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Orsini A, Digiacomo A, Ferretti S, Tamborino F, Basconi M, Cicchetti R, Litterio G, Dello Stritto G, Salzano G, Marchioni M, Schips L. Robotic bladder diverticulectomy with concurrent management of bladder outlet obstruction: A choice to consider. Urologia 2024:3915603241258107. [PMID: 38886984 DOI: 10.1177/03915603241258107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/20/2024]
Abstract
INTRODUCTION Acquired bladder diverticula (BD) are associated with bladder outlet obstruction. The aim of our study is to analyse the improvement in lower urinary tract symptoms (LUTS) in patients who underwent robot-assisted bladder diverticulectomy (RABD) combined with transurethral prostatectomy (TURP). MATERIAL AND METHODS A prospectively single-centre, single surgeon cohort of four patients with posterolateral BD due to bladder outlet obstruction (BOO) undergoing RABD combined with TURP between 2018 and 2023 was analysed. RESULTS Median age and maximum BD diameter were 73.5 years and 16 cm, respectively. All patients had severe LUTS and elevated postvoid residual (PVR). Preliminary uroflowmetry revealed bladder outlet obstruction with a median of maximum urine flow rate of 8.5 ml/s. The median operative time and blood loss were 212 min and 100 ml, respectively. No intraoperative complications were recorded. The median length of stay was 4 days. The International Prostate Symptom Score (IPSS) and PVR were compared between baseline, 1 month and 6 months after surgery. IPSS significantly decreased from 24 (IQR 24-25) preoperatively compared to the postoperative, at 1 month follow up 7 (IQR 6-8) (p < 0.0001). PVR significantly decreased too from 165 (IQR 150-187) to 35 ml (IQR 25-42) (p < 0.0001). In transitioning from the 1-month follow-up to the 6-month follow-up, no substantial statistical improvement was observed. CONCLUSION Concomitant performance of TURP with RABD is feasible and safe. Diverticulectomy in addiction at the endoscopic procedure should be discussed with patients who have obstructive lower urinary tract symptoms as viable alternative to single procedure individually performed.
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Affiliation(s)
- Angelo Orsini
- Urology Unit, Department of Medical, Oral and Biotechnological Sciences, 'G. d'Annunzio University', Chieti, Italy
| | - Alessio Digiacomo
- Urology Unit, Department of Medical, Oral and Biotechnological Sciences, 'G. d'Annunzio University', Chieti, Italy
| | - Simone Ferretti
- Urology Unit, Department of Medical, Oral and Biotechnological Sciences, 'G. d'Annunzio University', Chieti, Italy
| | - Flavia Tamborino
- Urology Unit, Department of Medical, Oral and Biotechnological Sciences, 'G. d'Annunzio University', Chieti, Italy
| | - Martina Basconi
- Urology Unit, Department of Medical, Oral and Biotechnological Sciences, 'G. d'Annunzio University', Chieti, Italy
| | - Rossella Cicchetti
- Urology Unit, Department of Medical, Oral and Biotechnological Sciences, 'G. d'Annunzio University', Chieti, Italy
| | - Giulio Litterio
- Urology Unit, Department of Medical, Oral and Biotechnological Sciences, 'G. d'Annunzio University', Chieti, Italy
| | - Guglielmo Dello Stritto
- Urology Unit, Department of Medical, Oral and Biotechnological Sciences, 'G. d'Annunzio University', Chieti, Italy
| | - Gaetano Salzano
- Urology Unit, Department of Medical, Oral and Biotechnological Sciences, 'G. d'Annunzio University', Chieti, Italy
| | - Michele Marchioni
- Urology Unit, Department of Medical, Oral and Biotechnological Sciences, 'G. d'Annunzio University', Chieti, Italy
| | - Luigi Schips
- Urology Unit, Department of Medical, Oral and Biotechnological Sciences, 'G. d'Annunzio University', Chieti, Italy
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Alhamar M, Al-Ahmadie HA, Feratovic R, Lin O. Sensitivity of urine cytology in detecting high-grade urothelial carcinoma in patients with neoplastic urinary bladder diverticula: A major cancer center experience. Cancer Cytopathol 2024; 132:144-151. [PMID: 38054371 DOI: 10.1002/cncy.22782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 09/28/2023] [Accepted: 10/18/2023] [Indexed: 12/07/2023]
Abstract
BACKGROUND Bladder diverticula are herniations of bladder urothelium and mucosa through the muscularis propria. The reported incidence of neoplasia arising in bladder diverticula is widely variable. The authors' objective was to study the characteristics and sensitivity of urine cytology in these patients with emphasis on primary intradiverticular bladder cancer (IDBC). METHODS A 17-year, retrospective review of all resected bladder diverticula associated with bladder carcinoma was performed. Cases that had complete diverticular resections and preresection urine samples were included in this study. The cases were divided into either primary IDBC or primary extradiverticular bladder cancer (EDBC). Demographic data and urine cytology characteristics were recorded, and sensitivity was calculated. For IDBC, a comparison between voided and cystoscopic urines was done for cases that had both collection methods performed. RESULTS Of 70 patients with IDBC, 47 patients had urine cytology results that were either positive for high grade-urothelial carcinoma (HG-UC) or suspicious for HG-UC. The sensitivity for HG-UC in IDBC samples was 80%, compared with 82% in EDBC samples (p > .05). Also, 28 patients in the IDBC group had both voided and cystoscopic urine samples for comparisons; in seven patients, the voided urine sample yielded a more definitive diagnosis; in 10 patients, the cystoscopic urine sample yielded a more definitive diagnosis; and, in 11 patients, both samples were equally diagnostic (p > .05). CONCLUSIONS The characteristics and sensitivity of urine cytology in bladder diverticula were investigated in association with neoplasia, with an emphasis on primary intradiverticular bladder cancer. The results indicated that urine cytology remains a reliable screening and diagnostic test for detecting IDBC, with sensitivity similar to that for detecting EDBC, and no significant difference was noted between voided and cystoscopic samples.
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Affiliation(s)
- Mohamed Alhamar
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering, New York, New York, USA
| | - Hikmat A Al-Ahmadie
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering, New York, New York, USA
| | - Rusmir Feratovic
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering, New York, New York, USA
| | - Oscar Lin
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering, New York, New York, USA
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Bös A, Potratz J, Aghayev A. [70-year-old patient with an unusual scrotal swelling]. Dtsch Med Wochenschr 2023; 148:1489-1490. [PMID: 37949076 DOI: 10.1055/a-2149-7631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2023]
Affiliation(s)
- Annika Bös
- Otto-von-Guericke-Universität Magdeburg, Universitätsklinik für Radiologie und Nuklearmedizin
| | - Johann Potratz
- Otto-von-Guericke-Universität Magdeburg, Universitätsklinik für Radiologie und Nuklearmedizin
| | - Anar Aghayev
- Otto-von-Guericke-Universität Magdeburg, Universitätsklinik für Radiologie und Nuklearmedizin
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Gao Y, Yoshida S, Takeyama A, Tagami M, Rajabi-Toustani R, Tsogtgerel M, Nambo Y. Use of Transabdominal Ultrasound and Maternal Hormone Testing for the Prenatal Monitoring of Equine Fetal Enlarged Bladder. J Equine Vet Sci 2023; 128:104867. [PMID: 37329927 DOI: 10.1016/j.jevs.2023.104867] [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: 03/02/2023] [Revised: 05/24/2023] [Accepted: 06/12/2023] [Indexed: 06/19/2023]
Abstract
Ultrasound examination during late gestation is one of the best methods for monitoring potential pregnancy risks. Enlarged bladder is a urological disorder rarely observed in equine fetuses. This clinical case report aimed to present a case illustrating the development of equine fetal enlarged bladder using transabdominal ultrasound examinations and maternal hormone evaluation during gestation. An 8-year-old Hokkaido native pony was impregnated by embryo transfer, and at 215 days of gestation, abnormalities of the fetal bladder were detected. The bladder volume increased with gestational age, and a second bladder was observed at 257 days of gestation. No abnormalities were observed in the fetal kidneys. Moreover, the maternal plasma progesterone concentration was measured throughout the gestation period. The progesterone concentration was elevated from 36 weeks of gestation until parturition. At 363 days of gestation, parturition induction was conducted, and a foal successfully delivered. This case report is the first to describe the development of equine fetal enlarged bladder and record the corresponding ultrasound and hormone profiles.
