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Ślusarczyk A, Wolański R, Miłow J, Piekarczyk H, Lipiński P, Zapała P, Niemczyk G, Kurzyna P, Wróbel A, Różański W, Radziszewski P, Zapała Ł. Can We Go beyond Pathology? The Prognostic Role of Risk Scoring Tools for Cancer-Specific Survival of Patients with Bladder Cancer Undergoing Radical Cystectomy. Biomedicines 2024; 12:1541. [PMID: 39062114 PMCID: PMC11275140 DOI: 10.3390/biomedicines12071541] [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: 04/18/2024] [Revised: 07/09/2024] [Accepted: 07/10/2024] [Indexed: 07/28/2024] Open
Abstract
Radical cystectomy (RC) remains a mainstay surgical treatment for non-metastatic muscle-invasive and BCG-unresponsive bladder cancer. Various perioperative scoring tools assess comorbidity burden, complication risks, and cancer-specific mortality (CSM) risk. We investigated the prognostic value of these scores in patients who underwent RC between 2015 and 2021. Cox proportional hazards were used in survival analyses. Risk models' accuracy was assessed with the concordance index (C-index) and area under the curve. Among 215 included RC patients, 63 (29.3%) died, including 53 (24.7%) cancer-specific deaths, with a median follow-up of 39 months. The AJCC system, COBRA score, and Charlson comorbidity index (CCI) predicted CSM with low accuracy (C-index: 0.66, 0.65; 0.59, respectively). Multivariable Cox regression identified the AJCC system and CCI > 5 as significant CSM predictors. Additional factors included the extent of lymph node dissection, histology, smoking, presence of concomitant CIS, and neutrophil-to-lymphocyte ratio, and model accuracy was high (C-index: 0.80). The internal validation of the model with bootstrap samples revealed its slight optimism of 0.06. In conclusion, the accuracy of the AJCC staging system in the prediction of CSM is low and can be improved with the inclusion of other pathological data, CCI, smoking history and inflammatory indices.
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Affiliation(s)
- Aleksander Ślusarczyk
- Department of General, Oncological and Functional Urology, Medical University of Warsaw, 02-091 Warsaw, Poland
| | - Rafał Wolański
- Department of General, Oncological and Functional Urology, Medical University of Warsaw, 02-091 Warsaw, Poland
| | - Jerzy Miłow
- 2nd Clinic of Urology, Medical University of Lodz, 93-513 Łódź, Poland
| | - Hanna Piekarczyk
- Department of General, Oncological and Functional Urology, Medical University of Warsaw, 02-091 Warsaw, Poland
| | - Piotr Lipiński
- 2nd Clinic of Urology, Medical University of Lodz, 93-513 Łódź, Poland
| | - Piotr Zapała
- Department of General, Oncological and Functional Urology, Medical University of Warsaw, 02-091 Warsaw, Poland
| | - Grzegorz Niemczyk
- Department of General, Oncological and Functional Urology, Medical University of Warsaw, 02-091 Warsaw, Poland
| | - Paweł Kurzyna
- Department of General, Oncological and Functional Urology, Medical University of Warsaw, 02-091 Warsaw, Poland
| | - Andrzej Wróbel
- Second Department of Gynecology, Medical University of Lublin, Jaczewskiego 8, 20-090 Lublin, Poland
| | - Waldemar Różański
- 2nd Clinic of Urology, Medical University of Lodz, 93-513 Łódź, Poland
| | - Piotr Radziszewski
- Department of General, Oncological and Functional Urology, Medical University of Warsaw, 02-091 Warsaw, Poland
| | - Łukasz Zapała
- Department of General, Oncological and Functional Urology, Medical University of Warsaw, 02-091 Warsaw, Poland
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Refugia JM, Thakker PU, Roebuck E, Brownstead HA, Rodriguez AR, Tsivian M. Surgeon-administered regional nerve blocks during radical cystectomy: a feasibility study. Int Urol Nephrol 2024; 56:2227-2234. [PMID: 38316683 DOI: 10.1007/s11255-023-03939-w] [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: 11/04/2023] [Accepted: 12/28/2023] [Indexed: 02/07/2024]
Abstract
OBJECTIVE To describe the technique for surgeon-administered, ultrasound-guided transversus abdominis plane (SU-TAP) blocks performed during radical cystectomy as a component of multimodal, perioperative pain management. METHODS Retrospective, case series of patients receiving SU-TAP blocks just prior to incision for RC. TAP blocks were performed by the surgeon with a standard technique using US guidance to instill an anesthetic solution. The primary outcome was opioid consumption at the intervals of 0-12, 12-24, 24-36, and 36-48 h postoperatively. Opioid consumption was reported as oral morphine milligram equivalents (MME). Secondary outcomes included time to perform SU-TAP blocks, and safety of block procedure. RESULTS 34 patients were included. During the median length of stay of 4 days (interquartile range [IQR] 3-7), only 30/34 (88%) of patients required opioids within the first 12 h post-op, decreasing to 38% by 48 h post-op. The median consumption decreased in the first 48 h from 21 MMEs (IQR 9-38) to 10 MMEs (IQR 8-15) at the 0-12 and 36-48 h intervals, respectively. The median time to perform block procedure was 6 min (IQR 4-8 min) and there were no safety events related to the SU-TAP blocks. Limitations include no comparative arm for opioid consumption. CONCLUSION Our data suggest that urologists may feasibly perform US-guided TAP blocks as a practical, efficient, and safe method of regional anesthesia. SU-TAP blocks should be considered in ERAS protocols for RC. Future comparative studies on opioid consumption compared to local infiltration and alternative block techniques are warranted.
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Affiliation(s)
- Justin M Refugia
- Department of Urology, Atrium Health Wake Forest Baptist Health, 140 Charlois Boulevard, Winston-Salem, NC, 27103, USA.
| | - Parth U Thakker
- Department of Urology, Atrium Health Wake Forest Baptist Health, 140 Charlois Boulevard, Winston-Salem, NC, 27103, USA
| | - Emily Roebuck
- Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Hilary A Brownstead
- Department of Anesthesiology, Atrium Health Wake Forest Baptist Health, Winston-Salem, NC, USA
| | - Alejandro R Rodriguez
- Department of Urology, Atrium Health Wake Forest Baptist Health, 140 Charlois Boulevard, Winston-Salem, NC, 27103, USA
| | - Matvey Tsivian
- Department of Urology, Atrium Health Wake Forest Baptist Health, 140 Charlois Boulevard, Winston-Salem, NC, 27103, USA
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Kwon AG, Brinzevich D, Borovik A, Bhalla R. Ileal conduit to small intestine fistula following extensive abdominopelvic resection and radiation for metastatic colon cancer. BMJ Case Rep 2023; 16:e254170. [PMID: 38056922 PMCID: PMC10711872 DOI: 10.1136/bcr-2022-254170] [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] [Indexed: 12/08/2023] Open
Abstract
A woman in her mid-60s presented with decreased output from urostomy, which was an opening from the neobladder (ileal conduit). Presentation was preceded by a 6-month history of alternating faecaluria and increased colostomy output. Laboratory studies were notable for normal anion gap metabolic acidosis. Creatinine level of the colostomy output was 17.7 mg/dL, a finding indicative of the presence of urine in the sample. CT enterography and X-ray loopogram confirmed neobladder to small intestine fistula.Neobladder creation is commonly performed in patients with bladder cancer requiring resection. Fistulas between the neobladder and intestine are observed in fewer than 2.7% of cases. The patient's history of extensive abdominopelvic resection, colostomy creation and radiation likely contributed to fistula development. We highlight the need for a high index of suspicion for a fistula in a patient with a neobladder experiencing recurrent urinary tract infections or a high colostomy output concurrently with low neobladder output.
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Affiliation(s)
- Alvin G Kwon
- Internal Medicine, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Daria Brinzevich
- Hematology/Oncology, Michigan Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Alexander Borovik
- Vascular and Interventional Radiology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Rakesh Bhalla
- Internal Medicine, Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
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4
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Zhang W, Huang X, Lin B, Zheng W, Ke Z, Lin X, Chen J, Cai H, Lin Y, Chen Y, Zheng Q, Wei Y, Xue X, Li X, Xu N. The effect of body mass index on quality of life in modified single stoma cutaneous ureterostomy or ileal conduit after radical cystectomy. Cancer Med 2023; 12:20930-20939. [PMID: 37902236 PMCID: PMC10709730 DOI: 10.1002/cam4.6638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 09/30/2023] [Accepted: 10/10/2023] [Indexed: 10/31/2023] Open
Abstract
OBJECTIVE To explore the influence of postoperative body mass index (BMI) change on postoperative quality of life (QOL) in patients undergoing radical cystectomy (RC) plus modified single stoma cutaneous ureterostomy (MSSCU) or ileal conduit (IC). METHODS Patients were divided into two groups according to different BMI change patterns: patients experiencing an elevated postoperative BMI level, along with a clinically significant increase in their BMI (an increase of more than 10%) were categorized as Group 1, while patients experiencing a decrease postoperative BMI level, along with a clinically significant reduction in their BMI (a decrease of more than 5%) were categorized as Group 2. Spearman correlation analysis was used to examine the correlations between quality-of-life scores and postoperative clinical parameters. RESULTS Spearman correlation analysis showed that postoperative BMI, late complications and catheter-free state were significantly associated with postoperative global QoL and symptom scale in MSSCU and postoperative global QoL and physical scale in IC patients. Additionally, postoperative BMI, catheter-free state and the use of adjuvant therapy were associated with bad performance in many scales of QoL like body image, future perspective, social scale, future perspective (MSSCU), and abdominal bloating (IC) (Table 2, p<0.05). Patients in Group 2 with significant weight loss had a better Global QoL, a lower rate of stomal stricture and a higher catheter-free state compared with those in Group 1 in both IC and MSSCU patients. MSSCU patients in Group 2 could achieve a comparable Global QoL as to IC patients in Group 1. CONCLUSION Controlling the substantial increase in body weight after surgery contributes to improving QoL, reducing the occurrence of stomal stricture, and ensuring a postoperative catheter-free state in BCa patients undergoing MSSCU.
