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Eilender BM, Katims AB, Pfail JL, Sfakianos J. Evolving Treatment in Non-muscle-Invasive Bladder Cancer. Urol Oncol 2022. [DOI: 10.1007/978-3-030-89891-5_16] [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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Dreger NM, Lohbeck A, Roth S, Gödde D, von Rundstedt FC, Degener S. Effectiveness and Safety of a Modified Technique of Transvesical Obturator Nerve Block to Avoid Adductor Contractions during Transurethral Resection of Bladder Tumors. Urol Int 2021; 106:775-783. [DOI: 10.1159/000520539] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Accepted: 09/26/2021] [Indexed: 11/19/2022]
Abstract
<b><i>Introduction:</i></b> The aim of the study was to evaluate the effectiveness of a modified transvesical obturator nerve block (ONB) in the prevention of obturator nerve reflex and consecutive bladder perforations (BPs) during transurethral resection of bladder tumors (TURBTs). <b><i>Materials and Methods:</i></b> A retrospective analysis of all patients resected in 2014–2015 due to a bladder tumor of the lateral walls, including a follow-up period until December 2018, was performed. Two groups were defined: in the first group, all patients underwent TURBT with a modified transvesical ONB. The second group underwent conventional TURBT with intermittent resection. Primary endpoints were the rates of adductor contractions and BPs. <b><i>Results:</i></b> Ninety-four out of 1,145 resected patients presented with tumors on the lateral wall of the bladder and a complete dataset including a long-term follow-up. Thirty-six patients were treated in the ONB group, and 58 patients comprised the control group. The median age in the 2 groups was 70.8 and 71.8 years in the first and second groups, respectively. Adductor spasms were reported in 8.33 versus 25.86% (<i>p</i> = 0.057) and perforation in 2.78 versus 17.24% (<i>p</i> = 0.047) in groups 1 and 2, respectively. After a median follow-up of 32.5 months, there was no significant difference in recurrence rates (52.78 vs. 51.72%, <i>p</i> = 0.672). In a subgroup analysis, lower perforation rates were recorded for the ONB group in patients with tumors <3 cm (0/30 vs. 8/46, <i>p</i> = 0.076) and in patients with unifocal tumors (0/12 vs. 5/23, <i>p</i> = 0.141). <b><i>Discussion/Conclusion:</i></b> The simplified approach of transvesical ONB demonstrated in this study appears to be an inexpensive, safe, effective, and simple-to-use technique.
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Liu Z, Long G, Zhang Y, Sun G, Ouyang W, Wang S, Xu H, Wang Z, Guan W, Yu X, Hu Z, Chen Z, Wang S, Li H. Thulium Laser Resection of Bladder Tumors vs. Conventional Transurethral Resection of Bladder Tumors for Intermediate and High Risk Non-Muscle-Invasive Bladder Cancer Followed by Intravesical BCG Immunotherapy. Front Surg 2021; 8:759487. [PMID: 34820417 PMCID: PMC8606824 DOI: 10.3389/fsurg.2021.759487] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 10/18/2021] [Indexed: 01/04/2023] Open
Abstract
Background: Thulium laser resection of bladder tumors (TmLRBT) is recently considered as a common treatment option for non-muscle-invasive bladder cancers (NMIBC), but whether it is superior to Transurethral resection of bladder tumors (TURBT) are still undetermined. Materials and Methods: We retrospectively screened our institution database to identify patients who were treated by conventional TURBT or TmLRBT for NMIBC and followed by intravesical bacillus Calmette-Guérin (BCG) immunotherapy. The preoperative characteristics, perioperative outcomes, and recurrence-free survival were compared to assess the safety and efficacy of the two procedures. Results: Eventually, 90 patients who underwent TmLRBT (n = 37) or TURBT (n = 53) followed by intravesical BCG immunotherapy were included. Two groups were similar in baseline characteristics except for the smaller tumor size of the TmLRBT group(1.7 cm vs. 2.2 cm; P = 0.036). Obturator nerve reflex occurred in eight patients in the TURBT group and 3 of them suffered from bladder perforation while none happened in the TmLRBT group. The TmLRBT also had a shorter irrigation duration. In the multivariate Cox regression, the TmLRBT was related to less recurrence risk (HR: 0.268; 95% CI, 0.095–0.759; P = 0.013). Conclusion: Our results suggested that TmLRBT is safer than conventional TURBT with fewer perioperative complications, and it offers better cancer control, therefore might be a superior option for NMIBC patients with intermediate and high recurrence risk.
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Affiliation(s)
- Zheng Liu
- Department of Urology, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China.,Hubei Institute of Urology, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Gongwei Long
- Department of Urology, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China.,Hubei Institute of Urology, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Yucong Zhang
- Department of Urology, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China.,Hubei Institute of Urology, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China.,Department of Geriatrics, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Guoliang Sun
- Department of Urology, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China.,Hubei Institute of Urology, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Wei Ouyang
- Department of Urology, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China.,Hubei Institute of Urology, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Shen Wang
- Department of Urology, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China.,Hubei Institute of Urology, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Hao Xu
- Department of Urology, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China.,Hubei Institute of Urology, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Zhihua Wang
- Department of Urology, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China.,Hubei Institute of Urology, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Wei Guan
- Department of Urology, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China.,Hubei Institute of Urology, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Xiao Yu
- Department of Urology, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China.,Hubei Institute of Urology, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Zhiquan Hu
- Department of Urology, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China.,Hubei Institute of Urology, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Zhong Chen
- Department of Urology, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China.,Hubei Institute of Urology, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Shaogang Wang
- Department of Urology, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China.,Hubei Institute of Urology, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Heng Li
- Department of Urology, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China.,Hubei Institute of Urology, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
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Schuettfort VM, Pradere B, Compérat E, Abufaraj M, Shariat SF. Novel transurethral resection technologies and training modalities in the management of nonmuscle invasive bladder cancer: a comprehensive review. Curr Opin Urol 2021; 31:324-331. [PMID: 33973535 DOI: 10.1097/mou.0000000000000892] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Conventional transurethral resection (TURBT) with tumor fragmentation is the primary step in the surgical treatment of nonmuscle invasive bladder cancer. Recently, new surgical techniques and training modalities have emerged with the aim to overcome short-comings of TURBT and improve oncologic outcomes. In this review, we provide a comprehensive update of recent techniques/techniques that aim to improve upon conventional TURBT and beyond. RECENT FINDINGS A systemic approach during conventional TURBT that features the use of a surgical checklist has been shown to improve recurrence-free survival. Several simulators have been developed and validated to provide additional training opportunities. However, transfer of improved simulator performance into real world surgery still requires validation. While there is no convincing data that demonstrate superior outcomes with bipolar TURBT, en-bloc resection already promises to offer lower rates of complications as well as potentially lower recurrence probabilities in select patients. SUMMARY TURBT remains the quintessential procedure for the diagnosis and treatment of bladder cancer. Urologists need to be aware of the importance and challenges of this procedure. Aside of embracing new resection techniques and a conceptual-systematic approach, training opportunities should be expanded upon to improve patient outcomes.
