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Petov V, Timofeeva E, Sukhanov R, Baniel J, Mustafin M, Fajkovic H, Morozov A, Teoh JY, Singla N, Laukhtina E, Herrmann TR, Shariat SF, Enikeev D. Prospective non-randomized comparison of transurethral laser en bloc resection vs. conventional resection of bladder tumors larger than 3 cm. Minerva Urol Nephrol 2024; 76:436-441. [PMID: 39051891 DOI: 10.23736/s2724-6051.24.05682-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/27/2024]
Abstract
BACKGROUND En bloc resection of bladder tumor (ERBT) is an established surgical treatment method for patients with non-muscle invasive bladder cancer (NMIBC) in tumors less than 3 cm. Data regarding the efficacy and safety of ERBT on larger than 3 cm tumors are sparse and its efficacy compared to conventional transurethral resection (TURBT) remains unclear. The aim of this study was to prospectively compare the feasibility, safety and oncological outcomes of laser (Tm-fiber) ERBT and TURBT in patients with primary bladder lesions ≥3 cm. METHODS A cohort of 45 patients who underwent surgery for primary NMIBC between February 2018 and March 2022 was collected prospectively. There was no randomization. All procedures were performed by two experienced surgeons. Inclusion criteria were as follows: age >18 years, primary Ta or T1 bladder tumor with a diameter of ≥3 cm, no more than 3 tumors and no history of upper tract urothelial carcinoma. Exclusion criteria were carcinoma in situ or invasion into muscle layer (≥T2). ERBT was performed with thulium fiber laser (IPG, Russia). Primary endpoints included efficacy with recurrence-free survival (RFS) at 3, 6 and 12 months. Secondary endpoints were safety parameters, perioperative data and specimen quality (the presence of muscle layer in specimens). RESULTS Twenty-eight patients underwent laser ERBT and 17 conventional TURBT. The location and size of the tumors were comparable in both groups. The success rate was 93.3% in the ERBT group with two cases of conversion from ERBT to TURBT. Detrusor muscle was present in 92.8% patients in the ERBT group versus 70.5% in the TURBT group (P=0.04). Obturator nerve reflex was observed only in the TURBT group: 17.6% vs. 0.0% (P=0.02). The frequency of other complications was comparable between the two groups. RFS was not statistically different between the two methods at 3 (93.9% vs. 94.1%, P=0.87), 6 (89.3% vs. 82.3%, P=0.5) and 12 months (89.3% vs. 70.6%, P=0.11). CONCLUSIONS Laser ERBT is a feasible and safe procedure to manage bladder tumors larger than 3 cm. While it seems safer than TURBT, its effect on efficacy remains to be assessed in larger trials.
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Affiliation(s)
- Vladislav Petov
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia -
| | - Ekaterina Timofeeva
- Institute for Clinical Medicine Named After N.V. Sklifosovsky, Sechenov University, Moscow, Russia
| | - Roman Sukhanov
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
| | - Jack Baniel
- Division of Urology, Rabin Medical Center, Petah Tikva, Israel
- Sackler Faculty of Medicine, University of Tel Aviv, Tel Aviv, Israel
| | - Mansur Mustafin
- Institute for Clinical Medicine Named After N.V. Sklifosovsky, Sechenov University, Moscow, Russia
| | - Harun Fajkovic
- Department of Urology and Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
- Karl Landsteiner Institute of Urology and Andrology, Vienna, Austria
| | - Andrey Morozov
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
| | - Jeremy Y Teoh
- Department of Surgery, S.H. Ho Urology Center, Chinese University of Hong Kong, Hong Kong, China
| | - Nirmish Singla
- Brady Urological Institute, School of Medicine, Johns Hopkins Medicine, Baltimore, MD, USA
| | - Ekaterina Laukhtina
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
- Department of Urology and Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Thomas R Herrmann
- Urology Spital Thurgau AG, Frauenfeld, Switzerland
- Hannover Medical Scholl MHH, Hannover, Germany
- Stellenbosch University Western Cape, Stellenbosch, South Africa
| | - Shahrokh F Shariat
- Department of Urology and Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
- Karl Landsteiner Institute of Urology and Andrology, Vienna, Austria
- Department of Urology, Weill Cornell Medical College, New York, NY, USA
- Department of Urology, University of Texas Southwestern, Dallas, TX, USA
- Department of Urology, Second Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Dmitry Enikeev
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
- Division of Urology, Rabin Medical Center, Petah Tikva, Israel
- Department of Urology and Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
- Karl Landsteiner Institute of Urology and Andrology, Vienna, Austria
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Taoka R, Sugimoto M. A surgical checklist for optimizing the quality and outcomes of transurethral resection of bladder tumors: A literature review. Int J Urol 2024; 31:846-851. [PMID: 38700051 DOI: 10.1111/iju.15480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Accepted: 04/15/2024] [Indexed: 05/05/2024]
Abstract
To preserve the bladder without compromising survival, further treatments need to be optimized to prevent the recurrence and progression of non-muscle invasive bladder cancer. In clinical practice, transurethral resection of bladder tumors is essential for bladder cancer management. The primary goal of surgery is to achieve accurate pathological evaluation and complete resection of bladder cancer; high resection quality is required for the procedure. A representative surrogate indicator of the resection quality is the presence of the detrusor muscle in the resection specimen. Therefore, complete visual resection of bladder cancer with a muscle layer is crucial for decreasing the recurrence and progression rates of non-muscle-invasive bladder cancer. However, this procedure is complex and requires sufficient experience and knowledge to be performed thoroughly, safely, and efficiently. Surgical checklists represent an approach to filling the knowledge and experience gaps and improving the quality and safety of surgery. By checking items during transurethral resection, it is expected that the recording of risk factors related to recurrence and progression will improve, the rate of visually complete resection with muscles will increase, and the rate of intravesical recurrence will decrease. The simplicity of checklists is an additional benefit. In recent years, surgical checklists have received increasing attention in order to achieve high-quality resections and reduce disparities between surgeons and institutions. This literature review outlines the evolving treatment strategies for patients with non-muscle-invasive bladder cancer, focusing on surgical checklists for the transurethral resection of bladder tumors.
