Possibilities of urological reconstructive procedures of urine derivation after radical cystectomy due to malignant disease

Karcinom mokraćnog mjehura zauzeo je sedmo mjesto po učestalosti kod muškaraca, a deseto mjesto kada se u obzir uzmu oba spola. Najčešće se javlja u dobi od 50 do 80 godina, omjer pojave bolesti kod muškaraca je 3:1. Povezan je s okolišnim čimbenicima, čimbenicima rada i životnim navikama. Pušenje se smatra najvažnijim rizičnim čimbenikom odgovornim za nastanak karcinoma mjehura u čak 50% slučajeva. Najčešći razlog javljanja pacijenta liječniku je pojava krvi u urinu (hematurija). Ukoliko se dijagnosticira tumor najbolje rezultate u liječenju karcinoma postići ćemo multidisciplinarnim pristupom. Sve veće iskustvo urologa i sam napredak operacijskih tehnika te otkrivanje bolesti u ranijim stadijima, dovodi do poboljšane kvalitete života i produljenje životnog vijeka. Karcinom mokraćnog mjehura u zavisnosti o uznapredovalosti liječi se kirurški, kemoterapijom ili radioterapijom ili kombinacijom. Radikalna cistektomija osnova je kirurškog liječenja bolesnika s mišićnoinvazivnim karcinomom. Ona danas predstavlja zlatni standard liječenja invanzivnog karcinoma mokraćnog mjehura, ali kod određenog broja pacijenata mogu se predložiti i druge metode liječenja. Radikalna cistektomija obuhvaća uklanjanje mokraćnog mjehura, zdjeličnih limfnih čvorova te dijelove reproduktivnih organa (žene- prednji zid vagine, maternica, jajnici, jajovodi; muškarci- prostata, sjemeni mjehurići). Nakon uklanjanja mokraćnog mjehura derivacija mokraće može biti kontinentna ili inkontinentna. Kontinentna podrazumijeva ortotopični mjehur sačinjen od segmenta tankog crijeva, zatim Menz pouch I (pouch spojen na pupak koji se prazni intermitentnom kateterizacijom). Inkontinentne derivacije su ureterokutanoneostomija, ileal conduit (Bricker). Tijekom boravka u bolnici bitna je suradnja pacijenta i medicinskog osoblja kako bi se pacijent postoperativno dobro oporavio te prilikom otpusta savladao tehnike njege i promjene vrećice za stomu. Radikalna cistektomija opsežan je zahvat koji uvelike utječe na promjenu kvalitete života i promjenu tjelesnog izgleda pacijenta. Sve više se pridaje važnost zadovoljstvu bolesnika te se individualiziranje liječenja pojavilo kao primarni cilj rekonstrukcije.Blader malignant cancer disease ranked 7th in incidence in men, and 10th in terms of both sexes. It is most common at the age of 50-80 years, the didease incidence ratio in men 3:1. It is asociated with enviromental factors, work factors and life habits. Smoking is consider to be the most important risk factor for the development of bladder cancer in as much as 50 percent. Apperance of blood in the urine is the most common reason for patient to visit a doctor. If the disease is diagnosed, the best results in the treatment will be achived with a multidisciplinary approach. The growing experience of urologist and the progress of surgical tehniques leads to improved quality og life and longer life expectancy. Depending on the progression of the bladder cancer, it can be treated surgicaly, with chemotherapy, radiotherapy or with combination of both methods. Radical cystectomy is the basis of surgical treatment of patients with muscular invasive cancer. Radical cystectomy is the gold standard for the treatment of muscular invasive bladder cancer, but there are other treatments that may be suggested for a number of patients. Surgery includes removal of bladder, pelvic lymph noder and parts of reproductive organs (women- anterior wall of vagina, uterus, ovaries, men- prostate). Urine derivation may be continent or incontinent. Continent consider an orthopnoic bladder composed of a segment of a small intestine, Meinz pouch I. (pouch attached to the novel which is emptied by intermittent catheterization). Incontinent derivation are ureterocutaneus neostomy, ileal conduit (Bricker). During the stay in the hospital, the cooperation between medical staff and patient is very important in order for patient to recover well and to overcome the care and changes of urostomy when leaving the hospital. Radical cystectomy is an extensive procedure that greatly affects the changes in the quality of life and apperance of the patient. Patient's ´satisfaction is becoming incresingly important such as individualization of treatment. That has emerged as primary goal of reconstruction