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Affiliation(s)
- Victor M Schuettfort
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Benjamin Pradere
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Eva Compérat
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Mohammad Abufaraj
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
- Division of Urology, Department of Special Surgery, Jordan University Hospital, The University of Jordan, Amman, Jordan
| | - Shahrokh F Shariat
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
- Division of Urology, Department of Special Surgery, Jordan University Hospital, The University of Jordan, Amman, Jordan
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
- Department of Urology, Weill Cornell Medical College, New York, New York
- Department of Urology, University of Texas Southwestern, Dallas, Texas, USA
- Department of Urology, Second Faculty of Medicine, Charles University, Prague, Czech Republic
- Karl Landsteiner Institute of Urology and Andrology, Vienna, Austria
- European Association of Urology Research Foundation, Arnhem, The Netherlands
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Rouprêt M, Pignot G, Masson-Lecomte A, Compérat E, Audenet F, Roumiguié M, Houédé N, Larré S, Brunelle S, Xylinas E, Neuzillet Y, Méjean A. [French ccAFU guidelines - update 2020-2022: bladder cancer]. Prog Urol 2021; 30:S78-S135. [PMID: 33349431 DOI: 10.1016/s1166-7087(20)30751-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE - To update French guidelines for the management of bladder cancer specifically non-muscle invasive (NMIBC) and muscle-invasive bladder cancers (MIBC). METHODS - A Medline search was achieved between 2018 and 2020, notably regarding diagnosis, options of treatment and follow-up of bladder cancer, to evaluate different references with levels of evidence. RESULTS - Diagnosis of NMIBC (Ta, T1, CIS) is based on a complete deep resection of the tumor. The use of fluorescence and a second-look indication are essential to improve initial diagnosis. Risks of both recurrence and progression can be estimated using the EORTC score. A stratification of patients into low, intermediate and high risk groups is pivotal for recommending adjuvant treatment: instillation of chemotherapy (immediate post-operative, standard schedule) or intravesical BCG (standard schedule and maintenance). Cystectomy is recommended in BCG-refractory patients. Extension evaluation of MIBC is based on contrast-enhanced pelvic-abdominal and thoracic CT-scan. Multiparametric MRI can be an alternative. Cystectomy associated with extended lymph nodes dissection is considered the gold standard for non-metastatic MIBC. It should be preceded by cisplatin-based neoadjuvant chemotherapy in eligible patients. An orthotopic bladder substitution should be proposed to both male and female patients with no contraindication and in cases of negative frozen urethral samples; otherwise transileal ureterostomy is recommended as urinary diversion. All patients should be included in an Early Recovery After Surgery (ERAS) protocol. For metastatic MIBC, first-line chemotherapy using platin is recommended (GC or MVAC), when performans status (PS <1) and renal function (creatinine clearance >60 mL/min) allow it (only in 50% of cases). In second line treatment, immunotherapy with pembrolizumab demonstrated a significant improvement in overall survival. CONCLUSION - These updated French guidelines will contribute to increase the level of urological care for the diagnosis and treatment of patients diagnosed with NMIBC and MIBC.
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Affiliation(s)
- M Rouprêt
- Comité de cancérologie de l'Association française d'urologie, groupe vessie, Maison de l'urologie, 11, rue Viète, 75017 Paris, France; Sorbonne Université, GRC n° 5, Predictive onco-uro, AP-HP, hôpital Pitié-Salpêtrière, 47-83, boulevard de l'Hôpital, 75013 Paris, France.
| | - G Pignot
- Comité de cancérologie de l'Association française d'urologie, groupe vessie, Maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie, Institut Paoli-Calmettes, 232, boulevard de Sainte-Marguerite, 13009 Marseille, France
| | - A Masson-Lecomte
- Comité de cancérologie de l'Association française d'urologie, groupe vessie, Maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie, hôpital Saint-Louis, Université Paris-Diderot, 10, avenue de Verdun, 75010 Paris, France
| | - E Compérat
- Comité de cancérologie de l'Association française d'urologie, groupe vessie, Maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'anatomie pathologique, hôpital Tenon, HUEP, Sorbonne Université, GRC n° 5, ONCOTYPE-URO, 4, rue de la Chine, 75020 Paris, France
| | - F Audenet
- Comité de cancérologie de l'Association française d'urologie, groupe vessie, Maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie, hôpital Foch, Université de Versailles - Saint-Quentin-en-Yvelines, 40, rue Worth, 92150 Suresnes, France
| | - M Roumiguié
- Comité de cancérologie de l'Association française d'urologie, groupe vessie, Maison de l'urologie, 11, rue Viète, 75017 Paris, France; Département d'urologie, CHU Rangueil, 1, avenue du Professeur-Jean-Poulhès, 31400 Toulouse, France
| | - N Houédé
- Comité de cancérologie de l'Association française d'urologie, groupe vessie, Maison de l'urologie, 11, rue Viète, 75017 Paris, France; Département d'oncologie médicale, CHU Carémeau, Université de Montpellier, rue du Professeur-Robert-Debré, 30900 Nîmes, France
| | - S Larré
- Comité de cancérologie de l'Association française d'urologie, groupe vessie, Maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie, CHU de Reims, rue du Général Koenig, 51100 Reims, France
| | - S Brunelle
- Comité de cancérologie de l'Association française d'urologie, groupe vessie, Maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service de radiologie, Institut Paoli-Calmettes, 232, boulevard de Sainte-Marguerite, 13009 Marseille, France
| | - E Xylinas
- Comité de cancérologie de l'Association française d'urologie, groupe vessie, Maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie, hôpital Bichat-Claude-Bernard, Assistance publique-Hôpitaux de Paris, Université Paris-Descartes, 46, rue Henri-Huchard, 75018 Paris, France
| | - Y Neuzillet
- Comité de cancérologie de l'Association française d'urologie, groupe vessie, Maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie, CHU de Reims, rue du Général Koenig, 51100 Reims, France
| | - A Méjean
- Comité de cancérologie de l'Association française d'urologie, groupe vessie, Maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie, hôpital européen Georges-Pompidou, AP-HP, Université de Paris, 20, rue Leblanc, 75015 Paris, France
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Bolat D, Yarimoglu S, Aydin ME. Monopolar versus bipolar transurethral resection of lateral wall-located bladder cancer under obturator nerve block: a single center prospective randomized study. Int Braz J Urol 2021; 47:584-593. [PMID: 33621007 PMCID: PMC7993959 DOI: 10.1590/s1677-5538.ibju.2020.0568] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 08/25/2020] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION The aim of the present prospective-randomized study was to compare perioperative outcomes and complications of bipolar and monopolar TURBT for lateral wall-located non-muscle invasive bladder cancers (NMIBC) under obturator nerve block (ONB). PATIENTS AND METHODS 80 patients who underwent TURBT for lateral wall-located primary bladder tumors under ONB from March, 2016 to November, 2019 were included in the present study. The patients were randomized equally into two groups; monopolar TUR (M-TURBT) and bipolar TUR (B-TURBT). The primary and secondary outcomes were safety (obturator jerk and bladder perforation) and efficacy (complete tumor resection and sampling of the deep muscle tissue). RESULTS Obturator jerk was detected in 2 patients (5%) in M-TURBT while obturator jerk was not observed during B-TURBT (p=0.494). Bladder perforation was not observed in both groups. All of the patients underwent complete tumor resection. There was no significant difference in muscle tissue sampling (67.5% vs. 72.5%, p=0.626) and thermal tissue damage rates (12.5% vs. 25%, p=0.201). The majority of complications were low-grade and the differences in Clavien grade 1-3 complications between groups were not statistically significant. CONCLUSION In the treatment of lateral-wall located NMIBCs, either M-TURBT or B-TURBT can be safely and effectively performed by combining spinal anesthesia with ONB. Even so, it should be taken into consideration that low-grade postoperative hemorrhagic complications may occur in patients who undergo M-TURBT.