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Affiliation(s)
- Rikiya Taoka
- Department of Urology, Faculty of Medicine, Kagawa University, Kagawa, Japan
| | - Mikio Sugimoto
- Department of Urology, Faculty of Medicine, Kagawa University, Kagawa, Japan
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Herrmann J, Hartung FO, Kriegmair MC, Becker B, Lusuardi L, Herrmann TRW, Netsch C. [Should we all switch to en-bloc resection of bladder tumours?]. Aktuelle Urol 2024; 55:250-254. [PMID: 38653465 DOI: 10.1055/a-2252-0237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2024]
Abstract
In En-Bloc Resection of Bladder Tumours (ERBT), tumours are not removed in fragments, but are dissected in one layer and, if possible, extracted in one piece. This method represents a significant shift in the surgical management of non-muscle-invasive bladder tumours, providing multiple benefits over the traditional transurethral resection of the bladder (TUR-B). The histological analysis of ERBT specimens is more accurate, enhancing diagnostic precision. Additionally, the presence of detrusor muscle in ERBT specimens is more frequent, indicating a more complete removal of the tumours. Recent years have seen the consolidation of a robust evidence base emphasizing the advantages of ERBT. Notably, a multicentric, prospective randomized trial has recently revealed a significant reduction in recurrence rates at 12 months follow-up compared with TUR-B. Experienced endourologists should explore this technique, as it may soon become the standard of care. The technique's elegance and effectiveness make it too important to be ignored.
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Affiliation(s)
- Jonas Herrmann
- Urologie und Urochirurgie, Universitätsklinikum Mannheim, Mannheim, Germany
| | | | | | - Benedikt Becker
- Abteilung für Urologie, Asklepios Klinik Barmbek, Hamburg, Germany
| | - Lukas Lusuardi
- Urologie, Paracelsus Medizinische Privatuniversität, Salzburg, Austria
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Gercek O, Keles I, Saritas TB, Koyuncu B, Topal K, Demirbas A. Effect of obturator nerve block during transurethral resection of bladder tumors on the disease recurrence, progression and surgery outcomes. Int Urol Nephrol 2023; 55:2765-2772. [PMID: 37531039 DOI: 10.1007/s11255-023-03727-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 07/25/2023] [Indexed: 08/03/2023]
Abstract
OBJECTIVE In our study, we aimed to evaluate the effect of the obturator nerve block (ONB) on the operation time, duration of hospital stay, complete resection, presence of muscle tissue in the pathology, second resection, recurrence, and progression, when applied in addition to spinal anesthesia in patients with primary bladder lateral wall tumor and Transurethral Resection of Bladder Tumor (TURBT) was planned. MATERIALS AND METHODS Seventy patients with bladder lateral wall tumors were included in the study. In addition, ONB was applied to 35 of the patients who underwent spinal anesthesia. The two groups were compared in terms of obturator reflex development, perforation, complete resection, presence of muscle tissue in pathology samples, need for second resection, need for second resection due to inadequate muscle tissue, and 1 year recurrence and progression rates. RESULTS When the two groups were compared for obturator reflex and bladder perforation, both were found to be lower in the ONB group (p = 0.002, p = 0.198, respectively). The rate of complete resection and the presence of muscle tissue in the pathology samples were higher in the ONB group (p = 0.045, p = 0.034, respectively). The rates of second resection and second resection due to inadequate muscle tissue were found to be higher in the group without ONB (p = 0.015, p = 0.106, respectively). In the 1-year follow-up, the recurrence rate was significantly lower in the ONB group (p < 0.001), while there was no significant difference between the progression rates (p = 0.106). CONCLUSION In our study, we found out that ONB applied in addition to spinal anesthesia increases the rate of complete and muscle tissue resection by decreasing the obturator reflex, and causes a significant reduction in the need for second resection and tumor recurrence.
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Affiliation(s)
- O Gercek
- Department of Urology, Afyonkarahisar Health Sciences University, Afyonkarahisar, Turkey.
| | - I Keles
- Department of Urology, Afyonkarahisar Health Sciences University, Afyonkarahisar, Turkey
| | - T B Saritas
- Department of Anesthesiology and Reanimation, Afyonkarahisar Health Sciences University, Afyonkarahisar, Turkey
| | - B Koyuncu
- Department of Anesthesiology and Reanimation, Afyonkarahisar Health Sciences University, Afyonkarahisar, Turkey
| | - K Topal
- Department of Urology, Afyonkarahisar State Hospital, Afyonkarahisar, Turkey
| | - A Demirbas
- Department of Urology, Bursa Doruk Hospital, Bursa, Turkey
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Volz Y, Trappmann R, Ebner B, Eismann L, Pyrgidis N, Pfitzinger P, Bischoff R, Schlenker B, Stief C, Schulz GB. Absence of detrusor muscle in TUR-BT specimen - can we predict who is at highest risk? BMC Urol 2023; 23:106. [PMID: 37287055 DOI: 10.1186/s12894-023-01278-7] [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: 02/21/2023] [Accepted: 05/25/2023] [Indexed: 06/09/2023] Open
Abstract
INTRODUCTION As a high-quality TUR-BT is important to ensure adequate treatment for bladder cancer patients, the aim of the current study is to investigate the impact of patient-related, surgical and tumor-specific parameters on detrusor muscle (DM) absence (primary objective) and to assess the impact of DM on the prognosis after a TUR-BT (secondary objective). PATIENTS AND METHODS Transurethral resection of bladder tumors (TUR-BTs) between 2009 and 2021 were retrospectively screened (n = 3237). We included 2058 cases (1472 patients) for the primary and 472 patients for secondary objective. Clinicopathological variables including tumor size, localization, multifocality, configuration, operation time and skill-level of the urologist were assessed. We analyzed predictors for missing DM and prognostic factors for recurrence-free survival (RFS) for the complete cohort and subgroups. RESULTS DM was present in 67.6% (n = 1371/2058). Surgery duration (continuous, minutes) was an independent predictor for absence of DM in the complete cohort (OR:0.98, r:0.012, 95%CI:0.98-0.99, p = 0.001). Other significant risk factors for missing DM were papillary tumors (OR:1.99, r:0.251, 95%CI:1.22-3.27, p = 0.006) in the complete cohort and bladder-roof and posterior-bladder-wall localization for re-resections. Absence of DM in high-grade BC correlated with reduced RFS (HR:1.96, 95%CI:1.0-3.79, p = 0.045). CONCLUSION Sufficient time for a TUR-BT is mandatory to assure DM in the TUR-BT specimen. Also, cases with more difficult locations of bladder tumors should be performed with utmost surgical diligence and endourological training should incorporate how to perform such operations. Of note, DM correlates with improved oncological prognosis in high-grade BC.
