-
Investigative and Clinical Urology May 2024We evaluated the risk factors associated with failure to complete gemcitabine-cisplatin (GP) neoadjuvant chemotherapy (NAC) for muscle-invasive bladder cancer (MIBC).
PURPOSE
We evaluated the risk factors associated with failure to complete gemcitabine-cisplatin (GP) neoadjuvant chemotherapy (NAC) for muscle-invasive bladder cancer (MIBC).
MATERIALS AND METHODS
In total, 231 patients with MIBC treated with NAC before undergoing radical cystectomy between 2013 and 2022 participated in this study. Logistic regression analysis was performed to assess the relationship between the likelihood of incomplete NAC and clinical and demographic variables, including age, sex, hypertension (HTN), diabetes mellitus (DM), prechemotherapy glomerular filtration rate, clinical T stage, clinical N stage, and body mass index (BMI).
RESULTS
Of 231 patients, 209 (90.5%) and 22 (9.5%) completed and discontinued the NAC course, respectively. The mean age was 66.13±9.15, 65.63±9.07, and 70.86±8.66 years for the total sample, continuation, and discontinuation groups, respectively (p=0.010). No significant inter-group differences in sex, HTN, height, weight, BMI, pre-chemotherapy glomerular filtration rate, clinical T stage, or clinical N stage were observed. According to the results of the multivariable analysis, age (odds ratio [OR] 1.076, 95% confidence interval [CI] 1.013-1.143, p=0.018) and the presence of DM (OR 2.541, 95% CI 1.028-6.281, p=0.043) were significantly associated with NAC discontinuation.
CONCLUSIONS
Thus, older age and presence of DM are potential risk factors for GP NAC discontinuation in patients with MIBC. Further studies are required to validate our findings and develop strategies to minimize the rate of GP NAC discontinuation in this population.
Topics: Humans; Urinary Bladder Neoplasms; Male; Cisplatin; Female; Gemcitabine; Aged; Deoxycytidine; Neoadjuvant Therapy; Risk Factors; Middle Aged; Neoplasm Invasiveness; Antineoplastic Combined Chemotherapy Protocols; Retrospective Studies; Treatment Failure; Cystectomy; Chemotherapy, Adjuvant
PubMed: 38714516
DOI: 10.4111/icu.20230389 -
Investigative and Clinical Urology May 2024This study investigated the efficacy of intravesical gemcitabine as an alternative to bacillus Calmette-Guérin (BCG) therapy. (Comparative Study)
Comparative Study
Comparative analysis of recurrence rates between intravesical gemcitabine and bacillus Calmette-Guérin induction therapy following transurethral resection of bladder tumors in patients with intermediate- and high-risk bladder cancer: A retrospective multicenter study.
PURPOSE
This study investigated the efficacy of intravesical gemcitabine as an alternative to bacillus Calmette-Guérin (BCG) therapy.
MATERIALS AND METHODS
Data were retrospectively collected across seven institutions from February 1999 to May 2023. Inclusion criteria included patients with intermediate- or high-risk non-muscle invasive bladder cancer (NMIBC) who underwent transurethral resection of bladder tumors (TURBT) and received at least four sessions of intravesical gemcitabine or BCG induction therapy. Patient characteristics, complete remission (CR), occurrence, and progression rates were compared.
RESULTS
In total, 149 patients were included in this study (gemcitabine, 63; BCG, 86). No differences were apparent between the two groups in baseline characteristics, except for the follow-up period (gemcitabine, 9.2±5.9 months vs. BCG, 43.9±41.4 months, p<0.001). There were no consistent significant differences observed between the two groups in the 3-month (gemcitabine, 98.4% vs. BCG, 95.3%; p=0.848), 6-month (94.9% vs. 90.0%, respectively; p=0.793) and 1-year CR rates (84.2% vs. 83.3%, respectively; p=0.950). Also, there was no significant statistical difference in progression-free survival between the two groups (p=0.953). The occurrence rates of adverse events were similar between the groups (22.2% vs. 22.1%; p=0.989); however, the rate of Clavien-Dindo grade 2 or higher was significantly higher in the BCG group (1.6% vs. 16.3%, respectively; p<0.001).
CONCLUSIONS
Intravesical gemcitabine demonstrated efficacy comparable to BCG therapy for the first year in patients with intermediate- and high-risk NMIBC. However, long-term follow-up studies are warranted.
