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Fa Yi Xue Za Zhi Oct 2021
Topics: Cystectomy; Female; Humans; Intrauterine Devices
PubMed: 35191241
DOI: 10.12116/j.issn.1004-5619.2020.201005 -
Archivos Espanoles de Urologia Dec 2020With increasing survival from bladder cancer, quality of life, should be one of the main goals following radical cystectomy and bilateral pelvic lymph node dissection... (Review)
Review
INTRODUCTION
With increasing survival from bladder cancer, quality of life, should be one of the main goals following radical cystectomy and bilateral pelvic lymph node dissection (PLND). This techniqueis associated with significant morbidity, which may have a critical effect on quality of life. Concerns about functional outcomes, such as continence, potency, and sexual function in women, play a role in decision making for urologists and younger patients with muscle-invasive bladder cancer. Several modifications to the classic radical cystectomy technique, include preservation of genital or pelvic organs, developing in the improvement of postoperative continence, potency rates and sexual functionin female patients. OBJECTIVE: This review summarizes the organ-sparing cystectomy techniques and its functional and oncological outcomes.
EVIDENCE ACQUISITION
A PubMed-based literature search was conducted up to April 2020. We selected the most recent and relevant original articles, metanalysis and reviews that have provided relevant information to guide organ-sparing cystectomy techniques and its functional and oncological outcomes.
EVIDENCE SYNTHESIS
In this review, we discuss selection criteria for male and female patients, organ-sparing cystectomy surgical techniques and its functional and oncological outcomes.
CONCLUSIONS
Radical cystectomy is associated with significant morbidity, which may have a critical effect on quality of life. Preservation of genital or pelvic organsin men and women, yield better sexual outcomes compared to radical cystectomy without compromising oncological outcomes in well selected patients. But no one of these techniques can be recommended over the classical standard radical cystectomy. Large-scale of prospective and multi-institutional studies are needed to conclude which patients are suitable for these techniques.
Topics: Cystectomy; Female; Humans; Male; Prospective Studies; Quality of Life; Treatment Outcome; Urinary Bladder Neoplasms
PubMed: 33269715
DOI: No ID Found -
International Journal of Surgery... Oct 2021To systematically review studies comparing the perioperative outcomes of intracorporeal robot-assisted radical cystectomy (iRARC) and open radical cystectomy (ORC). (Meta-Analysis)
Meta-Analysis Review
PURPOSE
To systematically review studies comparing the perioperative outcomes of intracorporeal robot-assisted radical cystectomy (iRARC) and open radical cystectomy (ORC).
METHODS
Systematic searches of PubMed, Web of Science and the Cochrane Library were performed in June 2020. Studies with data comparing iRARC and ORC were included in our review, and a pooled meta-analysis was completed.
RESULTS
In total, 8 studies (7 prospective studies, 1 retrospective study) comparing 1193 patients were included for our review and meta-analysis. Compared with ORC, iRARC demonstrated lower estimated blood loss (weighted mean difference (WMD): -449.25; 95% CI -566.47 - -332.03; p < 0.01), lower blood transfusion rates (OR: 0.31; 95% CI 0.22 - 0.46; p < 0.01), and lower postoperative complication rates with Clavien-Dindo grades III-IV (30 days: OR: 0.65; 95% CI 0.47 - 0.90; p = 0.01; 90 days: OR: 0.72; 95% CI 0.53 - 0.98; p = 0.04), but a longer operative time (WMD: 78.82; 95% CI 52.77 - 104.87; P < 0.01). Furthermore, there was no significant difference between iRARC and ORC in terms of postoperative complication rates with Clavien-Dindo grades Ⅰ-Ⅱ (30 days: OR: 0.71; 95% CI 0.36 - 1.40; p = 0.32; 90 days: OR: 0.98; 95% CI 0.74 - 1.30; p = 0.89), length of stay (WMD: -1.18; 95% CI -3.33 - -2.07; p = 0.06) and positive surgical margins (OR: 0.78; 95% CI 0.0.45 - 1.36; p = 0.38).
CONCLUSION
iRARC was associated with a significantly lower estimated blood loss and a lower blood transfusion rate and major postoperative complication rate than ORC.
Topics: Cystectomy; Humans; Postoperative Complications; Prospective Studies; Retrospective Studies; Robotic Surgical Procedures; Robotics; Treatment Outcome; Urinary Bladder Neoplasms
PubMed: 34600124
DOI: 10.1016/j.ijsu.2021.106137 -
European Urology Nov 2023Little is known regarding functional outcomes after robot-assisted radical cystectomy (RARC) and intracorporeal neobladder (ICNB) reconstruction.
BACKGROUND
Little is known regarding functional outcomes after robot-assisted radical cystectomy (RARC) and intracorporeal neobladder (ICNB) reconstruction.