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Affiliation(s)
- Yuanzhi Gao
- Department of Clinical Veterinary Sciences, Obihiro University of Agriculture and Veterinary Medicine, Hokkaido, Japan
| | - Sakura Yoshida
- Department of Clinical Veterinary Sciences, Obihiro University of Agriculture and Veterinary Medicine, Hokkaido, Japan
| | - Akiko Takeyama
- Department of Clinical Veterinary Sciences, Obihiro University of Agriculture and Veterinary Medicine, Hokkaido, Japan
| | - Masaaki Tagami
- Department of Clinical Veterinary Sciences, Obihiro University of Agriculture and Veterinary Medicine, Hokkaido, Japan
| | - Reza Rajabi-Toustani
- Department of Clinical Veterinary Sciences, Obihiro University of Agriculture and Veterinary Medicine, Hokkaido, Japan
| | - Munkhtuul Tsogtgerel
- Department of Clinical Veterinary Sciences, Obihiro University of Agriculture and Veterinary Medicine, Hokkaido, Japan
| | - Yasuo Nambo
- Department of Clinical Veterinary Sciences, Obihiro University of Agriculture and Veterinary Medicine, Hokkaido, Japan.
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Wiberg E, Vega A, Eriksson V, Banday V, Svensson J, Eriksson E, Jahnson S, Sherif A. A Validation Study of cT-Categories in the Swedish National Urinary Bladder Cancer Register-Norrland University Hospital. J Pers Med 2023; 13:1163. [PMID: 37511776 PMCID: PMC10381347 DOI: 10.3390/jpm13071163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Revised: 07/17/2023] [Accepted: 07/19/2023] [Indexed: 07/30/2023] Open
Abstract
BACKGROUND In Sweden, all patients with urinary bladder cancer (UBC) are recorded in the Swedish National Register for Urinary Bladder Cancer (SNRUBC). The purpose of this study was to validate the registered clinical tumour categories (cT-categories) in the SNRUBC for Norrland University Hospital, Sweden, from 2009 to 2020, inclusive. METHODS The medical records of all 295 patients who underwent radical cystectomy for the treatment of UBC were reviewed retrospectively. Possible factors impacting the cT-categories were identified. To optimise cT-classification, computed tomography urography of all patients with suspected tumour-associated hydronephrosis (TAH) or suspected tumour in bladder diverticulum (TIBD) were retrospectively reviewed by a radiologist. Discrepancy was tested with a logistic regression model. RESULTS cT-categories differed in 87 cases (29.5%). Adjusted logistic regression analysis found TIBD and TAH as significant predictors for incorrect registration; OR = 7.71 (p < 0.001), and OR = 17.7, (p < 0.001), respectively. In total, 48 patients (68.6%) with TAH and 12 patients (52.2%) with TIBD showed discrepancy regarding the cT-category. Incorrect registration was mostly observed during the years 2009-2012. CONCLUSION The study revealed substantial incorrect registration of cT-categories in SNRUBC. A major part of the misclassifications was related to TAH and TIBD. Registration of these variables in the SNRUBC might be considered to improve correct cT-classification.
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Affiliation(s)
- Erik Wiberg
- Department of Surgical and Perioperative Sciences, Urology and Andrology, Umeå University, 907 36 Umea, Sweden
| | - Andrés Vega
- Department of Surgical and Perioperative Sciences, Urology and Andrology, Umeå University, 907 36 Umea, Sweden
| | - Victoria Eriksson
- Department of Surgical and Perioperative Sciences, Urology and Andrology, Umeå University, 907 36 Umea, Sweden
| | - Viqar Banday
- Department of Surgical and Perioperative Sciences, Urology and Andrology, Umeå University, 907 36 Umea, Sweden
| | - Johan Svensson
- Department of Statistics, Umea School of Business, Economics and Statistics (USBE), Umea University, 907 36 Umea, Sweden
| | - Elisabeth Eriksson
- Department of Radiation Sciences, Diagnostic Radiology, Umeå University, 907 36 Umea, Sweden
| | - Staffan Jahnson
- Department of Urology, Biomedical and Clinical Sciences (BKV), Linköping University, 581 83 Linköping, Sweden
| | - Amir Sherif
- Department of Surgical and Perioperative Sciences, Urology and Andrology, Umeå University, 907 36 Umea, Sweden
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Janardanan S, Nigam A, Moschonas D, Perry M, Patil K. Urinary Bladder Diverticulum: A Single-Center Experience in the Management of Refractory Lower Urinary Symptoms Using a Robotic Platform. Cureus 2023; 15:e42354. [PMID: 37621793 PMCID: PMC10445242 DOI: 10.7759/cureus.42354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/24/2023] [Indexed: 08/26/2023] Open
Abstract
Introduction Urinary bladder diverticulum (UBD) is commonly seen in urological practice and, in most cases, does not need treatment specifically directed towards it. However, it can give rise to symptoms that are not distinct from this finding. This makes the evaluation and management of this complex patient group challenging. We present our experience with robotic bladder diverticulectomy (RBD) for acquired bladder diverticulum to assess the outcomes and safety of this procedure when patient symptoms have failed to respond to either medical or surgical treatment directed at other associated contributing factors. Methods We retrospectively collected data on all patients who underwent RBD for persistent lower urinary tract symptoms (LUTS) at Royal Surrey County Hospital, Guildford, between 2016 and 2021, including baseline characteristics, urodynamic findings, intraoperative and postoperative outcomes, and a six-month follow-up. Patients who were diagnosed with cancer in the diverticulum, associated pathology that may contribute to their symptoms, or who had concomitant procedures at the time of RBD were excluded from this study. Results We had six patients who underwent RBD; the median age and body mass index (BMI) were 63.8 years (range 48-73) and 27.1 kg/m2 (range 24-32), respectively. The most common presenting symptoms were refractory LUTS and recurrent urinary tract infections (UTIs). The urodynamic evaluation revealed varying findings like bladder outlet obstruction (BOO), poor compliance, and equivocal readings in these patients. All patients reported incomplete bladder emptying and double voiding, with half practicing clean intermittent self-catheterization (CISC). Diverticulum size averaged 9.4 cm (range 8.5-12). The median operative time and blood loss were 166 mins (range 150-180) and 75 mls (range 50-100), respectively. The average length of stay was 1.6 days (range 1-3). Three patients developed UTIs within a month after surgery, requiring a course of oral antibiotics. Post-void residual (PVR) measured an average of 32.6 mls (range 0-161) postoperatively compared to a preoperative average of 249 mls (range 125-400), showing a two-tailed p-value of 0.016. The International Prostate Symptom Score (IPSS) score for these patients showed an average of 27.83 (range 24-31) preoperatively compared to the postoperative average of eight (range 7-12), showing a two-tailed p-value of 0.0001. Final histology showed no malignancy, and all patients reported symptom improvement, with none requiring CISC after surgery. Conclusion RBD is a safe and effective procedure in carefully selected patients with refractory LUTS and UTIs showing good postoperative and functional outcomes. The presence of a large diverticulum can have a complex effect on bladder dynamics. In the era of robotic surgery and enhanced recovery, discussion about diverticulectomy should be encouraged after proper evaluation and counseling for patients who have failed to improve with other measures of treatment for their symptoms.