Topics: Humans; Urinary Bladder Neoplasms; Gemcitabine; Deoxycytidine; Retrospective Studies; BCG Vaccine; Male; Female; Administration, Intravesical; Aged; Neoplasm Recurrence, Local; Antimetabolites, Antineoplastic; Middle Aged; Adjuvants, Immunologic; Cystectomy; Risk Assessment; Urethra
PubMed: 38714515
DOI: 10.4111/icu.20230313 -
International Braz J Urol : Official... 2024Robotic-assisted radical cystectomy (RARC) with intracorporeal urinary diversion (ICUD) is associated with significant morbidity and mortality. We present an alternative...
BACKGROUND
Robotic-assisted radical cystectomy (RARC) with intracorporeal urinary diversion (ICUD) is associated with significant morbidity and mortality. We present an alternative technique that preserves the complete mesenteric vascularization during the isolation of the intestinal segment used in ICUD, including distal vessels. This approach aims to minimize the risk of ischemia in both the ileal anastomosis and the isolated loop at the diversion site.
METHODS
This cohort study included 31 patients, both male and female, who underwent RARC with ICUD from February 2018 to November 2023, performed by a single surgeon. Intraoperative and postoperative complications data were retrieved for analysis, employing our proposed mesentery-sparing technique in all cases. The primary endpoint was the incidence of intraoperative and postoperative complications directly attributable to the mesentery-sparing approach in ICUD. Secondary endpoints included other postoperative variables not directly related to mesentery preservation, such as the incidence of postoperative ileus requiring parenteral nutrition and the duration of hospitalization.
RESULTS
None of the patients experienced intraoperative or postoperative complications directly related to mesentery-sparing, such as intestinal fistulae or internal hernias. The median duration of hospitalization was 6 days, and postoperative ileus necessitating total parenteral nutrition occurred in 19% of the patients. Minor complications (Clavien-Dindo grades I-II) accounted for 27.6% of the cases and major complications (grades III-V) accounted for 20.6%.
CONCLUSION
The mesentery-sparing technique outlined herein offers an alternative method for preserving the vascularization of intestinal segments and reducing the risk of intestinal complications in ICUD during RARC.
Topics: Humans; Cystectomy; Female; Male; Robotic Surgical Procedures; Urinary Diversion; Middle Aged; Aged; Postoperative Complications; Mesentery; Urinary Bladder Neoplasms; Organ Sparing Treatments; Treatment Outcome; Intraoperative Complications; Retrospective Studies; Reproducibility of Results; Cohort Studies
PubMed: 38701184
DOI: 10.1590/S1677-5538.IBJU.2024.0153 -
Cureus Mar 2024This study's objective is to assess the effect of preoperative factors on postoperative hydroureteronephrosis (HUN) after radical cystectomy (RC) in patients with...
OBJECTIVE
This study's objective is to assess the effect of preoperative factors on postoperative hydroureteronephrosis (HUN) after radical cystectomy (RC) in patients with bladder cancer (BC).
METHODOLOGY
Patients who underwent RC for BC between January 2019 and November 2022 and had unilateral or bilateral postoperative HUN were retrospectively analyzed. Patients without preoperative HUN but with postoperative HUN constituted the patient group, while patients without both preoperative and postoperative HUN constituted the control group, and they were compared with each other.
RESULTS
Neoadjuvant chemotherapy (NAC) and postoperative metastasis were positively correlated with postoperative HUN ( = 0.238, = 0.007, and = 0.203, = 0.021, respectively). Multivariate logistic regression analysis showed that the postoperative HUN was significantly associated with NAC (= 0.048; Exp() = 6.896, 95% confidence interval [CI] 1.02-46.9) but not associated with the presence of metastasis ( = 0.054). Moreover, NAC increased the possibility of undergoing revision surgery ( = 0.002; Exp() = 26.9, 95% CI 3.2-225).
CONCLUSIONS
NAC is an independent factor for impaired anastomotic healing, increased postoperative HUN, and the need for revision surgery in patients with BC.
PubMed: 38690486
DOI: 10.7759/cureus.57306 -
Radiology Case Reports Jul 2024Cardiac echinococcosis, although rare, presents a range of clinical manifestations depending on the cyst's location within the heart. These manifestations can range from...
Cardiac echinococcosis, although rare, presents a range of clinical manifestations depending on the cyst's location within the heart. These manifestations can range from asymptomatic conditions to serious complications such as arrhythmias, valvular dysfunction, cardiac tamponade, heart failure, shock, or even death. This case report describes the unusual presentation of a young man with an intramyocardial hydatid cyst, which was incidentally discovered following an ischemic stroke. Diagnostic evaluation included echocardiography, as well as chest and abdominal angiography via computed tomography (angio-CT). Surgical intervention was undertaken, involving cystectomy and the removal of the cyst contents. The patient's postoperative recovery was uneventful and favorable. This report emphasizes important diagnostic and management considerations specific to cardiac hydatid cysts and includes a review of the relevant literature to provide context and depth to our findings.
