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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 -
The Urologic Clinics of North America May 2015Improvements in the accuracy of clinical staging and refinements in patient selection may allow for improved outcomes of bladder-preservation strategies for... (Review)
Review
Improvements in the accuracy of clinical staging and refinements in patient selection may allow for improved outcomes of bladder-preservation strategies for muscle-invasive bladder cancer incorporating radical transurethral resection (TUR) and partial cystectomy (PC). Retrospective studies of patients treated with radical cystectomy and pelvic lymph node dissection have reported an association between greater extent of lymphadenectomy and improved clinical outcomes. However, there is no consensus regarding the optimal extent of lymphadenectomy, as there are currently no reports from prospective, randomized trials to address this issue in regards to cancer-specific and overall survival. Future advances in the understanding of the appropriate extent of lymphadenectomy requires well-designed prospective clinical trials that directly compare varying extents of surgery with their ability to provide local and distant disease control and disease-specific survival.
Topics: Cystectomy; Humans; Lymph Node Excision; Neoadjuvant Therapy; Neoplasm Invasiveness; Organ Sparing Treatments; Patient Selection; Robotic Surgical Procedures; Urinary Bladder Neoplasms
PubMed: 25882561
DOI: 10.1016/j.ucl.2015.02.003 -
Urology Jan 2021To compare costs associated with radical versus partial cystectomy. Prior studies noted substantial costs associated with radical cystectomy, however, they lack surgical... (Comparative Study)
Comparative Study
OBJECTIVE
To compare costs associated with radical versus partial cystectomy. Prior studies noted substantial costs associated with radical cystectomy, however, they lack surgical comparison to partial cystectomy.
METHODS
A total of 2305 patients aged 66-85 years diagnosed with clinical stage T2-4a muscle-invasive bladder cancer from January 1, 2002 to December 31, 2011 were included. Total Medicare costs within 1 year of diagnosis following radical versus partial cystectomy were compared using inverse probability of treatment-weighted propensity score models. Cox regression and competing risks analysis were used to determine overall and cancer-specific survival, respectively.
RESULTS
Median total costs were not significantly different for radical than partial cystectomy in 90 days ($73,907 vs $65,721; median difference $16,796, 95% CI $10,038-$23,558), 180 days ($113,288 vs $82,840; median difference $36,369, 95% CI $25,744-$47,392), and 365 days ($143,831 vs $107,359; median difference $34,628, 95% CI $17,819-$53,558), respectively. Hospitalization, surgery, pathology/laboratory, pharmacy, and skilled nursing facility costs contributed largely to costs associated with either treatment. Patients who underwent partial cystectomy had similar overall survival but had worse cancer-specific survival (Hazard Ratio 1.45, 95% Confidence Interval, 1.34-1.58, P < .001) than patients who underwent radical cystectomy.
CONCLUSION
While treatments for bladder cancer are associated with substantial costs, we showed radical cystectomy had comparable total costs when compared to partial cystectomy among patients with muscle-invasive bladder cancer. However, partial cystectomy resulted in worse cancer-specific survival further supporting radical cystectomy as a high-value surgical procedure for muscle-invasive bladder cancer.
Topics: Aged; Aged, 80 and over; Clinical Decision-Making; Costs and Cost Analysis; Cystectomy; Female; Humans; Kaplan-Meier Estimate; Male; Medicare; Neoplasm Invasiveness; Propensity Score; SEER Program; Treatment Outcome; United States; Urinary Bladder; Urinary Bladder Neoplasms
PubMed: 32980405
DOI: 10.1016/j.urology.2020.08.058 -
AORN Journal Apr 2018
Topics: Cystectomy; Humans; Postoperative Complications; Preoperative Care; Treatment Outcome; Urologic Surgical Procedures; Workflow
PubMed: 29595911
DOI: 10.1002/aorn.12133 -
Veterinary Surgery : VS Apr 2024To describe a technique for laparoscopic partial cystectomy and evaluate sealing of canine urinary bladder tissue with an endoscopic stapler.
OBJECTIVE
To describe a technique for laparoscopic partial cystectomy and evaluate sealing of canine urinary bladder tissue with an endoscopic stapler.
STUDY DESIGN
Prospective, cadaveric study.
SAMPLE POPULATION
Eleven canine cadavers.
METHODS
Laparoscopic partial cystectomy was performed with an endoscopic gastrointestinal anastomosis (GIA) stapler. Leak testing and urodynamic evaluation was performed to measure intravesical pressure at initial leakage and catastrophic failure or the maximum pressure at which intravesical pressure plateaued. Surgical time, complications, and site of leakage were also recorded.
RESULTS
Laparoscopic partial cystectomy was successfully performed in 10 of 11 cadavers. Median procedure time was 13.6 min (10.1-15.2 min). Median intravesical pressure at initial leakage was 31 mmHg (28-56 mmHg) with a median increase from initial pressure of 15 mmHg (11-37 mmHg). No catastrophic failure of the cystectomy site was observed during leak testing. Intravesical pressure plateaued at a median of 52 mmHg (39-73 mmHg), which was a median of 13 mmHg (8-23 mmHg) higher than intravesical pressure at initial leakage. The median total volume infused at the time of plateau of intravesical pressure was 89 mL (58-133 mL).
