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Urologia Internationalis 2020Bladder endometriosis (BE) is rare. Deep invasive endometriosis is difficult to control with medications alone; such cases need surgical treatment. Good results of...
PURPOSE
Bladder endometriosis (BE) is rare. Deep invasive endometriosis is difficult to control with medications alone; such cases need surgical treatment. Good results of laparoscopic partial cystectomy with a transurethral (TU) resectoscope by the see-through technique for patients with BE are reported.
MATERIALS AND METHODS
From January 2008 to February 2016, 12 cases of symptomatic BE were seen in our institution. The chief complaints of 9 cases were micturition pain during menstruation. Preoperative cystoscopy showed a bladder mass with blueberry spots. All surgeries were performed under general anesthesia. Laparoscopic surgery was performed with a fan of 4 ports in the lower abdomen. First, the uterus and bilateral ovaries were checked. Then, the TU resectoscope was inserted. When the affected bladder wall was identified, it was again observed with the laparoscopic light source off, which made it possible to observe the twilight leaking inside from the bladder. This twilight came from the light source of the TU resectoscope via the unaffected bladder wall. In contrast, the thickness of the affected wall prevented the light from inside the bladder from passing through it. We call this the "see-through technique." The tumor was then safely dissected with both laparoscopic and TU resection procedures. Finally, the bladder was sutured by laparoscopic procedures using absorbable sterile surgical suture. The urethral catheter was removed after cystography 7 days after the operation.
RESULTS
The surgical margins of all cases were negative. There has been no recurrence of BE so far in any patients. There were no major adverse events perioperatively and the urinary symptoms improved in all cases.
CONCLUSIONS
By laparoscopic partial cystectomy assisted with a TU resectoscope and see-through technique, the edge of BE could be easily and precisely identified. These procedures are effective and safe for BE surgical treatment.
Topics: Adult; Cystectomy; Endometriosis; Female; Humans; Laparoscopy; Middle Aged; Retrospective Studies; Urethra; Urinary Bladder Diseases
PubMed: 32191941
DOI: 10.1159/000503795 -
Colorectal Disease : the Official... Nov 2020
Topics: Coloring Agents; Cystectomy; Fluorescence; Humans; Indocyanine Green; Laparoscopy
PubMed: 32460402
DOI: 10.1111/codi.15145 -
BJU International Jan 2017To report on patients undergoing robot-assisted partial cystectomy (RAPC), focusing on perioperative outcomes over a range of clinical, anatomical and pathological...
OBJECTIVE
To report on patients undergoing robot-assisted partial cystectomy (RAPC), focusing on perioperative outcomes over a range of clinical, anatomical and pathological variables, as well as the overall oncological efficacy of this approach.
PATIENTS AND METHODS
We retrospectively reviewed all patients who underwent RAPC by a single surgeon between 2005 and 2015. We identified 29 patients who underwent surgery for definitive management of a primary bladder tumour. Clinicopathological data and perioperative variables were recorded. Continuous variables were compared using the Student's t-test. Prediction of perioperative outcomes for those undergoing RAPC for intra-diverticular neoplasms was done using univariate logistic regression. Survival was estimated using the Kaplan-Meier method.
RESULTS
The median (interquartile range) patient age was 75 (65-81) years, 18 patients (62.1%) had an American Society of Anesthesiologists classification of ≥3, and 10 patients (34.5%) had a history of prior abdominal surgery. The median estimated blood loss (EBL) was 50 mL and the median length of stay (LOS) was 1 day. Two patients (6.9%) had a perioperative complication and five (17.9%) a post-discharge complication at ≤90 days, all of which were minor. The positive surgical margin rate was 3.6% and in those with muscle-invasive disease a median of 12 lymph nodes were removed. Neither the size of diverticulum nor the need for ureteric re-implantation was predictive of LOS, EBL, or complication (P > 0.05). We did not encounter any wound, port site, or unusual recurrence patterns to suggest the technical factors of a robotic approach influenced oncological outcomes. The 5-year overall and recurrence-free survival rates were 79% and 68%, respectively.
CONCLUSION
RAPC confers the ability to achieve favourable outcomes with low morbidity and reduced hospital stays. Oncological efficacy compares favourably with the published literature. For experienced surgeons, this may represent the optimal surgical approach for organ-preserving bladder surgery.
