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Dal Moro F, Zattoni F, Tonet E, Morlacco A, Betto G, Novara G. Perioperative and Functional Results for Robot-assisted Radical Cystectomy with Totally Intracorporeal Neobladder in Male Patients via the Vesica Patavina (Ves.Pa.) Technique: IDEAL Stage 2a Report. EUR UROL SUPPL 2023; 57:8-15. [PMID: 37771917 PMCID: PMC10522971 DOI: 10.1016/j.euros.2023.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/05/2023] [Indexed: 09/30/2023] Open
Abstract
Background Robot-assisted radical cystectomy (RARC) offers several advantages over open surgery, but intracorporeal neobladder construction (INC) is a challenging procedure. The vesica patavina (Ves.Pa.) refinement is a modification of the original technique that simplifies the neobladder configuration and reduces the risk of complications. Objective To present a stage 2a IDEAL (Idea, Development, Exploration, Assessment and Long-term follow-up) report on RARC with INC using the Ves.Pa. technique. Design setting and participants This was a prospective study of consecutive male patients undergoing RARC and Ves.Pa. INC performed by a single surgeon for muscle-invasive or non-muscle-invasive, bacillus Calmette-Guérin-refractory urothelial bladder cancer in a tertiary referral center. Surgical procedure RARC with INC using the refined Ves.Pa. technique. Measurements Complications were classified using the Clavien-Dindo scheme, and functional outcomes were assessed using validated questionnaires. Results and limitations A total of 20 male patients were treated. The median operative time was 382 min, and the median estimated blood loss was 350 ml. The incidence of high-grade complications was extremely low, with only one patient experiencing a grade IIIa complication. All patients had clear surgical margins. At median follow-up of 12 mo, statistically significant differences in all the functional scores measured were observed. Specifically, 6-mo parameters were all significantly worse than at baseline (all p < 0.05). No patients required intermittent catheterization. Severe urinary incontinence was experienced by approximately 25% of the patients. The median number of pad used was 0 during the day and 1 at night. The study is limited by its small sample size, single-center design, and short follow-up. Conclusions RARC with the refined Ves.Pa. technique for INC is safe, feasible, and replicable. The technique simplifies the procedure and reduces the risk of complications. The study results suggest acceptable oncological and functional outcomes over short-term follow-up. Patient summary We report our initial experience with robot-assisted removal of the bladder and construction of a new bladder using our modified technique, called Ves.Pa., in patients with bladder cancer. The technique is simple to perform. We observed a low rate of high-grade complications, and patients had surgical margins negative for cancer in all cases and fair functional outcomes at 12-month follow-up.
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Affiliation(s)
- Fabrizio Dal Moro
- Urology Clinic, Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy
| | - Fabio Zattoni
- Urology Clinic, Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy
| | - Elisa Tonet
- Urology Clinic, Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy
| | - Alessandro Morlacco
- Urology Clinic, Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy
| | - Giovanni Betto
- Urology Clinic, Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy
| | - Giacomo Novara
- Urology Clinic, Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy
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Zeng S, Feng X, Xing S, Xu Z, Miao Z, Liu Q. Advanced Peptide Nanomedicines for Bladder Cancer Theranostics. Front Chem 2022; 10:946865. [PMID: 35991612 PMCID: PMC9389364 DOI: 10.3389/fchem.2022.946865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 06/13/2022] [Indexed: 11/13/2022] Open
Abstract
Cancer is still a global public health problem. Although remarkable success has been achieved in cancer diagnosis and treatment, the high recurrence and mortality rates remain severely threatening to human lives and health. In recent years, peptide nanomedicines with precise selectivity and high biocompatibility have attracted intense attention in biomedical applications. In particular, there has been a significant increase in the exploration of peptides and their derivatives for malignant tumor therapy and diagnosis. Herein, we review the applications of peptides and their derivatives in the diagnosis and treatment of bladder cancer, providing new insights for the design and development of novel peptide nanomedicines for the treatment of bladder cancer in the future.