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Affiliation(s)
- Deniz Bolat
- University of Health Sciences, Bozyaka Training and Research Hospital, Izmir, Turkey
| | - Serkan Yarimoglu
- University of Health Sciences, Bozyaka Training and Research Hospital, Izmir, Turkey
| | - Mehmet Erhan Aydin
- University of Health Sciences, Bozyaka Training and Research Hospital, Izmir, Turkey
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Capibaribe DM, Dal Col LSB, Jalalizadeh M, Reis LO. How to avert a hidden trap: the severe obturator nerve re-flex. Int Braz J Urol 2021; 47:594-595. [PMID: 33621008 PMCID: PMC7993954 DOI: 10.1590/s1677-5538.ibju.2020.0568.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 01/19/2021] [Indexed: 11/22/2022] Open
Affiliation(s)
- Diego Moreira Capibaribe
- Divisão de Oncologia Urológica e Laboratório de UroSciências, Pontifícia Universidade Católica de Campinas - PUC-Campinas, Campinas, SP, Brasil.,Universidade Estadual de Campinas - Unicamp, Campinas, SP, Brasil
| | - Luciana Saboya Brito Dal Col
- Divisão de Oncologia Urológica e Laboratório de UroSciências, Pontifícia Universidade Católica de Campinas - PUC-Campinas, Campinas, SP, Brasil.,Universidade Estadual de Campinas - Unicamp, Campinas, SP, Brasil
| | - Mehrsa Jalalizadeh
- Divisão de Oncologia Urológica e Laboratório de UroSciências, Pontifícia Universidade Católica de Campinas - PUC-Campinas, Campinas, SP, Brasil.,Universidade Estadual de Campinas - Unicamp, Campinas, SP, Brasil
| | - Leonardo O Reis
- Divisão de Oncologia Urológica e Laboratório de UroSciências, Pontifícia Universidade Católica de Campinas - PUC-Campinas, Campinas, SP, Brasil.,Universidade Estadual de Campinas - Unicamp, Campinas, SP, Brasil
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Kaynar M, Celik ZE, Altintas E, Batur AF, Kilic O, Akand M, Gul M, Goktas S. Comparison of Two Different Bipolar Energy Resources in Transurethral Resection of Bladder Tumors. Urol Int 2021; 105:304-308. [PMID: 33454714 DOI: 10.1159/000512380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 10/18/2020] [Indexed: 12/09/2022]
Abstract
PURPOSE To determine whether the use of different bipolar resources is associated with different results on tissue and perioperative parameters in patients undergoing bipolar transurethral bladder tumor resection (bTURBT). METHODS In this single-center prospective study, patients diagnosed with bladder tumor randomized to undergo TURBT either with a Gyrus PlasmaKinetic system (n = 62) or Olympus TUR in saline (TURis) system (n = 51). Primary endpoint was to evaluate the alteration of patients' perioperative parameters, while secondary aim was to assess the thermal effect of these 2 different bipolar devices on the resected tissue samples by a grading system determined by tissue characteristics. RESULTS One hundred thirteen patients were randomized in the study, and 43 were excluded from the analysis due to the exclusion criteria. There were no significant differences between the groups in terms of mean age, tumor site, number of tumors, operative time, alteration in hemoglobin or hematocrit, blood transfusion rate, catheterization time, and postoperative stay. On the other hand, the ratio of obturator jerk was significantly higher in the Olympus TURis group (p = 0.028). The histopathological analyses of both groups determined muscularis propria and cautery artifact presence without a statistically significant difference (χ2: 0.476, p = 0.788). CONCLUSION Although the perioperative complications of bTURBT are low in nature, bladder perforation resulted from obturator jerk still poses a risk for extravesical tumor implantation. Urologists should be aware of this risk especially when they are using a TURis system.
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Affiliation(s)
- Mehmet Kaynar
- Department of Urology, School of Medicine, Selcuk University, Konya, Turkey
| | - Zeliha Esin Celik
- Department of Pathology, School of Medicine, Selcuk University, Konya, Turkey
| | - Emre Altintas
- Department of Urology, Akcakale State Hospital, Sanliurfa, Turkey
| | - Ali Furkan Batur
- Department of Urology, School of Medicine, Selcuk University, Konya, Turkey
| | - Ozcan Kilic
- Department of Urology, School of Medicine, Selcuk University, Konya, Turkey
| | - Murat Akand
- Department of Urology, School of Medicine, Selcuk University, Konya, Turkey
| | - Murat Gul
- Department of Urology, School of Medicine, Selcuk University, Konya, Turkey,
| | - Serdar Goktas
- Department of Urology, School of Medicine, Selcuk University, Konya, Turkey
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Abstract
The goals of transurethral resection of bladder tumour (TURBT) are to identify and eradicate visualized bladder tumour if technically safe and feasible and to obtain a specimen of satisfactory quality to enable accurate histological diagnosis. In the setting of high grade bladder tumour this generally entails the inclusion of detrusor muscle and assessment for the presence of associated carcinoma in situ (CIS), lymphovascular involvement or any variant form of bladder cancer. This will assist in determining risk stratification and prognostication of the bladder cancer and guides further treatment planning. Conversely, if suboptimal TURBT is performed there will be detrimental consequences on patient outcomes in regards to undergrading or understaging, increased recurrence or progression, and subsequently need for further treatments including more invasive interventions. This review article firstly summarises the key principles and complications of TURBT, as well as significance of re-TURBT. We also discuss a number of modifications and advances in detection technology and resection techniques that have shown to improve perioperative as well as pathological and oncological outcomes of bladder cancer. They include enhanced cystoscopy such as blue light cystoscopy (BLC), narrow band imaging (NBI) and en bloc resection of bladder tumour (ERBT) technique using various types of energy source.
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Affiliation(s)
- Lawrence H C Kim
- Department of Urology, Westmead Hospital, Sydney, Australia.,Discipline of Surgery, Sydney Medical School, University of Sydney, Sydney, Australia
| | - Manish I Patel
- Department of Urology, Westmead Hospital, Sydney, Australia.,Discipline of Surgery, Sydney Medical School, University of Sydney, Sydney, Australia
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Roumiguié M, Xylinas E, Brisuda A, Burger M, Mostafid H, Colombel M, Babjuk M, Palou Redorta J, Witjes F, Malavaud B. Consensus Definition and Prediction of Complexity in Transurethral Resection or Bladder Endoscopic Dissection of Bladder Tumours. Cancers (Basel) 2020; 12:cancers12103063. [PMID: 33092240 PMCID: PMC7589904 DOI: 10.3390/cancers12103063] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Revised: 10/05/2020] [Accepted: 10/06/2020] [Indexed: 12/24/2022] Open
Abstract
Simple Summary Transurethral resection of bladder tumours may be technically challenging. Complexity was defined by consensus from the literature by a panel of ten senior urologists as “any TURBT/En-bloc dissection that results in incomplete resection and/or prolonged surgery (>1 h) and/or significant (Clavien-Dindo ≥ 3) perioperative complications”. Patient and tumour’s characteristics that suggested to by the panel to relate to complex surgery were collected and then ranked by Delphi consensus. They were tested in the prediction of complexity in 150 clinical scenarios. After univariate and logistic regression analyses, significant characteristics were organized into a checklist that predicts complexity. Receiver operating characteristics (ROC) curves of the regression model and the corresponding calibration curve showed adequate discrimination (AUC = 0.916) and good calibration. The resulting Bladder Complexity Checklist can be used to deliver optimal preoperative information and personalise the organisation of surgery. Abstract Ten senior urologists were interrogated to develop a predictive model based on factors from which they could anticipate complex transurethral resection of bladder tumours (TURBT). Complexity was defined by consensus. Panel members then used a five-point Likert scale to grade those factors that, in their opinion, drove complexity. Consensual factors were highlighted through two Delphi rounds. Respective contributions to complexity were quantitated by the median values of their scores. Multivariate analysis with complexity as a dependent variable tested their independence in clinical scenarios obtained by random allocation of the factors. The consensus definition of complexity was “any TURBT/En-bloc dissection that results in incomplete resection and/or prolonged surgery (>1 h) and/or significant (Clavien-Dindo ≥ 3) perioperative complications”. Logistic regression highlighted five domains as independent predictors: patient’s history, tumour number, location, and size and access to the bladder. Receiver operating characteristic (ROC) analysis confirmed good discrimination (AUC = 0.92). The sum of the scores of the five domains adjusted to their regression coefficients or Bladder Complexity Score yielded comparable performance (AUC = 0.91, C-statistics, p = 0.94) and good calibration. As a whole, preoperative factors identified by expert judgement were organized to quantitate the risk of a complex TURBT, a crucial requisite to personalise patient information, adapt human and technical resources to individual situations and address TURBT variability in clinical trials.