OBJECTIVE
To report on urinary continence (UC) and erectile function (EF) at 12 mo after RARC and ICNB reconstruction and investigate predictors of these outcomes.
DESIGN, SETTING, AND PARTICIPANTS
We used data from a multi-institutional database of patients who underwent RARC and ICNB reconstruction for bladder cancer.
SURGICAL PROCEDURE
The cystoprostatectomy sensu stricto followed the conventional steps. ICNB reconstruction was performed at the physician's discretion according to the Studer/Wiklund, S pouch, Gaston, vescica ileale Padovana, or Hautmann technique. The techniques are detailed in the video accompanying the article.
MEASUREMENTS
The outcomes measured were UC and EF at 12 mo.
RESULTS AND LIMITATIONS
A total of 732 male patients were identified with a median age at diagnosis of 64 yr (interquartile range 58-70). The ICNB reconstruction technique was Studer/Wiklund in 74%, S pouch in 1.5%, Gaston in 19%, vescica ileale Padovana in 1.5%, and Hautmann in 4% of cases. The 12-mo UC rate was 86% for daytime and 66% for nighttime continence, including patients who reported the use of a safety pad (20% and 32%, respectively). The 12-mo EF rate was 55%, including men who reported potency with the aid of phosphodiesterase type 5 inhibitors (24%). After adjusting for potential confounders, neobladder type was not associated with UC. Unilateral nerve-sparing (odds ratio [OR] 3.85, 95% confidence interval [CI] 1.88-7.85; p < 0.001) and bilateral nerve-sparing (OR 6.25, 95% CI 3.55-11.0; p < 0.001), were positively associated with EF, whereas age (OR 0.93, 95% CI 0.91-0.95; p < 0.001) and an American Society of Anesthesiologists score of 3 (OR 0.46, 95% CI 0.25-0.89; p < 0.02) were inversely associated with EF.
CONCLUSIONS
RARC and ICNB reconstruction are generally associated with good functional outcomes in terms of UC. EF is highly affected by the degree of nerve preservation, age, and comorbidities.
PATIENT SUMMARY
We investigated functional outcomes after robot-assisted removal of the bladder in terms of urinary continence and erectile function. We found that, in general, patients have relatively good functional outcomes at 12 months after surgery.
Topics: Humans; Male; Urinary Bladder; Cystectomy; Robotics; Erectile Dysfunction; Treatment Outcome; Urinary Bladder Neoplasms; Robotic Surgical Procedures; Urinary Diversion
PubMed: 37117109
DOI: 10.1016/j.eururo.2023.04.009 -
International Braz J Urol : Official... 2022To describe the current scientific knowledge and clinical experience in low-grade-non-muscle-invasive bladder cancer (LG-NMIBC) patients in challenging scenarios. (Review)
Review
PURPOSE
To describe the current scientific knowledge and clinical experience in low-grade-non-muscle-invasive bladder cancer (LG-NMIBC) patients in challenging scenarios.
MATERIALS AND METHODS
Medline, Embase, Google Scholar, and Cochrane Central were searched until March 2021.
RESULTS
A total of 841 studies were identified, and abstracts were analyzed. Twenty-one relevant studies were then identified and reviewed. After all, information was gathered from 16 studies, the authors discussed the specific topics, and expert opinions were also included in the discussion. There have been some studies that can help us to have some insights on how to manage these patients. Very distinctive strategies have been reported in the literature, mainly anecdotally or in small randomized studies. Some of these treatments outlined in the present manuscript include repeated TURBTs, chemoablation, BCG immunoablation, partial cystectomy, radical cystectomy, radiotherapy, chemotherapy, and future perspectives. In the current manuscript, we have combined these strategies in a proposed algorithm.
CONCLUSION
For those LG-NMIBC patients in challenging scenarios, we have found repeated TURBTs, chemoablation, BCG immunoablation, partial cystectomy, radical cystectomy, radiotherapy, and chemotherapy are attractive modalities to treat them effectively. Also, the current manuscript proposes an algorithm to overcome these challenges.
Topics: BCG Vaccine; Cystectomy; Humans; Neoplasm Invasiveness; Urinary Bladder; Urinary Bladder Neoplasms
PubMed: 34156188
DOI: 10.1590/S1677-5538.IBJU.2021.0259 -
Proceedings of the Japan Academy.... 2020More than 90% of bladder cancer is composed of transitional cell carcinoma (TCC), being characterized by the development of multiple tumors in the entire urinary tract... (Review)
Review
More than 90% of bladder cancer is composed of transitional cell carcinoma (TCC), being characterized by the development of multiple tumors in the entire urinary tract over time. When cystectomy is conducted, the urinary tract must be reconstructed by various procedures, which can include an orthotopic neobladder using the patient's own intestine formed into a spherical shape anastomosed to the urethra. Using this procedure, patients can void urine from their own urethra even after cystectomy. The incidence of subsequent urethral cancer arising after cystectomy is known to be relatively high; however, if patients with a high risk of urethral recurrence are appropriately excluded, a neobladder can be safely provided for patients. Orthotopic neobladder use is reviewed from an oncological viewpoint and the patient's quality of life after cystectomy for bladder cancer.
