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World Journal of Clinical Cases Mar 2022Bone grafts have been applied for many years in orthopedic surgery to assist with bone repair for defects or bone discontinuity caused by trauma and tumors as well as...
BACKGROUND
Bone grafts have been applied for many years in orthopedic surgery to assist with bone repair for defects or bone discontinuity caused by trauma and tumors as well as periodontal defects. Jaw cysts are another common benign disease of the maxillofacial region which may lead to pathological bone fracture, loss of teeth, and infection. However, whether bone grafts are beneficial for bone regeneration in jaw cystic lesions and when bone grafts should be used remains unclear.
AIM
To study the efficacy of bone grafts compared to spontaneous healing in the treatment of jaw cystic lesions.
METHODS
A literature search was performed in Medline, Cochrane Library and Embase to identify related articles published in English in the last ten years. The following key words and MeSH terms were used: "jaw cyst", "cystic lesion", "odontogenic cyst", "periapical cyst", "dentigerous cyst", "follicular cyst", "keratocyst", "treatment", "surgery", "bone graft", "enucleation", "cystectomy", and "bone regeneration". Case reports, clinical trials, clinical studies, observational studies and randomized controlled trials were included. Study quality was evaluated.
RESULTS
Ten studies ( = 10) met the inclusion criteria. Five studies reported spontaneous bone healing after enucleation, three studies investigated the efficacy of various bone grafts, and two randomized comparative studies focused on the comparison between spontaneous healing and bone grafting. Over 90% of bone regeneration occurred within 6 mo after bone grafting. The bone regeneration rate after cystectomy showed great variation, ranging from 50% to 100% after 6 mo, but reaching over 90% after 12 mo.
CONCLUSION
While the long-term superiority of bone grafting compared with spontaneous healing after cystectomy is unclear, bone grafts accelerate the process of healing and significantly increase bone quality.
PubMed: 35434117
DOI: 10.12998/wjcc.v10.i9.2801 -
Cureus Mar 2022Bladder cancer (BC) is classified as a high-risk tumour type for venous thromboembolism (VTE). VTE presents an extra challenge in the management of patients with cancer,... (Review)
Review
Bladder cancer (BC) is classified as a high-risk tumour type for venous thromboembolism (VTE). VTE presents an extra challenge in the management of patients with cancer, given the increase in morbidity and mortality on having both conditions. To summarise the contemporary evidence on the VTE rate in patients with BC according to the stage, type of anti-cancer treatment and highlight VTE rate in the UK and other countries. A systematic review was carried out, and an electronic search for publications between January 2000 and November 2021 was done. Studies recording VTE in BC patients were included, whilst paediatric patients, case reports, studies reporting on a mix of arterial and venous thrombosis, studies reporting DVT or PE only and recorded hospitalised VTE only were excluded. The rate of VTE, country of origin, risk factors and thromboprophylaxis duration for VTE in BC patients were identified. A total of 38 papers met the search criteria. All publications were original research papers (cohort studies). The overall VTE rate in patients with BC was estimated at 1.9% to 4.7%. For those patients undergoing cystectomy, the VTE rate ranged from 3% to 17.6%; however, the VTE rate in the metastatic stage of BC patients ranged from 3.1% to 5.1%. The rates of VTE in BC patients are high, further increased by interventions such as surgery and chemotherapy. Thromboprophylaxis measures should be optimised. This review highlighted the fact that the VTE rate in BC varies between studies due to the heterogeneity of risk factors reported.
PubMed: 35411272
DOI: 10.7759/cureus.22945 -
BMC Surgery Mar 2022Parastomal hernia after ileal conduit urinary diversion is an underestimated and undertreated clinical entity, which heavily impairs patients' quality of life due to...
BACKGROUND
Parastomal hernia after ileal conduit urinary diversion is an underestimated and undertreated clinical entity, which heavily impairs patients' quality of life due to symptoms of pain, leakage, application or skin problems. As for all gastrointestinal stomata the best surgical repair technique has yet to be determined. Thereby, surgery for ileal conduit parastomal hernias poses some specific perioperative challenges. This review aims to give an overview of current evidence on the surgical treatment of parastomal hernia after cystectomy and ileal conduit urinary diversion, and on the use of prophylactic mesh at index surgery in its prevention.