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Affiliation(s)
- Yannic Volz
- Department of Urology, Ludwig-Maximilian-University Hospital , Munich, Germany.
| | - Rabea Trappmann
- Department of Urology, Ludwig-Maximilian-University Hospital , Munich, Germany
| | - Benedikt Ebner
- Department of Urology, Ludwig-Maximilian-University Hospital , Munich, Germany
| | - Lennert Eismann
- Department of Urology, Ludwig-Maximilian-University Hospital , Munich, Germany
| | - Nikolaos Pyrgidis
- Department of Urology, Ludwig-Maximilian-University Hospital , Munich, Germany
| | - Paulo Pfitzinger
- Department of Urology, Ludwig-Maximilian-University Hospital , Munich, Germany
| | - Robert Bischoff
- Department of Urology, Ludwig-Maximilian-University Hospital , Munich, Germany
| | - Boris Schlenker
- Department of Urology, Ludwig-Maximilian-University Hospital , Munich, Germany
| | - Christian Stief
- Department of Urology, Ludwig-Maximilian-University Hospital , Munich, Germany
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Pham MN, Ko OS, Huang R, Vo AX, Tsai KP, Lai JD, Hudnall MT, Halpern JA, Meeks JJ, Benson J, Soares R, Kim R, Bilimoria KY, Stulberg JJ, Auffenberg GB. An Evaluation of Peer-Rated Surgical Skill and its Relationship With Detrusor Muscle Sampling in Transurethral Resection of Bladder Tumor. Urology 2022; 169:134-140. [PMID: 36049631 PMCID: PMC10099284 DOI: 10.1016/j.urology.2022.07.057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Revised: 06/10/2022] [Accepted: 07/10/2022] [Indexed: 10/14/2022]
Abstract
OBJECTIVE To assess the reliability of peer-review of TURBT videos as a means to evaluate surgeon skill and its relationship to detrusor sampling. METHODS Urologists from an academic health system submitted TURBT videos in 2019. Ten blinded peers evaluated each surgeon's performance using a 10-item scoring instrument to quantify surgeon skill. Normalized composite skill scores for each surgeon were calculated using peer ratings. For surgeons submitting videos, we retrospectively reviewed all TURBT pathology results (2018-2019) to assess surgeon-specific detrusor sampling. A hierarchical logistic regression model was fit to evaluate the association between skill and detrusor sampling, adjusting for patient and surgeon factors. RESULTS Surgeon skill scores and detrusor sampling rates were determined for 13 surgeons performing 245 TURBTs. Skill scores varied from -6.0 to 5.1 [mean: 0; standard deviation (SD): 2.40]. Muscle was sampled in 72% of cases, varying considerably across surgeons (mean: 64.5%; SD: 30.7%). Among 8 surgeons performing >5 TURBTs during the study period, adjusted detrusor sampling rate was associated with sending separate deep specimens (odds ratio [OR]: 1.97; 95% confidence interval [CI]: 1.02-3.81, P = .045) but not skill (OR: 0.81; 95% CI: 0.57-1.17, P = .191). CONCLUSION Surgeon skill was not associated with detrusor sampling, suggesting there may be other drivers of variability of detrusor sampling in TURBT.
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Affiliation(s)
- Minh N Pham
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Oliver S Ko
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Reiping Huang
- Surgical Outcomes and Quality Improvement Center, Feinberg School of Medicine, Chicago, IL
| | - Amanda X Vo
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Kyle P Tsai
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Jeremy D Lai
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Matthew T Hudnall
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Joshua A Halpern
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL; Surgical Outcomes and Quality Improvement Center, Feinberg School of Medicine, Chicago, IL
| | - Joshua J Meeks
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Jonas Benson
- Northwestern Medicine Central DuPage Hospital, Winfield, IL; Northwestern Medicine Delnor Hospital, Geneva, IL; UroPartners LLC, Winfield, IL
| | - Ricardo Soares
- Department of Urology, Northwestern Medicine Kishwaukee Hospital, DeKalb, IL
| | - Ronald Kim
- Northwestern Medicine Lake Forest Hospital, Lake Forest, IL; UroPartners LLC, Lake Forest, IL
| | - Karl Y Bilimoria
- Surgical Outcomes and Quality Improvement Center, Feinberg School of Medicine, Chicago, IL
| | - Jonah J Stulberg
- Department of Surgery, University of Texas Health Science Center at Houston, Houston, TX
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Ippoliti S, Bhatt NR, Ilie CP. Transurethral resection of bladder tumour (TURBT) as a day-case: A real-world practice and patients’ perspective from a district general hospital (DGH). Urologia 2022; 90:68-74. [PMID: 35819224 DOI: 10.1177/03915603221110177] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Introduction: Day-case transurethral resection of bladder tumour (TURBT) is currently only performed in 18% cases across the United Kingdom. To determine 30-day readmission rate and morbidity after day-case TURBT in a district general hospital (DGH) and to report patient demographics, quality of TURBT and early recurrence rate as well as patient feedback after day-case TURBT. Methods: A retrospective audit of day-case TURBTs over a 3-year pre-COVID19 (2017–20) was performed. We only included patients who underwent a TURBT and excluded any cystoscopy and biopsy or fulguration. A day-case TURBT pathway is in place in this centre. Feedback was obtained using hospital patient feedback forms. Results: We included 77 patients who underwent TURBT in the day-case theatre, of these 5 patients required in-patient stay after the surgery. Of the remaining 72 discharged on the same day, 8 were re-admitted (11%) for Clavien-Dindo I complications. The readmission/failed discharge group had a higher rate of older patients, with higher ASA scores and longer operative times, however resection quality and tumour characteristics were not different from the day-case TURBTs. All patients reported an overall positive experience (good or very good). Conclusions: In the first of its kind audit reporting patient feedback after day-case TURBT, the data obtained can provide us and other centres adopting day-case TURBTs guidance to employ better patient selection to reduce readmission rates. Hence, day-case TURBT can be a feasible option in appropriately selected patients, with a suitable pathway in place.
