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Urology Mar 2022To examine the safety, feasibility and durability of robotic reimplantation of ureteroenteric stricture after radical cystectomy.
OBJECTIVE
To examine the safety, feasibility and durability of robotic reimplantation of ureteroenteric stricture after radical cystectomy.
MATERIALS AND METHODS
A retrospective multi-institutional review was performed for all patients undergoing robotic repair of ureteroenteric stricture from January 2010 to January 2019. Functional outcomes and complications were followed and data were analyzed with SPSS statistical software.
RESULTS
A total of 46 patients and 58 renal units were identified, of which 15 had right sided, 19 left sided and 12 patients had bilateral strictures. Presentation of stricture was asymptomatic in 14 (30.4%) patients. Symptomatic presentations included infection in 22 (47.8%), worsening renal function in 11 (23.9%) and pain in 3 (6.5%) patients. Median time from cystectomy to diagnosis of stricture was 5 months (1-40). Median stricture length was 1.5 cm (range 0.5-10). All strictures were of benign etiology except for 4 (6.9%), which were due to malignancy. Overall, 49 (84.5%) ureters underwent primary re-implantation, while 9 (15.5%) required Boari-like advancement flaps prior to re-implantation. Median operative time was 190 min (range 45-540) with median estimated blood loss of 50 mL (range 25-2000) and median length of stay of 2 days (range 1-33, IQR 2-4). Seven (15.2%) patients experienced complications; 3 (6.5%) were low grade and 4 (8.7%) high grade. With median follow up of 18 months (range 1-51) the stricture recurrence rate was 8.6%.
CONCLUSION
Robotic reimplantation of ureteroenteric strictures following radical cystectomy is safe and feasible in experienced centers with high success rates.
Topics: Constriction, Pathologic; Cystectomy; Humans; Postoperative Complications; Retrospective Studies; Robotic Surgical Procedures; Ureter; Urinary Diversion
PubMed: 35007620
DOI: 10.1016/j.urology.2021.11.020 -
Annals of Oncology : Official Journal... Dec 2020
Topics: Antibodies, Monoclonal, Humanized; Arachis; Carcinoma, Transitional Cell; Cystectomy; Humans
PubMed: 33068729
DOI: 10.1016/j.annonc.2020.10.468 -
Nutrients May 2024Nutrition is a key element of the prehabilitation process prior to surgery. The aim of this study was to identify the clinical pathways of nutritional prehabilitation... (Review)
Review
BACKGROUND/AIM
Nutrition is a key element of the prehabilitation process prior to surgery. The aim of this study was to identify the clinical pathways of nutritional prehabilitation before cystectomy.
METHODS
A systematic literature review was conducted in PubMed, the Cochrane Library, CINAHL, Scopus and the Web of Science databases. Quality and risk of bias assessment was conducted adhering to the JBI framework and evidence was evaluated according to the Oxford Centre for Evidence Based Medicine levels of evidence.
RESULTS
Out of 586 records identified, six studies were included. Among them, only two were randomized controlled trials. Immunonutrition has been shown to improve postoperative bowel function (3.12 vs. 3.74 days; RR 0.82; CI, 0.73-0.93; = 0.0029) and decrease postoperative complications (-36.7%; = 0.008) and readmission rates (-15.38%; = 0.03). Furthermore, oral nutritional supplements combined with nutritional counseling demonstrated an accelerated recovery of bowel function (-1 day; < 0.01), a reduction in the length of hospital stay (-1.75 days; = 0.01), an improvement in handgrip strength (+6.8%, < 0.001), an increase in bone mass (+0.3 kg, = 0.04), and a better BMI value (+2.3%, = 0.001).
CONCLUSIONS
Nutritional prehabilitation demonstrates potential in enhancing postoperative outcomes following radical cystectomy. Oral supplements, immunonutrition, and counseling exhibit efficacy in improving postoperative results.
Topics: Humans; Cystectomy; Postoperative Complications; Preoperative Care; Length of Stay; Preoperative Exercise; Nutritional Status; Dietary Supplements; Randomized Controlled Trials as Topic; Recovery of Function
PubMed: 38892615
DOI: 10.3390/nu16111682 -
World Journal of Surgical Oncology Apr 2021During the past two decades, laparoscopic radical nephroureterectomy (LRNU) has been proposed as an alternative technique to open radical nephroureterectomy (ORNU) and... (Comparative Study)
Comparative Study Meta-Analysis Review
BACKGROUND
During the past two decades, laparoscopic radical nephroureterectomy (LRNU) has been proposed as an alternative technique to open radical nephroureterectomy (ORNU) and has become increasingly accepted for the treatment of patients with upper tract urothelial carcinoma (UTUC). Nevertheless, the oncologic efficacy of LRNU remains controversial, especially for the treatment of locally advanced (T3/T4 and/or N+) UTUC. In this meta-analysis, we aimed to cumulatively compare the oncological outcomes of LRNU versus ORNU.
