1
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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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2
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Laukhtina E, Boehm A, Peyronnet B, Bravi CA, Batista Da Costa J, Soria F, D'Andrea D, Rajwa P, Quhal F, Yanagisawa T, König F, Mostafaei H, Enikeev D, Ingels A, Verhoest G, D'Hondt F, Mottrie A, Joniau S, Van Poppel H, de la Taille A, Bensalah K, Bruyère F, Shariat SF, Pradere B. Urethrectomy at the time of radical cystectomy for non-metastatic urothelial carcinoma of the bladder: a collaborative multicenter study. World J Urol 2022; 40:1689-1696. [PMID: 35596017 PMCID: PMC9236994 DOI: 10.1007/s00345-022-04025-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 04/13/2022] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION The optimal management of the urethra in patients planned for radical cystectomy (RC) remains unclear. We sought to evaluate the impact of urethrectomy on perioperative and oncological outcomes in patients treated with RC for non-metastatic urothelial carcinoma of the bladder (UCB). MATERIALS AND METHODS We assessed the retrospective data from patients treated with RC for UCB of five European University Hospitals. Associations of urethrectomy with progression-free (PFS), cancer-free (CSS), and overall (OS) survivals were assessed in univariable and multivariable Cox regression models. We performed a subgroup analysis in patients at high risk for urethral recurrence (UR) (urethral invasion and/or bladder neck invasion and/or multifocality and/or prostatic urethra involvement). RESULTS A total of 887 non-metastatic UCB patients were included. Among them, 146 patients underwent urethrectomy at the time of RC. Urethrectomy was performed more often in patients with urethral invasion, T3/4 tumor stage, CIS, positive frozen section analysis of the urethra, and those who received neoadjuvant chemotherapy, underwent robotic RC, and/or received an ileal conduit urinary diversion (all p < 0.001). Estimated blood loss and the postoperative complication rate were comparable between patients who received an urethrectomy and those who did not. Urethrectomy during RC was not associated with PFS (HR 0.83, p = 0.17), CSS (HR 0.93, p = 0.67), or OS (HR 1.08, p = 0.58). In the subgroup of 276 patients at high risk for UR, urethrectomy at the time of RC decreased the risk of progression (HR 0.58, p = 0.04). CONCLUSION In our study, urethrectomy at the time of RC seems to benefit only patients at high risk for UR. Adequate risk assessment of UCB patients' history may allow for better clinical decision-making and patient counseling.
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Affiliation(s)
- Ekaterina Laukhtina
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
| | - Axelle Boehm
- Department of Urology, University Hospital of Tours, Tours, France
| | - Benoit Peyronnet
- Department of Urology, University Hospital of Rennes, Rennes, France
| | - Carlo Andrea Bravi
- Unit of Urology, Division of Oncology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
- Department of Urology, Onze-Lieve-Vrouwziekenhuis Hospital, Aalst, Belgium
- ORSI Academy, Melle, Belgium
| | - Jose Batista Da Costa
- Department of Urology, University Hospital Henri Mondor, AP-HP, UPEC, AP-HP, 51 Avenue du Maréchal de Lattre de Tassigny, 95010, Créteil Cedex, France
| | - Francesco Soria
- Division of Urology, Department of Surgical Sciences, AOU Città della Salute e della Scienza di Torino, Torino School of Medicine, Turin, Italy
| | - David D'Andrea
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Pawel Rajwa
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
- Department of Urology, Medical University of Silesia, Zabrze, Poland
| | - Fahad Quhal
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
- Department of Urology, King Fahad Specialist Hospital, Dammam, Saudi Arabia
| | - Takafumi Yanagisawa
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Frederik König
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
- Department of Urology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Hadi Mostafaei
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
- Research Center for Evidence Based Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Dmitry Enikeev
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
| | - Alexandre Ingels
- Department of Urology, University Hospital Henri Mondor, AP-HP, UPEC, AP-HP, 51 Avenue du Maréchal de Lattre de Tassigny, 95010, Créteil Cedex, France
| | - Gregory Verhoest
- Department of Urology, University Hospital of Rennes, Rennes, France
| | - Frederiek D'Hondt
- Department of Urology, Onze-Lieve-Vrouwziekenhuis Hospital, Aalst, Belgium
- ORSI Academy, Melle, Belgium
| | - Alexandre Mottrie
- Department of Urology, Onze-Lieve-Vrouwziekenhuis Hospital, Aalst, Belgium
- ORSI Academy, Melle, Belgium
| | - Steven Joniau
- Department of Urology, University Hospitals Leuven, Leuven, Belgium
| | | | - Alexandre de la Taille
- Department of Urology, University Hospital Henri Mondor, AP-HP, UPEC, AP-HP, 51 Avenue du Maréchal de Lattre de Tassigny, 95010, Créteil Cedex, France
| | - Karim Bensalah
- Department of Urology, University Hospital of Rennes, Rennes, France
| | - Franck Bruyère
- Department of Urology, University Hospital of Tours, Tours, France
| | - Shahrokh F Shariat
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
- Karl Landsteiner Institute of Urology and Andrology, Vienna, Austria
- Department of Urology, Weill Cornell Medical College, New York, NY, USA
- Department of Urology, University of Texas Southwestern, Dallas, TX, USA
- Department of Urology, Second Faculty of Medicine, Charles University, Prague, Czech Republic
- Hourani Center for Applied Scientific Research, Al-Ahliyya Amman University, Amman, Jordan
| | - Benjamin Pradere
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.
- Department of Urology, La Croix Du Sud Hospital, Quint Fonsegrives, France.
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3
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Fabiano E, Riou O, Pointreau Y, Périchon N, Durdux C. Role of radiotherapy in the management of bladder cancer: Recommendations of the French society for radiation oncology. Cancer Radiother 2021; 26:315-322. [PMID: 34955411 DOI: 10.1016/j.canrad.2021.11.006] [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: 10/19/2022]
Abstract
We present the recommendations of the French society of oncological radiotherapy on the indications and techniques for external beam radiotherapy for bladder cancer.
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Affiliation(s)
- E Fabiano
- Département de radiothérapie, hôpital européen Georges-Pompidou, 20, rue Leblanc, 75015 Paris, France
| | - O Riou
- Département de radiothérapie, Institut régional du cancer, 34000 Montpellier, France
| | - Y Pointreau
- Département de radiothérapie, Institut interrégional de cancérologie, centre Jean-Bernard, clinique Victor-Hugo, 72000 Le Mans, France
| | - N Périchon
- Département de radiothérapie, centre Eugène-Marquis, 35000 Rennes, France
| | - C Durdux
- Département de radiothérapie, hôpital européen Georges-Pompidou, 20, rue Leblanc, 75015 Paris, France.
