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Tuderti G, Mastroianni R, Anceschi U, Bove AM, Brassetti A, Ferriero M, Misuraca L, Flammia RS, Proietti F, D'Annunzio S, Leonardo C, Guaglianone S, Anselmi M, Zampa A, Torregiani G, Gallucci M, Simone G. Learning curve for intracorporeal robotic Padua ileal bladder: 10-year functional assessment from a high-volume single-centre series. BJU Int 2024; 134:103-109. [PMID: 38459659 DOI: 10.1111/bju.16328] [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: 03/10/2024]
Abstract
OBJECTIVES To assess the impact of the learning curve (LC) on perioperative and long-term functional outcomes of a consecutive single-centre series of robot-assisted radical cystectomy with Padua intracorporeal orthotopic neobladder. PATIENTS AND METHODS Patients treated between 2013 and 2022 were included, with ≥1 year of follow-up. The entire cohort was divided in tertiles. Categorical and continuous variables were compared. Joinpoint regression analysis was used to identify significant changes over the decade in linear slope of the 1-year day- and night-time continence. Uni- and multivariable Cox regression analyses identified predictors of day- and night-time continence recovery. Day-time continence was defined as 'totally dry' (no pads), night-time continence as pad wetness ≤50 mL (one safety pad). RESULTS Overall, 200 patients were included. The mean hospital stay (P = 0.002) and 30-day complications (P = 0.04) significantly reduced over time; the LC significantly impacted on Trifecta achievement (P < 0.001). The 1-year day- and night-time continence probabilities displayed a significant improving trend (day-time continence annual average percentage change [AAPC] 11.45%, P < 0.001; night-time continence AAPC 10.05%, P = 0.009). The LC was an independent predictor of day- (hazard ratio [HR] 1.008; P < 0.001) and night-time continence (HR 1.004; P = 0.03) over time. CONCLUSION Patients at the beginning of the LC had significantly longer hospitalisations, more postoperative complications, and lower Trifecta rates. At the 10-year analyses, we observed a significant improving trend for both the 1-year day- and night-time continence probabilities, highlighting the crucial role of the LC. However, we are unable to assess the case volume needed to achieve a plateau in terms of day- and night-time continence rates.
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Affiliation(s)
- Gabriele Tuderti
- Department of Urology, IRCCS 'Regina Elena' National Cancer Institute, Rome, Italy
| | - Riccardo Mastroianni
- Department of Urology, IRCCS 'Regina Elena' National Cancer Institute, Rome, Italy
| | - Umberto Anceschi
- Department of Urology, IRCCS 'Regina Elena' National Cancer Institute, Rome, Italy
| | - Alfredo Maria Bove
- Department of Urology, IRCCS 'Regina Elena' National Cancer Institute, Rome, Italy
| | - Aldo Brassetti
- Department of Urology, IRCCS 'Regina Elena' National Cancer Institute, Rome, Italy
| | | | - Leonardo Misuraca
- Department of Urology, IRCCS 'Regina Elena' National Cancer Institute, Rome, Italy
| | - Rocco Simone Flammia
- Department of Urology, IRCCS 'Regina Elena' National Cancer Institute, Rome, Italy
| | - Flavia Proietti
- Department of Urology, IRCCS 'Regina Elena' National Cancer Institute, Rome, Italy
| | - Simone D'Annunzio
- Department of Urology, IRCCS 'Regina Elena' National Cancer Institute, Rome, Italy
| | - Costantino Leonardo
- Department of Urology, IRCCS 'Regina Elena' National Cancer Institute, Rome, Italy
| | | | - Marianna Anselmi
- Department of Urology, IRCCS 'Regina Elena' National Cancer Institute, Rome, Italy
| | - Ashanti Zampa
- Department of Urology, IRCCS 'Regina Elena' National Cancer Institute, Rome, Italy
| | - Giulia Torregiani
- Department of Urology, IRCCS 'Regina Elena' National Cancer Institute, Rome, Italy
| | - Michele Gallucci
- Department of Urology, IRCCS 'Regina Elena' National Cancer Institute, Rome, Italy
| | - Giuseppe Simone
- Department of Urology, IRCCS 'Regina Elena' National Cancer Institute, Rome, Italy
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Jing S, Yang E, Luo Z, Zhang Y, Ding H, Yang L, Dong Z, Shang P, Yue Z, Wu G, Bao J, Tian J, Wang J, Xiao N, Wang Z. Perioperative outcomes and continence following robotic-assisted radical cystectomy with mainz pouch II urinary diversion in patients with bladder cancer. BMC Cancer 2024; 24:127. [PMID: 38267934 PMCID: PMC10809619 DOI: 10.1186/s12885-024-11874-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 01/12/2024] [Indexed: 01/26/2024] Open
Abstract
