Contemporary cystectomy with continent diversion for muscle invasive disease provides minimal morbidity, offers good locoregional disease control and results in acceptable quality of life. The presence of positive regional lymph nodes is not a contraindication to this therapy.

Contemporary cystectomy can be performed with minimal mortality. Radical cystectomy for organ confined disease is followed by good therapeutic results and enhances the possibilities for functional restoration. With stage progression there is a stepwise reduction in survival probability. The radical operation can provide disease-free survival for an important subgroup of node positive cases (27.3%). Additional therapy is needed to improve the oncological outcome for advanced locoregional disease.

Objective To compare single-dose and multiple instilthe patients treated with epirubicin than in the control group (24, 25 and 52%, respectively; P<0.001). In lations of epirubicin in the chemoprophylaxis of superficial bladder tumours.those receiving epirubicin, the rates of recurrence were statistically comparable (P=0.9). Patients who had a Patients and methods In a prospective randomized and controlled study, 168 evaluable patients were large tumour burden showed slightly lower recurrence rates with single-dose epirubicin than with delayed assigned to three groups after transurethral resection of bladder tumour (TURBT) and histological confirmaintenance therapy but the diÂerence was statistically insignificant. Patients with a history of bladder mation of its superficial nature (pTa and pT1). The groups were comparable for tumour stage, grade and tumours before treatment had lower recurrence rates with maintenance treatment than with a single dose other tumour characteristics. In group 1, patients received a single dose of 50 mg epirubicin in 50 mL (34.6 and 22.6% in groups 1 and 2, respectively); again this diÂerence was statistically insignificant. normal saline immediately after TURBT; group 2 received 50 mg epirubicin in 50 mL normal saline Patients with grade 3 tumours showed a marginal diÂerence in favour of maintenance therapy. The rates 1-2 weeks after TURBT and the instillations were repeated for 8 weeks and thereafter monthly to of progression amongst the three groups were 5.5, 3.4 and 9.3%, respectively, with no significant diÂer-complete one year of treatment; group 3 (control group) received no adjuvant therapy after TURBT.ences. The overall toxicity rates were comparable in the two treated groups (22 and 25%). The patients were assessed by cysto-urethroscopy, urine cytology and DNA flow cytometry 8 weeks Conclusion With the possible exception of grade 3 tumours, single-dose immediate epirubicin is as eÂec-after resection and then every 3 months during the first 2 years and 6 monthly thereafter during the tive as delayed maintenance therapy, with the advantage of being more cost-eÂective. next 2 years. Intravenous urography was performed annually and when otherwise indicated.

Early and late complications develop in a significant number of patients. Most early complications may be treated conservatively, while late complications are mostly treated with endourological and/or open surgery. Close lifelong surveillance of patients is mandatory to detect and properly treat these complications.

The cystometric parameters significantly associated with nocturnal enuresis in patients with an orthotopic reservoir are post-void residual urine volume, frequency and maximum amplitude of uninhibited contractions. Urethral pressure and flow parameters did not sustain significance on multivariate analysis.

A prospective randomized clinical trial was done for 92 patients with carcinoma of the bilharzial bladder who underwent radical cystectomy alone or with 2,000 rad preoperative radiation. The postoperative mortality and morbidity were similar in both groups. Patients were followed for a minimum of 60 months. Over-all, there was a marginal, statistically insignificant improvement in survival among patients receiving preoperative radiotherapy. Nevertheless, 2 subpopulations demonstrated significant improvement in survival following preoperative radiation, that is patients with high stage (P3 and P4) and high grade tumors.

Continent diversion with the modified rectal bladder was done in 83 patients and 65 are currently evaluable with followup ranging from 6 to 36 months. There was no postoperative mortality and the morbidity rate was acceptable. Renal function and configuration were maintained in most patients (91%). Dessusception of the colorectal valve was observed in 7.6% of the patients. Evidence was provided that this valve is effective in prevention of regurgitation of the rectal contents to the proximal colon. All patients were continent during the day. Enuresis was noted in 6 patients and all of them responded to imipramine hydrochloride therapy. The results support earlier observations that the procedure offers distinct advantages over ureterosigmoidostomy and the simple rectal bladder.

This study demonstrates that epirubicin has better efficacy and lower toxicity than doxorubicin when used as an intravesical agent.