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Affiliation(s)
- Wan‐Jin Zhang
- Department of Urology, Urology Research Institute, The First Affiliated HospitalFujian Medical UniversityFuzhouChina
- Department of Urology, National Region Medical centre, Binhai Campus of the First Affiliated HospitalFujian Medical UniversityFuzhouChina
| | - Xu‐Yun Huang
- Department of Urology, Urology Research Institute, The First Affiliated HospitalFujian Medical UniversityFuzhouChina
- Department of Urology, National Region Medical centre, Binhai Campus of the First Affiliated HospitalFujian Medical UniversityFuzhouChina
| | - Bin Lin
- Department of Urology, Urology Research Institute, The First Affiliated HospitalFujian Medical UniversityFuzhouChina
- Department of Urology, National Region Medical centre, Binhai Campus of the First Affiliated HospitalFujian Medical UniversityFuzhouChina
| | - Wen‐Cai Zheng
- Department of Urology, Urology Research Institute, The First Affiliated HospitalFujian Medical UniversityFuzhouChina
- Department of Urology, National Region Medical centre, Binhai Campus of the First Affiliated HospitalFujian Medical UniversityFuzhouChina
| | - Zhi‐Bin Ke
- Department of Urology, Urology Research Institute, The First Affiliated HospitalFujian Medical UniversityFuzhouChina
- Department of Urology, National Region Medical centre, Binhai Campus of the First Affiliated HospitalFujian Medical UniversityFuzhouChina
| | - Xiao‐Dan Lin
- Department of Urology, Urology Research Institute, The First Affiliated HospitalFujian Medical UniversityFuzhouChina
- Department of Urology, National Region Medical centre, Binhai Campus of the First Affiliated HospitalFujian Medical UniversityFuzhouChina
| | - Jia‐Yin Chen
- Department of Urology, Urology Research Institute, The First Affiliated HospitalFujian Medical UniversityFuzhouChina
- Department of Urology, National Region Medical centre, Binhai Campus of the First Affiliated HospitalFujian Medical UniversityFuzhouChina
| | - Hai Cai
- Department of Urology, Urology Research Institute, The First Affiliated HospitalFujian Medical UniversityFuzhouChina
- Department of Urology, National Region Medical centre, Binhai Campus of the First Affiliated HospitalFujian Medical UniversityFuzhouChina
| | - Yun‐Zhi Lin
- Department of Urology, Urology Research Institute, The First Affiliated HospitalFujian Medical UniversityFuzhouChina
- Department of Urology, National Region Medical centre, Binhai Campus of the First Affiliated HospitalFujian Medical UniversityFuzhouChina
| | - Ye‐Hui Chen
- Department of Urology, Urology Research Institute, The First Affiliated HospitalFujian Medical UniversityFuzhouChina
- Department of Urology, National Region Medical centre, Binhai Campus of the First Affiliated HospitalFujian Medical UniversityFuzhouChina
| | - Qing‐Shui Zheng
- Department of Urology, Urology Research Institute, The First Affiliated HospitalFujian Medical UniversityFuzhouChina
- Department of Urology, National Region Medical centre, Binhai Campus of the First Affiliated HospitalFujian Medical UniversityFuzhouChina
| | - Yong Wei
- Department of Urology, Urology Research Institute, The First Affiliated HospitalFujian Medical UniversityFuzhouChina
- Department of Urology, National Region Medical centre, Binhai Campus of the First Affiliated HospitalFujian Medical UniversityFuzhouChina
| | - Xue‐Yi Xue
- Department of Urology, Urology Research Institute, The First Affiliated HospitalFujian Medical UniversityFuzhouChina
- Department of Urology, National Region Medical centre, Binhai Campus of the First Affiliated HospitalFujian Medical UniversityFuzhouChina
- Fujian Key Laboratory of Precision Medicine for Cancer, the First Affiliated HospitalFujian Medical UniversityFuzhouChina
| | - Xiao‐Dong Li
- Department of Urology, Urology Research Institute, The First Affiliated HospitalFujian Medical UniversityFuzhouChina
- Department of Urology, National Region Medical centre, Binhai Campus of the First Affiliated HospitalFujian Medical UniversityFuzhouChina
| | - Ning Xu
- Department of Urology, Urology Research Institute, The First Affiliated HospitalFujian Medical UniversityFuzhouChina
- Department of Urology, National Region Medical centre, Binhai Campus of the First Affiliated HospitalFujian Medical UniversityFuzhouChina
- Fujian Key Laboratory of Precision Medicine for Cancer, the First Affiliated HospitalFujian Medical UniversityFuzhouChina
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Jericevic D, Brucker B. Telemedicine in Overactive Bladder Syndrome. CURRENT BLADDER DYSFUNCTION REPORTS 2023; 18:103-108. [PMID: 37193335 PMCID: PMC10015147 DOI: 10.1007/s11884-023-00689-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/10/2023] [Indexed: 03/17/2023]
Abstract
Purpose of Review This review discusses the role and benefits of telemedicine as an integral component of the post-pandemic care paradigm in urological practice and, in particular, as part of the care of patients with overactive bladder (OAB). Recent Findings The COVID-19 pandemic accelerated the implementation of telemedicine across almost every medical specialty and (at least temporarily) swept away barriers including those regarding reimbursement and licensure. Telemedicine benefits patients and providers alike including savings on transportation costs, access to specialists or tertiary care from geographically remote locations, and minimized exposure to a contagious illness. Integration of telemedicine into clinical practice can reduce costs for office/exam space and staffing overhead, as well as facilitate greater scheduling efficiency. Many, if not most, aspects of care for the uncomplicated OAB patient can be as effectively managed remotely as with in-person encounters, across the treatment algorithm. Summary Telemedicine will almost certainly remain a key component in the care of OAB, general urology, and throughout all medical specialties.
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Affiliation(s)
- Dora Jericevic
- Departments of Urology and Obstetrics & Gynecology, New York University Langone Health, New York, NY USA
| | - Benjamin Brucker
- Departments of Urology and Obstetrics & Gynecology, New York University Langone Health, New York, NY USA
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Al Salhi Y, Fuschi A, Martoccia A, DE Nunzio C, Giorgio B, Sciarra A, Maggi M, Illiano E, Costantini E, Anastasios A, Carbone A, Pastore AL. Impact of early self-clean intermittent catheterization in orthotopic ileal neobladder: prospective randomized study to evaluate functional outcomes, continence status and urinary tract infections. Minerva Urol Nephrol 2023; 75:59-65. [PMID: 36197699 DOI: 10.23736/s2724-6051.22.04944-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Urinary diversions after radical cystectomy (RC) have a significant impact on quality of life and body image. Particularly for orthotopic neobladder (ONB), the rate of continence, urinary retention and urinary tract infections can impact on patient's quality of life. The aim of this study was to investigate whether early clean intermittent catheterization (CIC) might improve functional outcomes, continence status, and reduce the incidence of UTIs in patients with ONB. METHODS In this prospective randomized study patients were divided in two groups. Patients were on a standard postoperative care (group A) or started CIC within the first postoperative month (group B). All patients were evaluated postoperatively at 1, 3, 6, and 9 months after ONB. The CIC was executed 4 times/daily after each voluntary micturition. The postoperative evaluation included: post-void residual volume (PVR), urine analysis and culture, number of pads/day and the self-administrated questionnaire International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI SF). RESULTS Thirty-nine male and 8 female patients underwent laparoscopic or robotic RC with intracorporeal ONB (37 U shaped and 10 Padua reconstructions). At the first follow up, mean PVR was in group A and B, 136.5 mL and 125.7 mL (P value: 0.105), respectively. The ICIQ-UI SF mean score was 16.2 and 17.1 (P value: 0.243) respectively and the mean no. of pads/day was 3 in both groups. 15 patients in group A and 10 in group B reported episodes of symptomatic UTIs. At 3, 6 and 9 months follow up after surgery the PVR and the ICIQ-UI SF scores were significantly improved (P value <0.0001). The number of pads decreased to 2 pads/day in group A and 1 in group B at 9 months. The episodes of UTIs significantly decreased over the time (P value <0.0001). CONCLUSIONS Our data support the early introduction of self CIC in patients with ONB after RC. The CIC was significantly associated a reduced risk of incontinence, urinary retention, and UTI with significant improvement in QoL. These encouraging data need to be confirmed by further investigations with a larger number of patients.