METHODS
A systematic review was performed according to PRISMA-guidelines. The electronic databases Embase, PubMed, Cochrane Library, and Web of Science were searched. Studies were included if they presented postoperative outcomes of patients undergoing surgical treatment of parastomal hernia at the ileal conduit site, irrespective of the technique used. A search was performed to identify additional studies on prophylactic mesh in the prevention of ileal conduit parastomal hernia, that were not identified by the initial search.
RESULTS
Eight retrospective case-series were included for analysis, reporting different surgical techniques. If reported, highest complication rate was 45%. Recurrence rates varied highly, ranging from 0 to 80%. Notably, lower recurrence rates were reported in studies with shorter follow-up. Overall, available data suggest significant morbidity after the surgical treatment of ileal conduit parastomal hernias. Data from five conference abstracts on the matter were retrieved, and systematically reported. Regarding prophylactic mesh in the prevention of ileal conduit parastomal hernia, 5 communications were identified. All of them used keyhole mesh in a retromuscular position, and reported on favorable results in the mesh group without an increase in mesh-related complications.
CONCLUSION
Data on the surgical treatment of ileal conduit parastomal hernias and the use of prophylactic mesh in its prevention is scarce. Given the specific perioperative challenges and the paucity of reported results, more high-quality evidence is needed to determine the optimal treatment of this specific surgical problem. Initial results on the use of prophylactic mesh in the prevention of ileal conduit parastomal hernias seem promising.
Topics: Cystectomy; Hernia, Ventral; Humans; Quality of Life; Retrospective Studies; Surgical Mesh; Urinary Diversion
PubMed: 35351086
DOI: 10.1186/s12893-022-01509-y -
European Urology Focus Nov 2022Surveillance of the urethra and management of urethral recurrence (UR) after radical cystectomy (RC) is an area with poor evidence. (Review)
Review
Follow-up of the Urethra and Management of Urethral Recurrence After Radical Cystectomy: A Systematic Review and Proposal of Management Algorithm by the European Association of Urology-Young Academic Urologists: Urothelial Carcinoma Working Group.
CONTEXT
Surveillance of the urethra and management of urethral recurrence (UR) after radical cystectomy (RC) is an area with poor evidence.
OBJECTIVE
We aimed to summarize the available evidence and provide clinicians with practical recommendations on how to prevent and manage UR after RC for bladder cancer.
EVIDENCE ACQUISITION
The MEDLINE and EMBASE databases were searched during September 2021 for studies evaluating UR after RC. The primary endpoint was oncologic outcomes for patients who experienced UR depending on different surveillance and management approaches.
EVIDENCE SYNTHESIS
Forty-three studies were included in the quantitative synthesis. According to the currently available literature, a tight-knitted surveillance protocol should be implemented for males treated with RC and nonorthotopic neobladder diversion as well as patients with prostatic involvement, tumor multifocality, bladder neck involvement, and concomitant carcinoma in situ. A survival benefit of a prophylactic urethrectomy has been reported only in patients at very high risk for UR based on clinical factors. Surveillance protocols were highly heterogeneous and poorly documented among included studies. Patients whose UR was diagnosed based on clinical symptoms had a poor prognosis. Only limited data were available on the comparative effectiveness of watchful waiting after RC versus clinical symptom screening as part of a follow-up strategy. However, the use of regular cytology and/or urethroscopy seems useful in select patients at high risk for UR. Despite limited data on the optimal management of UR, urethra-sparing approaches (transurethral resection of UR) seem to be an option for Ta (only) recurrences; a salvage urethrectomy with or without chemotherapy should be the standard for all others.
CONCLUSIONS
Based on the currently available literature, we have proposed an algorithm to guide the decision-making process to help identify and treat UR after RC. Given the lack of evidence on how to deal with UR and surveil patients at risk for UR, this study may invigorate research in this area of unmet need.