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Affiliation(s)
- Simona Ippoliti
- The Queen Elizabeth Hospital, King’s Lynn NHS Foundation Trust, King’s Lynn, UK
- Harrogate District General Hospital, NHS Foundation Trust, Harrogate, UK
| | - Nikita R Bhatt
- The Queen Elizabeth Hospital, King’s Lynn NHS Foundation Trust, King’s Lynn, UK
- Urology Department, Cambridge University Hospitals, Cambridge, UK
| | - Cristian P Ilie
- The Queen Elizabeth Hospital, King’s Lynn NHS Foundation Trust, King’s Lynn, UK
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Wells HL, Lazenbury A, Fairchild L, Harris M. Applying an enhanced recovery approach to endoscopic procedures: Local experience with progression to day-case transurethral resection of bladder tumour. JOURNAL OF CLINICAL UROLOGY 2021. [DOI: 10.1177/2051415820903194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective: Transurethral resection of bladder tumour (TURBT) is a common urological procedure. With improvements in technology, technique and community support, our unit was able to implement a dedicated day-case pathway for patients undergoing TURBT. The aim of this study was to prove that this has been a safe and cost-effective improvement to our urology service. Patients and methods: A retrospective audit was carried out of 312 elective TURBT cases performed in one centre between 2011 and 2014 (36 excluded for lack of data/emergency status). Data were gathered regarding length of stay, causes of delayed discharge, readmissions and resection quality. Results: In 2011, 11% of TURBTs were performed as day cases, and 66% had an overnight stay. After introduction of the TURBT pathway, by 2014, 68% patients went home the same day, and 21% had an overnight stay. The 30-day readmission rate in 2011 was 7% (mostly following overnight stays), whereas 6% were readmitted in 2014. Resection quality was comparable across the two groups. Conclusion: Our experience suggests that day-case TURBT can be widely implemented without compromising quality or patient safety. Level of evidence: Not applicable for this multicentre audit.
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Affiliation(s)
| | - Abigail Lazenbury
- Department of Urology, Southampton General Hospital, University Hospital Southampton NHS Foundation Trust, UK
| | - Lucy Fairchild
- Department of Urology, Southampton General Hospital, University Hospital Southampton NHS Foundation Trust, UK
| | - Mark Harris
- Department of Urology, Southampton General Hospital, University Hospital Southampton NHS Foundation Trust, UK
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Huang WL, Huang CY, Huang KH, Pu YS, Chang HC, Chow PM. Outcomes of stratified transurethral resection of bladder tumor: A propensity score-matched analysis. J Formos Med Assoc 2021; 121:73-80. [PMID: 33551309 DOI: 10.1016/j.jfma.2021.01.012] [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: 08/29/2020] [Revised: 12/01/2020] [Accepted: 01/13/2021] [Indexed: 10/22/2022] Open
Abstract
BACKGROUND/PURPOSE Several strategies have been reported for improving the integrity of transurethral resection of bladder tumor (TURBT). However, no standard has been established. Stratified TURBT (SR) is one of protocols for TURBT, wherein exophytic tumors are first resected and retrieved, and tumor bases are then resected. In this study, we aimed to evaluate the outcomes of SR in patients with nonmuscle invasive bladder cancer (NMIBC). METHODS From January 2012 to December 2017, patients newly diagnosed as having NMIBC with a follow-up period of more than 2 years were enrolled and categorized into SR and conventional TURBT (CR) groups. Propensity score matching at a 2:1 ratio was performed. Outcomes were the detrusor muscle sampling rate, recurrence-free survival (RFS), and progression-free survival (PFS). RESULTS In total, 205 patients were included in our study. The detrusor muscle sampling rate was higher in the SR group (P = 0.043). After propensity score matching, 162 patients were selected for outcome analysis, with 108 and 54 patients undergoing SR and CR, respectively. Compared with the CR group, the SR group showed a lower recurrence rate (P = 0.015) and better RFS in univariate (P = 0.010) and multivariate (P = 0.006) Cox proportional hazards regression. Progression rate and PFS were not significantly different between the two groups. CONCLUSION SR results in a higher detrusor muscle sampling rate and better disease outcomes. Our findings suggest that SR is a promising strategy for TURBT in patients with NMIBC.
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Affiliation(s)
- Wei-Lun Huang
- Department of Urology, National Taiwan University Hospital, National Taiwan University, College of Medicine, Taipei, Taiwan
| | - Chao-Yuan Huang
- Department of Urology, National Taiwan University Hospital, National Taiwan University, College of Medicine, Taipei, Taiwan
| | - Kuo-How Huang
- Department of Urology, National Taiwan University Hospital, National Taiwan University, College of Medicine, Taipei, Taiwan
| | - Yeong-Shiau Pu
- Department of Urology, National Taiwan University Hospital, National Taiwan University, College of Medicine, Taipei, Taiwan
| | - Hong-Chiang Chang
- Department of Urology, National Taiwan University Hospital, National Taiwan University, College of Medicine, Taipei, Taiwan
| | - Po-Ming Chow
- Department of Urology, National Taiwan University Hospital, National Taiwan University, College of Medicine, Taipei, Taiwan.