Topics: Carcinogenesis; Cystectomy; Humans; Urinary Bladder Neoplasms
PubMed: 32788549
DOI: 10.2183/pjab.96.019 -
BMC Urology Sep 2021To investigate the feasibility and efficacy of carrying out pediatric laparoscopic partial cystectomies (LPC) when treating benign bladder tumors and urachal cysts.
OBJECTIVE
To investigate the feasibility and efficacy of carrying out pediatric laparoscopic partial cystectomies (LPC) when treating benign bladder tumors and urachal cysts.
METHODS
Retrospectivey analyzing 4 clinical cases involving children with bladder tumors, which were collected from October 2017 to December 2018. In these clinical cases, there were 3 male children and 1 female child, aged from 4.5 to 9.4 years old, with an average age of 6.5 years. An intraperitoneal laparoscopic partial cystectomy was performed in the treatment of 3 of these patients with benign bladder tumors and in 1 patient with an urachal cyst. The surgical procedures included a partial cystectomy and a complete intracavitary bladder suture.
RESULTS
All 4 cases were successful and no operation was transferred to opensurgery. The operation time was 100-120 min, with an average time of 108 min. The intraoperative blood loss was 10-20 ml, with an average loss of 15 ml. 6 h after the operation, the patients still maintained a fluid diet and 1 case of hematuria had occurred, with the catheter removed 12 days after the operation. No postoperative urine leakage, intestinal adhesion or intestinal obstruction occurred, and the average postoperative hospitalization time was 14 days.
CONCLUSION
Laparoscopic partial cystectomy is a safe and feasible method to be used for the treatment of benign bladder tumors and urachal cysts. It presents the advantages of being minimally invasive, and having a quick recovery and short hospitalization time. It is an alternative surgical method for the treatment of pediatric benign bladder tumors.
Topics: Blood Loss, Surgical; Child; Child, Preschool; Cystectomy; Feasibility Studies; Female; Hematuria; Humans; Laparoscopy; Male; Operative Time; Retrospective Studies; Urachal Cyst; Urinary Bladder Neoplasms
PubMed: 34526006
DOI: 10.1186/s12894-021-00893-6 -
European Urology Focus Jul 2023Patients undergoing radical cystectomy frequently suffer from infectious complications, including urinary tract infections (UTIs) and surgical site infections (SSIs)... (Review)
Review
CONTEXT
Patients undergoing radical cystectomy frequently suffer from infectious complications, including urinary tract infections (UTIs) and surgical site infections (SSIs) leading to emergency department visits, hospital readmission, and added cost.
OBJECTIVE
To summarize the literature regarding perioperative antibiotic prophylaxis, ureteric stent usage, and prevalence of infectious complications after cystectomy.
EVIDENCE ACQUISITION
A systematic review of PubMed/Medline, EMBASE, Cochrane Library, and reference lists was conducted.
EVIDENCE SYNTHESIS
We identified 20 reports including a total of 55 306 patients. The median rates of any infection, UTIs, SSIs, and bacteremia were 40%, 20%, 11%, and 6%, respectively. Perioperative antibiotic prophylaxis differed substantially between reports. Perioperative antibiotics were used only during surgery in one study but were continued over several days after surgery in all other studies. Empirical use of antibiotics for 1-3 d after surgery was described in 12 studies, 3-10 d in two studies, and >10 d in four studies. Time to stent removal ranged from 4 to 25 d after cystectomy. Prophylactic antibiotics were used before stent removal in nine of 20 studies; two of these studies used targeted antibiotics based on urine cultures from the ureteric stents, and the other seven studies used a single shot or 2 d of empirical antibiotics. Studies with any prophylactic antibiotic before stent removal found a lower median percentage of positive blood cultures after stent removal than studies without prophylactic antibiotics before stent removal (2% vs 9%).
CONCLUSIONS
We confirmed a high proportion of infectious complications after cystectomy, and a heterogeneous pattern of choice and duration of antibiotics during and after surgery or stent removal. These findings highlight a need for further studies and support quality prospective trials.
PATIENT SUMMARY
In this review, we observed wide variability in the use of antibiotics before or after surgical removal of the bladder.
Topics: Humans; Antibiotic Prophylaxis; Cystectomy; Prospective Studies; Anti-Bacterial Agents; Surgical Wound Infection; Urinary Tract Infections; Stents
PubMed: 36710211
DOI: 10.1016/j.euf.2023.01.012 -
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 -
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