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Nursing Open Oct 2023To identify and describe international practice in incontinence management after radical cystectomy and orthotopic neobladder. (Review)
Review
OBJECTIVES
To identify and describe international practice in incontinence management after radical cystectomy and orthotopic neobladder.
MATERIALS AND METHODS
A systematic scoping review following the methodology of the Joanne Briggs Institute was conducted in which the application searched 15 data sources to identify papers published in English, from 1979 to 2022.
RESULTS
Of the 16 papers that met the eligibility criteria, articles in Eastern countries mainly focus on the effect of conservative treatment, while in Western countries, more attention is paid to the effect of surgical treatment. Clinical characteristics of patients included conservative treatment failure, duration of post-operative intervention and unique differential treatment of male and female patients. Reported factors influencing the achievement of urinary incontinence (UI) include lack of evidence to guide management practice, limited value of conservative treatment, high risk of surgical treatment and uncertainty of efficacy; currently, early behavioural research and multimodal rehabilitation training have good results.
CONCLUSIONS
UI in neobladder patients is a distressing condition that is difficult to treat and often requires high-quality rehabilitation guidance and surgical intervention. Further research to address current knowledge gaps is important to inform practice.
Topics: Humans; Male; Female; Cystectomy; Urinary Diversion; Urinary Bladder Neoplasms; Urinary Bladder; Urinary Incontinence
PubMed: 37408112
DOI: 10.1002/nop2.1924 -
Journal of Medical Case Reports Dec 2022Bladder paraganglioma is a neuroendocrine tumor that accounts for less than 0.1% of all bladder tumors. Symptoms caused by catecholamine release such as hypertension,...
BACKGROUND
Bladder paraganglioma is a neuroendocrine tumor that accounts for less than 0.1% of all bladder tumors. Symptoms caused by catecholamine release such as hypertension, palpitation, syncope, and macroscopic hematuria are the most common findings. Treatment modalities include transurethral resection, and partial or total cystectomy.
CASE PRESENTATION
A 38-year-old Turkish female patient was examined for hematuria that had been persisting for 6 months. Among the clinical findings, only hematuria was present. Absence of adrenergic symptoms such as hypertension, palpitations, and syncope at the first presentation made it difficult to consider bladder paraganglioma in the differential diagnosis. Therefore, cystoscopy and transurethral resection were performed with the thought of urothelial cancer. Findings such as hypertension and bradycardia that developed during diagnostic transurethral resection suggested that it might be bladder paraganglioma. After the radiological evaluation and endocrinological preparation, the patient underwent partial cystectomy.
CONCLUSION
The rarity of cases having been reported in the literature leads to uncertainties in the management of bladder paraganglioma. Adrenergic symptoms developing during transurethral resection should suggest paraganglioma in the differential diagnosis. A multidisciplinary approach and medical treatment are mandatory to prevent life-threatening complications such as hypertensive crisis, vascular collapse, and multiple-organ system failure. We aimed to report the clinical presentation that includes only macroscopic hematuria mimicking urothelial cancer and to emphasize the multidisciplinary approach in the treatment.
Topics: Humans; Female; Adult; Urinary Bladder; Cystectomy; Hematuria; Urinary Bladder Neoplasms; Pheochromocytoma; Paraganglioma; Hypertension; Carcinoma, Transitional Cell; Adrenal Gland Neoplasms; Adrenergic Agents
PubMed: 36566235
DOI: 10.1186/s13256-022-03715-x -
Archivos Espanoles de Urologia May 2023To evaluate the efficiency of open radical cystectomy (ORC) in relation to laparoscopic radical cystectomy (LRC) for muscle-invasive bladder cancer, and incidence of...
OBJECTIVE
To evaluate the efficiency of open radical cystectomy (ORC) in relation to laparoscopic radical cystectomy (LRC) for muscle-invasive bladder cancer, and incidence of postoperative recurrence.
METHODS
A total of 90 patients with muscle-invasive bladder cancer admitted to our urology department from January 2019 to May 2022 were included in this study. Using the random number table, the patients were assigned equally to ORC and LRC groups. The perioperative data of the patients were collected and recorded. The outcome indicators comprised erythrocyte pressure and creatinine levels, blood gas analysis, type of urinary diversion, and histopathology of surgically removed tumors.
RESULTS
Operation time of LRC was significantly longer than that of ORC, but other perioperative indices of LRC were better than those of ORC ( < 0.05). Hematocrit levels in LRC group were higher than those in ORC group at postoperative 1 day and before discharge ( < 0.05). However, creatinine levels were lower in LRC group than in ORC group at postoperative 1 day and before discharge ( < 0.05). Moreover, LRC resulted in better blood gas indices than ORC ( < 0.05). There were no significant differences in the type of urinary diversion and histopathological results from surgically removed tumor between the two groups ( > 0.05). Patients who received LRC had a lower incidence of complications than those given ORC ( < 0.05).
