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Özsoy Ç, Demir Y, Yılmaz K, Ölçücü MT, Kılıç Ş, Ateş M. Prospective evaluation of surgical margins in non-muscle invasive bladder cancer following primary transurethral resection. THE FRENCH JOURNAL OF UROLOGY 2024; 34:102705. [PMID: 39059766 DOI: 10.1016/j.fjurol.2024.102705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2024] [Revised: 07/17/2024] [Accepted: 07/18/2024] [Indexed: 07/28/2024]
Abstract
PURPOSE Non-muscle invasive bladder cancers (NMIBC) constitute approximately 75% of bladder cancer cases. Primary transurethral resection (TUR) plays a pivotal role in both diagnosis and treatment. However, despite initial resection, tumors are often missed, leaving behind microscopic residual tumors. This study aims to prospectively investigate the surgical margins of tumors, which may serve as a potential source of residual tumors. MATERIALS AND METHODS Seventy patients diagnosed with NMIBC who underwent primary TUR were enrolled in this study. Following initial resection, samples were collected from the normal-appearing mucosa extending 1cm beyond the surgical margins. Lesions were categorized as 'healthy margins' for benign lesions, 'tumoral margins' for urothelial cancer, and 'dysplastic margins' for urothelial dysplasia. Clinical and pathological features of these groups were compared, and risk factors for detecting transitional cell carcinoma (TCC) in the normal-looking mucosa were analyzed. RESULTS The tumoral margins group showed a significantly higher rate of T1 stage tumors compared to the healthy margins group, and a significantly higher rate of high-grade (HG) tumors compared to the dysplastic margins group. Moreover, the tumoral margins group had a significantly higher proportion of high-risk patients (85.7%) compared to the other groups, while the healthy margins group had a significantly higher proportion of low-risk patients (35.3%) compared to the tumoral margins group (0.0%). Additionally, the tumoral margins group demonstrated a significantly higher rate of carcinoma in situ (CIS) compared to the healthy margins group (35.7% vs. 5.9%). Detection of urothelial cancer at the margins was associated with T1 stage, HG stage, and the presence of CIS based on univariate analyses. CONCLUSION To minimize residual tumors and prevent recurrence in patients undergoing primary TUR, we advocate for the resection of macroscopically visible tumors with nearly 2cm of intact bladder tissue, thereby enhancing the quality of TUR. LEVEL OF EVIDENCE This study provides Level II evidence, based on its design as a prospective observational study. The findings are derived from well-designed cohort analyses, providing significant associations and insights into the factors affecting surgical margins in NMIBC patients.
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Affiliation(s)
- Çağatay Özsoy
- Adnan Menderes University Medical Faculty, Department of Urology, Aydın, Turkey.
| | - Yiğit Demir
- Antalya Training and Research Hospital, Department of Urology, Antalya, Turkey
| | - Kayhan Yılmaz
- Antalya Training and Research Hospital, Department of Urology, Antalya, Turkey
| | - Mahmut Taha Ölçücü
- Antalya Training and Research Hospital, Department of Urology, Antalya, Turkey
| | - Şahin Kılıç
- Antalya Training and Research Hospital, Department of Urology, Antalya, Turkey
| | - Mutlu Ateş
- Antalya Training and Research Hospital, Department of Urology, Antalya, Turkey
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Fernandes CN, Vale L, Sousa JV, Antunes-Lopes T, Silva CM, Silva J. Surgeon experience in second-look transurethral resection of bladder cancer - a prospective study. Actas Urol Esp 2024; 48:448-453. [PMID: 38160792 DOI: 10.1016/j.acuroe.2023.12.007] [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: 09/12/2023] [Accepted: 10/11/2023] [Indexed: 01/03/2024]
Abstract
INTRODUCTION AND OBJECTIVES Transurethral resection of bladder tumor (TURBT) is crucial in the treatment of bladder tumors and when incorrectly performed can cause staging mistakes. To avoid these errors, a second resection is recommended in selected cases. The aim of this study is to evaluate the surgeon's ability to predict histologically complete primary resection of newly diagnosed bladder tumors avoiding the need for a second TURBT. METHODS This is a prospective, observational study involving 47 consecutive patients with newly diagnosed bladder tumors who had previously undergone primary TURBT, and met EAU criteria for second-look TURBT. Second-look TURBT specimens were analyzed for routine histological assessment and compared with the surgeon's impression of the tumor at initial resection. RESULTS Of 91 patients submitted to primary TURBT, 47 met the criteria for second-look TURBT. Second-look specimens revealed residual disease in 20.9% of patients and 3 (6.4%) of patients showed upstaging disease. The sensitivity of a senior to detect disease on second-look TURBT in relation to muscle invasion was 75%, and the specificity was 85%. CONCLUSIONS Second-look TURBT is crucial in the treatment of bladder cancer and cannot be replaced by a surgeon's opinion, so international recommendations should be followed. Supervision of less experienced surgeons is a cornerstone.
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Affiliation(s)
- C N Fernandes
- Servicio de Urología, Hospital Universitario de São João, Oporto, Portugal.
| | - L Vale
- Servicio de Urología, Hospital Universitario de São João, Oporto, Portugal; Facultad de Medicina, Universidad de Oporto, Oporto, Portugal
| | - J V Sousa
- Servicio de Urología, Hospital Universitario de São João, Oporto, Portugal
| | - T Antunes-Lopes
- Servicio de Urología, Hospital Universitario de São João, Oporto, Portugal; Facultad de Medicina, Universidad de Oporto, Oporto, Portugal
| | - C M Silva
- Servicio de Urología, Hospital Universitario de São João, Oporto, Portugal; Facultad de Medicina, Universidad de Oporto, Oporto, Portugal
| | - J Silva
- Servicio de Urología, Hospital Universitario de São João, Oporto, Portugal; Facultad de Medicina, Universidad de Oporto, Oporto, Portugal
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Demir R, Koc S, Ozturk DG, Bilir S, Ozata Hİ, Williams R, Christy J, Akkoc Y, Tinay İ, Gunduz-Demir C, Gozuacik D. Artificial intelligence assisted patient blood and urine droplet pattern analysis for non-invasive and accurate diagnosis of bladder cancer. Sci Rep 2024; 14:2488. [PMID: 38291121 PMCID: PMC10827787 DOI: 10.1038/s41598-024-52728-7] [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: 08/16/2023] [Accepted: 01/23/2024] [Indexed: 02/01/2024] Open
Abstract
Bladder cancer is one of the most common cancer types in the urinary system. Yet, current bladder cancer diagnosis and follow-up techniques are time-consuming, expensive, and invasive. In the clinical practice, the gold standard for diagnosis remains invasive biopsy followed by histopathological analysis. In recent years, costly diagnostic tests involving the use of bladder cancer biomarkers have been developed, however these tests have high false-positive and false-negative rates limiting their reliability. Hence, there is an urgent need for the development of cost-effective, and non-invasive novel diagnosis methods. To address this gap, here we propose a quick, cheap, and reliable diagnostic method. Our approach relies on an artificial intelligence (AI) model to analyze droplet patterns of blood and urine samples obtained from patients and comparing them to cancer-free control subjects. The AI-assisted model in this study uses a deep neural network, a ResNet network, pre-trained on ImageNet datasets. Recognition and classification of complex patterns formed by dried urine or blood droplets under different conditions resulted in cancer diagnosis with a high specificity and sensitivity. Our approach can be systematically applied across droplets, enabling comparisons to reveal shared spatial behaviors and underlying morphological patterns. Our results support the fact that AI-based models have a great potential for non-invasive and accurate diagnosis of malignancies, including bladder cancer.
