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International Braz J Urol : Official... 2020Standard management of muscle-invasive bladder cancer involves radical cystectomy with pelvic lymph node dissection. However, patients may be ineligible for surgery or... (Review)
Review
BACKGROUND
Standard management of muscle-invasive bladder cancer involves radical cystectomy with pelvic lymph node dissection. However, patients may be ineligible for surgery or may wish to avoid the morbidity of cystectomy due to quality of life concerns. Bladder preservation therapies have emerged as alternatives treatment options that can provide comparable oncologic outcomes while maintaining patients' quality of life.
OBJECTIVE
To review bladder preservation therapies, patient selection criteria, and functional and oncologic outcomes for BPT in muscle-invasive bladder cancer.
MATERIALS AND METHODS
We conducted a comprehensive literature review of bladder preservation therapies in Pubmed and Embase.
DISCUSSION
The ideal patient for BPT has low-volume T2 disease, absence of CIS, absence of hydronephrosis, and a maximal TURBT with regular surveillance. Technological advancements involving cancer staging, TURBT technique, and chemotherapy and radiation therapy regimens have improved BPT outcomes, with oncologic outcomes now comparable to those of radical cystectomy. Advancements in BPT also includes a heightened focus on improving quality of life for patients undergoing bladder preservation. Preservation strategies with most evidence for use include trimodality therapy and partial cystectomy with pelvic lymph node dissection.
CONCLUSIONS
This review highlights the breadth of strategies that aim to preserve a patient's bladder while still optimizing local tumor control and overall survival. Future areas for innovation include the use of predictive biomarkers and implementation of immunotherapy, moving the field towards patient-tailored care.
Topics: Combined Modality Therapy; Cystectomy; Humans; Neoplasm Invasiveness; Neoplasm Staging; Organ Sparing Treatments; Urinary Bladder Neoplasms
PubMed: 31961624
DOI: 10.1590/S1677-5538.IBJU.2020.99.01 -
Journal of Veterinary Internal Medicine Jan 2020Lower urinary tract transitional cell carcinoma (TCC) is an important but rarely described disease of cats.
BACKGROUND
Lower urinary tract transitional cell carcinoma (TCC) is an important but rarely described disease of cats.
OBJECTIVES
To report the clinical characteristics, treatments, and outcomes in a cohort of cats with lower urinary tract TCC and to test identified variables for prognostic relevance.
ANIMALS
One-hundred eighteen client-owned cats with lower urinary tract carcinoma.
METHODS
Medical records were retrospectively reviewed to obtain information regarding clinical characteristics, treatments, and outcomes. Recorded variables were analyzed statistically.
RESULTS
Median age of affected cats was 15 years (range, 5.0-20.8 years) and median duration of clinical signs was 30 days (range, 0-730 days). The trigone was the most common tumor location (32/118; 27.1%) as assessed by ultrasound examination, cystoscopy, or both. Treatment was carried out in 73 of 118 (61.9%) cats. Metastatic disease was documented in 25 of 118 (21.2%) cats. Median progression-free survival and survival time for all cats were 113 days (95% confidence interval [CI], 69-153) and 155 days (95% CI, 110-222), respectively. Survival increased significantly (P < .001) when comparing cats across the ordered treatment groups: no treatment, treatment without partial cystectomy, and treatment with partial cystectomy. Partial cystectomy (hazard ratio [HR], 0.31; 95% CI, 0.17-0.87) and treatment with nonsteroidal anti-inflammatory drugs (HR, 0.55; 95% CI, 0.33-0.93) were significantly associated with longer survival times.
CONCLUSIONS AND CLINICAL IMPORTANCE
The results support treatment using partial cystectomy and NSAIDs in cats with TCC.
Topics: Animals; Anti-Inflammatory Agents, Non-Steroidal; Carcinoma, Transitional Cell; Cat Diseases; Cats; Cohort Studies; Cystectomy; Retrospective Studies; Treatment Outcome; Urinary Bladder Neoplasms
PubMed: 31721288
DOI: 10.1111/jvim.15656 -
The Urologic Clinics of North America May 2018Retrospective observational studies support the utility of robotic-assisted radical cystectomy (RARC). Randomized controlled trials (RCTs) have shown that RARC with... (Review)
Review
Retrospective observational studies support the utility of robotic-assisted radical cystectomy (RARC). Randomized controlled trials (RCTs) have shown that RARC with extracorporeal urinary diversion may lead to decreased estimated blood loss, decreased rate of transfusion, similar oncologic outcomes, cost-effectiveness, and variable increased operative times. Although RCTs comparing RARC with open radical cystectomy are currently ongoing, it may be several years before the utility of RARC is known. The discussion on the role of cystectomy, indications, outcomes, care pathways, access to high-volume care centers, and efforts to decrease complications may prove as important as the technique itself.
Topics: Cystectomy; Humans; Learning Curve; Randomized Controlled Trials as Topic; Robotic Surgical Procedures; Urinary Bladder Neoplasms
PubMed: 29650134
DOI: 10.1016/j.ucl.2017.12.012 -
Archivos Espanoles de Urologia Jul 2019Bladder leiomyomas are rare benign tumors; their common presentation are irritative and obstructive urinary symptoms. The treatment is complete surgical resection.