PURPOSE To present the widely unknown perioperative outcomes and continence status of bladder cancer patients following robotic-assisted radical cystectomy (RARC) with Mainz pouch II urinary diversion (UD). MATERIALS AND METHODS From November 2020 to December 2023, 37 bladder cancer patients who underwent RARC with Mainz pouch II UD were retrospectively assessed (ChiCTR2300070279). The results, which included patient demographics, perioperative data, continence, and complications (early ≤ 30 days and late ≤ 30 days) were reported using the RC-pentafecta criteria. RC-pentafecta criteria included ≥ 16 lymph nodes removed, negative soft tissue surgical margins, absence of major (Grade III-IV) complication at 90 days, absence of clinical recurrence at ≤ 12 months, and absence of long-term UD-related sequelae. A numeric rating scale assessed patient satisfaction with urinary continence 30 days after surgery. The validated Patient Assessment of Constipation Symptoms (PAC-SYM) questionnaire was used to evaluate bowel function. The Kaplan-Meier curve was used to evaluate overall survival (OS). RESULTS Of the 37 patients evaluated over a median (range) follow-up period of 23.0 (12.0-36.5) months. The median (range) age was 65 (40-81) years. The median (range) time to urinary continence after surgery was 2.3 (1.5-6) months. Of the 37 patients, 31 (83.8%) were continent both during the day and at night, 34 (91.9%) were continent during the day, 32 (86.5%) were continent at night, 35 (94.6%) were satisfied with their urinary continence status, and 21 (56.8%) were very satisfied. The mean (range) voiding frequency was 6 (4-10) during the day and 3 (2-5.5) at night. The mean (range) PAC-SYM total score was 9.50 (4.00-15.00). In 12 (32.4%) of the patients, RC-pentafecta was achieved, and achieving RC-pentafecta was linked to better satisfaction scores (7.3 vs. 5.5, p = 0.034). There was no significant difference between RC-pentafecta and No RC-pentafecta groups in terms of OS (25.6 vs. 21.5 months, p = 0.16). 7 (19.4%) patients experienced late complications. CONCLUSIONS Mainz pouch II UD following RARC in bladder cancer patients results in a satisfactory continence rate. Achieving RC-pentafecta was correlated with better satisfaction scores. The intracorporeal approach to Mainz pouch II UD is beneficial for female patients due to its reduced invasiveness. TRIAL REGISTRATION ChiCTR2300070279; Registration: 07/04/2023, Last updated version: 01/06/2023. Retrospectively registered.
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Affiliation(s)
- Suoshi Jing
- Institute of Urology, Key Laboratory of Gansu Province for Urological Diseases, Lanzhou University Second Hospital, Gansu Nephro-Urological Clinical Center, 730030, Lanzhou, China
- Department of Urology, The First Hospital of Lanzhou University, 730030, Lanzhou, China
| | - Enguang Yang
- Institute of Urology, Key Laboratory of Gansu Province for Urological Diseases, Lanzhou University Second Hospital, Gansu Nephro-Urological Clinical Center, 730030, Lanzhou, China
| | - Zuoxi Luo
- Institute of Urology, Key Laboratory of Gansu Province for Urological Diseases, Lanzhou University Second Hospital, Gansu Nephro-Urological Clinical Center, 730030, Lanzhou, China
| | - Yunxin Zhang
- Institute of Urology, Key Laboratory of Gansu Province for Urological Diseases, Lanzhou University Second Hospital, Gansu Nephro-Urological Clinical Center, 730030, Lanzhou, China
| | - Hui Ding
- Institute of Urology, Key Laboratory of Gansu Province for Urological Diseases, Lanzhou University Second Hospital, Gansu Nephro-Urological Clinical Center, 730030, Lanzhou, China
| | - Li Yang
- Institute of Urology, Key Laboratory of Gansu Province for Urological Diseases, Lanzhou University Second Hospital, Gansu Nephro-Urological Clinical Center, 730030, Lanzhou, China
| | - Zhilong Dong
- Institute of Urology, Key Laboratory of Gansu Province for Urological Diseases, Lanzhou University Second Hospital, Gansu Nephro-Urological Clinical Center, 730030, Lanzhou, China
| | - Panfeng Shang
- Institute of Urology, Key Laboratory of Gansu Province for Urological Diseases, Lanzhou University Second Hospital, Gansu Nephro-Urological Clinical Center, 730030, Lanzhou, China
| | - Zhongjin Yue
- Institute of Urology, Key Laboratory of Gansu Province for Urological Diseases, Lanzhou University Second Hospital, Gansu Nephro-Urological Clinical Center, 730030, Lanzhou, China
| | - Gongjin Wu
- Institute of Urology, Key Laboratory of Gansu Province for Urological Diseases, Lanzhou University Second Hospital, Gansu Nephro-Urological Clinical Center, 730030, Lanzhou, China
| | - Junsheng Bao
- Institute of Urology, Key Laboratory of Gansu Province for Urological Diseases, Lanzhou University Second Hospital, Gansu Nephro-Urological Clinical Center, 730030, Lanzhou, China
| | - Junqiang Tian
- Institute of Urology, Key Laboratory of Gansu Province for Urological Diseases, Lanzhou University Second Hospital, Gansu Nephro-Urological Clinical Center, 730030, Lanzhou, China
| | - Jiaji Wang
- Institute of Urology, Key Laboratory of Gansu Province for Urological Diseases, Lanzhou University Second Hospital, Gansu Nephro-Urological Clinical Center, 730030, Lanzhou, China
| | - Nan Xiao
- Institute of Urology, Key Laboratory of Gansu Province for Urological Diseases, Lanzhou University Second Hospital, Gansu Nephro-Urological Clinical Center, 730030, Lanzhou, China
| | - Zhiping Wang
- Institute of Urology, Key Laboratory of Gansu Province for Urological Diseases, Lanzhou University Second Hospital, Gansu Nephro-Urological Clinical Center, 730030, Lanzhou, China.