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Affiliation(s)
- Ramiz Demir
- Koç University Research Center for Translational Medicine (KUTTAM), Istanbul, Turkey
| | - Soner Koc
- Department of Computer Engineering, Koç University, Istanbul, Turkey
- KUIS AI Center, Koç University, Istanbul, Turkey
| | - Deniz Gulfem Ozturk
- Koç University Research Center for Translational Medicine (KUTTAM), Istanbul, Turkey
| | - Sukriye Bilir
- SUNUM Nanotechnology Research and Application Center, Istanbul, Turkey
| | | | - Rhodri Williams
- School of Engineering, University of Edinburgh, Edinburgh, UK
| | - John Christy
- School of Engineering, University of Edinburgh, Edinburgh, UK
| | - Yunus Akkoc
- Koç University Research Center for Translational Medicine (KUTTAM), Istanbul, Turkey
| | - İlker Tinay
- Anadolu Medical Center, Gebze, Kocaeli, Turkey
| | - Cigdem Gunduz-Demir
- Department of Computer Engineering, Koç University, Istanbul, Turkey.
- KUIS AI Center, Koç University, Istanbul, Turkey.
- School of Medicine, Koç University, Istanbul, Turkey.
| | - Devrim Gozuacik
- Koç University Research Center for Translational Medicine (KUTTAM), Istanbul, Turkey.
- SUNUM Nanotechnology Research and Application Center, Istanbul, Turkey.
- School of Medicine, Koç University, Istanbul, Turkey.
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Dave P, Patel RD, Desai K, Davila J, Sankin A. A Procedural Checklist for Transurethral Resection of Bladder Tumors (TURBT) Enhances Operative Dictation and Assesses Surgeon Accuracy of Tumor Characteristic Predictions. Bladder Cancer 2023; 9:335-344. [PMID: 38174124 PMCID: PMC10759802 DOI: 10.3233/blc-230074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 10/28/2023] [Indexed: 01/05/2024]
Abstract
BACKGROUND A lack of standardization is pervasive in procedural application and reporting templates for TURBT with the use of a surgical checklist proposed as a means for quality improvement. OBJECTIVE To introduce a TURBT checklist to assess surgeon prediction accuracy and the impact of standardized documentation on quality of resection and oncologic outcomes. METHODS Nine critical elements of a high-quality TURBT identified by literature review were incorporated into a prospectively implemented checklist for operative reports. The checklist included both visualized and predicted tumor characteristics. A retrospective single-institution analysis compared quality of dictation pre- and post-checklist implementation. Surgeon predictions were compared to final pathology reports to determine rates of concordance. Kaplan-Meier curves examined the association of checklist use with recurrence free survival (RFS). RESULTS 333 operative reports were included in this analysis, of which 107 (32.1%) were completed pre-checklist implementation. The average number of critical elements reported was 8.69 with checklist use compared to 4.99 without (p < 0.001). There was no significant difference in RFS between the pre- and post-checklist cohorts (log-rank test p = 0.53). Surgeons were least and most accurate in predicting low grade tumor (43.5%) and absence of muscle invasion (96.6%), respectively. CONCLUSIONS Incorporation of a TURBT surgical checklist improves operative dictation and quality of reporting but did not directly impact RFS. With quality of initial resection a proven correlate to recurrence rates, checklist implementation to improve surgical performance and long-term oncologic outcomes reveals an interesting area of exploration highlighting the need for more standardized methodology when performing these procedures.
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Affiliation(s)
- Priya Dave
- Department of Urology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Rutul D. Patel
- Department of Urology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Kush Desai
- Department of Urology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Jonathan Davila
- Smith Institute for Urology, Northwell Health, Lake Success, NY, USA
| | - Alex Sankin
- Department of Urology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
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Xiong S, Dong W, Deng Z, Jiang M, Li S, Hu B, Liu X, Chen L, Xu S, Fan B, Fu B. Value of the application of computed tomography-based radiomics for preoperative prediction of unfavorable pathology in initial bladder cancer. Cancer Med 2023; 12:15868-15880. [PMID: 37434436 PMCID: PMC10469743 DOI: 10.1002/cam4.6225] [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: 02/20/2023] [Revised: 05/15/2023] [Accepted: 06/01/2023] [Indexed: 07/13/2023] Open
Abstract
OBJECTIVES To construct and validate unfavorable pathology (UFP) prediction models for patients with the first diagnosis of bladder cancer (initial BLCA) and to compare the comprehensive predictive performance of these models. MATERIALS AND METHODS A total of 105 patients with initial BLCA were included and randomly enrolled into the training and testing cohorts in a 7:3 ratio. The clinical model was constructed using independent UFP-risk factors determined by multivariate logistic regression (LR) analysis in the training cohort. Radiomics features were extracted from manually segmented regions of interest in computed tomography (CT) images. The optimal CT-based radiomics features to predict UFP were determined by the optimal feature filter and the least absolute shrinkage and selection operator algorithm. The radiomics model consist with the optimal features was constructed by the best of the six machine learning filters. The clinic-radiomics model combined the clinical and radiomics models via LR. The area under the curve (AUC), accuracy, sensitivity, specificity, positive and negative predictive value, calibration curve and decision curve analysis were used to evaluate the predictive performance of the models. RESULTS Patients in the UFP group had a significantly older age (69.61 vs. 63.93 years, p = 0.034), lager tumor size (45.7% vs. 11.1%, p = 0.002) and higher neutrophil to lymphocyte ratio (NLR; 2.76 vs. 2.33, p = 0.017) than favorable pathologic group in the training cohort. Tumor size (OR, 6.02; 95% CI, 1.50-24.10; p = 0.011) and NLR (OR, 1.50; 95% CI, 1.05-2.16; p = 0.026) were identified as independent predictive factors for UFP, and the clinical model was constructed using these factors. The LR classifier with the best AUC (0.817, the testing cohorts) was used to construct the radiomics model based on the optimal radiomics features. Finally, the clinic-radiomics model was developed by combining the clinical and radiomics models using LR. After comparison, the clinic-radiomics model had the best performance in comprehensive predictive efficacy (accuracy = 0.750, AUC = 0.817, the testing cohorts) and clinical net benefit among UFP-prediction models, while the clinical model (accuracy = 0.625, AUC = 0.742, the testing cohorts) was the worst. CONCLUSION Our study demonstrates that the clinic-radiomics model exhibits the best predictive efficacy and clinical net benefit for predicting UFP in initial BLCA compared with the clinical and radiomics model. The integration of radiomics features significantly improves the comprehensive performance of the clinical model.