MATERIALS AND METHODS
The present meta-analysis was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. A search was conducted of three electronic databases, namely, Medline, Embase, and Cochrane Library. Outcome measurements of cancer-specific survival (CSS), overall survival (OS), intravesical recurrence-free survival (IVRFS), and recurrence-free survival (RFS), including hazard ratios (HRs) and 95% confidence intervals (CIs), were extracted and pooled.
RESULTS
Eighteen articles published from 2007 to 2020 were included in the final quantitative analysis. One study was a randomized controlled trial (RCT), and the remaining articles had a retrospective design. Among a total of 10,730 participants in the selected papers, 5959 (55.5%) and 4771 (44.5%) underwent ORNU and LRNU, respectively. The results of pooled analyses revealed no significant differences in CSS (HR 0.84, 95% CI 0.60-1.19, p = 0.33), OS (HR 0.84, 95% CI 0.62-1.13, p = 0.25), IVRFS (HR 1.08, 95% CI 0.85-1.39, p = 0.52), and RFS (HR 1.09, 95% CI 0.94-1.25, p = 0.26) between LRNU and ORNU groups. Furthermore, the results of subgroup analyses for pT3/T4 and pTany N+ populations did not confirm any statistically significant differences between LRNU and ORNU in terms of any survival parameter.
CONCLUSIONS
Our present meta-analysis of current evidence suggests that LRNU and ORNU have comparable oncological outcomes in patients with UTUC, even in those with locally advanced disease. Further multicenter RCTs with large sample sizes and uniform data regarding specific surgical procedures, such as bladder cuff excision, are required to establish definitive conclusions.
Topics: Carcinoma, Transitional Cell; Cystectomy; Humans; Kidney Neoplasms; Laparoscopy; Nephroureterectomy; Prognosis; Randomized Controlled Trials as Topic; Ureteral Neoplasms
PubMed: 33882936
DOI: 10.1186/s12957-021-02236-z -
Archivio Italiano Di Urologia,... Jun 2022Radical cystectomy (RC) continues to be standard of care for muscle-invasive bladder cancer and recurrent or refractory nonmuscle invasive bladder cancer. Unfortunately,...
INTRODUCTION AND OBJECTIVES
Radical cystectomy (RC) continues to be standard of care for muscle-invasive bladder cancer and recurrent or refractory nonmuscle invasive bladder cancer. Unfortunately, it has high rates of perioperative morbidity and mortality. One of the most important predictors of postoperative outcomes is frailty, while the majority of complications are diversion related. The aim of our study was to evaluate safety of extraperitoneal cystectomy with ureterocutaneostomy in patients considered as frail.
MATERIALS AND METHODS
We retrospectively collected data of frail patients who underwent extraperitoneal cystectomy with ureterocutaneostomy from October 2018 to August 2020 in a single center. We evaluated frailty by assessing patients' age, body mass index (BMI), nutritional status by Malnutrition Universal Screening Tool, overall health by RAI (Risk Analysis Index) and ASA (American Society of Anaesthesiologists) score, and laboratory analyses. We observed intraoperative outcomes and rates of perioperative (within 30 days) and early postoperative (within 90 days) complications (Clavien-Dindo classification). We defined extraperitoneal cystectomy with ureterocutaneostomy as safe if patients did not develop Clavien Dindo IIIb, or worse, complication.
RESULTS
A total of 34 patients, 3 female and 31 male, were analyzed. The median age was 77, BMI 26, RAI 28, ASA 3 and the majority had preexisting renal insufficiency. Blood analyses revealed presence of severe preoperative hypoalbuminemia and anemia in half of our cohort. Intraoperative median blood loss was 250 cc, whilst operative time 245 min. During perioperative period 60% of our cohort developed Clavien Dindo II complication and during early postoperative period 32% of patients required readmission. One death occurred during early postoperative period (2.9%). After 12 months of follow-up, we observed stability of the renal function for most patients.
CONCLUSIONS
We believe that extraperitoneal cystectomy with ureterocutaneostomy could be considered as a treatment option for elderly and/or frail patients.
Topics: Aged; Blood Loss, Surgical; Cystectomy; Female; Frailty; Humans; Male; Postoperative Complications; Retrospective Studies; Treatment Outcome; Urinary Bladder; Urinary Bladder Neoplasms
PubMed: 35775336
DOI: 10.4081/aiua.2022.2.144 -
Cancer Medicine Nov 2022Given the low incidence of urachal carcinoma of the bladder (UCB), there is limited published data from contemporary population-based cohorts. This study aimed to...