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Affiliation(s)
- Yazan Al Salhi
- Unit of Urology, Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University, Latina, Italy
| | - Andrea Fuschi
- Unit of Urology, Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University, Latina, Italy
| | - Alessia Martoccia
- Unit of Urology, Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University, Latina, Italy
| | - Cosimo DE Nunzio
- Department of Urology, Sant'Andrea Hospital, Sapienza University, Rome, Italy
| | - Bozzini Giorgio
- Department of Urology, ASST Valle Olona, Busto Arsizio, Varese, Italy
| | - Alessandro Sciarra
- Department of Urology, Umberto I Polyclinic Hospital, Sapienza University, Rome, Italy
| | - Martina Maggi
- Department of Urology, Umberto I Polyclinic Hospital, Sapienza University, Rome, Italy
| | - Ester Illiano
- Department of Surgical and Biomedical Science, Andrological and Urogynecology Clinic, Santa Maria Terni Hospital, University of Perugia, Terni, Italy
| | - Elisabetta Costantini
- Department of Surgical and Biomedical Science, Andrological and Urogynecology Clinic, Santa Maria Terni Hospital, University of Perugia, Terni, Italy
| | | | - Antonio Carbone
- Unit of Urology, Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University, Latina, Italy
| | - Antonio L Pastore
- Unit of Urology, Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University, Latina, Italy -
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Mostafa MM, Khallaf A, Kamel M, Patil N, Mahdy A. Outcomes of continent and incontinent external urinary diversion in management of patients with refractory non-malignant lower urinary tract dysfunction. Arch Ital Urol Androl 2022; 94:384-389. [PMID: 36576458 DOI: 10.4081/aiua.2022.4.384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Accepted: 11/25/2022] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVE To evaluate the early and late outcomes of continent and incontinent external urinary diversion in management of patients with refractory non-malignant lower urinary tract dysfunction (LUTD). MATERIALS AND METHODS The charts of patients with refractory non-malignant LUTD who underwent continent or incontinent external urinary diversion at University of Cincinnati hospitals in the period between March 2012 and December 2019 were retrospectively reviewed. The demographic and baseline characteristics, surgery indications, operative data, early and late outcomes were collected, analyzed, and compared. RESULTS A total of 78 patients including 55 patients with neurogenic bladder (NGB) and 23 patients with non-neurogenic bladder (non-NGB) refractory non-malignant LUTD were included. Fifty-three patients underwent incontinent urinary diversions (IUD), while 25 patients underwent continent urinary diversions (CUD). During the first 4 postoperative weeks, 53.85% (n=42) of patients developed complications, and the incidence was nonsignificantly higher in patients with NGB than those with non- NGB (56.36% vs 47.83%, p-value=0.490). Fever was exclusively encountered in patients with NGB earlier, while stomal retraction occurred only in patients with non-NGB later. More non- NGB patients had early wound infection. There was an overall improvement of urological symptoms in 52 patients (66.67%), and the rate was non-significantly higher in non-NGB patients than NGB patients (78.26% vs 61.82%, p-value=0.160). Late complications were reported in 47 patients and were more encountered in those with non-NGB than those with NGB (65.22% vs 58.18%). Stomal leakage and stenosis occurred more with CUD than with IUD (52% vs 0% and 28% vs 3.77%, respectively). CONCLUSIONS External urinary diversion can achieve a reasonable level of urological symptoms control in patients with refractory non-malignant LUTD, but with associated adverse outcomes. Although non-significantly, these complications tend to be higher in patients with IUD and/or NGB during the early postoperative period and higher with CUD and/or non-NGB on the long-term.
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Affiliation(s)
- Mostafa M Mostafa
- Division of Urology, Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA; Asiut University Hospitals, Asiut.
| | - Ashraf Khallaf
- Division of Urology, Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, OH.
| | - Mohamed Kamel
- Division of Urology, Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, OH.
| | - Nilesh Patil
- Division of Urology, Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, OH.
| | - Ayman Mahdy
- Division of Urology, Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, OH.
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Kuchulakanti SA, Shenoy PM. Hypokalaemic quadriparesis in a patient with urinary diversion through Indiana pouch. BMJ Case Rep 2022; 15:e248123. [PMID: 35487629 PMCID: PMC9058711 DOI: 10.1136/bcr-2021-248123] [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] [Accepted: 04/15/2022] [Indexed: 11/03/2022] Open
Abstract
A man in his 20s, a patient with chronic kidney disease with a baseline estimated glomerular filtration rate of 33 mL/min/1.73 m2, who had an Indiana pouch continent urinary diversion procedure done at 6 years of age for bladder exstrophy, presented to the emergency room with sudden-onset progressive quadriparesis over 6 hours with power 1/5 in all the limbs with preserved reflexes. He was fully conscious and oriented, with stable vital signs. On evaluation, he had severe hypokalaemia and severe metabolic acidosis (both high anion gap and non-anion gap acidosis). Imaging studies showed bilateral gross hydroureteronephrosis, and renal and pouch calculi. Hypokalaemia was promptly treated with intravenous potassium chloride and acidosis with emergency haemodialysis. The patient had a complete motor recovery following intravenous potassium correction and was discharged with oral potassium and bicarbonate supplements. Here, the Indiana pouch, its metabolic and electrolyte complications, and its treatment are discussed.
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Affiliation(s)
| | - Pradeep M Shenoy
- Nephrology, KS Hegde Medical Academy, Mangalore, Karnataka, India
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Santos FLD, Castanheira JS, Mota MS, Brum AN, Barlem JGT, Paloski GDR. Perfil de usuários de um serviço de estomaterapia: análise de cluster. ESCOLA ANNA NERY 2022. [DOI: 10.1590/2177-9465-ean-2021-0307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Resumo Objetivo Analisar o perfil das pessoas com estomias intestinais e/ou urinárias acompanhadas em serviço de estomaterapia, conforme variáveis sociodemográficas e clínicas. Método Trata-se de um estudo transversal, realizado com 90 usuários do serviço de estomaterapia. A coleta foi realizada de janeiro a fevereiro de 2020, por meio de dois instrumentos: COH-QOL-Ostomy, adaptado e traduzido para o contexto brasileiro; e City of Hope Quality of Life – Ostomy Questionnaire, instrumento original com questionário elaborado pelas próprias pesquisadoras, contemplando os aspectos sociodemográfico e clínico. Esses dados foram transferidos e organizados no Software Statistical Package for the Social Science, versão 22. Resultados Foram identificados quatro grupos distintos. No cluster 1, o grupo possui de duas a três complicações associadas ao estoma e 52,9% possuem colostomia. No cluster 2, 45% não apresentam nenhuma complicação e 70% têm urostomia. Já no cluster 3, a totalidade do grupo apresenta uma complicação e colostomia. E no cluster 4, nenhum participante do grupo apresenta complicação e todos têm colostomia. Conclusão e implicações para a prática O estudo proporcionou a geração de dados que podem auxiliar no planejamento do trabalho desenvolvido pelas equipes de saúde junto aos pacientes estomizados.
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10
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Roebuck E, Beano H, Robinson M, Edwards D, Worrilow WM, Sinks A, Gaston KE, Clark PE, Riggs SB. Surgeon-Administered Transversus Abdominis Plane (TAP) Block is Associated with Decreased Opioid Usage and Length of Stay following Radical Cystectomy. Urology 2021; 161:135-141. [PMID: 34864053 DOI: 10.1016/j.urology.2021.11.023] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 10/18/2021] [Accepted: 11/18/2021] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To study the effect of surgeon-administered Transversus Abdominis Plane block (sTAP) on opioid usage and length of stay (LOS). METHODS Starting in April 2018, two surgeons at our institution gradually introduced sTAP for radical cystectomy (RC) patients. We performed a retrospective observational cohort analysis of RC patients catalogued in a prospectively maintained database using the ERAS Interactive Auditing System. Two surgeons adopted the sTAP block technique in April 2018. We included patients undergoing RC for bladder malignancy under ERAS protocol between 1/2017-8/2020. Primary outcomes included LOS, and POD0-3 total opioids consumption measured by morphine milligram equivalents (MME). Multivariable linear or logistic models evaluated the association of TAP with outcomes while controlling for potential confounders. RESULTS Among 178 patients included in analysis, 84 patients underwent sTAP block and 94 did not. Multivariable analysis demonstrated significantly lower POD0-3 total opioid usage (106.4 vs 192.2 MME, p=.004), and mean LOS (5.6 vs 7.7 days, p<.001) among the sTAP group. CONCLUSION sTAP appears to be an effective adjunct to RC care associated with improved LOS, and POD0-3 opioid consumption. Further studies are needed to optimize TAP block technique and anesthetic composition.
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Affiliation(s)
- Emily Roebuck
- Department of Urology, Carolinas Medical Center/Atrium Health, Charlotte, NC, USA
| | - Hamza Beano
- Department of Urology, University of Virginia, Charlottesville, VA, USA
| | - Myra Robinson
- Department of Cancer Biostatistics, Levine Cancer Institute/Atrium health, Charlotte, NC, USA
| | - Daniel Edwards
- Department of Urology, Carolinas Medical Center/Atrium Health, Charlotte, NC, USA
| | - William M Worrilow
- Department of Urology, Carolinas Medical Center/Atrium Health, Charlotte, NC, USA
| | - Alexander Sinks
- Department of Urology, Carolinas Medical Center/Atrium Health, Charlotte, NC, USA
| | - Kris E Gaston
- Department of Urology, Carolinas Medical Center/Atrium Health, Charlotte, NC, USA
| | - Peter E Clark
- Department of Urology, Carolinas Medical Center/Atrium Health, Charlotte, NC, USA
| | - Stephen B Riggs
- Department of Urology, Carolinas Medical Center/Atrium Health, Charlotte, NC, USA.
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11
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Tartaglione G, Foschi N, Ragonese M, Recupero SM, Ieria FP, Tarantino G, Bassi P. A gravity-assisted approach to the management of urinary diversion: 99mTc-MAG3 diuresis renography with F + 10(sp) method. Ann Nucl Med 2021; 35:1127-1135. [PMID: 34236580 DOI: 10.1007/s12149-021-01648-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 06/20/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Radical cystectomy with permanent urinary diversion is the gold standard treatment for invasive muscle bladder cancer. Hydronephrosis is common in these patients, but Ultrasound (US) or Computed Tomography Urography (CTU) scan are unable to discriminate obstructive from non-obstructive hydronephrosis. We used Diuresis Renography (DR) with F + 10 in seated position (sp) method in the identification of patients with a Uretero-ileal Anastomosis Stricture (UAS) who would benefit from surgical therapy. METHODS We studied 39 asymptomatic patients, who underwent radical cystectomy and urinary diversion. Based on radiological findings (US, CTU) 44 kidneys were hydronephrotic. All patients underwent a 99mTc-MAG3 DR with F + 10(sp) method. We acquired a DR for 20 min with the patient in a seated position. Patient drank 400-500 mL of water at 5 min after tracer injection and received a 20 mg bolus of Furosemide at 10 min during dynamic acquisition. The indices Time to peak, diuretic half time, and 20 min/peak ratio have been evaluated. Retrograde pyelography confirmed UAS in all patients with DR obstructive findings. We repeated DR as follow-up in two subgroups of patients. RESULTS DR with F + 10(sp) method showed obstructive findings in 36 out of 44 hydronephrotic kidneys. 6 patients showed non-obstructive findings. 32 patients showed obstructive findings (20 out of 32 developed UAS within 12 months after surgery). Fifteen pts underwent a surgical treatment of UAS. In 1 patient with equivocal findings, we observed an ileo-ureteral reflux. CONCLUSIONS The DR with F + 10(sp) method in the seated position has a lower uncertain diagnostic rate, compared to the radiological findings of US or CTU, in management of bladder cancer patients with urinary diversion. The semiquantitative indices diuretic half time and 20 min/peak ratio evaluated in a condition of favorable gravity reduce uncertain responses improving interobserver concordance.