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Affiliation(s)
- Situ Xiong
- Department of UrologyThe First Affiliated Hospital of Nanchang UniversityNanchangChina
- Jiangxi Institute of UrologyNanchangChina
| | - Wentao Dong
- Department of RadiologyJiangxi Provincial People's Hospital, The First Affiliated Hospital of Nanchang Medical CollegeNanchangChina
| | - Zhikang Deng
- Department of Nuclear Medicine, Jiangxi Provincial People's HospitalThe First Affiliated Hospital of Nanchang Medical CollegeNanchangChina
| | - Ming Jiang
- Department of UrologyThe First Affiliated Hospital of Nanchang UniversityNanchangChina
- Jiangxi Institute of UrologyNanchangChina
| | - Sheng Li
- Department of UrologyThe First Affiliated Hospital of Nanchang UniversityNanchangChina
- Jiangxi Institute of UrologyNanchangChina
| | - Bing Hu
- Department of UrologyThe First Affiliated Hospital of Nanchang UniversityNanchangChina
- Jiangxi Institute of UrologyNanchangChina
| | - Xiaoqiang Liu
- Department of UrologyThe First Affiliated Hospital of Nanchang UniversityNanchangChina
- Jiangxi Institute of UrologyNanchangChina
| | - Luyao Chen
- Department of UrologyThe First Affiliated Hospital of Nanchang UniversityNanchangChina
- Jiangxi Institute of UrologyNanchangChina
| | - Songhui Xu
- Department of UrologyThe First Affiliated Hospital of Nanchang UniversityNanchangChina
- Jiangxi Institute of UrologyNanchangChina
| | - Bing Fan
- Department of RadiologyJiangxi Provincial People's Hospital, The First Affiliated Hospital of Nanchang Medical CollegeNanchangChina
| | - Bin Fu
- Department of UrologyThe First Affiliated Hospital of Nanchang UniversityNanchangChina
- Jiangxi Institute of UrologyNanchangChina
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Shafique MA, Haseeb A, Siddiq MA, Mussarat A, Rangwala HS, Mustafa MS. Current and Emerging Treatments for Urothelial Carcinoma: A Focus on Enfortumab Vedotin. Cancer Manag Res 2023; 15:699-706. [PMID: 37485038 PMCID: PMC10362867 DOI: 10.2147/cmar.s418009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 07/17/2023] [Indexed: 07/25/2023] Open
Abstract
Urothelial carcinoma is a common malignancy that affects the urinary system, with bladder cancer being the most prevalent form. Although the management of early-stage disease has seen significant improvements, the treatment of locally advanced and metastatic urothelial carcinoma remains challenging. Over the past decade, there has been an explosion in the number of therapies available for the treatment of advanced disease, with immune checkpoint inhibitors and antibody-drug conjugates leading the way. Enfortumab vedotin is an antibody-drug conjugate that targets Nectin-4, a protein that is overexpressed in urothelial carcinoma cells. In clinical trials, it has shown promising outcomes for the treatment of advanced urothelial carcinoma that has progressed after chemotherapy or immunotherapy. The US Food and Drug Administration has granted expedited approval for enfortumab vedotin in the treatment of advanced urothelial carcinoma. This review provides an overview of the current and emerging treatments for urothelial carcinoma, with a particular focus on enfortumab vedotin. We discuss the mechanisms of action, clinical efficacy, safety, and ongoing research of enfortumab vedotin, along with the current landscape of other approved therapies and promising agents in development. The aim of this review is to provide a comprehensive and up-to-date summary of the available treatment options for urothelial carcinoma, including their limitations and future prospects.
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Affiliation(s)
| | - Abdul Haseeb
- Department of Medicine, Jinnah Sindh Medical University, Karachi, Pakistan
| | | | - Abdullah Mussarat
- Department of Medicine, Jinnah Sindh Medical University, Karachi, Pakistan
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Meng X, Li S, He K, Hu H, Feng C, Li Z, Wang Y. Evaluation of Whole-Tumor Texture Analysis Based on MRI Diffusion Kurtosis and Biparametric VI-RADS Model for Staging and Grading Bladder Cancer. Bioengineering (Basel) 2023; 10:745. [PMID: 37508772 PMCID: PMC10376391 DOI: 10.3390/bioengineering10070745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 06/16/2023] [Accepted: 06/18/2023] [Indexed: 07/30/2023] Open
Abstract
BACKGROUND to evaluate the feasibility of texture analysis (TA) based on diffusion kurtosis imaging (DKI) in staging and grading bladder cancer (BC) and to compare it with apparent diffusion coefficient (ADC) and biparametric vesical imaging reporting and data system (VI-RADS). MATERIALS AND METHODS In this retrospective study, 101 patients with pathologically confirmed BC underwent MRI with multiple-b values ranging from 0 to 2000 s/mm2. ADC- and DKI-derived parameters, including mean kurtosis (MK) and mean diffusivity (MD), were obtained. First-order texture histogram parameters of MK and MD, including the mean; 5th, 25th, 50th, 75th, and 90th percentiles; inhomogeneity; skewness: kurtosis; and entropy; were extracted. The VI-RADS score was evaluated based on the T2WI and DWI. The Mann-Whitney U-test was used to compare the texture parameters and ADC values between non-muscle-invasive bladder cancer (NMIBC) and muscle-invasive bladder cancer (MIBC), as well as between low and high grades. Receiver operating characteristic analysis was used to evaluate the diagnostic performance of each significant parameter and their combinations. RESULTS The NMIBC and low-grade group had higher MDmean, MD5th, MD25th, MD50th, MD75th, MD90th, and ADC values than those of the MIBC and the high-grade group. The NMIBC and low-grade group yielded lower MKmean, MK25th, MK50th, MK75th, and MK90th than the MIBC and high-grade group. Among all histogram parameters, MD75th and MD90th yielded the highest AUC in differentiating MIBC from NMIBC (both AUCs were 0.87), while the AUC for ADC was 0.86. The MK75th and MK90th had the highest AUC (both 0.79) in differentiating low- from high-grade BC, while ADC had an AUC of 0.68. The AUC (0.92) of the combination of DKI histogram parameters (MD75th, MD90th, and MK90th) with biparametric VI-RADS in staging BC was higher than that of the biparametric VI-RADS (0.89). CONCLUSIONS Texture-analysis-derived DKI is useful in evaluating both the staging and grading of bladder cancer; in addition, the histogram parameters of the DKI (MD75th, MD90th, and MK90th) can provide additional value to VI-RADS.