Topics: Aged; Aged, 80 and over; Cystectomy; Female; Humans; Male; Retrospective Studies; Robotic Surgical Procedures; Time Factors; Treatment Outcome; Urinary Bladder Neoplasms
PubMed: 27207269
DOI: 10.1111/bju.13535 -
Journal of Surgical Oncology Sep 1995Thirty two patients--23 males and 9 females with a mean age of 52.5 years--underwent planned partial cystectomy for histologically proved muscle invasive bladder cancer.... (Clinical Trial)
Clinical Trial
Thirty two patients--23 males and 9 females with a mean age of 52.5 years--underwent planned partial cystectomy for histologically proved muscle invasive bladder cancer. Twenty patients had transitional cell carcinoma and 12 had adenocarcinoma of the bladder. One patient had well-differentiated, 18 had moderately differentiated, and 13 had poorly differentiated tumours. The tumour size was < 2 cm in 7 patients, 2-4 cm in 19 patients, and > 4 cm in 6 patients. Patients with single primary muscle invasive tumours situated in the upper half of the bladder were considered eligible for partial cystectomy. The presence of multicentric urothelial disease, of dysplasia, or carcinoma-in-situ in bladder mucosa away from the tumour on multiple random punch biopsies was considered contraindications to partial cystectomy. All patients underwent partial cystectomy with bilateral pelvic lymphadenectomy. The tumour-free margins of resection were confirmed by intraoperative frozen section examination. The bladder was closed primarily in all patients, although three patients required re-implantation of the ureter. No patient received adjuvant radiation or chemotherapy. Five patients had pathological stage B1 (T2), 18 had B2 (T3A), and 9 had C (T3B) disease. No patient had metastatic pelvic lymph nodes. There was one postoperative death due to unrelated medical cause. Five patients had minor complications that resolved with conservative measures. All patients had adequate bladder capacity of > 250 cc at 6 months after surgery, and none had symptoms attributable to reduced bladder capacity. The overall actuarial survival was 80.1% at 5 years.(ABSTRACT TRUNCATED AT 250 WORDS)
Topics: Adenocarcinoma; Adult; Biopsy; Carcinoma, Transitional Cell; Chemotherapy, Adjuvant; Cystectomy; Female; Humans; Lymph Node Excision; Male; Middle Aged; Neoplasm Invasiveness; Prognosis; Radiotherapy, Adjuvant; Survival Rate; Urinary Bladder; Urinary Bladder Neoplasms
PubMed: 7666665
DOI: 10.1002/jso.2930600106 -
Journal of Obstetrics and Gynaecology... Feb 2014Endocervicosis, endosalpingiosis, endometriosis, and adenomyosis represent choristomas of Mullerian origin and are referred to as mullerianosis. These conditions... (Review)
Review
Combined transurethral and laparoscopic partial cystectomy and robotically assisted bladder repair for the treatment of bladder endocervicosis: case report and review of the literature.
BACKGROUND
Endocervicosis, endosalpingiosis, endometriosis, and adenomyosis represent choristomas of Mullerian origin and are referred to as mullerianosis. These conditions frequently coexist, and they may present with pelvic pain, mass lesions, and/or infertility. Clinically, they are indistinguishable from one another, and histologically their epithelium is that of the endocervix, endosalpinx, or endometrium. Endocervicosis can be found in the urinary tract, frequently presenting as a bladder lesion or bladder dysfunction.
CASE
We report here a case of bladder endocervicosis in a woman with extensive endometriosis and a bladder tumour who presented with chronic pelvic pain and infertility. Pelvic endometriosis was excised and vaporized with the CO2 laser, and the bladder lesion was excised in a combined transurethral and laparoscopic approach using the CO2 laser and robotic monopolar electrosurgical scissors. The cystotomy was then repaired using the robot, and the patient had an uneventful recovery with good clinical outcomes including spontaneous conception.
CONCLUSION
Endocervicosis of the urinary bladder is a rare Mullerian choristoma. Symptomatic lesions can be removed surgically by various surgical techniques, and a collaborative team-based approach is in the patient's best interest.
Topics: Adult; Cervix Uteri; Choristoma; Cystectomy; Electrosurgery; Endometriosis; Female; Humans; Infertility, Female; Laparoscopy; Laser Therapy; Mullerian Ducts; Pelvic Pain; Robotics; Urinary Bladder Diseases
PubMed: 24518913
DOI: 10.1016/S1701-2163(15)30660-5 -
Transplantation Proceedings Apr 2018Paraganglioma (extra-adrenal pheochromocytoma) of the bladder is a very rare disease, accounting for 0.06% of all bladder tumors. Optimal management of bladder...
BACKGROUND
Paraganglioma (extra-adrenal pheochromocytoma) of the bladder is a very rare disease, accounting for 0.06% of all bladder tumors. Optimal management of bladder paraganglioma before kidney transplantation is unknown. We report a case of partial cystectomy for urinary bladder paraganglioma before living kidney transplantation.