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Thakare N, Lamb BW, Biers S. Orthotopic bladder substitution: Surgical aspects and optimization of outcomes. BJUI COMPASS 2021; 2:359-369. [PMID: 35474698 PMCID: PMC8988640 DOI: 10.1002/bco2.84] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Revised: 03/07/2021] [Accepted: 03/07/2021] [Indexed: 12/17/2022] Open
Abstract
Objectives Orthotopic bladder substitution (OBS) is a management option for urinary diversion in men and women undergoing cystectomy. The aim of the procedure is to provide a functional continent urinary reservoir of adequate capacity, compliance and low pressure. We have provided a narrative review of the existing literature and highlighted areas where improvement and standardization can be recommended. Methods Literature search included database search for publications from January 1970 to November 2020, using keywords including OBS, bladder reconstruction, neobladder, radical cystectomy, robotic cystectomy, intracorporeal neobladder, surgical technique, patient selection and outcomes. Results Due to various factors including indications, operative technique and risk of complications, OBS is an enormous undertaking and commitment for patients, surgeons and health professionals involved in the care pathway. The main considerations for patient selection, the technical elements of the procedure and the rationale behind these are discussed. Previously considered to be a choice for a select few, the inclusion criteria have expanded over the last decade. Similarly, surgical techniques including the choice and configuration of bowel segments, construction of anastomosis and nerve or organ sparing procedures have evolved over the years. Minimally invasive laparoscopic and robotic assisted surgery has added further perspectives to the existing literature on OBS. Understanding the principles of operative techniques and assessing the best evidence to influence patient management is crucial as it has a major impact on clinical outcomes. Peri- and post-operative care, focused on the prevention of complications and morbidity, affects long-term functional and oncological outcomes, which ultimately dictates the quality of life. Conclusions This concise overview of OBS literature highlights the importance of pre-operative, peri-operative, and post-operative aspects with regards to the optimization of patient care. To achieve the best results, meticulous attention should be paid in all these areas, surgical and multi-disciplinary. Patient education and counseling, with shared decision making are central to the success of the procedure.
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Affiliation(s)
- N. Thakare
- Department of UrologyCambridge University Hospitals NHS Foundation TrustAddenbrooke’s HospitalCambridgeUK
| | - B. W. Lamb
- Department of UrologyCambridge University Hospitals NHS Foundation TrustAddenbrooke’s HospitalCambridgeUK
- Faculty of Health, Education, Medicine and Social CareAnglia Ruskin UniversityChelmsfordUK
| | - S. Biers
- Department of UrologyCambridge University Hospitals NHS Foundation TrustAddenbrooke’s HospitalCambridgeUK
- Faculty of Health, Education, Medicine and Social CareAnglia Ruskin UniversityChelmsfordUK
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Khalifa J, Supiot S, Pignot G, Hennequin C, Blanchard P, Pasquier D, Magné N, de Crevoisier R, Graff-Cailleaud P, Riou O, Cabaillé M, Azria D, Latorzeff I, Créhange G, Chapet O, Rouprêt M, Belhomme S, Mejean A, Culine S, Sargos P. Recommendations for planning and delivery of radical radiotherapy for localized urothelial carcinoma of the bladder. Radiother Oncol 2021; 161:95-114. [PMID: 34118357 DOI: 10.1016/j.radonc.2021.06.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 05/05/2021] [Accepted: 06/03/2021] [Indexed: 12/17/2022]
Abstract
PURPOSE Curative radio-chemotherapy is recognized as a standard treatment option for muscle-invasive bladder cancer (MIBC). Nevertheless, the technical aspects for MIBC radiotherapy are heterogeneous with a lack of practical recommendations. METHODS AND MATERIALS In 2018, a workshop identified the need for two cooperative groups to develop consistent, evidence-based guidelines for irradiation technique in the delivery of curative radiotherapy. Two radiation oncologists performed a review of the literature addressing several topics relative to radical bladder radiotherapy: planning computed tomography acquisition, target volume delineation, radiation schedules (total dose and fractionation) and dose delivery (including radiotherapy techniques, image-guided radiotherapy (IGRT) and adaptive treatment modalities). Searches for original and review articles in the PubMed and Google Scholar databases were conducted from January 1990 until March 2020. During a meeting conducted in October 2020, results on 32 topics were presented and discussed with a working group involving 15 radiation oncologists, 3 urologists and one medical oncologist. We applied the American Urological Association guideline development's method to define a consensus strategy. RESULTS A consensus was obtained for all 34 except 4 items. The group did not obtain an agreement on CT enhancement added value for planning, PTV margins definition for empty bladder and full bladder protocols, and for pelvic lymph-nodes irradiation. High quality evidence was shown in 6 items; 8 items were considered as low quality of evidence. CONCLUSION The current recommendations propose a homogenized modality of treatment both for routine clinical practice and for future clinical trials, following the best evidence to date, analyzed with a robust methodology. The XXX group formulates practical guidelines for the implementation of innovative techniques such as adaptive radiotherapy.
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Affiliation(s)
- Jonathan Khalifa
- Department of Radiotherapy, Institut Claudius Regaud, Institut Universitaire du Cancer de Toulouse Oncopole, France
| | - Stéphane Supiot
- Department of Radiotherapy, Institut de Cancérologie de l'Ouest, Nantes Saint-Herblain, France
| | - Géraldine Pignot
- Department of Urology, Institut Paoli Calmettes, Marseille, France
| | | | - Pierre Blanchard
- Department of Radiotherapy, Institut Gustave Roussy, Villejuif, France
| | - David Pasquier
- Department of Radiotherapy, Centre Oscar Lambret, Lille, France
| | - Nicolas Magné
- Department of Radiotherapy, Institut de Cancérologie Lucien Neuwirth, Saint Priest en Jarez, France
| | | | - Pierre Graff-Cailleaud
- Department of Radiotherapy, Institut Claudius Regaud, Institut Universitaire du Cancer de Toulouse Oncopole, France
| | - Olivier Riou
- Department of Radiotherapy, Institut du Cancer de Montpellier, France
| | | | - David Azria
- Department of Radiotherapy, Institut du Cancer de Montpellier, France
| | - Igor Latorzeff
- Department of Radiotherapy, Clinique Pasteur, Toulouse, France
| | | | - Olivier Chapet
- Department of Radiotherapy, Hospices Civils de Lyon, France
| | - Morgan Rouprêt
- Department of Urology, Hôpital Pitié-Salpétrière, APHP Sorbonne Université, Paris, France
| | - Sarah Belhomme
- Department of Medical Physics, Institut Bergonié, Bordeaux, France
| | - Arnaud Mejean
- Department of Urology, Hôpital Européen Georges-Pompidou, Paris, France
| | - Stéphane Culine
- Department of Medical Oncology, Hôpital Saint-Louis, Paris, France
| | - Paul Sargos
- Department of Radiotherapy, Institut Bergonié, Bordeaux, France.
