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Actas Urologicas Espanolas May 2021Radical cystectomy with urinary diversion associated with extended pelvic lymphadenectomy continues to be the treatment of choice in muscle invasive bladder cancer.... (Review)
Review
INTRODUCTION AND OBJECTIVES
Radical cystectomy with urinary diversion associated with extended pelvic lymphadenectomy continues to be the treatment of choice in muscle invasive bladder cancer. Sixty-four percent of patients submitted to this procedure present postoperative complications, with urinary infection being responsible in 20-40% of cases. The aim of this project is to assess the rate of urinary infection as a cause of re-admission after cystectomy, and to identify protective and predisposing factors for urinary infection in our environment. Finally, we will evaluate the outcomes after the establishment of a prophylactic antibiotic protocol after removal of ureteral catheters.
MATERIAL AND METHODS
Retrospective descriptive study of cystectomized patients in the Urology Service of the Hospital Clínico Universitario of Zaragoza, from January 2012 to December 2018. A urinary tract infection (UTI) prevention protocol after catheter removal is established for all patients since October 2017.
RESULTS
UTI is responsible for 54.7% of readmissions, with 55.1% of these being due to UTI after removal of ureteral catheters. Of the patients who received with prophylaxis, 9.5% presented UTIs after withdrawal, compared to 10.6% in the group of patients without prophylaxis. The patient who is re-admitted for UTI after withdrawal has a mean catheter time of 24.3±7.2 days, compared to 24.5±7.4 days for patients in the group without UTI (P=.847).
CONCLUSIONS
The type of urinary diversion performed is not related to the rate of urinary infection. The regression model does not identify antibiotic prophylaxis, nor catheter time, as independent factors of UTI after catheter removal.
Topics: Antibiotic Prophylaxis; Cystectomy; Humans; Retrospective Studies; Urinary Diversion; Urinary Tract Infections
PubMed: 33516599
DOI: 10.1016/j.acuro.2020.10.001 -
The Journal of Urology Jan 2023There are conflicting reports regarding radical cystectomy complication risk from obesity subcategories, and a BMI threshold below which complication risk is notably...
PURPOSE
There are conflicting reports regarding radical cystectomy complication risk from obesity subcategories, and a BMI threshold below which complication risk is notably reduced is undefined. A BMI threshold may be helpful in prehabilitation to aid patient counseling and inform weight loss strategies to potentially mitigate obesity-associated complication risk. This study aims to identify such a threshold and further investigate the association between BMI subcategories and perioperative complications from radical cystectomy.
MATERIALS AND METHODS
Data were extracted from the Canadian Bladder Cancer Information System, a prospective registry across 14 academic centers. Five hundred and eighty-nine patients were analyzed. Perioperative (≤90 days) complications were compared between BMI subcategories. Unconditional multivariable logistic regression and cubic spline analysis were performed to determine the association between BMI and complication risk and identify a BMI threshold.
RESULTS
Perioperative complications were reported in 51 (30%), 97 (43%), and 85 (43%) normal, overweight, and obese patients (02). BMI was independently associated with developing any complication (OR 1.04 95% CI 1.01, 1.07). Predicted complication risk began to rise consistently above a BMI threshold of 34 kg/m. Both overweight (OR 2.00 95% CI 1.26-3.17) and obese (OR 1.98 95% CI 1.24-3.18) patients had increased risk of complications compared to normal BMI patients.
CONCLUSIONS
Complication risk from radical cystectomy is independently associated with BMI. Both overweight and obese patients are at increased risk compared to normal BMI patients. A BMI threshold of 34 kg/m has been identified, which may inform prehabilitation treatment strategies.
Topics: Humans; Body Mass Index; Cystectomy; Canada; Obesity
PubMed: 36250946
DOI: 10.1097/JU.0000000000002988 -
International Journal of Urology :... Oct 2019
Editorial Comment from Dr Kojima to Renal function after bladder-preserving therapy for patients with muscle-invasive bladder cancer: Results of selective bladder-preserving tetramodality therapy consisting of maximal transurethral resection, induction chemoradiotherapy and partial cystectomy.
Topics: Chemoradiotherapy; Cystectomy; Humans; Organ Sparing Treatments; Urinary Bladder Neoplasms
PubMed: 31353632
DOI: 10.1111/iju.14074 -
International Journal of Urology :... Oct 2019
Editorial Comment from Dr Kobayashi to Renal function after bladder-preserving therapy for patients with muscle-invasive bladder cancer: Results of selective bladder-preserving tetramodality therapy consisting of maximal transurethral resection, induction chemoradiotherapy and partial cystectomy.
