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The Journal of Urology Oct 2020
Topics: Cystectomy; Neoadjuvant Therapy; Smoking; Urinary Bladder
PubMed: 32648803
DOI: 10.1097/JU.0000000000000813.01 -
Current Opinion in Urology Jul 2023Bilateral pelvic lymph node dissection (PLND) at the time of radical cystectomy (RC) provides important staging information and oncologic benefit in patients with... (Review)
Review
PURPOSE OF REVIEW
Bilateral pelvic lymph node dissection (PLND) at the time of radical cystectomy (RC) provides important staging information and oncologic benefit in patients with bladder cancer. The optimal extent of the PLND remains controversial. Our aim is to highlight nodal mapping studies and the data that guides optimization of both staging and oncologic outcomes. We then review contemporary randomized trials studying the extent of PLND.
RECENT FINDINGS
A recent randomized trial (RCT) powered for a 15% improvement in recurrence-free survival (RFS) of extended (e) over limited (l)PLND was completed but failed to identify this large difference in outcome. Concerns over study design limit the ability to interpret the oncologic results. Importantly, ePLND minimally changed surgical morbidity. An ongoing, similar RCT (SWOG S1011) powered to detect a 10% difference in RFS has completed accrual, but no published outcomes are available.
SUMMARY
RC and ePLND can provide cure in 33% of LN positive bladder cancer patients. Current data support a 5% improvement in RFS if ePLND is routinely used in MIBC patients. Two randomized trials powered to identify much larger (15 and 10%) improvements in RFS are unlikely to identify such an ambitious benefit by extending the PLND.
Topics: Humans; Pelvis; Urinary Bladder Neoplasms; Lymph Node Excision; Urinary Bladder; Cystectomy; Muscles; Lymph Nodes
PubMed: 37021936
DOI: 10.1097/MOU.0000000000001096 -
Journal of Ayub Medical College,... 2021Leiomyoma of the urinary bladder is a rare bladder tumour, which is benign in nature. On presentation, it resembles urothelial cancer but it has an excellent prognosis....
Leiomyoma of the urinary bladder is a rare bladder tumour, which is benign in nature. On presentation, it resembles urothelial cancer but it has an excellent prognosis. We reported two cases of urinary bladder leiomyoma. Both the patients presented with lower urinary tract symptoms (LUTS) and the patient in the second case also had painless haematuria. Bladder mass was detected initially on ultrasound and confirmed on contrast-enhanced computed tomography (CT). Transurethral resection of bladder tumour was performed in both cases and no recurrence was found on initial follow-up. But the second case had haematuria and recurrence on subsequent follow-up and managed by performing a partial cystectomy. Endoscopic management of bladder leiomyoma is a safe treatment option for bladder leiomyoma and if multiple recurrences noted with symptoms, then partial cystectomy can be considered. Histopathology is the only definitive way of establishing the diagnosis. These patients can be followed up initially with cystoscopy, and if no recurrence is detected, subsequent follow-up can be carried out with ultrasound.
Topics: Cystectomy; Cystoscopy; Humans; Leiomyoma; Urinary Bladder; Urinary Bladder Neoplasms
PubMed: 35124930
DOI: No ID Found -
The International Journal of Medical... Aug 2022To report our contemporary experience with robotic-assisted partial cystectomy (RAPC) for muscle invasive bladder cancer.
OBJECTIVE
To report our contemporary experience with robotic-assisted partial cystectomy (RAPC) for muscle invasive bladder cancer.
METHODS
This is a retrospective review of patients who underwent robotic-assisted partial cystectomy with us between 2013 and 2020 and provided ≥12 months of follow up.
RESULTS AND LIMITATIONS
The median operative time for our 35 patients was 190 min (Interquartile range [IQR] 155-280). Four patients developed grade 3 or higher complications (ileus, pneumonia, and urethral stricture). At 12 months follow-up, the median IPSS score was 10 (IQR 7-11), and recurrence happened in seven patients (recurrence-free survival 80%). Five of the patients who developed recurrence died because of their disease, and two other patients died of causes unrelated to their cancer.
CONCLUSIONS
We describe our technique, functional outcomes, and short-term follow up results in highly selected patients with muscle-invasive bladder cancer treated with RAPC.
Topics: Cystectomy; Humans; Muscles; Retrospective Studies; Robotic Surgical Procedures; Treatment Outcome; Urinary Bladder Neoplasms
PubMed: 35262267
DOI: 10.1002/rcs.2390 -
Current Opinion in Supportive and... Dec 2021To provide a contemporary rationale for bladder preservation as a treatment strategy for muscle-invasive urothelial carcinoma of the bladder. Although the standard of... (Review)
Review
PURPOSE OF REVIEW
To provide a contemporary rationale for bladder preservation as a treatment strategy for muscle-invasive urothelial carcinoma of the bladder. Although the standard of care for this important and serious clinical condition has been radical cystectomy augmented with neoadjuvant systemic chemotherapy, it is associated with substantial morbidity and quality of life (QoL) implications. This article explores the bladder sparing alternatives to radical cystectomy and urinary diversion to assist Urologists, Medical Oncologists, and Palliative Care providers in their informed decision making with patients.
