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Urology Nov 2022To present our experience in a single pediatric urology practice over a 10-year period with bladder tumors in the pediatric population in an effort to add to the...
OBJECTIVE
To present our experience in a single pediatric urology practice over a 10-year period with bladder tumors in the pediatric population in an effort to add to the relatively small amount of existing data. We hope to expand the community's knowledge of presentations, management and natural history of pediatric bladder tumors.
METHODS
We retrospectively queried our electronic medical records for International Classification of Diseases, Tenth Revision (ICD-10) and Current Procedural Terminology (CPT) codes relevant for bladder tumors. Patients with underlying bladder pathology, such as neurogenic bladder, history of bladder exstrophy, and history of bladder augmentation, were excluded.
RESULTS
We identified 30 patients with bladder tumors from 2011 to 2021. There were 21 males and 9 females. Age at diagnosis ranged from 16 months to 19 years. Tumors identified were: 11 of various inflammatory subtypes; 4 papillomas; 4 rhabdomyosarcomas; 3 papillary urothelial neoplasms of low malignant potential and 8 of other types. Treatment included transurethral resection of bladder tumor, chemoradiation and laparoscopic partial cystectomy. Twenty nine patients had disease limited to the bladder and 1 had disease outside the bladder. Follow-up ranged from 2 weeks to 13 years (median 19 months). All patients had no evidence of disease at most recent follow-up.
CONCLUSION
Pediatric bladder tumors range from aggressive rhabdomyosarcomas to more benign urothelial lesions. Fortunately, the latter type of tumor is the more prevalent lesion. Knowledge of the treatment options and natural history of these tumors will hopefully be of benefit to clinicians and parents alike.
Topics: Male; Female; Child; Humans; Infant; Urinary Bladder Neoplasms; Retrospective Studies; Cystectomy; Urothelium; Rhabdomyosarcoma
PubMed: 35970356
DOI: 10.1016/j.urology.2022.08.001 -
Clinical Nutrition ESPEN Jun 2023Enhanced recovery after surgery (ERAS®) pathways aim to improve patient outcomes by applying multimodal practices before, during, and after operative procedures....
Impact of nutritional compliance within ERAS protocols for hepatopancreatobiliary, radical cystectomy, and head and neck procedures: A case-matched analysis adjusted for major complications.
BACKGROUND
Enhanced recovery after surgery (ERAS®) pathways aim to improve patient outcomes by applying multimodal practices before, during, and after operative procedures. Compared with standard care before ERAS, we investigated whether compliance to ERAS guidelines for nutritional care, preoperative oral carbohydrate loading and postoperative oral nutrition, was associated with a decrease in hospital length of stay (LOS) after pancreaticoduodenectomy, distal pancreatectomy, hepatectomy, radical cystectomy, and head and neck tumor resection with reconstruction.
METHODS
Compliance to ERAS nutrition recommendations was evaluated. Post-ERAS cohort was retrospectively analyzed. Pre-ERAS cohort consisted of case matched patients one year before ERAS: age more than or less than 65 years, body mass index (BMI) more than greater than or less than 30 kg/m, diabetes mellitus, sex, and procedure. Each cohort consisted of 297 patients. Binary linear regressions evaluated the incremental effect of postoperative nutrition timing and preoperative carbohydrate loading on LOS. Multivariate regressions adjusted for postoperative complications.
RESULTS
Compliance with preoperative carbohydrate loading for the post-ERAS cohort was 81.7%. Mean hospital LOS was significantly shorter for the post-ERAS cohort compared with pre-ERAS cohort (8.3 vs 10.0 days, p < 0.001). By procedure, LOS was significantly shorter for patients undergoing pancreaticoduodenectomy (p = 0.003), distal pancreatectomy (p = 0.014), and head and neck procedures (p = 0.024). Early postoperative oral nutrition was associated with a 3.75-day shorter LOS (p < 0.001); no nutrition was associated with a 3.29-day longer LOS (p < 0.001).
CONCLUSION
Compliance with ERAS protocols for specific nutritional care practices was associated with a statistically significant decrease in LOS without subsequent increases in 30-day readmission rates and positive financial impact. These findings suggest that ERAS guidelines for perioperative nutrition are a strategic pathway to improved patient recovery and value-based care in surgery.
