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Inicio Revista Colombiana de Cancerología Bolsa de Indiana en el tratamiento de tumores malignos de la pelvis y de sus sec...
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Vol. 14. Núm. 1.
Páginas 37-46 (Enero 2010)
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Vol. 14. Núm. 1.
Páginas 37-46 (Enero 2010)
DOI: 10.1016/S0123-9015(10)70113-X
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Bolsa de Indiana en el tratamiento de tumores malignos de la pelvis y de sus secuelas. Experiencia de 20 años en el Instituto Nacional de Cancerología
Indiana Pouch for the Treatment of Pelvic Tumors and their Aftermaths: A 20-Year Experience at the National Cancer Institute
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Ricardo López Gil1, Felipe Zamora2, Jorge Daniel Anzola2, César Lemos3, Nelson Rodríguez4
1 Clínica de Urología del Instituto Nacional de Cancerología, Bogotá, Colombia
2 Grupo de Investigación Clínica, Instituto Nacional de Cancerología, Bogotá, Colombia
3 Departamento de Urología, Universidad El Bosque, Bogotá, Colombia
4 Matemático. Bogotá, Colombia
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Resumen
Objetivo

Valorar la función renal y los efectos colaterales de la bolsa de Indiana como método quirúrgico.

Método

Reporte de serie de casos de 75 pacientes operados desde junio de 1987 hasta junio del 2008 con bolsa de Indiana.

Resultados

Los tumores incluyeron 36 cánceres de vejiga, 35 cánceres de útero, 2 melanomas vaginales, 1 cáncer de vulva y 1 osteoclastoma, La bolsa se usó en 35 cistectomías radicales y 14 exenteraciones pélvicas, y en 26 pacientes se hizo sin cirugía extirpativa tumoral. El 95% de pacientes mantuvo la función renal. Los electrolitos séricos permanecieron normales. La continencia completa se consiguió en 92% de los casos. La capacidad promedio del reservorio fue de 536,5 ml; 21 (25,8%) riñones sanos se perdieron al reimplantarse. Por otra parte, 22 (56,4%) riñones hidronefróticos llegaron a ser sanos. Complicaciones: temprana, 6,66%; tardía 46,0%. Reintervención: temprana, 8,0%; tardía 40,1%. Mortalidad perioperatoria 8,0%; mortalidad acumulativa, 45,30%. Supervivencia promedio: 30,7 meses.

Conclusiones

La bolsa de Indiana es una derivación urinaria útil cuando no es factible preservar la uretra. Presenta más complicaciones tardías que tempranas. La hidronefrosis, el daño parenquimatoso y la neocistolitiasis fueron frecuentes en esta serie, con 48% de pacientes irradiados.

Palabras clave:
derivación urinaria
reservorios urinarios continentes
hidronefrosis
Abstract
Objective

To evaluate the renal function and side effects of the Indiana pouch at the National Cancer Institute of Colombia.

Method

75 cases with history of Indiana Pouch reconstructive surgery were recruited from June 1987 to June, 2008.

Results

36 bladder; 35 uterine cancer; 1 vulvar cancer, vaginal cancer, 2 melanomas; and 1 osteoclastoma were included. The Indiana Pouch was used in 35 radical cystectomies, and 14 pelvic exenterations. In 26 cases, there was non-surgical tumor extirpation. 95% of patients continued with proper renal function and normal serum electrolytes. Complete continence was in 92% of cases. The average reservoir capacity was 536.5ml; 22 (24.7%) healthy kidneys were lost after re-implantation. In contrast, 22 (56.4%) hydro-nephronic kidneys became healthy. Early complications were present in 6.66% of cases; and late complications in 46.70%. Early re-intervention was observed in 8.0%; late, 40.1%. Perioperative mortality was 8.0%; cumulative mortality, 45.3%. The average survival was 30.7 months.

Conclusions

The Indiana Pouch is a useful urinary device when urethra preservation is not possible. Complications occur late rather than early. Hydronephrosis, parenchymatic damage and neo-cystolytiasis were frequent in this series, wherein 48% of patients were irradiated.

Key words:
Urinary diversion
colonic pouches
hydronephrosis
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Copyright © 2010. Instituto Nacional de Cancerología
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