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Affiliation(s)
- Sarosh Janardanan
- Department of Urology, Ashford and St Peter's National Health Services Foundation Trust, Chertsey, GBR
- Department of Urology, Royal Surrey County Hospital, Guildford, GBR
| | - Anurag Nigam
- Department of Urology, Royal Surrey County Hospital, Guildford, GBR
| | | | - Matthew Perry
- Department of Urology, Royal Surrey County Hospital, Guildford, GBR
| | - Krishna Patil
- Department of Urology, Royal Surrey County Hospital, Guildford, GBR
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Ho MC, Hashim H. Surveillance and Management of Bladder Diverticulum in the Setting of Bladder Outlet Obstruction. CURRENT BLADDER DYSFUNCTION REPORTS 2022. [DOI: 10.1007/s11884-022-00664-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
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8
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Abdulrahman SA, Muhammad I, Abdulrahman A, Raslan K, Alshehabi Z. Urothelial carcinoma arising within a congenital bladder diverticulum in an adult male: A rare case report and literature review. Ann Med Surg (Lond) 2022; 77:103666. [PMID: 35638012 PMCID: PMC9142640 DOI: 10.1016/j.amsu.2022.103666] [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: 03/10/2022] [Revised: 04/18/2022] [Accepted: 04/18/2022] [Indexed: 12/02/2022] Open
Abstract
Introduction and importance Neoplasms arising from vesical diverticula are rare clinical entities known as intradiverticular bladder tumors. The bladder diverticulum harboring these tumors can be congenital or acquired. Congenital diverticula are predominantly found in children and are extremely rare in adults. Case presentation A 56-year-old male admitted to our hospital with a 10-days history of painless gross hematuria and blood clots. Physical examination and vital signs were unremarkable. Radiologic examination revealed a bladder diverticulum with a mass inside it. Pathological examination confirmed the diagnosis of TCC tumor arising from congenital bladder diverticula. Clinical discussion While intradiverticular bladder tumors account for only 1% of all bladder tumors، and the finding of a congenital bladder diverticulum is a rare anomaly in adults, the concurrence of a tumor arising within a congenital bladder diverticulum is almost non-existent in adults. Conclusion We aimed to present a rare case of urothelial carcinoma arising from a congenital diverticulum in an adult while highlighting the diagnostic and therapeutic options used in managing such tumors. Congenital diverticula are predominantly found in children and are extremely rare in adults. The concurrence of a tumor arising within a congenital bladder diverticulum is almost non-existent in adults. Physicians should always consider the possibility of tumors developing within these diverticula.
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Affiliation(s)
- Seif-Aldin Abdulrahman
- Faculty of Medicine, Cancer Research Center, Tishreen University, Latakia, Syria
- Corresponding author.
| | - Ibrahim Muhammad
- Faculty of Medicine, Cancer Research Center, Tishreen University, Latakia, Syria
| | - Ali Abdulrahman
- Faculty of Medicine, Cancer Research Center, Tishreen University, Latakia, Syria
| | - Khidr Raslan
- Department of Urology, Tishreen University Hospital, Latakia, Syria
| | - Zuheir Alshehabi
- Department of Pathology, Cancer Research Center, Tishreen University, Latakia, Syria
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Kajaia D, Hager B, Kliebisch S, Weingärtner K, Seggewiss-Bernhardt R, Zugor V. [Robot-assisted laparoscopic bladder diverticulum resection (RABDR)]. Aktuelle Urol 2022; 53:254-261. [PMID: 33975364 DOI: 10.1055/a-1327-5509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
AIMS Since October 2018, urinary bladder diverticulum resections at our Department of Urology have been carried out with robot assistance and with minimal invasivion, Paediatrical urological and robot-assisted minimally invasive urological surgery for the Bamberg Social Foundation were performed with the DaVinci robotic systemTM. The aim of the present study was to record the surgical results of our patients and to compare these if necessary with available data on optimal diagnostic and therapy. METHODS In this retrospective analysis, we included all patients who received RAHDR between October 2018 and March 2020. The primary endpoints were postoperative blood loss (postoperative haemoglobin decrease), the operation time (min), complications according to the Clavien-Dindo classification, length of hospital stay (days), postoperative residual urine, postoperative urine extravasation at the anastomosis of the bladder, postoperative quality of life and postoperative satisfaction with micturition. RESULTS We reviewed a total of 11 patients, all of whom were male. Mean age was 64.8 years (52-82). Average BMI was 26.5 (19-37). 3 patients were ranked with ASA score III, 5 with II and 3 with I. The average residual urine value preoperatively was 183 ml (90-240). A cystogram to rule out extravasation was performed on day 6 postoperatively. The mean duration of surgery was 212 min (148-294) and the mean duration of hospitalisation was 7.6 days (6-10). The mean residual urinary value after surgery was 25 ml (10-60). The mean postoperative maximum of flow was measured at 27.7 ml/s (11-55). No contrast agent extravasation in the cystogram was detected in any of the patients. The complications according to Clavien were not measurable. The mean postoperative haemoglobin decrease was 1.61 g/dl (0-3. 2). CONCLUSIONS In most cases, the removal of one or more bladder diverticula is possible using the minimally invasive robotic technique. Various surgeries such as YV-bladder neck plastic, prostate adenoma enucleation, bladder stone restoration, and inguinal herniotomy can be carried out simultaneously. A robot-assisted urinary bladder diverticulum resection is an effective and gentle procedure. However, it must be considered that it brings financial disadvantages due to the lack of adequate representation within the German DRG-system (Diagnosis Related Groups).