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Affiliation(s)
- Sheng Zeng
- Department of Urology, Tianjin First Central Hospital, Tianjin, China
| | - Xiaodi Feng
- Department of Urology, Qingdao Hospital of Traditional Chinese Medicine (Qingdao Hiser Hospital), ShanDong, China
| | - Shaoqiang Xing
- Department of Urology, Weihai Central Hospital, ShanDong, China
| | - Zhaoliang Xu
- Department of Urology, First Central Clinical College, Tianjin Medical University, Tianjin, China
| | - Zhizhao Miao
- School of Medicine, Nankai University, Tianjin, China
| | - Qian Liu
- Department of Urology, Tianjin First Central Hospital, Tianjin, China
- School of Medicine, Nankai University, Tianjin, China
- *Correspondence: Qian Liu,
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Bolenz C, Ohlmann CH, Gschwend J. [Do's and Dont's for radical cystectomy and urinary diversion - how to minimise postoperative complications]. Aktuelle Urol 2022; 53:159-166. [PMID: 35172350 DOI: 10.1055/a-1745-8471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Radical cystectomy (RC) with urinary diversion is a challenging surgical intervention. There is significant risk of postoperative complications, particularly linked to urinary diversion and the patient's comorbidities. The surgeon and the multidisciplinary team need to be familiar with all potential complications. In order to achieve optimal oncological and functional outcomes, multiple factors have to be considered during perioperative management, including the adherence to evidence-based guidelines, standardised concepts of enhanced recovery and best surgical practice for RC and urinary diversion. All measures should aim to minimise complication rates after RC and to accelerate recovery. We summarise essential Dos and Don'ts when performing RC with different forms of urinary diversion.
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Affiliation(s)
- Christian Bolenz
- Klinik für Urologie und Kinderurologie, Universitätsklinikum Ulm, Ulm, Germany
| | | | - Jürgen Gschwend
- Klinik und Poliklinik für Urologie, Technische Universität München, München, Germany
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Korkes F, Timóteo F, Martins S, Nascimento M, Monteiro C, Santiago JH, Baccaglini W, Silveira MA, Pedroso EF, Gava MM, Patel P, Spiess PE, Glina S. Dramatic Impact of Centralization and a Multidisciplinary Bladder Cancer Program in Reducing Mortality: The CABEM Project. JCO Glob Oncol 2021; 7:1547-1555. [PMID: 34767463 PMCID: PMC8594663 DOI: 10.1200/go.21.00104] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Muscle-invasive bladder cancer (MIBC) is an aggressive disease with a complex treatment. In Brazil, as in most developing countries, data are scarce, but mortality seems exceedingly high. We have created a centralization program involving a multidisciplinary clinic in a region comprising seven municipalities. The aim of this study is to evaluate the impact of a multidisciplinary clinic and a centralization-of-care program (CABEM program) on MIBC treatment in Brazil. PATIENTS AND METHODS A total of 116 consecutive patients were evaluated. In group 1, 58 patients treated for MIBC before establishing a bladder cancer program from 2011 to 2017 were retrospectively evaluated. Group 2 represented 58 patients treated for MIBC after the implementation of the CABEM centralization program. Age, sex, staging, comorbidity indexes, mortality rates, type of treatment, and perioperative outcomes were compared. RESULTS Patients from group 2 versus 1 were older (68 v 64.2 years, P = .02) with a higher body mass index (25.5 v 22.6 kg/m2, P = .017) and had more comorbidities according to both age-adjusted Charlson Comorbidity Index (4.2 v 2.8, P = .0007) and Isbarn index (60.6 v 43.9, P = .0027). Radical cystectomy (RC) was the only treatment modality for patients in group 1, whereas in group 2, there were 31 (53%) RC; three (5%) partial cystectomies; seven (12%) trimodal therapies; 13 (22%) palliative chemotherapies; and three (5%) exclusive transurethral resections of the bladder tumor. No patient in group 1 received neoadjuvant chemotherapy, whereas it was offered to 69% of patients treated with RC. Ninety-day mortality rates were 34.5% versus 5% for groups 1 versus 2 (P < .002). One-year mortality was also lower in group 2. CONCLUSION Our data support that a centralization program, a structured bladder clinic associated with protocols, a multidisciplinary team, and inclusion of chemotherapy and radiotherapy treatments can pleasingly improve outcomes for patients with MIBC.