Topics: Chemoradiotherapy; Cystectomy; Humans; Organ Sparing Treatments; Urinary Bladder Neoplasms
PubMed: 31327166
DOI: 10.1111/iju.14075 -
Investigative and Clinical Urology Nov 2022This study aimed to compare the functional and oncological outcomes of females who underwent uterus-sparing radical cystectomy (USRC) and standard radical cystectomy...
PURPOSE
This study aimed to compare the functional and oncological outcomes of females who underwent uterus-sparing radical cystectomy (USRC) and standard radical cystectomy (SRC).
MATERIALS AND METHODS
Between February 2009 and December 2020, 90 female patients who underwent radical cystectomy with urinary diversion were included in this study, comprising the USRC and SRC groups. Functional outcomes were assessed in 63 patients who only underwent radical cystectomy with neobladder formation. Questionnaire scores, clean intermittent catheterization (CIC) rate, and urinary continence rate were analyzed. Oncological outcomes were assessed in 86 patients, regardless of the urinary diversion type. Overall survival (OS), cancer-specific survival (CSS), and recurrence-free survival (RFS) were compared.
RESULTS
CIC rate was significantly lower in the USRC group than in the SRC group (14.7% vs. 48.0%; p=0.005). The continence rate was significantly higher in the USRC group than in the SRC group (85.3% vs. 40.0%; p=0.001). There were no significant differences in OS (p=0.890), CSS (p=0.700), or RFS (p=0.270) between the two groups. In multivariate analysis, uterine preservation did not significantly increase the hazard ratio (HR) of OS (HR, 0.62; 95% CI, 0.18-2.11; p=0.450), CSS (HR, 0.99; 95% CI, 0.22-4.40; p=0.990), or RFS (HR, 0.46; 95% CI, 0.19-1.11; p=0.840).
CONCLUSIONS
USRC resulted in higher continence rates and lower CIC rates than SRC without negatively affecting oncological outcomes. Hence, with thorough deliberation, USRC should be considered for females undergoing radical cystectomy.
Topics: Humans; Female; Cystectomy; Retrospective Studies; Urinary Bladder Neoplasms; Treatment Outcome; Uterus
PubMed: 36347550
DOI: 10.4111/icu.20220220 -
Nursing Open Oct 2023To identify and describe international practice in incontinence management after radical cystectomy and orthotopic neobladder. (Review)
Review
OBJECTIVES
To identify and describe international practice in incontinence management after radical cystectomy and orthotopic neobladder.
MATERIALS AND METHODS
A systematic scoping review following the methodology of the Joanne Briggs Institute was conducted in which the application searched 15 data sources to identify papers published in English, from 1979 to 2022.
RESULTS
Of the 16 papers that met the eligibility criteria, articles in Eastern countries mainly focus on the effect of conservative treatment, while in Western countries, more attention is paid to the effect of surgical treatment. Clinical characteristics of patients included conservative treatment failure, duration of post-operative intervention and unique differential treatment of male and female patients. Reported factors influencing the achievement of urinary incontinence (UI) include lack of evidence to guide management practice, limited value of conservative treatment, high risk of surgical treatment and uncertainty of efficacy; currently, early behavioural research and multimodal rehabilitation training have good results.
CONCLUSIONS
UI in neobladder patients is a distressing condition that is difficult to treat and often requires high-quality rehabilitation guidance and surgical intervention. Further research to address current knowledge gaps is important to inform practice.
Topics: Humans; Male; Female; Cystectomy; Urinary Diversion; Urinary Bladder Neoplasms; Urinary Bladder; Urinary Incontinence
PubMed: 37408112
DOI: 10.1002/nop2.1924 -
Archivos Espanoles de Urologia May 2023To evaluate the efficiency of open radical cystectomy (ORC) in relation to laparoscopic radical cystectomy (LRC) for muscle-invasive bladder cancer, and incidence of...
OBJECTIVE
To evaluate the efficiency of open radical cystectomy (ORC) in relation to laparoscopic radical cystectomy (LRC) for muscle-invasive bladder cancer, and incidence of postoperative recurrence.
METHODS
A total of 90 patients with muscle-invasive bladder cancer admitted to our urology department from January 2019 to May 2022 were included in this study. Using the random number table, the patients were assigned equally to ORC and LRC groups. The perioperative data of the patients were collected and recorded. The outcome indicators comprised erythrocyte pressure and creatinine levels, blood gas analysis, type of urinary diversion, and histopathology of surgically removed tumors.