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Tuderti G, Mastroianni R, Chiacchio G, Anceschi U, Bove AM, Brassetti A, Ferriero M, Misuraca L, Flammia RS, Proietti F, D'Annunzio S, Leonardo C, Guaglianone S, Anselmi M, Zampa A, Galosi AB, Torregiani G, Gallucci M, Simone G. Long-term oncologic and functional outcomes following robot-assisted radical cystectomy and intracorporeal Padua ileal bladder: results from a single high-volume center. World J Urol 2023; 41:2359-2366. [PMID: 37518504 DOI: 10.1007/s00345-023-04523-8] [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: 05/28/2023] [Accepted: 07/04/2023] [Indexed: 08/01/2023] Open
Abstract
PURPOSE To report long-term oncologic and functional outcomes of a large consecutive single center series of Robot-assisted radical cystectomy (RARC)- intracorporeal (IC) Urinary Diversion (UD), identifying their predicting factors. METHODS A single center Bladder cancer (BC) database was queried for "RARC" and "ICUD", including patients treated between January 2012 and September 2020. Kaplan-Meier curves were assessed disease-free (DFS), cancer-specific (CSS) and overall survival (OS) probability. Univariable (UV) and multivariable (MV) analysis were adopted to identify predictors of DFS, CSS and OS. Kaplan-Meier method evaluated day- and night-time continence recovery probabilities; UV and MV analysis were adopted to identify predictors of Day-time continence. RESULTS Overall, 251 patients were included. Among them, 192 patients underwent intracorporeal ileal orthotopic neobladder (ION) (76.5%). Five-year DFS, CSS and OS rates were 66.5%, 65.4% and 61.5%; pT stage ≥ 3 and pathologic nodal involvement were identified as negative independent predictors of DFS (HR 2.39, p = 0.001, HR 4.64, p ≤ 0.001), CSS (HR 2.20, p = 0.01, HR 3.97, p < 0.001) and OS (HR 2.25, p = 0.005, HR 3.95, p < 0.001). In RARC-ION patients, Trifecta rate was 64.1%. One-year day- and night-time continence rates were 78.6% and 48.3%. Age (HR 0.98, p = 0.03), female gender (HR 0.57, p = 0.008) and complications Clavien grade ≥ 3 (HR 0.55, p = 0.03) were identified as independent predictors of day-time incontinence. CONCLUSIONS Long-term oncologic outcomes and their predicting factors seem aligned to the largest historical open series and multi-institutional robotic series data. According to the identified predicting factors undermining a proper achievement of day-time continence, this represents an objective support, in order to properly advice specific sub-group of patients.
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Affiliation(s)
- Gabriele Tuderti
- Department of Urology, IRCCS "Regina Elena" National Cancer Institute, Via Elio, Chianesi 53, Rome, Italy.
| | - Riccardo Mastroianni
- Department of Urology, IRCCS "Regina Elena" National Cancer Institute, Via Elio, Chianesi 53, Rome, Italy
| | - Giuseppe Chiacchio
- Department of Urology, IRCCS "Regina Elena" National Cancer Institute, Via Elio, Chianesi 53, Rome, Italy
- Urology Unit, Azienda Ospedaliero-Universitaria Ospedali Riuniti di Ancona, Università Politecnica delle Marche, Ancona, Italy
| | - Umberto Anceschi
- Department of Urology, IRCCS "Regina Elena" National Cancer Institute, Via Elio, Chianesi 53, Rome, Italy
| | - Alfredo Maria Bove
- Department of Urology, IRCCS "Regina Elena" National Cancer Institute, Via Elio, Chianesi 53, Rome, Italy
| | - Aldo Brassetti
- Department of Urology, IRCCS "Regina Elena" National Cancer Institute, Via Elio, Chianesi 53, Rome, Italy
| | - Mariaconsiglia Ferriero
- Department of Urology, IRCCS "Regina Elena" National Cancer Institute, Via Elio, Chianesi 53, Rome, Italy
| | - Leonardo Misuraca
- Department of Urology, IRCCS "Regina Elena" National Cancer Institute, Via Elio, Chianesi 53, Rome, Italy
| | - Rocco Simone Flammia
- Department of Urology, IRCCS "Regina Elena" National Cancer Institute, Via Elio, Chianesi 53, Rome, Italy
- Department of Urology, "Sapienza" University of Rome, Rome, Italy
| | - Flavia Proietti
- Department of Urology, IRCCS "Regina Elena" National Cancer Institute, Via Elio, Chianesi 53, Rome, Italy
| | - Simone D'Annunzio
- Department of Urology, IRCCS "Regina Elena" National Cancer Institute, Via Elio, Chianesi 53, Rome, Italy
| | - Costantino Leonardo
- Department of Urology, IRCCS "Regina Elena" National Cancer Institute, Via Elio, Chianesi 53, Rome, Italy
| | - Salvatore Guaglianone
- Department of Urology, IRCCS "Regina Elena" National Cancer Institute, Via Elio, Chianesi 53, Rome, Italy
| | - Marianna Anselmi
- Department of Urology, IRCCS "Regina Elena" National Cancer Institute, Via Elio, Chianesi 53, Rome, Italy
| | - Ashanti Zampa
- Department of Urology, IRCCS "Regina Elena" National Cancer Institute, Via Elio, Chianesi 53, Rome, Italy
| | - Andrea Benedetto Galosi
- Urology Unit, Azienda Ospedaliero-Universitaria Ospedali Riuniti di Ancona, Università Politecnica delle Marche, Ancona, Italy
| | - Giulia Torregiani
- Department of Urology, IRCCS "Regina Elena" National Cancer Institute, Via Elio, Chianesi 53, Rome, Italy
| | - Michele Gallucci
- Department of Urology, IRCCS "Regina Elena" National Cancer Institute, Via Elio, Chianesi 53, Rome, Italy