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10
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Değer MD, Çelik S, Yıldız A, Sarı H, Yılmaz B, Bozkurt O, Tuna B, Yörükoğlu K, Aslan G. Can we perform frozen section instead of repeat transurethral resection in bladder cancer? Urol Oncol 2020; 39:237.e15-237.e20. [PMID: 32948432 DOI: 10.1016/j.urolonc.2020.08.031] [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: 05/28/2020] [Revised: 07/12/2020] [Accepted: 08/23/2020] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To confirm frozen section (FS) method for muscularis propria (MP) sampling and to compare the FS method with the ReTUR section (RS) procedure to reduce needing for second resection that can cause waste of time for definitive treatment of muscle-invasive bladder cancer. METHODS A total of 27 patients who admitted to our clinic and was performed transurethral resection of bladder tumor (TUR-BT) due to bladder tumor and had an indication of ReTUR were evaluated prospectively in the study. During the first TUR-BT procedure (as permanent section), FS examination was also performed to the patients. ReTUR was performed 2-6 weeks after the first TUR-BT procedure. RESULTS Presences of MP were observed in 51.8% and 77.7% of FS and permanent section examinations. In the comparing of the presence of residual tumor in the methods, although 12 of 27 patients were found to have a residual tumor in FS, it was found to be in only 6 of 12 patients in RS. There was no statistical significance between FS and RS methods for MP sampling and detecting of residual tumor. CONCLUSIONS FS was found to be a comparable method with the RS method (ReTUR procedure) for the sampling of MP and detecting of residual tumor, despite the limitations in the pathological examination FS. Especially in patients with detected residual tumor after the pathological consultation of FS during the procedure, re-resection can be a choice at the end of the first TUR-BT instead of ReTUR.
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Affiliation(s)
- Müslim Doğan Değer
- Department of Urology, Dokuz Eylül University, School of Medicine, İzmir, Turkey.
| | - Serdar Çelik
- Department of Basic Oncology, Dokuz Eylül University, Institute of Oncology, İzmir, Turkey
| | - Alperen Yıldız
- Department of Urology, Dokuz Eylül University, School of Medicine, İzmir, Turkey
| | - Hilmi Sarı
- Department of Urology, Dokuz Eylül University, School of Medicine, İzmir, Turkey
| | - Batuhan Yılmaz
- Department of Urology, Dokuz Eylül University, School of Medicine, İzmir, Turkey
| | - Ozan Bozkurt
- Department of Urology, Dokuz Eylül University, School of Medicine, İzmir, Turkey
| | - Burçin Tuna
- Department of Pathology, Dokuz Eylül University, School of Medicine, İzmir, Turkey
| | - Kutsal Yörükoğlu
- Department of Pathology, Dokuz Eylül University, School of Medicine, İzmir, Turkey
| | - Güven Aslan
- Department of Urology, Dokuz Eylül University, School of Medicine, İzmir, Turkey
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Glaser AP, Jordan BJ, Cohen J, Desai A, Silberman P, Meeks JJ. Automated Extraction of Grade, Stage, and Quality Information From Transurethral Resection of Bladder Tumor Pathology Reports Using Natural Language Processing. JCO Precis Oncol 2019. [DOI: 10.1200/po.17.00128.2019.test] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Affiliation(s)
- Alexander P. Glaser
- Feinberg School of Medicine, Northwestern University, Chicago, IL
- Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL
| | - Brian J. Jordan
- Feinberg School of Medicine, Northwestern University, Chicago, IL
- Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL
| | - Jason Cohen
- Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Anuj Desai
- Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Philip Silberman
- Northwestern University Clinical and Translational Sciences Institute, Northwestern University, Chicago, IL
| | - Joshua J. Meeks
- Feinberg School of Medicine, Northwestern University, Chicago, IL
- Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL
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12
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Soria F, Marra G, D'Andrea D, Gontero P, Shariat SF. The rational and benefits of the second look transurethral resection of the bladder for T1 high grade bladder cancer. Transl Androl Urol 2019; 8:46-53. [PMID: 30976568 PMCID: PMC6414350 DOI: 10.21037/tau.2018.10.19] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
The second look transurethral resection of the bladder (TURB) represents a fundamental step in the treatment of papillary non-muscle invasive bladder cancer (NMIBC); it is therefore recommended by all guidelines. However, not all the literature agrees on its staging value and its ability to improve oncological outcomes of patients. Therefore, the purpose of this review is to evaluate the strengths and weaknesses of second look TURB, trying to depict its evolving role in the management of high grade NMIBC. Using Medline, a non-systematic review was performed including articles between January 2000 and June 2018. English language original articles, reviews and editorials were selected based on their clinical relevance. To date, TURB seems to be largely inadequate in retrieving a correct diagnosis and in removing all tumor tissue. Second look TURB maximizes staging accuracy, allows to clear residual cancer and yields prognostic advantages allowing key information to identify possible candidates for immediate radical cystectomy for very high risk T1HG tumors. Moreover, it seems to have a therapeutic benefit by improving recurrence- and progression-free survivals. However, few recent large studies showed that these advantages seem to be limited to patients without detrusor muscle present at first resection. Similarly, the presence of residual disease and the risk of upstaging are related to the presence of detrusor muscle in specimen. It could well be that in the future the presence of detrusor muscle would be a quality criteria to avoid an unnecessary second look TURB as shown by recent studies using the en-bloc resection technique. Finally, it has to be underlined that this is a surgical procedure not free of risks and complications and with a non-negligible impact on patients’ quality of life, waiting lists and healthcare costs. Therefore, future studies trying to identify the criteria that may better allow which patients to select for a second look TURB while avoiding an unnecessary intervention with possible risks and associated cost are needed to allow a personalized approach to even this one size fits all strategy.