CASE PRESENTATION
A 59-year-old man with a 27-year history of hemodialysis was referred to our department for further examination of a bladder tumor detected during pre-transplantation testing. Cystoscopy revealed a submucosal tumor on the right side of the bladder. The patient experienced a hypertensive crisis during transurethral resection of the bladder tumor. Endocrinologic and pathologic examinations confirmed the diagnosis of paraganglioma in the urinary bladder. A partial cystectomy was performed before kidney transplantation. Nine months after partial cystectomy, the patient underwent AB0-incompatible living kidney transplantation from his spouse. No disease recurrence or graft rejection was observed 12 months after the transplantation.
CONCLUSIONS
To our knowledge, this is the 1st report on the management of paraganglioma in the urinary bladder before living kidney transplantation. Kidney transplantation after partial cystectomy is an option that may be considered in patients with paraganglioma of the urinary bladder, with careful observations of bladder function and vesicoureteral reflux to the grafts.
Topics: Adult; Cystectomy; Humans; Kidney Failure, Chronic; Kidney Transplantation; Male; Middle Aged; Paraganglioma; Urinary Bladder Neoplasms
PubMed: 29661460
DOI: 10.1016/j.transproceed.2018.01.015 -
Annals of Surgical Oncology May 2019Two procedures widely performed to treat locally advanced colorectal cancer adherent to the urinary bladder are total cystectomy (as part of pelvic exenteration) and... (Comparative Study)
Comparative Study
BACKGROUND
Two procedures widely performed to treat locally advanced colorectal cancer adherent to the urinary bladder are total cystectomy (as part of pelvic exenteration) and partial cystectomy; however, little is known about outcomes following partial cystectomy.
METHODS
A retrospective database of patients with colorectal cancer involving the urinary bladder who underwent R0 or R1 resection at our institution from 2001 to 2015 was constructed. The histological extent of bladder invasion and long-term outcomes were examined.
RESULTS
Of the 89 consecutive patients, 49 underwent partial cystectomy and all had negative margins of the bladder. Tumor invasion to the urinary bladder was confirmed histologically in 19 of 49 patients (coincidence rate of diagnosis, 39%): invasion only to the bladder serosa (n = 3), invasion to the bladder muscle (n = 4), and invasion beyond the bladder muscle without (n = 1) and with (n = 11) exposure to the bladder lumen. The 5-year recurrence-free and overall survival rates were 63.2% and 70.2% in the partial cystectomy group, and 66.2% and 72.7% in the total cystectomy group (p = 0.567 and 0.648), respectively. Except for the remnant bladder, recurrence sites were very similar to sites observed in patients who underwent total cystectomy. Intravesical recurrence occurred in four patients 3-13 months after the initial surgery, all of whom showed bladder lumen exposure to the tumor.
CONCLUSIONS
With regard to long-term outcomes and low diagnostic concordance rates of clinical and pathological bladder invasion, partial cystectomy seems a generally acceptable treatment option. However, when the bladder lumen is exposed to a colorectal tumor, surgeons should be cognizant of possible intravesical recurrence and act accordingly.
Topics: Adult; Aged; Aged, 80 and over; Colorectal Neoplasms; Cystectomy; Female; Follow-Up Studies; Humans; Male; Middle Aged; Neoplasm Invasiveness; Neoplasm Recurrence, Local; Postoperative Complications; Prognosis; Retrospective Studies; Survival Rate; Urinary Bladder Neoplasms; Young Adult
PubMed: 30847751
DOI: 10.1245/s10434-019-07276-0 -
The Journal of Urology Sep 2005Partial cystectomy is perceived to be a less morbid, less technically demanding procedure than radical cystectomy, although only select patients (approximately 6% to...
PURPOSE
Partial cystectomy is perceived to be a less morbid, less technically demanding procedure than radical cystectomy, although only select patients (approximately 6% to 10%) are appropriate candidates (solitary tumor in space/time, absence of carcinoma in situ). From a quality of care perspective, overuse of partial cystectomy may signify inappropriate delivery of health care.
MATERIALS AND METHODS
Subjects who underwent extirpative treatment for bladder cancer between 1988 and 2000 were identified within the Surveillance, Epidemiology and End Results (SEER, 3,381) registry and the Nationwide Inpatient Sample (NIS, 22,088). Adjusted models were developed to identify clinical factors independently associated with the use of partial cystectomy for bladder cancer treatment within each sample.
