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Duwe G, Kamal MM, Wiesmann C, Banasiewicz KE, Wagner I, Fischer ND, Haack M, Frey LJ, Mager R, Höfner T, Sparwasser P, Tsaur I, Wiesner C, Thomas C, Thüroff JW, Hohenfellner R, Brandt MP, Haferkamp A. Temporal Trends in Urinary Diversion among Patients Undergoing Radical Cystectomy Between 1986 and 2022: Experience at the University Medical Center Mainz with 2224 Cases. Ann Surg Oncol 2024; 31:7220-7228. [PMID: 38969859 PMCID: PMC11413057 DOI: 10.1245/s10434-024-15730-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Accepted: 06/19/2024] [Indexed: 07/07/2024]
Abstract
BACKGROUND Analysis of temporal trends of urinary diversion (UD) and identification of predictive factors for continent urinary diversion (CUD) in patients with bladder cancer (BC) is scarce and data on large cohorts are missing. We aimed to describe longitudinal temporal trends and predictive factors for UD among patients with BC receiving radical cystectomy (RC). PATIENTS AND METHODS We retrospectively analysed institutional data collected from patients undergoing RC from 1986 to 2022 to describe changes in patients' characteristics and UD. Primary end points were patients' characteristics associated with type of UD. Logistic regression analysis was used to determine predictive factors for CUD. RESULTS In total, 2224 patients (77.16% male, 22.84% female) with a mean age of 66 years [standard deviation (SD), 10.64 years] were included. We observed an increase in mean age from 59.86 (10.8) years (1986-1990) to 69.85 (9.99) years (2016-2022) (p < 0.001). The proportion of CUD gradually declined from 43.72% (94/215; 1986-1990) to 18.38% (86/468; 2016-2022). Patients who were male [odds ratio (OR): 1.92, 95% confidence interval (CI): 1.43-2.57, p < 0.001), younger (OR: 0.88, 95% CI: 0.87-0.89, p < 0.001) and had no hydronephrosis prior to RC (OR: 2.2, 95% CI: 1.66-2.92, p < 0.001) were more likely to receive CUD. CONCLUSIONS We report the largest European single-center cohort of UD after RC, demonstrating a significant shift from CUD to IUD, accompanied by an increasing age. Finally, our data mirrors the development and extensive experience with the Mainz Pouch-I in the 1980's and 1990's together with other colon pouches.
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Affiliation(s)
- Gregor Duwe
- Department of Urology and Paediatric Urology, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany.
| | - Mohamed M Kamal
- Department of Urology and Paediatric Urology, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Crispin Wiesmann
- Department of Urology and Paediatric Urology, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Katarzyna E Banasiewicz
- Department of Urology and Paediatric Urology, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Isabel Wagner
- Department of Urology and Paediatric Urology, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Nikita Dhruva Fischer
- Department of Urology and Paediatric Urology, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Maximilian Haack
- Department of Urology and Paediatric Urology, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Lisa Johanna Frey
- Department of Urology and Paediatric Urology, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Rene Mager
- Department of Urology and Paediatric Urology, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Thomas Höfner
- Department of Urology, Ordensklinikum Linz Elisabethinen, Linz, Austria
| | - Peter Sparwasser
- Department of Urology, University Hospital and Faculty of Medicine Eberhard Karls University Tübingen, Tuebingen, Germany
| | - Igor Tsaur
- Department of Urology, University Hospital and Faculty of Medicine Eberhard Karls University Tübingen, Tuebingen, Germany
| | | | - Christian Thomas
- Department of Urology, University Hospital Carl Gustav-Carus, TU Dresden, Dresden, Germany
| | - Joachim Wolfgang Thüroff
- Department of Urology and Paediatric Urology, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Rudolf Hohenfellner
- Department of Urology and Paediatric Urology, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Maximilian Peter Brandt
- Department of Urology and Paediatric Urology, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Axel Haferkamp
- Department of Urology and Paediatric Urology, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
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Mekayten M, Tin AL, Sidhu A, Liso N, Kimm S, Mansour M, Cheung F, Ajay D, Sandhu JS. Trans Oblique Ileal Conduit Technique Has a Low Risk of Parastomal Hernias. Urology 2024:S0090-4295(24)00711-8. [PMID: 39218081 DOI: 10.1016/j.urology.2024.08.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2024] [Revised: 08/06/2024] [Accepted: 08/20/2024] [Indexed: 09/04/2024]