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Affiliation(s)
- Xiaoyan Meng
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Shichao Li
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Kangwen He
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Henglong Hu
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Cui Feng
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Zhen Li
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Yanchun Wang
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
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Volz Y, Trappmann R, Ebner B, Eismann L, Pyrgidis N, Pfitzinger P, Bischoff R, Schlenker B, Stief C, Schulz GB. Absence of detrusor muscle in TUR-BT specimen - can we predict who is at highest risk? BMC Urol 2023; 23:106. [PMID: 37287055 DOI: 10.1186/s12894-023-01278-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 05/25/2023] [Indexed: 06/09/2023] Open
Abstract
INTRODUCTION As a high-quality TUR-BT is important to ensure adequate treatment for bladder cancer patients, the aim of the current study is to investigate the impact of patient-related, surgical and tumor-specific parameters on detrusor muscle (DM) absence (primary objective) and to assess the impact of DM on the prognosis after a TUR-BT (secondary objective). PATIENTS AND METHODS Transurethral resection of bladder tumors (TUR-BTs) between 2009 and 2021 were retrospectively screened (n = 3237). We included 2058 cases (1472 patients) for the primary and 472 patients for secondary objective. Clinicopathological variables including tumor size, localization, multifocality, configuration, operation time and skill-level of the urologist were assessed. We analyzed predictors for missing DM and prognostic factors for recurrence-free survival (RFS) for the complete cohort and subgroups. RESULTS DM was present in 67.6% (n = 1371/2058). Surgery duration (continuous, minutes) was an independent predictor for absence of DM in the complete cohort (OR:0.98, r:0.012, 95%CI:0.98-0.99, p = 0.001). Other significant risk factors for missing DM were papillary tumors (OR:1.99, r:0.251, 95%CI:1.22-3.27, p = 0.006) in the complete cohort and bladder-roof and posterior-bladder-wall localization for re-resections. Absence of DM in high-grade BC correlated with reduced RFS (HR:1.96, 95%CI:1.0-3.79, p = 0.045). CONCLUSION Sufficient time for a TUR-BT is mandatory to assure DM in the TUR-BT specimen. Also, cases with more difficult locations of bladder tumors should be performed with utmost surgical diligence and endourological training should incorporate how to perform such operations. Of note, DM correlates with improved oncological prognosis in high-grade BC.
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Affiliation(s)
- Yannic Volz
- Department of Urology, Ludwig-Maximilian-University Hospital , Munich, Germany.
| | - Rabea Trappmann
- Department of Urology, Ludwig-Maximilian-University Hospital , Munich, Germany
| | - Benedikt Ebner
- Department of Urology, Ludwig-Maximilian-University Hospital , Munich, Germany
| | - Lennert Eismann
- Department of Urology, Ludwig-Maximilian-University Hospital , Munich, Germany
| | - Nikolaos Pyrgidis
- Department of Urology, Ludwig-Maximilian-University Hospital , Munich, Germany
| | - Paulo Pfitzinger
- Department of Urology, Ludwig-Maximilian-University Hospital , Munich, Germany
| | - Robert Bischoff
- Department of Urology, Ludwig-Maximilian-University Hospital , Munich, Germany
| | - Boris Schlenker
- Department of Urology, Ludwig-Maximilian-University Hospital , Munich, Germany
| | - Christian Stief
- Department of Urology, Ludwig-Maximilian-University Hospital , Munich, Germany
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Wang CW, Lee PJ, Wu CW, Ho CH. Comparison of Pathological Outcome and Recurrence Rate between En Bloc Transurethral Resection of Bladder Tumor and Conventional Transurethral Resection: A Meta-Analysis. Cancers (Basel) 2023; 15:cancers15072055. [PMID: 37046715 PMCID: PMC10093679 DOI: 10.3390/cancers15072055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 03/27/2023] [Accepted: 03/28/2023] [Indexed: 04/03/2023] Open
Abstract
Current treatment for non-muscle invasive bladder cancer (NMIBC) is the conventional transurethral resection of bladder tumor (CTURBT), but the en bloc transurethral resection of bladder tumor (ERBT) has been gaining more attraction in recent years considering better specimen integrity. Thus, we conducted this meta-analysis to compare the safety and efficacy of ERBT versus CTURBT. Trials were collected from an online database. The primary outcomes included identification of detrusor muscle in specimen, residual tumor, 3, 12, and 24-month recurrence rates and same-site recurrence rate. A total of 31 trials were included. The ERBT group had a higher rate of identification of detrusor muscle in specimens (p = 0.003) and lower residual tumor (p < 0.001). Other than that, lower rates of 3-month (p = 0.005) and 24-month recurrence rate (p < 0.001), same-site recurrence rate (p < 0.001) and complications were also observed. For perioperative outcomes, shorter hospitalization time (HT) (p < 0.001), and catheterization time (CT) (p < 0.001) were also revealed in the ERBT group. No significant difference was found in operative time (OT) (p = 0.93). The use of ERBT showed better pathological outcomes and fewer complications, so it could be considered a more effective treatment option for NMIBC.
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10
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Lai AL, Law YM. VI-RADS in bladder cancer: Overview, pearls and pitfalls. Eur J Radiol 2023; 160:110666. [PMID: 36689790 DOI: 10.1016/j.ejrad.2022.110666] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Accepted: 12/19/2022] [Indexed: 01/04/2023]
Abstract
Multiparametric magnetic resonance imaging (mpMRI) of the urinary bladder has shown high diagnostic performance in accurate staging of bladder cancer. Vesical Imaging Reporting and Data System (VI-RADS) scoring was developed in 2018 to standardize imaging and reporting of bladder cancer on mpMRI and is an excellent tool in preoperative T-staging of patients with high risk bladder cancer. However, there is no concise guide in the literature for practical use of VI-RADS in everyday clinical reporting. In this review, we describe our experience with mpMRI in pretreatment workup of bladder cancer, illustrate the imaging characteristics of VI-RADS categories 1 to 5 using case review, and discuss practical pearls and pitfalls in the use of mpMRI and VI-RADS in the hope of providing an accessible reference for radiologists in daily reporting.
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Affiliation(s)
- Anna Lois Lai
- Department of Diagnostic Radiology, Singapore General Hospital, Singapore.
| | - Yan Mee Law
- Department of Diagnostic Radiology, Singapore General Hospital, Singapore
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11
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Zhang W, Zhou B, Deng J, Han G, Ni W, Nie Q. Retrospective analysis of 1470-/980-nm dual-wavelength laser en bloc resection versus transurethral resection of bladder tumor for primary non-muscle-invasive bladder cancer. Lasers Med Sci 2023; 38:44. [PMID: 36656398 DOI: 10.1007/s10103-023-03708-2] [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: 06/03/2022] [Accepted: 01/11/2023] [Indexed: 01/20/2023]
Abstract
To compare the safety and efficacy of en bloc resection of non-muscle-invasive bladder cancer (NMIBC) using a 1470-/980-nm dual-wavelength laser (DwLRBT) compared to the gold standard, transurethral resection (TURBT). The study group included 251 patients with a confirmed diagnosis of NMIBC, 97 in the DwLRBT group and 154 in the TURBT group. Clinical characteristics, complications, and recurrence-free survival were compared between the two groups. There were no differences between the two groups with regard to age, sex, mean tumor size, mean tumor number, tumor location, risk, fever, and reoperation. Compared to TURBT, DwLRBT was associated with a shorter hospitalization time (mean±standard deviation: 5.81±1.48 days vs. 4.96±1.32, respectively, p=0.001), shorter catheterization time (4.98±1.47 vs. 4.20±1.48 days, respectively; p=0.035), and smaller volume of intraoperative bleeding (8.43±6.21 ml vs. 6.15±5.08, respectively; p=0.003). Recurrence-free survival (RFS) was better for DwLRBT than TURBT in the overall cohort (hazard ratio [HR], 0.4323; 95% confidence interval [CI], 0.2852-0.6554; p=0.0004) and for the following subgroups and tumor types: intermediate-risk (HR, 0.2654; 95%CI, 0.1020-0.6904; p=0.0245) and high-risk (HR, 0.4461; 95% CI, 0.2778-0.7162; p=0.0027) groups; and for pedunculate bladder tumors (HR, 0.4158; 95%CI, 0.2401-0.7202; p=0.0063), single bladder tumors (HR, 0.4136; 95%CI, 0.2376-0.7293; p=0.0072), and multiple bladder tumors (HR, 0.2727; 95%CI, 0.1408-0.5282; p=0.0014). DwLRBT is associated with better operative and postoperative outcomes, including, importantly, a longer RFS, compared to TURBT.
