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The Urologic Clinics of North America Nov 1992Partial cystectomy remains an uncommonly performed procedure in the urologist's armamentarium. Historically, it has had a limited role in the treatment of bladder cancer... (Review)
Review
Partial cystectomy remains an uncommonly performed procedure in the urologist's armamentarium. Historically, it has had a limited role in the treatment of bladder cancer because of the variable reported success rate and because of the high success rate of local endoscopic excision. When patients with muscle-invasive lesions are appropriately selected, 5-year survival rates following partial cystectomy approximate those of radical cystectomy in the treatment of transitional-cell carcinoma while preserving a physiologically functioning bladder. Therefore, not only does partial cystectomy represent a valuable treatment option, but it appears to be the procedure of choice for local muscle-invasive transitional-cell carcinoma of the bladder when careful selection criteria are utilized. Future studies are needed to define its precise role in affording bladder preservation when used in association with adjuvant chemotherapy. Partial cystectomy also remains a surgical option for a variety of less common benign and malignant lesions of the bladder.
Topics: Carcinoma, Transitional Cell; Cystectomy; Humans; Neoplasm Invasiveness; Neoplasm Recurrence, Local; Postoperative Complications; Survival Rate; Urinary Bladder Diseases; Urinary Bladder Neoplasms
PubMed: 1441027
DOI: No ID Found -
Urologic Oncology Dec 2022Partial cystectomy (PC) is a bladder sparing option to treat bladder cancer in a carefully selected group of patients. We sought to analyze outcomes of partial...
PURPOSE
Partial cystectomy (PC) is a bladder sparing option to treat bladder cancer in a carefully selected group of patients. We sought to analyze outcomes of partial cystectomy (PC) in a contemporary cohort of patients at a single institution.
MATERIAL AND METHODS
Records were reviewed for 43 patients with a primary urothelial carcinoma (UC) who had a partial cystectomy with curative intent at Columbia University Medical Center from 2004 to 2019. Endpoints of interest were noninvasive recurrence (defined as any recurrent nonmuscle invasive disease), advanced recurrence (defined as a muscle invasive recurrence or metastasis), and death. We used unadjusted Cox proportional hazards regressions and log rank tests to estimate the association between clinical characteristics and endpoints of interest.
RESULTS
Among 43 patients with bladder cancer treated with partial cystectomy, median patient age was 73 years (interquartile range 67-77.5) and 86% were male. Twenty-three percent of patients received preoperative neoadjuvant chemotherapy (NAC) and 49% of patients were given perioperative intravesical chemotherapy at the time of PC. Pathologic stage was
cystectomy and 8 patients (19%) died of bladder cancer. On univariate analysis, lymphovascular invasion (hazard ratio [HR] 4.4, confidence interval [CI] 1.3-14.3), pathological stage (HR 5.9, CI 1.3-27.4), and NAC (HR 6.5, CI 1.9-22.7) were associated with advanced recurrence. Noninvasive recurrence was associated with not receiving perioperative intravesical chemotherapy (HR 0.7, CI 0.1-6.0). CONCLUSIONS
In well-selected patients, partial cystectomy offers adequate local control of bladder cancer. The risk of systemic progression is similar to reported case series of RC.
Topics: Humans; Male; Aged; Female; Cystectomy; Carcinoma, Transitional Cell; Urinary Bladder Neoplasms; Urinary Bladder; Neoplasm Recurrence, Local; Retrospective Studies; Treatment Outcome
PubMed: 36216663
DOI: 10.1016/j.urolonc.2022.09.003 -
Journal of Gastrointestinal Cancer Jun 2022Advanced colon cancers with bladder invasion pose a heavy burden and challenge towards patients and surgeons. Herein, we report our series with regards to operative and... (Review)
Review
PURPOSE
Advanced colon cancers with bladder invasion pose a heavy burden and challenge towards patients and surgeons. Herein, we report our series with regards to operative and oncological outcomes in our 8 years of experience.
METHODS
All patients with advanced colonic tumours and suspected bladder invasion being operated from 2012 to 2020 were included. The histological findings, clinical and oncological outcomes were evaluated.
RESULTS
Twenty-two patients were included. Partial cystectomy was performed in 17 of them (77%). No neoadjuvant treatment was prescribed. All preoperative computed tomography (CT) scan showed bladder invasion or colovesical fistula. True tumour invasion to bladder (T4b disease) was confirmed in 17 patients (77%) by histopathology. The 3-year overall survival and recurrence rates were 82% and 9%, respectively.
CONCLUSION
En bloc resection of colonic tumour with adherent bladder in advanced colon cancers can achieve a good operative and oncological outcome without neoadjuvant therapy. The relatively low concordance rate between preoperative CT scan and final histopathology may limit the benefit of routine administration of neoadjuvant therapy as it may overtreat and delay subsequent oncological treatment of our patients with possible added morbidity.