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Prospective evaluation of definitive chemoradiotherapy with volumetric modulated arc therapy in patients with muscle invasive carcinoma of urinary bladder. Contemp Oncol (Pozn) 2020; 24:177-182. [PMID: 33235544 PMCID: PMC7670179 DOI: 10.5114/wo.2020.100275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Accepted: 08/25/2020] [Indexed: 12/24/2022] Open
Abstract
Introduction Concurrent chemoradiotherapy (CTRT) remains one of the treatment options in patients with muscle invasive bladder cancer (MIBC) unwilling/unsuitable for radical surgery. We evaluated the role of volumetric modulated arc therapy (VMAT) in MIBC patients treated with definitive CTRT. Material and methods 25 patients of histologically proven transitional cell MIBC (T2–T4a, N0, M0) unwilling/unsuitable for radical surgery (after maximal transurethral resection of bladder tumour) were recruited in this prospective study. Primary clinical target volume (CTV) consisted of the gross tumour and whole bladder. Primary planning target volume (PTV) and nodal PTV were prescribed 60 Gy and 54 Gy (both in 30 fractions). Concurrent chemotherapy was cisplatin (40 mg/m2) weekly. Acute toxicities were assessed as per Common Terminology Criteria for Adverse Events (CTCAE) version 4.0. Survival estimates were done from the date of registration using the Kaplan-Meier method. Results Median age was 70 years (37–80 years). Median overall treatment time was 45 days (44–51). Median number of chemotherapy cycles was 5 (range 3–6). 5 (20%) and 4 (16%) patients respectively suffered from acute grade ≥ 2 gastrointestinal and grade ≥ 2 genitourinary toxicities during treatment. One patient each had grade 3 anaemia and neutropenia. At a median follow-up of 34 months (10–45 months), 3-year progression-free survival and overall survival were 65.6% and 81.2% respectively. 3-year distant metastasis-free survival was 90.5%. Bladder preservation rate at 3 years was 68%. Conclusions Definitive CTRT with VMAT is well tolerated in patients with MIBC unsuitable for surgery and yields decent survival and bladder preservation outcome.
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7
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Kalampokis N, Grivas N, Ölschläger M, Hassan FN, Gakis G. Radical Cystectomy in Female Patients - Improving Outcomes. Curr Urol Rep 2019; 20:83. [PMID: 31781877 DOI: 10.1007/s11934-019-0951-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
PURPOSE OF REVIEW To review the methods of improving surgical, oncological, and functional outcomes in women with bladder cancer treated with radical cystectomy. RECENT FINDINGS Οrthotopic urinary diversion (ONB) is a safe option for well-selected women as it combines high rates of daytime and nighttime continence with exceptional oncologic outcomes. It is considered safe even for patients with limited lymph node disease and trigone involvement, as long as a preoperative biopsy of the bladder neck or an intraoperative frozen section analysis of distal urethral margin rules out malignant disease. Nerve-sparing techniques have shown promising results. For well-selected patients with early invasive disease, sparing of internal genitalia has proven to be oncologically safe. Yet, generally accepted and evidence-based oncological and functional follow-up schemes for women after radical cystectomy are still lacking. Properly designed prospective studies are needed with adequate number of participants in order to safely conclude about a broader use of pelvic organ-sparing cystectomy.
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Affiliation(s)
| | - Nikolaos Grivas
- Department of Urology, G. Hatzikosta General Hospital, Ioannina, Greece
- Department of Urology, Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Markus Ölschläger
- Department of Urology and Pediatric Urology, University Hospital of Würzburg, Julius Maximillians University, Oberdürrbacher Strasse 6, 97080, Würzburg, Germany
| | - Fahmy Nabil Hassan
- Department of Urology and Pediatric Urology, University Hospital of Würzburg, Julius Maximillians University, Oberdürrbacher Strasse 6, 97080, Würzburg, Germany
| | - Georgios Gakis
- Department of Urology and Pediatric Urology, University Hospital of Würzburg, Julius Maximillians University, Oberdürrbacher Strasse 6, 97080, Würzburg, Germany.
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Urethral Carcinoma. Urol Oncol 2019. [DOI: 10.1007/978-3-319-42623-5_40] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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9
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Gakis G. Urethral Carcinoma. Urol Oncol 2019. [DOI: 10.1007/978-3-319-42603-7_40-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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10
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Zhou X, Ji H, Zhang H, Xiong T, Pan J, Chen Z. Treatment and outcomes of urethral recurrence after orthotopic neobladder replacement in patients with bladder cancer - practice in a single centre. J Int Med Res 2018; 46:3928-3937. [PMID: 29936879 PMCID: PMC6136033 DOI: 10.1177/0300060518782015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Objectives To report on the treatment of urethral recurrence after orthotopic urinary
diversion at our institution. Methods We retrospectively reviewed clinical information of urethral recurrence in
patients who underwent radical cystectomy and orthotopic urinary diversion
between January 1998 and January 2013. Results Of 341 patients, 282 presented for follow-up (median follow-up: 56 months;
range: 1–174 months). Eight patients developed local recurrence of
urothelial cancer after radical cystectomy. The rate of urethral recurrence
(1.4%) in female patients who underwent orthotopic urinary diversion was
lower than in male patients (3.3%). The median (range) time to recurrence
was 33 (6–120) months after radical cystectomy and orthotopic urinary
diversion. Recurrences were treated by transurethral resection of tumour,
urethrectomy, neobladder resection, revision of urinary diversion, adjuvant
chemotherapy, or radiation therapy, based on individual circumstances.
Survival analysis showed that 5-year cancer-specific survival was
significantly higher in patients with urethral recurrence alone (83.3%),
compared with patients with other recurrences, including pelvic/abdomen
recurrence and distant metastasis (26.8%). Conclusions En bloc urethrectomy and revision of urinary diversion remain the principle
surgical choices. Selection of transurethral tumour resection was based on
tumour stage and was used in carefully chosen patients. Cancer-specific
survival might depend on multidisciplinary therapy.
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Affiliation(s)
- Xiaozhou Zhou
- 1 Urology Institute of People's Liberation Army, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Huixiang Ji
- 1 Urology Institute of People's Liberation Army, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Heng Zhang
- 1 Urology Institute of People's Liberation Army, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Tailin Xiong
- 1 Urology Institute of People's Liberation Army, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Jinhong Pan
- 1 Urology Institute of People's Liberation Army, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Zhiwen Chen
- 1 Urology Institute of People's Liberation Army, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China.,2 Southwest Cancer Center, Third Military Medical University (Army Medical University), Chongqing, China
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Urinary diversion in the genitourinary cancer survivor. Gynecol Oncol 2018; 148:414-421. [DOI: 10.1016/j.ygyno.2017.10.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Revised: 10/13/2017] [Accepted: 10/15/2017] [Indexed: 11/19/2022]
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12
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Ha YS, Kim TH. The Surveillance for Muscle-Invasive Bladder Cancer (MIBC). Bladder Cancer 2018. [DOI: 10.1016/b978-0-12-809939-1.00030-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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13
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Hoy NY, Cohn JA, Kowalik CG, Kaufman MR, Stuart Reynolds W, Dmochowski RR. Management of Voiding Dysfunction After Female Neobladder Creation. Curr Urol Rep 2017; 18:33. [PMID: 28283915 DOI: 10.1007/s11934-017-0682-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Functional complications after orthotopic neobladder urinary diversion (ONB), including urinary incontinence and urinary retention, present unique challenges. The purpose of this review is to outline contemporary treatment options for voiding dysfunction after ONB in females. RECENT FINDINGS Meticulous surgical technique in the form of urethral nerve-sparing has been shown to play an important role in maintaining continence, as has sparing the uterus when possible. Data supporting the effectiveness of lifestyle measures, urethral bulking, pubovaginal slings, and transobturator slings in the treatment of urinary incontinence are widely variable and limited to case reports. Urinary retention is still most effectively managed with self-catheterization. Voiding dysfunction after ONB can be devastating. Recent advances focus on improving surgical techniques to decrease the risk of incontinence and retention, as post-operative management options are limited.