Abstract
OBJECTIVE To outline our surgical technique and outcomes of a ipsilateral "transoblique" ileal conduit performed during pelvic exenteration with a Vertical Rectus Abdominis Myocutaneous flap. We report hernia rates in a transrectus group as reference. METHODS We identified patients from January 2007 to August 2020. The transoblique conduit is placed on the ipsilateral side as the VRAM, through the internal, external oblique, and transverse abdominis muscles. Stomal hernias were assessed radiologically. Transrectus patients were those undergoing radical cystectomy matched based on surgery date, age, and sex in a 3:1 ratio. We employed a Kaplan-Meier plot to visualize the duration between surgery and hernia. We calculated the hernia rate 2 years after surgery. Additionally, we present the 30-day postoperative complication rate. RESULTS Fifty underwent transoblique conduits and we matched them to 190 transrectus patients. Sixty-seven percent were men with a median age of 62. Exactly 10/50 patients in the transoblique and 44/190 in the transrectus group developed a hernia, with a median follow-up of 2.2 years (IQR 0.8, 4.0). The 2-year KM-estimated parastomal hernia rate was 14% (95% CI 1.6%, 25%) for the transoblique conduits, 21% (95% CI 15%, 28%) for the transrectus and 24% (95% CI 6.5%, 39%) for colostomies. Among the transoblique patients, 22 (44%) experienced at least 1 postoperative complication. CONCLUSION A transoblique ileal conduit is safe in patients undergoing a right VRAM flap during a pelvic exenteration with a low parastomal hernia and complication rates.
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Affiliation(s)
| | - Amy L Tin
- Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - Nicole Liso
- Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - Mazen Mansour
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - Felix Cheung
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - Divya Ajay
- Memorial Sloan Kettering Cancer Center, New York, NY
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Kim AH, Ruel NH, Yamzon J, Zhumkhawala AA, Lau CS, Yuh BE, Chan KG. Indiana Pouch Continent Cutaneous Urinary Diversion After Robotic-assisted Radical Cystectomy: A 16-Year Experience. Urology 2024; 183:e325-e327. [PMID: 37951362 DOI: 10.1016/j.urology.2023.10.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Revised: 10/15/2023] [Accepted: 10/23/2023] [Indexed: 11/14/2023]
Abstract
BACKGROUND Population-based practice patterns in the United States reveal continent diversions are only performed in 8%-10.4% of patients.1-4 Ideally, for patients undergoing radical cystectomy the choice of urinary diversion should be influenced by clinical factors and patient preference, with discussions surrounding quality of life. Unfortunately, receipt of continent diversion has been shown to be influenced by a plethora of other factors such as surgeon preference/training, geography, socioeconomic status, gender, and hospital volume.1-3 Thus, by providing detailed instruction and long-term follow-up, we hope to mitigate some of these disparities by changing the perceptions regarding feasibility and complications of continent diversions. OBJECTIVE To provide step-by-step instruction and to report long-term clinical outcomes in bladder cancer patients receiving an Indiana pouch continent cutaneous urinary diversion (CCUD) after robot-assisted radical cystectomy. DESIGN, SETTING, AND PARTICIPANTS After Institutional Review Board approval, a prospectively maintained bladder cancer database was queried for patients with T1-T4, N0-N1, M0 bladder cancer undergoing radical cystectomy with CCUD at a tertiary referral center from 2004 to 2020. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Complications at 30- and 90-day were recorded according to the Clavien-Dindo classification. Continence rates were recorded by chart review. RESULTS AND LIMITATIONS A total of 97 patients were included with a median follow-up of 93months. Clinically, 91.8% had ≤T2 disease and 29.9% received neoadjuvant chemotherapy. The median length of surgery was 8.0 hours, length of hospital stay was 8.3days, and urinary continence rate was 99.0%. The overall complication rate was 73.2% and 76.5% at 30- and 90-day, respectively. The major complication rate (Clavien III-V) was 17.5% at 30-day and 22.7% at 90-day. The most common major complications were abdominal infection and uretero-colonic stricture. The readmission rate was 21.4% and median overall survival was 108months. CONCLUSION CCUD provides exceptional functional outcomes with acceptable complication rates compared to other diversion types. CCUD is a reliable reconstructive option and with this step-by-step video as a reference, we hope it will be offered to more patients.
