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Mirto BF, Barone B, Balsamo R, Abate M, Caputo VF, Sciarra A, Calogero A, Romano L, Napolitano L, Sciorio C, Lucarelli G, Lasorsa F, Ferro M, Busetto GM, Del Giudice F, Manfredi C, Tătaru S, Pradere B, Imbimbo C, Crocetto F. Early and late post-procedural complications in different orthotopic neobladder surgical approaches: A systematic review. Surg Oncol 2024; 55:102090. [PMID: 38917777 DOI: 10.1016/j.suronc.2024.102090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2024] [Revised: 05/05/2024] [Accepted: 05/27/2024] [Indexed: 06/27/2024]
Abstract
Bladder cancer (BCa) represents the second most common malignancy of the genitourinary tract. The major risk factors include age, gender, smoking attitude, and occupational exposure, while the exact etiopathogenesis is still uncertain. Patients diagnosed with a BCa showing invasion of the muscle layer below the submucosa must undergo radical cystectomy (RC) with urinary diversion (UD). Many different surgical approaches to UD have been developed. Packaging an orthotopic neobladder (ON) with a bowel tract represents the gold standard when certain patient selection criteria are satisfied. Using PRISMA guidelines, we performed a systematic review assessing early (within 90 days) and late (beyond 90 days) post-procedural complications of different ON surgical approaches. A comprehensive systematic search was conducted in PubMed, Scopus, and Google Scholar databases to identify papers starting from 2012 using dedicated keywords ("neobladder", "orthotopic neobladder", "complications'' and "outcomes"). A total of 27 articles were found to satisfy the inclusion criteria and selected. Although the ON is a safe procedure that guarantees the patient the best quality of life (QoL), it is not free from risks. Many complications could occur during and after the surgical time which imposes the necessity of strict follow-up and careful checks over time, which should be properly discussed with patients before.
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Affiliation(s)
- Benito Fabio Mirto
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples Federico II, Naples, Italy
| | - Biagio Barone
- Department of Surgical Sciences, Urology Unit, AORN Sant'Anna e San Sebastiano, Caserta, Via Ferdinando Palasciano, 81100, Caserta, Italy.
| | | | - Marco Abate
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples Federico II, Naples, Italy
| | - Vincenzo Francesco Caputo
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples Federico II, Naples, Italy
| | - Antonella Sciarra
- Department of Experimental Medicine, University of Campania 'Luigi Vanvitelli', Naples, NA, Italy
| | - Armando Calogero
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, 80131, Italy
| | - Lorenzo Romano
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples Federico II, Naples, Italy
| | - Luigi Napolitano
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples Federico II, Naples, Italy
| | - Carmine Sciorio
- Urology Unit, Alessandro Manzoni Hospital, ASST, Lecco, Italy
| | - Giuseppe Lucarelli
- Department of Emergency & Organ Transplantation - Urology, Andrology & Kidney Transplantation Unit, University of Bari, Bari, Italy
| | - Francesco Lasorsa
- Department of Emergency & Organ Transplantation - Urology, Andrology & Kidney Transplantation Unit, University of Bari, Bari, Italy
| | - Matteo Ferro
- Division of Urology, European Institute of Oncology (IEO)-IRCCS, Milan, Italy
| | - Gian Maria Busetto
- Department of Urology and Organ Transplantation, University of Foggia, 71122, Foggia, Italy
| | - Francesco Del Giudice
- Department of Maternal Infant and Urologic Sciences, Policlinico Umberto I Hospital, "Sapienza" University of Rome, 00161, Rome, Italy
| | - Celeste Manfredi
- Urology Unit, Department of Woman, Child and of General and Specialist Surgery, University of Campania "Luigi Vanvitelli", 80121, Naples, Italy
| | - Sabin Tătaru
- Department of Simulation Applied in Medicine, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Targu Mures, Romania
| | - Benjamin Pradere
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, 1030, Austria; Department of Urology, La Croix du Sud Hospital, 31130, Quint-Fonsegrives, France
| | - Ciro Imbimbo
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples Federico II, Naples, Italy