CONCLUSIONS
LRC reduced perioperative complications, decreased mean length of hospital stays, and enhanced recovery of gastrointestinal and renal functions. These data suggest that LRC is safer and more efficient than ORC. However, further studies are required prior to clinical application of this procedure.
Topics: Humans; Cystectomy; Laparoscopy; Treatment Outcome; Creatinine; Urinary Bladder Neoplasms; Muscles
PubMed: 37340525
DOI: 10.56434/j.arch.esp.urol.20237603.23 -
Investigative and Clinical Urology May 2016To describe a novel modification to robot-assisted partial cystectomy (RAPC) that allows for intraoperative surgical margin assessment by bimanual-examination and...
PURPOSE
To describe a novel modification to robot-assisted partial cystectomy (RAPC) that allows for intraoperative surgical margin assessment by bimanual-examination and frozen-section analysis.
MATERIALS AND METHODS
A total of 7 patients underwent RAPC at a single tertiary-care institution between 2008 and 2013. The technique evolved over the study-period and permitted real-time intraoperative surgical margin evaluation in the last 5 patients via bimanual-examination and frozen-section analysis, utilizing the GelPOINT platform (a hand-assist device). The GelPOINT platform was placed through a 4- to 5-cm vertical supraumbilical incision and allowed for rapid retrieval of the bladder specimen without compromising the pneumoperitoneum or prolonging the operative time. Perioperative, oncological and functional outcomes were evaluated; all patients had a minimum 12-month follow-up. At the time of last follow-up, a cross-sectional survey of patients was performed to evaluate regret/satisfaction utilizing validated questionnaires.
RESULTS
The mean age was 72.5 years; 71.4% of the patients were men (n=5). All patients underwent RAPC for a malignant indication. The mean operative and console times were 291 and 217 minutes, respectively. No patient had a positive surgical margin. Mean length-of-stay was 1.7 days. At a median follow-up of 38.9 months, 1 patient experienced a local recurrence 6 months postsurgery. The only mortality was secondary to Lewy-body disease, in the same patient, 1 year postoperatively. Patient assessment of regret and satisfaction indicated 0% regret and 0% dissatisfaction.
CONCLUSIONS
The 'modified' technique of RAPC is technically feasible, safe, and reproducible; further, RAPC leads to favorable oncological, functional and quality-of-life outcomes in patients eligible for partial cystectomy.
Topics: Aged; Cystectomy; Female; Follow-Up Studies; Frozen Sections; Humans; Intraoperative Care; Male; Margins of Excision; Middle Aged; Operative Time; Patient Satisfaction; Quality of Life; Robotic Surgical Procedures; Specimen Handling; Ultrasonography; Urinary Bladder Neoplasms
PubMed: 27195322
DOI: 10.4111/icu.2016.57.3.221 -
PloS One 2023To evaluate primarily the relationship between postoperative complications and hospital costs, and secondarily the relationship between postoperative complications and...
OBJECTIVES
To evaluate primarily the relationship between postoperative complications and hospital costs, and secondarily the relationship between postoperative complications and mortality, following radical cystectomy.
METHODS
Postoperative complications were retrospectively examined for 147 patients undergoing radical cystectomy at a university hospital between January 2012 and July 2021. Complications were defined and graded using the Clavien-Dindo classification system. In-hospital cost was calculated using an activity-based costing methodology. Regression modelling was used to investigate the relationships among a priori selected perioperative variables, complications, and costs. The effect of complications on postoperative mortality was ascertained using time-dependent coefficients in a Cox proportional hazards regression model.
RESULTS
135 (92%) patients experienced one or more postoperative complications. The medians of hospital cost for patients who experienced no complications and those who experienced complications were $42,796.3 (29,222.9-53,532.5) and $81,050.1 (49,614.8-122,533.6) respectively, p < 0.001. Hospital costs were strongly associated with complication severity: Clavien-Dindo grade II complications increased costs by 45.2% (p < 0.001, 95% CI 19.1%-76.6%), and Clavien-Dindo grade III to V complications increased costs by 107.5% (p < 0.001, 95% CI 52.4%-181.8%). Each additional count of complication and increase in Clavien-Dindo complication grade increased the risk of mortality 1.28-fold (RR = 1.28, p = 0.006, 95% CI 1.08-1.53) and 2.50-fold (RR = 2.50, p = 0.012 95% CI 1.23-5.07) respectively.
CONCLUSIONS
These findings demonstrate a high prevalence of complications following cystectomy and significant associated increases in hospital costs and mortality. Postoperative complications are a key target for cost-containment strategies.
TRIAL REGISTRATION
Trial Registration: Australian New Zealand Clinical Trials Registry (ACTRN:12622000057785.