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Affiliation(s)
- Albert H Kim
- Louis Stokes Cleveland Veterans Affairs Medical Center, Urology Section, Cleveland, OH
| | - Nora H Ruel
- City of Hope National Medical Center, Division of Biostatistics, Department of Computational and Biostatistics, Duarte, CA
| | - Jonathan Yamzon
- City of Hope National Medical Center, Division of Urology and Urologic Oncology, Duarte, CA
| | - Ali-Ashgar Zhumkhawala
- City of Hope National Medical Center, Division of Urology and Urologic Oncology, Duarte, CA
| | - Clayton S Lau
- City of Hope National Medical Center, Division of Urology and Urologic Oncology, Duarte, CA
| | - Bertram E Yuh
- City of Hope National Medical Center, Division of Urology and Urologic Oncology, Duarte, CA
| | - Kevin G Chan
- City of Hope National Medical Center, Division of Urology and Urologic Oncology, Duarte, CA.
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Zhang W, Huang X, Lin B, Zheng W, Ke Z, Lin X, Chen J, Cai H, Lin Y, Chen Y, Zheng Q, Wei Y, Xue X, Li X, Xu N. The effect of body mass index on quality of life in modified single stoma cutaneous ureterostomy or ileal conduit after radical cystectomy. Cancer Med 2023; 12:20930-20939. [PMID: 37902236 PMCID: PMC10709730 DOI: 10.1002/cam4.6638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 09/30/2023] [Accepted: 10/10/2023] [Indexed: 10/31/2023] Open
Abstract
OBJECTIVE To explore the influence of postoperative body mass index (BMI) change on postoperative quality of life (QOL) in patients undergoing radical cystectomy (RC) plus modified single stoma cutaneous ureterostomy (MSSCU) or ileal conduit (IC). METHODS Patients were divided into two groups according to different BMI change patterns: patients experiencing an elevated postoperative BMI level, along with a clinically significant increase in their BMI (an increase of more than 10%) were categorized as Group 1, while patients experiencing a decrease postoperative BMI level, along with a clinically significant reduction in their BMI (a decrease of more than 5%) were categorized as Group 2. Spearman correlation analysis was used to examine the correlations between quality-of-life scores and postoperative clinical parameters. RESULTS Spearman correlation analysis showed that postoperative BMI, late complications and catheter-free state were significantly associated with postoperative global QoL and symptom scale in MSSCU and postoperative global QoL and physical scale in IC patients. Additionally, postoperative BMI, catheter-free state and the use of adjuvant therapy were associated with bad performance in many scales of QoL like body image, future perspective, social scale, future perspective (MSSCU), and abdominal bloating (IC) (Table 2, p<0.05). Patients in Group 2 with significant weight loss had a better Global QoL, a lower rate of stomal stricture and a higher catheter-free state compared with those in Group 1 in both IC and MSSCU patients. MSSCU patients in Group 2 could achieve a comparable Global QoL as to IC patients in Group 1. CONCLUSION Controlling the substantial increase in body weight after surgery contributes to improving QoL, reducing the occurrence of stomal stricture, and ensuring a postoperative catheter-free state in BCa patients undergoing MSSCU.
