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Diabetes Is a Risk Factor for the Prognosis of Patients with Bladder Cancer: A Meta-Analysis. JOURNAL OF ONCOLOGY 2022; 2022:1997507. [PMID: 36199796 PMCID: PMC9529383 DOI: 10.1155/2022/1997507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 08/17/2022] [Indexed: 11/29/2022]
Abstract
Objective To systematically evaluate the impact of diabetes on the prognosis of bladder cancer patients after radical cystectomy (RC). Methods PubMed, Embase, and Cochrane Library databases were selected from inception to October 2021. The studies on the effects of diabetes on bladder cancer patients after RC were included for analysis. The inclusion and exclusion criteria were independently selected for literature screening, the quality of the included studies was evaluated, and data were extracted. Results A total of 5 cohort studies were included, with a total of 2 661 subjects, including 391 cases in the diabetic group, non-diabetes. Meta-analysis results show that diabetes increases the overall risk of death in patients after RC (HR = 1.36, 95% CI: 1.30 ∼ 1.43, P < 0.001) and the risk of tumor-specific death (HR = 1.59, 95% CI: 1.29 ∼ 1.95, P < 0.001). Sensitivity analysis shows that the stability of this study is well. Conclusion Diabetes was an independent risk factor in terms of overall and cancer-specific survival in patients who underwent RC.
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Kava BR, Lopategui DM, Levine A, Ramasamy R. Trans-Fascial Placement of a High, Sub Muscular Reservoir in Patients Following Radical Cystectomy: Safety, Efficacy, and Predictability of Final Reservoir Location Verified With Abdominal Imaging. J Sex Med 2020; 16:338-345. [PMID: 30770075 DOI: 10.1016/j.jsxm.2018.12.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2018] [Revised: 12/09/2018] [Accepted: 12/20/2018] [Indexed: 01/16/2023]
Abstract
INTRODUCTION With the increasing utilization of ectopic reservoir placement during multicomponent penile implant surgery, safety concerns have been raised about whether passing the reservoir through the floor of the inguinal canal consistently results in placement of the reservoir within the correct location. AIM To evaluate the safety, efficacy, and patient satisfaction associated with direct-vision, trans-fascial sub muscular reservoir placement in consecutive patients who had previously undergone radical cystectomy. METHODS Perioperative data, complications, and follow up for the 12 cystectomy patients were evaluated using a comprehensive database of consecutive patients undergoing penile prosthesis placement at our center. Efficacy and patient satisfaction were based upon responses to the Erectile Function and Satisfaction Domains of the International Index of Erectile Function (IIEF). Taking advantage of the need for post cystectomy imaging in monitoring for cancer recurrence, we reviewed post- implant imaging with the purpose of ascertaining the final reservoir location. MAIN OUTCOME MEASURE Using intraoperative photographs, we describe the technique of trans-fascial sub muscular reservoir placement. Perioperative complications, device efficacy and satisfaction, and the accuracy of reservoir placement are also evaluated. RESULTS Average patient age was 65 ± 7 years old and the mean time between cystectomy and implant placement was 41 ± 29 months. With a mean follow up of 26 ± 21 months, complications included: 1 reservoir herniation and 1 high riding pump requiring repositioning. Mean IIEF-EF domain was 29.8 ± 0.5 and mean IIEF-satisfaction domain was 17.7 ± 4.5. Other than the herniated reservoir, imaging confirmed accurate reservoir placement in 8 of 9 cases. In 3 patients a small cephalad portion of the reservoir extends posteriorly into the peritoneal or preperitoneal space, with no clinical consequences. CLINICAL IMPLICATIONS Ectopic reservoir placement using a trans-fascial submuscular approach seems to be a safe method for multicomponent penile implant surgery in patients who have undergone radical cystectomy. Post-implant imaging confirms that the device is consistently placed in the correct sub muscular location. STRENGTHS & LIMITATIONS This is a novel approach to performing the procedure and a practical manner to ascertain the reservoir position. The limited number of patients prevents generalization of our findings. CONCLUSION Trans-fascial, sub muscular reservoir placement is a safe means of ectopically placing the reservoir of a multicomponent penile implant following radical cystectomy. Post implant IIEF scores indicate high device efficacy and patient satisfaction. Post implant imaging confirms that the reservoir is almost always in the desired location. Kava BR, Lopatagui DM, Levine A, et al. Trans-Fascial Placement of a High, Sub Muscular Reservoir in Patients Following Radical Cystectomy: Safety, Efficacy, and Predictability of Final Reservoir Location Verified With Abdominal Imaging. J Sex Med 2019;16:338-345.