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Affiliation(s)
- Francesco Soria
- Department of Urology and Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria.,Division of Urology, Department of Surgical Sciences, San Giovanni Battista Hospital, University of Studies of Torino, Turin, Italy
| | - Giancarlo Marra
- Division of Urology, Department of Surgical Sciences, San Giovanni Battista Hospital, University of Studies of Torino, Turin, Italy
| | - David D'Andrea
- Department of Urology and Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Paolo Gontero
- Division of Urology, Department of Surgical Sciences, San Giovanni Battista Hospital, University of Studies of Torino, Turin, Italy
| | - Shahrokh F Shariat
- Department of Urology and Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria.,Karl Landsteiner Institute of Urology and Andrology, Vienna, Austria.,Department of Urology, Weill Cornell Medical College, New York Presbyterian Hospital, New York, NY, USA.,Department of Urology, University of Texas Southwestern Medical Center, Dallas, USA
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13
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Schulz GB, Grimm T, Buchner A, Jokisch F, Casuscelli J, Kretschmer A, Mumm JN, Ziegelmüller B, Stief CG, Karl A. Validation of a High-End Virtual Reality Simulator for Training Transurethral Resection of Bladder Tumors. JOURNAL OF SURGICAL EDUCATION 2019; 76:568-577. [PMID: 30181038 DOI: 10.1016/j.jsurg.2018.08.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Revised: 07/15/2018] [Accepted: 08/01/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE The oncological outcome in patients with bladder cancer (BC) significantly correlates with the quality of transurethral resection of bladder tumors (TUR-BT). Virtual reality (VR) training simulators have been developed to improve surgical skills. We evaluated the advantages and limitations of the novel Uro Trainer (UT) (Karl Storz GmbH, Germany) with respect to training for TUR-BT. DESIGN Participants underwent VR training based on 4 different TUR-BT cases accompanied by self-assessment and evaluation questionnaires. Results were compared between experienced endourologists and novices, and furthermore, correlated with self-rated capabilities for content and construct validity. Student's t tests, Pearson's correlation, and chi-squared tests were performed for statistical evaluation. SETTING The study was performed at the tertiary care urological department of the Ludwig-Maximilians-University, Munich, Germany. PARTICIPANTS A total of 22 urological physicians, including residents and consultants, were included in the study. RESULTS There is a need to improve TUR-BT training as 27.3% of the participants had already experienced overtaxing situations during TUR-BT and only a few reported of high satisfaction with the classical "see one-do one" teaching mode. Construct validity was demonstrated, as consultants achieved significantly higher overall scores (p < 0.001) and safety (p = 0.004) and visualization (p = 0.001) subscores. Interestingly, the self-assessed capability to perform a TUR-BT correlated significantly (p = 0.01) with overall UT scores. Significant progress of self-rated abilities was shown for several parameters, including inspection (p = 0.046) and resection (p = 0.026). Although participants indicated improvements in several procedural skills and overall benefit of the VR training with the UT was rated 4.6 on a 5-point scale by consultants, limitations of the UT were demonstrated predominantly for tissue feedback and authenticity of different tissue layers. CONCLUSIONS The novel VR simulator showed a high face and construct validity, and therefore has a great potential to complement endourological training.
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Affiliation(s)
- Gerald B Schulz
- Department of Urology, Ludwig-Maximilians-University, Munich, Germany.
| | - Tobias Grimm
- Department of Urology, Ludwig-Maximilians-University, Munich, Germany
| | - Alexander Buchner
- Department of Urology, Ludwig-Maximilians-University, Munich, Germany
| | - Friedrich Jokisch
- Department of Urology, Ludwig-Maximilians-University, Munich, Germany
| | | | | | - Jan-Niclas Mumm
- Department of Urology, Ludwig-Maximilians-University, Munich, Germany
| | | | - Christian G Stief
- Department of Urology, Ludwig-Maximilians-University, Munich, Germany
| | - Alexander Karl
- Department of Urology, Ludwig-Maximilians-University, Munich, Germany
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14
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Glaser AP, Jordan BJ, Cohen J, Desai A, Silberman P, Meeks JJ. Automated Extraction of Grade, Stage, and Quality Information From Transurethral Resection of Bladder Tumor Pathology Reports Using Natural Language Processing. JCO Clin Cancer Inform 2018; 2:1-8. [PMID: 30652586 PMCID: PMC7010439 DOI: 10.1200/cci.17.00128] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
PURPOSE Bladder cancer is initially diagnosed and staged with a transurethral resection of bladder tumor (TURBT). Patient survival is dependent on appropriate sampling of layers of the bladder, but pathology reports are dictated as free text, making large-scale data extraction for quality improvement challenging. We sought to automate extraction of stage, grade, and quality information from TURBT pathology reports using natural language processing (NLP). METHODS Patients undergoing TURBT were retrospectively identified using the Northwestern Enterprise Data Warehouse. An NLP algorithm was then created to extract information from free-text pathology reports and was iteratively improved using a training set of manually reviewed TURBTs. NLP accuracy was then validated using another set of manually reviewed TURBTs, and reliability was calculated using Cohen's κ. RESULTS Of 3,042 TURBTs identified from 2006 to 2016, 39% were classified as benign, 35% as Ta, 11% as T1, 4% as T2, and 10% as isolated carcinoma in situ. Of 500 randomly selected manually reviewed TURBTs, NLP correctly staged 88% of specimens (κ = 0.82; 95% CI, 0.78 to 0.86). Of 272 manually reviewed T1 tumors, NLP correctly categorized grade in 100% of tumors (κ = 1), correctly categorized if muscularis propria was reported by the pathologist in 98% of tumors (κ = 0.81; 95% CI, 0.62 to 0.99), and correctly categorized if muscularis propria was present or absent in the resection specimen in 82% of tumors (κ = 0.62; 95% CI, 0.55 to 0.73). Discrepancy analysis revealed pathologist notes and deeper resection specimens as frequent reasons for NLP misclassifications. CONCLUSION We developed an NLP algorithm that demonstrates a high degree of reliability in extracting stage, grade, and presence of muscularis propria from TURBT pathology reports. Future iterations can continue to improve performance, but automated extraction of oncologic information is promising in improving quality and assisting physicians in delivery of care.