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Affiliation(s)
- Wenqiang Zhang
- Department of Urology, Zhuhai People's Hospital (Zhuhai Hospital affiliated with Jinan University), Zhuhai, 519000, China
| | - Bin Zhou
- Department of Pathology, Zhuhai People's Hospital (Zhuhai Hospital affiliated with Jinan University), Zhuhai, 519000, China
| | - Jian Deng
- Department of Urology, Zhuhai People's Hospital (Zhuhai Hospital affiliated with Jinan University), Zhuhai, 519000, China
| | - Gengyu Han
- Department of Urology, Zhuhai People's Hospital (Zhuhai Hospital affiliated with Jinan University), Zhuhai, 519000, China
| | - Wenjun Ni
- Department of Urology, Zhuhai People's Hospital (Zhuhai Hospital affiliated with Jinan University), Zhuhai, 519000, China.
| | - Qiwei Nie
- Department of Urology, Zhuhai People's Hospital (Zhuhai Hospital affiliated with Jinan University), Zhuhai, 519000, China.
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Kobayashi K, Matsuyama H, Oka S, Nakamura K, Misumi T, Hiroyoshi T, Ito H, Isoyama N, Hirata H, Matsumoto H, Shiraishi K. Risks and benefits of transurethral resection of the bladder tumor using photodynamic diagnosis with oral 5-aminolevulinic acid hydrochloride according to age and history of recurrence in patients with non-muscle invasive bladder cancer. Photodiagnosis Photodyn Ther 2023; 41:103294. [PMID: 36681259 DOI: 10.1016/j.pdpdt.2023.103294] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 01/15/2023] [Accepted: 01/17/2023] [Indexed: 01/20/2023]
Abstract
BACKGROUND Patient selection for transurethral resection of the bladder tumor using photodynamic diagnosis (PDD-TURBT) with oral 5-aminolevulinic acid (5-ALA) hydrochloride for non-muscle-invasive bladder cancer (NMIBC) is still unclear as to the best balance of risks (adverse events including hypotension) and benefits (reduction of intravesical recurrence). METHODS This single-center retrospective study between April 2013 and March 2022, compared the intravesical recurrence-free survival between patients who underwent PDD-TURBT and WL-TURBT using propensity score matching. RESULTS A total of 222 patients who underwent PDD-TURBT and 177 patients who underwent WL-TURBT for NMIBC were included. Propensity score matching was used to compare intravesical recurrence-free survival in 119 NMIBC patients in the both treatment groups. The intravesical recurrence-free survival within 500 days was significantly higher in the PDD-TURBT group than in the WL-TURBT group (P = 0.039; hazard ratio [HR] 0.48 [0.23-0.98]). Subgroup analysis showed that PDD-TURBT contributed to the reduction of short-term intravesical recurrence in patients aged < 75 years (P = 0.02; HR 0.22 [0.06-0.79]) and primary disease (P = 0.038; HR 0.35 [0.13-0.94]). Hypotension with a systolic blood pressure of < 80 mmHg was observed in 79 patients (35.6%) during PDD-TURBT surgery. In particular, age ≥75 years and general anesthesia were independent prognostic factors for predicting intraoperative hypotension. CONCLUSIONS PDD-TURBT reduced short-term intravesical recurrence in NMIBC, whereas a higher frequency of hypotension was found in patients aged ≥ 75 years. These results suggest that the risks and benefits of PDD-TURBT are well balanced in younger patients (< 75 years) and those with primary disease.
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Affiliation(s)
- Keita Kobayashi
- Department of Urology, Graduate School of Medicine, Yamaguchi University, 1-1-1, Minami-Kogushi, Ube, Yamaguchi, 755-8505, Japan.
| | - Hideyasu Matsuyama
- Department of Urology, Graduate School of Medicine, Yamaguchi University, 1-1-1, Minami-Kogushi, Ube, Yamaguchi, 755-8505, Japan
| | - Shintaro Oka
- Department of Urology, Graduate School of Medicine, Yamaguchi University, 1-1-1, Minami-Kogushi, Ube, Yamaguchi, 755-8505, Japan
| | - Kimihiko Nakamura
- Department of Urology, Graduate School of Medicine, Yamaguchi University, 1-1-1, Minami-Kogushi, Ube, Yamaguchi, 755-8505, Japan
| | - Taku Misumi
- Department of Urology, Graduate School of Medicine, Yamaguchi University, 1-1-1, Minami-Kogushi, Ube, Yamaguchi, 755-8505, Japan
| | - Toshiya Hiroyoshi
- Department of Urology, Graduate School of Medicine, Yamaguchi University, 1-1-1, Minami-Kogushi, Ube, Yamaguchi, 755-8505, Japan
| | - Hideaki Ito
- Department of Urology, Graduate School of Medicine, Yamaguchi University, 1-1-1, Minami-Kogushi, Ube, Yamaguchi, 755-8505, Japan
| | - Naohito Isoyama
- Department of Urology, Graduate School of Medicine, Yamaguchi University, 1-1-1, Minami-Kogushi, Ube, Yamaguchi, 755-8505, Japan
| | - Hiroshi Hirata
- Department of Urology, Graduate School of Medicine, Yamaguchi University, 1-1-1, Minami-Kogushi, Ube, Yamaguchi, 755-8505, Japan
| | - Hiroaki Matsumoto
- Department of Urology, Graduate School of Medicine, Yamaguchi University, 1-1-1, Minami-Kogushi, Ube, Yamaguchi, 755-8505, Japan
| | - Koji Shiraishi
- Department of Urology, Graduate School of Medicine, Yamaguchi University, 1-1-1, Minami-Kogushi, Ube, Yamaguchi, 755-8505, Japan
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13
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Fan J, Liang H, Fan J, Li L, Zhang G, Pei X, Yang T, He D, Wu K. Diagnostic accuracy of cystoscopic biopsy for tumour grade in outpatients with urothelial carcinoma of the bladder and the risk factors of upgrading. Asian J Urol 2023; 10:19-26. [PMID: 36721698 PMCID: PMC9875145 DOI: 10.1016/j.ajur.2021.09.003] [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: 07/07/2020] [Revised: 03/22/2021] [Accepted: 05/13/2021] [Indexed: 02/03/2023] Open
Abstract
Objective To assess the concordance of tumour grade in specimens obtained from diagnostic cystoscopic biopsy and transurethral resection of bladder tumour (TURBT) and explore the risk factors of upgrading. Methods The medical records of 205 outpatients who underwent diagnostic cystoscopic biopsy before initial TURBT were retrospectively reviewed. Comparative analysis of the tumour grade of biopsy and operation specimens was performed. Tumour grade changing from low-grade to high-grade with or without variant histology was defined as upgrading. Logistic regression analyses were performed to identify the risk factors of upgrading. Results For the 205 patients, the concordance of tumour grade between specimens obtained from biopsy and operation was 0.639. The concordance for patients who were preoperatively diagnosed with low-grade and high-grade was 0.504 and 0.912, respectively. Univariate and multivariate logistic regression analyses showed that older age, tumour multifocality, high neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and low lymphocyte-to-monocyte ratio (LMR) were significantly associated with upgrading (odds ratio ranging from 0.412 to 4.364). The area under the curve of the different multivariate models was improved from 0.752 to 0.821, and decision curve analysis demonstrated a high net benefit when NLR, LMR, and PLR were added. Conclusion Diagnostic cystoscopic biopsy may not accurately represent the true grade of primary bladder cancer, especially for outpatients with low-grade bladder cancer. Moreover, older age, tumour multifocality, high NLR, PLR, and low LMR are risk factors of upgrading, and systemic inflammatory markers improve the predictive ability.