UNLABELLED
Bladder leiomyomas are rare benign tumors; their common presentation are irritative and obstructive urinary symptoms. The treatment is complete surgical resection.
OBJECTIVE
To present our experience in the diagnosis and the treatment of bladder leiomyoma.
METHODS
A series of three clinical cases.
RESULTS
In our series, two patients were women and one was man. The mean age was 33 years. Two women presented with irritative urinary symptoms and palpation of a pelvic mass, and the man was asymptomatic. Ultrasound showed the presence of an adnexal mass with left hydronephrosis in a female patient, bladder tumor in another female patient and pelvic mass of unknown etiology in the male patient. CT scan and MRI demonstrated the bladder origin of the lesion. A biopsy confirmed a bladder leiomyoma. Surgical treatment was partial cystectomy in all patients, and in one of them, nephrectomy was performed. During follow-up, all patients were asymptomatic and without recurrence.
CONCLUSIONS
Imaging studies guide to diagnosis. Transurethral resection is recommended in lesions smaller than 3 cm. and enucleation or partial cystectomy in larger lesions. Prognosis is good.
Topics: Adult; Cystectomy; Female; Humans; Leiomyoma; Male; Neoplasm Recurrence, Local; Urinary Bladder Neoplasms
PubMed: 31274128
DOI: No ID Found -
The Surgical Clinics of North America Apr 2020Urologists have always been leaders in advancing surgical technology and were the first to utilize modern robotic surgery for robotic-assisted laparoscopic radical... (Review)
Review
Urologists have always been leaders in advancing surgical technology and were the first to utilize modern robotic surgery for robotic-assisted laparoscopic radical proctectomy. Surgeon ergonomics, instrument precision, operative time, and postoperative recovery were all objectively improved. In urology, robotic surgery is now used for all intra-abdominal, retroperitoneal, and pelvic procedures and has been expanded to renal transplants and pediatric use. Modern robotic surgery has become an essential part of treating complex urologic disease in the developed world. Urologists continue to lead the way with the latest robotic surgical systems, including the newly approved single port systems.
Topics: Cystectomy; Humans; Laparoscopy; Nephrectomy; Prostatectomy; Robotic Surgical Procedures; Urologic Diseases; Urologic Surgical Procedures
PubMed: 32169184
DOI: 10.1016/j.suc.2019.12.003 -
European Urology Focus Nov 2023Radical cystectomy is considered a procedure of high complexity with a relative high complication rate. (Meta-Analysis)
Meta-Analysis Review
CONTEXT
Radical cystectomy is considered a procedure of high complexity with a relative high complication rate.
OBJECTIVE
To systematically summarize the literature regarding the complications of radical cystectomy and the factors that contribute to them.
EVIDENCE ACQUISITION
We searched MEDLINE/PubMed, ClinicalTrials.gov, and Cochrane Library, according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines for randomized controlled trials (RCTs) on complications related to radical cystectomy.
EVIDENCE SYNTHESIS
A total of 3766 studies were screened, and 44 studies were included in this systematic review and meta-analysis. Complications following radical cystectomy are quite common. The most common complications were gastrointestinal complications (20%), infectious complications (17%), and ileus (14%). The majority of complications occurring were Clavien I-II (45%). Specific measurable patient factors are related to certain complications and can be used to stratify risk and assist in preoperative counseling, while proper design of high-quality RCTs may better reflect real-life complication rates.
CONCLUSIONS
In our study, RCTs with a low risk of bias had higher complication rates than studies with a high risk of bias, underlining the need for further improvement on complication reporting in order to refine surgical outcomes.
PATIENT SUMMARY
Radical cystectomy is usually followed by high complication rates, which affect patients and are, in turn, strongly associated with patients' preoperative health status.
Topics: Humans; Cystectomy; Urinary Bladder Neoplasms; Robotic Surgical Procedures; Postoperative Complications; Treatment Outcome; Randomized Controlled Trials as Topic
PubMed: 37246124
DOI: 10.1016/j.euf.2023.05.002 -
The Urologic Clinics of North America Feb 2021Robotic-assisted radical cystectomy has gained increasing popularity over the past decade. Initially, the procedure was performed with extracorporeal urinary diversion... (Review)
Review
Robotic-assisted radical cystectomy has gained increasing popularity over the past decade. Initially, the procedure was performed with extracorporeal urinary diversion given the technical challenges of the intracorporeal approach. Since then, innovative techniques have been described to facilitate bowel manipulation, assess ureteral and mesenteric vasculature, and perform ureteroenteric and urethro-ileal anastomosis. Overcoming the learning curve associated with intracorporeal urinary diversion can lead to decreased blood loss, shorter operative times, and faster convalescence, particularly with enhanced recovery protocols. Herein we review technical points, complications, outcomes, and future innovations in intracorporeal urinary diversion."