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Affiliation(s)
- Girolamo Tartaglione
- Department of Nuclear Medicine, Cristo Re Hospital, 25 Via delle, Calasanziane, 00167, Rome, Italy.
| | - Nazario Foschi
- Department of Urology, A. Gemelli Hospital IRCCS-Catholic University of Sacred Heart, Rome, Italy
| | - Mauro Ragonese
- Department of Urology, A. Gemelli Hospital IRCCS-Catholic University of Sacred Heart, Rome, Italy
| | - Salvatore M Recupero
- Department of Urology, Fatebenefratelli San Giovanni Calibita Hospital, Rome, Italy
| | - Francesco P Ieria
- Department of Nuclear Medicine, Cristo Re Hospital, 25 Via delle, Calasanziane, 00167, Rome, Italy
| | | | - Pierfrancesco Bassi
- Department of Urology, A. Gemelli Hospital IRCCS-Catholic University of Sacred Heart, Rome, Italy
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12
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Anaissie J, Dursun F, Wallis CJD, Klaassen Z, Taylor J, Obando-Perez C, Xu J, Boone T, Khavari R, Satkunasivam R. Dissecting the role of radical cystectomy and urinary diversion in post-operative complications: an analysis using the American College of Surgeons national surgical quality improvement program database. Int Braz J Urol 2021; 47:1006-1019. [PMID: 34260178 PMCID: PMC8321454 DOI: 10.1590/s1677-5538.ibju.2020.1098] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Accepted: 01/29/2021] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE To characterize the contribution of the extirpative and reconstructive portions of radical cystectomy (RC) to complications rates, and assess differences between urinary diversion (UD) types. MATERIALS AND METHODS We conducted a retrospective cohort study comparing patients undergoing UD alone or RC+UD for bladder cancer from 2006 to 2017 using ACS National Surgical Quality Improvement Program database. The primary outcome was major complications, while secondary outcomes included minor complications and prolonged length of stay. Propensity score matching (PSM) was utilized to assess the association between surgical procedure (UD alone or RC+UD) and outcomes, stratified by diversion type. Lastly, we examined differences in complication rates between ileal conduit (IC) vs. continent UD (CUD). RESULTS When comparing RC + IC and IC alone, PSM yielded 424 pairs. IC alone had a lower risk of any complication (HR 0.63, 95% CI 0.52-0.75), venous thromboembolism (HR 0.45, 95% CI 0.22-0.91) and bleeding needing transfusion (HR 0.41, 95% CI 0.32-0.52). This trend was also noted when comparing RC + CUD to CUD alone. CUD had higher risk of complications than IC, both with (56.6% vs 52.3%, p = 0.031) and without RC (47.8% vs 35.1%, p=0.062), and a higher risk of infectious complications, both with (30.5% vs 22.7%, p< 0.001) and without RC (34.0% vs 22.0%, p=0.032). CONCLUSIONS RC+UD, as compared to UD alone, is associated with an increased risk of major complications, including bleeding needing transfusion and venous thromboembolism. Additionally, CUD had a higher risk of post-operative complication than IC.
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Affiliation(s)
- James Anaissie
- Baylor College of MedicineMichael E. DeBakey Veterans Affairs Medical CenterDepartment of UrologyHoustonTexasUSADepartment of Urology, Baylor College of Medicine and Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas, USA
| | - Furkan Dursun
- Houston Methodist HospitalDepartment of UrologyHoustonTXUSADepartment of Urology, Houston Methodist Hospital, Houston, TX, USA
- University of Texas Health Science CenterDepartment of UrologySan AntonioTXUSADepartment of Urology, University of Texas Health Science Center at San Antonio, TX, USA
| | - Christopher J. D. Wallis
- Vanderbilt UniversityDepartment of UrologyNashvilleTNUSADepartment of Urology Vanderbilt University, Nashville, TN, USA
| | - Zachary Klaassen
- Augusta UniversityMedical College of GeorgiaDivision of UrologyAugustaGeorgiaUSADivision of Urology, Medical College of Georgia - Augusta University, Augusta, Georgia, USA
| | - Jennifer Taylor
- Baylor College of MedicineMichael E. DeBakey Veterans Affairs Medical CenterDepartment of UrologyHoustonTexasUSADepartment of Urology, Baylor College of Medicine and Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas, USA
| | - Cinthya Obando-Perez
- Houston Methodist HospitalDepartment of UrologyHoustonTXUSADepartment of Urology, Houston Methodist Hospital, Houston, TX, USA
| | - Jiaqiong Xu
- Houston Methodist HospitalCenter for Outcomes ResearchHoustonTXUSACenter for Outcomes Research, Houston Methodist Hospital, Houston, TX, USA
| | - Timothy Boone
- Houston Methodist HospitalDepartment of UrologyHoustonTXUSADepartment of Urology, Houston Methodist Hospital, Houston, TX, USA
| | - Rose Khavari
- Houston Methodist HospitalDepartment of UrologyHoustonTXUSADepartment of Urology, Houston Methodist Hospital, Houston, TX, USA
| | - Raj Satkunasivam
- Houston Methodist HospitalDepartment of UrologyHoustonTXUSADepartment of Urology, Houston Methodist Hospital, Houston, TX, USA
- Houston Methodist HospitalCenter for Outcomes ResearchHoustonTXUSACenter for Outcomes Research, Houston Methodist Hospital, Houston, TX, USA
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13
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Multicenter external validation of the radical cystectomy pentafecta in a European cohort of patients undergoing robot-assisted radical cystectomy with intracorporeal urinary diversion for bladder cancer. World J Urol 2021; 39:4335-4344. [PMID: 34216242 PMCID: PMC8602171 DOI: 10.1007/s00345-021-03753-y] [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: 03/07/2021] [Accepted: 05/29/2021] [Indexed: 11/17/2022] Open
Abstract
Objective To perform an external validation of this RC-pentafecta. Method Between January 2014 and December 2019, 104 consecutive patients who underwent RARC with ICUD within 6 urological centers were analyzed retrospectively. Patients who simultaneously demonstrated negative soft tissue surgical margins (STSMs), a lymph node (LN) yield ≥ 16, absence of major (Clavien–Dindo grade III–V) 90-day postoperative complications, absence of UD-related long-term sequelae, and absence of 12-month clinical recurrence were considered to have achieved RC-pentafecta. A multivariable logistic regression model was used to measure predictors for achieving RC-pentafecta. We analyzed the influence of this RC-pentafecta on survival, and the impact ofthe surgical experience. Results Since 2014, 104 patients who had completed at least 12 months of follow-up were included. Over a mean follow-up of 18 months, a LN yield ≥ 16, negative STSMs, absence of major complications at 90 days, and absence of UD-related surgical sequelae and clinical recurrence at ≤ 12 months were observed in 56%, 96%, 85%, 81%, and 91% of patients, respectively, resulting in a RC-pentafecta rate of 39.4%. Multivariate analysis showed that age was an independent predictor of pentafecta achievement (odds ratio [OR], 0.96; 95% confidence interval [CI], 0.90. 0.99; p = 0.04). The surgeon experience had an impact on the validation of the criteria. Conclusion This study confirmed that the RC-pentafecta is reproducible and could be externally used for the outcome assessment after RARC with ICUD. Therefore, the RC-pentafecta could be a useful tool to assess surgical success and its impact on different outcomes.
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14
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Chen B, Chen X, Wang W, Shen J, Song Z, Ji H, Zhang F, Wu J, Na J, Li S. Tissue-engineered autologous peritoneal grafts for bladder reconstruction in a porcine model. J Tissue Eng 2021; 12:2041731420986796. [PMID: 33613958 PMCID: PMC7874343 DOI: 10.1177/2041731420986796] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 12/18/2020] [Indexed: 01/08/2023] Open
Abstract
Ileal neobladder construction is a common treatment for patients with bladder cancer after radical cystectomy. However, metabolic disorders caused by transposed bowel segments occur frequently. Bladder tissue engineering is a promising alternative approach. Although numerous studies have reported bladder reconstruction using acellular and cellular scaffolds, there are also disadvantages associated with these methods, such as immunogenicity of synthetic grafts and incompatible mechanical properties of the biomaterials. Here, we engineered an autologous peritoneal graft consisting of a peritoneal sheet and the seromuscular layer from the ileum. Three months after the surgery, compared with the neobladder made from the ileum, the reconstructed neobladder using our new method showed normal function and better gross morphological characteristics. Moreover, histopathological and transcriptomic analysis revealed urothelium-like cells expressing urothelial biomarkers appeared in the neobladder, while no such changes were observed in the control group. Overall, our study provides a new strategy for bladder tissue engineering and informs a variety of future research prospects.