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Affiliation(s)
- Mathieu Roumiguié
- Department of Urology, Institut Universitaire du Cancer, 31059 Toulouse CEDEX 9, France;
| | | | - Antonin Brisuda
- Department of Urology, 2nd Faculty of Medicine, Charles University, Teaching Hospital Motol, 15006 Prague, Czech Republic; (A.B.); (M.B.)
| | - Maximillian Burger
- St. Josef, Klinik für Urologie, Caritas-Krankenhaus, 93053 Regensburg, Germany;
| | - Hugh Mostafid
- Department of Urology, Royal Surrey County Hospital, Surrey, Guildford GU2 7RF, UK;
| | - Marc Colombel
- Department of Urology, Hôpital Edouard Herriot, 69437 Lyon, France;
| | - Marek Babjuk
- Department of Urology, 2nd Faculty of Medicine, Charles University, Teaching Hospital Motol, 15006 Prague, Czech Republic; (A.B.); (M.B.)
| | | | - Fred Witjes
- Department of Urology, Radboud UMC, 6525 GA Nijmegen, The Netherlands;
| | - Bernard Malavaud
- Department of Urology, Institut Universitaire du Cancer, 31059 Toulouse CEDEX 9, France;
- Correspondence:
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Abstract
Transurethral resection of bladder cancer is a standard procedure in urology which requires complete resection. Knowledge of the possible complications and their management is essential for practicing urologists. The most common complications are catheter related bladder symptoms, bleeding, infections and perforation of the bladder. Resection of the orifice and positional damage are seldom but severe complications which need immediate treatment. In this review, we summarise the above mentioned complications as well as their management.
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Affiliation(s)
- David Mally
- Universitätsklinikum Düsseldorf, Klinik für Urologie, Düsseldorf
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Best Practices to Optimise Quality and Outcomes of Transurethral Resection of Bladder Tumours. Eur Urol Oncol 2020; 4:12-19. [PMID: 32684515 DOI: 10.1016/j.euo.2020.06.010] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 06/17/2020] [Accepted: 06/28/2020] [Indexed: 11/21/2022]
Abstract
CONTEXT Transurethral resection of bladder tumour (TURBT) for bladder cancer (BC) is an underappreciated common urological procedure. TURBT outcomes are highly variable, and results are dependent on judgement and surgical skill. OBJECTIVE To perform a narrative review and identify optimal best practice in TURBT including preparation, choice of equipment, procedural steps, surgical technique, and management of difficult scenarios and complications. EVIDENCE ACQUISITION Medline, Embase, and the Cochrane Central Register of Controlled Trials were searched. Important studies were identified and reviewed by an international panel of urologists representing major urological societies and guideline panels with a record of academic publication in this field. In areas where the group identified a lack of evidence or agreement, discussions took place until a consensus was reached. EVIDENCE SYNTHESIS A total of 814 studies were identified and 43 were included. The majority were retrospective (level of evidence 3), with only two prospective randomised trials. Four broad themes were identified, which formed the basis for the review: (1) the role of TURBT within the overall management of BC, (2) TURBT techniques, (3) measurement of outcomes including quality control and checklists, and (4) postoperative management. Familiarity with all aspects of the procedure is necessary to minimise morbidity and improve oncological outcomes. Development of new instruments and techniques, and prospective audit of TURBT outcomes are important future goals. CONCLUSIONS TURBT is a common and challenging operation with known variable outcomes. To reduce these variations and optimise outcomes, best practice based on evidence and expert opinion is recommended. PATIENT SUMMARY Transurethral resection of bladder tumour (TURBT) is a common but deceptively difficult urological operation. Optimal outcomes depend on experience and surgical skill. An international group of experienced TURBT surgeons review critical aspects of the procedure and share best practice to stimulate further discussion.
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Does bipolar energy provide any advantage over monopolar surgery in transurethral resection of non-muscle invasive bladder tumors? A systematic review and meta-analysis. World J Urol 2020; 39:1093-1105. [PMID: 32591900 DOI: 10.1007/s00345-020-03313-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Accepted: 06/16/2020] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVE To provide most recent and high quality evidence concerning the comparison between monopolar and bipolar transurethral resection of non-muscle invasive bladder tumors. MATERIALS AND METHODS Two researchers performed a systematic review of the current literature independently, to identify studies published in English language. MEDLINE, EMBASE and Cochrane Central Register of Controlled Trials and Cochrane Database of Systematic Reviews were searched from inception to 31st May 2019. The included primary endpoints of the study were: detrusor muscle sampling rates, cautery artifact occurrence among specimens and 1- or 2-year recurrence rates, overall complication rate, transfusion rate, obturator reflex and bladder perforation rates. Secondary endpoints were length of hospital stay, operation room time, hemoglobin drop, urinary tract infections, TUR-syndrome, serum sodium drop and acute urinary retention rates. RESULTS 23 studies (14 RCTs and 9 observational) were included for qualitative and quantitative synthesis, recruiting 9815 patients in monopolar resection group and 10,112 patients in bipolar resection group (experimental). We found significant differences in favor of bipolar energy in terms of cautery artifact and length of stay with bladder perforation rates were found to be significantly better in bipolar system even though these results did not sustain when RCT's only analysis was performed. No differences were found in rates of obturator reflex (even though RCT's analysis advised differently), tumor recurrence and most of the secondary endpoints. CONCLUSIONS Bipolar transurethral bladder tumor resection is as safe and efficient as its monopolar counterpart. Bipolar technology is related to less obturator nerve contractions and less tissue thermal artifacts during resection and may result in less hospital stay.
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Bipolar versus monopolar transurethral resection of non-muscle-invasive bladder cancer: a systematic review and meta-analysis of randomized controlled trials. World J Urol 2020; 39:1177-1186. [PMID: 32462303 DOI: 10.1007/s00345-020-03271-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Accepted: 05/18/2020] [Indexed: 02/05/2023] Open
Abstract
PURPOSE To compare the efficacy and safety of bipolar and monopolar transurethral resection of bladder tumors (TURBT) in non-muscle invasive bladder cancer (NMIBC) treatment. METHODS A systematic search of all Randomized Controlled Trials (RCTs), which compared bipolar TURBT (bTURBT) and monopolar TURBT (mTURBT) in NMIBC treatment, were performed in PubMed, Web of Science, Cochrane Library and Embase up to February 1, 2019. We evaluated their efficacy by operative time, hospitalization time, catheterization time, and recurrence rate. While obturator jerk, bladder perforation, thermal damage, and overall complications were used to evaluate their safety. RESULTS A total of 13 RCTs, involving 2379 patients, were included. There were no statistically significant differences in efficacy between bTURBT and mTURBT in NMIBC treatment, such as operative time (p = 0.12), hospitalization time (p = 0.13), catheterization time (p = 0.50), and recurrence rate (p = 0.88). Compared to the safety in mTURBT in NMIBC treatment, no significant advantages were observed in that in bTURBT as well, such as obturator jerk (p = 0.12), bladder perforation (p = 0.11), thermal damage (p = 0.24), and overall complications (p = 0.65). CONCLUSIONS Our analysis demonstrated that bTURBT has no significant advantages in efficacy and safety in NMIBC treatment compared to that in mTURBT. Thus, bTURBT could not completely replace mTURBT as a safer and more effective NMIBC treatment.