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Affiliation(s)
- Bruce R Kava
- Department of Urology, University of Miami Miller School of Medicine, Miami, FL, USA.
| | - Diana M Lopategui
- Department of Urology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Amanda Levine
- Department of Urology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Ranjith Ramasamy
- Department of Urology, University of Miami Miller School of Medicine, Miami, FL, USA
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Gadzinski AJ, Psutka SP. Risk stratification metrics for bladder cancer: Comprehensive Geriatric Assessments. Urol Oncol 2020; 38:725-733. [PMID: 32037198 DOI: 10.1016/j.urolonc.2020.01.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2019] [Revised: 12/27/2019] [Accepted: 01/08/2020] [Indexed: 12/26/2022]
Abstract
Despite advances in surgical technique and perioperative care pathways, complication rates following radical cystectomy for bladder cancer remain high and perioperative outcomes for elderly patients are suboptimal. Furthermore, subjective risk assessments of patients with bladder cancer, with a high prevalence of complex comorbidity burden and risk of frailty, may result in undertreatment of patients assumed to be poor operative candidates. A critical component of preoperative patient counseling and treatment selection is accurate and objective preoperative risk appraisal. Comprehensive Geriatric Assessments are multi-domain evaluations of the medical, functional, and psychosocial aspects of health designed specifically for use in elderly patients with the objective of identifying vulnerabilities that may be targeted with interventions for improvement. While currently recommended by multiple guideline bodies for use in the preoperative evaluation of elderly patients with bladder cancer there is a paucity of data describing their use in contemporary clinical practice. Herein, then, we will describe the components of a Comprehensive Geriatric Assessments and propose strategies for their integration into the preoperative surgical workflow.
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Affiliation(s)
| | - Sarah P Psutka
- Department of Urology, University of Washington, Seattle, WA.
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Dombrowski M, May M, Spachmann PJ, Ganesh Kumar M, Fritsche HM, Brookman-May S, Maurer O, Burger M, Gilfrich C. Influence of Gender and Age on the Willingness to Reduce Nicotine Consumption-Results of a Survey in Urological Cancer Patients (KRAUT Study). Clin Genitourin Cancer 2018; 16:e1181-e1187. [PMID: 30224329 DOI: 10.1016/j.clgc.2018.07.031] [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] [Received: 03/25/2018] [Revised: 07/26/2018] [Accepted: 07/29/2018] [Indexed: 11/17/2022]
Abstract
PURPOSE Our objective was to investigate whether patients with urologic tumors were aware of smoking as a risk factor for the development and progression of several urologic cancers and the extent of the medical education they had received. Another aim was to investigate whether gender or age influenced patients' willingness to change their smoking habits. MATERIALS AND METHODS Patients with histologically malignant urologic tumors were enrolled in our questionnaire-based study from September 2013 to December 2014 in 2 urology departments. Patients were asked about their smoking habits and their general understanding of the relationship between smoking and the onset of cancer (urologic cancer and lung cancer). Also, the extent of information they had acquired from a physician was assessed. The descriptive and oncologic data of the patients were recorded. RESULTS Of 258 enrolled patients, 186 (72.1%) had never had an informational discussion with a doctor about smoking and their urologic tumor disease. Of the 160 active and former smokers, only 45 (28.1%) were planning to stop or reduce smoking because of their tumor disease. The willingness to change smoking habits was greater for women, with a statistically significant difference (odds ratio, 5.59; P = .002). Younger patients aged <58 years were also more willing to reduce or stop smoking. CONCLUSION In our study, most patients with urologic cancer were unaware of smoking as the most probable cause of tumor development. The patients had not received proper counseling from doctors on smoking and the risk it poses for tumor progression. Efforts to balance compliance among the genders and age groups through risk-adapted counseling should be undertaken.