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Affiliation(s)
- Biao Chen
- School of Clinical Medicine, Tsinghua University, Beijing, China.,Department of Urology, The First Hospital of Tsinghua University, Beijing, China
| | - Xia Chen
- Center for Stem Cell Biology and Regenerative Medicine, School of Medicine, Tsinghua University, Beijing, China
| | - Wenjia Wang
- Department of Urology, The First Hospital of Tsinghua University, Beijing, China
| | - Jun Shen
- Department of Urology, The Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou, China
| | - Zhiqiang Song
- Department of Urology, The First Hospital of Tsinghua University, Beijing, China
| | - Haoyu Ji
- School of Clinical Medicine, Tsinghua University, Beijing, China.,Department of Urology, The First Hospital of Tsinghua University, Beijing, China
| | - Fangyuan Zhang
- School of Clinical Medicine, Tsinghua University, Beijing, China.,Department of Urology, The First Hospital of Tsinghua University, Beijing, China
| | - Jianchen Wu
- Department of Urology, The First Hospital of Tsinghua University, Beijing, China
| | - Jie Na
- Center for Stem Cell Biology and Regenerative Medicine, School of Medicine, Tsinghua University, Beijing, China
| | - Shengwen Li
- School of Clinical Medicine, Tsinghua University, Beijing, China.,Department of Urology, The First Hospital of Tsinghua University, Beijing, China
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15
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Attawettayanon W, Anukoolphaiboon A, Chalieopanyarwong V, Pripatnanont C. Biphasic change in renal function after radical cystectomy and urinary diversion: Result from tertiary center in Thailand. UROLOGICAL SCIENCE 2021. [DOI: 10.4103/uros.uros_102_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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16
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Demaegd L, Albersen M, Muilwijk T, Milenkovic U, Moris L, Everaerts W, Van Poppel H, Van der Aa F, Joniau S, Akand M. Comparison of postoperative complications of ileal conduits versus orthotopic neobladders. Transl Androl Urol 2020; 9:2541-2554. [PMID: 33457228 PMCID: PMC7807350 DOI: 10.21037/tau-20-713] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Background Radical cystectomy (RC) and urinary diversion (UD), with either an ileal conduit (IC) or an orthotopic neobladder (NB), is a complex surgery, in which various complications can occur. In this study, we compared postoperative complication rates after a RC and UD performed for the treatment of muscle-invasive bladder cancer or recurring high-risk non-muscle-invasive bladder cancer in our center. Methods We retrospectively included 604 patients that underwent UDs from December 1996 to August 2015. Complications were classified by type and severity according to the Clavien-Dindo classification (CDC). Univariate and multivariate analyses were performed to identify predictive factors of short-term (≤30 d), intermediate-term (31-90 d), and long-term (>90 d) complications. Results Four hundred and forty-five (74%) and 159 (26%) patients received ICs and NBs, respectively. These groups had significantly different long-term complication rates (IC: 39.7% vs. NB: 49%, P=0.046), but similar short-term (P=0.319) and intermediate-term complication rates (P=0.397). Short-term complications (CDC I-V) were predicted by male gender, age-adjusted Charlson comorbidity index (aCCI) ≥3, and American Society of Anesthesiologists (ASA) score ≥3. Compared to minor short-term complications (CDC I-II), major short-term complications (CDC III-V) were predicted by male gender and a previous abdominal/pelvic surgery, and long-term major complications were predicted by the type of UD (NB). Conclusions The increasing risk of short-term complications with increasing aCCI and ASA score can be used when counseling the patients who are planned to undergo a RC with UD. Patients that receive NBs should be informed of the increased risk of reoperations compared to an IC.
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Affiliation(s)
- Liesbeth Demaegd
- Department of Urology, University Hospitals Leuven, Leuven, Belgium
| | - Maarten Albersen
- Department of Urology, University Hospitals Leuven, Leuven, Belgium
| | - Tim Muilwijk
- Department of Urology, University Hospitals Leuven, Leuven, Belgium
| | - Uros Milenkovic
- Department of Urology, University Hospitals Leuven, Leuven, Belgium
| | - Lisa Moris
- Department of Urology, University Hospitals Leuven, Leuven, Belgium
| | - Wouter Everaerts
- Department of Urology, University Hospitals Leuven, Leuven, Belgium
| | | | - Frank Van der Aa
- Department of Urology, University Hospitals Leuven, Leuven, Belgium
| | - Steven Joniau
- Department of Urology, University Hospitals Leuven, Leuven, Belgium
| | - Murat Akand
- Department of Urology, University Hospitals Leuven, Leuven, Belgium.,Department of Urology, School of Medicine, Selçuk University, Konya, Turkey
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17
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Cacciamani GE, Aron M, Gill I, Desai M. Re: Oncological outcome according to attainment of pentafecta after robot-assisted radical cystectomy in patients with bladder cancer in the multicentre KORARC database. BJU Int 2020 July 18. DOI: 10.1111/ bju.15178. BJU Int 2020; 126:644-645. [PMID: 32870582 DOI: 10.1111/bju.15222] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Accepted: 08/11/2020] [Indexed: 12/01/2022]
Affiliation(s)
- Giovanni Enrico Cacciamani
- Catherine and Joseph Aresty Department of Urology, USC Institute of Urology, Keck School of Medicine/Norris Cancer Center, University of Southern California, Los Angeles, CA, USA
| | - Monish Aron
- Catherine and Joseph Aresty Department of Urology, USC Institute of Urology, Keck School of Medicine/Norris Cancer Center, University of Southern California, Los Angeles, CA, USA
| | - Inderbir Gill
- Catherine and Joseph Aresty Department of Urology, USC Institute of Urology, Keck School of Medicine/Norris Cancer Center, University of Southern California, Los Angeles, CA, USA
| | - Mihir Desai
- Catherine and Joseph Aresty Department of Urology, USC Institute of Urology, Keck School of Medicine/Norris Cancer Center, University of Southern California, Los Angeles, CA, USA
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18
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Oh JJ, Lee S, Ku JH, Kwon TG, Kim TH, Jeon SH, Lee SH, Nam JK, Kim WS, Jeong BC, Lee JY, Hong SH, Rha KH, Han WK, Ham WS, Lee YG, Lee YS, Park SY, Yoon YE, Kang SG, Kang SH. Oncological outcome according to attainment of pentafecta after robot-assisted radical cystectomy in patients with bladder cancer included in the multicentre KORARC database. BJU Int 2020; 127:182-189. [PMID: 32682331 DOI: 10.1111/bju.15178] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
OBJECTIVES To investigate the oncological significance of a robot-assisted radical cystectomy (RARC)-related pentafecta in patients with bladder cancer. PATIENTS AND METHODS Using the KORARC database, which includes data from 12 centres, data from 730 patients who underwent RARC between April 2007 and May 2019 were prospectively collected and retrospectively analysed. Pentafecta was achieved if patients met all of the following criteria: (i) negative soft tissue surgical margin; (ii) ≥16 lymph nodes removed; (iii) no major complications (Clavien-Dindo grade 3-5) within 90 days; (iv) no clinical recurrence within the first 12 months; and (v) no ureteroenteric stricture. Patients were divided into two groups according to pentafecta attainment, and a comparison of overall survival (OS) and cancer-specific survival (CSS) using multivariate Cox proportional analysis was then carried out. RESULTS Of the 730 patients included in this analysis, 208 (28.5%) attained the RARC pentafecta; the remaining 522 (71.5%) did not. The mean age of the patients was 64.67 years, 85.1% were men, 53.6% received a conduit, 37.7% received orthotopic neobladders and the total complication rate was 57.8%. Those who attained the pentafecta received more neobladders (P = 0.039), were more likely to be treated with the intracorporeal technique (P < 0.001), had longer operating times (P = 0.020) and had longer console time (P = 0.021) compared with those who did not attain the pentafecta. Over a mean of 31.1 months of follow-up, the pentafecta attainment group had significantly higher OS and CSS rates compared with the non-attainment group (10-year OS 70.4% vs 58.1%, respectively [P = 0.016]; 10-year CSS 87.8% vs 70.0%, respectively [P = 0.036]). Multivariate analysis showed that the RARC pentafecta was a significant predictor of overall mortality (hazard ratio 0.561; P = 0.038). CONCLUSIONS Patients who attained the RARC pentafecta had significantly better survival outcomes compared with those who did not. These criteria could be used to standardize assessment of the surgical quality of RARC. In the future, a similar study using an independent cohort is warranted to confirm our results.
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Affiliation(s)
- Jong Jin Oh
- Department of Urology, Seoul National University Bundang Hospital, Seongnam, Korea.,Department of Urology, Seoul National University College of Medicine, Seoul, Korea
| | - Sangchul Lee
- Department of Urology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Ja Hyeon Ku
- Department of Urology, Seoul National University College of Medicine, Seoul, Korea.,Department of Urology, Seoul National University Hospital, Seoul, Korea
| | - Tae Gyun Kwon
- Department of Urology, Kyungpook National University School of Medicine, Daegu, Korea
| | - Tae-Hwan Kim
- Department of Urology, Kyungpook National University School of Medicine, Daegu, Korea
| | - Seung Hyun Jeon
- Department of Urology, Kyung Hee University School of Medicine, Seoul, Korea
| | - Sang Hyup Lee
- Department of Urology, Kyung Hee University School of Medicine, Seoul, Korea
| | - Jong Kil Nam
- Department of Urology, Busan National University Yangsan Hospital, Yangsan, Korea
| | - Wan Seok Kim
- Department of Urology, College of Medicine, Busan Paik Hospital, Inje University, Busan, Korea
| | - Byong Chang Jeong
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ji Youl Lee
- Department of Urology, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
| | - Sung Hoo Hong
- Department of Urology, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
| | - Koon Ho Rha
- Department of Urology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Woong Kyu Han
- Department of Urology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Won Sik Ham
- Department of Urology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Young Goo Lee
- Department of Urology, Hallym University Kangnam Sacred Heart Hospital, Hallym University School of Medicine, Seoul, Korea
| | - Yong Seong Lee
- Department of Urology, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
| | - Sung Yul Park
- Department of Urology, Hanyang University College of Medicine, Seoul, Korea
| | - Young Eun Yoon
- Department of Urology, Hanyang University College of Medicine, Seoul, Korea
| | - Sung Gu Kang
- Department of Urology, Korea University College of Medicine, Seoul, Korea
| | - Seok Ho Kang
- Department of Urology, Korea University College of Medicine, Seoul, Korea
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19
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How to assess renal function in patients with a neobladder. Clin Chim Acta 2020; 504:154. [PMID: 32032608 DOI: 10.1016/j.cca.2020.02.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Accepted: 02/03/2020] [Indexed: 11/24/2022]
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20
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Zhong H, Shen Y, Yao Z, Chen X, Gao J, Xiang A, Wang W. Long-term outcome of spiral ileal neobladder with orthotopic ureteral reimplantation. Int Urol Nephrol 2020; 52:41-49. [PMID: 31560108 PMCID: PMC6957550 DOI: 10.1007/s11255-019-02296-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Accepted: 09/19/2019] [Indexed: 11/30/2022]
Abstract
PURPOSE The purpose of this study was to analyze long-term complications, urodynamics, and quality of life (QoL) of patients after orthotopic ileal neobladder with orthotopic ureteral reimplantation to enrich clinical data and provide a basis for clinical use of this surgery. METHODS Between January 2007 and January 2013, 72 consecutive patients who underwent spiral ileal neobladder following radical cystectomy were enrolled. The neobladder was created using a modified Camey-II technique. Complications were reviewed and staged according to Clavien-Dindo classification and evaluated in long-term follow-up. Urodynamics were performed, and QoL was assessed by the Functional Assessment of Cancer Therapy for Bladder Cancer (FACT-BL) instrument. RESULTS The total follow-up time was 60 months, and the total survival rates at 3 and 5 years after surgery were 76.4% (55/72) and 65.3% (47/72), respectively. There were 34 (47.2%) early complications in 23 (31.9%) patients and 42 (58.3%) late complications in 35 (48.6%) patients. The total satisfactory control rates were 69.1% and 66.0% at 3 and 5 years after the surgery, respectively. Urodynamic studies were performed in some patients, and the receiver operating characteristic curve analysis showed that pressure at maximum capacity, compliance, and post void residual urine had predictive value for mortality (P < 0.05). The total FACT-BL scores of patients at 1, 3, and 5 years postoperation were 125.0 ± 15.2, 127.0 ± 16.2, and 120.6 ± 13.5, respectively, and it decreased at 5 years postoperation (P < 0.05). CONCLUSION Spiral ileal neobladder with orthotopic ureteral reimplantation offers satisfactory long-term results, and urodynamic monitoring might have prognostic value.