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Affiliation(s)
- Fernando Korkes
- Division of Urology, Faculdade de Medicina do ABC, Santo André, Brazil.,Hospital Municipal da Vila Santa Catarina and Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Frederico Timóteo
- Division of Urology, Faculdade de Medicina do ABC, Santo André, Brazil.,Hospital Municipal da Vila Santa Catarina and Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Suelen Martins
- Division of Oncology, Faculdade de Medicina do ABC, Santo André, Brazil
| | | | - Camila Monteiro
- Division of Urology, Faculdade de Medicina do ABC, Santo André, Brazil
| | - José H Santiago
- Division of Urology, Faculdade de Medicina do ABC, Santo André, Brazil
| | - Willy Baccaglini
- Division of Urology, Faculdade de Medicina do ABC, Santo André, Brazil.,Hospital Municipal da Vila Santa Catarina and Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Marcel A Silveira
- Division of Urology, Faculdade de Medicina do ABC, Santo André, Brazil
| | - Eduardo F Pedroso
- Division of Urology, Faculdade de Medicina do ABC, Santo André, Brazil
| | - Marcello M Gava
- Division of Urology, Faculdade de Medicina do ABC, Santo André, Brazil
| | | | | | - Sidney Glina
- Division of Urology, Faculdade de Medicina do ABC, Santo André, Brazil
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Abstract
PURPOSE OF REVIEW To review the most recent data on urinary diversions (UD) surgical outcomes performed at time of radical cystectomy (RC). RECENT FINDINGS Looking at the recent specific literature, the most recent factors introduced in the field of UDs are the preoperative assessment of patient's frailty and the use of the robotic system. According to the available evidence, frailty status is a good preoperative predictor of surgical outcomes and patient recovery. Several questionaries measuring patient's frailty status have been evaluated as a proxy to prevent RC complications and to improve the choice of the UDs.Robot-assisted RC has gained popularity and both continent and incontinent UD are now performed through an intra-corporeal technique. Studies on Robot-assisted UDs showed that both intra-corporeal and extra-corporeal approaches (ICUD and ECUD, respectively) are safe and feasible. Compared to the open techniques, they improve intraoperative blood loss and postoperative recovery. However, accessibility to the Da-Vinci System and the need of robotic skills limit the application of these techniques to high-volume institutes. SUMMARY Patient's frailty status and the use of robotic surgery are the most recent factors introduced to improve the choice of UD and surgical outcomes.
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Jaipuria J, Karimi AM, Singh A, Thapa BB, Gupta S, Sadasukhi N, Venkatasubramaniyan M, Pathak P, Kasaraneni P, Khanna A, Narayan TA, Sharma G, Rawal S. Pitcher pot neourethral modification of ileal orthotopic neobladder achieves satisfactory long‐term functional and quality of life outcomes with low clean intermittent self‐catheterization rate. BJUI COMPASS 2021; 2:292-299. [PMID: 35475302 PMCID: PMC8988529 DOI: 10.1002/bco2.82] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 02/16/2021] [Accepted: 02/19/2021] [Indexed: 12/24/2022] Open
Abstract
Objective To describe a decade of our experience with a neo‐urethral modification of ileal orthotopic neobladder (pitcher pot ONB). Multiple investigators have reported similar modifications. However, long‐term longitudinal functional and quality of life (QOL) outcomes are lacking. Methods Prospectively maintained hospital registry for 238 ONB patients comprising a mix of open and robotic surgery cohorts from 2007 to 2017, and minimum of 2 years of follow‐up was retrospectively queried. QOL was evaluated using Bladder Cancer Index (BCI). Longitudinal trends of QOL domain parameters were analysed. List of perioperative variables that have a biologically plausible association with continence, potency, and post‐operative BCI QOL sexual, urinary, and bowel domain scores was drawn. Variables included surgery type, Body Mass Index (BMI), T and N stage, neurovascular bundle (NVB) sparing, age, and related pre‐operative BCI QOL domain score. Prognostic associations were analysed using multivariable Cox proportional hazard models and multilevel mixed‐effects modeling. Results The study comprised 80 and 158 patients who underwent open and robotic sandwich technique cohorts, respectively. Open surgery was associated with significantly higher “any” complication (40% vs 27%, P‐value .050) and “major” complication rate (15% vs 11%, P‐value .048). All patients developed a bladder capacity >400 cc with negligible post‐void residual urine, and all but one patient achieved spontaneous voiding by the end of study period (<1% clean intermittent self‐catheterization [CISC] rate). By 15 months, QOL for all three domains had recovered to reach a plateau. About 45% of patients achieved potency, and the median time to achieve day and night time continence was 9 and 12 months respectively. Lower age and NVBs spared during surgery were found to be significantly associated with the earlier achievement of potency, day and night time continence, as well as better urinary and sexual summary QOL scores. Conclusions Pitcher pot neobladder achieves satisfactory long‐term functional and QOL outcomes with negligible CISC rate. Results were superior with incremental nerves spared during surgery.