| | - Giuseppe Simone
- Department of Urology, IRCCS "Regina Elena" National Cancer Institute, Via Elio, Chianesi 53, Rome, Italy
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Shimizu F, Muto S, Kitamura K, China T, Shirakawa T, Kimura T, Ieda T, Nagata M, Isotani S, Nakagawa Y, Horie S. Robot-Assisted Radical Cystectomy with Modified Vesica Ileale Padovana (VIP) Neobladder Configuration Using a Hybrid Approach: Initial Experience. J Pers Med 2023; 13:jpm13050802. [PMID: 37240972 DOI: 10.3390/jpm13050802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 05/04/2023] [Accepted: 05/05/2023] [Indexed: 05/28/2023] Open
Abstract
PURPOSE We developed a new technique to fold a neobladder (NB) simply by using a modified Vesica Ileale Padovana (VIP) with a hybrid approach. We provide a step-by-step description of our technique as it was used in this initial experience. METHODS A total of 10 male patients with a median age of 66 years underwent robot-assisted radical cystectomy (RARC) with an orthotopic NB via a hybrid approach from March 2022 to February 2023. After the isolation of the bladder and bilateral pelvic lymphadenectomy, Wallace plate creation was performed, and the robot was undocked. We extracorporeally performed the removal of the specimen and a side-to-side ileoileal anastomosis, and then the VIP NB posterior plate was rotated 90 degrees counterclockwise using a 45 cm detubularized ileum. The robot was redocked; then, circumferential urethra-ileal anastomosis, side-to-middle anterior wall closure, and ureteric afferent limb anastomosis were performed. RESULTS The median estimated blood loss was 524 mL, and the mean operative time was 496 min. Patients had a high continence rate, and no high-grade complications were observed. CONCLUSION The NB configuration using the modified VIP method for a hybrid approach is a feasible surgical technique to minimize the movement of robotic forceps. In particular, it may be more useful in Asian individuals with narrow pelvises.
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Affiliation(s)
- Fumitaka Shimizu
- Department of Urology, Juntendo University Graduate School of Medicine, Tokyo 113-8431, Japan
| | - Satoru Muto
- Department of Urology, Juntendo University Graduate School of Medicine, Tokyo 113-8431, Japan
| | - Kosuke Kitamura
- Department of Urology, Juntendo University Graduate School of Medicine, Tokyo 113-8431, Japan
| | - Toshiyuki China
- Department of Urology, Juntendo University Graduate School of Medicine, Tokyo 113-8431, Japan
| | - Tomoya Shirakawa
- Department of Urology, Juntendo University Graduate School of Medicine, Tokyo 113-8431, Japan
| | - Tomoki Kimura
- Department of Urology, Juntendo University Graduate School of Medicine, Tokyo 113-8431, Japan
| | - Takeshi Ieda
- Department of Urology, Juntendo University Graduate School of Medicine, Tokyo 113-8431, Japan
| | - Masayoshi Nagata
- Department of Urology, Juntendo University Graduate School of Medicine, Tokyo 113-8431, Japan
| | - Shuji Isotani
- Department of Urology, Juntendo University Graduate School of Medicine, Tokyo 113-8431, Japan
| | - Yuki Nakagawa
- Department of Urology, Juntendo University Graduate School of Medicine, Tokyo 113-8431, Japan
| | - Shigeo Horie
- Department of Urology, Juntendo University Graduate School of Medicine, Tokyo 113-8431, Japan
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Impact of Patient, Surgical, and Perioperative Factors on Discharge Disposition after Radical Cystectomy. Cancers (Basel) 2022; 14:cancers14215288. [PMID: 36358707 PMCID: PMC9654179 DOI: 10.3390/cancers14215288] [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: 09/22/2022] [Revised: 10/24/2022] [Accepted: 10/25/2022] [Indexed: 11/16/2022] Open
Abstract
Radical cystectomy (RC) is a complex procedure associated with lengthy hospital stays and high complication and readmission rates. We evaluated the impact of patient, surgical, and perioperative factors on discharge disposition following RC at a tertiary referral center. From 2012 to 2019, all bladder cancer patients undergoing RC at our institution were identified (n = 1153). Patients were classified based on discharge disposition: to home or to continued facility-based rehabilitation centers (CFRs, n = 180 (15.61%) patients). On multivariate analysis of patient factors only, age [Risk Ratio (RR): 1.07, p < 0.001)], single marital status (RR: 1.09, p < 0.001), and living alone prior to surgery (RR: 2.55, p = 0.004) were significant predictors of discharge to CFRs. Multivariate analysis of patient, surgical, and perioperative factors indicated age (RR: 1.09, p < 0.001), single marital status (RR: 3.9, p < 0.001), living alone prior to surgery (RR: 2.42, p = 0.01), and major post-operative (Clavien > 3) complications (RR: 3.44, p < 0.001) were significant independent predictors of discharge to CFRs. Of note, ERAS did not significantly impact discharge disposition. Specific patient and perioperative factors significantly impact discharge disposition. Patients who are older, living alone prior to surgery, and/or have a major post-operative complication are more likely to be discharged to CFRs after RC.