RECENT FINDINGS
Bladder sparing strategies such as partial cystectomy and trimodality therapy offer long-term cancer outcomes comparable to radical cystectomy in carefully selected patients. Moreover, the toxicity profile in patients, having improved over time, is acceptable, including a low risk of salvage cystectomy.
SUMMARY
Bladder preservation therapy offers an alternative to radical cystectomy. In some patients, it can be done with curative intent and in others it can assist with symptom palliation. Bladder preservation can maintain QoL and provide similar oncologic outcomes to radical surgery, although randomized controlled trials have not been performed. Understanding patient selection is a critical step in balancing bladder preservation and cancer survival.
Topics: Carcinoma, Transitional Cell; Cystectomy; Humans; Neoplasm Invasiveness; Quality of Life; Treatment Outcome; Urinary Bladder; Urinary Bladder Neoplasms
PubMed: 34726191
DOI: 10.1097/SPC.0000000000000579 -
Minerva Urologica E Nefrologica = the... Aug 2019Radical cystectomy (RC) is one of the most complex and morbid surgical procedures in urology, that is not devoid of postoperative complications. Minimally invasive... (Review)
Review
INTRODUCTION
Radical cystectomy (RC) is one of the most complex and morbid surgical procedures in urology, that is not devoid of postoperative complications. Minimally invasive surgery, and especially robot-assisted RC (RARC) has emerged as an alternative to open RC (ORC) in an attempt to minimize surgical morbidity and facilitate the surgical approach. The aim of this paper was to present the current knowledge on the oncological efficacy and complication outcomes of RARC.
EVIDENCE ACQUISITION
A non-systematic review on all relevant studies with the keywords "Radical cystectomy," "Open," "Robot-assisted," "Complications," "Recurrence," "Survival," "Neobladder," "Potency," "Continence" and "Intracorporeal" was performed using PubMed, MEDLINE, Embase, American Urological Association (AUA), European Society of Medical Oncology (ESMO) and European Association of Urology (EAU) Guidelines.
EVIDENCE SYNTHESIS
RARC shows similar lymph node yields and positive surgical margin rates as well as perioperative complication outcomes compared with ORC. RARC exhibits significantly less blood loss and less intra- and postoperative blood transfusion. Moreover, survival and recurrence rates are not related to the surgical approach. Finally, RARC seems to be more expensive and has a longer operating time compared to the open technique.
CONCLUSIONS
As current evidence shows, RARC seems as a technically feasible and safe procedure, providing equivalent perioperative and oncological results compared to ORC. More prospective, randomized-controlled trials are necessary to draw definitive conclusions on all comparative aspects.
Topics: Cystectomy; Humans; Minimally Invasive Surgical Procedures; Postoperative Complications; Robotic Surgical Procedures; Treatment Outcome; Urinary Bladder Neoplasms; Urologic Surgical Procedures
PubMed: 31086134
DOI: 10.23736/S0393-2249.19.03435-0 -
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 -
BJU International Apr 2022To evaluate whether urothelial carcinoma (UC) with sarcomatoid differentiation is associated with a lower pathological response rate to neoadjuvant chemotherapy (NAC)...
OBJECTIVE
To evaluate whether urothelial carcinoma (UC) with sarcomatoid differentiation is associated with a lower pathological response rate to neoadjuvant chemotherapy (NAC) and worse oncological outcomes compared to UC without variant histology among patients undergoing radical cystectomy.
PATIENTS AND METHODS
Patients with UC undergoing cystectomy from 1995 to 2018 at the Memorial Sloan Kettering Cancer Centre were identified. Patients with sarcomatoid differentiation at transurethral resection (TUR) or cystectomy, and patients without variant histology were selected. Downstaging from ≥cT2 to ≤pT1N0 defined partial response and pT0N0 defined complete response. Recurrence-free, cancer-specific and overall survival were modelled.
RESULTS
We identified 131 patients with sarcomatoid differentiation and 1722 patients without variant histology, of whom 25 with sarcomatoid histology on biopsy and 313 without variant histology received NAC. Those with sarcomatoid differentiation presented with higher consensus tumour stage (94% ≥T2 vs 62%; P < 0.001) and were, therefore, more likely to receive NAC (29% vs 18%; P = 0.003). We found no evidence to support a difference in partial (24% vs 31%) or complete (20% vs 24%) response between patients with sarcomatoid histology and those with pure UC at TUR (P = 0.6). Among patients with sarcomatoid differentiation, 5-year recurrence-free survival was 55% (95% confidence interval [CI] 41-74) among patients receiving NAC and 40% (95% CI 31-52) among patients undergoing cystectomy alone (P = 0.1). Adjusting for stage, nodal involvement, margin status and receipt of NAC, sarcomatoid differentiation was associated with worse recurrence-free (hazard ratio [HR] 1.82, 95% CI 1.39-2.39), disease-specific (HR 1.66, 95% CI 1.23-2.22), and overall survival (HR 1.37, 95% CI 1.06-1.78).