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Affiliation(s)
- Huan Zhong
- Department of Urology, The First People's Hospital of Huzhou, The First Affiliated Hospital of Huzhou Teachers College, No. 158, Guangchanghou Road, Huzhou, 313000, Zhejiang, China
| | - Yuefan Shen
- Department of Urology, The First People's Hospital of Huzhou, The First Affiliated Hospital of Huzhou Teachers College, No. 158, Guangchanghou Road, Huzhou, 313000, Zhejiang, China
| | - Zixiang Yao
- Department of Urology, The First People's Hospital of Huzhou, The First Affiliated Hospital of Huzhou Teachers College, No. 158, Guangchanghou Road, Huzhou, 313000, Zhejiang, China
| | - Xiaonong Chen
- Department of Urology, The First People's Hospital of Huzhou, The First Affiliated Hospital of Huzhou Teachers College, No. 158, Guangchanghou Road, Huzhou, 313000, Zhejiang, China
| | - Jianguo Gao
- Department of Urology, The First People's Hospital of Huzhou, The First Affiliated Hospital of Huzhou Teachers College, No. 158, Guangchanghou Road, Huzhou, 313000, Zhejiang, China
| | - Anping Xiang
- Department of Urology, The First People's Hospital of Huzhou, The First Affiliated Hospital of Huzhou Teachers College, No. 158, Guangchanghou Road, Huzhou, 313000, Zhejiang, China
| | - Weigao Wang
- Department of Urology, The First People's Hospital of Huzhou, The First Affiliated Hospital of Huzhou Teachers College, No. 158, Guangchanghou Road, Huzhou, 313000, Zhejiang, China.
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21
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Cacciamani GE, Winter M, Medina LG, Ashrafi AN, Miranda G, Tafuri A, Landsberger H, Lin-Brande M, Rajarubendra N, De Castro Abreu A, Berger A, Aron M, Gill IS, Desai MM. Radical cystectomy pentafecta: a proposal for standardisation of outcomes reporting following robot-assisted radical cystectomy. BJU Int 2019; 125:64-72. [PMID: 31260600 DOI: 10.1111/bju.14861] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To propose a standardisable composite method for reporting outcomes of radical cystectomy (RC) that incorporates both perioperative morbidity and oncological adequacy. PATIENTS AND METHODS From July 2010 to December 2017, 277 consecutive patients who underwent robot-assisted RC with intracorporeal urinary diversion (UD) for bladder cancer at our Institution were prospectively analysed. Patients who simultaneously demonstrated negative soft tissue surgical margins (STSMs), ≥16 lymph node (LN) yield, absence of major (grade III-IV) complications at 90 days, absence of UD-related long-term sequelae and absence of clinical recurrence at ≤12 months, were considered as having achieved the RC-pentafecta. A multivariable logistic regression model was assessed to measure predictors for achieving RC-pentafecta. RESULTS AND LIMITATIONS Since 2010, 270 of 277 patients that had completed at least 12 months of follow-up were included. Over a mean follow-up of 22.3 months, ≥16 LN yield, negative STSMs, absence of major complications at 90 days, and absence of UD-related surgical sequelae and clinical recurrence at ≤12 months were observed in 93.0%, 98.9%, 76.7%, 81.5% and 92.2%, patients, respectively, resulting in a RC-pentafecta rate of 53.3%. Multivariable logistic regression analysis revealed age (odds ratio [OR] 0.95; P = 0.002), type of UD (OR 2.19; P = 0.01) and pN stage (OR 0.48; P = 0.03) as independent predictors for achieving RC-pentafecta. CONCLUSIONS We present a RC-pentafecta as a standardisable composite endpoint that incorporates perioperative morbidity and oncological adequacy as a potential tool to assess quality of RC. This tool may be useful for assessing the learning curve and calculating cost-effectiveness amongst others but needs to be externally validated in future studies.
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Affiliation(s)
- Giovanni E Cacciamani
- USC Institute of Urology, Keck Medicine of USC, University of Southern California, Los Angeles, CA, USA
| | - Matthew Winter
- USC Institute of Urology, Keck Medicine of USC, University of Southern California, Los Angeles, CA, USA
| | - Luis G Medina
- USC Institute of Urology, Keck Medicine of USC, University of Southern California, Los Angeles, CA, USA
| | - Akhbar N Ashrafi
- USC Institute of Urology, Keck Medicine of USC, University of Southern California, Los Angeles, CA, USA
| | - Gus Miranda
- USC Institute of Urology, Keck Medicine of USC, University of Southern California, Los Angeles, CA, USA
| | - Alessandro Tafuri
- USC Institute of Urology, Keck Medicine of USC, University of Southern California, Los Angeles, CA, USA.,Department of Urology, University of Verona, Verona, Italy
| | - Hannah Landsberger
- USC Institute of Urology, Keck Medicine of USC, University of Southern California, Los Angeles, CA, USA
| | - Michael Lin-Brande
- USC Institute of Urology, Keck Medicine of USC, University of Southern California, Los Angeles, CA, USA
| | - Nieroshan Rajarubendra
- USC Institute of Urology, Keck Medicine of USC, University of Southern California, Los Angeles, CA, USA
| | - Andre De Castro Abreu
- USC Institute of Urology, Keck Medicine of USC, University of Southern California, Los Angeles, CA, USA
| | - Andre Berger
- USC Institute of Urology, Keck Medicine of USC, University of Southern California, Los Angeles, CA, USA
| | - Monish Aron
- USC Institute of Urology, Keck Medicine of USC, University of Southern California, Los Angeles, CA, USA
| | - Inderbir S Gill
- USC Institute of Urology, Keck Medicine of USC, University of Southern California, Los Angeles, CA, USA
| | - Mihir M Desai
- USC Institute of Urology, Keck Medicine of USC, University of Southern California, Los Angeles, CA, USA
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Hupe MC, Vahlensieck W, Ozimek T, Struck JP, Hennig MJ, Tezval H, von Klot CA, Merseburger AS, Kuczyk MA, Kramer MW. Diarrhea and flatulence are major bowel disorders after radical cystectomy: Results from a cross-sectional study in bladder cancer patients. Urol Oncol 2018; 36:237.e1-237.e8. [DOI: 10.1016/j.urolonc.2017.12.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Revised: 11/26/2017] [Accepted: 12/23/2017] [Indexed: 12/14/2022]
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Przydacz M, Corcos J. Revisiting Ureterosigmoidostomy, a Useful Technique of Urinary Diversion in Functional Urology. Urology 2018; 115:14-20. [PMID: 29355572 DOI: 10.1016/j.urology.2018.01.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Revised: 01/02/2018] [Accepted: 01/04/2018] [Indexed: 11/15/2022]
Abstract
Ureterosigmoidostomy has largely been disregarded in recent times but has now seen a resurgence of interest because of its potential applicability to newer, minimally invasive surgical techniques. The advantages of ureterosigmoidostomy over intestinal conduits are urinary continence (obviating the need for stoma and external appliances), ease, and rapidity of performance as well as acceptance by patients. Ureterosigmoidostomy has been characterized by good continence outcomes and it offers good quality of life. Possible complications are anastomosis stenosis, coloureteral reflux, electrolyte imbalance, hydronephrosis, pyelonephritis, chronic renal failure, colorectal cancer, and others. Ureterosigmoidostomy is therefore only advisable for patients ready to accept long-term follow-up.
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Affiliation(s)
- Mikolaj Przydacz
- Department of Urology, Jewish General Hospital, McGill University, Montreal, Quebec, Canada.
| | - Jacques Corcos
- Department of Urology, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
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24
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Bell MA, Wright EJ, Fang SH, Johnson MH, Sopko NA. Management of advanced adenocarcinoma in Indiana Pouch urinary diversion. Urol Case Rep 2018; 17:53-55. [PMID: 29379738 PMCID: PMC5782398 DOI: 10.1016/j.eucr.2018.01.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Accepted: 01/10/2018] [Indexed: 11/26/2022] Open
Abstract
Adenocarcinoma is a rare finding following urinary diversion with gastrointestinal segments. This report describes an 80-year-old woman with a history of bladder cancer who subsequently developed a pT4 adenocarcinoma 8 years following her radical cystectomy and Indiana Pouch continent urinary diversion. An en bloc resection of the pouch and affected small bowel was performed and the patient underwent conversion to an ileal conduit diversion. We use this case to highlight a mechanism for possible pathogenesis and the management of adenocarcinoma in urinary diversions including the need for regular surveillance and the surgical approach.