| | - Felice Crocetto
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples Federico II, Naples, Italy
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Hattori Y, Nagoshi A, Fujiwara T, Kambe T, Mine Y, Hagimoto H, Abe Y, Yamashita D, Tsutsumi N, Shibasaki N, Yamasaki T, Kawakita M. Safety of urethral preservation using urethral frozen section analysis in radical cystectomy. BJUI COMPASS 2024; 5:806-810. [PMID: 39157162 PMCID: PMC11327487 DOI: 10.1002/bco2.377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Revised: 04/11/2024] [Accepted: 05/07/2024] [Indexed: 08/20/2024] Open
Abstract
Background The objective of this study is to assess whether urethral preservation can be performed safely using frozen section analysis (FSA) of the urethral stump on urethral recurrence after radical cystectomy. Methods Between June 2012 and July 2022, we investigated consecutive male patients who underwent urethral FSA during radical cystectomy for urothelial carcinoma. For FSA-abnormal cases, urethrectomy was performed, and for FSA-normal cases, the urethra was preserved. The diagnostic accuracy of FSA was assessed in comparison with the pathological findings of the permanent sections of the same tissue. Postoperatively, computed tomography and urinary cytology were performed as routine surveillance of recurrence. Results Of the 77 patients included in this study, three patients with abnormal FSA underwent concurrent urethrectomy. The negative predictive value of urethral FSA was 100%. With a median postoperative follow-up of 38 months (interquartile ranges 21-71), no urethral recurrence was observed. Conclusions FSA may be useful in determining the indication for urethrectomy.
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Affiliation(s)
- Yuto Hattori
- Department of UrologyKobe City Medical Centre General HospitalKobeJapan
| | - Akihiko Nagoshi
- Department of UrologyKobe City Medical Centre General HospitalKobeJapan
| | - Tasuku Fujiwara
- Department of UrologyKobe City Medical Centre General HospitalKobeJapan
| | - Takanari Kambe
- Department of UrologyKobe City Medical Centre General HospitalKobeJapan
| | - Yuta Mine
- Department of UrologyKobe City Medical Centre General HospitalKobeJapan
| | - Hiroki Hagimoto
- Department of UrologyKobe City Medical Centre General HospitalKobeJapan
| | - Yohei Abe
- Department of UrologyKobe City Medical Centre General HospitalKobeJapan
| | - Daisuke Yamashita
- Department of PathologyKobe City Medical Centre General HospitalKobeJapan
| | - Naofumi Tsutsumi
- Department of UrologyKobe City Medical Centre General HospitalKobeJapan
| | - Noboru Shibasaki
- Department of UrologyKobe City Medical Centre General HospitalKobeJapan
| | | | - Mutsushi Kawakita
- Department of UrologyKobe City Medical Centre General HospitalKobeJapan
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Zennami K, Sumitomo M, Nukaya T, Takenaka M, Ichino M, Takahara K, Sasaki H, Kusaka M, Shiroki R. Impact of Urethra-Preserving Surgery During Radical Cystectomy: An Optimal Urethral Management in the Robotic Era. Clin Genitourin Cancer 2024; 22:102146. [PMID: 39043553 DOI: 10.1016/j.clgc.2024.102146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2024] [Revised: 05/07/2024] [Accepted: 06/23/2024] [Indexed: 07/25/2024]
Abstract
OBJECTIVES The optimal indication and survival benefits of prophylactic urethrectomy (PU) during radical cystectomy remain unclear. Therefore, this study aims to evaluate the impact of urethra-preserving surgery (UPS) on oncological outcome including its recurrence patterns, and to establish an optimal urethral management strategy with a novel UPS technique in the robotic era. PATIENTS AND METHODS We retrospectively analyzed 281 male patients with bladder cancer who received radical cystectomy (RC) (115 with and 166 without PU) at our institutions between 2010 and 2023. Subsequently, perioperative and oncological outcomes were assessed between propensity score-matched cohorts. RESULTS Urethral recurrence (UR) occurred in 5 patients (5/166, 3.0%), all of whom underwent open-RC. Three among those (1.8%) with concomitant metastasis were died of cancer. There were no statistically significant differences between the PU and UPS groups in urethral-recurrence free survival (urethral-RFS) (P = .14), local-RFS (P = .59) and overall survival (OS) (P = .84) in the