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Affiliation(s)
- Jiten Jaipuria
- Amity Centre for Cancer Epidemiology & Cancer Research Amity Institute of Biotechnology Amity University Uttar Pradesh Noida India
- Department of Surgical Oncology Uro‐oncology Division Rajiv Gandhi Cancer Institute and Research Centre New Delhi India
| | - Ahmad Mamoon Karimi
- Department of Surgical Oncology Uro‐oncology Division Rajiv Gandhi Cancer Institute and Research Centre New Delhi India
| | - Amitabh Singh
- Department of Surgical Oncology Uro‐oncology Division Rajiv Gandhi Cancer Institute and Research Centre New Delhi India
| | - Bikash Bikram Thapa
- Department of Surgical Oncology Uro‐oncology Division Rajiv Gandhi Cancer Institute and Research Centre New Delhi India
| | - Shashikant Gupta
- Department of Surgical Oncology Uro‐oncology Division Rajiv Gandhi Cancer Institute and Research Centre New Delhi India
| | - Nripesh Sadasukhi
- Department of Surgical Oncology Uro‐oncology Division Rajiv Gandhi Cancer Institute and Research Centre New Delhi India
| | | | - Preeti Pathak
- Department of Surgical Oncology Uro‐oncology Division Rajiv Gandhi Cancer Institute and Research Centre New Delhi India
| | - Priyatham Kasaraneni
- Department of Surgical Oncology Uro‐oncology Division Rajiv Gandhi Cancer Institute and Research Centre New Delhi India
| | - Ashish Khanna
- Department of Surgical Oncology Uro‐oncology Division Rajiv Gandhi Cancer Institute and Research Centre New Delhi India
| | - Tushar Aditya Narayan
- Department of Surgical Oncology Uro‐oncology Division Rajiv Gandhi Cancer Institute and Research Centre New Delhi India
| | - Girish Sharma
- Centre for Medical Biotechnology, Coordinator Amity Centre for Cancer Epidemiology & Cancer Research Amity Institute of Biotechnology Amity University Uttar Pradesh Noida India
| | - Sudhir Rawal
- Department of Surgical Oncology Uro‐oncology Division Rajiv Gandhi Cancer Institute and Research Centre New Delhi India
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Barani M, Hosseinikhah SM, Rahdar A, Farhoudi L, Arshad R, Cucchiarini M, Pandey S. Nanotechnology in Bladder Cancer: Diagnosis and Treatment. Cancers (Basel) 2021; 13:2214. [PMID: 34063088 PMCID: PMC8125468 DOI: 10.3390/cancers13092214] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 04/29/2021] [Accepted: 05/04/2021] [Indexed: 02/07/2023] Open
Abstract
Bladder cancer (BC) is the second most common cancer of the urinary tract in men and the fourth most common cancer in women, and its incidence rises with age. There are many conventional methods for diagnosis and treatment of BC. There are some current biomarkers and clinical tests for the diagnosis and treatment of BC. For example, radiotherapy combined with chemotherapy and surgical, but residual tumor cells mostly cause tumor recurrence. In addition, chemotherapy after transurethral resection causes high side effects, and lack of selectivity, and low sensitivity in sensing. Therefore, it is essential to improve new procedures for the diagnosis and treatment of BC. Nanotechnology has recently sparked an interest in a variety of areas, including medicine, chemistry, physics, and biology. Nanoparticles (NP) have been used in tumor therapies as appropriate tools for enhancing drug delivery efficacy and enabling therapeutic performance. It is noteworthy, nanomaterial could be reduced the limitation of conventional cancer diagnosis and treatments. Since, the major disadvantages of therapeutic drugs are their insolubility in an aqueous solvent, for instance, paclitaxel (PTX) is one of the important therapeutic agents utilized to treating BC, due to its ability to prevent cancer cell growth. However, its major problem is the poor solubility, which has confirmed to be a challenge when improving stable formulations for BC treatment. In order to reduce this challenge, anti-cancer drugs can be loaded into NPs that can improve water solubility. In our review, we state several nanosystem, which can effective and useful for the diagnosis, treatment of BC. We investigate the function of metal NPs, polymeric NPs, liposomes, and exosomes accompanied therapeutic agents for BC Therapy, and then focused on the potential of nanotechnology to improve conventional approaches in sensing.