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Affiliation(s)
- Nathan Y Hoy
- Division of Urology, University of Alberta, Edmonton, AB, Canada
| | - Joshua A Cohn
- Department of Urologic Surgery, Vanderbilt University Medical Center, 1302A Medical Center North, Nashville, TN, 37232, USA.
| | - Casey G Kowalik
- Department of Urologic Surgery, Vanderbilt University Medical Center, 1302A Medical Center North, Nashville, TN, 37232, USA
| | - Melissa R Kaufman
- Department of Urologic Surgery, Vanderbilt University Medical Center, 1302A Medical Center North, Nashville, TN, 37232, USA
| | - W Stuart Reynolds
- Department of Urologic Surgery, Vanderbilt University Medical Center, 1302A Medical Center North, Nashville, TN, 37232, USA
| | - Roger R Dmochowski
- Department of Urologic Surgery, Vanderbilt University Medical Center, 1302A Medical Center North, Nashville, TN, 37232, USA
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Ladurner C, Comploj E, Trenti E, Palermo S, Pycha A, Pycha A. Radical cystectomy: do we need standardization? Expert Rev Anticancer Ther 2016; 17:101-107. [PMID: 27937057 DOI: 10.1080/14737140.2017.1271326] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
INTRODUCTION The first series of radical cystectomy with a definition of surgical landmarks was published in 1949 and was characterized by a high perioperative mortality and a 5-year survival rate around 50%. Decades later, nevertheless many surgical progresses were made and the perioperative mortality dropped to 2,5%, this had not lead to an improvement of long term survival rates, also because a standardization of the procedure is still missing. Areas covered: Radical cystectomy is performed with different surgical techniques obmitting a standardization. The comparability of many studies is therefore difficult or havely compromised. A paragon with other diciplines was made emphazing that there high surgical quality is defined, measured and controlled. A systematic literature search was made selecting finally 76 article adressing this issue. Expert commentary: Surgical guidelines in uro-oncology are vague and a definition of surgical quality is missing. A view outside of the box could be very helpful. This is a plea for a change.
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Affiliation(s)
| | - Evi Comploj
- a Department of Urology , General Hospital of Bolzano , Bolzano , Italy
| | - Emanuela Trenti
- a Department of Urology , General Hospital of Bolzano , Bolzano , Italy
| | - Salvatore Palermo
- a Department of Urology , General Hospital of Bolzano , Bolzano , Italy
| | - Alexander Pycha
- b Department of Urology , Riga Stradins University , Riga , Latvia
| | - Armin Pycha
- a Department of Urology , General Hospital of Bolzano , Bolzano , Italy.,c Department of Urology , Sigmund Freud University, Medical School , Vienna , Austria
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Gakis G, Black PC, Bochner BH, Boorjian SA, Stenzl A, Thalmann GN, Kassouf W. Systematic Review on the Fate of the Remnant Urothelium after Radical Cystectomy. Eur Urol 2016; 71:545-557. [PMID: 27720534 DOI: 10.1016/j.eururo.2016.09.035] [Citation(s) in RCA: 70] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Accepted: 09/22/2016] [Indexed: 01/08/2023]
Abstract
CONTEXT Urothelial carcinoma is considered a pan-urothelial disease. As such, the remnant urothelium in the upper urinary tract and urethra following radical cystectomy (RC) remains at risk for secondary urothelial tumors (SUTs). OBJECTIVE To describe the incidence, diagnosis, treatment, and outcomes of patients with SUTs after RC. EVIDENCE ACQUISITION A systematic search was conducted using PubMed database according to Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines to identify studies between 1970 and 2016 reporting on malignant diseases of the urothelium after RC for bladder cancer. The search strategy separated between upper and lower tract urothelial tumors. EVIDENCE SYNTHESIS Of a total of 1069 studies, 57 were considered for evidence synthesis. SUTs occured in approximately 4-10% of patients after RC. Carcinoma in situ of the bladder, a history of nonmuscle invasive bladder cancer, and tumor involvement of the distal ureter are the strongest risk factors for secondary upper tract tumors. Risk factors for secondary urethral tumors represent urothelial malignancy in the prostatic urethra/prostate and bladder neck (in women), nonorthotopic diversions, and positive findings on permanent sections. The majority of patients (84%) with SUTs, presented with urothelial recurrence without evidence of metastasis. Of those, 84.0% were treated with surgery, 10.5% with systemic chemotherapy and/or radiotherapy, and 5.6% with topical chemotherapy and/or immunotherapy. After a median follow-up of 91 mo (range: 26-155), 65.9% of patients died of disease and 21.5% died of other causes. Detection and treatment of SUTs at an asymptomatic stage can reduce the risks of cancer-specfific and overall mortality by 30%. A limitation of the study is that the available data were retrospective. CONCLUSIONS SUTs are rare oncological events and most patients have an adverse prognosis despite absence of distant disease at diagnosis. Therefore, surveillance of the remnant urothelium should be implemented for patients with histological features of panurothelial disease as it may improve timely detection and treatment. PATIENT SUMMARY Secondary tumors of the renal pelvis, ureters, and urethra occur in approximately 4-10% of patients after radical removal of the bladder for bladder cancer. These patients' prognoses are reduced, likely due to delayed diagnosis. Therefore, routine surveillance might be important to detect tumors at an early stage.
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Affiliation(s)
- Georgios Gakis
- Department of Urology, Eberhard-Karls University of Tübingen, Germany.