Topics: Cystectomy; Enhanced Recovery After Surgery; Forecasting; Humans; Learning Curve; Robotic Surgical Procedures; Urinary Bladder; Urinary Bladder Neoplasms; Urinary Diversion
PubMed: 33218594
DOI: 10.1016/j.ucl.2020.09.005 -
Urologia Internationalis 2022Localized urachal cancer (UrC) can be treated with an open partial cystectomy (OPC) with en bloc resection of the urachal remnant and umbilicus. Robot-assisted partial...
INTRODUCTION
Localized urachal cancer (UrC) can be treated with an open partial cystectomy (OPC) with en bloc resection of the urachal remnant and umbilicus. Robot-assisted partial cystectomy (RAPC) is an alternative approach, of which its safety and efficacy for UrC remains to be determined. In the present study, we analyze these outcomes after RAPC, compared with OPC.
METHODS
We retrospectively evaluated 55 cN0M0 UrC patients who underwent RAPC (n = 8) or OPC (n = 47) between 1994 and 2020. Overall survival (OS) and recurrence-free survival (RFS) were assessed using Kaplan-Meier methods. Positive surgical margins (PSM), port-site recurrences (PSR) versus wound recurrences were compared. Complications were recorded using the Clavien-Dindo classification.
RESULTS
Median follow-up was 40 months (IQR 21-95). Two-year OS and RFS for RAPC were 73% (95% confidence intervals (CI); 56-89 months) and 60% (95% CI; 42-78 months), respectively, versus 90% (95% CI; 85-95 months) and 66% (95% CI; 59-73 months) for OPC. PSM rate was 13% in both groups. PSR occurred in 2/8 (25%) patients after RAPC. No wound recurrences occurred after OPC. Postoperative complications occurred in 2/8 (25%) patients after RAPC, versus 5/47 (11%) after OPC (p = 0.27).
CONCLUSION
Both RAPC and OPC seem feasible surgical modalities to treat localized UrC with comparable survival. The PSR rate of 25% after RAPC should prompt us to be cautious to recommend RAPC as no such recurrences were seen using OPC.
Topics: Cystectomy; Humans; Margins of Excision; Retrospective Studies; Robotic Surgical Procedures; Robotics; Treatment Outcome; Urinary Bladder Neoplasms
PubMed: 35134799
DOI: 10.1159/000521605 -
Archivio Italiano Di Urologia,... Sep 2022The aim of the study is to make a review of the literature about bladder malakoplakia. (Review)
Review
OBJECTIVE
The aim of the study is to make a review of the literature about bladder malakoplakia.
MATERIAL AND METHODS
We searched articles on the PUBMED web-literature database with the following keywords: "vesical malakoplakia" and "bladder malakoplakia". In the literature we found 254 articles. At final we have excluded 219 articles, including in our study only 35 articles.
RESULTS
The overall average age found was 50.85 years. The average age of men was 43.22 years, while that of women was 53.37 years. 75% of the patient cases were women and 25% were men. Regarding comorbidities, in 5.55% of the cases were missing whereas 47.22% of the patients suffered from recurrent urinary tract infection (UTI) and 19.44% from immune system disorders. Urine culture was positive in 69.44% with E.coli being isolated in 92% of cases. Hydroureteronephrosis was present in 44.44% of the cases: left in 6.25% of cases, right in 18.75% and bilateral in 75%. The mean serum creatinine of patients with hydroureteronephrosis was 5.11 (1-21) mg/dl. The most frequent site of the lesion was the vesicoureteral junction (VUJ) (42.31%), followed by the trigone (38.46%). 30.56% of patients were treated with antibiotic and surgery (transurethral resection of bladder, partial or radical cystectomy), less frequent options were antibiotics alone and surgery alone. The recurrence rate was 15%.
CONCLUSIONS
Malakoplakia is a disorder usually related to other affections, like UTI and immunodepression, and it seem to be caused by an abnormal macrophage function. In almost half of the described cases of isolated bladder malakoplakia, hydroureteronephrosis and renal failure were present.Treatment is not standardized, but both medical and surgical therapies are effective to avoid recurrence.
Topics: Adult; Anti-Bacterial Agents; Creatinine; Cystectomy; Female; Humans; Malacoplakia; Male; Middle Aged; Urinary Bladder
PubMed: 36165484
DOI: 10.4081/aiua.2022.3.350 -
Journal of Surgical Oncology Dec 2015Robot-assisted radical cystectomy (RARC) has rapidly penetrated the field of urology since its inception in 2003. Several observational studies, retrospective reports,... (Review)
Review
Robot-assisted radical cystectomy (RARC) has rapidly penetrated the field of urology since its inception in 2003. Several observational studies, retrospective reports, and three randomized controlled trials (RCT) have preliminarily demonstrated the safety and efficacy of (RARC). Additionally, results from the RAZOR RCT will be available in 2016-2017 to better substantiate the use of (RARC).
Topics: Blood Loss, Surgical; Cystectomy; Female; Humans; Hysterectomy; Length of Stay; Lymph Node Excision; Male; Neoplasm Invasiveness; Operative Time; Ovariectomy; Randomized Controlled Trials as Topic; Robotic Surgical Procedures; Salpingectomy; United States; Urinary Bladder Neoplasms; Urinary Diversion; Vagina
PubMed: 26310514
DOI: 10.1002/jso.24009