Topics: Humans; Cystectomy; Retrospective Studies; Hospital Costs; Australia; Postoperative Complications; Urinary Bladder Neoplasms
PubMed: 36827411
DOI: 10.1371/journal.pone.0282324 -
Archivio Italiano Di Urologia,... Dec 2022Intradiverticular bladder tumors (IDBT) are uncommon clinical entities. We reviewed the literature for clinical presentation, diagnosis and therapeutic options to... (Review)
Review Meta-Analysis
OBJECTIVE
Intradiverticular bladder tumors (IDBT) are uncommon clinical entities. We reviewed the literature for clinical presentation, diagnosis and therapeutic options to establish recommendations for diagnostic and therapeutic management.
METHODS
Bibliographic research was performed using PubMed from database inception until October 15, 2022. A pooled analysis was performed of 498 patients with IDBT presented in the literature. The evaluation included patient sex, age, diagnostic methods, symptoms, localization of the tumor, tumor staging, tumor histopathology, treatment, and the presence of recurrence. To express results, descriptive statistics were used appropriately.
RESULTS
The mean age at diagnosis was 64.81 years (range 49 days to 84 years). The ratio between men and women was ≈ 24:1, suggesting a male predominance (85% male, 3.6% female). The most common presenting symptom was gross hematuria (60.88%). Most of the patients had cystoscopy (56.85%) and intravenous or computed tomography urography (52.01%). Regarding tumor staging, most of the patients were diagnosed with pT1 tumors. For the histopathology of IDBT, 87.95% of the specimens were transitional cell carcinomas and in 10.84% there were concomitant CIS. Regarding the treatment, radical cystectomy was chosen in 34.34%, partial cystectomy in 26.66%, diverticulectomy in 15.95% and transurethral resection of bladder tumour (TURBT) in 16.36% of the patients.
CONCLUSIONS
Most common diagnostic tool for IDBT seems to be cystoscopy followed by computerized tomography urogram. Due to the absence of muscle layer in the diverticulum and the highgrade histology of most of them at diagnosis, cystectomy is the first therapeutic choice. However, for patients that are not considered appropriate candidates or for those presenting with lowgrade and low volume tumors, TURBT is a good option.
Topics: Humans; Female; Male; Infant; Urinary Bladder Neoplasms; Carcinoma, Transitional Cell; Urinary Bladder; Neoplasm Staging; Cystoscopy; Cystectomy
PubMed: 36576457
DOI: 10.4081/aiua.2022.4.486 -
Urologia Internationalis 2012The bladder is the most common affected site in urinary tract endometriosis, being diagnosed during gynecologic follow-up. The surgical urological treatment might lead... (Review)
Review
BACKGROUND
The bladder is the most common affected site in urinary tract endometriosis, being diagnosed during gynecologic follow-up. The surgical urological treatment might lead to good results.
STUDY OBJECTIVE
To define the state of the art in the diagnosis and treatment of bladder endometriosis.
METHODS
We performed a literature review by searching the MEDLINE database for articles published between 1996 and 2011, limiting the searches to the words: urinary tract endometriosis, bladderendometriosis, symptoms, diagnosis and treatment.
RESULTS
Deep pelvic endometriosis usually involves the urinary system, with the bladder being affected in 85% of cases. The diagnosis has to be considered as a step-by-step procedure. Currently, the treatment is usually surgical, consisting of either transurethral resection or partial cystectomy, and eventually associated with hormonal therapy. The hormonal therapy alone counteracts only the stimulus of endometriotic tissue proliferation, with no effects on the scarring caused by this tissue. The overall recurrence rate is about 30% for combined therapies and about 35% for the hormonal treatment alone.
CONCLUSIONS
The bladder is the most common affected site in urinary tract endometriosis. Most of the time, this condition is diagnosed because of the complaint of urinary symptoms during gynecologic follow-up procedures for a deep pelvic endometriosis: a close collaboration between the gynecologist and the urologist is advisable, especially in highly specialized centers. The surgical urological treatment might lead to good results in terms of patients' compliance and prognosis.
Topics: Cystectomy; Diagnosis, Differential; Endometriosis; Female; Hormones; Humans; Prognosis; Recurrence; Treatment Outcome; Ultrasonography; Urinary Bladder; Urinary Bladder Diseases; Urology
PubMed: 22813980
DOI: 10.1159/000339519 -
Urology Journal Jan 2022The aim of this study was to introduce an advanced surgical technique for laparoscopic radical cystectomy (LRC), evaluate the perioperative outcome and compare it to...
"Two-zone and Three-segment" Laparoscopic Radical Cystectomy vs Conventional Laparoscopic Radical Cystectomy for Male Patients With Bladder Urothelial Carcinoma: A Retrospective Analysis.