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Affiliation(s)
- Junjie Fan
- Department of Urology, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China,Department of Urology, Baoji Center Hospital, Baoji, China
| | - Hua Liang
- Department of Pathology, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Jinhai Fan
- Department of Urology, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Lei Li
- Department of Urology, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Guanjun Zhang
- Department of Pathology, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Xinqi Pei
- Department of Urology, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Tao Yang
- Department of Urology, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Dalin He
- Department of Urology, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Kaijie Wu
- Department of Urology, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China,Corresponding author.
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14
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Bube SH, Brix R, Christensen MB, Thostrup M, Grimstrup S, Hansen RB, Dahl C, Konge L, Azawi N. Surgical experience is predictive for bladder tumour resection quality. Scand J Urol 2022; 56:391-396. [PMID: 36065477 DOI: 10.1080/21681805.2022.2119271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVES To assess the resection quality of transurethral bladder tumour resection (TURBT) and the association to surgeon experience depending on the presence of detrusor muscle. METHODS A retrospective study on 640 TURBT procedures performed at Zealand University Hospital, Denmark, from 1 January 2015 - 31 December 2016. Data included patient characteristics, procedure type, surgeon category, supervisor presence, surgical report data, pathological data, complications data and recurrence data. Analysis was performed using simple and multiple logistic regression on the association between surgeon experience and the presence of detrusor muscle in resected tissue from TURBT. RESULTS Supervised junior residents had significant lower detrusor muscle presence (73%) compared with consultants (83%) (OR = 0.4, 95% CI = 0.21-0.83). Limitations were the retrospective design and the diversity of included TURBT. CONCLUSIONS It was found that surgical experience predicts detrusor muscle presence and supervised junior residents performing TURBT on patients resulted in less detrusor muscle than consultants.
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Affiliation(s)
- Sarah H Bube
- Department of Urology, Zealand University Hospital, Roskilde, Denmark.,Copenhagen Academy for Medical Education and Simulation, Rigshospitalet, Copenhagen, Denmark.,University of Copenhagen, Copenhagen, Denmark
| | - Rasmus Brix
- Department of Urology, Herlev/Gentofte University Hospital, Gentofte, Denmark
| | | | - Mathias Thostrup
- Department of Urology, Herlev/Gentofte University Hospital, Gentofte, Denmark
| | - Søren Grimstrup
- Copenhagen Academy for Medical Education and Simulation, Rigshospitalet, Copenhagen, Denmark
| | - Rikke B Hansen
- Copenhagen Academy for Medical Education and Simulation, Rigshospitalet, Copenhagen, Denmark.,Department of Urology, Herlev/Gentofte University Hospital, Gentofte, Denmark
| | - Claus Dahl
- Department of Urology, Capio Ramsay Santé, Hellerup, Denmark
| | - Lars Konge
- Copenhagen Academy for Medical Education and Simulation, Rigshospitalet, Copenhagen, Denmark.,Department of Urology, Capio Ramsay Santé, Hellerup, Denmark
| | - Nessn Azawi
- Department of Urology, Zealand University Hospital, Roskilde, Denmark.,University of Copenhagen, Copenhagen, Denmark
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15
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Radiomics Nomogram Based on High-b-Value Diffusion-Weighted Imaging for Distinguishing the Grade of Bladder Cancer. Life (Basel) 2022; 12:life12101510. [DOI: 10.3390/life12101510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 09/03/2022] [Accepted: 09/23/2022] [Indexed: 12/24/2022] Open
Abstract
Background: The aim was to evaluate the feasibility of radiomics features based on diffusion-weighted imaging (DWI) at high b-values for grading bladder cancer and to compare the possible advantages of high-b-value DWI over the standard b-value DWI. Methods: Seventy-four participants with bladder cancer were included in this study. DWI sequences using a 3 T MRI with b-values of 1000, 1700, and 3000 s/mm2 were acquired, and the corresponding ADC maps were generated, followed with feature extraction. Patients were randomly divided into training and testing cohorts with a ratio of 8:2. The radiomics features acquired from the ADC1000, ADC1700, and ADC3000 maps were compared between low- and high-grade bladder cancers by using the Wilcox analysis, and only the radiomics features with significant differences were selected. The least absolute shrinkage and selection operator method and a logistic regression were performed for the feature selection and establishing the radiomics model. A receiver operating characteristic (ROC) analysis was conducted to assess the diagnostic performance of the radiomics models. Results: In the training cohorts, the AUCs of the ADC1000, ADC1700, and ADC3000 model for discriminating between low- from high-grade bladder cancer were 0.901, 0.920, and 0.901, respectively. In the testing cohorts, the AUCs of ADC1000, ADC1700, and ADC3000 were 0.582, 0.745, and 0.745, respectively. Conclusions: The radiomics features extracted from the ADC1700 maps could improve the diagnostic accuracy over those extracted from the conventional ADC1000 maps.
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16
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Chang CW, Tang TY, Geng JH, Jhan JH, Wang HS, Shen JT, Lee YC. The Safety and Efficacy of Vela Laser En-Bloc Endoscopic Resection versus Conventional Transurethral Resection of Bladder Tumor-A Single Center Experience. J Clin Med 2022; 11:jcm11175233. [PMID: 36079164 PMCID: PMC9457292 DOI: 10.3390/jcm11175233] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Revised: 08/24/2022] [Accepted: 09/02/2022] [Indexed: 11/16/2022] Open
Abstract
(1) Background: The current gold standard treatment of bladder cancer is conventional transurethral resection of the bladder tumor (CTURBT) using monopolar or bipolar resectoscopes. Laser en-bloc resection of the bladder tumor (LERBT) could achieve a higher quality of the specimen, reduce perioperative complications, and decrease the recurrence rate. Here, we compare the efficacy and safety of en-bloc Vela laser resection versus the conventional monopolar/bipolar resection; (2) Methods: A total of 100 clinically cT1-2 patients with bladder cancer were retrospectively reviewed in this study. Among these patients, 50 patients received LERBT, and 50 patients received CTURBT. The baseline characteristics, operation variables, and clinical outcomes were collected. The primary performance was the presence of muscle layer in the specimen. Perioperative complications and recurrence-free survival (RFS) were also compared. Independent t-test, Chi-square test, Kaplan–Meier curves, and the Cox-regression model were used in the analysis; (3) Results: The median age of the patients in the laser and resectoscope groups was 69.2 and 68.0 years old, respectively. The statistical difference in the presence of the detrusor muscle was 92.0% in the laser group and 70.0% in the CTURBT group (p = 0.005). A lower incidence of bladder perforation (p = 0.041) and major surgical complications (p = 0.046) in the LEBRT group was observed. We found no differences in operation duration, catheterization time, and hospitalization time after adjustment. Additionally, there was no statistical difference in RFS after a median follow-up time of 25 months; (4) Conclusions: Endoscopic laser en-bloc resection of bladder tumor with Vela laser is an effective method with higher muscle inclusion rate and fewer complications.