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Piazza P, Bravi CA, Puliatti S, Cacciamani GE, Knipper S, Amato M, Dell'Oglio P, Mazzone E, Rosiello G, Farinha R, Sarchi L, Scarcella S, Wisz P, Schiavina R, Develtere D, De Backer P, De Groote R, D'Hondt F, Mottrie A. Assessing pentafecta achievement after robot-assisted radical cystectomy and its association with surgical experience: Results from a high-volume institution. Urol Oncol 2022; 40:272.e11-272.e20. [PMID: 35094932 DOI: 10.1016/j.urolonc.2022.01.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 11/25/2021] [Accepted: 01/01/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVES Radical cystectomy (RC) represents the gold standard treatment for high-risk bladder cancer. Despite evidence suggesting that surgical experience correlates with perioperative and oncologic outcomes of robot-assisted RC (RARC), validated tools to assess its quality objectively are lacking. We aimed to evaluate the impact of RC-Pentafecta (absence of early major complications, absence of urinary diversion related sequelae at ≤12 months, absence of soft tissue surgical margins, ≥16 lymph nodes at final pathology and absence of clinical recurrence at ≤12 months) on oncological outcomes and the role of surgical experience on its achievement. MATERIALS AND METHODS We retrospectively evaluated 366 patients undergoing RARC with intracorporeal urinary diversion in a single tertiary centre with a minimum of 1 year follow-up. Surgeries were performed using the DaVinci Xi system according to a previously described technique. Kaplan-Meier curves were used to investigate 5-years overall survival and cancer specific mortality-free survival (CSS) according to RC-Pentafecta achievement. Multivariable Cox's regressions were performed to evaluate the impact of RC-Pentafecta on overall mortality. Multivariable logistic regressions were performed to explore the effect of surgical experience on RC-pentafecta achievement. Locally weighted scatterplot smoother function was used to graphically explore this relationship. RESULTS Patients achieving RC-Pentafecta showed higher 5-year overall survival (71.8% vs. 59.6%, P < 0.001) and CSS (84% vs. 71%, P < 0.001) when compared with patients not achieving it. At multivariable Cox's regression, RC-Pentafecta achievement (HR 0.57, P = 0.03), positive surgical margins (HR 2.48, P = 0.002), pN+ (HR 2.23, P = 0.002), pT≥3 (HR 1.71, P = 0.04) and current smoking status (HR 2.4, P = 0.006) were significant predictors of overall mortality. At multivariable logistic regression surgical experience (OR 1.2, P < 0.001), age (OR 0.93, P = 0.04), previous prostate surgery (OR 0.7, P = 0.02) and pT≥3 (OR 0.8, P = 0.03) were independent predictors of RC-Pentafecta achievement. A linear relationship between surgical experience and RC-Pentafecta achievement, without reaching a plateau, was observed. CONCLUSIONS RC-Pentafecta is a valuable tool to assess surgical quality of RARC and the experience of the center where the surgery is performed and may be used to identify "referral" centers for treatment of high-risk bladder cancer.
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Affiliation(s)
- Pietro Piazza
- Division of Urology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; Department of Urology, OLV Hospital, Aalst, Belgium; ORSI Academy, Melle, Belgium.