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Risk assessment of neuromuscular stimulation by energy-based transurethral resection devices: an ex vivo test standard. BMC Urol 2020; 20:59. [PMID: 32460737 PMCID: PMC7254752 DOI: 10.1186/s12894-020-00630-5] [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: 06/19/2019] [Accepted: 05/18/2020] [Indexed: 11/12/2022] Open
Abstract
Background During transurethral resection of bladder tumours (TURB), radio-frequency (RF) currents can lead to adverse neuromuscular stimulation (NMS). Here we present a novel ex vivo method to determine the risk of RF generators and their bipolar TURB modes to cause NMS. We aimed to develop an experimental platform for safety evaluation of new RF generators and their modes with a newly established test standard, suitable for replacement or reduction of animal testing. Methods We tested four contemporary RF generators with their bipolar modes for TURB in saline. A two-stage ex vivo approach was pursued: First, we recorded voltages at possible positions of the obturator nerve behind a porcine bladder wall in a TURB model using 18 RF applications per generator. Second, these voltage records were used as stimuli to evoke nerve compound action potentials (CAPs) in isolated porcine axillary nerves. The NMS potential was defined as the ratio between the observed area under the CAPs and the theoretical CAP area at maximum response and a firing rate of 250 Hz, which would reliably induce tetanic muscle responses in most human subjects. The measurement protocol was tailored to optimise reproducibility of the obtained NMS potentials and longevity of the nerve specimens. Results As prerequisite for the clinical translation of our results, the robustness of our test method and reproducibility of the NMS potential are demonstrated with an excellent correlation (r = 0.93) between two sets of identical stimuli (n = 72 each) obtained from 16 nerve segments with similar diameters (4.2 ± 0.37 mm) in the nerve model. The RF generators differed significantly (p < 0.0001) regarding NMS potential (medians: 0–3%). Conclusions Our test method is suitable for quantifying the NMS potential of different electrosurgical systems ex vivo with high selectivity at a reasonable degree of standardization and with justifiable effort. Our results suggest that the clinical incidence of NMS is considerably influenced by the type of RF generator. Future generations of RF generators take advantage from the proposed test standard through higher safety and less animal testing. Health professionals and treated patients will benefit most from improved RF surgery using generators with a low NMS risk.
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Sharma G, Sharma AP, Mavuduru RS, Bora GS, Devana SK, Singh SK, Mandal AK. Safety and efficacy of bipolar versus monopolar transurethral resection of bladder tumor: a systematic review and meta-analysis. World J Urol 2020; 39:377-387. [PMID: 32318856 DOI: 10.1007/s00345-020-03201-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Accepted: 04/03/2020] [Indexed: 10/24/2022] Open
Abstract
PURPOSE Transurethral resection of bladder tumor is the standard of care for the management of patients with bladder mass. Primary objective of this study was to compare safety and efficacy of the two energy modalities used for TURBT (monopolar and bipolar). MATERIALS AND METHODS Systematic literature search of various electronic databases was conducted to include all the randomized studies comparing two groups. Standard PRISMA (Preferred reporting Items for Systematic reviews and Meta-analysis) guidelines were pursued for this review and study protocol was registered with PROSPERO (CRD42019139987). RESULTS In the present review, eight RCTs including 1147 patients were included. Resection time, hospital stay and catheter duration were significantly shorter with bipolar group. There was no significant difference in incidence of obturator reflex (OR 0.65, CI [0.35, 1.2], p = 0.17), whereas incidence of bladder perforation was significantly higher in the monopolar group (6.4% versus 3.3%, p = 0.01. However, sensitivity analysis including 3 high quality studies revealed equal incidence of bladder perforations. Need for blood transfusion was similar in the two groups but fall in hemoglobin was significantly lower in bipolar group (MD - 0.45 CI [- 0.72, - 0.18], p = 0.0009). Bipolar group was found to have significantly lower incidence of tissue artifacts due to thermal energy on pathological examination (OR 0.27 CI [0.15, 0.47], p < 0.00001). CONCLUSIONS Bipolar and monopolar devices are equally safe in terms of obturator jerk and bladder perforation. Bipolar group was significantly better as compared to monopolar for hospital stay, catheter duration and fall in hemoglobin; however, the clinical relevance of most of these parameters is little.
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Affiliation(s)
- Gopal Sharma
- Department of Urology, Advance Urology Centre (B Block, Level II), PGIMER, Nehru Hospital Building, Chandigarh, 160012, India
| | - Aditya Prakash Sharma
- Department of Urology, Advance Urology Centre (B Block, Level II), PGIMER, Nehru Hospital Building, Chandigarh, 160012, India.
| | - Ravimohan S Mavuduru
- Department of Urology, Advance Urology Centre (B Block, Level II), PGIMER, Nehru Hospital Building, Chandigarh, 160012, India
| | - Girdhar Singh Bora
- Department of Urology, Advance Urology Centre (B Block, Level II), PGIMER, Nehru Hospital Building, Chandigarh, 160012, India
| | - Sudheer K Devana
- Department of Urology, Advance Urology Centre (B Block, Level II), PGIMER, Nehru Hospital Building, Chandigarh, 160012, India
| | - Shrawan K Singh
- Department of Urology, Advance Urology Centre (B Block, Level II), PGIMER, Nehru Hospital Building, Chandigarh, 160012, India
| | - Arup K Mandal
- Department of Urology, Advance Urology Centre (B Block, Level II), PGIMER, Nehru Hospital Building, Chandigarh, 160012, India
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Suarez-Ibarrola R, Hein S, Farin E, Waldbillig F, Kriegmair MC, Ritter M, Klingler HC, Herrmann TRW, Gratzke C, Miernik A. Current Standards in the Endoscopic Management of Bladder Cancer: A Survey Evaluation among Urologists in German-Speaking Countries. Urol Int 2020; 104:410-416. [PMID: 32209791 DOI: 10.1159/000506653] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Accepted: 02/17/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION To assess the current diagnostic, treatment, and documentation strategies for bladder cancer (BC) in German-speaking countries. MATERIALS AND METHODS A 14-item web-based survey was distributed among members of the German, Austrian, and Swiss Associations of Urology, addressing physicians who perform cystoscopies and transurethral resection of bladder tumors (TURB). RESULTS The survey was responded to by 308 of 5,564 urologists with a mean age of 49.5 years (response rate: 5.5%). The majority of participants (57.3%) practice in an outpatient setting. White light cystoscopy only is used by 60.2%, with additional photodynamic diagnosis and narrow band imaging by 36.8 and 12.5%, respectively. Endoscopic findings are documented in written form by 93.5%, followed by image capture (33.7%) and a central data archive (20.8%). Inpatient hospital urologists document cystoscopic findings by freehand drawing (21.4 vs. 11.4%, p = 0.017), and with a fixed bladder scheme (31.3 vs. 7.4%, <0.05) significantly more frequently. Cystoscopic findings are mainly conveyed to other health professionals in written form (77.4%), and significantly more often by inpatient urologists (p < 0.05). CONCLUSIONS Significant differences exist in the approach to documenting and communicating cystoscopic BC findings. Accurate graphic documentation of lesions, visualization of the mucosa's totality, and meticulous consultation of previous surgical reports require improvements to reduce recurrence and progression rates.