CONCLUSIONS
Sarcomatoid differentiation was associated with higher stage at presentation and independently associated with worse survival. Given similar pathological response rates if sarcomatoid differentiation is detected at initial resection, and greater survival among patients receiving NAC, treatment with NAC appears warranted. Other drivers of the poor outcomes of this histology must be investigated.
Topics: Carcinoma, Transitional Cell; Cystectomy; Humans; Neoplasm Recurrence, Local; Treatment Outcome; Urinary Bladder Neoplasms
PubMed: 33866683
DOI: 10.1111/bju.15428 -
BJU International Dec 2019To examine predictors of early readmissions after radical cystectomy (RC). Factors associated with preventable readmissions may be most evident in readmissions that...
OBJECTIVE
To examine predictors of early readmissions after radical cystectomy (RC). Factors associated with preventable readmissions may be most evident in readmissions that occur within 3 days of discharge, commonly termed 'bounce-back' readmissions, and identifying such factors may inform efforts to reduce surgical readmissions.
PATIENTS AND METHODS
We utilised the Healthcare Cost and Utilization Project's State Inpatient Databases to examine 1867 patients undergoing RC in 2009 and 2010, and identified all patients readmitted within 30 days of discharge. We assessed differences between patients experiencing bounce-back readmission compared to those readmitted 8-30 days after discharge using logistic regression models and also calculated abbreviated LACE scores to assess the utility of common readmissions risk stratification algorithms.
RESULTS
The 30-day and bounce-back readmission rates were 28.4% and 5.6%, respectively. Although no patient or index hospitalisation characteristics were significantly associated with bounce-back readmissions in adjusted analyses, bounce-back patients did have higher rates of gastrointestinal (14.3% vs 6.7%, P = 0.02) and wound (9.5% vs 3.0%, P < 0.01) diagnoses, as well as increased index and readmission length of stay (5 vs 4 days, P = 0.01). Overall, the median abbreviated LACE score was 7, which fell into the moderate readmission risk category, and no difference was observed between readmitted and non-readmitted patients.
CONCLUSION
One in five readmissions after RC occurs within 3 days of initial discharge, probably due to factors present at discharge. However, sociodemographic and clinical factors, as well as traditional readmission risk tools were not predictive of this bounce-back. Effective strategies to reduce bounce-back readmission must identify actionable clinical factors prior to discharge.
Topics: Aged; Cystectomy; Female; Humans; Length of Stay; Male; Patient Readmission; Postoperative Complications
PubMed: 31313473
DOI: 10.1111/bju.14874 -
International Journal of Environmental... Nov 2022The goal of the study was to compare laparoscopic and open radical cystectomy in treatment of muscle-invasive bladder cancer in the Department of Urology and Oncological...
The goal of the study was to compare laparoscopic and open radical cystectomy in treatment of muscle-invasive bladder cancer in the Department of Urology and Oncological Urology PUM in Szczecin. A total of 78 patients in the study group underwent laparoscopic cystectomy between 2016−2018, and 81 patients from the control group had open cystectomy between 2014−2016. Both groups were comparable in terms of age, stage, and concomitant diseases. The 3 year overall survival was comparable in both groups (37.7% for laparoscopy and 44.4% for open, p = 0.64). There was no difference in positive surgical margin rate. Lymph node yield during cystectomy was higher in open cystectomy (14 vs. 11.5, p = 0.001). Post-operative blood loss and transfusion rates were lower in laparoscopic cystectomy. Decrease in hemoglobin level was lower in laparoscopy (0.9 mmol/L, p < 0.001). Intraoperative transfusion rate was 11.8% in laparoscopy vs. 34.8% in open cystectomy (p = 0.002). Operation time, duration of hospitalisation, and time to full oral alimentation were comparable in both groups. Patients with BMI > 30 kg/m2 and those with pT3-T4 cancer in the laparoscopy group had less septic complications post-operatively. Patients with ASA score ≥ 3 from the laparoscopy group had fewer reoperations due to ileus. Laparoscopic cystectomy is less invasive and offers similar oncological outcomes to the open method. Patients benefit from less tissue trauma, less blood loss, and faster recovery. The presented results, as well as other publications, should encourage a wider use of this procedure in everyday urological practice.
Topics: Humans; Cystectomy; Treatment Outcome; Urinary Bladder Neoplasms; Laparoscopy; Muscles; Retrospective Studies
PubMed: 36498068
DOI: 10.3390/ijerph192315995