BACKGROUND
Given the low incidence of urachal carcinoma of the bladder (UCB), there is limited published data from contemporary population-based cohorts. This study aimed to describe demographic, clinicopathological features, and survival outcomes of patients diagnosed with UCB.
METHODS
The National Cancer Database (2004-2016) was queried for UCB patients. Descriptive analyses characterized demographics and clinicopathologic features. We assessed 5-year overall survival (OS) rates of the entire cohort and subgroups of localized/locally advanced and metastatic disease. We utilized Cox proportional hazards models to assess the association between covariates of interest and all-cause mortality and to examine the impact of surgical technique and chemotherapy.
RESULTS
We identified 841 patients with UCB. The most common histologic subtype was non-mucinous adenocarcinoma (39.6%). Approximately 50% had ≥cT2 disease, and 14.3% were metastatic at diagnosis. Altogether, partial cystectomy (60%) was most performed, and lymph node dissection was performed in 377 patients (44.8%), with specific temporal increase in utilization over the study period (p < 0.001). Overall, median OS was 59 months, and 5-year OS was 49%. In patients with localized/locally advanced disease, we found no association between partial and radical cystectomy (Hazards ratio [HR] 1.75; 95% CI 0.72-4.3) as well as receipt of perioperative chemotherapy (HR 1.97, 95% CI 0.79-4.90) and outcomes. Lastly, receipt of systemic therapy was not associated with survival benefit (HR 0.785, 95% CI 0.37-1.65) in metastatic disease cohort.
CONCLUSION
This large population-based cohort provides insight into the surgical management and systemic therapy, without clear evidence on the association of chemotherapy and survival in the perioperative and metastatic setting.
Topics: Humans; Carcinoma, Transitional Cell; Urinary Bladder; Neoplasm Staging; Urinary Bladder Neoplasms; Cystectomy; Retrospective Studies
PubMed: 35509235
DOI: 10.1002/cam4.4786 -
Investigative and Clinical Urology Sep 2022With the increasing application of laparoscopic or robot-assisted radical cystectomy, a reliable and promising method is needed for reducing postoperative complications....
Laparoscopic radical cystectomy with pelvic lymph node dissection and ileal orthotopic neobladder by a total extraperitoneal approach: Our initial technique and short-term outcomes.
PURPOSE
With the increasing application of laparoscopic or robot-assisted radical cystectomy, a reliable and promising method is needed for reducing postoperative complications. We describe the short-term outcomes of totally extraperitoneal laparoscopic radical cystectomy (TELRC) with extraperitoneal pelvic lymph node dissection (EPLND) and extraperitoneal ileal orthotopic neobladder (EION) techniques.
MATERIALS AND METHODS
From January 2020 to December 2021, we performed TELRC and EPLND with EION in 72 patients in our center. The accompanying video highlights our novel techniques. The patients' demographic data, intraoperative data, and perioperative complications were collected, and short-term oncological and functional results are reported.
RESULTS
All procedures were technically successful without conversion to open surgery. The patients' mean body mass index was 26.22±5.71. Median age was 57.51±12.34 years. Average hospital stay was 13.78±4.62 days. Median intraoperative blood loss was 112.92±88.56 mL. No blood transfusion was needed during the operations and only one blood transfusion was performed during the perioperative period. Mean operating time was 259.44±49.84 minutes. Average cost was US$9,875.71±1,873.08. Postoperative short-term complications included short-term ileus (n=3), infection (n=13), leakage of urine (n=11), and lymph fistula (n=7). One late complication of unilateral vesicoureteral anastomotic stenosis occurred. The mean follow-up was 13.42±8.77 months, and no patient developed local or systemic recurrence. The short-term follow-up and small cohort of patients limited our evaluation of outcomes.
CONCLUSIONS
TELRC with PLND and EION was technically feasible and clinically promising, with a reduced potential harm of postoperative complications. Long-term follow-up and a larger cohort of patients are needed for further study.
Topics: Aged; Cystectomy; Humans; Laparoscopy; Lymph Node Excision; Middle Aged; Postoperative Complications; Treatment Outcome; Urinary Bladder Neoplasms
PubMed: 36067997
DOI: 10.4111/icu.20220156 -
Magyar Onkologia Dec 2021Urothelial cell tumors are the most common malignant urinary tract lesions, affecting the bladder in the majority of cases, however, 5% of the tumors occur in the upper...