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Affiliation(s)
- Mahmood Barani
- Department of Chemistry, Shahid Bahonar University of Kerman, Kerman 76169-14111, Iran;
| | - Seyedeh Maryam Hosseinikhah
- Nanotechnology Research Center, Pharmaceutical Technology Institute, Mashhad University of Medical Sciences, Mashhad 91886-17871, Iran; (S.M.H.); (L.F.)
| | - Abbas Rahdar
- Department of Physics, Faculty of Science, University of Zabol, Zabol 98613-35856, Iran
| | - Leila Farhoudi
- Nanotechnology Research Center, Pharmaceutical Technology Institute, Mashhad University of Medical Sciences, Mashhad 91886-17871, Iran; (S.M.H.); (L.F.)
| | - Rabia Arshad
- Department of Pharmacy, Quaid-I-Azam University, Islamabad 45320, Pakistan;
| | - Magali Cucchiarini
- Center of Experimental Orthopaedics, Saarland University Medical Center, 66421 Homburg/Saar, Germany
| | - Sadanand Pandey
- Department of Chemistry, College of Natural Science, Yeungnam University, 280 Daehak-Ro, Gyeongsan 38541, Korea
- Particulate Matter Research Center, Research Institute of Industrial Science & Technology (RIST), 187-12, Geumho-ro, Gwangyang-si 57801, Korea
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Incontinent Urinary Diversion. Bladder Cancer 2021. [DOI: 10.1007/978-3-030-70646-3_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Abstract
Patient empowerment includes measures that promote their autonomy and self-determination in the physician-patient relationship. In addition to successful medical treatment, goals include long-term treatment satisfaction and the best possible quality of life for the patients and their social environment. Various initiatives and projects from German urology are already used to empower our patients. Entscheidungshilfe Prostatakrebs (decision aid for prostate cancer) and the German language decision aid for advanced bladder cancer and for the choice of urinary diversion are implemented under the umbrella of the PatientenAkademie (patient academy) of German Urologists. With more than 12,000 users, Entscheidungshilfe Prostatakrebs is very well established in urological care in Germany. The randomized evaluation study with planned 1200 participants is close to the successful completion of recruitment. Another project from the German urology sector is the project "antiCoagulation Help App for SurgERy" (CHASER). The aim is to develop a smartphone-based decision aid for the perioperative management of patients undergoing antithrombotic therapy. Online support groups can also contribute to empowerment and have been analyzed systematically for prostate cancer patients. A large randomized study on this topic is currently in preparation. Continuing advances in digitalization can thus provide us with useful support in order to provide individual information to our patients. The German Urological Association and its PatientenAkademie have been committed to this for many years.