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Affiliation(s)
- Mirja Dombrowski
- Department of Urology, Caritas St Josef Medical Center, University of Regensburg, Regensburg, Germany; Department of Cardiology, Barmherzige Brüder Hospital Regensburg, Regensburg, Germany.
| | - Matthias May
- Department of Urology, St Elisabeth Hospital Straubing, Straubing, Germany
| | - Philipp Julian Spachmann
- Department of Urology, Caritas St Josef Medical Center, University of Regensburg, Regensburg, Germany
| | - Manju Ganesh Kumar
- Department of Urology, Caritas St Josef Medical Center, University of Regensburg, Regensburg, Germany
| | - Hans-Martin Fritsche
- Department of Urology, Caritas St Josef Medical Center, University of Regensburg, Regensburg, Germany; Department of Urology, Surgical Clinic Munich-Bogenhausen, Munich, Germany
| | - Sabine Brookman-May
- Department of Urology, Ludwig-Maximilians-University, Campus Grosshadern, Munich, Germany; Janssen Pharma Research and Development, Los Angeles, CA
| | - Odilo Maurer
- Department of Urology, St Elisabeth Hospital Straubing, Straubing, Germany
| | - Maximilian Burger
- Department of Urology, Caritas St Josef Medical Center, University of Regensburg, Regensburg, Germany
| | - Christian Gilfrich
- Department of Urology, St Elisabeth Hospital Straubing, Straubing, Germany
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Staging the Host: Personalizing Risk Assessment for Radical Cystectomy Patients. Eur Urol Oncol 2018; 1:292-304. [DOI: 10.1016/j.euo.2018.05.010] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2018] [Revised: 05/12/2018] [Accepted: 05/22/2018] [Indexed: 12/26/2022]
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Williams SB, Kamat AM, Chamie K, Froehner M, Wirth MP, Wiklund PN, Black PC, Steinberg GD, Boorjian SA, Daneshmand S, Goebell PJ, Pohar KS, Shariat SF, Thalmann GN. Systematic Review of Comorbidity and Competing-risks Assessments for Bladder Cancer Patients. Eur Urol Oncol 2018; 1:91-100. [PMID: 30345422 DOI: 10.1016/j.euo.2018.03.005] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Context Radical cystectomy continues to be associated with a significant risk of morbidity and all-cause mortality (ACM). Practice pattern data demonstrating underuse of surgery for patients with muscle-invasive and high-risk non-muscle invasive bladder cancer (BC) have been linked to the advanced age and higher comorbidity status of such patients, which suggests that rates of ACM as well as cancer-specific mortality should be incorporated into patient counseling and guideline recommendations. Objective To review the literature on risk assessment tools for preoperative comorbidity in BC that may aid in treatment decision-making. Evidence acquisition A systematic search was conducted using Ovid and Medline according to Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines to identify studies between 1970 and 2017 reporting on comorbidity risk assessment (CRA) tools for BC. Prospective and retrospective studies were included. Evidence synthesis There are no published randomized control trials comparing CRA tools for BC. Patients undergoing radical cystectomy with combined high-risk comorbidity and performance scores may face up to a sevenfold greater risk of other-cause mortality compared to those with low scores. The Charlson Comorbidity Index is one of the most widely studied indices for 90-d perioperative mortality and overall and cancer-specific survival, with an area under the receiver operating characteristic curve of up to 0.810. Prospective studies of CRA tools for BC have consistently shown that patients with higher comorbidity have worse outcomes. While not specific for BC, comorbidity indices provide useful assessment of competing risks. Competing-risks assessment tools are lacking, with limited studies assessing the impact of these tools on treatment decision-making by patients and providers. We provide the impetus for incorporation of comorbidity risks into practice guidelines when discussing treatment options with patients. Conclusions CRA tools should be incorporated into preoperative treatment counseling and the assessment of postoperative outcomes. While retrospective evidence supports the use of CRA tools for BC, further comparative studies evaluating the effectiveness of these tools and identifying the patients most likely to benefit from a treatment according to competing-risks assessment are needed. Patient summary In this review we explored the clinical evidence for comorbidity risk assessment tools in bladder cancer. We found evidence to support incorporation of comorbidity risks into practice guidelines when discussing treatment options with patients.