CONCLUSION
Laparoscopic stapled partial cystectomy was feasible in canine cadavers. Endoscopic GIA staplers appear to seal the canine urinary bladder with minimal leakage.
CLINICAL SIGNIFICANCE
Use of an endoscopic GIA stapler may provide a minimally invasive option for partial cystectomy in dogs. Further evaluation for application to clinical cases is warranted.
Topics: Humans; Dogs; Animals; Cystectomy; Urinary Bladder; Prospective Studies; Feasibility Studies; Laparoscopy; Cadaver; Dog Diseases
PubMed: 37888770
DOI: 10.1111/vsu.14045 -
Journal of Robotic Surgery Jun 2018Reports of surgical outcomes after robotic partial cystectomy are limited. The objective of this study is to review surgical outcomes after robotic partial cystectomy at...
Reports of surgical outcomes after robotic partial cystectomy are limited. The objective of this study is to review surgical outcomes after robotic partial cystectomy at a large tertiary referral center and compare outcomes with patients undergoing open partial cystectomy. Patients undergoing robotic partial cystectomy between 2003 and 2014 were identified. Patients were matched 2:1 based on gender, age, and Charlson Comorbidity Score with patients undergoing open partial cystectomy during the same time period. Patient charts were reviewed for surgical outcomes. Conditional logistic regression adjusted for matching was used to compare outcomes. At our institution, 11 patients underwent robotic partial cystectomy between 2003 and 2014. Median operative time was significantly longer in the robotic group, 214 (IQR 93, 230) minutes, than the open group, 93 (IQR 58, 143) minutes (p = 0.01). There was no difference in median estimated blood loss (p = 0.1). No patient required transfusion. There were no intraoperative complications. Median hospital stay was significantly shorter in the robotic partial cystectomy group, 1 (IQR 1, 2) day, than the open partial cystectomy group, 2 (IQR 2, 4) days (p = 0.01). Median duration of catheterization and complications within 30 days of surgery were not statistically different between the two groups. Median follow-up was 15.5 (IQR 8.6, 19.7) months for the robotic partial cystectomy group and 40.7 (IQR 6.5, 69.4) months for the open partial cystectomy group. Robotic partial cystectomy is safe, effective, and is associated with minimal morbidity when performed in properly selected patients for benign and malignant indications. When compared with open partial cystectomy, robotic partial cystectomy is associated with a longer operative time, but results in a shorter postoperative hospital stay.
Topics: Aged; Cystectomy; Female; Humans; Male; Middle Aged; Postoperative Complications; Retrospective Studies; Robotic Surgical Procedures; Treatment Outcome; Urinary Bladder; Urinary Bladder Neoplasms
PubMed: 28601954
DOI: 10.1007/s11701-017-0717-x -
Clinical Genitourinary Cancer Apr 2020We investigated the effect of partial cystectomy (PC) on cancer-specific mortality (CSM) and other-cause mortality (OCM) and the effect of pelvic lymph node dissection...
Partial Cystectomy With Pelvic Lymph Node Dissection for Patients With Nonmetastatic Stage pT2-T3 Urothelial Carcinoma of Urinary Bladder: Temporal Trends and Survival Outcomes.
INTRODUCTION
We investigated the effect of partial cystectomy (PC) on cancer-specific mortality (CSM) and other-cause mortality (OCM) and the effect of pelvic lymph node dissection (PLND) during PC on CSM.
MATERIALS AND METHODS
Within the Surveillance, Epidemiology, and End Results database (2004-2015), 11,429 cases of nonmetastatic stage pT2-T3 urothelial carcinoma of the urinary bladder treated with either PC or radical cystectomy (RC) were identified. All comparisons between PC and RC relied on propensity score (PS; ratio, 1:1) adjusted univariable and multivariable logistic and competing risks regression models. In contrast, all comparisons between PLND and no PLND at PC relied on inverse probability of treatment weighting-adjusted univariable and multivariable Cox regression models.
RESULTS
Within the SEER database, PC had been performed in 979 patients (8.6%). The PC annual rates decreased from 11.0% to 6.8% during the study period (P < .001). In PS-adjusted multivariable analyses focusing on CSM and OCM, no statistically significant difference between the PC and RC groups (P = .2 and P = .3, respectively). The annual PLND rates with PC (50.3%) did not vary over time (P = .3). In the overall cohort and the PC subgroup, PLND was associated with a lower CSM rate (hazard ratio, 0.56; P < .001; and hazard ratio, 0.57; P < .001, respectively).
CONCLUSIONS
A small proportion of patients with stage pT2-T3 urothelial carcinoma of the urinary bladder were candidates for PC. In the PS-adjusted multivariable analyses, no statistically significant differences were found in CSM or OCM between the PC and RC groups. Within the PC group, PLND had been omitted 50% of the time despite its association with lower CSM.