Topics: Colonic Neoplasms; Colorectal Neoplasms; Cystectomy; Humans; Neoplasm Invasiveness; Treatment Outcome; Urinary Bladder; Urinary Bladder Neoplasms
PubMed: 33689114
DOI: 10.1007/s12029-021-00623-z -
Current Opinion in Urology Mar 2015While radical cystectomy continues to be the gold standard for surgical management of muscle invasive bladder cancer, there has been a renewed interest in partial... (Review)
Review
PURPOSE OF REVIEW
While radical cystectomy continues to be the gold standard for surgical management of muscle invasive bladder cancer, there has been a renewed interest in partial cystectomy as a viable treatment alternative. The purpose of this review is to summarize and discuss the recent literature regarding partial cystectomy for bladder cancer.
RECENT FINDINGS
Utilization of partial cystectomy has remained stable, at a rate of 7-10% of all cystectomies performed nationally. Additionally, recent population-based series as well as single institution cohorts have found that partial cystectomy did not compromise survival when compared to radical cystectomy. While patients may recur, those with organ-confined disease had no difference in survival following salvage cystectomy when compared to primary radical cystectomy. Current data indicate 14% of patients experience an in-hospital complication, which is a marked decrease compared to radical cystectomy. Finally, innovations in surgical technique, such as robotics, as well as the inclusion of partial cystectomy into trimodal therapy, offer exciting new frontiers in bladder cancer treatment.
SUMMARY
Once maligned, partial cystectomy now represents a standard-of-care option for management of bladder cancer. Although additional research is needed to clarify patient selection and outcomes, partial cystectomy is an important treatment option for appropriately selected patients.
Topics: Carcinoma, Transitional Cell; Cystectomy; Humans; Organ Sparing Treatments; Patient Selection; Treatment Outcome; Urinary Bladder; Urinary Bladder Neoplasms
PubMed: 25581537
DOI: 10.1097/MOU.0000000000000145 -
Lower Urinary Tract Symptoms Nov 2023Interstitial cystitis/bladder pain syndrome (IC/BPS) presents a significant challenge for urologists in terms of management, owing to its chronic nature and adverse... (Review)
Review
Interstitial cystitis/bladder pain syndrome (IC/BPS) presents a significant challenge for urologists in terms of management, owing to its chronic nature and adverse impact on patient quality of life. Given the potential distinction between two disease entities within IC/BPS, namely Hunner-type IC and BPS without Hunner lesion, there is a need for an optimal therapeutic approach that focuses on the bladder lesions in Hunner-type IC. In cases where Hunner lesions are observed, complete transurethral ablation of these lesions should be prioritized as the initial intervention, as it has demonstrated effectiveness in symptom control. However, recurrence remains a limitation of this intervention. The techniques of resection and coagulation are equally effective in terms of symptom relief and recurrence prevention. Reconstructive surgery becomes necessary in cases of end-stage IC/BPS where various therapeutic approaches have failed. Patient selection is crucial in reconstructive surgery, particularly for patients with clear Hunner lesions and small bladder capacity who have not responded to previous treatments. Furthermore, it is vital to consider the patients' expectations and preferences adequately. Based on a comprehensive review of the literature and our own clinical experiences, subtotal cystectomy followed by bladder augmentation is considered a safe and effective surgical option. This stepwise and tailored therapeutic approach aims to optimize patients' quality of life by specifically targeting Hunner-type IC.
Topics: Humans; Cystitis, Interstitial; Urinary Bladder; Cystectomy; Quality of Life; Cystoscopy
PubMed: 37750459
DOI: 10.1111/luts.12505 -
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 -
The Urologic Clinics of North America May 2018Retrospective observational studies support the utility of robotic-assisted radical cystectomy (RARC). Randomized controlled trials (RCTs) have shown that RARC with... (Review)
Review
Retrospective observational studies support the utility of robotic-assisted radical cystectomy (RARC). Randomized controlled trials (RCTs) have shown that RARC with extracorporeal urinary diversion may lead to decreased estimated blood loss, decreased rate of transfusion, similar oncologic outcomes, cost-effectiveness, and variable increased operative times. Although RCTs comparing RARC with open radical cystectomy are currently ongoing, it may be several years before the utility of RARC is known. The discussion on the role of cystectomy, indications, outcomes, care pathways, access to high-volume care centers, and efforts to decrease complications may prove as important as the technique itself.
Topics: Cystectomy; Humans; Learning Curve; Randomized Controlled Trials as Topic; Robotic Surgical Procedures; Urinary Bladder Neoplasms
PubMed: 29650134
DOI: 10.1016/j.ucl.2017.12.012 -
Urologia Internationalis 2022Localized urachal cancer (UrC) can be treated with an open partial cystectomy (OPC) with en bloc resection of the urachal remnant and umbilicus. Robot-assisted partial...