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Affiliation(s)
- Michael A Bell
- The James Buchanan Brady Urological Institute and Department of Urology, The Johns Hopkins University School of Medicine, 1800 Orleans Street, Marburg 420, Baltimore, MD 21287, USA
| | - Edward J Wright
- The James Buchanan Brady Urological Institute and Department of Urology, The Johns Hopkins University School of Medicine, 1800 Orleans Street, Marburg 420, Baltimore, MD 21287, USA
| | - Sandy H Fang
- Department of Surgery, Ravitch Division of GI Surgery, The Johns Hopkins University School of Medicine, 1800 Orleans Street, Sheikh Zayed Tower, Baltimore, MD 21287, USA
| | - Michael H Johnson
- The James Buchanan Brady Urological Institute and Department of Urology, The Johns Hopkins University School of Medicine, 1800 Orleans Street, Marburg 420, Baltimore, MD 21287, USA
| | - Nikolai A Sopko
- The James Buchanan Brady Urological Institute and Department of Urology, The Johns Hopkins University School of Medicine, 1800 Orleans Street, Marburg 420, Baltimore, MD 21287, USA
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25
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Urinary Tissue Engineering: Challenges and Opportunities. Sex Med Rev 2017; 6:35-44. [PMID: 29066225 DOI: 10.1016/j.sxmr.2017.08.004] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Revised: 08/09/2017] [Accepted: 08/17/2017] [Indexed: 01/14/2023]
Abstract
INTRODUCTION In this review, we discuss major advancements and common challenges in constructing and regenerating a neo-urinary conduit (NUC). First, we focus on the need for regenerating the urothelium, the hallmark the urine barrier, unique to urinary tissues. Second, we focus on clinically feasible scaffolds based on decellularized matrices and molded collagen that are currently of great research interest. AIM To discuss the major advancements in constructing a tissue-engineered NUC (TE-NUC) and the challenges involved in their successful clinical translation. METHODS A comprehensive search of peer-reviewed literature from PubMed and Google Scholar on subjects related to urothelium regeneration, decellularized tissue matrices, and collagen scaffolds was conducted. MAIN OUTCOME MEASURE We evaluated the main biological and mechanical functions of urinary tissues, the need for TE implants to create a urinary diversion, the reasons for their failures in clinical settings, and the applications of decellularized tissue matrices and collagen-based molded scaffolds in their regeneration. RESULTS It is necessary to create a urine barrier that prevents urine leakage into the stroma that can cause failure of the graft. Despite the regeneration potential of the urothelium, the limited supply of healthy urothelial cells in patients with bladder cancer remains a major challenge. In this context, alternative strategies, such as transdifferentiation of cells into urothelium or engineered scaffolds based on decellularized tissues and molded collagen with robust urine barrier properties, are active areas of research. CONCLUSION There is an immediate need for developing a functional TE-NUC that can improve the quality of life of patients with bladder cancer. It is possible to achieve a TE-NUC by bioengineering an implant that has appropriate biological and mechanical properties to store and transport urine. We anticipate that future advancements in urothelium regeneration and material design will lead us closer to successful neo-urinary tissue constructs. Singh A, Bivalacqua TJ, Sopko N. Urinary Tissue Engineering: Challenges and Opportunities. Sex Med Rev 2018;6:35-44.
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26
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Chang SS, Bochner BH, Chou R, Dreicer R, Kamat AM, Lerner SP, Lotan Y, Meeks JJ, Michalski JM, Morgan TM, Quale DZ, Rosenberg JE, Zietman AL, Holzbeierlein JM. Treatment of Non-Metastatic Muscle-Invasive Bladder Cancer: AUA/ASCO/ASTRO/SUO Guideline. J Urol 2017; 198:552-559. [PMID: 28456635 DOI: 10.1016/j.juro.2017.04.086] [Citation(s) in RCA: 574] [Impact Index Per Article: 82.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/21/2017] [Indexed: 02/08/2023]
Abstract
PURPOSE This multidisciplinary, evidence-based guideline for clinically non-metastatic muscle-invasive bladder cancer focuses on the evaluation, treatment and surveillance of muscle-invasive bladder cancer guided toward curative intent. MATERIALS AND METHODS A systematic review utilizing research from the Agency for Healthcare Research and Quality as well as additional supplementation by the authors and consultant methodologists was used to develop the guideline. Evidence-based statements were based on body of evidence strengths Grade A, B or C and were designated as Strong, Moderate and Conditional Recommendations with additional statements presented in the form of Clinical Principles or Expert Opinions. RESULTS For the first time for any type of malignancy, the American Urological Association, American Society of Clinical Oncology, American Society for Radiation Oncology and Society of Urologic Oncology have formulated an evidence-based guideline based on a risk-stratified clinical framework for the management of muscle-invasive urothelial bladder cancer. This document is designed to be used in conjunction with the associated treatment algorithm. CONCLUSIONS The intensity and scope of care for muscle-invasive bladder cancer should focus on the patient, disease and treatment response characteristics. This guideline attempts to improve a clinician's ability to evaluate and treat each patient, but higher quality evidence in future trials will be essential to improve level of care for these patients.
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Affiliation(s)
- Sam S Chang
- American Urological Association Education and Research, Inc., Linthicum, Maryland; American Society of Clinical Oncology, Alexandria, Virginia; American Society for Radiation Oncology, Arlington, Virginia; Society of Urologic Oncology, Inc., Schaumburg, Illinois
| | - Bernard H Bochner
- American Urological Association Education and Research, Inc., Linthicum, Maryland; American Society of Clinical Oncology, Alexandria, Virginia; American Society for Radiation Oncology, Arlington, Virginia; Society of Urologic Oncology, Inc., Schaumburg, Illinois
| | - Roger Chou
- American Urological Association Education and Research, Inc., Linthicum, Maryland; American Society of Clinical Oncology, Alexandria, Virginia; American Society for Radiation Oncology, Arlington, Virginia; Society of Urologic Oncology, Inc., Schaumburg, Illinois
| | - Robert Dreicer
- American Urological Association Education and Research, Inc., Linthicum, Maryland; American Society of Clinical Oncology, Alexandria, Virginia; American Society for Radiation Oncology, Arlington, Virginia; Society of Urologic Oncology, Inc., Schaumburg, Illinois
| | - Ashish M Kamat
- American Urological Association Education and Research, Inc., Linthicum, Maryland; American Society of Clinical Oncology, Alexandria, Virginia; American Society for Radiation Oncology, Arlington, Virginia; Society of Urologic Oncology, Inc., Schaumburg, Illinois
| | - Seth P Lerner
- American Urological Association Education and Research, Inc., Linthicum, Maryland; American Society of Clinical Oncology, Alexandria, Virginia; American Society for Radiation Oncology, Arlington, Virginia; Society of Urologic Oncology, Inc., Schaumburg, Illinois
| | - Yair Lotan
- American Urological Association Education and Research, Inc., Linthicum, Maryland; American Society of Clinical Oncology, Alexandria, Virginia; American Society for Radiation Oncology, Arlington, Virginia; Society of Urologic Oncology, Inc., Schaumburg, Illinois
| | - Joshua J Meeks
- American Urological Association Education and Research, Inc., Linthicum, Maryland; American Society of Clinical Oncology, Alexandria, Virginia; American Society for Radiation Oncology, Arlington, Virginia; Society of Urologic Oncology, Inc., Schaumburg, Illinois
| | - Jeff M Michalski
- American Urological Association Education and Research, Inc., Linthicum, Maryland; American Society of Clinical Oncology, Alexandria, Virginia; American Society for Radiation Oncology, Arlington, Virginia; Society of Urologic Oncology, Inc., Schaumburg, Illinois
| | - Todd M Morgan
- American Urological Association Education and Research, Inc., Linthicum, Maryland; American Society of Clinical Oncology, Alexandria, Virginia; American Society for Radiation Oncology, Arlington, Virginia; Society of Urologic Oncology, Inc., Schaumburg, Illinois
| | - Diane Z Quale
- American Urological Association Education and Research, Inc., Linthicum, Maryland; American Society of Clinical Oncology, Alexandria, Virginia; American Society for Radiation Oncology, Arlington, Virginia; Society of Urologic Oncology, Inc., Schaumburg, Illinois
| | - Jonathan E Rosenberg
- American Urological Association Education and Research, Inc., Linthicum, Maryland; American Society of Clinical Oncology, Alexandria, Virginia; American Society for Radiation Oncology, Arlington, Virginia; Society of Urologic Oncology, Inc., Schaumburg, Illinois
| | - Anthony L Zietman
- American Urological Association Education and Research, Inc., Linthicum, Maryland; American Society of Clinical Oncology, Alexandria, Virginia; American Society for Radiation Oncology, Arlington, Virginia; Society of Urologic Oncology, Inc., Schaumburg, Illinois
| | - Jeffrey M Holzbeierlein
- American Urological Association Education and Research, Inc., Linthicum, Maryland; American Society of Clinical Oncology, Alexandria, Virginia; American Society for Radiation Oncology, Arlington, Virginia; Society of Urologic Oncology, Inc., Schaumburg, Illinois
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Singh A, Lee D, Sopko N, Matsui H, Sabnekar P, Liu X, Elisseeff J, Schoenberg MP, Pienta K, Bivalacqua TJ. Biomanufacturing Seamless Tubular and Hollow Collagen Scaffolds with Unique Design Features and Biomechanical Properties. Adv Healthc Mater 2017; 6. [PMID: 28135047 DOI: 10.1002/adhm.201601136] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Revised: 12/19/2016] [Indexed: 01/14/2023]
Abstract
A versatile process to develop designer collagen scaffolds for hollow and tubular tissue engineering applications is presented. This process creates seamless and biomechanically tunable scaffolds ranging from ureter-like microsized tubings to structures with highly customized lumens that resemble intestinal villi, fluid bladders, and alveolar sacs that together with stem cells can potentially be used in preclinical and clinical settings.