Topics: Age Factors; Aged; Aged, 80 and over; Carcinoma, Transitional Cell; Cystectomy; Female; Humans; Kaplan-Meier Estimate; Lymph Node Excision; Male; Middle Aged; Multivariate Analysis; Neoplasm Staging; Retrospective Studies; SEER Program; Treatment Outcome; Urinary Bladder; Urinary Bladder Neoplasms
PubMed: 32001182
DOI: 10.1016/j.clgc.2019.09.008 -
European Urology Dec 2023
A Pilot Study on Hyperthermic Intraperitoneal Chemotherapy after Radical or Partial Cystectomy with Pelvic Lymph Node Dissection for High-risk Muscle-invasive Bladder Cancer.
Topics: Humans; Cystectomy; Pilot Projects; Hyperthermic Intraperitoneal Chemotherapy; Urinary Bladder Neoplasms; Lymph Node Excision; Muscles
PubMed: 37353441
DOI: 10.1016/j.eururo.2023.06.005 -
International Braz J Urol : Official... 2020Leiomyomas of the urinary bladder are very rare neoplasms and are the most common benign mesenchymal tumors of the bladder, accounting for 35% of these. Treatment of...
INTRODUCTION AND OBJECTIVE
Leiomyomas of the urinary bladder are very rare neoplasms and are the most common benign mesenchymal tumors of the bladder, accounting for 35% of these. Treatment of leiomyomas is mainly surgical and approaches range from transurethral resection to open segmental resection or laparoscopic partial cystectomy. We sought to present the surgical technique of robot-assisted transvesical partial cystectomy for bladder leiomyoma.
MATERIALS AND METHODS
A 25-year-old man presented to urology department with urinary frequency and urgency. Ultrasound and MRI examinations revealed a 30x20mm oval mass in the posterolateral aspect of bladder wall suggestive of bladder leiomyoma. Patient was submitted to cystoscopy with placement of a right ureteral stent and lesion demarcation, ans then a robot-assisted partial cystectomy with the following steps was performed: opening of peritoneum over bladder dome and dissection of perivesical fat, opening of bladder wall, incision of bladder mucosa, sharp and blunt dissection of lesion, closure of bladder layers with a knotless closure device.
RESULTS
Procedure was performed in 2 hours and there were no complications. Blood loss was minimal (50ml), patient was discharged after 24 hours and bladder catheter was removed after 5 days. Histopathological evaluation revealed a bladder leiomyoma with negative surgical margins.
CONCLUSION
Robot-assisted partial cystectomy is a feasible modality for treatment of intravesical bladder leiomyomas, facilitating transvesical resection and reconstruction.
Topics: Adult; Cystectomy; Humans; Magnetic Resonance Imaging; Male; Robotic Surgical Procedures; Urinary Bladder Neoplasms
PubMed: 32022531
DOI: 10.1590/S1677-5538.IBJU.2018.0801 -
The Journal of Urology Oct 2012To our knowledge long-term oncologic outcomes following partial cystectomy for urothelial carcinoma remain to be defined. We evaluated patterns of recurrence and... (Comparative Study)
Comparative Study
PURPOSE
To our knowledge long-term oncologic outcomes following partial cystectomy for urothelial carcinoma remain to be defined. We evaluated patterns of recurrence and survival among matched patients treated with partial vs radical cystectomy for bladder cancer.
MATERIALS AND METHODS
We identified 86 patients who underwent partial cystectomy for pT1-4N0-1Mx urothelial carcinoma between 1980 and 2006 at our institution. They were matched 1:2 to patients undergoing radical cystectomy based on age, gender, pathological T stage and receipt of neoadjuvant chemotherapy. Survival was estimated using Kaplan-Meier analysis and compared with the log rank test.
RESULTS
Median postoperative followup was 6.2 years (range 0 to 27). No difference was noted for 10-year distant recurrence-free survival (61% vs 66%, p = 0.63) or cancer specific survival (58% vs 63%, p = 0.67) between patients treated with partial and radical cystectomy, respectively. Interestingly, 4 of 86 patients (5%) who underwent partial cystectomy showed extravesical pelvic tumor recurrence postoperatively vs 29 of 167 (17%) who underwent radical cystectomy (p = 0.004). In addition, 33 of 86 patients (38%) were diagnosed with intravesical recurrence of tumor after partial cystectomy and 16 of 86 (19%) initially treated with partial cystectomy ultimately underwent radical cystectomy.
CONCLUSIONS
Our matched analysis demonstrated no difference in metastasis-free or cancer specific survival between select patients undergoing partial cystectomy and those undergoing radical cystectomy. Nevertheless, patients treated with partial cystectomy remain at risk for intravesical recurrence and, thus, they should be counseled and surveilled accordingly.
Topics: Aged; Carcinoma, Transitional Cell; Case-Control Studies; Cystectomy; Female; Humans; Male; Middle Aged; Neoplasm Recurrence, Local; Retrospective Studies; Survival Rate; Treatment Outcome; Urinary Bladder Neoplasms
PubMed: 22901583
DOI: 10.1016/j.juro.2012.06.029