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Affiliation(s)
- Rodrigo Suarez-Ibarrola
- Department of Urology, Faculty of Medicine, University of Freiburg Medical Centre, Freiburg, Germany,
| | - Simon Hein
- Department of Urology, Faculty of Medicine, University of Freiburg Medical Centre, Freiburg, Germany
| | - Erik Farin
- Section of Health Care Research and Rehabilitation Research, University of Freiburg Medical Centre, Freiburg, Germany
| | - Frank Waldbillig
- Department of Urology, University Hospital Mannheim, Mannheim, Germany
| | | | - Manuel Ritter
- Department of Urology and Pediatric Urology, University Hospital Bonn, Bonn, Germany
| | - Hans C Klingler
- Department of Urology and Pediatric Urology, Wilhelminenspital, Vienna, Austria.,Department of Urology, Medical University of Vienna, Vienna, Austria
| | | | - Christian Gratzke
- Department of Urology, Faculty of Medicine, University of Freiburg Medical Centre, Freiburg, Germany
| | - Arkadiusz Miernik
- Department of Urology, Faculty of Medicine, University of Freiburg Medical Centre, Freiburg, Germany
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Poletajew S, Krajewski W, Gajewska D, Sondka-Migdalska J, Borowik M, Buraczyński P, Dzięgała M, Łykowski M, Przudzik M, Tukiendorf A, Woźniak R, Bar K, Jabłonowski Z, Roslan M, Słojewski M, Zdrojowy R, Radziszewski P, Dziobek K. Prediction of the risk of surgical complications in patients undergoing monopolar transurethral resection of bladder tumour - a prospective multicentre observational study. Arch Med Sci 2020; 16:863-870. [PMID: 32542089 PMCID: PMC7286316 DOI: 10.5114/aoms.2019.88430] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2019] [Accepted: 04/21/2019] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION The aim of the study was to identify predictors of surgical complications of transurethral resection of bladder tumour (TURBT). MATERIAL AND METHODS We prospectively recruited 983 consecutive patients undergoing TURBT within 7 months in six academic institutions. All patients were followed up from the surgery up to 30 days postoperatively with at least one telephone contact at the end of the observation. The primary study endpoint was any intra- or postoperative surgical complication. For the identification of predictors of complications, univariate and multivariate logistic regression models were used. Trial registration: ClinicalTrials.gov (NCT03029663). Registered 24 January 2017. RESULTS Surgical complications were noticed in 228 (23.2%) patients, including 83 (8.4%) patients with more than one complication and 33 cases of Clavien-Dindo grade 3 complications (3.3%). The most common in-hospital complications were bleeding (n = 139, 14.1%) and bladder perforation (n = 46, 4.7%). In a multivariate analysis, nicotine use, high ASA score, and the presence of high-grade tumour were the most significant predictors of high-grade complications. The stage of the disease was the strongest predictor of bleeding, while the presence of muscle in the specimen and resident surgeon were the strongest predictors for bladder perforation. CONCLUSIONS TURBT poses a significant risk of surgical complications, the majority of which are of low grade.
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Affiliation(s)
- Sławomir Poletajew
- Department of General, Oncological, and Functional Urology, Medical University of Warsaw, Warsaw, Poland
| | - Wojciech Krajewski
- Department of Urology and Oncological Urology, Wroclaw Medical University, Wroclaw, Poland
- Corresponding author: Wojciech Krajewski PhD, Department of Urology and Oncological Urology, Wrocław Medical University, 213 Borowska St, 50-556 Wrocław, Poland, Phone: +48 691 510 609, E-mail:
| | - Dominika Gajewska
- Department of Urology and Urological Oncology, Pomeranian Medical University, Szczecin, Poland
| | | | - Michał Borowik
- Department of Urology, University of Warmia and Mazury, Olsztyn, Poland
| | - Paweł Buraczyński
- Department of Urology and Urologic Oncology, Medical University of Lublin, Lublin, Poland
| | - Mateusz Dzięgała
- Department of Urology and Oncological Urology, Wroclaw Medical University, Wroclaw, Poland
| | - Marcin Łykowski
- Department of General, Oncological, and Functional Urology, Medical University of Warsaw, Warsaw, Poland
| | - Maciej Przudzik
- Department of Urology, University of Warmia and Mazury, Olsztyn, Poland
| | | | - Rafał Woźniak
- Chair of Statistics and Econometrics, Faculty of Economic Sciences, University of Warsaw, Warsaw, Poland
| | - Krzysztof Bar
- Department of Urology and Urologic Oncology, Medical University of Lublin, Lublin, Poland
| | | | - Marek Roslan
- Department of Urology, University of Warmia and Mazury, Olsztyn, Poland
| | - Marcin Słojewski
- Department of Urology and Urological Oncology, Pomeranian Medical University, Szczecin, Poland
| | - Romuald Zdrojowy
- Department of Urology and Oncological Urology, Wroclaw Medical University, Wroclaw, Poland
| | - Piotr Radziszewski
- Department of General, Oncological, and Functional Urology, Medical University of Warsaw, Warsaw, Poland
| | - Konrad Dziobek
- Maria Sklodowska-Curie Memorial Cancer Centre and Institute of Oncology, Krakow Branch, Krakow, Poland
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Technical developments in transurethral resection of bladder tumours. Contemp Oncol (Pozn) 2019; 23:195-201. [PMID: 31992950 PMCID: PMC6978765 DOI: 10.5114/wo.2019.91530] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Accepted: 08/04/2019] [Indexed: 11/26/2022] Open
Abstract
Bladder cancer is one of the most common malignancies worldwide. The transurethral resection of bladder tumour (TURB) remains the gold standard in both diagnostics and treatment. Because of the importance of TURB in bladder cancer management and the fact that TURB is one of the most commonly performed urologic procedures, it is the subject of continuous technological development. The latest advances in the field of endourology are aimed at increasing surgical accuracy and thus reducing the risk of bladder tumour recurrence and progression. However, despite the constant progress in technology and technique, there are still a lack of good quality data showing the superiority of any of the methods. The aim of this paper is to present available data on new technological developments in surgical technique of TURB. Advantages and disadvantages of currently available methods are discussed, and literature showing their effectiveness and safety is shown.
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Gunlusoy B, Bolat D, Degirmenci T. Re: “Monopolar vs. bipolar transurethral resection for nonmuscle invasive bladder carcinoma: A post hoc analysis from a randomized controlled trial”. Urol Oncol 2019; 37:177-178. [DOI: 10.1016/j.urolonc.2018.11.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Accepted: 11/14/2018] [Indexed: 10/27/2022]
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21
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NSQIP
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Indexed Complications Following Transurethral Bladder Tumor Resection and Contemporary Financial Implications. UROLOGY PRACTICE 2018. [DOI: 10.1016/j.urpr.2017.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Fernández MI, Brausi M, Clark PE, Cookson MS, Grossman HB, Khochikar M, Kiemeney LA, Malavaud B, Sanchez-Salas R, Soloway MS, Svatek RS, Vikram R, Vrieling A, Kamat AM. Epidemiology, prevention, screening, diagnosis, and evaluation: update of the ICUD-SIU joint consultation on bladder cancer. World J Urol 2018; 37:3-13. [PMID: 30105454 DOI: 10.1007/s00345-018-2436-y] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Accepted: 08/06/2018] [Indexed: 12/23/2022] Open
Abstract
PURPOSE To update current recommendations on prevention, screening, diagnosis, and evaluation of bladder cancer (BC) based on a thorough assessment of the most recent literature on these topics. METHODS A non-systematic review was performed, including articles until June 2017. A variety of original articles, reviews, and editorials were selected according to their epidemiologic, demographic, and clinical relevance. Assessment of the level of evidence and grade of recommendations was performed according to the International Consultation on Urological Diseases grading system. RESULTS BC is the ninth most common cancer worldwide with 430,000 new cases in 2012. Currently, approximately 165,000 people die from the disease annually. Absolute incidence and prevalence of BC are expected to rise significantly during the next decades because of population ageing. Tobacco smoking is still the main risk factor, accounting for about 50% of cases. Smoking cessation is, therefore, the most relevant recommendation in terms of prevention, as the risk of developing BC drops almost 40% within 5 years of cessation. BC screening is not recommended for the general population. BC diagnosis remains mainly based on cystoscopy, but development of new endoscopic and imaging technologies may rapidly change the diagnosis algorithm. The same applies for local, regional, and distant staging modalities. CONCLUSIONS A thorough understanding of epidemiology, risk factors, early detection strategies, diagnosis, and evaluation is essential for correct, evidence-based management of BC patients. Recent developments in endoscopic techniques and imaging raise the hope for providing better risk-adopted approaches and thereby improving clinical outcomes.