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Affiliation(s)
- Alexander P. Glaser
- Alexander P. Glaser, Brian J. Jordan, Jason Cohen, Anuj Desai, Joshua J. Meeks, Feinberg School of Medicine, Northwestern University; Alexander P. Glaser, Brian J. Jordan, Joshua J. Meeks, Robert H. Lurie Comprehensive Cancer Center, Northwestern University; and Philip Silberman, Clinical and Translational Sciences Institute, Northwestern University, Chicago, IL
| | - Brian J. Jordan
- Alexander P. Glaser, Brian J. Jordan, Jason Cohen, Anuj Desai, Joshua J. Meeks, Feinberg School of Medicine, Northwestern University; Alexander P. Glaser, Brian J. Jordan, Joshua J. Meeks, Robert H. Lurie Comprehensive Cancer Center, Northwestern University; and Philip Silberman, Clinical and Translational Sciences Institute, Northwestern University, Chicago, IL
| | - Jason Cohen
- Alexander P. Glaser, Brian J. Jordan, Jason Cohen, Anuj Desai, Joshua J. Meeks, Feinberg School of Medicine, Northwestern University; Alexander P. Glaser, Brian J. Jordan, Joshua J. Meeks, Robert H. Lurie Comprehensive Cancer Center, Northwestern University; and Philip Silberman, Clinical and Translational Sciences Institute, Northwestern University, Chicago, IL
| | - Anuj Desai
- Alexander P. Glaser, Brian J. Jordan, Jason Cohen, Anuj Desai, Joshua J. Meeks, Feinberg School of Medicine, Northwestern University; Alexander P. Glaser, Brian J. Jordan, Joshua J. Meeks, Robert H. Lurie Comprehensive Cancer Center, Northwestern University; and Philip Silberman, Clinical and Translational Sciences Institute, Northwestern University, Chicago, IL
| | - Philip Silberman
- Alexander P. Glaser, Brian J. Jordan, Jason Cohen, Anuj Desai, Joshua J. Meeks, Feinberg School of Medicine, Northwestern University; Alexander P. Glaser, Brian J. Jordan, Joshua J. Meeks, Robert H. Lurie Comprehensive Cancer Center, Northwestern University; and Philip Silberman, Clinical and Translational Sciences Institute, Northwestern University, Chicago, IL
| | - Joshua J. Meeks
- Alexander P. Glaser, Brian J. Jordan, Jason Cohen, Anuj Desai, Joshua J. Meeks, Feinberg School of Medicine, Northwestern University; Alexander P. Glaser, Brian J. Jordan, Joshua J. Meeks, Robert H. Lurie Comprehensive Cancer Center, Northwestern University; and Philip Silberman, Clinical and Translational Sciences Institute, Northwestern University, Chicago, IL
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15
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Suarez-Ibarrola R, Soria F, Abufaraj M, D'Andrea D, Preto M, Gust KM, Briganti A, Shariat SF, Gontero P. Surgical checklist impact on recurrence-free survival of patients with non-muscle-invasive bladder cancer undergoing transurethral resection of bladder tumour. BJU Int 2018; 123:646-650. [PMID: 30248235 DOI: 10.1111/bju.14557] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To evaluate the impact of an eight-item surgical checklist (SC) on the recurrence-free survival (RFS) of patients with non-muscle-invasive bladder cancer (NMIBC) undergoing transurethral resection of bladder tumour (TURBT). PATIENTS AND METHODS A group of urologists at two tertiary referral centres, with expertise in bladder cancer, identified eight critical items that should be performed in every high-quality TURBT. An eight-item SC was prospectively implemented into clinical practice and the operative reports of TURBTs performed before and after implementation were reviewed. Results from both institutions were combined to estimate the impact of introducing the SC on oncological outcomes. Multivariable logistic and Cox hazards regression analyses were performed to evaluate the impact of the SC on the presence of detrusor muscle in the TURBT specimen and on RFS, respectively. RESULTS The operative reports of 266 TURBTs performed after the SC implementation were reviewed and compared to those of 281 TURBTs performed prior to the SC introduction. The SC was independently associated with a significant improvement in RFS (P = 0.02). However, the introduction of the SC was not significantly associated with the presence of detrusor muscle in the surgical specimen (P = 0.4). CONCLUSION The use of an eight-item SC during TURBT in clinical practice increases the quality of operative reports thereby potentially improving individualised risk-stratification and care resulting in lower disease recurrence rates. Therefore, the introduction of a SC can be recommended to enhance oncological outcomes by improving surgical standardisation and operative reporting.