Topics: Humans; Aged; Cystectomy; Retrospective Studies; Postoperative Complications; Pancreaticoduodenectomy; Nutritional Status
PubMed: 37202034
DOI: 10.1016/j.clnesp.2023.03.001 -
Urologic Oncology Aug 2021To investigate treatment patterns of partial cystectomy (PC), neoadjuvant chemotherapy (NAC), lymph node dissection (LND), and treatment delays, and the associations...
OBJECTIVES
To investigate treatment patterns of partial cystectomy (PC), neoadjuvant chemotherapy (NAC), lymph node dissection (LND), and treatment delays, and the associations with overall survival (OS) among patients with muscle-invasive bladder cancer.
PATIENTS AND METHODS
We identified patients with cT2-4cN0cM0 urothelial carcinoma of the bladder in the National Cancer Database who underwent PC from 2007 through 2015. We performed descriptive statistics and assessed temporal trends using the Cochrane-Armitage test. Our outcomes of interest were NAC, LND, and treatment delay defined as ≥8 or ≥12 weeks for patients who underwent NAC or upfront surgery, respectively. We used logistic regression and multivariable Cox proportional hazards models to evaluate predictors and associations with OS, respectively.
RESULTS
A total of 9,199 patients met inclusion criteria. Over the study period, PC utilization decreased from 9% to 7% (P = 0.06). Compared with patients who underwent radical cystectomy, patients treated with PC less frequently received NAC (7% vs. 17%, P < 0.01) and LND (57% vs. 91%, P < 0.01), but were less likely to experience treatment delays (25% vs. 31%, P < 0.01). Only 4.1% (27/655) of patients treated with PC received the combination of NAC, LND, and no treatment delay. In a Cox model, adequacy of LND was associated with improved OS (<10 nodes: HR 0.62, 95% CI 0.48-0.81 and ≥10 nodes: HR 0.48, 95% Cl 0.32-0.72).
CONCLUSION
PC is uncommon and associated with poorer utilization of NAC and LND, but fewer treatment delays. The adequacy of LND was associated with improved OS while NAC and treatment delay were not.
Topics: Aged; Aged, 80 and over; Antineoplastic Combined Chemotherapy Protocols; Chemotherapy, Adjuvant; Combined Modality Therapy; Cystectomy; Female; Follow-Up Studies; Humans; Lymph Node Excision; Male; Muscle Neoplasms; Neoadjuvant Therapy; Neoplasm Invasiveness; Prognosis; Survival Rate; Time-to-Treatment; Urinary Bladder Neoplasms
PubMed: 33640225
DOI: 10.1016/j.urolonc.2021.01.016 -
International Journal of Urology :... Mar 2023To clarify the trends in radical cystectomy and to compare surgical outcomes among surgical approaches focusing on robot-assisted radical cystectomy based on a Japanese...
Trends of radical cystectomy and comparisons of surgical outcomes among surgical approaches focusing on robot-assisted radical cystectomy: A Japanese nationwide database study.
OBJECTIVE
To clarify the trends in radical cystectomy and to compare surgical outcomes among surgical approaches focusing on robot-assisted radical cystectomy based on a Japanese nationwide database.
METHODS
The Diagnosis Procedure Combination database was used to extract data on radical cystectomy cases. Trends in open radical cystectomy, laparoscopic radical cystectomy, minimum incision endoscopic radical cystectomy, and robot-assisted radical cystectomy between April 2012 and March 2021 were evaluated. Basic characteristics and peri-operative indicators were compared among the four groups. Propensity score matching was applied to assess the differences between open radical cystectomy and robot-assisted radical cystectomy.
RESULTS
During the study period, a decreasing number of open radical cystectomies and an increasing number of minimally invasive radical cystectomies were shown in the total cohort of 28 345 cases. The number of robot-assisted radical cystectomies rapidly increased after government approval in 2018. Minimally invasive radical cystectomies, including robot-assisted radical cystectomies, had a significantly lower complication rate, a shorter length of stay, and a lower blood transfusion rate, but a longer anesthesia time than open radical cystectomies. In the propensity score matching analysis comparing the surgical outcomes of robot-assisted radical cystectomy and open radical cystectomy, similar results were demonstrated, and blood transfusion rates were equivalent.