PATIENT SUMMARY
Early diagnosis and tailored management of urethral recurrence could help improve oncologic outcomes in these patients.
Topics: Humans; Carcinoma, Transitional Cell; Cystectomy; Urinary Bladder Neoplasms; Urinary Bladder
PubMed: 35337773
DOI: 10.1016/j.euf.2022.03.004 -
Disease Markers 2022The purpose of this meta-analysis is to determine the survival benefits and pathological outcomes of neoadjuvant chemotherapy (NAC) combined with radical cystectomy (RC)... (Comparative Study)
Comparative Study Meta-Analysis
The purpose of this meta-analysis is to determine the survival benefits and pathological outcomes of neoadjuvant chemotherapy (NAC) combined with radical cystectomy (RC) administered to patients with cT2 or cT3-4N0M0 muscle-invasive bladder cancer (MIBC). PubMed, Embase, and the Cochrane Library were searched for comparing the use of NAC in combination with RC and RC alone in patients with different MIBC stages. A fixed effects model was used to calculate hazard ratio (HR) and odds ratio (OR) with 95% confidence intervals (CIs), and the statistic was used to assess heterogeneity. Moreover, we determined possible sources of heterogeneity by subgroup and sensitivity analyses. Fifteen studies were finally selected. For cT2 bladder cancer, NAC combined with RC significantly increased the rates of pathological complete response (pCR) (OR = 4.84, 95% CI: 1.18-19.92, = 0.029) but did not improve overall survival (OS) (HR = 0.86, 95% CI: 0.72-1.02, = 0.078) across six studies. Regarding cT3-4 bladder cancer, NAC has a significantly improved effect on OS (HR = 0.69; 95% CI: 0.59-0.81, < 0.001, across seven studies and 5726 patients) and pCR (pooled OR = 4.80; 95% CI: 2.06-11.23, < 0.001, across two studies) than RC alone. Most studies were randomized prospective trials (level 1 evidence), and all the effects were irrespective of the type of study design and did not vary between subgroups of patients. In conclusion, NAC combined with RC is recommended for patients with T3-4aN0M0 but not for patients with T2N0M0.
Topics: Cystectomy; Humans; Neoadjuvant Therapy; Neoplasm Staging; Treatment Outcome; Urinary Bladder Neoplasms
PubMed: 35280442
DOI: 10.1155/2022/8493519 -
Translational Andrology and Urology Jan 2022This study aimed to systematically evaluate the efficacy of laparoscopic radical cystectomy (LRC) surgical therapy in patients with bladder cancer (BC), and to provide...
BACKGROUND
This study aimed to systematically evaluate the efficacy of laparoscopic radical cystectomy (LRC) surgical therapy in patients with bladder cancer (BC), and to provide evidence for the clinical treatment of BC.
METHODS
The Embase, Ovid, PubMed, Medline, Springer, and Web of Sciences database were searched to screen articles with clinical controlled trials on LRC treatment of BC. The Cochrane Handbook 5.0.2 software and Review Manager 5.3 software were adopted to evaluate the risk of bias and to perform a meta-analysis of the included articles in this study.
RESULTS
A total of 12 articles were obtained, including 1,283 research cases. The meta-analysis results showed that relative to the control group (Ctrl), the observation group (Observ group) had significantly lower intraoperative blood loss (IBL) after LRC [mean difference (MD) =-458.75; 95% confidential interval (CI): -505.75 to -411.76; Z=19.13; P<0.00001], blood transfusion rate (BTR) (odds ratio =0.36; 95% CI: 0.13-0.94; Z=2.08; and P=0.04), use of analgesics (MD =-24.53; 95% CI: -39.04 to -10.01; Z=3.31; and P=0.0009), and incidence of postoperative complications (Risk ratio =0.58; 95% CI: 0.39-0.85; Z=2.77; and P=0.006). However, and the length of hospital stay could not be shortened (MD =-2.43; 95% CI: -4.83 to -0.02; Z=1.98; and P=0.05).
DISCUSSION
LRC treatment of BC could effectively reduce the amount of IBS, and lower the intraoperative BTR, use of analgesics, and incidence of postoperative complications. Therefore, it could be used in the clinical surgical treatment of BC patients.