entire cohort. However, the UPS group showed significantly worse urethral-RFS (P = .008), local-RFS (P = .005) and OS (P = .03) in patients with high-risk of UR. Analysis of recurrence patterns revealed that UPS in high-risk patients significantly increased local recurrence (25.8% vs. 5.0%, P = .02). Conversely, a novel robotic-UPS technique demonstrated significantly favorable perioperative outcomes, comparable local-RFS (P = .79) and OS (P = .16) without UR (0/134, 0%) when compared to robotic-PU. Robotic-UPS also exhibited significantly better local-RFS (P =.007) and OS (P < .001) than open-UPS. CONCLUSIONS UR-related death was rare and PU did not show a survival benefit for the entire cohort. However, inappropriate UPS in patients at high-risk of UR may increase local recurrence which might be responsible for poor survival after UPS rather than disease progression derived from UR. The robotic-UPS has the potential to reduce unnecessary PU, urethral and local recurrence without compromising survival.
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Affiliation(s)
- Kenji Zennami
- Department of Urology, Fujita Health University School of Medicine, Toyoake, Japan.
| | - Makoto Sumitomo
- Department of Urology, Fujita Health University School of Medicine, Toyoake, Japan
| | - Takuhisa Nukaya
- Department of Urology, Fujita Health University School of Medicine, Toyoake, Japan
| | - Masashi Takenaka
- Department of Urology, Fujita Health University School of Medicine, Toyoake, Japan
| | - Manabu Ichino
- Department of Urology, Fujita Health University School of Medicine, Toyoake, Japan
| | - Kiyoshi Takahara
- Department of Urology, Fujita Health University School of Medicine, Toyoake, Japan
| | - Hitomi Sasaki
- Department of Urology, Fujita Health University School of Medicine, Toyoake, Japan
| | - Mamoru Kusaka
- Department of Urology, Fujita Health University Okazaki Medical Center, Okazaki, Japan
| | - Ryoichi Shiroki
- Department of Urology, Fujita Health University School of Medicine, Toyoake, Japan
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Truong TTH, Nguyen DKH, Dinh KN, Thai MS. Urethral Recurrence After Cystectomy and Orthotopic Bladder Reconstruction: A Rare Case of Recurrent Bladder Cancer After 12 Years and Review of the Literature. CLINICAL MEDICINE INSIGHTS-CASE REPORTS 2024; 17:11795476231224188. [PMID: 38269148 PMCID: PMC10804922 DOI: 10.1177/11795476231224188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 12/15/2023] [Indexed: 01/26/2024]
Abstract
Introduction Radical cystectomy combined with orthotopic urinary diversion is a chosen approach for treating invasive bladder cancer. However, urothelial cell carcinoma is characterized by its potential for recurrence and the development of multiple tumors in the urinary tracts. In the natural progression of transitional cell carcinoma, the remaining ureteral stump is considered a predicted site for possible recurrence after radical cystectomy. Currently, there is no specific recommendation for the diagnosis and management of this condition. Objective We report a rare case in a 74-year-old male patient who was diagnosed with anterior urethral carcinoma following a history of radical cystectomy and Hautmann ileal neobladder reconstruction. Additionally, we summarize some novel findings regarding risk factors, diagnosis, treatment, and prognosis in patients with recurrent bladder cancer in the urethra after radical cystectomy. Methods A case report and mini review. Results The patient was diagnosed with recurrent bladder cancer in the urethral after radical cystectomy using magnetic resonance imaging of the pelvis, cystoscopy, and biopsy. Complete urethrectomy and creation of a permanent percutaneous urinary diversion were performed. No intraoperative or postoperative complications were recorded. The patient was discharged 3 days after the surgery. Conclusion Urethral cancer following radical cystectomy for bladder cancer treatment is a rare condition. Risk factors for this occurrence include male gender, non-use of orthotopic neobladder reconstruction technique, invasive tumors in the prostatic urethra, and multifocal tumors. The treatment of these tumors can be determined based on the extent of invasion and histological characteristics, leading to the choice between radical urethrectomy or alternative conservative treatments.