| | - Peter C Black
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Bernard H Bochner
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | - Arnulf Stenzl
- Department of Urology, Eberhard-Karls University of Tübingen, Germany
| | - George N Thalmann
- Department of Urology, Inselspital Bern, University of Bern, Switzerland
| | - Wassim Kassouf
- Division of Urology, McGill University, Montreal, QC, Canada
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Moomjian LN, Carucci LR, Guruli G, Klausner AP. Follow the Stream: Imaging of Urinary Diversions. Radiographics 2016; 36:688-709. [DOI: 10.1148/rg.2016150180] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Pohar KS, Smith ND. Management of the urethra in the cystectomy patient. Bladder Cancer 2015. [DOI: 10.1002/9781118674826.ch16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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20
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Gakis G, Ali-El-Dein B, Babjuk M, Hrbacek J, Macek P, Burkhard FC, Thalmann GN, Shaaban AA, Stenzl A. Urethral recurrence in women with orthotopic bladder substitutes: A multi-institutional study. Urol Oncol 2015; 33:204.e17-23. [DOI: 10.1016/j.urolonc.2015.01.020] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2014] [Revised: 12/26/2014] [Accepted: 01/26/2015] [Indexed: 10/23/2022]
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21
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Schmid M, Rink M, Traumann M, Bastian PJ, Bartsch G, Ellinger J, Grimm MO, Hadaschik B, Haferkamp A, Hakenberg OW, Aziz A, Hartmann F, Herrmann E, Hohenfellner M, Janetschek G, Gierth M, Pahernik SH, Protzel C, Roigas J, Gördük M, Lusuardi L, May M, Trinh QD, Fisch M, Chun FKH. Evidence from the 'PROspective MulticEnTer RadIcal Cystectomy Series 2011 (PROMETRICS 2011)' study: how are preoperative patient characteristics associated with urinary diversion type after radical cystectomy for bladder cancer? Ann Surg Oncol 2014; 22:1032-42. [PMID: 25164037 DOI: 10.1245/s10434-014-4029-3] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2014] [Indexed: 12/17/2022]
Abstract
PURPOSE The aim of this study was to examine preoperative patients' characteristics associated with the urinary diversion (UD) type (continent vs. incontinent) after radical cystectomy (RC) and UD-associated postoperative complications. MATERIALS In 2011, 679 bladder cancer patients underwent RC at 18 European tertiary care centers. Data were prospectively collected within the 'PROspective MulticEnTer RadIcal Cystectomy Series 2011' (PROMETRICS 2011). Logistic regression models assessed the impact of preoperative characteristics on UD type and evaluated diversion-related complication rates. RESULTS Of 570 eligible patients, 28.8, 2.6, 59.3, and 9.3% received orthotopic neobladders, continent cutaneous pouches, ileal conduits, and ureterocutaneostomies, respectively. In multivariable analyses, female sex (odds ratio [OR] 3.9; p = 0.002), American Society of Anesthesiologists score ≥3 (OR 2.3; p = 0.02), an age-adjusted Charlson Comorbidity Index ≥3 (OR 4.1; p < 0.001), and a positive biopsy of the prostatic urethra in the last transurethral resection of the bladder prior to RC (OR 4.9; p = 0.03) were independently associated with incontinent UD. There were no significant differences in 30- and/or 90-day complication rates between the UD types. Perioperative transfusion rates and 90-day mortality were significantly associated with incontinent UD (p < 0.001, respectively). Limitations included the small sample size and a certain level of heterogeneity in the application of clinical pathways between the different participating centers. CONCLUSIONS Within this prospective contemporary cohort of European RC patients treated at tertiary care centers, the majority of patients received an incontinent UD. Female sex and pre-existing comorbidities were associated with receiving an incontinent UD. The risk of overall complications did not vary according to UD type.
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Affiliation(s)
- Marianne Schmid
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany,
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Hrbáček J, Macek P, Ali-El-Dein B, Thalmann GN, Stenzl A, Babjuk M, Shaaban AA, Gakis G. Treatment and Outcomes of Urethral Recurrence of Urinary Bladder Cancer in Women after Radical Cystectomy and Orthotopic Neobladder: A Series of 12 Cases. Urol Int 2014; 94:45-9. [DOI: 10.1159/000363112] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2013] [Accepted: 04/23/2014] [Indexed: 11/19/2022]
Abstract
Introduction: The incidence, treatment, and outcome of urethral recurrence (UR) after radical cystectomy (RC) for muscle-invasive bladder cancer with orthotopic neobladder in women have rarely been addressed in the literature. Patients and Methods: A total of 12 patients (median age at recurrence: 60 years) who experienced UR after RC with an orthotopic neobladder were selected for this study from a cohort of 456 women from participating institutions. The primary clinical and pathological characteristics at RC, including the manifestation of the UR and its treatment and outcome, were reviewed. Results: The primary bladder tumors in the 12 patients were urothelial carcinoma in 8 patients, squamous cell carcinoma and adenocarcinoma in 1 patient each, and mixed histology in 2 patients. Three patients (25%) had lymph node-positive disease at RC. The median time from RC to the detection of UR was 8 months (range 4-55). Eight recurrences manifested with clinical symptoms and 4 were detected during follow-up or during a diagnostic work-up for clinical symptoms caused by distant metastases. Treatment modalities were surgery, chemotherapy, radiotherapy, and bacillus Calmette-Guérin urethral instillations. Nine patients died of cancer. The median survival after the diagnosis of UR was 6 months. Conclusions: UR after RC with an orthotopic neobladder in females is rare. Solitary, noninvasive recurrences have a favorable prognosis when detected early. Invasive recurrences are often associated with local and distant metastases and have a poor prognosis.
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Rouanne M, Legrand G, Neuzillet Y, Ghoneim T, Cour F, Letang N, Yonneau L, Hervé JM, Botto H, Lebret T. Long-Term Women-Reported Quality of Life After Radical Cystectomy and Orthotopic Ileal Neobladder Reconstruction. Ann Surg Oncol 2014; 21:1398-404. [DOI: 10.1245/s10434-013-3458-8] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2013] [Indexed: 01/08/2023]
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A feasibility study of peritoneum preservation in radical cystectomy with extraperitonealization of orthotopic neobladder for invasive high-grade bladder cancer: a preliminary analysis. Int Urol Nephrol 2013; 46:1107-13. [PMID: 24356919 DOI: 10.1007/s11255-013-0632-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2013] [Accepted: 12/11/2013] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To describe a technique for radical cystectomy with extraperitonealization of orthotopic neobladder (RCEN) that reduces bowel-related complications by preservation of the peritoneum. MATERIALS AND METHODS Fifteen patients with non-metastatic bladder cancer underwent RCEN by a peritoneum preserving technique. The study included 13 patients with T1 high-grade bladder cancer and 2 with T2a bladder cancer. To compare perioperative outcomes including bowel-related complications, we also reviewed 15 patients who underwent traditional cystectomy with ileal Studer neobladder who were matched for age, sex, body mass index, American Society of Anesthesiologists (ASA) score, tumor stage, tumor grade, tumor size, and location. Female genital organs were preserved in five female patients who underwent the RCEN technique. RESULTS There was no significant difference between the two cohorts (RECN vs. traditional technique) with respect to age, body mass index, ASA score, or tumor characteristics. The mean operative time was similar between the two groups. The patients who underwent RECN exhibited earlier recovery of normal gas pattern on plain abdominal X-ray during the postoperative period and an earlier resumption of normal diet. The mean hospital stay was shorter in the RECN group than the traditional group. CONCLUSIONS The RECN technique preserving the whole peritoneum is a feasible approach that significantly reduces bowel-related complications in selected patients.