CONCLUSION
For the past decade, the number of minimally invasive radical cystectomies has steadily increased without compromised surgical outcomes, except for anesthesia time. Robot-assisted radical cystectomies in particular rapidly became widespread in Japan after government approval in 2018 and became a standard surgery within the first 3 years.
Topics: Humans; Cystectomy; Robotics; East Asian People; Robotic Surgical Procedures; Urinary Bladder Neoplasms; Treatment Outcome; Postoperative Complications
PubMed: 36520885
DOI: 10.1111/iju.15099 -
World Journal of Urology Jun 2021To evaluate late complications in a large cohort of patients undergoing robot-assisted radical cystectomy (RARC) with totally intracorporeal urinary diversion (ICUD).
INTRODUCTION AND OBJECTIVES
To evaluate late complications in a large cohort of patients undergoing robot-assisted radical cystectomy (RARC) with totally intracorporeal urinary diversion (ICUD).
MATERIALS AND METHODS
We prospectively enrolled patients who underwent RARC and ICUD between August 2012 and June 2019. We excluded patients with Ejection fraction < 36%, retinal vasculopathy, ventriculoperitoneal shunts, and those treated without curative intent. All complications and their onset date have been recorded, defined, and graded according to Clavien classification adapted for radical cystectomy.
RESULTS
210 patients were included, 76% of whom were men, with a mean age of 62 years. Urinary diversions used were Padua Ileal Bladder (PIB) in 80% of cases, and ileal conduit (IC) in 20% of patients (generally older and with more comorbidity). The mean follow-up was 30 ± 22 months. The stenosis rate of uretero-ileal anastomosis was 14%, while a reduction in eGFR (≥ 20%) was observed in about half of the cases. UTIs occurred in 37% of the patients, especially in the first 12 months. Only 2% of patients had bowel occlusion, whereas incisional hernia, lymphocele, and systemic events (metabolic acidosis and major cardiovascular events) occurred respectively in 20%, 10%, and 1% of cases.
CONCLUSIONS
Our study evaluates first late complications in a cohort of patients who underwent RARC with ICUD. These data are encouraging and in line with findings from a historical series of open radical cystectomy (ORC). This study is a further step in supporting RARC as a safe and effective surgical option for the treatment of muscle-invasive bladder cancer (MIBC) in tertiary referral centers.
Topics: Aged; Cystectomy; Female; Humans; Male; Middle Aged; Postoperative Complications; Retrospective Studies; Robotic Surgical Procedures; Time Factors; Urinary Diversion
PubMed: 32747981
DOI: 10.1007/s00345-020-03378-7 -
BJU International Nov 2022To describe clinical, imaging, and histopathological characteristics of inflammatory myofibroblastic tumour (IMT) of the urinary bladder and provide initial management...
OBJECTIVES
To describe clinical, imaging, and histopathological characteristics of inflammatory myofibroblastic tumour (IMT) of the urinary bladder and provide initial management and surveillance recommendations.
PATIENTS AND METHODS
We identified patients with IMT of the bladder treated at our facility from 1998 to 2020. Categorical variables were analysed with chi-square and Fisher's exact tests and continuous variables with the Mann-Whitney U-test. Kaplan-Meier analysis was performed for recurrence-free survival.
RESULTS
IMT was diagnosed in 35 patients with median (interquartile range [IQR]) follow-up of 20 (11.5-68.5) months. At initial diagnosis 86% were clinically organ-confined, 9% locally advanced, and 5% metastatic. Majority of patients (92%) had residual disease on re-staging transurethral resection (TUR). Of the 15 patients with organ-confined disease managed initially with TUR alone, five (33%) recurred at a median (IQR) of 5 (3.0-5.5) months from initial diagnosis. Presentation with visible haematuria was associated with recurrence (100% in recurrence vs 40% in non-recurrence groups, P = 0.044). There were no patients who developed a recurrence beyond 6 months after diagnosis. Partial or radical cystectomy was required in 23% and 9% of patients, respectively. One patient presented with metastatic disease associated with anaplastic lymphoma kinase (ALK) translocation and achieved a durable complete remission with 7 months of crizotinib therapy.