PURPOSE
The aim of this study was to introduce an advanced surgical technique for laparoscopic radical cystectomy (LRC), evaluate the perioperative outcome and compare it to that of conventional LRC (CLRC).
MATERIALS AND METHODS
Between March 2018 and March 2020, sixty patients were divided into the "two-zone and three-segment" laparoscopic radical cystectomy (TTLRC) group or the CLRC group. Patient baseline characteristics, preoperative characteristics and postoperative complications were collected.
RESULTS
The TTLRC technique was developed based on the pelvic anatomy of six formalin fixed male cadavers. None of the patient baseline characteristics, including ECOG-PS score, comorbidity, ASA score and Hb, were significantly different between the two groups (p>0.05). There were significant differences in the operating time and estimated blood loss (total time: 3±0.2 vs 3.8±0.4, p<0.001; time to cystectomy and lymph node dissection: 1.7±0.2 vs 2.2±0.3, p<0.001; estimated blood loss 182.1±18.8 vs 264.3±27.4, p<0.001). Although there were no differences in late complications, early complications were significantly different between the two groups (p = 0.033). No statistically significant differences were found between the two groups in other outcomes (p>0.05).
CONCLUSION
The TTLRC technique achieves a clearer surgical field, has a shorter operating time and produces less blood loss than CLRC. It is safe and feasible for urologists to perform this improved LRC procedure.
Topics: Carcinoma, Transitional Cell; Cystectomy; Humans; Laparoscopy; Male; Retrospective Studies; Treatment Outcome; Urinary Bladder; Urinary Bladder Neoplasms
PubMed: 35075626
DOI: 10.22037/uj.v19i.6919 -
Advances in Clinical and Experimental... 2014Bladder cancer is one of the most frequent human cancers. In 2011 more than six thousand people in Poland developed BC and more than three thousand died because of it.... (Review)
Review
Bladder cancer is one of the most frequent human cancers. In 2011 more than six thousand people in Poland developed BC and more than three thousand died because of it. Treatment of bladder cancer depends on its stage. In less advanced tumours (Ta, Tcis, T1) transurethral resection of bladder tumor with adjuvant immunotherapy is often therapeutic. In more advanced cases (≥ T2) radical cystectomy is needed. There are several surgical types of post-cystectomy urinary diversion divided into two fundamental types - enabling and not enabling urine continence. The most common procedures include ureterocutaneostomy, ileal or colon conduit, orthopic ileal bladder, heterotopic continent bladder replacement (pouch) and urinary diversion via the rectum. Depending on type of cystectomy, various metabolic complications occur, because the absorptive-secretory function of used bowel segment is intact. Complications include bowel dysfunction, malabsorption of various vitamins, acid-base imbalance, electrolyte imbalance, abnormalities in bone metabolism, formation of renal calculi, secondary malignancies and disturbances in function of kidneys or liver. Early diagnosed complications can be treated easier, recognised in advanced stages are often irreversible. In our paper we present review of different approaches to bladder cancer treatment and metabolic complications occurring after these procedures.
Topics: Cystectomy; Humans; Postoperative Complications; Urinary Bladder Neoplasms; Urinary Diversion
PubMed: 25166450
DOI: 10.17219/acem/28251 -
World Journal of Urology Jun 2020The aim of this review is to present an anesthesiological overview on surgical safety for radical cystectomy implementing the cornerstones of today's rapidly evolving... (Review)
Review
PURPOSE
The aim of this review is to present an anesthesiological overview on surgical safety for radical cystectomy implementing the cornerstones of today's rapidly evolving field of perioperative medicine.
METHODS
This is a narrative review of current perioperative medicine and surgical safety concepts for major surgery in general with special focus on radical cystectomy.
RESULTS
The tendency for perioperative care and surgical safety is to consider it a continuous proactive pathway rather than a single surgical intervention. It starts at indication for surgery and lasts until full functional recovery. Preoperative optimization leads to superior outcome by mobilizing and/or increasing physiological reserve. Multidisciplinary teamwork involving all the relevant parties from the beginning of the pathway is crucial for outcome rather than an isolated specialist approach. This fact has gained importance in times of an ageing frail population and rising health care cost. We also present our 2019 Cystectomy Enhanced Recovery Approach for optimization of perioperative care for open radical cystectomy in a high caseload center.
CONCLUSIONS
With the implementation of in itself simple but crucial steps in perioperative medicine such as multimodal prehabilitation, safety checks, better perioperative monitoring and enhanced recovery concepts, even complex surgical procedures such as radical cystectomy can be performed safer. Emphasis has to be laid on a more global view of the patients' path through the perioperative process than on the surgical procedure alone.
Topics: Anesthesiology; Attitude of Health Personnel; Clinical Protocols; Cystectomy; Humans; Patient Safety; Perioperative Care; Postoperative Complications
PubMed: 31201522
DOI: 10.1007/s00345-019-02839-y