RESULTS
Among patients who underwent extirpative surgery for bladder cancer, 18% and 20% of those in SEER and NIS, respectively, underwent partial cystectomy. Significant decreases in use between early and later years were noted in both samples (SEER-22% to 13%, NIS-24% to 17%, both p <0.0001). Partial cystectomy was preferentially used in the elderly, those with stage I disease, females and black patients. Furthermore, partial cystectomy was more commonly provided in rural, nonteaching, low volume hospitals.
CONCLUSIONS
Trends in national use of partial cystectomy are consistent between the NIS and SEER with 13% to 17% of patients currently being treated with partial in lieu of radical cystectomy. Partial cystectomy is disproportionately used in certain medical centers (nonteaching, rural, low volume) and patient populations (elderly, black, females, stage I disease) reflecting selective referral or overuse.
Topics: Aged; Aged, 80 and over; Cystectomy; Female; Health Services Misuse; Hospitals, Rural; Humans; Male; Middle Aged; Neoplasm Staging; Patient Selection; Quality of Health Care; Referral and Consultation; Registries; United States; Urinary Bladder Neoplasms; Utilization Review
PubMed: 16094056
DOI: 10.1097/01.ju.0000169477.30477.3d -
The Journal of Urology Jun 2006Partial cystectomy is a surgical option for select patients diagnosed with urothelial carcinoma. We review our experience with partial cystectomy for muscle invasive...
PURPOSE
Partial cystectomy is a surgical option for select patients diagnosed with urothelial carcinoma. We review our experience with partial cystectomy for muscle invasive urothelial carcinoma to assess local control and survival rates.
MATERIAL AND METHODS
From 1982 to 2003 a total of 37 patients with muscle invasive urothelial carcinoma underwent partial cystectomy with curative intent. Reviewed data included history of superficial tumors, presence of variant histology, tumor location, clinical stage, pathological stage, presence of carcinoma in situ, adjuvant therapy and disease status.
RESULTS
The 5-year overall, disease specific and recurrence-free survival rates were 67%, 87% and 39%, respectively. Mean followup was 72.6 months (range 6 to 217). Of the 37 patients 19 (51%) did not have tumor recurrence, 9 (24%) had superficial recurrence in the bladder that was treated successfully and 9 (24%) had recurrence with advanced disease. A total of 24 patients (65%) had an intact bladder with no evidence of disease after a median of 53 months. There were 6 patients (16%) who died of bladder cancer, 3 of whom died of late recurrence of muscle invasive cancer (41, 44 and 138 months after partial cystectomy). On multivariate analysis higher pathological stage (HR 3.4, p = 0.04) was associated with shorter recurrence-free survival. A history of superficial tumors (p <0.01) and clinical stage (p = 0.01) was associated with advanced recurrence-free survival. The use of adjuvant chemotherapy (HR 0.18, p = 0.03) was associated with prolonged advanced recurrence-free survival, however adjuvant chemotherapy did not impact overall survival.
CONCLUSIONS
Partial cystectomy provides adequate local control of muscle invasive bladder cancer in select patients. Because late recurrence is not uncommon and is potentially life threatening, lifelong followup with cystoscopy is recommended.
Topics: Adult; Aged; Aged, 80 and over; Carcinoma, Transitional Cell; Cystectomy; Female; Humans; Male; Middle Aged; Neoplasm Invasiveness; Neoplasm Recurrence, Local; Retrospective Studies; Survival Rate; Urinary Bladder Neoplasms
PubMed: 16697803
DOI: 10.1016/S0022-5347(06)00322-3 -
The Surgical Clinics of North America Apr 2020Urologists have always been leaders in advancing surgical technology and were the first to utilize modern robotic surgery for robotic-assisted laparoscopic radical... (Review)
Review
Urologists have always been leaders in advancing surgical technology and were the first to utilize modern robotic surgery for robotic-assisted laparoscopic radical proctectomy. Surgeon ergonomics, instrument precision, operative time, and postoperative recovery were all objectively improved. In urology, robotic surgery is now used for all intra-abdominal, retroperitoneal, and pelvic procedures and has been expanded to renal transplants and pediatric use. Modern robotic surgery has become an essential part of treating complex urologic disease in the developed world. Urologists continue to lead the way with the latest robotic surgical systems, including the newly approved single port systems.
Topics: Cystectomy; Humans; Laparoscopy; Nephrectomy; Prostatectomy; Robotic Surgical Procedures; Urologic Diseases; Urologic Surgical Procedures
PubMed: 32169184
DOI: 10.1016/j.suc.2019.12.003