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Gakis G, Efstathiou J, Lerner SP, Cookson MS, Keegan KA, Guru KA, Shipley WU, Heidenreich A, Schoenberg MP, Sagaloswky AI, Soloway MS, Stenzl A. ICUD-EAU International Consultation on Bladder Cancer 2012: Radical cystectomy and bladder preservation for muscle-invasive urothelial carcinoma of the bladder. Eur Urol 2012; 63:45-57. [PMID: 22917985 DOI: 10.1016/j.eururo.2012.08.009] [Citation(s) in RCA: 293] [Impact Index Per Article: 24.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2012] [Accepted: 08/06/2012] [Indexed: 11/16/2022]
Abstract
CONTEXT New guidelines of the International Consultation on Urological Diseases for the treatment of muscle-invasive bladder cancer (MIBC) have recently been published. OBJECTIVE To provide a comprehensive overview of the current role of radical cystectomy (RC) in MIBC. EVIDENCE ACQUISITION A detailed Medline analysis was performed for original articles addressing the role of RC with regard to indication, timing, surgical extent, perioperative morbidity, oncologic outcome, and follow-up. The analysis also included radiation-based bladder-preserving strategies. EVIDENCE SYNTHESIS The major findings are presented in an evidence-based fashion and are based on large retrospective unicenter and multicenter series with some prospective data. CONCLUSIONS Open RC is the standard treatment for locoregional control of MIBC. Delay of RC is associated with reduced cancer-specific survival. In males, standard RC includes the removal of the bladder, prostate, seminal vesicles, and distal ureters; in females, RC includes an anterior pelvic exenteration including the bladder, entire urethra and adjacent vagina, uterus, and distal ureters. A procedure sparing the urethra and the urethra-supplying autonomous nerves can be performed in case of a planned orthotopic neobladder. Further technical variations (ie, seminal-sparing or vaginal-sparing techniques) aimed at improving functional outcomes must be weighed against the risk of a positive margin. Laparoscopic surgery is promising, but long-term data are required prior to accepting it as an option equivalent to the open procedure. Lymphadenectomy should remove all lymphatic tissue around the common iliac, external iliac, internal iliac, and obturator region bilaterally. Complications after RC should be reported according to the modified Clavien grading system. In selected patients with MIBC, bladder-preserving therapy with cystectomy reserved for tumor recurrence represents a safe and effective alternative to immediate RC.
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Affiliation(s)
- Georgios Gakis
- Department of Urology, University Hospital Tuebingen, Germany.
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Anderson CB, Cookson MS, Chang SS, Clark PE, Smith JA, Kaufman MR. Voiding Function in Women with Orthotopic Neobladder Urinary Diversion. J Urol 2012; 188:200-4. [DOI: 10.1016/j.juro.2012.03.004] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2011] [Indexed: 10/28/2022]
Affiliation(s)
| | - Michael S. Cookson
- Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Sam S. Chang
- Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Peter E. Clark
- Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Joseph A. Smith
- Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Melissa R. Kaufman
- Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
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Hindson BR, Turner SL, Millar JL, Foroudi F, Gogna NK, Skala M, Kneebone A, Christie DRH, Lehman M, Wiltshire KL, Tai KH. Australian & New Zealand Faculty of Radiation Oncology Genito-Urinary Group: 2011 consensus guidelines for curative radiotherapy for urothelial carcinoma of the bladder. J Med Imaging Radiat Oncol 2012; 56:18-30. [PMID: 22339742 DOI: 10.1111/j.1754-9485.2011.02336.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Curative radiotherapy, with or without concurrent chemotherapy, is recognized as a standard treatment option for muscle-invasive bladder cancer. It is commonly used for two distinct groups of patients: either for those medically unfit for surgery, or as part of a 'bladder preserving' management plan incorporating the possibility of salvage cystectomy. However, in both situations, the approach to radiotherapy varies widely around the world. The Australian and New Zealand Faculty of Radiation Oncology Genito-Urinary Group recognised a need to develop consistent, evidence-based guidelines for patient selection and radiotherapy technique in the delivery of curative radiotherapy. Following a workshop convened in May 2009, a working party collated opinions and conducted a wide literature appraisal linking each recommendation with the best available evidence. This process was subject to ongoing re-presentation to the Faculty of Radiation Oncology Genito-Urinary Group members prior to final endorsement. These Guidelines include patient selection, radiation target delineation, dose and fractionation schedules, normal tissue constraints and investigational techniques. Particular emphasis is given to the rationale for the target volumes described. These Guidelines provide a consensus-based framework for the delivery of curative radiotherapy for muscle-invasive bladder cancer. Widespread input from radiation oncologists treating bladder cancer ensures that these techniques are feasible in practice. We recommend these Guidelines be adopted widely in order to encourage a uniformly high standard of radiotherapy in this setting, and to allow for better comparison of outcomes.
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Affiliation(s)
- Benjamin R Hindson
- William Buckland Radiation Oncology, Alfred Health, Melbourne, Victoria, Australia.
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Jentzmik F, Schrader AJ, de Petriconi R, Hefty R, Mueller J, Doetterl J, Eickhoff A, Schrader M. The ileal neobladder in female patients with bladder cancer: long-term clinical, functional, and oncological outcome. World J Urol 2012; 30:733-9. [DOI: 10.1007/s00345-012-0837-x] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2011] [Accepted: 01/30/2012] [Indexed: 10/14/2022] Open
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Kübler H, Gschwend JE. Ileal neobladder in women with bladder cancer: cancer control and functional aspects. Curr Opin Urol 2012; 21:478-82. [PMID: 21897260 DOI: 10.1097/mou.0b013e32834b31c4] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
PURPOSE OF REVIEW Radical cystectomy and urinary diversion is the accepted standard of care for invasive bladder cancer. Although orthotopic neobladder is the preferred method of urinary diversion in men, less experience is available for women. Recent studies and reports on this subject are summarized and reviewed. RECENT FINDINGS Urethra-sparing cystectomy in women and orthotopic urinary diversion can be performed safely in appropriately selected women with invasive bladder cancer. Excellent oncological outcomes can be expected with a minimal risk of urethral recurrence in case of negative frozen section of the proximal urethra. Orthotopic neobladder diversion offers excellent clinical and functional results, and should be the diversion of choice in most women following cystectomy. Female sexual dysfunction can be avoided in patients who received neurovascular preservation, although quality of life declined in women who had undergone non-nerve-sparing radical cystectomy. SUMMARY Urethra-sparing cystectomy does not compromise the oncologic outcome in women with bladder cancer. The excellent functional outcome and voiding pattern with orthotopic urinary diversion argues in favor of this technique as the preferred method for lower urinary tract reconstruction after radical cystectomy. Nerve-sparing radical cystectomy preserves female sexual function and improves quality of life.