PubMed: 35242642
DOI: 10.21037/tau-21-1076 -
Arab Journal of Urology 2022To systematically review the evidence about the effect of neoadjuvant chemotherapy (NAC) for muscle-invasive bladder cancer (MIBC) with pure urothelial carcinoma (pUC)... (Review)
Review
OBJECTIVE
To systematically review the evidence about the effect of neoadjuvant chemotherapy (NAC) for muscle-invasive bladder cancer (MIBC) with pure urothelial carcinoma (pUC) in radical cystectomy (RC) candidates affected by variant histology (VH) bladder cancer.
METHODS
A review of the current literature was conducted through the Medline and National Center for Biotechnology Information (NCBI) PubMed, Scopus databases in May 2020. The updated Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed for this systematic review. Keywords used were 'bladder cancer', 'bladder carcinoma', 'bladder tumour' and 'bladder cancer variants' and 'neoadjuvant chemotherapy'. Only original articles in English published after 2000 and reporting oncological outcomes a series of more than five patients with VH were included. We excluded series in which the oncological outcomes of patients with pUC and VH were undistinguishable.
RESULTS
The literature search identified 2231 articles. A total of 51 full-text articles were assessed for eligibility, with 17 eventually considered for systematic review, for a cohort of 450,367 patients, of which 5010 underwent NAC + RC. The median age at initial diagnosis ranged from 61 to 71 years. Most patients received cisplatin-gemcitabine, methotrexate-vinblastine-adriamycin-cisplatin, or carboplatin-based chemotherapy. Only one study reported results of neoadjuvant immunotherapy. The median follow-up ranged from 1 to 120 months. The results showed that squamous cell carcinoma (SCC) is less sensitive to NAC than pUC and that SCC predicts poorer prognosis. NAC was found to be a valid approach in treating small cell carcinoma and may have potential benefit in micropapillary carcinoma.
CONCLUSIONS
NAC showed the best oncological outcomes in small cell variants and micropapillary carcinoma, while NAC survival benefit for SCC and adenocarcinoma variants needs further studies. Drawing definite considerations on the efficacy of NAC in VH is complicated due to the heterogeneity of present literature. Present results need to be confirmed in randomised controlled trials.
PubMed: 35223104
DOI: 10.1080/2090598X.2021.1994230 -
Cancers Jan 2022In Bacillus Calmette-Guérin (BCG) refractory non-muscle-invasive bladder cancer (NMIBC), radical cystectomy is the gold standard. The advent of immune checkpoint... (Review)
Review
From Interferon to Checkpoint Inhibition Therapy-A Systematic Review of New Immune-Modulating Agents in Bacillus Calmette-Guérin (BCG) Refractory Non-Muscle-Invasive Bladder Cancer (NMIBC).
BACKGROUND
In Bacillus Calmette-Guérin (BCG) refractory non-muscle-invasive bladder cancer (NMIBC), radical cystectomy is the gold standard. The advent of immune checkpoint inhibitors (CPIs) has permanently changed the therapy landscape of bladder cancer (BC). This article presents a systematic review of immune-modulating (IM) therapies (CPIs and others) in BCG-refractory NMIBC.
METHODS
In total, 406 articles were identified through data bank research in PubMed/Medline, with data cutoff in October 2021. Four full-text articles and four additional congress abstracts were included in the review.
RESULTS
Durvalumab plus Oportuzumab monatox, Pembrolizumab, and Nadofaragene firadenovec (NF) show complete response (CR) rates of 41.6%, 40.6%, and 59.6% after 3 months, with a long-lasting effect, especially for NF (12-month CR rate of 30.5%). Instillations with oncolytic viruses such as NF and CG0070 show good efficacy without triggering significant immune-mediated systemic adverse events. Recombinant BCG VPM1002BC could prove to be valid as an alternative to BCG in the future. The recombinant pox-viral vector vaccine PANVAC™ is not convincing in combination with BCG. Interleukin mediating therapies, such as ALT-803, are currently being studied.