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Affiliation(s)
- Wan‐Jin Zhang
- Department of Urology, Urology Research Institute, The First Affiliated HospitalFujian Medical UniversityFuzhouChina
- Department of Urology, National Region Medical centre, Binhai Campus of the First Affiliated HospitalFujian Medical UniversityFuzhouChina
| | - Xu‐Yun Huang
- Department of Urology, Urology Research Institute, The First Affiliated HospitalFujian Medical UniversityFuzhouChina
- Department of Urology, National Region Medical centre, Binhai Campus of the First Affiliated HospitalFujian Medical UniversityFuzhouChina
| | - Bin Lin
- Department of Urology, Urology Research Institute, The First Affiliated HospitalFujian Medical UniversityFuzhouChina
- Department of Urology, National Region Medical centre, Binhai Campus of the First Affiliated HospitalFujian Medical UniversityFuzhouChina
| | - Wen‐Cai Zheng
- Department of Urology, Urology Research Institute, The First Affiliated HospitalFujian Medical UniversityFuzhouChina
- Department of Urology, National Region Medical centre, Binhai Campus of the First Affiliated HospitalFujian Medical UniversityFuzhouChina
| | - Zhi‐Bin Ke
- Department of Urology, Urology Research Institute, The First Affiliated HospitalFujian Medical UniversityFuzhouChina
- Department of Urology, National Region Medical centre, Binhai Campus of the First Affiliated HospitalFujian Medical UniversityFuzhouChina
| | - Xiao‐Dan Lin
- Department of Urology, Urology Research Institute, The First Affiliated HospitalFujian Medical UniversityFuzhouChina
- Department of Urology, National Region Medical centre, Binhai Campus of the First Affiliated HospitalFujian Medical UniversityFuzhouChina
| | - Jia‐Yin Chen
- Department of Urology, Urology Research Institute, The First Affiliated HospitalFujian Medical UniversityFuzhouChina
- Department of Urology, National Region Medical centre, Binhai Campus of the First Affiliated HospitalFujian Medical UniversityFuzhouChina
| | - Hai Cai
- Department of Urology, Urology Research Institute, The First Affiliated HospitalFujian Medical UniversityFuzhouChina
- Department of Urology, National Region Medical centre, Binhai Campus of the First Affiliated HospitalFujian Medical UniversityFuzhouChina
| | - Yun‐Zhi Lin
- Department of Urology, Urology Research Institute, The First Affiliated HospitalFujian Medical UniversityFuzhouChina
- Department of Urology, National Region Medical centre, Binhai Campus of the First Affiliated HospitalFujian Medical UniversityFuzhouChina
| | - Ye‐Hui Chen
- Department of Urology, Urology Research Institute, The First Affiliated HospitalFujian Medical UniversityFuzhouChina
- Department of Urology, National Region Medical centre, Binhai Campus of the First Affiliated HospitalFujian Medical UniversityFuzhouChina
| | - Qing‐Shui Zheng
- Department of Urology, Urology Research Institute, The First Affiliated HospitalFujian Medical UniversityFuzhouChina
- Department of Urology, National Region Medical centre, Binhai Campus of the First Affiliated HospitalFujian Medical UniversityFuzhouChina
| | - Yong Wei
- Department of Urology, Urology Research Institute, The First Affiliated HospitalFujian Medical UniversityFuzhouChina
- Department of Urology, National Region Medical centre, Binhai Campus of the First Affiliated HospitalFujian Medical UniversityFuzhouChina
| | - Xue‐Yi Xue
- Department of Urology, Urology Research Institute, The First Affiliated HospitalFujian Medical UniversityFuzhouChina
- Department of Urology, National Region Medical centre, Binhai Campus of the First Affiliated HospitalFujian Medical UniversityFuzhouChina