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Korkes F, Cunha FTS, Nascimento MP, Rodrigues AFS, Baccaglini W, Glina S. Mortality after radical cystectomy is strongly related to the institution's volume of surgeries. EINSTEIN-SAO PAULO 2020; 18:eAO5628. [PMID: 33295426 PMCID: PMC7690935 DOI: 10.31744/einstein_journal/2020ao5628] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Accepted: 06/24/2020] [Indexed: 11/09/2022] Open
Abstract
Objective: To analyze mortality rates and hospitalization data after radical cystectomy in each public healthcare center in São Paulo in the last decade, considering the number of surgeries performed at each center. Methods: This study included patients from the Departamento de Informática do Sistema Único de Saúde from the state of São Paulo, who underwent radical cystectomy between 2008 and 2018. Data analyzed included organization name, number of procedures/year, in-hospital death rates and hospital length of stay. Results: A total of 1,377 radical cystectomies were registered in the public health system in São Paulo, between 2008-2018. A total of 91 institutions performed at least one radical cystectomy in the decade analyzed. The number of radical cystectomies performed per organization during the years analyzed ranged from one to 161. Only 45.6% of patients were operated in organizations that performed more than five radical cystectomies yearly. A total of 684 patients were operated in organizations with higher surgical volume. There were 117 in-hospital deaths, representing an 8.5% mortality rate for the state of São Paulo during the last decade. Whereas highest volume organizations (>6 radical cystectomies/year) had a mortality rate of 6.1%, the lowest volume (<1 radical cystectomy /year) had a 17.5% in-hospital mortality rate. Conclusion: There was a strong relation between organization volume of radical cystectomy and in-hospital mortality rate after radical cystectomy in São Paulo from 2008-2018. Unfortunately, we could not observe a trend toward centralization of such complex procedures, as it has occurred in developed countries during the last decades.
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Affiliation(s)
| | | | | | | | | | - Sidney Glina
- Faculdade de Medicina do ABC, Santo André, SP, Brazil
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Cicione A, De Nunzio C, Lombardo R, Trucchi A, Manno S, Lima E, Tubaro A. Complications and quality of life of ileal conduit, orthotopic neobladder and ureterocutaneostomy: systematic review of reports using the Clavien-Dindo Classification. MINERVA UROL NEFROL 2020; 72:408-419. [PMID: 32734749 DOI: 10.23736/s0393-2249.20.03641-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Radical cystectomy (RC) and urinary diversion (UD) are two steps of the same surgical procedure involving likely complications and important impact on quality of life (QoL). The literature was reviewed to identify recent studies reporting UDs complications occurred 90 days after surgery and graded by Clavien-Dindo Classification System (CCS). EVIDENCE ACQUISITION A comprehensive systematic Medline search was performed in PubMed/Medline, Embase and Scopus databases to identify reports published in English starting from 2013 using key words related to review outcome (i.e. neobladder, ileal conduct, ureterocutaneostomy, cystectomy, QoL). Complications were defined as minor or major whether the CCS grade was ≤2 or ≥3, respectively. Then, manuscripts references were screened to identify unfounded studies. Only studies using CCS to report surgical complications were considered. EVIDENCE SYNTHESIS Retrieved studies were reported according to two main items of complications and QoL. About UDs complications, fourteen studies were identified incorporating overall 4436 patients. Up to 50% of patients experienced at least one low-grade complications (CCS≤2) requiring pharmacological treatment to be healed. On the other hand, high-grade complications (CCS≥3) occurred in 0.7-42% of cases and required surgical interventions (CCS 3a and 3b) or life support (CCS=4). Finally, mortality (CCS=5) rated between 0.4-7%. Regarding QoL, six studies were analyzed with overall 445 patients. Most of them were retrospective and showed conflicting results whether the external UDs were better than neobladder in term of impact on QoL. CONCLUSIONS The use of a standardized system such as CCS improves analyses of literature. However, rigorous patient selection for UD type makes unable a randomized comparison between UDs in terms of complications and QoL impact.
