the physiological emptying process of stool (bowel movement, sensory rectal function, awareness of need for defecation, motoric rectal and anal function, straining ability). Those wanting to improve the situation for bladder cancer survivors may consider communicating before surgery the possibility of stool-emptying problems, and asking about them after surgery. Editorial Comment: This multi-institutional study from Sweden retrospectively reviewed long-term defecation disturbances in patients who had undergone cystectomy for bladder cancer. The authors contacted patients and sent out a specific bowel emptying questionnaire, which was filled out by 92% of patients identified to have undergone cystectomy. The results demonstrated 30% reporting disturbances of bowel emptying following cystectomy. This report raises awareness of potential nonurological issues following cystectomy and urinary diversion that may affect patient satisfaction. The authors suggest that potential bowel issues be discussed with patients before cystectomy and urinary diversion. Richard K. Babayan, M.D.
BLADDER, PENIS AND URETHRAL CANCER, AND BASIC PRINCIPLES OF ONCOLOGY
a relatively high rate of radiation exposure. It appears that selective ureteral cytologies are necessary to evaluate patients with upper tract filling defects and to monitor those at high risk for upper tract tumors. David P. Wood, M.D.
This is a large multi-institutional study that attempted to assess the accuracy of urinary cytology to detect aggressive urothelial cancers in the upper tracts. Records of 326 patients who had undergone radical nephroureterectomy or distal ureterectomy without history of bladder cancer were reviewed, and urinary cytology was not predictive of either muscle invasive disease or high grade urothelial lesions. The authors conclude that markers other than cytology are needed to correlate better with grade and stage of upper tract lesions. Richard K. Babayan, M.D.
Re: Defecation Disturbances After Cystectomy for Urinary Bladder Cancer H. Thulin, U. Kreicbergs, E. Onelöv, C. Ahlstrand, M. Carringer, S. Holmäng, B. Ljungberg, P. U. Malmström, D. Robinsson, H. Wijkström, N. P. Wiklund, G. Steineck and L. Henningsohn Division of Clinical Cancer Epidemiology, Department of Oncology and Pathology, Karolinska Institutet, Karolinska University Hospital-Huddinge, Stockholm, Sweden BJU Int 2011; 108: 196 –203.
Objective: To describe and compare long-term defecation disturbances in patients who had undergone a cystectomy due to urinary bladder cancer with non-continent urostomies, continent reservoirs and orthotopic neobladder urinary diversions. Patients and Methods: During their follow-up we attempted to contact all men and women aged 30 – 80 years who had undergone cystectomy and urinary diversion at seven Swedish hospitals. During a qualitative phase we identified defecation disturbances as a distressful symptom and included this item in a study-specific questionnaire together with free-hand comments. The patients completed the questionnaire at home. Outcome variables were dichotomized and the results are presented as relative risks with 95% confidence interval. Results: The questionnaire was returned from 452 (92%) of 491 identified patients. Up to 30% reported problems with the physiological emptying process of stool (bowel movement, sensory rectal function, awareness of need for defecation, motoric rectal and anal function, straining ability). A sense of decreased straining capacity was reported by 20% of the men and women with non-continent urostomy and 14% and 8% of those with continent reservoirs and orthotopic neobladders, respectively. Conclusions: Of the cystectomized individuals 30% reported problems with the physiological emptying process of stool (bowel movement, sensory rectal function, awareness of need for defecation, motoric rectal and anal function, straining ability). Those wanting to improve the situation for bladder cancer survivors may consider communicating before surgery the possibility of stool-emptying problems, and asking about them after surgery. Editorial Comment: This multi-institutional study from Sweden retrospectively reviewed long-term defecation disturbances in patients who had undergone cystectomy for bladder cancer. The authors contacted patients and sent out a specific bowel emptying questionnaire, which was filled out by 92% of patients identified to have undergone cystectomy. The results demonstrated 30% reporting disturbances of bowel emptying following cystectomy. This report raises awareness of potential nonurological issues following cystectomy and urinary diversion that may affect patient satisfaction. The authors suggest that potential bowel issues be discussed with patients before cystectomy and urinary diversion. Richard K. Babayan, M.D.