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Affiliation(s)
| | | | - Ky Nam Dinh
- Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Vietnam
| | - Minh Sam Thai
- Urology Department of Cho Ray Hospital, Ho Chi Minh City, Vietnam
- The University of Medicine and Pharmacy, Ho Chi Minh City, Vietnam
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Salgado-Parente A, Antolinos-Macho E, González-Huete A, García-Latorre R, Canales-Lachén E, González-Gordaliza MC. What do we see when we do not see the bladder? Review of the main urinary diversion techniques and their complications. RADIOLOGIA 2023; 65:554-567. [PMID: 38049254 DOI: 10.1016/j.rxeng.2023.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 04/25/2023] [Indexed: 12/06/2023]
Abstract
OBJECTIVE To review the different types of urinary diversion surgeries (UDS) in order to recognize the expected findings in a postoperative study, using different imaging techniques. To recognize the main postoperative complications, both early and late. CONCLUSION UDS are surgical procedures whose purpose is to redirect urine flow after cystectomy, generally in an oncologic context. The imaging evaluation of urological surgeries is often a radiological challenge, with CT being the most commonly used image modality. Therefore, it is essential to know the main surgical techniques, the expected postoperative findings and the optimization of imaging techniques for early diagnosis and correct evaluation of postoperative complications.
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Affiliation(s)
- A Salgado-Parente
- Departamento de Radiología, Hospital Universitario Ramón y Cajal, Madrid, Spain.
| | - E Antolinos-Macho
- Departamento de Radiología, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - A González-Huete
- Departamento de Radiología, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - R García-Latorre
- Departamento de Radiología, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - E Canales-Lachén
- Departamento de Radiología, Hospital Universitario Ramón y Cajal, Madrid, Spain
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Murata Y, Shinojima T, Nakahira Y, Hamada M, Sasaki A, Asakura H. Recurrent urethral tumor with neuroendocrine differentiation in a female patient after radical cystectomy for bladder cancer. IJU Case Rep 2023; 6:199-202. [PMID: 37405032 PMCID: PMC10315247 DOI: 10.1002/iju5.12581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 02/18/2023] [Indexed: 07/06/2023] Open
Abstract
Introduction Urethral recurrence after radical cystectomy in female patients with bladder cancer is relatively uncommon. Recurrent bladder tumors with neuroendocrine differentiation are extremely rare. Case presentation A 71-year-old female patient who underwent radical cystectomy for bladder cancer presented with vaginal bleeding 19 months postoperatively. She was diagnosed with bladder cancer urethral recurrence. Urethral tumor en-bloc resection with the anterior vaginal wall was performed by combining abdominal and vaginal approaches. Pathological examination revealed a recurrent tumor of urothelial bladder cancer containing small-cell carcinoma components. Conclusion This case is the first report of a recurrent tumor with small-cell carcinoma in the female urethra after radical cystectomy for pure urothelial carcinoma.
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Affiliation(s)
- Yasuaki Murata
- Department of UrologySaitama Medical UniversityMoroyamaSaitamaJapan
| | | | - Yoko Nakahira
- Department of UrologySaitama Medical UniversityMoroyamaSaitamaJapan
| | - Mei Hamada
- Department of PathologySaitama Medical UniversityMoroyamaSaitamaJapan
| | - Atsushi Sasaki
- Department of PathologySaitama Medical UniversityMoroyamaSaitamaJapan
| | - Hirotaka Asakura
- Department of UrologySaitama Medical UniversityMoroyamaSaitamaJapan
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