- Fujian Key Laboratory of Precision Medicine for Cancer, the First Affiliated HospitalFujian Medical UniversityFuzhouChina
| | - Xiao‐Dong Li
- Department of Urology, Urology Research Institute, The First Affiliated HospitalFujian Medical UniversityFuzhouChina
- Department of Urology, National Region Medical centre, Binhai Campus of the First Affiliated HospitalFujian Medical UniversityFuzhouChina
| | - Ning Xu
- Department of Urology, Urology Research Institute, The First Affiliated HospitalFujian Medical UniversityFuzhouChina
- Department of Urology, National Region Medical centre, Binhai Campus of the First Affiliated HospitalFujian Medical UniversityFuzhouChina
- Fujian Key Laboratory of Precision Medicine for Cancer, the First Affiliated HospitalFujian Medical UniversityFuzhouChina
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Early and midterm complications of the continent catheterizable Indiana Pouch urinary diversion: A 7 year experience. Urology 2022; 167:229-233. [DOI: 10.1016/j.urology.2022.04.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 04/06/2022] [Accepted: 04/14/2022] [Indexed: 11/15/2022]
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Elshabrawy A, Wang H, Dursun F, Kaushik D, Liss M, Svatek RS, Mansour AM. Diffusion of robot-assisted radical cystectomy: Nationwide trends, predictors, and association with continent urinary diversion. Arab J Urol 2022; 20:159-167. [PMID: 35935907 PMCID: PMC9354633 DOI: 10.1080/2090598x.2022.2032562] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
Objectives To assess the utilisation trends of robot-assisted radical cystectomy (RARC), rates of performing continent urinary diversions (CUDs), and impact of diffusion of RARC on CUD rates. Methods We investigated the National Cancer Database for patients with muscle-invasive bladder cancer (MIBC) who underwent RC between 2004 and 2015. Patients were stratified by surgical technique into open (ORC) and RARC groups, and by type of urinary diversion into continent (CUD) and ileal conduit (ICUD) groups. Linear regression models were fitted to evaluate time trends for surgery and conversion techniques. Multivariate logistic regression models were utilised to identify independent predictors of RARC and CUD. Results A total of 14466 patients underwent RC for MIBC, of which 4914 (34%) underwent RARC. There was a significant increase in adoption of RARC from 22% in 2010 to 40% in 2015 (R2 = 0.96, P < 0.001), this was not associated with a change in the rates of CUD over the same period (P = 0.22). Across all years, ICUD was the primary type of urinary diversion, CUD was only offered in 12% in 2010 compared to 9.9% in 2015 (R2 = 0.33, P = 0.22). Multivariate analysis identified male gender (odds ratio [OR] 1.18, P = 0.03), academic centres (OR 1.74, P = 0.001), and lower T stage (T4 vs T2; OR 0.78, P = 0.03) as independent predictors of CUD, while surgical technique was not associated with odds of receiving CUD (P = 0.8). Conclusions There is significant nationwide increasing trend of adoption of RARC. This diffusion was not associated with a decline in CUD, which remains significantly underutilised in both ORC and RARC groups. Abbreviations CUD: continent urinary diversion; ICD-O: International Classification of Diseases for Oncology; ICUD: ileal conduit urinary diversion; (N)MIBC: (non-)muscle-invasive bladder cancer; NAC, neoadjuvant chemotherapy; NCDB: National Cancer Database; OR: odds ratio;(O)(RA)RC: (open) (robot-assisted) radical cystectomy.