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Affiliation(s)
- Che-Wei Chang
- Department of Urology, Kaohsiung Municipal Siaogang Hospital, Kaohsiung Medical University, Kaohsiung 81267, Taiwan
- Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 80708, Taiwan
- Department of Urology, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 80708, Taiwan
| | - Tsz-Yi Tang
- Department of Urology, Kaohsiung Municipal Siaogang Hospital, Kaohsiung Medical University, Kaohsiung 81267, Taiwan
- Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 80708, Taiwan
- Department of Urology, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 80708, Taiwan
| | - Jiun-Hung Geng
- Department of Urology, Kaohsiung Municipal Siaogang Hospital, Kaohsiung Medical University, Kaohsiung 81267, Taiwan
- Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 80708, Taiwan
- Department of Urology, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 80708, Taiwan
- Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 80708, Taiwan
| | - Jhen-Hao Jhan
- Department of Urology, Kaohsiung Municipal Siaogang Hospital, Kaohsiung Medical University, Kaohsiung 81267, Taiwan
- Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 80708, Taiwan
- Department of Urology, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 80708, Taiwan
- Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 80708, Taiwan
| | - Hsun-Shuan Wang
- Department of Urology, Kaohsiung Municipal Siaogang Hospital, Kaohsiung Medical University, Kaohsiung 81267, Taiwan
- Department of Urology, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 80708, Taiwan
- Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 80708, Taiwan
| | - Jung-Tsung Shen
- Department of Urology, Kaohsiung Municipal Siaogang Hospital, Kaohsiung Medical University, Kaohsiung 81267, Taiwan
| | - Yung-Chin Lee
- Department of Urology, Kaohsiung Municipal Siaogang Hospital, Kaohsiung Medical University, Kaohsiung 81267, Taiwan
- Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 80708, Taiwan
- Department of Urology, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 80708, Taiwan
- Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 80708, Taiwan
- Correspondence:
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17
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Bhirud DP, Mittal A, Kumar S, Narain TA, Kishore S, Navriya SC, Ranjan SK, Panwar VK. When to Avoid a Restaging Procedure for Non-muscle Invasive Bladder Cancer? Inferences from a Tertiary Care Center. Indian J Surg Oncol 2022; 13:604-611. [PMID: 36187522 PMCID: PMC9515286 DOI: 10.1007/s13193-022-01516-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 01/31/2022] [Indexed: 11/30/2022] Open
Abstract
The increasing incidence of urinary bladder carcinoma is alarming. Approximately seventy percent of these patients are non-muscle invasive bladder cancer (NMIBC). Restage transurethral resection of bladder tumor (TURBT) is the current recommendation for any T1 and or high-grade non muscle invasive bladder cancers (NMIBC) to accurately stage the malignancy. The question whether a second surgery is always required as a restage procedure is still unanswered. The patient's concern about completeness, morbidity, and financial considerations of a major surgery cannot be overlooked. Moreover, it also puts a strain on the already overburdened healthcare system. To answer this question, whether it is oncologically sound to omit a second resection, the current study evaluated the outcomes of patients undergoing restage TURBT, and analyzed the preoperative factors predicting a change in the staging of this malignancy. The study design was a prospective observational including NMIBC patients from September 2018 to February 2020. A total of 72 patients underwent restage TURBT. Their demographic data, imaging and cystoscopic findings, and histopathological data were recorded. The objective was to study the clinico-pathological correlations and factors predicting recurrence and upstaging of tumor in NMIBC patients undergoing restage TURBT. A total of 101 patients were found eligible for restage TURBT. Eventually, 72 underwent restage TURBT. Twelve (16.7%) patient had recurrence at restage while 3(4.16%) were upstaged to T2. Presence of lower urinary tract symptoms (LUTS) was independently associated with the risk of recurrence of same stage compared to no recurrence (p-0.025, OR-8.793, 95% CI-1.316-98.773). Chemical exposure (p-0.042) was also significantly associated with the same. Presence of lymphadenopathy on CT was independently associated with the risk of upstaging compared to no recurrence (p-0.032, OR-18.25, 95% CI-1.292-257.85). The study concluded that in the presence of a well-performed and adequate initial TURBT, restage TURBT could be skipped for further management. However, in small subgroup of patients with lymphadenopathy on preoperative imaging having a higher risk of tumor recurrence and upstaging, and patients with a history of chemical exposure and previous lower urinary tract symptoms having a high risk of recurrence alone, restage TURBT should still be performed to accurately stage the disease. Further studies with large patient cohort are needed to confirm and reinforce the facts proposed. Supplementary Information The online version contains supplementary material available at 10.1007/s13193-022-01516-8.
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Affiliation(s)
| | - Ankur Mittal
- Department of Urology, AiimsRishikesh, Uttarakhand India 249203
| | - Sunil Kumar
- Department of Urology, AiimsRishikesh, Uttarakhand India 249203
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18
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Nicola R, Pecoraro M, Lucciola S, Dos Reis RB, Narumi Y, Panebianco V, Muglia VF. VI-RADS score system - A primer for urologists. Int Braz J Urol 2022; 48:609-622. [PMID: 35195385 PMCID: PMC9306377 DOI: 10.1590/s1677-5538.ibju.2021.0560] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 08/31/2021] [Indexed: 12/24/2022] Open
Abstract
Bladder cancer (BCa) is one of the most common cancers worldwide and is also considered to be one of the most relapsing and aggressive neoplasms. About 30% of patients will present with muscle invasive disease, which is associated with a higher risk for metastatic disease. The aim of this article is to review the state of art imaging in Radiology, while providing a complete guide to urologists, with case examples, for the rationale of the development of the Vesical Imaging Reporting and Data System (VI-RADS), a scoring system emphasizing a standardized approach to multiparametric Magnetic Resonance Imaging (mpMRI) acquisition, interpretation, and reporting for BCa. Also, we examine relevant external validation studies and the consolidated literature of mpMRI for bladder cancer. In addition, this article discusses some of the potential clinical implications of this scoring system for disease management and follow-up.