| | - Carlo Andrea Bravi
- Department of Urology, OLV Hospital, Aalst, Belgium; ORSI Academy, Melle, Belgium; Department of Urology, Division of Experimental Oncology, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Stefano Puliatti
- Department of Urology, OLV Hospital, Aalst, Belgium; ORSI Academy, Melle, Belgium; Department of Urology, University of Modena and Reggio Emilia, Modena, Italy
| | | | - Sophie Knipper
- Department of Urology, OLV Hospital, Aalst, Belgium; ORSI Academy, Melle, Belgium; Martini-Klinik Prostate Cancer Center, Hamburg, Germany
| | - Marco Amato
- Department of Urology, OLV Hospital, Aalst, Belgium; ORSI Academy, Melle, Belgium; Department of Urology, University of Modena and Reggio Emilia, Modena, Italy
| | - Paolo Dell'Oglio
- Department of Urology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Elio Mazzone
- Department of Urology, Division of Experimental Oncology, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Giuseppe Rosiello
- Department of Urology, Division of Experimental Oncology, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | | | - Luca Sarchi
- Department of Urology, OLV Hospital, Aalst, Belgium; ORSI Academy, Melle, Belgium; Department of Urology, University of Modena and Reggio Emilia, Modena, Italy
| | - Simone Scarcella
- Department of Urology, OLV Hospital, Aalst, Belgium; ORSI Academy, Melle, Belgium; Department of Urology, Polytechnic University of Marche Region, Ancona, Italy
| | | | - Riccardo Schiavina
- Division of Urology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; University of Bologna, Bologna, Italy
| | - Dries Develtere
- Department of Urology, OLV Hospital, Aalst, Belgium; ORSI Academy, Melle, Belgium
| | - Pieter De Backer
- ORSI Academy, Melle, Belgium; Department of Urology, University of Ghent, Ghent, Belgium
| | - Ruben De Groote
- Department of Urology, OLV Hospital, Aalst, Belgium; ORSI Academy, Melle, Belgium
| | - Frederiek D'Hondt
- Department of Urology, OLV Hospital, Aalst, Belgium; ORSI Academy, Melle, Belgium
| | - Alexandre Mottrie
- Department of Urology, OLV Hospital, Aalst, Belgium; ORSI Academy, Melle, Belgium
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Zhao Q, Yang F, Hao H, Li X, Wu L, Li X, Xing N. Surgical techniques, oncologic and functional outcomes of two types of modified ileal orthotopic neobladders. Transl Androl Urol 2021; 10:2970-2981. [PMID: 34430400 PMCID: PMC8350254 DOI: 10.21037/tau-21-251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 06/08/2021] [Indexed: 11/29/2022] Open
Abstract
Background In recent years, the construction of orthotopic neobladder has become the focus of research. Our study is aim to illustrate and evaluate surgical techniques, oncologic and functional outcomes of two types of modified ileal orthotopic neobladders (IONB). Methods We retrospectively reviewed of 64 patients who underwent laparoscopic radical cystectomy (LRC) + Xing’s neobladder (n=41), Institute of Urology Peking University neobladder (IUPUB) (n=23) at two tertiary referral centers. Then demographic characteristics, operation outcomes were analyzed. In addition, postoperative complication rates, oncologic outcomes, continence, and neobladders’ function were further evaluated. Results All LRC + IONB were carried out in 64 patients successfully. Pathological results show that 63 were urothelial carcinoma and 1 was adenocarcinoma. Time to flatus was 3 [1–6] d in Xing’s neobladder group while 3 [2–5] d in IUPUB group (P=0.049). In terms of overall survival (OS), cancer specific survival (CSS) and recurrence-free survival (RFS), there is no statistical difference between the two groups. Overall, grade 1–2 complications were 36%, grade 3–4 complications were 1.6% on the 30th day, and 15.6%, 1.6% respectively on the 90th day. On the whole, daytime and night continence were 96.4%, 83.6% respectively one year after operation. Conclusions The two types of modified IONB are safe and feasible. The technical improvements significantly simplify the procedure and decrease the difficulty of the surgery, probably shorten the operative time and reduce blood loss. Furthermore, they take the advantage of less late complications and comparative good functional outcomes without affecting the prognosis of oncology. In addition, Xing’s neobladder is more beneficial to the recovery of postoperative gastrointestinal function.
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Affiliation(s)
- Qinxin Zhao
- Department of Urology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Feiya Yang
- Department of Urology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Han Hao
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, Beijing, China
| | - Xinfei Li
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, Beijing, China
| | - Liyuan Wu
- Department of Urology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xuesong Li
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, Beijing, China
| | - Nianzeng Xing
- Department of Urology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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A tissue-engineered urinary conduit in a porcine urinary diversion model. Sci Rep 2021; 11:16754. [PMID: 34408168 PMCID: PMC8373918 DOI: 10.1038/s41598-021-94613-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 07/01/2021] [Indexed: 12/25/2022] Open
Abstract
The use of an ileal segment is a standard method for urinary diversion after radical cystectomy. Unfortunately, utilization of this method can lead to numerous surgical and metabolic complications. This study aimed to assess the tissue-engineered artificial conduit for urinary diversion in a porcine model. Tissue-engineered tubular polypropylene mesh scaffolds were used for the right ureter incontinent urostomy model. Eighteen male pigs were divided into three equal groups: Group 1 (control ureterocutaneostomy), Group 2 (the right ureter-artificial conduit-skin anastomoses), and Group 3 (4 weeks before urostomy reconstruction, the artificial conduit was implanted between abdomen muscles). Follow-up was 6 months. Computed tomography, ultrasound examination, and pyelogram were used to confirm the patency of created diversions. Morphological and histological analyses were used to evaluate the tissue-engineered urinary diversion. All animals survived the experimental procedures and follow-up. The longest average patency was observed in the 3rd Group (15.8 weeks) compared to the 2nd Group (10 weeks) and the 1st Group (5.8 weeks). The implant's remnants created a retroperitoneal post-inflammation tunnel confirmed by computed tomography and histological evaluation, which constitutes urostomy. The simultaneous urinary diversion using a tissue-engineered scaffold connected directly with the skin is inappropriate for clinical application.