CONCLUSIONS
No patient with IMT treated with aggressive endoscopic management developed recurrences beyond 6 months. There were additionally no recurrences noted after definitive radical or partial cystectomy. These data support organ sparing therapy with aggressive endoscopic management and short-term surveillance in patients with localised IMT, with extirpative surgery reserved for refractory cases.
Topics: Humans; Urinary Bladder; Anaplastic Lymphoma Kinase; Urinary Bladder Neoplasms; Crizotinib; Cystectomy; Neoplasm Recurrence, Local
PubMed: 34773684
DOI: 10.1111/bju.15638 -
Seminars in Ultrasound, CT, and MR Aug 2020Various surgical techniques exist for urinary diversion post cystectomy and each have different imaging features. This diverse range of surgical procedures can make... (Review)
Review
Various surgical techniques exist for urinary diversion post cystectomy and each have different imaging features. This diverse range of surgical procedures can make imaging interpretation difficult and so familiarity with the postoperative anatomy is essential. Multiple imaging modalities and techniques are available for the radiologist's assessment including fluoroscopic studies, computed tomography, magnetic resonance, and radionuclide imaging. Knowledge of when each of these modalities is indicated and the typical imaging appearances is essential for early identification of postoperative complications and detection of tumor recurrence. This information enables the radiologist to make an accurate and early diagnosis and subsequently guide the management pathway for these patients.
Topics: Cystectomy; Humans; Multimodal Imaging; Postoperative Complications; Urinary Bladder; Urinary Diversion
PubMed: 32620229
DOI: 10.1053/j.sult.2020.04.008 -
International Journal of Urology :... Jun 2021To compare perioperative and oncologic survival outcomes between laparoscopic radical cystectomy and open radical cystectomy.
OBJECTIVES
To compare perioperative and oncologic survival outcomes between laparoscopic radical cystectomy and open radical cystectomy.
METHODS
A total of 607 patients underwent open radical cystectomy (n = 412) or laparoscopic radical cystectomy (n = 195) at a single academic institution from January 2006 to April 2017. Their medical records were retrospectively analyzed. One-to-one propensity score matching was carried out to reduce selection bias. Estimated blood loss and complications were compared. Overall survival, cancer-specific survival and progression-free survival estimates for all patients and patients with locally advanced bladder cancer were analyzed using the Kaplan-Meier method.
RESULTS
Either before or after matching, the laparoscopic radical cystectomy group had less estimated blood loss (P < 0.001 and P < 0.001) and fewer complications (P < 0.001 and P = 0.008). There was no difference in the overall survival (P = 0.216 and P = 0.961) and progression-free survival (P = 0.826 and P = 0.462) for all the patients having either laparoscopic radical cystectomy or open radical cystectomy. However, the 5-year progression-free survival of open radical cystectomy was higher than that of laparoscopic radical cystectomy (P = 0.019 and P = 0.021) for patients with locally advanced bladder cancer.
CONCLUSIONS
Laparoscopic radical cystectomy is superior to open radical cystectomy in terms of perioperative outcomes, and similar to open radical cystectomy in terms of oncologic outcomes for patients with early stage bladder cancer. However, for patients with locally advanced bladder cancer, laparoscopic radical cystectomy seems to be associated with shorter progression-free survival than open radical cystectomy.
Topics: Cystectomy; Humans; Laparoscopy; Retrospective Studies; Survival Analysis; Treatment Outcome; Urinary Bladder Neoplasms
PubMed: 33714227
DOI: 10.1111/iju.14537 -
Actas Urologicas Espanolas Mar 2021Radical cystectomy is a complex surgery with a high rate of complications including infections, which lead to increased morbidity and mortality, longer hospital stay and...