RESULTS
Operation time of LRC was significantly longer than that of ORC, but other perioperative indices of LRC were better than those of ORC ( < 0.05). Hematocrit levels in LRC group were higher than those in ORC group at postoperative 1 day and before discharge ( < 0.05). However, creatinine levels were lower in LRC group than in ORC group at postoperative 1 day and before discharge ( < 0.05). Moreover, LRC resulted in better blood gas indices than ORC ( < 0.05). There were no significant differences in the type of urinary diversion and histopathological results from surgically removed tumor between the two groups ( > 0.05). Patients who received LRC had a lower incidence of complications than those given ORC ( < 0.05).
CONCLUSIONS
LRC reduced perioperative complications, decreased mean length of hospital stays, and enhanced recovery of gastrointestinal and renal functions. These data suggest that LRC is safer and more efficient than ORC. However, further studies are required prior to clinical application of this procedure.
Topics: Humans; Cystectomy; Laparoscopy; Treatment Outcome; Creatinine; Urinary Bladder Neoplasms; Muscles
PubMed: 37340525
DOI: 10.56434/j.arch.esp.urol.20237603.23 -
Current Opinion in Urology Sep 2023Radical cystectomy is the standard of care for patients with localized muscle-invasive bladder cancer (MIBC). In this context, bladder-sparing strategies (BSS) have been... (Review)
Review
PURPOSE OF REVIEW
Radical cystectomy is the standard of care for patients with localized muscle-invasive bladder cancer (MIBC). In this context, bladder-sparing strategies (BSS) have been investigated as viable alternatives for patients who are unfit for radical cystectomy or aim to preserve their bladder without compromising oncological outcomes. This review aims to provide the most up-to-date evidence on BSSs as an alternative treatment for patients with MIBC.
RECENT FINDINGS
Different studies have highlighted the long-term efficacy of trimodal therapy or chemoradiation protocols. However, due to the lack of randomized controlled trials, there is still a lack of high-level evidence on BSS efficacy as compared to radical cystectomy. Consequently, the adoption of these approaches is still limited. A possible turning point could be represented by the introduction of immunotherapy, as several studies are investigating the potential combination with chemoradiotherapy or radiotherapy alone. Patient selection, together with the implementation of new predictive biomarkers and imaging tools, may improve the efficacy of BSS in the near future.
SUMMARY
Radical cystectomy with perioperative chemotherapy remains the gold standard treatment for MIBC patients. Nevertheless, BSS can be considered a viable option in selected patients who desire to preserve their bladder. Further evidence is needed to clearly state the role of BSS in MIBC.
Topics: Humans; Urinary Bladder; Urinary Bladder Neoplasms; Cystectomy; Combined Modality Therapy; Neoplasm Invasiveness; Muscles
PubMed: 37395512
DOI: 10.1097/MOU.0000000000001113 -
JAMA Jun 2022
Topics: Cystectomy; Humans; Robotic Surgical Procedures; Urinary Bladder; Urinary Bladder Neoplasms
PubMed: 35569078
DOI: 10.1001/jama.2022.6417 -
Seminars in Oncology Nursing Feb 2021The purpose of this paper is to summarize existing evidence about nursing interventions to selected symptoms experienced by patients undergoing radical cystectomy (RC)... (Review)
Review
OBJECTIVE
The purpose of this paper is to summarize existing evidence about nursing interventions to selected symptoms experienced by patients undergoing radical cystectomy (RC) to maintain or return to their daily life activities.
DATA SOURCES
A non-systematic narrative review was conducted. A search in PubMed and CINAHL was conducted eliciting evidence about frequent symptoms experienced after RC. The following search terms were used: radical cystectomy and/or nursing interventions, pain, distress, fatigue, urinary dysfunction, sexual dysfunction, loss of appetite, sleep disturbance, and enhanced recovery after surgery (ERAS).
CONCLUSION
Evidence in the ERAS pathway is still lacking regarding the effect of preoperative education and counseling of the patient and the most difficult part to implement is related to preoperative optimization of the patient such as lifestyle changes. Most nursing interventions to alleviate symptoms in the rehabilitation period after RC are still practice based.
IMPLICATIONS FOR NURSING PRACTICE
Priority should be given to implementation of the ERAS protocol. To improve the management of symptoms experienced by patients in the RC rehabilitation period it is essential that validated screening tools to identify the symptoms be used. Accepted and effective strategies for treating the individual symptoms should be initiated and clear treatment outcomes should be defined. Urology nurse researchers should investigate the concept of symptom clusters to clarify whether there are more efficient methods to identify symptoms or symptom clusters and if so would the use of symptom clusters knowledge improve patient care.
Topics: Cystectomy; Fatigue; Humans; Treatment Outcome
PubMed: 33408048
DOI: 10.1016/j.soncn.2020.151110