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Robot-Assisted Intracorporeal Orthotopic Ileal Neobladder: Description of the "Shell" Technique. J Clin Med 2021; 10:jcm10163601. [PMID: 34441897 PMCID: PMC8397133 DOI: 10.3390/jcm10163601] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Revised: 08/04/2021] [Accepted: 08/11/2021] [Indexed: 11/17/2022] Open
Abstract
Background: Robot-assisted radical cystectomy (RARC) with intracorporeal neobladder (ICNB) remains a very complicated, technically demanding and time-consuming surgical procedure. In the current study we describe our robot-assisted intracorporeal “Shell” neobladder reconstruction. Methods: From January 2017 to December 2019, we performed 30 intracorporeal ileal neobladder “Shell” reconstructions. We prospectively collected demographics and clinical and pathological data and retrospectively analysed perioperative, functional and oncological outcomes. Results: No conversion to open surgery or intraoperative blood transfusion was necessary. The median whole operative time was 493 min (IQR 433–530 min), ranging from 514 min (IQR 502–554 min) recorded during the first ten procedures to 470 min (IQR 442–503 min) of the last ten. The median estimated blood loss was 400 mL (IQR 350–700 mL). The median length of stay was 11 days (IQR 10–17). Both early and late complication rates were 46.7%. The high-grade early complication rate accounted for 20%, while the high-grade late complication rate was 30%. The daytime continence rate registered was 73.3%, while night-time continence rate was 60%. Conclusions: Our results demonstrated “Shell” neobladder reconstruction as a technically feasible procedure, with good functional outcomes in tertiary referral centre. Longer follow-up and larger populations are needed to validate these preliminary results.
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Abstract
PURPOSE OF REVIEW To review the most recent data on urinary diversions (UD) surgical outcomes performed at time of radical cystectomy (RC). RECENT FINDINGS Looking at the recent specific literature, the most recent factors introduced in the field of UDs are the preoperative assessment of patient's frailty and the use of the robotic system. According to the available evidence, frailty status is a good preoperative predictor of surgical outcomes and patient recovery. Several questionaries measuring patient's frailty status have been evaluated as a proxy to prevent RC complications and to improve the choice of the UDs.Robot-assisted RC has gained popularity and both continent and incontinent UD are now performed through an intra-corporeal technique. Studies on Robot-assisted UDs showed that both intra-corporeal and extra-corporeal approaches (ICUD and ECUD, respectively) are safe and feasible. Compared to the open techniques, they improve intraoperative blood loss and postoperative recovery. However, accessibility to the Da-Vinci System and the need of robotic skills limit the application of these techniques to high-volume institutes. SUMMARY Patient's frailty status and the use of robotic surgery are the most recent factors introduced to improve the choice of UD and surgical outcomes.
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Tuderti G, Mastroianni R, Brassetti A, Bove AM, Misuraca L, Anceschi U, Ferriero M, Gallucci M, Simone G. Robot-assisted radical cystectomy with intracorporeal neobladder: impact of learning curve and long-term assessment of functional outcomes. Minerva Urol Nephrol 2020; 73:754-762. [PMID: 33016028 DOI: 10.23736/s2724-6051.20.03948-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND There is paucity of data about functional outcomes of Robot-assisted Radical Cystectomy (RARC) with intracorporeal orthotopic neobladder (ICON), and the impact of learning curve (LC) on those outcomes remains to be addressed. The aim of this study was to report long-term functional outcomes of our single center series of RARC with ICON, assessing the role of LC in their achievement. METHODS Patients treated with Robot assisted radical cystectomy with intracorporeal orthotopic neobladder in our center between January 2012 and August 2019 were retrospectively analyzed. Preoperative, clinical, perioperative, pathologic and functional data were reported. The first cases were divided in tertiles, for assessing the impact of learning curve on the outcomes evaluated. Long-term functional outcomes of the whole cohort were evaluated. RESULTS Overall, 167 patients were included. Concerning tertiles analysis, operative time (P<0.001), incidence of low (P=0.002) and high grade (P=0.001) complications and hospital stay (P=0.04) decreased significantly over time. Day-time continence recovery probability was significantly lower in the initial case series (1-yr rate 68.4%, 87% and 89.8 for I, II and III tertile, respectively; P=0.04;). Accordingly, Trifecta achievement was significantly higher in II and III tertiles (P=0.01). At a median follow- up of 34 months, the incidence of significant renal function deterioration of the whole cohort was 16.7%. Overall, 12, 24 and 60-mo day-time continence rates were 74.8%, 82.7% and 82.7%. CONCLUSIONS Patients treated at the beginning of the learning curve show worse perioperative and functional results. Once standardized the procedure, complications rates, hospital stay, and day-time continence recovery experienced a significant improvement. At a long-term analysis of functional outcomes of our patients, renal function preservation and continence recovery results are encouraging.