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Affiliation(s)
- David Kajaia
- Sozialstiftung Bamberg, Klinik für Urologie, Kinderurologie und roboterassistierte minimalinvasive Urologie, Bamberg
| | - Benjamin Hager
- Sozialstiftung Bamberg, Klinik für Urologie, Kinderurologie und roboterassistierte minimalinvasive Urologie, Bamberg
| | - Stefan Kliebisch
- Sozialstiftung Bamberg, Klinik für Urologie, Kinderurologie und roboterassistierte minimalinvasive Urologie, Bamberg
| | - Karl Weingärtner
- Sozialstiftung Bamberg, Klinik für Urologie, Kinderurologie und roboterassistierte minimalinvasive Urologie, Bamberg
| | - Ruth Seggewiss-Bernhardt
- Sozialstiftung Bamberg, Medizinische Klinik V, Hämatologie und Internistische Onkologie, Bamberg
| | - Vahudin Zugor
- Sozialstiftung Bamberg, Klinik für Urologie, Kinderurologie und roboterassistierte minimalinvasive Urologie, Bamberg
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Prognostic Utility of MRI Features in Intradiverticular Bladder Tumor. Acad Radiol 2022; 29:219-228. [PMID: 33162319 PMCID: PMC8096867 DOI: 10.1016/j.acra.2020.10.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 10/01/2020] [Accepted: 10/05/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND Intradiverticular bladder tumors (IDBT) are rare but clinically important, as they are difficult to assess endoscopically due to limited anatomic access and risk of perforation. MRI may be helpful in assessing IDBT and providing relevant staging and prognostic information. PURPOSE To assess MRI findings of IDBT and their relationship with overall survival. METHODS This retrospective study included 31 consecutive patients with IDBT undergoing MRI from 2008 to 2018 identified through electronic medical records and PACS database search. Two radiologists independently assessed the following MRI features: size (>3 vs ≤3 cm), diverticular neck involvement, Vesical Imaging-Reporting and Data System (VI-RADS) score (>3 vs ≤3), perivesical fat infiltration, additional tumors and suspicious pelvic lymph nodes. Overall survival was estimated using Kaplan-Meier analysis; and the relationship with clinicopathological and MRI features was determined using the Cox proportional-hazards regression model. Inter-reader agreement was assessed using intraclass correlation coefficients (ICC) and Cohen's kappa (K). RESULTS Median follow-up was 1044 days (interquartile range, 474-1952 days). Twenty-six (83.9%) patients underwent surgical treatment with or without neoadjuvant chemotherapy. On MRI, greater tumor size (>3 cm), diverticular neck involvement, perivesical extension, and suspicious lymph nodes were associated with lower overall survival (HR = 3.6-8.1 and 4.3-6.3 for the 2 radiologists, p ≤ 0.03). Other clinicopathological or MRI findings were not associated with survival (p = 0.27-0.65). Inter-reader agreement was excellent for tumor size (ICC = 0.991; 95% CI 0.982-0.996), fair for VI-RADS (K = 0.52, 95% CI, 0.22-0.82), and moderate for others (K = 0.61-0.79). CONCLUSION In patients with IDBT, several MRI features were significantly associated with overall survival. Utilizing all available clinicopathological and imaging information may improve estimation of prognosis.
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11
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Lahham S, Gutierrez S. Diagnosis of Bladder Diverticula with Point-of-Care Ultrasound. Clin Pract Cases Emerg Med 2021; 5:466-467. [PMID: 34813446 PMCID: PMC8610476 DOI: 10.5811/cpcem.2021.7.53199] [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: 05/12/2021] [Accepted: 07/26/2021] [Indexed: 11/29/2022] Open
Abstract
Case Presentation A 65-year-old male presented to the emergency department with symptoms including fever, abnormal urinalysis, and elevated post-void residual. Point-of-care ultrasound was used to rapidly diagnose a bladder diverticulum. The patient was subsequently seen by urology for outpatient bladder repair. Discussion Bladder diverticula, an out-pouching of the bladder, may occur congenitally or as a result of various bladder conditions and/or surgery. Although bladder diverticula are rare and often asymptomatic, severe complications including frequent recurring urinary tract infections may arise depending on the patient.
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Affiliation(s)
- Shadi Lahham
- University of California, Irvine, Department of Emergency Medicine, Orange, California
| | - Salvador Gutierrez
- University of California, Irvine, Department of Emergency Medicine, Orange, California
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12
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Voskuilen CS, Seiler R, Rink M, Poyet C, Noon AP, Roghmann F, Necchi A, Aziz A, Lavollé A, Young MJ, Marks P, Saba K, van Rhijn BW, Fransen van de Putte EE, Ablat J, Black PC, Sosnowski R, Dobruch J, Kumar P, Jallad S, Catto JW, Xylinas E, Hendricksen K. Urothelial Carcinoma in Bladder Diverticula: A Multicenter Analysis of Characteristics and Clinical Outcomes. Eur Urol Focus 2020; 6:1226-1232. [DOI: 10.1016/j.euf.2018.12.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Revised: 11/27/2018] [Accepted: 12/04/2018] [Indexed: 02/07/2023]
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13
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He CH, Su YJ. Woman with fullness in the lower abdomen. J Am Coll Emerg Physicians Open 2020. [PMID: 33000017 DOI: 10.1002/emp2.12010.] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Affiliation(s)
- Chun-Hsien He
- Department of Emergency Medicine Mackay Memorial Hospital Taipei City Taiwan
| | - Yu-Jang Su
- Department of Emergency Medicine Mackay Memorial Hospital Taipei City Taiwan.,Department of Medicine Mackay Medical College Taipei City Taiwan
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14
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Tan MO, Yam WL, Tan YK, Chia SJ, Ng KS. A Rare Case of Acute Urinary Bladder Diverticulitis Mimicking Acute Appendicitis. AMERICAN JOURNAL OF CASE REPORTS 2020; 21:e925236. [PMID: 32780730 PMCID: PMC7440753 DOI: 10.12659/ajcr.925236] [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] [Indexed: 11/25/2022]
Abstract
Patient: Male, 52-year-old Final Diagnosis: Urinary bladder diverticulitis Symptoms: Right iliac fossa pain Medication: — Clinical Procedure: Computed tomography • cystoscopy Specialty: Urology
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Affiliation(s)
- Min-On Tan
- Department of Radiology, Changi General Hospital, Singapore, Singapore
| | - Wai Loon Yam
- Department of Urology, Changi General Hospital, Singapore, Singapore
| | - Yung Khan Tan
- Urohealth Medical Clinic, Mount Elizabeth Novena Specialist Centre, Singapore, Singapore
| | - Sing Joo Chia
- ML've Urocare Center, Mount Elizabeth Novena Hospital, Singapore, Singapore
| | - Keng Sin Ng
- Department of Radiology, Mount Alvernia Hospital, Singapore, Singapore
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15
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Cornejo KM, Rice-Stitt T, Wu CL. Updates in Staging and Reporting of Genitourinary Malignancies. Arch Pathol Lab Med 2020; 144:305-319. [PMID: 32101056 DOI: 10.5858/arpa.2019-0544-ra] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
CONTEXT.— The 8th edition of the American Joint Committee on Cancer (AJCC) staging manual changed the tumor, node, metastasis (TNM) classification systems of genitourinary malignancies in 2017. However, some of the changes appear not well appreciated or recognized by practicing pathologists. OBJECTIVE.— To review the major changes compared with the 7th edition in cancers of the prostate, penis, testis, bladder, urethra, renal pelvis/ureter, and kidney and discuss the challenges that pathologists may encounter. DATA SOURCES.— Peer-reviewed publications and the 8th and 7th editions of the AJCC Cancer Staging Manual. CONCLUSIONS.— This article summarizes the updated staging of genitourinary malignancies, specifically highlighting changes from the 7th edition that are relevant to the pathologic staging system. Pathologists should be aware of the updates made in hopes of providing clarification and the remaining diagnostic challenges associated with these changes.