CONCLUSION
CPIs and other IM agents now offer an increasing opportunity for bladder-preserving strategies. Studies on different substances are ongoing and will yield new findings.
PubMed: 35158964
DOI: 10.3390/cancers14030694 -
Translational Cancer Research Mar 2021Our aim is to report the incidence and risk factors of parastomal hernia (PH) after radical cystectomy (RC) and ileal conduit (IC) diversion with a cumulative analysis.
BACKGROUND
Our aim is to report the incidence and risk factors of parastomal hernia (PH) after radical cystectomy (RC) and ileal conduit (IC) diversion with a cumulative analysis.
METHODS
Various databases, including PubMed, the Cochrane Library, Embase and Web of Science, were retrieved electronically and manually to identify eligible studies from inception to August 20, 2020. Two reviewers independently searched the above databases and selected the studies using prespecified standardized criteria. The Newcastle-Ottawa Scale (NOS) was used to assess the risk of bias in the included studies, and the data was completed by STATA version 14.2.
RESULTS
Fifteen studies were included in the final analysis. A pooled analysis of eight studies representing 1,878 patients reported the incidence of overall radiographic PH was 23% (95% CI: 17-29%). The 1-year PH incidence rate and 2-year incidence rate of RC and IC were 14% (95% CI: 6-22%) and 26% (95% CI: 14-38%), respectively. A pooled analysis of nine studies reported the incidence of clinically evident PH was 15% (95% CI: 10-19%). PH-related symptoms were reported in six studies, and the pooled result was 29% (95% CI: 24-33%), and a pooled analysis of ten studies showed that 20% (95% CI: 11-28%) of patients required surgical repair. However, it's noteworthy that among symptomatic PH patients undergoing surgical repair, the pooled analysis of five studies showed that up to 26% (95% CI: 16-36%) of patients suffered PH recurrence. The most frequent risk factor was body mass index (BMI). Patients with BMI ≥22.9 kg/m experienced 2.92-fold higher risk of PH than their counterparts [hazard ratio (HR): 2.92; 95% CI: 1.65-5.19].
CONCLUSIONS
Our findings indicated that the PH incidence rate after RC and IC was significantly higher in radiographic evaluation than that of clinical examination, and the recurrence of repairment is considerable for patients requiring reconstruction.
PubMed: 35116464
DOI: 10.21037/tcr-20-3349 -
Journal of Robotic Surgery Oct 2022The adoption of minimally invasive laparoscopic techniques has revolutionised urological practice. This necessitates a pneumoperitoneum (PNP) and the impact the PNP...
The adoption of minimally invasive laparoscopic techniques has revolutionised urological practice. This necessitates a pneumoperitoneum (PNP) and the impact the PNP pressure has on post-operative outcomes is uncertain. During the current COVID-19 era guidance has suggested the utilisation of lower PNP pressures to mitigate the risk of intra-operative viral transmission. Review the current literature regarding the impact of pneumoperitoneum pressure, within the field of urology, on post-operative outcomes. A search of the PubMed, Medline and EMBASE databases was undertaken to identify studies that met the inclusion criteria. The Preferred Reporting Items for Systematic Reviews (PRISMA) guidelines were adhered to. Ten studies, that included both randomised controlled trials and retrospective case series reviews, were identified that met the inclusion criteria. The effect of PNP pressure on outcomes following prostatectomy, live donor nephrectomy, partial nephrectomy and a variety of benign upper tract procedures were discussed. Low pressure PNP appears safe when compared to high pressure PNP, potentially reducing post-operative pain and rates of ileus. When compared to general surgery, there is a lack of quality evidence investigating the impact of PNP pressures on outcomes within urology. Low pressure PNP appears non-inferior to high pressure PNP. More research is required to validate this finding, particularly post-cystectomy and nephrectomy.
Topics: COVID-19; Humans; Male; Minimally Invasive Surgical Procedures; Pain, Postoperative; Pneumoperitoneum, Artificial; Retrospective Studies; Urologic Surgical Procedures, Male
PubMed: 35094219
DOI: 10.1007/s11701-021-01349-7