PubMed: 38689810
DOI: 10.1016/j.radcr.2024.03.080 -
Cureus Mar 2024Echinococcal cysts (ECs) are a significant public health concern globally, particularly in endemic regions. Among these, primary retroperitoneal echinococcal cysts... (Review)
Review
Echinococcal cysts (ECs) are a significant public health concern globally, particularly in endemic regions. Among these, primary retroperitoneal echinococcal cysts (PRECs) present unique challenges due to their location and complex presentations. Total cystectomy, involving complete removal of the EC and surrounding tissue, is a surgical option for managing PRECs. However, evidence regarding its efficacy and safety is limited. We conducted a systematic review following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines to evaluate the role of total cystectomy in managing PRECs. A comprehensive search of databases yielded four relevant studies. These studies reported favorable outcomes following total cystectomy, including low recurrence rates and minimal postoperative complications. However, challenges such as technical complexity and proximity to vital structures were noted. Future research should focus on evaluating minimally invasive approaches, exploring adjuvant therapies, identifying predictors of recurrence, and assessing cost-effectiveness. This systematic review underscores the need for further investigation to optimize the management of PRECs and improve patient outcomes.
PubMed: 38686260
DOI: 10.7759/cureus.57218 -
IJU Case Reports May 2024Cutaneous ureterostomy is beneficial for older patients in a hypoalimentation state, providing less invasive options than intestinal tract reconstruction techniques....
INTRODUCTION
Cutaneous ureterostomy is beneficial for older patients in a hypoalimentation state, providing less invasive options than intestinal tract reconstruction techniques. However, complications such as ileus and stoma site hernia still pose risks owing to the anatomical location of the ureter. We introduce a novel method, complete retroperitoneal cutaneous ureterostomy, performed simultaneously with robot-assisted radical cystectomy.
CASE PRESENTATION
Our technique involves extending the retroperitoneal space to minimize complications and achieve stent-free outcomes. The median procedure time for complete retroperitoneal cutaneous ureterostomy was approximately 30 min. The stent-free rates at 1 and 4 months postoperatively were 66.7% and 100%, respectively; no case of stent reinsertion after stent removal was reported.
CONCLUSION
Our approach is promising for avoiding postoperative intestinal tract complications.
PubMed: 38686063
DOI: 10.1002/iju5.12717 -
Scandinavian Journal of Urology Apr 2024Radical cystectomy (RC) for bladder cancer is associated with an inherent risk of complications and even postoperative mortality. The number of hospitals performing RC...
OBJECTIVE
Radical cystectomy (RC) for bladder cancer is associated with an inherent risk of complications and even postoperative mortality. The number of hospitals performing RC has decreased in Sweden over time, and since a formal regional centralization in 2017 cystectomy care is currently provided by nine hospitals.
MATERIAL AND METHODS
In the Swedish National Urinary Bladder Cancer Register (SNRUBC) 90-day complications after RC have been registered with high coverage since 2012. Descriptive data and short-term outcomes were compared in relation to centralization of the cystectomy care by stratifying data before (2012-2016) and after (2017-2023).
RESULTS
Out of all 4,638 cystectomies, 2,738 (59%) were performed after the centralization in 2017 and onwards. The median age at RC increased from 71 (Inter Quartile Range [IQR] 65-76) to 73 (IQR 67-77) years, and the proportion of patients with comorbidity (American Society of Anesthesiologists [ASA] 3 or 4) increased from 32% to 37% after the centralization (p < 0.001). The number of patients suffering from high-grade complications within 90 days of surgery corresponding to Clavien grade three were 345 (18%) and 407 (15%), and corresponding to Clavien grade four 61 (3%) and 64 (2%) before and after centralization, respectively. Reoperations within 90 days of RC decreased from 234/1,900 (12%) to 208/2,738 (8%) (p < 0.001), and 90-day mortality decreased from 84/1,900 (4%) to 85/2,738 (3%) (p = 0.023) before and after centralization, respectively.
CONCLUSION
After the centralization of the cystectomy-care in Sweden, older patients and individuals with more extensive comorbidity were offered RC whereas 90-day mortality and the proportion of patients subjected to reoperations within 90 days of surgery decreased without increasing waiting times.
Topics: Humans; Urinary Bladder Neoplasms; Cystectomy; Sweden; Aged; Male; Female; Postoperative Complications; Time Factors; Treatment Outcome; Registries; Centralized Hospital Services
PubMed: 38685576
DOI: 10.2340/sju.v59.40120 -
Frontiers in Medicine 2024Malignant tumors of the ureteric bud are not common, and cervical involvement is even rarer. So far, there have been no such cases in the literature.