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Affiliation(s)
- Gabriele Tuderti
- Department of Urology, Regina Elena National Cancer Institute, Rome, Italy -
| | - Riccardo Mastroianni
- Department of Urology, Regina Elena National Cancer Institute, Rome, Italy.,Department of Urology, Sapienza University, Rome, Italy
| | - Aldo Brassetti
- Department of Urology, Regina Elena National Cancer Institute, Rome, Italy
| | - Alfredo M Bove
- Department of Urology, Regina Elena National Cancer Institute, Rome, Italy
| | - Leonardo Misuraca
- Department of Urology, Regina Elena National Cancer Institute, Rome, Italy
| | - Umberto Anceschi
- Department of Urology, Regina Elena National Cancer Institute, Rome, Italy
| | | | | | - Giuseppe Simone
- Department of Urology, Regina Elena National Cancer Institute, Rome, Italy
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Zhou X, Zheng J, He P, Zhang J, Wang C, Zheng J, Li X, Lang L, Zhou Z, Chen Z. Refinement Surgical Technique, and Perioperative and Functional Outcomes in Patients With Robotic Intracorporeal Hautmann Orthotopic Neobladder. Urology 2020; 138:45-51. [PMID: 32006548 DOI: 10.1016/j.urology.2020.01.025] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 01/01/2020] [Accepted: 01/17/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To illustrate our refinement technique for robotic intracorporeal orthotopic Hautmann neobladder with adherence to open surgical principles and evaluate perioperative and functional outcomes. PATIENTS AND METHODS Robot-assisted radical cystectomy with intracorporeal Hautmann orthotopic neobladder was performed by the same surgeon in 40 patients with bladder cancer from November 2017 to March 2019. Baseline demographics, pathologic data, 90-day complications, and functional outcomes at both 6 and 12 months were evaluated with questionnaire and urodynamic analysis. RESULTS Median follow-up was 14 months (range 4-20). Median operative time was 320 (230-500) minutes, and the estimated blood loss was 300 (100-2000) mL. No conversion to the open technique was reported. The overall 90-day complication rate was 45%, and the high-grade complication rate was only 10%. The daytime satisfactory continence rate was 90% at both 6 months (30 patients) and 12 months (20 patients), while the night-time satisfactory continence rate was 76.7% and 80.0% at 6 months and 12 months, respectively. One patient underwent clean intermittent catheterization. The cohort had minimal postvoid residual volume, normal compliance, and a mean capacity of 328.7 cm3 (range 170-500) at 6 months postoperatively. CONCLUSION Our preliminary data indicate that robotic intracorporeal Hautmann neobladder configuration is a feasible surgical technique and can achieve a low pressure and sufficient capacity for satisfactory early voiding patterns. Refinement of the stepwise process can effectively decrease the time of the operation. Long-term functional and oncological outcomes remain to be evaluated with longer follow-up and more cases.
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Affiliation(s)
- Xiaozhou Zhou
- Department of Urology, Urology Institute of PLA, Southwest Hospital, Third Military Medical University (Army Medical University), Sha Pingba, Chongqing, China
| | - Ji Zheng
- Department of Urology, Urology Institute of PLA, Southwest Hospital, Third Military Medical University (Army Medical University), Sha Pingba, Chongqing, China
| | - Peng He
- Department of Urology, Urology Institute of PLA, Southwest Hospital, Third Military Medical University (Army Medical University), Sha Pingba, Chongqing, China
| | - Jingqi Zhang
- Department of Urology, Urology Institute of PLA, Southwest Hospital, Third Military Medical University (Army Medical University), Sha Pingba, Chongqing, China
| | - Cong Wang
- Department of Urology, Urology Institute of PLA, Southwest Hospital, Third Military Medical University (Army Medical University), Sha Pingba, Chongqing, China
| | - Jun Zheng
- Department of Urology, Urology Institute of PLA, Southwest Hospital, Third Military Medical University (Army Medical University), Sha Pingba, Chongqing, China
| | - Xuemei Li
- Department of Urology, Urology Institute of PLA, Southwest Hospital, Third Military Medical University (Army Medical University), Sha Pingba, Chongqing, China
| | - Lang Lang
- Department of Urology, Urology Institute of PLA, Southwest Hospital, Third Military Medical University (Army Medical University), Sha Pingba, Chongqing, China
| | - Zhansong Zhou
- Department of Urology, Urology Institute of PLA, Southwest Hospital, Third Military Medical University (Army Medical University), Sha Pingba, Chongqing, China
| | - Zhiwen Chen
- Department of Urology, Urology Institute of PLA, Southwest Hospital, Third Military Medical University (Army Medical University), Sha Pingba, Chongqing, China.
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KAKIZOE T. Orthotopic neobladder after cystectomy for bladder cancer. PROCEEDINGS OF THE JAPAN ACADEMY. SERIES B, PHYSICAL AND BIOLOGICAL SCIENCES 2020; 96:255-265. [PMID: 32788549 PMCID: PMC7443376 DOI: 10.2183/pjab.96.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 05/01/2020] [Indexed: 06/11/2023]
Abstract
More than 90% of bladder cancer is composed of transitional cell carcinoma (TCC), being characterized by the development of multiple tumors in the entire urinary tract over time. When cystectomy is conducted, the urinary tract must be reconstructed by various procedures, which can include an orthotopic neobladder using the patient's own intestine formed into a spherical shape anastomosed to the urethra. Using this procedure, patients can void urine from their own urethra even after cystectomy. The incidence of subsequent urethral cancer arising after cystectomy is known to be relatively high; however, if patients with a high risk of urethral recurrence are appropriately excluded, a neobladder can be safely provided for patients. Orthotopic neobladder use is reviewed from an oncological viewpoint and the patient's quality of life after cystectomy for bladder cancer.
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Albisinni S, Veccia A, Aoun F, Diamand R, Esperto F, Porpiglia F, Roumeguère T, De Nunzio C. A systematic review and meta-analysis comparing the outcomes of open and robotic assisted radical cystectomy. MINERVA UROL NEFROL 2019; 71:553-568. [DOI: 10.23736/s0393-2249.19.03546-x] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Leaver RB. Technology and the urology nurse. INTERNATIONAL JOURNAL OF UROLOGICAL NURSING 2019. [DOI: 10.1111/ijun.12196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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