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Affiliation(s)
- Hubert Kübler
- Department of Urology, Technische Universität München, Munich, Germany
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Orthotopic bladder substitution following radical cystectomy in women: Comparative study between sigmoid and ileal neobladders. Urol Oncol 2012; 30:38-43. [DOI: 10.1016/j.urolonc.2009.11.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2009] [Revised: 10/18/2009] [Accepted: 11/04/2009] [Indexed: 11/21/2022]
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Daneshmand S, Bartsch G. Improving selection of appropriate urinary diversion following radical cystectomy for bladder cancer. Expert Rev Anticancer Ther 2011; 11:941-8. [PMID: 21707291 DOI: 10.1586/era.11.19] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Radical cystectomy represents the gold-standard of treatment for invasive bladder cancer. Following cystectomy, various options for urinary diversion may be offered to patients. This article represents an overview of the history of urinary diversion, explains the current selection criteria used at one of the most experienced bladder cancer centers worldwide, and provides an update on the current understanding of continence mechanisms. Furthermore, we review the current literature on quality of life for patients with different forms of urinary diversion. Excellent functional results can be achieved with continent forms of urinary diversion. It is important to consider the relative and absolute contraindications when choosing any form of urinary diversion. Proper patient selection and thorough standardized preoperative counseling is critical in achieving optimal results.
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Affiliation(s)
- Siamak Daneshmand
- Norris Comprehensive Cancer Center, USC Institute of Urology, 1441 Eastlake Ave, Suite 7416, CA 90089, USA.
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Cagiannos I, Morash C. Surveillance strategies after definitive therapy of invasive bladder cancer. Can Urol Assoc J 2011; 3:S237-42. [PMID: 20019993 DOI: 10.5489/cuaj.1205] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Following definitive therapy for muscle invasive bladder cancer, patients remain at risk for local and distant recurrence. Additionally, recurrences can result from formation of new tumours elsewhere in the urinary tract. We review patterns of recurrence and the prognosis associated with recurrence. Optimal surveillance strategies are discussed.
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Yang G, Whitson JM, Breyer BN, Konety BR, Carroll PR. Oncological and functional outcomes of radical cystectomy and orthotopic bladder replacement in women. Urology 2011; 77:878-83. [PMID: 21215428 DOI: 10.1016/j.urology.2010.08.065] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2010] [Revised: 08/08/2010] [Accepted: 08/21/2010] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To report oncological and functional results in women undergoing radical cystectomy and orthotopic bladder replacement. MATERIALS AND METHODS The charts of all women undergoing bladder replacement after radical cystectomy at UCSF through April 2008 were reviewed. Pathologic characteristics, survival (overall and disease-specific), and urinary functional outcomes are reported. Survival was estimated using Kaplan-Meier methods, and Cox proportional hazards regression analyses were performed to determine factors associated with incontinence, retention, and mortality. RESULTS Fifty-six women with a mean follow-up of 35 months were analyzed. The cancer recurrence rate was 32%. Kaplan-Meier estimated 5-year recurrence-free, cancer-specific, and overall survival were 54%, 57%, and 47%, respectively. Pathologic lymph node status (HR 14.2, P <.001) and age at diagnosis (HR 1.7, P = .04) were the only clinical or pathologic characteristics significantly associated with survival. The overall continence rate (no pads) was 57%. Hypercontinence occurred in 24% of patients. CONCLUSIONS With careful patient selection and usage of urethral frozen section, rates of local recurrence are low. Overall rates of incontinence (43%) and hypercontinence (24%) are similar to those previously reported. When pathologically organ-confined, women have an excellent disease-specific survival. Orthotopic bladder replacement is a safe and effective form of urinary diversion after radical cystectomy in women.
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Affiliation(s)
- Glen Yang
- Department of Urology, UCSF, Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco, CA 94143, USA.
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Follow-up of patients after curative bladder cancer treatment: guidelines vs. practice. Curr Opin Urol 2010; 20:437-42. [DOI: 10.1097/mou.0b013e32833cf10e] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Lawrentschuk N, Colombo R, Hakenberg OW, Lerner SP, Månsson W, Sagalowsky A, Wirth MP. Prevention and Management of Complications Following Radical Cystectomy for Bladder Cancer. Eur Urol 2010; 57:983-1001. [DOI: 10.1016/j.eururo.2010.02.024] [Citation(s) in RCA: 160] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2009] [Accepted: 02/17/2010] [Indexed: 01/11/2023]
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Abstract
This article provides a review of bladder cancer etiology, diagnosis, and management for WOC nurses. Bladder cancer incidence continues to rise yearly in the United States, and patients with bladder cancer comprise some of the most challenging cases in urologic oncology. Nurses are involved with all aspects of the processes of care for the patient with bladder cancer, from initial diagnosis and treatment to postsurgical care and follow-up. For nonmuscle invasive bladder cancer, treatment includes transurethral resection followed by intravesical chemotherapy or immunotherapy to prevent recurrence or progression. Radical cystectomy along with chemotherapy protocols provides a survival advantage for muscle invasive bladder cancer, although the timing of chemotherapy remains controversial. Numerous factors are considered when determining the type of urinary diversion used at the time of radical cystectomy, but patient, family, surgeon, and nursing input are essential for preserving an optimal health-related quality of life and reducing morbidity. Patients with metastatic bladder cancer are generally treated with a cisplatin-based chemotherapy but continue to have a poor prognosis. Newer therapies involving novel molecular-targeted agents provide hope for the future for patients with metastatic disease.
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Liu D, Feng F, Shen Z, Xia W, Zhou W, Wang M, Zhu Y, Wang J, Tang Q. Clinical experience in a modified Roux-Y-shaped sigmoid neobladder: assessment of complications and voiding patterns in 43 patients. BJU Int 2009; 105:533-8. [PMID: 19747352 DOI: 10.1111/j.1464-410x.2009.08773.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To evaluate the complications and urinary voiding patterns in patients with a new Roux-Y-shaped continent neobladder, using a modified sigmoid pouch. PATIENTS AND METHODS Between June 2003 and July 2008, 43 patients (26 men and 17 women, mean age 69.5 years) underwent a modified Roux-Y-shaped sigmoid continent neobladder reconstruction after radical cystectomy. The surgical procedures involved the construction of a Roux-Y-shaped sigmoid pouch, making an antifeces-refluxing valve into the sigmoid urine reservoir and ureterosigmoidostomy using the Leadbetter method. This pouch method has not been described before. The patients' clinical, biochemical, radiological and urodynamic variables were assessed. RESULTS During the mean (range) follow-up of 24 (6-65) months, there were no deaths related to the procedure. In 16% of the patients, early complications occurred, whereas 12% had late complications. There were no cases with local recurrence and metastasis. Routine electrolyte evaluation revealed a slight metabolic acidosis in six patients (14%). Hypovitaminosis B(12) did not occur in any patients. All patients were continent in the daytime and night-time continence was poor in eight patients (19%). The mean (sd, range) neobladder capacity and residual urine volume was 330 (110, 120-410) mL and 48 (26, 25-80) mL, respectively. Moreover, the maximum urinary flow rate was 9.2-25.3 mL/s. CONCLUSION The modified Roux-Y-shaped sigmoid neobladder replacement provides a new simple surgical procedure with low complication rates. The procedure offers comparatively satisfactory daytime continence with low postvoid residual urine volumes and voiding patterns. This technique is a valid alternative to continent urinary diversion.