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Affiliation(s)
- Antonio Cicione
- Department of Urology, Sant'Andrea Hospital, Sapienza University, Rome, Italy -
| | - Cosimo De Nunzio
- Department of Urology, Sant'Andrea Hospital, Sapienza University, Rome, Italy
| | - Riccardo Lombardo
- Department of Urology, Sant'Andrea Hospital, Sapienza University, Rome, Italy
| | - Alberto Trucchi
- Department of Urology, Sant'Andrea Hospital, Sapienza University, Rome, Italy
| | - Stefano Manno
- Department of Urology, Pugliese-Ciaccio Hospital, Catanzaro, Italy
| | - Estevao Lima
- Life and Health Sciences Research Institute, University of Minho, Braga, Portugal
| | - Andrea Tubaro
- Department of Urology, Sant'Andrea Hospital, Sapienza University, Rome, Italy
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Korkes F, Palou J. High mortality rates after radical cystectomy: we must have acceptable protocols and consider the rationale of cutaneous ureterostomy for high-risk patients. Int Braz J Urol 2020; 45:1090-1093. [PMID: 31626516 PMCID: PMC6844359 DOI: 10.1590/s1677-5538.ibju.2019.05.03] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Affiliation(s)
- Fernando Korkes
- Disciplina de Urologia, Faculdade de Medicina do ABC, Santo André, SP, Brasil
| | - Juan Palou
- Fundacion Puigvert Universitat Autonoma de Barcelona, Espanha
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Zhong H, Shen Y, Yao Z, Chen X, Gao J, Xiang A, Wang W. Long-term outcome of spiral ileal neobladder with orthotopic ureteral reimplantation. Int Urol Nephrol 2020; 52:41-49. [PMID: 31560108 PMCID: PMC6957550 DOI: 10.1007/s11255-019-02296-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Accepted: 09/19/2019] [Indexed: 11/30/2022]
Abstract
PURPOSE The purpose of this study was to analyze long-term complications, urodynamics, and quality of life (QoL) of patients after orthotopic ileal neobladder with orthotopic ureteral reimplantation to enrich clinical data and provide a basis for clinical use of this surgery. METHODS Between January 2007 and January 2013, 72 consecutive patients who underwent spiral ileal neobladder following radical cystectomy were enrolled. The neobladder was created using a modified Camey-II technique. Complications were reviewed and staged according to Clavien-Dindo classification and evaluated in long-term follow-up. Urodynamics were performed, and QoL was assessed by the Functional Assessment of Cancer Therapy for Bladder Cancer (FACT-BL) instrument. RESULTS The total follow-up time was 60 months, and the total survival rates at 3 and 5 years after surgery were 76.4% (55/72) and 65.3% (47/72), respectively. There were 34 (47.2%) early complications in 23 (31.9%) patients and 42 (58.3%) late complications in 35 (48.6%) patients. The total satisfactory control rates were 69.1% and 66.0% at 3 and 5 years after the surgery, respectively. Urodynamic studies were performed in some patients, and the receiver operating characteristic curve analysis showed that pressure at maximum capacity, compliance, and post void residual urine had predictive value for mortality (P < 0.05). The total FACT-BL scores of patients at 1, 3, and 5 years postoperation were 125.0 ± 15.2, 127.0 ± 16.2, and 120.6 ± 13.5, respectively, and it decreased at 5 years postoperation (P < 0.05). CONCLUSION Spiral ileal neobladder with orthotopic ureteral reimplantation offers satisfactory long-term results, and urodynamic monitoring might have prognostic value.
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Affiliation(s)
- Huan Zhong
- Department of Urology, The First People's Hospital of Huzhou, The First Affiliated Hospital of Huzhou Teachers College, No. 158, Guangchanghou Road, Huzhou, 313000, Zhejiang, China
| | - Yuefan Shen
- Department of Urology, The First People's Hospital of Huzhou, The First Affiliated Hospital of Huzhou Teachers College, No. 158, Guangchanghou Road, Huzhou, 313000, Zhejiang, China
| | - Zixiang Yao
- Department of Urology, The First People's Hospital of Huzhou, The First Affiliated Hospital of Huzhou Teachers College, No. 158, Guangchanghou Road, Huzhou, 313000, Zhejiang, China
| | - Xiaonong Chen
- Department of Urology, The First People's Hospital of Huzhou, The First Affiliated Hospital of Huzhou Teachers College, No. 158, Guangchanghou Road, Huzhou, 313000, Zhejiang, China
| | - Jianguo Gao
- Department of Urology, The First People's Hospital of Huzhou, The First Affiliated Hospital of Huzhou Teachers College, No. 158, Guangchanghou Road, Huzhou, 313000, Zhejiang, China
| | - Anping Xiang
- Department of Urology, The First People's Hospital of Huzhou, The First Affiliated Hospital of Huzhou Teachers College, No. 158, Guangchanghou Road, Huzhou, 313000, Zhejiang, China
| | - Weigao Wang
- Department of Urology, The First People's Hospital of Huzhou, The First Affiliated Hospital of Huzhou Teachers College, No. 158, Guangchanghou Road, Huzhou, 313000, Zhejiang, China.