INTRODUCTION
Localized urachal cancer (UrC) can be treated with an open partial cystectomy (OPC) with en bloc resection of the urachal remnant and umbilicus. Robot-assisted partial cystectomy (RAPC) is an alternative approach, of which its safety and efficacy for UrC remains to be determined. In the present study, we analyze these outcomes after RAPC, compared with OPC.
METHODS
We retrospectively evaluated 55 cN0M0 UrC patients who underwent RAPC (n = 8) or OPC (n = 47) between 1994 and 2020. Overall survival (OS) and recurrence-free survival (RFS) were assessed using Kaplan-Meier methods. Positive surgical margins (PSM), port-site recurrences (PSR) versus wound recurrences were compared. Complications were recorded using the Clavien-Dindo classification.
RESULTS
Median follow-up was 40 months (IQR 21-95). Two-year OS and RFS for RAPC were 73% (95% confidence intervals (CI); 56-89 months) and 60% (95% CI; 42-78 months), respectively, versus 90% (95% CI; 85-95 months) and 66% (95% CI; 59-73 months) for OPC. PSM rate was 13% in both groups. PSR occurred in 2/8 (25%) patients after RAPC. No wound recurrences occurred after OPC. Postoperative complications occurred in 2/8 (25%) patients after RAPC, versus 5/47 (11%) after OPC (p = 0.27).
CONCLUSION
Both RAPC and OPC seem feasible surgical modalities to treat localized UrC with comparable survival. The PSR rate of 25% after RAPC should prompt us to be cautious to recommend RAPC as no such recurrences were seen using OPC.
Topics: Cystectomy; Humans; Margins of Excision; Retrospective Studies; Robotic Surgical Procedures; Robotics; Treatment Outcome; Urinary Bladder Neoplasms
PubMed: 35134799
DOI: 10.1159/000521605 -
Clinical Techniques in Small Animal... Feb 2000Knowledge of the regional anatomy and healing characteristics of the urinary bladder are crucial to successful surgical intervention in common disorders of the bladder.... (Review)
Review
Knowledge of the regional anatomy and healing characteristics of the urinary bladder are crucial to successful surgical intervention in common disorders of the bladder. Innervation and blood supply enter the neck region of the bladder on the dorsal surface. Surgical approach to the bladder is via a ventral midline incision. Cystotomy is most commonly performed on the ventral surface of the bladder and the incision is closed using absorbable suture material in a single-layer, appositional closure. Removal of urinary calculi is the most common indication for cystotomy and should be accompanied by mucosal biopsy and culture. After cystotomy for removal of calculi, a lateral radiograph should be made to confirm removal of all calculi. Partial cystectomy is indicated for bladder trauma, neoplasia, patent urachus, and urachal diverticula. A large percentage of the bladder wall can be excised with gradual return to near normal function when the trigone region is preserved. Complete cystectomy is not recommended because of the patient morbidity and client dissatisfaction with these procedures. Tube cystostomy is performed routinely for temporary or permanent urinary diversion. Temporary diversion may be performed concurrently with surgical repair of urethral trauma or to relieve acute urethral obstructions. Permanent cystostomy may be performed in cases of neurogenic bladder atony or bladder cancer.
Topics: Animals; Cystectomy; Cystostomy; Dog Diseases; Dogs; Urinary Bladder Diseases
PubMed: 10911680
DOI: 10.1053/svms.2000.7300 -
Actas Urologicas Espanolas Sep 2015To present our center's experience in single-port umbilical laparoendoscopic partial cystectomies, in both benign and malignant pathologies. Patient characteristics,...
OBJECTIVE
To present our center's experience in single-port umbilical laparoendoscopic partial cystectomies, in both benign and malignant pathologies. Patient characteristics, perioperative aspects and the surgical techniques used are reviewed.
MATERIAL AND METHOD
Since May 2012, five patients have undergone a transumbilical single-port laparoendoscopic partial cystectomy with curved equipment through a reusable multichannel system and a 3.5mm accessory trocar. Patients were three males and two females aged between 28 and 78 (median: 44±42.5) years. The etiologies were endometriosis (in 2 cases), a tumor in the diverticulum, a congenital bladder diverticulum and ureterocele (1 case of each).
RESULTS
Median surgery time was 273±163.4minutes, and intraoperative bleeding 250±175ml. None of the patients required transfusion. The postoperative period was uneventful, with good results and no complications. The hospital stay was 3±1 days. With monitoring of 20±17.5 months, morphological and functional recovery in the bladder and ureter was confirmed in all cases and the patient with neoplastic disease was disease-free more than 2 years after the surgery.
CONCLUSIONS
An umbilical laparoendoscopic partial cystectomy represents a viable surgical option and ensures that excellent surgical and cosmetic results are achieved.
Topics: Adult; Aged; Cystectomy; Female; Humans; Laparoscopy; Male; Middle Aged; Umbilicus
PubMed: 25749459
DOI: 10.1016/j.acuro.2014.12.007