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Affiliation(s)
- Ahmed Elshabrawy
- Department of Urology, University of Texas (UT) Health, San Antonio, TX, USA
| | - Hanzhang Wang
- Department of Urology, University of Texas (UT) Health, San Antonio, TX, USA
| | - Furkan Dursun
- Department of Urology, University of Texas (UT) Health, San Antonio, TX, USA
| | - Dharam Kaushik
- Department of Urology, University of Texas (UT) Health, San Antonio, TX, USA
- UT Health San Antonio/MD Anderson Mays Cancer Center, San Antonio, TX, USA
| | - Michael Liss
- Department of Urology, University of Texas (UT) Health, San Antonio, TX, USA
- UT Health San Antonio/MD Anderson Mays Cancer Center, San Antonio, TX, USA
| | - Robert S. Svatek
- Department of Urology, University of Texas (UT) Health, San Antonio, TX, USA
- UT Health San Antonio/MD Anderson Mays Cancer Center, San Antonio, TX, USA
| | - Ahmed M. Mansour
- Department of Urology, University of Texas (UT) Health, San Antonio, TX, USA
- UT Health San Antonio/MD Anderson Mays Cancer Center, San Antonio, TX, USA
- Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
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Management Trends and Outcomes of Patients Undergoing Radical Cystectomy for Urothelial Carcinoma of the Bladder: Evolution of the University of Southern California Experience over 3,347 Cases. J Urol 2022; 207:302-313. [PMID: 34994657 PMCID: PMC8746892 DOI: 10.1097/ju.0000000000002242] [Citation(s) in RCA: 35] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
PURPOSE There are conflicting reports on outcome trends following radical cystectomy (RC) for bladder cancer. MATERIALS AND METHODS Evolution of modern bladder cancer management and its impact on outcomes was analyzed using a longitudinal cohort of 3,347 patients who underwent RC at an academic center between 1971 and 2018. Outcomes included recurrence-free survival (RFS) and overall survival (OS). Associations were assessed using univariable and multivariable models. RESULTS In all, 70.9% of cases underwent open RC in the last decade, although trend for robot-assisted RC rose since 2009. While lymphadenectomy template remained consistent, nodal submission changed to anatomical packets in 2002 with increase in yield (p <0.001). Neoadjuvant chemotherapy (NAC) use increased with time with concomitant decrease in adjuvant chemotherapy; this was notable in the last decade (p <0.001) and coincided with improved pT0N0M0 rate (p=0.013). Median 5-year RFS and OS probabilities were 65% and 55%, respectively. Advanced stage, NAC, delay to RC, lymphovascular invasion and positive margins were associated with worse RFS (all, multivariable p <0.001). RFS remained stable over time (p=0.73) but OS improved (5-year probability, 1990-1999 51%, 2010-2018 62%; p=0.019). Among patients with extravesical and/or node-positive disease, those who received NAC had worse outcomes than those who directly underwent RC (p ≤0.001). CONCLUSIONS Despite perioperative and surgical advances, and improved pT0N0M0 rates, there has been no overall change in RFS trend following RC, although OS rates have improved. While patients who are downstaged with NAC derive great benefit, our real-world experience highlights the importance of preemptively identifying NAC nonresponders who may have worse post-RC outcomes.
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Ahmadi H, Reddy S, Nguyen C, Douglawi A, Ladi‐Seyedian S, Roberts S, Ghoreifi A, Ghodoussipour S, Bhanvadia SK, Djaladat H, Schuckman A, Daneshmand S. Long‐Term Renal Function in Patients with CKD following Radical Cystectomy and Orthotopic Neobladder. BJU Int 2022; 130:200-207. [DOI: 10.1111/bju.15685] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Revised: 12/06/2021] [Accepted: 12/20/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Hamed Ahmadi
- Department of Urology Norris Comprehensive Cancer Center University of Southern California Los Angeles CA USA
| | - Sharath Reddy
- Department of Urology Norris Comprehensive Cancer Center University of Southern California Los Angeles CA USA
| | - Charles Nguyen
- Department of Urology Norris Comprehensive Cancer Center University of Southern California Los Angeles CA USA
| | - Antoin Douglawi
- Department of Urology Norris Comprehensive Cancer Center University of Southern California Los Angeles CA USA
| | - Sanam Ladi‐Seyedian
- Department of Urology Norris Comprehensive Cancer Center University of Southern California Los Angeles CA USA
| | - Sidney Roberts
- Department of Urology Norris Comprehensive Cancer Center University of Southern California Los Angeles CA USA
| | - Alireza Ghoreifi
- Department of Urology Norris Comprehensive Cancer Center University of Southern California Los Angeles CA USA
| | - Saum Ghodoussipour
- Division of Urology Department of Surgery Rutgers Cancer Institute of New Jersey Rutgers New Jersey Medical School Newark NJ USA
| | - Sumeet K. Bhanvadia
- Department of Urology Norris Comprehensive Cancer Center University of Southern California Los Angeles CA USA
| | - Hooman Djaladat
- Department of Urology Norris Comprehensive Cancer Center University of Southern California Los Angeles CA USA
| | - Anne Schuckman
- Department of Urology Norris Comprehensive Cancer Center University of Southern California Los Angeles CA USA