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Affiliation(s)
- Rodrigo Suarez-Ibarrola
- Department of Urology and Comprehensive Cancer Center, Vienna General Hospital, Medical University of Vienna, Vienna, Austria
| | - Francesco Soria
- Department of Urology and Comprehensive Cancer Center, Vienna General Hospital, Medical University of Vienna, Vienna, Austria.,Division of Urology, University of the Studies of Turin, AOU Città della Salute e della Scienza di Torino Presidio Molinette, Turin, Italy
| | - Mohammad Abufaraj
- Department of Urology and Comprehensive Cancer Center, Vienna General Hospital, Medical University of Vienna, Vienna, Austria.,Division of Urology, Department of Special Surgery, Jordan University Hospital, The University of Jordan, Amman, Jordan
| | - David D'Andrea
- Department of Urology and Comprehensive Cancer Center, Vienna General Hospital, Medical University of Vienna, Vienna, Austria
| | - Mirko Preto
- Division of Urology, University of the Studies of Turin, AOU Città della Salute e della Scienza di Torino Presidio Molinette, Turin, Italy
| | - Kilian M Gust
- Department of Urology and Comprehensive Cancer Center, Vienna General Hospital, Medical University of Vienna, Vienna, Austria.,Karl Landsteiner Institute of Urology and Andrology, Vienna, Austria
| | - Alberto Briganti
- Department of Urology, Urological Research Institute, San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy
| | - Shahrokh F Shariat
- Department of Urology and Comprehensive Cancer Center, Vienna General Hospital, Medical University of Vienna, Vienna, Austria.,Karl Landsteiner Institute of Urology and Andrology, Vienna, Austria.,Department of Urology, Weill Cornell Medical College, New York Presbyterian Hospital, New York, NY, USA.,Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Paolo Gontero
- Division of Urology, University of the Studies of Turin, AOU Città della Salute e della Scienza di Torino Presidio Molinette, Turin, Italy
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16
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Hurle R, Colombo P, Lazzeri M, Lughezzani G, Buffi NM, Saita A, Elefante GM, Morenghi E, Forni G, Cardone P, Lista G, Maffei D, Guazzoni G, Casale P. Pathological Outcomes for Patients Who Failed To Remain Under Active Surveillance for Low-risk Non-muscle-invasive Bladder Cancer: Update and Results from the Bladder Cancer Italian Active Surveillance Project. Eur Urol Oncol 2018; 1:437-442. [PMID: 31158085 DOI: 10.1016/j.euo.2018.05.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Revised: 05/01/2018] [Accepted: 05/10/2018] [Indexed: 10/14/2022]
Abstract
BACKGROUND It has been shown that active surveillance (AS) is feasible and effective in a subset of patients with recurrent low-grade (LG) non-muscle-invasive bladder cancer (NMIBC). OBJECTIVE To update a previous preliminary series and investigate pathological outcomes for patients who failed to remain on AS. DESIGN, SETTING, AND PARTICIPANTS Prospective observational cohort study started in February 2008, and currently still active, at a tertiary university hospital, including patients with pathologically confirmed NMIBC who experienced recurrence during follow-up. INTERVENTION AS monitoring consisted of cytology and in-office flexible cystoscopy every 3 mo for the first year, and every 6 mo thereafter. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS The primary endpoint was pathological results for patients who failed to remain on AS. The secondary outcome was an update of clinical results from our previous series. Data were complemented by descriptive statistical analysis and univariable and multivariable proportional hazards Cox regression. RESULTS AND LIMITATIONS Overall, 167 patients were included. Of 181 AS events, 61 (33.7%) were deemed to require treatment because of positive cytology (n=10), gross haematuria (n=11), and increases in the tumour number (n=15), or size (n=17), or both (n=8). The median time on AS was 12 mo (interquartile range 4-26). Pathological specimens from AS failures did not show any malignancy in 20 cases. Histopathology identified urothelial hyperplasia and oedema, submucosal vascular ectasia, mucosal erosion, polypoid cystitis, von Brunn nest hyperplasia, and squamous metaplasia. The time from first transurethral resection to AS start was inversely associated with recurrence-free survival (hazard ratio 0.97, 95% confidence interval 0.96-1.00; p=0.024). The study lacks statistical subanalyses focusing on patients with failure and negative neoplastic pathological outcomes. CONCLUSIONS AS might be a reasonable strategy in patients presenting with small LG pTa/pT1a recurrent bladder tumours. Approximately 30% of patients deemed to have AS failure did not harbour any neoplastic lesion, strengthening the role of AS. PATIENT SUMMARY Patients with small low-grade pTa/pT1a recurrent papillary bladder tumours could benefit from an active surveillance protocol with no significant risk of pathological progression to muscle-invasive cancer.
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Affiliation(s)
- Rodolfo Hurle
- Department of Urology, Istituto Clinico Humanitas IRCCS, Clinical and Research Hospital, Rozzano, Italy
| | - Piergiuseppe Colombo
- Department of Pathology, Istituto Clinico Humanitas IRCCS, Clinical and Research Hospital, Rozzano, Italy
| | - Massimo Lazzeri
- Department of Urology, Istituto Clinico Humanitas IRCCS, Clinical and Research Hospital, Rozzano, Italy.
| | - Giovanni Lughezzani
- Department of Urology, Istituto Clinico Humanitas IRCCS, Clinical and Research Hospital, Rozzano, Italy
| | - Nicolò Maria Buffi
- Department of Urology, Istituto Clinico Humanitas IRCCS, Clinical and Research Hospital, Rozzano, Italy
| | - Alberto Saita
- Department of Urology, Istituto Clinico Humanitas IRCCS, Clinical and Research Hospital, Rozzano, Italy
| | - Grazia Maria Elefante
- Department of Pathology, Istituto Clinico Humanitas IRCCS, Clinical and Research Hospital, Rozzano, Italy
| | - Emanuela Morenghi
- Department of Biomedical Science, Humanitas University, Rozzano, Italy; Department of Biostatistics, Istituto Clinico Humanitas IRCCS, Clinical and Research Hospital, Rozzano, Italy
| | - Giovanni Forni
- Department of Urology, Istituto Clinico Humanitas IRCCS, Clinical and Research Hospital, Rozzano, Italy
| | - Pasquale Cardone
- Department of Urology, Istituto Clinico Humanitas IRCCS, Clinical and Research Hospital, Rozzano, Italy
| | - Giuliana Lista
- Department of Urology, Istituto Clinico Humanitas IRCCS, Clinical and Research Hospital, Rozzano, Italy
| | - Davide Maffei
- Department of Urology, Istituto Clinico Humanitas IRCCS, Clinical and Research Hospital, Rozzano, Italy
| | - Giorgio Guazzoni
- Department of Urology, Istituto Clinico Humanitas IRCCS, Clinical and Research Hospital, Rozzano, Italy
| | - Paolo Casale
- Department of Urology, Istituto Clinico Humanitas IRCCS, Clinical and Research Hospital, Rozzano, Italy
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Effect of obturator nerve block during transurethral resection of lateral bladder wall tumors on the presence of detrusor muscle in tumor specimens and recurrence of the disease. Kaohsiung J Med Sci 2017; 33:86-90. [DOI: 10.1016/j.kjms.2016.11.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Revised: 10/26/2016] [Accepted: 11/01/2016] [Indexed: 11/20/2022] Open
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