ARTICLE INFO ______________________________________________________________ ______________________Introduction: To determine the parameters affecting the outcome of ureteroneocystostomy (UNC) procedure for vesicoureteral reflux (VUR). Materials and Methods:Data of 398 patients who underwent UNC procedure from 2001 to 2012 were analyzed retrospectively. Different UNC techniques were used according to laterality of reflux and ureteral orifice configuration. Effects of several parameters on outcome were examined. Disappearance of reflux on control VCUG or absence of any kind of UTI/symptoms in patients without control VCUG was considered as clinical improvement.Results: Mean age at operation was 59.2 ± 39.8 months and follow-up was 25.6 ± 23.3 months. Grade of VUR was 1-2, 3 and 4-5 in 17, 79, 302 patients, respectively. Male to female ratio was 163/235. UNC was performed bilaterally in 235 patients and intravesical approach was used in 373 patients. The frequency of voiding dysfunction, scar on preoperative DMSA, breakthrough infection and previous surgery was 28.4%, 70.7%, 49.3% and 22.4%, respectively. Twelve patients (8.9%) with postoperative contralateral reflux were excluded from the analysis. Overall clinical improvement rate for UNC was 92%. Gender, age at diagnosis and operation, laterality and grade of reflux, mode of presentation, breakthrough infections (BTI) under antibiotic prophylaxis, presence of voiding dysfunction and renal scar, and operation technique did not affect the surgical outcome. However, the clinical improvement rate was lower in patients with a history of previous endoscopic intervention (83.9% vs. 94%). Postoperative UTI rate was 27.2% and factors affecting the occurrence of postoperative UTI were previous failed endoscopic injection on univariate analysis and gender, preoperative BTI, postoperative VUR state, voiding dysfunction on multivariate analysis. Surgery related complication rate was 2% (8/398). These were all low grade complications (blood transfusion in 1, hematoma under incision in 3 and prolonged hospitalization secondary to UTI in 4 patients).In long term, 12 patients are under nephrologic follow-up because of hypertension in 5, increased serum creatinine in 5, proteinuria in 1 and hematuria in 1 patient and all these patients had preoperative scarred kidneys. Conclusions: Despite its invasive nature, UNC has a very high success rate with a negligible percent of complications. In our cohort, the only factor that negatively affected the clinical improvement rate was the history of previous antireflux interventions where the predictive factors for postoperative UTI were previous failed endoscopic injection, female gender, preoperative BTI, persistent VUR and voiding dysfunction.

Radikal sistektomi (RS), kasa invaze mesane tümörünün standart cerrahi tedavisidir. Cerrahi kaliteyi arttırmak için, ilk olarak iyi cerrahi kalite tanımlanmalı ve takiben başarılı bir cerrahiyi öngören faktörler ortaya konmalıdır. RS'nin cerrahi kalitesini artırmak, kasa invaze mesane tümörlü hastalarda "daha uzun sağkalım" anlamına gelir. Cerrahi kaliteyi etkileyen temel faktörler; hastane hacmi, cerrahın deneyim ve yeteneği, lenfadenektomideki sayı ve sınırlar, üriner diversiyon tipi ve perioperatif mortalite ve morbiditedir. RS ameliyatı yapılırken daha kaliteli cerrahi, daha iyi onkolojik sonuçlar ve özetle daha iyi yaşam kalitesi için tanımlanan faktörlerin hepsi göz önünde bulundurulmalıdır. (Üroonkoloji Bülteni 2014;13:70-74) Anah tar Ke li me ler: Mesane tümörü, sistektomi, cerrahi kalite Radical cystectomy (RC) continues to evolve as a surgical option in the treatment of muscle-invasive bladder tumors. For quality improvement in surgery, good surgical quality should be defined after which the predictors for a successful surgery should be determined. Improving the quality of RC surgery for muscle-invasive bladder cancer patients means "longer survival". Major factors which affect surgical quality, are; hospital capacity and environment, experience and skills of surgeons, lymph nodes removals and range of lymphadenectomy, types of urinary diversion and perioperative mortality and morbidity rates of patients. In order to achieve higher surgical quality and in consequence a better quality of life, improved oncological outcomes and all above mentioned factors should be taken into consideration. ( GirişMesane tümörü genitoüriner sistem tümörleri içerisinde ikinci sıklıkla karşımıza çıkar. Tanı anında tümörlerin %20-%40'ı kasa invazedir (1). Radikal sistektomi (RS) ve pelvik lenf nodu diseksiyonu kasa invaze mesane tümörü tedavisinde standart cerrahi tedavi şeklidir (2). Aynı zamanda RS mesane koruyucu tedavi sırasında nüks eden hastalarda (3), nonürotelyal kanserlerde, mikropapiller mesane kanseri ve karsinosarkomlarda (4), intrakaviter tedaviye dirençli kas invazif olmayan hastalarda ve intraktabl ağrı, gros hematüri gibi semptomları olan metastatik hastalarda palyatif olarak da uygulanabilen (5) önemli bir tedavi seçeneğidir. Mesane tümörü tedavisindeki öncelikli amaç hastayı kanserden kurtarmak, en iyi onkolojik sonuçları elde etmek ve perioperatif mortalite, morbiditeyi en aza indirmek olmalıdır. Son yıllarda cerrahi teknikte, anestezide, postoperatif bakımdaki gelişmelerle RS'ye bağlı morbidite %14-%20, mortalite ise %1-%2 düzeyine inmiştir (6,7). RS'nin cerrahi kalitesi mortalite, morbidite, hastanın yaşam kalitesi, onkolojik sonuçları içine alan geniş kapsamlı bir kavramdır. Cerrahi kaliteyi belirleyen faktörler: Merkeze ait özellikler, üriner diversiyon seçimi, lenfadenektominin kapsamı ve sayısı, cerrahi sonuçlar şeklinde ana başlıklar altında incelenebilir. Şimdi bunlara sırasıyla değinelim; Merkeze Ait ÖzelliklerRS'nin yapıldığı merkez ve bu merkezin mevcut şartları, cerrahi kaliteyi belirlemede...