Urothelial cell tumors are the most common malignant urinary tract lesions, affecting the bladder in the majority of cases, however, 5% of the tumors occur in the upper urinary tract (urethra, renal pelvis). About 2,000 new diseases occur in Hungary every year and due to this tumor, almost 1,000 deaths occur in every year. The purpose of this paper is to summarize the results of radical surgery indicated in patients with non-invasive and muscle-invasive urothelial cancer, as well as its international recommendations. Based on the AUA and EAU guidelines, the latest and standard treatment options are described. Transurethral resection (TUR) is still a gold standard in the initial diagnosis and treatment of non-muscle invasive bladder cancer (NMIBC). The indication for radical cystectomy in addition to muscle invasive tumors (T2-T4a, N0-Nx, M0) is BCG resistant in T1G3 (evidence level: 3, recommendation level: B). Risk stratification is of paramount importance for the future treatment and follow-up of patients with bladder urothelial cell tumors. Although the proportions of changes in surgical care lag behind the novelties of urooncological treatments, advances in surgical technique, urinary tract reconstruction, and multimodal therapy may continue to improve the prognosis and quality of life of patients with bladder urothelial cell tumors. Tenke P, Fábián N, Németh Z. Modern surgical treatment of urothelial tumors.
Topics: Carcinoma, Transitional Cell; Cystectomy; Humans; Neoplasm Invasiveness; Quality of Life; Urinary Bladder Neoplasms
PubMed: 34874361
DOI: No ID Found -
International Braz J Urol : Official... 2019The health-related QoL is a patient-centered evaluation covering several aspects. This evaluation seems to be particularly important in patients submitted to radical... (Review)
Review
INTRODUCTION
The health-related QoL is a patient-centered evaluation covering several aspects. This evaluation seems to be particularly important in patients submitted to radical cystectomy (RC) and urinary diversion with ileal conduit (IC) or a neobladder (NB).
OBJECTIVE
Review all recent data comparing QoL outcomes after radical cystectomy with NB and IC diversions.
EVIDENCE ACQUISITION
A systematic search in PubMed/Medline, Embase, and Cochrane databases was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement in December 2018. All articles published from January 01, 2012 to December 31, 2018, were included. A study was considered relevant if it compared QoL outcomes using validated questionnaires (EORTC QLQ C30, FACT-G, FACT-BL, FACT-VCI, and BCI).
EVIDENCE SYNTHESIS
In 11 included studies, a total of 1389 participants were accounted (730 NB and 659 IC cases). The studies were conducted in 8 different countries, two were prospective, and none was randomized. There were two studies favoring results with a neobladder, 3 with incontinent diversion and 6 with no differences. The EORTC-QLQ-C30 was the most used instrument (5 studies) followed by FACT VCI and BCI (3 studies each). Given the heterogeneity of data and lack of prospective studies, a meta-analysis was not performed.
CONCLUSION
No superiority of one urinary diversion was characterized. It seems that the choice must be individualized with an extensive preoperative orientation of the patient and their relatives. That will probably infl uence how the patient accepts the new condition.
Topics: Cystectomy; Female; Humans; Male; Quality of Life; Surveys and Questionnaires; Time Factors; Treatment Outcome; Urinary Diversion
PubMed: 31808396
DOI: 10.1590/S1677-5538.IBJU.2018.0858 -
Journal of Medical Case Reports Dec 2022Bladder paraganglioma is a neuroendocrine tumor that accounts for less than 0.1% of all bladder tumors. Symptoms caused by catecholamine release such as hypertension,...
BACKGROUND
Bladder paraganglioma is a neuroendocrine tumor that accounts for less than 0.1% of all bladder tumors. Symptoms caused by catecholamine release such as hypertension, palpitation, syncope, and macroscopic hematuria are the most common findings. Treatment modalities include transurethral resection, and partial or total cystectomy.
CASE PRESENTATION
A 38-year-old Turkish female patient was examined for hematuria that had been persisting for 6 months. Among the clinical findings, only hematuria was present. Absence of adrenergic symptoms such as hypertension, palpitations, and syncope at the first presentation made it difficult to consider bladder paraganglioma in the differential diagnosis. Therefore, cystoscopy and transurethral resection were performed with the thought of urothelial cancer. Findings such as hypertension and bradycardia that developed during diagnostic transurethral resection suggested that it might be bladder paraganglioma. After the radiological evaluation and endocrinological preparation, the patient underwent partial cystectomy.
CONCLUSION
The rarity of cases having been reported in the literature leads to uncertainties in the management of bladder paraganglioma. Adrenergic symptoms developing during transurethral resection should suggest paraganglioma in the differential diagnosis. A multidisciplinary approach and medical treatment are mandatory to prevent life-threatening complications such as hypertensive crisis, vascular collapse, and multiple-organ system failure. We aimed to report the clinical presentation that includes only macroscopic hematuria mimicking urothelial cancer and to emphasize the multidisciplinary approach in the treatment.
Topics: Humans; Female; Adult; Urinary Bladder; Cystectomy; Hematuria; Urinary Bladder Neoplasms; Pheochromocytoma; Paraganglioma; Hypertension; Carcinoma, Transitional Cell; Adrenal Gland Neoplasms; Adrenergic Agents
PubMed: 36566235
DOI: 10.1186/s13256-022-03715-x