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Affiliation(s)
- Mario I Fernández
- Department of Urology, Clínica Alemana, Santiago, Chile.,Faculty of Medicine, Clínica Alemana Universidad del Desarrollo, Santiago, Chile
| | | | - Peter E Clark
- Department of Urology, Atrium Health, Levine Cancer Institute, Charlotte, NC, USA
| | - Michael S Cookson
- Department of Urology, The University of Oklahoma Health Sciences Center & The Stephenson Cancer Center, Oklahoma City, OK, USA
| | - H Barton Grossman
- Department of Urology, Unit 1373, The University of Texas MD Anderson Cancer Center, 1155 Pressler, Houston, TX, 77030, USA
| | - Makarand Khochikar
- Department of Urology, Siddhi Vinayak Ganapati Cancer Hospital, Miraj, India
| | - Lambertus A Kiemeney
- Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Bernard Malavaud
- Department of Urology, Toulouse Cancer Institute, Toulouse, France
| | | | - Mark S Soloway
- Department of Urology, Memorial Healthcare System, Miami, FL, USA
| | - Robert S Svatek
- Department of Urology, University of Texas Health, San Antonio, TX, USA
| | - Raghunandan Vikram
- Department of Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Alina Vrieling
- Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Ashish M Kamat
- Department of Urology, Unit 1373, The University of Texas MD Anderson Cancer Center, 1155 Pressler, Houston, TX, 77030, USA.
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Bolat D, Gunlusoy B, Aydogdu O, Aydin ME, Dincel C. Comparing the short - term outcomes and complications of monopolar and bipolar transurethral resection of bladder tumors in patients with coronary artery disese: a prospective, randomized, controlled study. Int Braz J Urol 2018; 44:717-725. [PMID: 29617081 PMCID: PMC6092640 DOI: 10.1590/s1677-5538.ibju.2017.0309] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Accepted: 01/28/2018] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION To compare the perioperative outcomes and complications of monopolar and bipolar transurethral resection of bladder tumors (TURBT) in patients with coronary artery disease (CAD). MATERIALS AND METHODS A total of 90 CAD patients with newly diagnosed bladder cancer who underwent TURBT were randomized into monopolar TURBT (M-TURBT) and bipolar TURBT (B-TURBT) groups. Primary outcome was safety of the procedures including obturator jerk, bladder perforation, clot retention, febrile urinary tract infection and TUR syndrome. The secondary outcome was the efficacy of TURBT procedures, including complete tumor resection, sampling of the deep muscle tissue and sampling of the qualified tissues without any thermal damage. RESULTS Mean ages of the patients in M-TURBT and B-TURBT groups were 71.36±7.49 and 73.71±8.15 years, respectively (p=0.157). No significant differences were found between M-TURBT and B-TURBT groups regarding complete tumor resection (76.2% vs. 87.5%, p=0.162) and muscle tissue sampling rates (71.4% vs. 64.6%,p=0.252). Obturator jerk was detected in 16.7% of the patients in M-TURBT group and 2.1% in B-TURBT group (p=0.007). No statistically significant differences were found between the groups regarding intraoperative and postoperative complications. CONCLUSIONS Both monopolar and bipolar systems can be used safely and effectively during TURBT procedure in CAD patients. Due to the more frequently seen obturator jerk in M-TURBT than B-TURBT, careful surgical approach is needed during M-TURBT.
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Affiliation(s)
- Deniz Bolat
- Department of Urology, Bozyaka Training and Research Hospital, Izmir, Turkey
| | - Bulent Gunlusoy
- Department of Urology, Bozyaka Training and Research Hospital, Izmir, Turkey
| | - Ozgu Aydogdu
- Department of Urology, Bozyaka Training and Research Hospital, Izmir, Turkey
| | - Mehmet Erhan Aydin
- Department of Urology, Bozyaka Training and Research Hospital, Izmir, Turkey
| | - Cetin Dincel
- Department of Urology, Bozyaka Training and Research Hospital, Izmir, Turkey
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Liem EI, McCormack M, Chan ES, Matsui Y, Geavlete P, Choi YD, de Reijke TM, Farahat Y, Inman BA, de la Rosette JJ, Naito S. Monopolar vs. bipolar transurethral resection for non–muscle invasive bladder carcinoma: A post-hoc analysis from a randomized controlled trial. Urol Oncol 2018; 36:338.e1-338.e11. [DOI: 10.1016/j.urolonc.2018.03.015] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Revised: 02/28/2018] [Accepted: 03/19/2018] [Indexed: 01/08/2023]
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25
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Transurethral resection of bladder cancer on the lateral bladder wall without obturator nerve block: extent of adductor spasms using the monopolar versus bipolar technique—a prospective randomised study. World J Urol 2018; 36:1085-1091. [DOI: 10.1007/s00345-018-2248-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2017] [Accepted: 02/20/2018] [Indexed: 11/25/2022] Open
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26
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Chang TC, Marcq G, Kiss B, Trivedi DR, Mach KE, Liao JC. Image-Guided Transurethral Resection of Bladder Tumors - Current Practice and Future Outlooks. Bladder Cancer 2017; 3:149-159. [PMID: 28824942 PMCID: PMC5545914 DOI: 10.3233/blc-170119] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Transurethral resection of bladder tumor (TURBT) under white light cystoscopy (WLC) is the cornerstone for the diagnosis, removal and local staging of non-muscle invasive bladder cancer (NMIBC). Despite technological improvements over the decades, significant shortcomings remain with WLC for tumor detection, thereby impacting the surgical quality and contributing to tumor recurrence and progression. Enhanced cystoscopy modalities such as blue light cystoscopy (BLC) and narrow band imaging (NBI) aid resections by highlighting tumors that might be missed on WLC. Optical biopsy technologies such as confocal laser endomicroscopy (CLE) and optical coherence tomography (OCT) characterize tissue in real-time to ensure a more thorough resection. New resection techniques, particularly en bloc resection, are actively under investigation to improve the overall quality of resections and aid pathologic interpretation. Moreover, new image processing computer algorithms may improve perioperative planning and longitudinal follow-up. Clinical translation of molecular imaging agents is also on the horizon to improve optical diagnosis of bladder cancer. This review focuses on emerging technologies that can impact the quality of TURBT to improve the overall management of NMIBC.
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Affiliation(s)
- Timothy C Chang
- Department of Urology, Stanford University School of Medicine, Stanford, CA, USA.,Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
| | - Gautier Marcq
- Department of Urology, Stanford University School of Medicine, Stanford, CA, USA.,Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
| | - Bernhard Kiss
- Department of Urology, Stanford University School of Medicine, Stanford, CA, USA.,Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
| | - Dharati R Trivedi
- Department of Urology, Stanford University School of Medicine, Stanford, CA, USA.,Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
| | - Kathleen E Mach
- Department of Urology, Stanford University School of Medicine, Stanford, CA, USA.,Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
| | - Joseph C Liao
- Department of Urology, Stanford University School of Medicine, Stanford, CA, USA.,Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
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27
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Avallone MA, Sack BS, El-Arabi A, Charles DK, Herre WR, Radtke AC, Davis CM, See WA. Ten-Year Review of Perioperative Complications After Transurethral Resection of Bladder Tumors: Analysis of Monopolar and Plasmakinetic Bipolar Cases. J Endourol 2017; 31:767-773. [PMID: 28557554 DOI: 10.1089/end.2017.0056] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES To evaluate the rate of perioperative complications after plasmakinetic bipolar and monopolar transurethral resection of bladder tumor (BTURB and MTURB). In addition, the study identifies patient and procedure characteristics associated with early complications. PATIENTS AND METHODS Retrospective review was conducted on patients undergoing transurethral resection of bladder tumor procedures at a single institution from 2003 to 2013 to assess the 30-day complication rates associated with BTURB and MTURB. RESULTS Four hundred twenty-seven patients met inclusion criteria and underwent 586 procedures (379 BTURB and 207 MTURB). Baseline patient demographics, tumor stage, and tumor grade were similar in BTURB and MTURB cohorts. The overall complication rate was 34.3% for MTURB and 26.7% for BTURB. The most frequent complications were acute urinary retention (AUR) 11%, hematuria 8%, and urinary tract infection (UTI) 7%. There was no statistical difference in rates of AUR, hematuria, UTI, or readmission for continuous bladder irrigation or hemostasis procedures between BTURB and MTURB cohorts. There was a trend toward lower perforation rate during BTURB (2.6% vs 5.8%). In multivariate logistic regression analysis, MTURB, male gender, and large resections were predictive of overall complications. Male gender was associated with hematuria and AUR. Large bladder tumor resection size was also associated with increased risk of overall complications and AUR. CONCLUSION BTURB was associated with a lower risk of overall complications, but there was no difference in the rate of hematuria in the two cohorts. Male gender and large tumor size are associated with higher risk of early complications.