BACKGROUND
Malignant tumors of the ureteric bud are not common, and cervical involvement is even rarer. So far, there have been no such cases in the literature.
CASE SUMMARY
A 50-year-old woman developed intermittent light bleeding in the past 7 months and lower abdominal pain in the past 2 months. The human papillomavirus 16 (HPV) DNA, P16 chemical staining, thinPrep cytology test (TCT), and cervical and cervical canal tissue biopsy were all negative. Pelvic color Doppler ultrasound exhibited incomplete mediastinal uterus and heterogeneous echo from the cervical canal to the posterior wall of the cervix. Pelvic contrast-enhanced CT showed left cervical mass, left retroperitoneal mass, absence of the left kidney, and mediastinal uterus. An increase in human epididymal protein 4 (HE4) (133.6 pmol/L) was detected, while other tumor markers were at normal levels. Based on these examination results, a diagnosis of "cervical fibroids, left retroperitoneal mass, incomplete mediastinal uterus, left kidney deficiency"[SIC] was conducted, and expanded hysterectomy, right adnexectomy, and left retroperitoneal mass resection were performed. Through intraoperative rapid pathological diagnosis, postoperative pathological diagnosis combined with the re-evaluation of laboratory, and imaging and intraoperative examination results, the patient was diagnosed with ureteric bud intestinal-type adenocarcinoma involving the cervix. The patient has been tracked and followed up for approximately 11 months. She underwent six courses of chemotherapy. At present, the medication has been discontinued for 4 months, and there is no recurrence, metastasis, or deterioration of the tumor.
CONCLUSION
For large masses of the cervix, it is feasible for the operation to be performed, improving the prognosis. There were a few limitations. A preoperative aspiration biopsy of masses was not performed to differentiate benign from malignant. Preoperative urography was not performed to clarify the function of the malformed urinary system structure. Partial cystectomy should be performed simultaneously with the resection of the ureteric bud for intestinal-type adenocarcinoma. In this case, a partial cystectomy was not performed, which can only be compensated with postoperative chemotherapy. Moreover, this patient did not undergo genetic screening, and it is currently unclear whether there are any genetic mutations associated with ureteric bud intestinal adenocarcinoma.
PubMed: 38681049
DOI: 10.3389/fmed.2024.1374653 -
Asian Journal of Urology Apr 2024To develop and internally validate a nomogram to predict recurrence-free survival (RFS) including the time to radical cystectomy (RC) and perioperative blood transfusion...
OBJECTIVE
To develop and internally validate a nomogram to predict recurrence-free survival (RFS) including the time to radical cystectomy (RC) and perioperative blood transfusion (PBT) as potential predictors.
METHODS
Patients who underwent open RC and ileal conduit between January 1996 to December 2016 were split into developing (=948) and validating (=237) cohorts. The time to radical cystectomy (TTC) was defined as the interval between the onset of symptoms and RC. The regression coefficients of the independent predictors obtained by Cox regression were used to construct the nomogram. Discrimination, validation, and clinical usefulness in the validation cohort were assessed by the area under the curve, the calibration plot, and decision curve analysis.
RESULTS
In the developing dataset, the 1-, 5-, and 10-year RFS were 83.0%, 47.2%, and 44.4%, respectively. On multivariate analysis, independent predictors were TTC (hazards ratio [HR] 1.07, 95% confidence interval [CI] 1.05-1.08, <0.001), PBT (one unit: HR 1.40, 95% CI 1.03-1.90, =0.03; two or more units: HR 1.72, 95% CI 1.29-2.29, <0.001), bilateral hydronephrosis (HR 1.54, 95% CI 1.21-1.97, <0.001), squamous cell carcinoma (HR 0.60, 95% CI 0.45-0.81, =0.001), pT3-T4 (HR 1.77, 95% CI 1.41-2.22, <0.001), lymph node status (HR 1.53, 95% CI 1.21-1.95, <0.001), and lymphovascular invasion (HR 1.28, 95% CI 1.01-1.62, =0.044). The areas under the curve in the validation dataset were 79.3%, 69.6%, and 76.2%, for 1-, 5-, and 10-year RFS, respectively. Calibration plots showed considerable correspondence between predicted and actual survival probabilities. The decision curve analysis revealed a better net benefit of the nomogram.
CONCLUSION
A nomogram with good discrimination, validation, and clinical utility was constructed utilizing TTC and PBT in addition to standard pathological criteria.
PubMed: 38680591
DOI: 10.1016/j.ajur.2022.09.002