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Affiliation(s)
- Kristine M Cornejo
- From the Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Travis Rice-Stitt
- From the Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Chin-Lee Wu
- From the Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
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16
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Kang Q, Kang B, Yu Y, Yang B. Transurethral enucleation of the prostate combined with laparoscopic bladder diverticulectomy. MINIM INVASIV THER 2020; 31:144-148. [PMID: 32432482 DOI: 10.1080/13645706.2020.1768123] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Objective: We present a one-session procedure for treating bladder diverticula combined with benign prostatic hyperplasia (BPH).Material and methods: Between January 2015 and April 2019, transurethral plasmakinetic enucleation of the prostate (TUEP) followed by laparoscopic bladder diverticulectomy (LD) were performed in 12 patients at our institution, in four of them combined with bladder stone(s) and in one patient combined with diverticular tumor. Clinical data were retrospectively collected.Results: The mean size of the prostate was 137.3 ± 96.3 (65.5-403.3) ml. The mean maximal diameter of the diverticulum was 8.0 ± 2.7 (3.2-12.0) cm. The mean total operation time was 214.2 ± 69.0 (120-300) min, and the mean enucleation time was 23.2 ± 6.4 (12-35) min. The mean intraoperative blood loss was 52.1 ± 14.9 (30-80) ml. The average pre- and post-operative maximum flow rate was 5.1 ± 1.4 (2.4-8.5) ml/s and 12.8 ± 2.3 (9.6-17.1) ml/s. Except for urinary infection in one patient, no other severe peri- or postoperative complications were observed.Conclusions: TUEP accompanied by LD in one session provides an effective and minimally invasive surgical treatment for bladder diverticula combined with BPH, with or without bladder stones, and permits reasonable operation time and rapid discharge.
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Affiliation(s)
- Qianyu Kang
- Department of Urology, the Second Hospital of Dalian Medical University, Dalian, Liaoning Province, China
| | - Bin Kang
- Department of General Surgery, the Third People's Hospital of Ningxia, Yinchuan, China
| | - Yang Yu
- Department of Urology, the Second Hospital of Dalian Medical University, Dalian, Liaoning Province, China
| | - Bo Yang
- Department of Urology, the Second Hospital of Dalian Medical University, Dalian, Liaoning Province, China
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17
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He C, Su Y. Woman with fullness in the lower abdomen. J Am Coll Emerg Physicians Open 2020; 1:57-58. [PMID: 33000017 PMCID: PMC7493472 DOI: 10.1002/emp2.12010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Revised: 12/06/2019] [Accepted: 12/09/2019] [Indexed: 02/05/2023] Open
Affiliation(s)
- Chun‐Hsien He
- Department of Emergency MedicineMackay Memorial HospitalTaipei CityTaiwan
| | - Yu‐Jang Su
- Department of Emergency MedicineMackay Memorial HospitalTaipei CityTaiwan
- Department of MedicineMackay Medical CollegeTaipei CityTaiwan
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18
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Dataset for the reporting of carcinoma of the bladder-cystectomy, cystoprostatectomy and diverticulectomy specimens: recommendations from the International Collaboration on Cancer Reporting (ICCR). Virchows Arch 2020; 476:521-534. [PMID: 31915958 DOI: 10.1007/s00428-019-02727-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Revised: 11/20/2019] [Accepted: 11/28/2019] [Indexed: 12/11/2022]
Abstract
The International Collaboration on Cancer Reporting (ICCR) is a not for profit organisation whose goal is to produce standardised internationally agreed and evidence-based datasets for pathology reporting. With input from pathologists worldwide, the datasets are intended to be uniform and structured. They include all items necessary for an objective and accurate pathology report which enables clinicians to apply the best treatment for the patient. This dataset has had input from a multidisciplinary ICCR expert panel. The rationale for some items being required and others recommended is explained, based on the latest literature. The dataset incorporates data from the World Health Organization (WHO) 2016, and also from the latest (8th edition) TNM staging system of the American Joint Committee on Cancer (AJCC). Fifteen required elements and eight recommended items are described. This dataset provides all the details for a precise and valuable pathology report required for patient management and prognostication. This dataset is intended for worldwide use, and should facilitate the collection of standardised comparable data on bladder carcinoma at an international level.
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19
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Poletajew S, Krajewski W, Adamowicz J, Kołodziej A, Zdrojowy R, Radziszewski P. Management of Intradiverticular Bladder Tumours: A Systematic Review. Urol Int 2019; 104:42-47. [PMID: 31851992 DOI: 10.1159/000503868] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Accepted: 09/30/2019] [Indexed: 12/31/2022]
Abstract
The aim of this systematic review was to present available data on diagnostic and therapeutic options in intradiverticular bladder tumour cases. A literature search within the Medline database was conducted in March 2019 with combinations of the following search terms: bladder cancer, bladder tumour, bladder diverticulum, diverticulum, intradiverticular. Seventeen relevant articles were identified. Diagnostic and therapeutic options for intradiverticular bladder tumour follow the general management of bladder cancer patients. The most important differences include a higher rate of non-urothelial histology, higher rate of invasive cancers (stage T1 and higher), no stage T2 disease due to lack of a muscularis propria layer and potential role of partial cystectomy or diverticulectomy in the treatment. Among cystectomized patients, the survival is comparable to general bladder cancer patients after cystectomy. Data on accuracy of imaging and endoscopy in diagnosing intradiverticular bladder tumour are poor. There is no study comparing different treatment modalities in intradiverticular bladder tumour patients. Limitations of this review include low number and low evidence level of available studies, as well as low number and heterogeneity of enrolled subjects. Available literature data cannot be the basis for clinical recommendations in intradiverticular bladder tumour cases. While bladder cancer is the most common urinary tract malignancy and at least 1% of cases are intradiverticular, further research in this field is justified.
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Affiliation(s)
- Sławomir Poletajew
- Department of General, Oncological and Functional Urology, Medical University of Warsaw, Warsaw, Poland, .,Second Department of Urology, Medical Centre of Postgraduate Education, Warsaw, Poland,
| | - Wojciech Krajewski
- Department of Urology and Oncological Urology, Wrocław Medical University, Wrocław, Poland
| | - Jan Adamowicz
- Chair of Urology, Department of Regenerative Medicine, Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland
| | - Anna Kołodziej
- Department of Urology and Oncological Urology, Wrocław Medical University, Wrocław, Poland
| | - Romuald Zdrojowy
- Department of Urology and Oncological Urology, Wrocław Medical University, Wrocław, Poland
| | - Piotr Radziszewski
- Department of General, Oncological and Functional Urology, Medical University of Warsaw, Warsaw, Poland
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20
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Simultaneous Laparoscopic Surgery for Bladder Diverticulum and Urachal Remnant: A Case Report. Case Rep Urol 2019; 2019:5785189. [PMID: 31559104 PMCID: PMC6735193 DOI: 10.1155/2019/5785189] [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: 04/27/2019] [Revised: 07/14/2019] [Accepted: 07/18/2019] [Indexed: 11/17/2022] Open
Abstract
A 44-year-old woman visited a hospital with microscopic hematuria in June 2009. Computed tomography showed a large bladder diverticulum at right lateral wall and urachal remnant. Cystoscopic examination showed a large diverticulum at the right lateral wall that closes to the dome. She was followed up closely without therapeutic intervention; however, the residual urine increased gradually and frequent bladder diverticulitis developed. She underwent laparoscopic bladder diverticulectomy and excision of the urachal remnant simultaneously without any complications in August 2017. Laparoscopic approach for a large bladder diverticulum and urachal remnant is useful with safe, effective, and minimally invasive.