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Korkes F, Palou J. High mortality rates after radical cystectomy: we must have acceptable protocols and consider the rationale of cutaneous ureterostomy for high-risk patients. Int Braz J Urol 2019. [PMID: 31808395 PMCID: PMC6909864 DOI: 10.1590/s1677-5538.ibju.2019.06.03] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Affiliation(s)
| | - Juan Palou
- Universitat Autonoma de Barcelona, Espanha
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15
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Cacciamani GE, De Marco V, Sebben M, Rizzetto R, Cerruto MA, Porcaro AB, Gill IS, Artibani W. Robot-assisted Vescica Ileale Padovana: A New Technique for Intracorporeal Bladder Replacement Reproducing Open Surgical Principles. Eur Urol 2019; 76:381-390. [DOI: 10.1016/j.eururo.2018.11.037] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Accepted: 11/16/2018] [Indexed: 10/27/2022]
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16
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Leow JJ, Bedke J, Chamie K, Collins JW, Daneshmand S, Grivas P, Heidenreich A, Messing EM, Royce TJ, Sankin AI, Schoenberg MP, Shipley WU, Villers A, Efstathiou JA, Bellmunt J, Stenzl A. SIU–ICUD consultation on bladder cancer: treatment of muscle-invasive bladder cancer. World J Urol 2019; 37:61-83. [DOI: 10.1007/s00345-018-2606-y] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Accepted: 12/12/2018] [Indexed: 01/09/2023] Open
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Talat Z, Onal B, Cetinel B, Demirdag C, Citgez S, Dogan C. The surgical technique and initial outcomes of Anatolian neobladder: a novel technique of ileal neobladder after radical cystectomy. BMC Urol 2018; 18:94. [PMID: 30367600 PMCID: PMC6203991 DOI: 10.1186/s12894-018-0406-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Accepted: 10/17/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND We describe a detailed novel step-by-step approach for creation of an ileal neobladder and compare the outcomes with standart neobladder. METHODS Between August 2009 and January 2016, 36 consecutive patients with bladder cancer underwent radical cystectomy and orthotopic urinary diversion with an ileal neobladder. A novel technique of ileal neobladder construction, called the Anatolian neobladder, was designed by a single surgeon (ZT). Demographics and clinical data were collected. Perioperative, oncologic, and functional outcomes were reported. Complications were graded as early or late. These outcomes were compared with patients who underwent standard neobladder during this period in our center. RESULTS The operation was technically successful in all cases. Early postoperative complications occurred in 33.3% of the patients. Daytime continence was achieved successfully in 83.3% of the patients. No patient had severe metabolic acidosis. Six patients (16.6%) died during follow-up, five due to metastatic bladder cancer and one due to a cardiac problem. There was no any statistically significant difference between novel technique and standard neobladder for oncological and functional outcomes. CONCLUSIONS The Anatolian ileal neobladder is as feasible and safe as standard neobladder technique for urinary diversion in patients with bladder cancer undergoing radical cystectomy.
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Affiliation(s)
- Z Talat
- Department of Urology, Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Fatih, 34098, Istanbul, Turkey
| | - B Onal
- Department of Urology, Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Fatih, 34098, Istanbul, Turkey
| | - B Cetinel
- Department of Urology, Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Fatih, 34098, Istanbul, Turkey
| | - C Demirdag
- Department of Urology, Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Fatih, 34098, Istanbul, Turkey
| | - S Citgez
- Department of Urology, Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Fatih, 34098, Istanbul, Turkey.
| | - C Dogan
- Department of Urology, Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Fatih, 34098, Istanbul, Turkey
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