| | - Siamak Daneshmand
- Department of Urology Norris Comprehensive Cancer Center University of Southern California Los Angeles CA USA
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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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Wang P, Xiao S, Fu W, Song Y, Sun S, Zhang F, Shen D, Zhu J, Wang Z, Chen J, Qiao J, Zhang X. Robot-assisted radical cystectomy with intracorporeal Mainz Ⅱ rectosigmoid pouch for muscle-invasive bladder cancer. Int J Med Robot 2021; 17:e2284. [PMID: 34004045 DOI: 10.1002/rcs.2284] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 04/19/2021] [Accepted: 05/17/2021] [Indexed: 01/02/2023]
Abstract
BACKGROUND To report the surgical techniques and results of robot-assisted radical cystectomy (RARC) with intracorporeal Mainz Ⅱ rectosigmoid pouch at our centre. METHODS Two female patients were treated with this procedure. Construction of the pouch was divided into four main steps: incision of the rectum and sigmoid colon, closure of the posterior wall of the pouch, reimplantation of the ureters at the bottom of pouch in an anti-reflux manner, and closure of the anterior wall. Surgical results and perioperative complications were assessed. RESULTS The operations were performed completely intracorporeally. No perioperative complications were observed. Postoperatively, high-grade invasive urothelial carcinoma was detected. On postoperative day 60, no bilateral ureteral dilation was detected. Two patients demonstrated total continence. Clinical recurrence was not observed during the follow-up period. CONCLUSIONS With careful patient selection, robot-assisted intracorporeal Mainz Ⅱ rectosigmoid pouch might be a simple minimally invasive surgical technique to be evaluated in repeated applications.
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Affiliation(s)
- Pengchao Wang
- Department of Urology, Hainan Hospital of Chinese PLA General Hospital, Sanya, China
| | - Shuwei Xiao
- Department of Urology, The First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Weijun Fu
- Department of Urology, The First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Yong Song
- Department of Urology, The First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Shengkun Sun
- Department of Urology, The First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Fan Zhang
- Department of Urology, The First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Dan Shen
- Department of Urology, The First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Jie Zhu
- Department of Urology, The First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Zhongxin Wang
- Department of Urology, The First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Jie Chen
- Department of Urology, Jinan Central Hospital, Cheeloo College of Medicine, Shandong University, Shandong, China
| | - Jianguo Qiao
- Department of Urology, The Second People's Hospital of Datong Hospital, Shanxi, China
| | - Xu Zhang
- Department of Urology, The First Medical Center of Chinese PLA General Hospital, Beijing, China
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Incontinent Urinary Diversion. Bladder Cancer 2021. [DOI: 10.1007/978-3-030-70646-3_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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12
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Impact of hospital and surgeon volumes on short-term and long-term outcomes of radical cystectomy. Curr Opin Urol 2020; 30:701-710. [PMID: 32732625 DOI: 10.1097/mou.0000000000000805] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSE OF REVIEW There is heightened awareness and trends towards centralizing high-risk, complex surgeries such as radical cystectomy to minimize complications and improve survival. However, after nearly a decade of mandated and/or passive centralization of care, debate regarding its benefits and harms continues. RECENT FINDINGS During the past decade, mandated and passive centralization has led to an increase in radical cystectomies performed in high-volume hospitals (HVHs) and, perhaps by high-volume surgeons (HVS), in addition to efforts to increase the uptake of multidisciplinary strategies in the management of radical cystectomy patients. Consequently, 30 and 90-day mortality rates and overall survival have improved, and major complications and transfusion rates have decreased. Factors impacting surgical quality, such as negative surgical margin(s), pelvic lymphadenectomy and/or lymph node yield rates have increased. However, current studies have not demonstrated a coadditive impact of centralization on oncological outcomes (i.e. cancer-specific and recurrence-free survival). The benefits of centralization on oncologic survival of radical cystectomy remain unclear given the varied definitions of HVHs and HVSs across studies. In fact, centralization of radical cystectomy could lead to an increase in patient load in HVHs and for HVSs, thereby leading to longer surgery waiting times, a factor that is important in the management of muscle-invasive bladder cancer. SUMMARY The benefits of centralization of radical cystectomy with multidisciplinary management are shown increasingly and convincingly. More studies are necessary to prospectively test the benefits, risks and harms of centralization.