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21
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Magers MJ, Lopez-Beltran A, Montironi R, Williamson SR, Kaimakliotis HZ, Cheng L. Staging of bladder cancer. Histopathology 2019; 74:112-134. [PMID: 30565300 DOI: 10.1111/his.13734] [Citation(s) in RCA: 95] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Revised: 08/13/2018] [Accepted: 08/15/2018] [Indexed: 12/13/2022]
Abstract
Urothelial carcinoma of the urinary bladder is a heterogeneous disease with multiple possible treatment modalities and a wide spectrum of clinical outcome. Treatment decisions and prognostic expectations hinge on accurate and precise staging, and the recently published American Joint Committee on Cancer (AJCC) Staging Manual, 8th edition, should be the basis for staging of urinary bladder tumours. It is unfortunate that the International Union Against Cancer (UICC) 8th edition failed to incorporate new data which is considered in the AJCC 8th edition. Thus, the AJCC 8th edition is the focus of this review. Several critical changes and clarifications are made by the AJCC 8th edition relative to the 7th edition. Although the most obvious changes in the 8th edition are in the N (i.e. perivesical lymph node involvement now classified as N1) and M (i.e. M1 is subdivided into M1a and M1b) categories, several points are clarified in the T category (e.g. substaging of pT1 should be attempted). Further optimisation, however, is required. No particular method of substaging pT1 is formally recommended. In this review, these modifications are discussed, as well as points, which require further study and optimisation.
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Affiliation(s)
- Martin J Magers
- Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Antonio Lopez-Beltran
- Department of Urology, Indiana University School of Medicine, Indianapolis, IN, USA.,Department of Pathology, Cordoba, Spain
| | - Rodolfo Montironi
- Faculty of Medicine, Department of Surgery, Unit of Anatomical Pathology, Cordoba, Spain.,Champalimaud Clinical Center, Lisbon, Portugal
| | - Sean R Williamson
- Institute of Pathological Anatomy and Histopathology, School of Medicine, Polytechnic University of the Marche Region (Ancona), United Hospitals, Ancona, Italy.,Department of Pathology and Laboratory Medicine and Henry Ford Cancer Institute, Henry Ford Health System, Detroit, MI, USA
| | | | - Liang Cheng
- Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, IN, USA.,Department of Pathology, Wayne State University School of Medicine, Detroit, MI, USA
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22
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Gallan AJ, Choy B, Paner GP. Contemporary Grading and Staging of Urothelial Neoplasms of the Urinary Bladder: New Concepts and Approaches to Challenging Scenarios. Surg Pathol Clin 2018; 11:775-795. [PMID: 30447841 DOI: 10.1016/j.path.2018.07.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Grading and staging of urothelial neoplasm are the most crucial factors in risk stratification and management; both necessitate optimal accuracy and consistency. Several updates and recommendations have been provided though recent publications of the 4th edition of the World Health Organization classification, the 8th edition of the American Joint Committee on Cancer staging system, and the International Consultation on Urological Diseases-European Association of Urology updates on bladder cancer. Updates and recent studies have provided better insights into and approaches to the challenging scenarios in grading and staging of urothelial neoplasm; however, there remain aspects that need further investigation and refinement.
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Affiliation(s)
- Alexander J Gallan
- Department of Pathology, University of Chicago, 5841 South Maryland Avenue, AMB S626-MC6101, Chicago, IL 60637, USA
| | - Bonnie Choy
- Department of Pathology, University of Chicago, 5841 South Maryland Avenue, AMB S626-MC6101, Chicago, IL 60637, USA
| | - Gladell P Paner
- Department of Pathology, University of Chicago, 5841 South Maryland Avenue, AMB S626-MC6101, Chicago, IL 60637, USA; Department of Surgery, Section of Urology, University of Chicago, 5841 South Maryland Avenue, AMB S626-MC6101, Chicago, IL 60637, USA.
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23
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Salman MY, Fazlıoğlu A, Kurtuluş FO, Ünlüer SE. Surgical treatment of bladder diverticulum with radical prostatectomy. A case report and literature review. ARCHIVES OF CLINICAL AND EXPERIMENTAL MEDICINE 2018. [DOI: 10.25000/acem.455144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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24
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Cacciamani G, De Luyk N, De Marco V, Sebben M, Bizzotto L, De Marchi D, Cerruto MA, Siracusano S, Benito Porcaro A, Artibani W. Robotic bladder diverticulectomy: step-by-step extravesical posterior approach - technique and outcomes. Scand J Urol 2018; 52:285-290. [PMID: 30339480 DOI: 10.1080/21681805.2018.1492965] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVE The aim of this study was to evaluate the feasibility of robotic extravesical posterior surgical bladder diverticulectomy for treatment of symptomatic bladder diverticula (BD). MATERIALS AND METHODS Data from patients with posterior BD who consecutively underwent robotic bladder diverticulectomy (RBD) from 2013 to 2016 in Azienda Ospedaliera Universitaria Integrata, Verona, were retrospectively reviewed. Baseline characteristics, perioperative outcomes including operative time (OT), estimated blood loss (EBL), postoperative transfusion rate and length of hospital stay (LOS), and early (30 days) and late (90 days) postoperative complications were recorded and analysed. RESULTS Six patients underwent RBD. Storage, voiding and postvoiding lower urinary tract symptoms (LUTS) were reported by 33.3%, 100% and 33.3% of patients, respectively. The median [interquartile range (IQR)] BD diameter was 7.1 (5.5-9.5) cm; median (IQR) preoperative postvoiding residual volume (PVR) was 300 (90-395) ml. The median (IQR) OT was 112.5 (83.7-133.7) min and median (IQR) EBL was 25.8 (0-50) ml. The median (IQR) LOS was 7 (4.7-9.0) days. One patient (16.7%) reported early minor postoperative complication. No patient showed early or late major postoperative complications. At 2 month follow-up, all patients underwent a lower abdomen ultrasound and minimal or no postoperative PVR was found. At 6 month follow-up no LUTS were reported. CONCLUSIONS RBD appears to be a safe treatment for posterior BD with excellent perioperative and functional outcomes. The three-dimensional visualization, greater magnification and wristed instrumentation with seven degrees of freedom allow precise dissection of BD and reconstruction of the bladder wall.
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Affiliation(s)
- Giovanni Cacciamani
- a Department of Urology , Azienda Ospedaliera Universitaria Integrata, University of Verona , Verona , Italy
| | - Nicolò De Luyk
- a Department of Urology , Azienda Ospedaliera Universitaria Integrata, University of Verona , Verona , Italy
| | - Vincenzo De Marco
- a Department of Urology , Azienda Ospedaliera Universitaria Integrata, University of Verona , Verona , Italy
| | - Marco Sebben
- a Department of Urology , Azienda Ospedaliera Universitaria Integrata, University of Verona , Verona , Italy
| | - Leonardo Bizzotto
- a Department of Urology , Azienda Ospedaliera Universitaria Integrata, University of Verona , Verona , Italy
| | - Davide De Marchi
- a Department of Urology , Azienda Ospedaliera Universitaria Integrata, University of Verona , Verona , Italy
| | - Maria Angela Cerruto
- a Department of Urology , Azienda Ospedaliera Universitaria Integrata, University of Verona , Verona , Italy
| | - Salvatore Siracusano
- a Department of Urology , Azienda Ospedaliera Universitaria Integrata, University of Verona , Verona , Italy
| | - Antonio Benito Porcaro
- a Department of Urology , Azienda Ospedaliera Universitaria Integrata, University of Verona , Verona , Italy
| | - Walter Artibani
- a Department of Urology , Azienda Ospedaliera Universitaria Integrata, University of Verona , Verona , Italy
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25
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Favorito LA. Bladder diverticula with more than 5 cm increases the risk of acute urinary retention in BPH. Int Braz J Urol 2018; 44:662-663. [PMID: 30020582 PMCID: PMC6092645 DOI: 10.1590/s1677-5538.ibju.2018.04.01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023] Open
Affiliation(s)
- Luciano A. Favorito
- Univ. Est. do Rio de Janeiro - UERJ, Brasil; Hospital da Lagoa Federal, Brasil; International Braz J Urol, Brasil
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26
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Wang G, McKenney JK. Urinary Bladder Pathology: World Health Organization Classification and American Joint Committee on Cancer Staging Update. Arch Pathol Lab Med 2018; 143:571-577. [DOI: 10.5858/arpa.2017-0539-ra] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Context.—
Since the publication of the previous World Health Organization (WHO) Classification of Tumours on the Pathology and Genetics of Tumours of the Urinary System and Male Genital Organs in 2004, significant new knowledge has been generated regarding the pathology and genetics of bladder neoplasia. Publication of the 2016 WHO “Blue Book” has codified that new data into updated recommendations for classification and prognostication. Similarly, the recent release of the 8th edition of the American Joint Committee on Cancer (AJCC) Cancer Staging Manual, which was implemented in January 2018, has also addressed staging criteria for bladder cancer in several unique settings to clarify their application.