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Affiliation(s)
- Anirudha Singh
- Department of Urology; The James Buchanan Brady Urological Institute; The Johns Hopkins School of Medicine; Baltimore MD 21287 USA
- Department of Chemical and Biomolecular Engineering; Johns Hopkins University; Baltimore MD 21218 USA
- Translational Tissue Engineering Center; Johns Hopkins University; Baltimore MD 21231 USA
| | - David Lee
- Translational Tissue Engineering Center; Johns Hopkins University; Baltimore MD 21231 USA
| | - Nikolai Sopko
- Department of Urology; The James Buchanan Brady Urological Institute; The Johns Hopkins School of Medicine; Baltimore MD 21287 USA
| | - Hotaka Matsui
- Department of Urology; The James Buchanan Brady Urological Institute; The Johns Hopkins School of Medicine; Baltimore MD 21287 USA
| | - Praveena Sabnekar
- Department of Urology; The James Buchanan Brady Urological Institute; The Johns Hopkins School of Medicine; Baltimore MD 21287 USA
| | - Xiaopu Liu
- Department of Urology; The James Buchanan Brady Urological Institute; The Johns Hopkins School of Medicine; Baltimore MD 21287 USA
| | - Jennifer Elisseeff
- Translational Tissue Engineering Center; Johns Hopkins University; Baltimore MD 21231 USA
| | - Mark P. Schoenberg
- Department of Urology; Albert Einstein College of Medicine; Bronx NY 10467 USA
| | - Kenneth Pienta
- Department of Urology; The James Buchanan Brady Urological Institute; The Johns Hopkins School of Medicine; Baltimore MD 21287 USA
- Department of Surgery and Oncology; Johns Hopkins Medical Institutions and Sidney Kimmel Comprehensive Cancer Center (SKCC); Baltimore MD 21287 USA
| | - Trinity J. Bivalacqua
- Department of Urology; The James Buchanan Brady Urological Institute; The Johns Hopkins School of Medicine; Baltimore MD 21287 USA
- Department of Surgery and Oncology; Johns Hopkins Medical Institutions and Sidney Kimmel Comprehensive Cancer Center (SKCC); Baltimore MD 21287 USA
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Kingo PS, Rasmussen TM, Nørregaard R, Borre M, Høyer S, Jensen JB. Evaluation of robot-assisted laparoscopic versus open cystectomy and effect of carbon dioxide-pneumoperitoneum on histopathological findings in ureteroenteric anastomoses: results from an experimental randomized porcine study. Scand J Urol 2016; 51:50-56. [PMID: 27809635 DOI: 10.1080/21681805.2016.1247294] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE The aim of this study was to investigate the histopathology of ureteroenteric anastomoses (UEAs) after radical cystectomy (RC) with an ileal conduit in a porcine model using different surgical techniques. The study also evaluated the potential anti-inflammatory effect of preoperative carbon dioxide-pneumoperitoneum (CO2P). MATERIALS AND METHODS Forty female Danish Landrace pigs were randomized to four groups: three intervention groups [open surgery ± prior CO2P and robot-assisted laparoscopic cystectomy (RALC)], all subjected to RC and an ileal conduit, and one control group. After euthanization, UEAs were harvested and histopathologically evaluated. RESULTS Five pigs were excluded from the study owing to postoperative complications. Operating room time and clamping of the right and left ureters were significantly longer in the robotic than in the open groups (p < .01). Inflammatory infiltration grade of the left ureter was significantly higher in RALC (p = .032). No statistically significant difference was observed between the open groups receiving prior CO2P or not. CONCLUSIONS Results showed a statistically significant higher inflammatory infiltration grade of the left ureter in RALC, emphasizing the importance of using meticulous techniques when mobilizing the left ureter using the robot. It was not possible to conclude with certainty whether CO2P could constitute an anti-inflammatory agent for local inflammation.
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Affiliation(s)
- Pernille Skjold Kingo
- a Department of Urology , Aarhus University Hospital , Aarhus , Denmark.,b Department of Clinical Medicine , Aarhus University Hospital , Aarhus , Denmark
| | | | - Rikke Nørregaard
- b Department of Clinical Medicine , Aarhus University Hospital , Aarhus , Denmark
| | - Michael Borre
- a Department of Urology , Aarhus University Hospital , Aarhus , Denmark.,b Department of Clinical Medicine , Aarhus University Hospital , Aarhus , Denmark
| | - Søren Høyer
- c Department of Pathology , Aarhus University Hospital , Aarhus , Denmark
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Abstract
Urologic tissue engineering efforts have been largely focused on bladder and urethral defect repair. The current surgical gold standard for treatment of poorly compliant pathological bladders and severe urethral stricture disease is enterocystoplasty and onlay urethroplasty with autologous tissue, respectively. The complications associated with autologous tissue use and harvesting have led to efforts to develop tissue-engineered alternatives. Natural and synthetic materials have been used with varying degrees of success, but none has proved consistently reliable for urologic tissue defect repair in humans. Silk fibroin (SF) scaffolds have been tested in bladder and urethral repair because of their favorable biomechanical properties including structural strength, elasticity, biodegradability, and biocompatibility. SF scaffolds have been used in multiple animal models and have demonstrated robust regeneration of smooth muscle and urothelium. The pre-clinical data involving SF scaffolds in urologic defect repair are encouraging and suggest that they hold potential for future clinical use.
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Affiliation(s)
- Bryan S Sack
- Urological Diseases Research Center, Boston Children's Hospital, Boston, MA, 02115, USA. .,Department of Surgery, Harvard Medical School, Boston, MA, 02115, USA.
| | - Joshua R Mauney
- Urological Diseases Research Center, Boston Children's Hospital, Boston, MA, 02115, USA. .,Department of Surgery, Harvard Medical School, Boston, MA, 02115, USA. .,Department of Urology, John F. Enders Research Laboratories, Boston Children's Hospital, 300 Longwood Ave., Rm. 1009, Boston, MA, 02115, USA.
| | - Carlos R Estrada
- Urological Diseases Research Center, Boston Children's Hospital, Boston, MA, 02115, USA. .,Department of Surgery, Harvard Medical School, Boston, MA, 02115, USA. .,Department of Urology, Boston Children's Hospital, 300 Longwood Ave., Hunnewell 3, Boston, MA, 02115, USA.
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30
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Golombos DM, O'Malley P, Lewicki P, Stone BV, Scherr DS. Robot-assisted partial cystectomy: perioperative outcomes and early oncological efficacy. BJU Int 2016; 119:128-134. [DOI: 10.1111/bju.13535] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- David M. Golombos
- Department of Urology; Weill Cornell Medical College; New York Presbyterian Hospital; New York NY USA
| | - Padraic O'Malley
- Department of Urology; Weill Cornell Medical College; New York Presbyterian Hospital; New York NY USA
| | - Patrick Lewicki
- Department of Urology; Weill Cornell Medical College; New York Presbyterian Hospital; New York NY USA
| | - Benjamin V. Stone
- Department of Urology; Weill Cornell Medical College; New York Presbyterian Hospital; New York NY USA
| | - Douglas S. Scherr
- Department of Urology; Weill Cornell Medical College; New York Presbyterian Hospital; New York NY USA
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31
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The Long-Term Follow-Up and Complications Associated with Urinary Diversion in the Cancer Survivor. CURRENT BLADDER DYSFUNCTION REPORTS 2016. [DOI: 10.1007/s11884-016-0359-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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32
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Sloff M, Simaioforidis V, Tiemessen DM, Janke HP, Kortmann BBM, Roelofs LAJ, Geutjes PJ, Oosterwijk E, Feitz WFJ. Tubular Constructs as Artificial Urinary Conduits. J Urol 2016; 196:1279-86. [PMID: 27185613 DOI: 10.1016/j.juro.2016.04.092] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/21/2016] [Indexed: 12/11/2022]
Abstract
PURPOSE A readily available artificial urinary conduit might be substituted for autologous bowel in standard urinary diversions and minimize bowel associated complications. However, the use of large constructs remains challenging as host cellular ingrowth and/or vascularization is limited. We investigated large, reinforced, collagen based tubular constructs in a urinary diversion porcine model and compared subcutaneously pre-implanted constructs to cell seeded and basic constructs. MATERIALS AND METHODS Reinforced tubular constructs were prepared from type I collagen and biodegradable Vicryl® meshes through standard freezing, lyophilization and cross-linking techniques. Artificial urinary conduits were created in 17 female Landrace pigs, including 7 with a basic untreated construct, 5 with a construct seeded with autologous urothelial and smooth muscle cells, and 5 with a free graft formed by subcutaneous pre-implantation of a basic construct. All pigs were evaluated after 1 month. RESULTS The survival rate was 94%. At evaluation 1 basic and 1 cell seeded conduit were occluded. Urinary flow was maintained in all conduits created with pre-implanted constructs. Pre-implantation of the basic construct resulted in a vascularized tissue tube, which could be used as a free graft to create an artificial conduit. The outcome was favorable compared to that of the other conduits. Urinary drainage was better, hydroureteronephrosis was limited and tissue regeneration was improved. CONCLUSIONS Subcutaneous pre-implantation of a basic reinforced tubular construct resulted in a vascularized autologous tube, which may potentially replace bowel in standard urinary diversions. To our knowledge we introduce a straightforward 2-step procedure to create artificial urinary conduits in a large animal model.
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Affiliation(s)
- Marije Sloff
- Department of Urology, Radboud Institute for Molecular Life Sciences and Amalia's Children Hospital, Radboud University Medical Center, Nijmegen, The Netherlands.
| | - Vasileios Simaioforidis
- Department of Urology, Radboud Institute for Molecular Life Sciences and Amalia's Children Hospital, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Dorien M Tiemessen
- Department of Urology, Radboud Institute for Molecular Life Sciences and Amalia's Children Hospital, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Heinz P Janke
- Department of Urology, Radboud Institute for Molecular Life Sciences and Amalia's Children Hospital, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Barbara B M Kortmann
- Department of Urology, Radboud Institute for Molecular Life Sciences and Amalia's Children Hospital, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Luc A J Roelofs
- Department of Urology, Radboud Institute for Molecular Life Sciences and Amalia's Children Hospital, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Paul J Geutjes
- Department of Urology, Radboud Institute for Molecular Life Sciences and Amalia's Children Hospital, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Egbert Oosterwijk
- Department of Urology, Radboud Institute for Molecular Life Sciences and Amalia's Children Hospital, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Wout F J Feitz
- Department of Urology, Radboud Institute for Molecular Life Sciences and Amalia's Children Hospital, Radboud University Medical Center, Nijmegen, The Netherlands
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