INTRODUCTION AND OBJECTIVE
Radical cystectomy is a complex surgery with a high rate of complications including infections, which lead to increased morbidity and mortality, longer hospital stay and higher costs. The aim of this work is to evaluate health care-associated infections (HAIs) in these patients, as well as associated microorganisms, antibiotic resistance profiles and risk factors.
MATERIAL AND METHODS
Prospective study from 2012 to 2017. Epidemiologic variables, comorbidities and surgical variables are collected. The microorganisms involved and antibiotic susceptibility patterns are analyzed.
RESULTS
122 patients. Mean age 67 (SD:18,42). Mean hospital stay 23.5 days (18.42). HAIs rate of 45%, with predominant urinary tract infections (43%) and surgical wound infections (31%). Positive cultures in 78.6% of cases. Increased isolation of Enterococcus (18%) and Escherichia coli (13%). Forty-three percent of microorganisms were resistant to amoxicillin/ampicillin, 23% to beta-lactamases and 36% to quinolones. Empirical treatment was adequate in 87.5%. Hospital stay is increased (17 days, p< 0.05) due to HAIs. Lower rate of infectious complications in the laparoscopic vs. open approach (p< 0.001) and in orthotopic vs. ileal conduit diversion (p = 0.04) CONCLUSIONS: We found a high rate of HAIs in our radical cystectomy series, with predominant urinary tract and surgical wound infections. E.coli and Enterococcus spp. are the most frequently isolated microorganisms, with high rates of resistance to some commonly used antibiotics.
Topics: Adolescent; Adult; Aged; Cross Infection; Cystectomy; Drug Resistance, Microbial; Female; Humans; Male; Middle Aged; Postoperative Complications; Prospective Studies; Risk Factors; Young Adult
PubMed: 32948346
DOI: 10.1016/j.acuro.2020.06.004 -
Seminars in Oncology Nursing Oct 2020Muscle invasive bladder cancer (MIBC) is commonly treated with radical cystectomy. Patients who require radical cystectomy are often frail, unwell, have multiple... (Review)
Review
BACKGROUND
Muscle invasive bladder cancer (MIBC) is commonly treated with radical cystectomy. Patients who require radical cystectomy are often frail, unwell, have multiple comorbidities, and can experience unmet supportive care needs. Due to these complexities, patients requiring radical cystectomy are often considered high risk for anesthetics, and therefore improving their physical and psychological well-being is crucial prior to radical surgery. Prehabilitation is the practice of enhancing a patient's functional and psychological capacity before surgery, with the aim of improving postoperative outcomes. This narrative review aims to identify and evaluate the role of physical exercise, nutritional intervention, and person-centered holistic approaches to prehabilitation in people affected by MIBC treated by radical cystectomy.
DATA SOURCES
Electronic databases including CINAHL, MEDLINE, PsychINFO, Scopus, and grey literature were searched using Google scholar until June 2020.
CONCLUSION
Evidence to support specific prehabilitation clinical recommendations in people affected by MIBC is emerging. Prehabilitation including exercise prescription, nutritional intervention, and person-centered holistic support is an important part of the clinical pathway for people affected by MIBC. Individualized prehabilitation programs across the multidisciplinary team should be considered to provide specific individual recommendations to avoid "one size fits all". Given the limited research in this clinical area, future high-quality multi-center prospective trials are urgently needed.
IMPLICATIONS FOR NURSING PRACTICE
People affected by MIBC can experience a range of unmet supportive care needs in routine clinical care delivery at the time of diagnosis and into survivorship. Evidence is emerging around the role of multidisciplinary interventions in the form of exercise, nutritional input, and holistic supportive care to improve physical and psychological well-being prior to major surgery. Specialist nurses are ideally placed to ensure that individual holistic care needs are addressed, and appropriate care and support is provided. Nurses can trigger timely referrals to members of the multidisciplinary team to coordinate an integrated person-centered approach to prehabilitation service provision to address the unmet needs of people undergoing treatment for MIBC.
Topics: Cystectomy; Female; Humans; Male; Nutrition Therapy; Patient-Centered Care; Preoperative Exercise; Urinary Bladder Neoplasms
PubMed: 33010983
DOI: 10.1016/j.soncn.2020.151072