Objective.—
To highlight subtle changes within the recent WHO and AJCC publications that may affect daily surgical pathology practice.
Data Sources.—
Peer-reviewed published literature, the 2016 WHO Classification of Tumours of the Urinary System and Male Genital Organs, and the 8th edition of the AJCC Cancer Staging Manual were reviewed.
Conclusions.—
Selected changes and/or clarifications are discussed and include classification of flat and papillary urothelial neoplasia, select variant patterns of invasive urothelial carcinoma, staging of invasive carcinoma in bladder diverticula, and staging of carcinomas involving the prostate gland.
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Affiliation(s)
- Gang Wang
- From the Department of Pathology, University of Texas MD Anderson Cancer Center, Houston (Dr Wang); and the Robert J. Tomsich Pathology and Laboratory Medicine Institute, Department of Anatomic Pathology, Cleveland Clinic, Cleveland, Ohio (Dr McKenney)
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27
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Abstract
PURPOSE OF REVIEW Management of genitourinary malignancy is likely to encompass a large portion of most of the urologist's practice. The challenge for the modern urologist is not only in understanding the management of commonly seen genitourinary malignancies, but also in recognizing unusual variants and their differences in management. This is evermore important as new technologies have refined the ability to identify rare entities. This review presents a brief overview of the various genitourinary malignancy subtypes seen within urology. RECENT FINDINGS All major organ subtypes are highlighted along with an overview of the current understanding of their associated malignancies. An update on the current state management paradigms as well as future directions is also outlined. SUMMARY After reading this review, the urologist should have a deeper understanding of the breadth of disorders in genitourinary oncology and a clearer approach to the management of these problems. Additionally, ongoing avenues for research are highlighted.
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28
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Preciado-Estrella DA, Cortés-Raygoza P, Morales-Montor JG, Pacheco-Gahbler C. Multiple bladder diverticula treated with robotic approach-assisted with cystoscopy. Urol Ann 2018; 10:114-117. [PMID: 29416289 PMCID: PMC5791449 DOI: 10.4103/ua.ua_108_17] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A bladder diverticulum (BD) is a herniation of the bladder urothelium through the muscular bladder wall. As a result, BD presents as a thin walled bag, urine filled connected to bladder lumen through a neck or ostium. The clinical problem with bladder diverticula is their poorly empty during micturition which results in multiple lower urinary tract symptoms as well as recurrent urinary tract infections. Bladder diverticula can be grossly classified in two groups as follows: congenital or acquired with different age presentation and etiological factors in each one. Vast majority of BD occur in adults especially in men. Acquired BD, are commonly diagnosed in the setting of neurogenic dysfunction or bladder outlet obstruction, they use to be multiple, associated with trabeculated bladder and prostatic enlargement.
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29
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Challenges in Pathologic Staging of Bladder Cancer: Proposals for Fresh Approaches of Assessing Pathologic Stage in Light of Recent Studies and Observations Pertaining to Bladder Histoanatomic Variances. Adv Anat Pathol 2017; 24:113-127. [PMID: 28398951 DOI: 10.1097/pap.0000000000000152] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The paradigm of pathologic stage (pT) categorization in bladder cancer remains the depth of invasion into the different histologic layers of the bladder wall. However, the approaches to assigning pT stage category toward an enhanced outcome stratification have been marked by challenges and innovations, due in part to our growing appreciation of the surprisingly perplexing bladder histoanatomy. Upstaging of pT1 tumors after radical cystectomy is substantial and underscores the potential value of pT1 substaging in transurethral resection (TUR) specimens. The 2017 American Joint Committee on Cancer tumor-node-metastasis system recommends pT1 substaging but recognizes the need to optimize the approach. Over the years, the cut-off for microinvasion has been significantly lowered to 0.5 mm and is now a promising scheme for pT1 (micrometric) substaging. Unlike the micrometric approach, histoanatomic substaging using muscularis mucosae (MM) and vascular plexus as landmarks is less feasible in TUR specimens and inconsistent in stratifying the outcome of pT1 tumors. The lamina propria possesses inherent variations in depth, MM, and vascular plexus dispositions that should be factored in future pT1 substaging proposals. Histoanatomic variations among the bladder regions also occur, and studies suggest that trigone and bladder neck cancers may have more adverse outcomes. The muscularis propria (MP), besides being the essential histologic landmark for assigning pT2 stage category, is also considered a surrogate for the adequacy of TUR, furthering the importance of identifying its presence in TUR specimens. MP, however, may be mimicked by hyperplastic or isolated MP-like MM muscle bundles in the lamina propria with overstaging implications, and caution should be exercised in distinguishing these 2 muscle types morphologically and immunohistochemically. Presence of additional superficial MP unique from the detrusor muscle proper may also complicate staging at the trigone and ureter insertion sites. With regard to the depth of MP invasion, large and multicenter studies have reaffirmed the prognostic significance of pT2a/b subcategories. It is revealed that there are at least 3 ways used to demarcate the irregular MP to perivesical soft tissue junction, and use of a common criterion indicates improvement in pT2b/pT3a staging reproducibility. Although studies have shown significantly poorer outcome in pT3b compared with pT3a tumors, this designation has a substantial reliance on the prosector's gross assessment of perivesical soft tissue invasion which if performed incorrectly may lead to staging inaccuracy of pT3 tumors. The 8th edition of the American Joint Committee on Cancer has updated the staging schema for bladder cancers with concomitant prostatic stromal invasion and cancers within bladder diverticula. Because of 2 possible pT designations, prostatic stromal invasion in TUR specimens should not be automatically staged as either pT4a or pT2 (urethral). Recent data support that bladder cancer invading into the seminal vesicle has comparable outcome to pT4b tumors. Interestingly, several studies in pT4a tumors, which are staged based on sex-specific organs, have shown poorer outcome in females than males after radical cystectomy, and while there are possibly several reasons, they may also include anatomic factors. Despite the progress has been made, work remains to be done to inform future bladder cancer pT category definitions and their reproducibility in application and prognostication.