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Affiliation(s)
- Michael A Avallone
- Department of Urology, Medical College of Wisconsin , Milwaukee, Wisconsin
| | - Bryan S Sack
- Department of Urology, Medical College of Wisconsin , Milwaukee, Wisconsin
| | - Ahmad El-Arabi
- Department of Urology, Medical College of Wisconsin , Milwaukee, Wisconsin
| | - David K Charles
- Department of Urology, Medical College of Wisconsin , Milwaukee, Wisconsin
| | - William R Herre
- Department of Urology, Medical College of Wisconsin , Milwaukee, Wisconsin
| | - Andrew C Radtke
- Department of Urology, Medical College of Wisconsin , Milwaukee, Wisconsin
| | - Carley M Davis
- Department of Urology, Medical College of Wisconsin , Milwaukee, Wisconsin
| | - William A See
- Department of Urology, Medical College of Wisconsin , Milwaukee, Wisconsin
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28
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Zainfeld D, Daneshmand S. Transurethral Resection of Bladder Tumors: Improving Quality Through New Techniques and Technologies. Curr Urol Rep 2017; 18:34. [PMID: 28283914 DOI: 10.1007/s11934-017-0680-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/05/2023]
Abstract
PURPOSE OF REVIEW Cystoscopy with transurethral resection of bladder tumors (TURBT) is essential in the diagnosis of bladder cancer as well as the management of non-muscle-invasive disease yet remains a comparatively imprecise procedure secondary to variability among patients, tumors, and surgeons alike. We will review evolving technologies and techniques used to enhance safety and efficacy of TURBT performance and education in the management of bladder cancer. RECENT FINDINGS Though a generally safe procedure, efficacy of TURBT in terms of complete tumor excision, appropriate pathologic diagnosis, and absence of complications can vary significantly with direct impact on patient outcomes. Application of new techniques including bipolar electrocautery and photodynamic enhancement continues to shape endoscopic management of bladder cancer and improve safety, tumor excision rates, and downstream outcomes. High-quality bladder tumor resection is essential for effective bladder cancer management. Technologies such as bipolar electrocautery and photodynamic visualization improve safety and tumor eradication. Improved education and surgical technique will further standardize high-level outcomes for patients undergoing TURBT.
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Affiliation(s)
- Daniel Zainfeld
- USC Norris Comprehensive Cancer Center, 1441 Eastlake Avenue, Suite 7416, Los Angeles, CA, 90089, USA
| | - Siamak Daneshmand
- USC Norris Comprehensive Cancer Center, 1441 Eastlake Avenue, Suite 7416, Los Angeles, CA, 90089, USA.
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29
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Can we improve transurethral resection of the bladder tumour for nonmuscle invasive bladder cancer? Curr Opin Urol 2017; 27:149-155. [DOI: 10.1097/mou.0000000000000370] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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30
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Malmström PU, Agrawal S, Bläckberg M, Boström PJ, Malavaud B, Zaak D, Hermann GG. Non-muscle-invasive bladder cancer: a vision for the future. Scand J Urol 2017; 51:87-94. [PMID: 28535714 DOI: 10.1080/21681805.2017.1283359] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The management of non-muscle-invasive bladder cancer (NMIBC) has evolved from the first reports on bladder endoscopy and transurethral resection to the introduction of adjuvant intravesical treatment. However, disease recurrence and progression remain an ongoing risk, placing a heavy burden on healthcare resources and on patients' quality of life. Deeper understanding of the molecular basis of the disease and developments in optics, lasers and computer science are already offering opportunities to revolutionize care and improve long-term prognosis. This article discusses developments likely to cause a paradigm shift towards the delivery of personalized care and reduced burden of disease in NMIBC.
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Affiliation(s)
- Per-Uno Malmström
- a Department of Urology, Division of Surgical Sciences , Uppsala University , Uppsala , Sweden
| | - Sachin Agrawal
- b Department of Urology, Ashford & St Peter's NHS Trust , St Peter's Hospital , Chertsey , UK
| | - Mats Bläckberg
- c Department of Urology and Surgery , Helsingborg Hospital , Helsingborg , Sweden
| | - Peter J Boström
- d Department of Urology , Turku University Hospital , Turku , Finland
| | - Bernard Malavaud
- e Department of Urology , Toulouse Cancer Institute , Toulouse , France
| | - Dirk Zaak
- f Department of Urology , Traunstein Hospital , Traunstein , Germany
| | - Gregers G Hermann
- g Department of Urology , Herlev & Gentofte Hospital, University of Copenhagen , Herlev , Denmark
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31
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Liu Z, Tian Q, Xia S, Yin H, Yao D, Xiu Y. Evaluation of the improved tubeless cutaneous ureterostomy technique following radical cystectomy in cases of invasive bladder cancer complicated by peritoneal metastasis. Oncol Lett 2016; 11:1401-1405. [PMID: 26893750 PMCID: PMC4734275 DOI: 10.3892/ol.2015.4045] [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: 11/02/2015] [Accepted: 12/21/2015] [Indexed: 12/02/2022] Open
Abstract
Radical cystectomy, as the most common surgical treatment for patients with invasive bladder cancer (IBC) complicated by peritoneal metastasis, is usually accompanied by a urinary diversion procedure. In this study, we evaluated the improved tubeless cutaneous ureterostomy technique by comparing the resulting clinical effects with either a traditional ureterostomy and an ileal conduit urinary diversion. Clinical data from 85 patients who underwent 1 of the 3 procedures between April 2012 and April 2015 were analyzed retrospectively. In total, 30 patients underwent improved tubeless cutaneous ureterostomy, 28 patients underwent a traditional cutaneous ureterostomy and 27 underwent an ileal conduit urinary diversion following radical cystectomy. The incidence of complications, including stoma infection, nipple atrophy, terminal necrosis, urine leakage, external orifice stenosis, uronephrosis and ureterectasia in the group of patients treated with the improved tubeless ureterostomy technique was significantly lower than that of the patients in the other 2 groups, and the difference was statistically significant (P<0.05). In addition, the duration of the surgery, intra-operative bleeding, the duration of the hospitalization period and the time to extubation in the patients treated with the improved tubeless ureterostomy technique were significantly decreased (P<0.05) compared with the patients in the other 2 groups. Finally, the health-related quality of life of the patients treated with the improved tubeless ureterostomy technique was significantly higher (P<0.05) than that of the patients in the other 2 groups. The findings of our study demonstrated that the use of the improved tubeless cutaneous ureterostomy technique following radical cystectomy in patients with IBC complicated by peritoneal metastasis resulted in improved clinical effects. Thus, improved tubeless cutaneous ureterostomy may be a promising alternative for enhancing the quality of life of patients with IBC.
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Affiliation(s)
- Zan Liu
- Department of Urology, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang 150001, P.R. China
| | - Qiuye Tian
- Department of Human Resources, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang 150001, P.R. China
| | - Shunyao Xia
- Department of Urology, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang 150001, P.R. China
| | - Huaifu Yin
- Department of Urology, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang 150001, P.R. China
| | - Dayong Yao
- Department of Urology, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang 150001, P.R. China
| | - Youcheng Xiu
- Department of Urology, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang 150001, P.R. China
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