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Affiliation(s)
- Stephen B Williams
- Division of Urology, The University of Texas Medical Branch, Galveston, TX, USA
| | - Ashish M Kamat
- Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Karim Chamie
- Department of Urology, University of California Los Angeles, Los Angeles, CA, USA
| | - Michael Froehner
- Department of Urology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Manfred P Wirth
- Department of Urology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Peter N Wiklund
- Department of Urology, Karolinska University Hospital, Stockholm, Sweden
| | - Peter C Black
- Department of Urologic Science, University of British Columbia, Vancouver, BC, Canada
| | - Gary D Steinberg
- Department of Surgery, Section of Urology, University of Chicago, Chicago, IL, USA
| | | | - Sia Daneshmand
- USC Institute of Urology, Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, USA
| | - Peter J Goebell
- Department of Urology, Friedrich-Alexander University, Erlangen, Germany
| | - Kamal S Pohar
- Department of Urology, Ohio State University, Columbus, OH, USA
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Tai HC, Hong JH, Lin YH, Lu YC, Chiang Y, Huang KH, Cheng CH, Pu YS. Comparative analysis between radical cystectomy and trimodality therapy for clinical Stage II Bladder Cancer: Experience from a tertiary referral center. UROLOGICAL SCIENCE 2018. [DOI: 10.4103/uros.uros_13_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Mandel P, Chandrasekar T, Chun FK, Huland H, Tilki D. Radical prostatectomy in patients aged 75 years or older: review of the literature. Asian J Androl 2017; 21:215663. [PMID: 28948940 PMCID: PMC6337955 DOI: 10.4103/aja.aja_43_17] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2017] [Accepted: 07/20/2017] [Indexed: 12/01/2022] Open
Abstract
Given the demographic trends toward a considerably longer life expectancy, the percentage of elderly patients with prostate cancer will increase further in the upcoming decades. Therefore, the question arises, should patients ≥75 years old be offered radical prostatectomy and under which circumstances? For treatment decision-making, life expectancy is more important than biological age. As a result, a patient's health and mental status has to be determined and radical treatment should only be offered to those who are fit. As perioperative morbidity and mortality in these patients is increased relative to younger patients, patient selection according to comorbidities is a key issue that needs to be addressed. It is known from the literature that elderly men show notably worse tumor characteristics, leading to worse oncologic outcomes after treatment. Moreover, elderly patients also demonstrate worse postoperative recovery of continence and erectile function. As the absolute rates of both oncological and functional outcomes are still very reasonable in patients ≥75 years, a radical prostatectomy can be offered to highly selected and healthy elderly patients. Nevertheless, patients clearly need to be informed about the worse outcomes and higher perioperative risks compared to younger patients.
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Affiliation(s)
- Philipp Mandel
- Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg 20246, Germany
| | - Thenappan Chandrasekar
- Division of Urology, Department of Surgical Oncology, Princess Margaret Cancer Centre, University Health Network and the University of Toronto, Toronto, Ontario M5G 2M9, Canada
| | - Felix K Chun
- Department of Urology, University Hospital Hamburg-Eppendorf, Hamburg 20246, Germany
| | - Hartwig Huland
- Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg 20246, Germany
| | - Derya Tilki
- Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg 20246, Germany
- Department of Urology, University Hospital Hamburg-Eppendorf, Hamburg 20246, Germany
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Hong JH, Lin YH, Lu YC, Chiang Y, Tai HC, Huang KH, Cheng CH, Pu YS. Comparative analysis between radical cystectomy and trimodality therapy for clinical stage II bladder cancer – Experience from a tertiary referral center. UROLOGICAL SCIENCE 2017. [DOI: 10.1016/j.urols.2017.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Dybowski B. Competing risks of cystectomy - from calculator to decision. Cent European J Urol 2017; 70:128-129. [PMID: 28462002 PMCID: PMC5407339 DOI: 10.5173/ceju.2016.943] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Accepted: 11/03/2016] [Indexed: 11/22/2022] Open
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