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Ghodoussipour S, Daneshmand S. Voiding Dysfunction After Neobladder Urinary Diversion. CURRENT BLADDER DYSFUNCTION REPORTS 2020. [DOI: 10.1007/s11884-019-00573-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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14
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Gronostaj K, Czech AK, Fronczek J, Wiatr T, Przydacz M, Dudek P, Curylo L, Szczeklik W, Chlosta P. Implementation of neoadjuvant chemotherapy in muscle invasive bladder cancer treatment in Poland: a single institution retrospective study. Cent European J Urol 2019; 72:100-105. [PMID: 31482015 PMCID: PMC6715095 DOI: 10.5173/ceju.2019.1892] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2019] [Revised: 03/04/2019] [Accepted: 06/09/2019] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Even though the survival benefit of neoadjuvant chemotherapy (NAC) in the treatment of muscle invasive bladder cancer (MIBC) is well established, NAC has not been widely used in Poland until recently. The aim of our study was to evaluate the utilization of NAC and its association with survival in MIBC. MATERIAL AND METHODS Patients who underwent radical cystectomy (RC) for MIBC between December 2012 and December 2017 were included in the study. Data were collected in the perioperative period and long-term observation was continued up to August 2018. Kaplan-Meier curves were used to estimate the probability of survival. RESULTS A sample of 155 patients with a median age of 65 (IQR: 60-69) years was analyzed. In this group, 79 patients (51%) were treated with NAC prior to RC. Patients in the NAC+RC group were younger, more often had a positive smoking history, and had lower preoperative levels of hemoglobin, white blood cells and C-reactive protein. A 90-day complication rate and mortality were similar in both groups and in the entire cohort were equal to 64.5% and 5.2%, respectively. The overall survival (OS) was on average 150 days longer in the RC+NAC group compared to the RC-only group when patients were followed-up for 3 years (95%CI:3 4 - 267; p = 0.011). CONCLUSIONS We demonstrated a high utilization of NAC at our institution. The use of NAC was associated with a better prognosis than RC alone and was not associated with an increased morbidity or mortality. Our results support the use NAC as a safe and effective treatment modality in MIBC.
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Affiliation(s)
- Katarzyna Gronostaj
- Jagiellonian University Medical College, Department of Urology, Cracow, Poland
| | | | - Jakub Fronczek
- Jagiellonian University Medical College, Department of Intensive Care and Perioperative Medicine, Cracow, Poland
| | - Tomasz Wiatr
- Jagiellonian University Medical College, Department of Urology, Cracow, Poland
| | - Mikolaj Przydacz
- Jagiellonian University Medical College, Department of Urology, Cracow, Poland
| | - Przemyslaw Dudek
- Jagiellonian University Medical College, Department of Urology, Cracow, Poland
| | - Lukasz Curylo
- Jagiellonian University Medical College, Department of Urology, Cracow, Poland
| | - Wojciech Szczeklik
- Jagiellonian University Medical College, Department of Intensive Care and Perioperative Medicine, Cracow, Poland
| | - Piotr Chlosta
- Jagiellonian University Medical College, Department of Urology, Cracow, Poland
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