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30
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Humphrey PA, Moch H, Cubilla AL, Ulbright TM, Reuter VE. The 2016 WHO Classification of Tumours of the Urinary System and Male Genital Organs-Part B: Prostate and Bladder Tumours. Eur Urol 2016; 70:106-119. [PMID: 26996659 DOI: 10.1016/j.eururo.2016.02.028] [Citation(s) in RCA: 1099] [Impact Index Per Article: 137.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Accepted: 02/04/2016] [Indexed: 02/07/2023]
Abstract
UNLABELLED It has been 12 yr since the publication of the last World Health Organization (WHO) classification of tumours of the prostate and bladder. During this time, significant new knowledge has been generated about the pathology and genetics of these tumours. Intraductal carcinoma of the prostate is a newly recognized entity in the 2016 WHO classification. In most cases, it represents intraductal spread of aggressive prostatic carcinoma and should be separated from high-grade prostatic intraepithelial neoplasia. New acinar adenocarcinoma variants are microcystic adenocarcinoma and pleomorphic giant cell adenocarcinoma. Modifications to the Gleason grading system are incorporated into the 2016 WHO section on grading of prostate cancer, and it is recommended that the percentage of pattern 4 should be reported for Gleason score 7. The new WHO classification further recommends the recently developed prostate cancer grade grouping with five grade groups. For bladder cancer, the 2016 WHO classification continues to recommend the 1997 International Society of Urological Pathology grading classification. Newly described or better defined noninvasive urothelial lesions include urothelial dysplasia and urothelial proliferation of uncertain malignant potential, which is frequently identified in patients with a prior history of urothelial carcinoma. Invasive urothelial carcinoma with divergent differentiation refers to tumours with some percentage of "usual type" urothelial carcinoma combined with other morphologies. Pathologists should mention the percentage of divergent histologies in the pathology report. PATIENT SUMMARY Intraductal carcinoma of the prostate is a newly recognized entity in the 2016 World Health Organization classification. Better defined noninvasive urothelial lesions include urothelial dysplasia and urothelial proliferation of uncertain malignant potential.
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Affiliation(s)
- Peter A Humphrey
- Department of Pathology, Yale University School of Medicine, New Haven, CT, USA
| | - Holger Moch
- Department of Pathology, University Hospital Zurich, Zurich, Switzerland.
| | - Antonio L Cubilla
- Instituto de Patología e Investigación, Facultad de Ciencias Médicas, Universidad Nacional de Asunción, San Lorenzo, Paraguay
| | - Thomas M Ulbright
- Department of Pathology and Laboratory Medicine, Indiana University Health Partners, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Victor E Reuter
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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Zimmermann O, Torzewski J, Reichenbach-Klinke E, Zenk C. Large diverticulum of the urinary bladder: A rare cause of deep vein thrombosis with consecutive pulmonary embolism. Can Urol Assoc J 2015; 9:E321-3. [PMID: 26029307 DOI: 10.5489/cuaj.2533] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
A 73-year-old man was admitted with progressive dyspnea; he also had benign prostatic hyperplasia (BPH). An angio computed tomography scan showed pulmonary embolism with thrombi in both main pulmonary arteries. By duplex ultrasonography, we detected a thrombus in the right vena femoralis superficialis and vena femoralis communis. Simultaneously, we also noticed a large diverticulum on the right side of the urinary bladder and urinary stasis II of the left kidney. We consider the BPH as the trigger for a secondary diverticulum of the urinary bladder. As a result of its large dimensions, mechanical compression of the deep right pelvic veins resulted in thrombosis which finally caused the pulmonary embolism. With respect to the urinary stasis II, surgical excavation of the diverticulum with infravesical desobstruction was planned. The potentially lethal course of large diverticula may require surgery.
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Affiliation(s)
- Oliver Zimmermann
- Cardiovascular Center Oberallgäu Kempten, Hospital Immenstadt, Germany
| | - Jan Torzewski
- Cardiovascular Center Oberallgäu Kempten, Hospital Immenstadt, Germany
| | | | - Christine Zenk
- Department of Internal Medicine, Hospital Immenstadt, Germany
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Zhong H, George S, Kauffman E, Guru K, Azabdaftari G, Xu B. Clinicopathologic characterization of intradiverticular carcinoma of urinary bladder - a study of 22 cases from a single cancer center. Diagn Pathol 2014; 9:222. [PMID: 25425482 PMCID: PMC4254201 DOI: 10.1186/s13000-014-0222-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2014] [Accepted: 11/10/2014] [Indexed: 12/12/2022] Open
Abstract
Background To examine histopathologic features and clinical outcomes of intradiverticular bladder carcinomas. Methods Twenty-two consecutive patients with intradiverticular bladder carcinoma treated with either endoscopic transurethral resection or partial or radical cystectomy at a single institution between years of 1995 to 2011. Clinicopathologic characteristics and oncologic outcomes of patients were retrospectively analyzed, including tissue histology re-review by genitourinary pathologists. Results Histologically, 9 cases (41%) were non-invasive papillary urothelial carcinoma, 13 cases (59%) were invasive urothelial carcinoma, including three cases of small cell carcinoma. Final pathology revealed synchronous extradiverticular urothelial carcinomas in 6 out of 9 cases (67%) of non-invasive and 2 out of 10 cases (20%) invasive intradiverticular urothelial carcinoma, respectively. More than half of cases (13/22, 59%) showed a distinctive hypertrophic layer of muscularis mucosae. There was no statistical difference in disease free survival or overall survival between non-invasive and invasive tumors within approximately 3 years of follow up (mean 38 months, median 32 months). While stage T3 patients generally did poorly, oncologic outcomes for stage T1 patients were no different than those of stage Ta. Conclusion Intradiverticular carcinomas are often associated with a hypertrophic layer of muscularis mucosae that can potentially confound tumor staging. Non-invasive intradiverticular urothelial carcinomas are more likely to have coexisting synchronous extradiverticular lesions. The absence of a muscularis propria layer may not necessarily predispose T1 tumors to more aggressive disease. Virtual Slides The virtual slide(s) for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/13000_2014_222
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Affiliation(s)
- Hua Zhong
- Department of Pathology and Laboratory Medicine, Roswell Park Cancer Institute, Elm and Carlton Streets, Buffalo, NY, 14263, USA. .,Current address: Department of Pathology and Laboratory Medicine, Robert Wood Johnson Medical School, UMDNJ, One Robert Wood Johnson Place - MEB 212, New Brunswick, NJ, 08901, USA.
| | - Saby George
- Department of Medicine, Roswell Park Cancer Institute, Elm and Carlton Streets, Buffalo, NY, 14263, USA.
| | - Eric Kauffman
- Department of Urology, Roswell Park Cancer Institute, Elm and Carlton Streets, Buffalo, NY, 14263, USA.
| | - Khurshid Guru
- Department of Urology, Roswell Park Cancer Institute, Elm and Carlton Streets, Buffalo, NY, 14263, USA.
| | - Gissou Azabdaftari
- Department of Pathology and Laboratory Medicine, Roswell Park Cancer Institute, Elm and Carlton Streets, Buffalo, NY, 14263, USA.
| | - Bo Xu
- Department of Pathology and Laboratory Medicine, Roswell Park Cancer Institute, Elm and Carlton Streets, Buffalo, NY, 14263, USA.
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Tudor J, Cantley RL, Jain S. Primary small cell carcinoma arising from a bladder diverticulum. J Urol 2014; 192:236-7. [PMID: 24747653 DOI: 10.1016/j.juro.2014.04.044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/11/2014] [Indexed: 11/28/2022]
Affiliation(s)
- James Tudor
- University of Toledo School of Medicine, Toledo, Ohio
| | - Richard L Cantley
- Department of Pathology, University of Toledo Medical Center, Toledo, Ohio
| | - Samay Jain
- Department of Urology, University of Toledo Medical Center, Toledo, Ohio
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