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Affiliation(s)
- DingYi Liu
- Department of Urology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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40
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Stein JP, Penson DF, Lee C, Cai J, Miranda G, Skinner DG. Long-Term Oncological Outcomes in Women Undergoing Radical Cystectomy and Orthotopic Diversion for Bladder Cancer. J Urol 2009; 181:2052-8; discussion 2058-9. [DOI: 10.1016/j.juro.2009.01.020] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2008] [Indexed: 10/21/2022]
Affiliation(s)
- John P. Stein
- Departments of Urology and Preventive Medicine, Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, California
| | - David F. Penson
- Departments of Urology and Preventive Medicine, Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, California
| | - Charlotte Lee
- Departments of Urology and Preventive Medicine, Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, California
| | - Jie Cai
- Departments of Urology and Preventive Medicine, Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, California
| | - Gus Miranda
- Departments of Urology and Preventive Medicine, Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, California
| | - Donald G. Skinner
- Departments of Urology and Preventive Medicine, Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, California
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41
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Wang J, Xing N, Zhang X, Yan Y, Zhang J, Li X, Zhang W, Guan D. Orthotopic ileal neobladder reconstruction in patients with recurring bladder cancer after renal transplantation--a report of two cases and a review of the literature. Clin Transplant 2009; 23:700-4. [PMID: 19486344 DOI: 10.1111/j.1399-0012.2009.00988.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Renal transplant recipients have a high risk of developing multiple and invasive urothelial tumors because of long-term immunosuppression and infections with oncogenic viruses in China. However, treatment of renal transplant recipients who developed invasive bladder tumor is challenging. We aimed to evaluate the efficacy and safety of orthotopic ileal neobladder reconstruction following radical cystectomy in renal transplant recipients. Orthotopic ileal neobladder reconstruction and preservation of the transplanted kidney were performed in two patients after one and 36 months of transplantation, respectively. One recipient was lacking a bladder because of prior cystectomy before the transplantation, and the other developed multiple and invasive bladder cancer after the transplantation. During the 14-month and seven-yr follow-up postoperation, no serious complications occurred except slight hydronephrosis in one patient. No rejection and graft dysfunction occurred in both patients with reduced dosage of immunosuppressants, and serum creatinine as a marker of renal function remained stable. Urinary continence was satisfactory during the day and night with voluntary voiding. Our experience showed that radical cystectomy and orthotopic ileal neobladder reconstruction in transplant patients with stable renal function is a safe and effective way to provide better quality of life, satisfactory urinary diversion and preservation of renal function simultaneously.
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Affiliation(s)
- Jianwen Wang
- The Division of Urology, Beijing Organ Transplantation Center, Beijing ChaoYang Hospital, Capital University of Medical Sciences, Beijing, China
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42
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Tracey E, Roder D, Luke C, Bishop J. Bladder cancer survivals in New South Wales, Australia: why do women have poorer survival than men? BJU Int 2009; 104:498-504. [PMID: 19338538 DOI: 10.1111/j.1464-410x.2009.08527.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To investigate factors that most influenced survival from bladder cancer in New South Wales, Australia (NSW) and to consider the impact of changes in coding practices on the reporting the of bladder cancer outcomes. PATIENTS AND METHODS All NSW cases of bladder cancer diagnosed between 1980 and 2003 were followed to the end of 2004 (17 923 cases). Survival analysis was undertaken using Kaplan-Meier unadjusted disease-specific survival and adjusted disease-specific survival using Cox proportional hazards regression modelling. This analysis was unique in that it modelled the effect of sex, age, country of birth, socio-economic status (SES), histological type, extent of disease and period of diagnosis on survival from bladder cancer in NSW. RESULTS After adjusting for sex, age, extent of disease, SES, period of diagnosis and histological type, the likelihood of death was 11% (95% confidence interval, CI 5-18%) higher in females than in males, with case fatality most influenced by age at diagnosis, extent of disease, and histological type. When the analysis was repeated for cases with a method 6 (i.e. coding undertaken in the registry after examination of the pathology report, which would enhance accuracy), the likelihood of death was 13% (95% CI 5-21%) higher in females than in males. CONCLUSIONS The NSW analysis controls for variability in coding, extent of disease at diagnosis and histological type of cancer. The analysis shows significantly lower survival from bladder cancer in NSW women compared with men, with no improvement in survival from 1980 to 2003. Possible reasons for the lower survivals in women, the lack of improvement in survival and coding differences in jurisdictions are discussed.
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Affiliation(s)
- Elizabeth Tracey
- The Cancer Institute New South Wales, Alexandria, NSW, Australia.
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43
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Granberg CF, Boorjian SA, Crispen PL, Tollefson MK, Farmer SA, Frank I, Blute ML. Functional and oncological outcomes after orthotopic neobladder reconstruction in women. BJU Int 2008; 102:1551-5. [DOI: 10.1111/j.1464-410x.2008.07909.x] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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44
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45
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Kulkarni JN, Rizvi SJ, Acharya UP, Kumar KSS, Tiwari P. Gynecologic-tract sparing extra peritoneal retrograde radical cystectomy with neobladder. Int Braz J Urol 2008; 34:180-7; discussion 187-90. [DOI: 10.1590/s1677-55382008000200008] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/18/2008] [Indexed: 11/21/2022] Open
Affiliation(s)
| | | | | | | | - P. Tiwari
- Bombay Hospital Institute of Medical Sciences, India
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46
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Stein JP, Hertz J, Nichols PW. Urethral recurrence in a woman after continent orthotopic urinary diversion for bladder cancer. Urology 2008; 71:755.e1-2. [PMID: 18280556 DOI: 10.1016/j.urology.2007.11.068] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2007] [Revised: 10/21/2007] [Accepted: 11/14/2007] [Indexed: 11/26/2022]
Abstract
We describe a 55-year-old woman with a urethral recurrence of transitional cell carcinoma of her bladder 4 years after she underwent radical cystectomy with negative margins and no evidence of invasion of the bladder neck, anterior vaginal wall, or proximal urethra. This was the first urethral recurrence in an appropriately selected female patient at our institution. This report emphasizes the need for long-term follow-up in patients after radical cystectomy and the need for guidelines for appropriate selection of female patients for continent orthotopic urinary diversion.
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Affiliation(s)
- John P Stein
- Department of Urology, University of Southern California Keck School of Medicine and Norris Comprehensive Cancer Center, Los Angeles, California 90089, USA.
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47
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Hohenfellner M. [Perspectives in urinary diversion]. Urologe A 2007; 47:41-2, 44-5. [PMID: 18084738 DOI: 10.1007/s00120-007-1604-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
"Perspectives in Urinary Diversion" was the title of a presentation held during the opening session of the 56th annual meeting of the German Urological Association in Hamburg on September 21, 2006. It focused on the balance between obstruction and reflux of ureters implanted in diverted intestinal segments, the choice of intestinal segments for orthotopic pouches, orthotopic diversion in the female, the status of rectal diversions, and alternatives to the use of intestinal segments.
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Affiliation(s)
- M Hohenfellner
- Urologische Universitätsklinik, Heidelberg, Deutschland.
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