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Affiliation(s)
- Refky Nicola
- Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Martina Pecoraro
- Department of Radiological Sciences, Oncology and Pathology, Sapienza University of Rome, Italy
| | - Sara Lucciola
- Department of Radiological Sciences, Oncology and Pathology, Sapienza University of Rome, Italy
| | - Rodolfo Borges Dos Reis
- Departamento de Cirurgia, Divisão de Urologia - Faculdade de Medicina de Ribeirão Preto - USP, Ribeirão Preto, SP, Brasil
| | | | - Valeria Panebianco
- Department of Radiological Sciences, Oncology and Pathology, Sapienza University of Rome, Italy
| | - Valdair Francisco Muglia
- Departamento de Imagens Médicas, Oncologia e Hematologia - Divisão de Imagem, Faculdade de Medicina de Ribeirão Preto - USP, Ribeirão Preto, SP, Brasil
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19
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Oswald D, Pallauf P, Deininger S, Herrmann TRW, Netsch C, Becker B, Fiedler M, Haecker A, Homberg R, Klein JT, Lehrich K, Miernik A, Olbert P, Schöb DS, Sievert KD, Gross AJ, Westphal J, Lusuardi L. [Safety and efficacy of en bloc vs. conventional transurethral resection of bladder tumors: a meta-analysis and systematic review]. UROLOGIE (HEIDELBERG, GERMANY) 2022; 61:644-652. [PMID: 35286433 DOI: 10.1007/s00120-022-01765-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/13/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND En bloc tumor resection of bladder tumors (ERBT) is a novel alternative procedure to conventional resection of bladder tumor (cTURBT), which might help to address common problems of the standard method, such as inadequate detrusor muscle in specimens, high re-resection rates and high recurrence rates. OBJECTIVE To analyze current data on ERBT in efficacy and safety compared to cTURBT. DATA SOURCES PubMed. STUDY SELECTION Two independent authors identified trials based on keywords and inclusion criteria. A third author was consulted in case of discrepancies. Screening keywords: ERBT, en bloc transurethral resection of bladder tumor, TURBT en bloc. A meta-analysis of 13 studies was performed. The effect size was estimated based on odds ratios and mean differences including their corresponding two-sided 95% confidence intervals. DATA SYNTHESIS The analyzed studies comprised a homogenous collective in terms of tumor size, tumor multiplicity and tumor stage. Operation time did not significantly differ between the methods. Differences were observed in hospitalization and catheterization time in favor of ERBT. Reported complications did not show clear differences. There was significantly more detrusor muscle in the specimens in the ERBT group. No significant differences were found in recurrence up to 2 years of follow-up. CONCLUSION ERBT is a safe alternative to conventional TURBT with promising features regarding effective resection of detrusor muscle. More standardized data on recurrence rates, different resection modalities and resection margin results are needed.
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Affiliation(s)
- D Oswald
- Universitätsklink für Urologie und Andrologie, Paracelsus Medizinische Universität Salzburg, Müllner Hauptstraße 48, 5020, Salzburg, Österreich.
| | - P Pallauf
- Universitätsklink für Urologie und Andrologie, Paracelsus Medizinische Universität Salzburg, Müllner Hauptstraße 48, 5020, Salzburg, Österreich
| | - S Deininger
- Universitätsklink für Urologie und Andrologie, Paracelsus Medizinische Universität Salzburg, Müllner Hauptstraße 48, 5020, Salzburg, Österreich
| | | | - C Netsch
- Abteilung für Urologie, Asklepios Klinik Barmbek, Hamburg, Deutschland
| | - B Becker
- Abteilung für Urologie, Asklepios Klinik Barmbek, Hamburg, Deutschland
| | - M Fiedler
- Klinik für Urologie, SLK-Kliniken Heilbronn GmbH, Heilbronn, Deutschland
| | - A Haecker
- Klinik für Urologie und Kinderurologie, Gesundheitsverbund Landkreis Konstanz, Klinikum Konstanz, Konstanz, Deutschland
| | - R Homberg
- Klinik für Urologie, Kinderurologie und Uro-Gynäkologie, St. Barbara-Klinik Hamm-Heessen, Hamm, Deutschland
| | - J T Klein
- Urologische Klinik am Lerchenberg, Heilbronn, Deutschland
| | - K Lehrich
- Klinik für Urologie, Vivantes Auguste-Viktoria-Klinikum, Berlin, Deutschland
| | - A Miernik
- Medizinische Fakultät, Klinik für Urologie, Universitätsklinikum Freiburg, Freiburg, Deutschland
| | - P Olbert
- BRIXSANA private clinic, Brixen, Italien
| | - D S Schöb
- Medizinische Fakultät, Klinik für Urologie, Universitätsklinikum Freiburg, Freiburg, Deutschland
| | - K D Sievert
- UKOWL, Campus Klinikum Lippe, Detmold, Deutschland
| | - A J Gross
- Abteilung für Urologie, Asklepios Klinik Barmbek, Hamburg, Deutschland
| | - J Westphal
- Klinik für Urologie, Kinderurologie und Urogynäkologie, Krankenhaus Maria Hilf der Alexianer GmbH, Krefeld, Deutschland
| | - L Lusuardi
- Universitätsklink für Urologie und Andrologie, Paracelsus Medizinische Universität Salzburg, Müllner Hauptstraße 48, 5020, Salzburg, Österreich
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20
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İnce O, Yıldız H, Kisbet T, Ertürk ŞM, Önder H. Classification of retinoblastoma-1 gene mutation with machine learning-based models in bladder cancer. Heliyon 2022; 8:e09311. [PMID: 35520623 PMCID: PMC9061624 DOI: 10.1016/j.heliyon.2022.e09311] [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: 11/26/2021] [Revised: 01/19/2022] [Accepted: 04/20/2022] [Indexed: 11/19/2022] Open
Abstract
Purpose This study aims to evaluate the potential of machine learning algorithms built with radiomics features from computed tomography urography (CTU) images that classify RB1 gene mutation status in bladder cancer. Method The study enrolled CTU images of 18 patients with and 54 without RB1 mutation from a public database. Image and data preprocessing were performed after data augmentation. Feature selection steps were consisted of filter and wrapper methods. Pearson’s correlation analysis was the filter, and a wrapper-based sequential feature selection algorithm was the wrapper. Models with XGBoost, Random Forest (RF), and k-Nearest Neighbors (kNN) algorithms were developed. Performance metrics of the models were calculated. Models’ performances were compared by using Friedman’s test. Results 8 features were selected from 851 total extracted features. Accuracy, sensitivity, specificity, precision, recall, F1 measure and AUC were 84%, 80%, 88%, 86%, 80%, 0.83 and 0.84, for XGBoost; 72%, 80%, 65%, 67%, 80%, 0.73 and 0.72 for RF; 66%, 53%, 76%, 67%, 53%, 0.60 and 0.65 for kNN, respectively. XGBoost model had outperformed kNN model in Friedman’s test (p = 0.006). Conclusions Machine learning algorithms with radiomics features from CTU images show promising results in classifying bladder cancer by RB1 mutation status non-invasively.
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Affiliation(s)
- Okan İnce
- Health Sciences University Prof. Dr. Cemil Tascioglu City Hospital, Department of Radiology, Turkey
- Corresponding author.
| | - Hülya Yıldız
- Health Sciences University Prof. Dr. Cemil Tascioglu City Hospital, Department of Radiology, Turkey
| | - Tanju Kisbet
- Health Sciences University Prof. Dr. Cemil Tascioglu City Hospital, Department of Radiology, Turkey
| | - Şükrü Mehmet Ertürk
- Istanbul University Istanbul Medical Faculty, Department of Radiology, Turkey
| | - Hakan Önder
- Health Sciences University Prof. Dr. Cemil Tascioglu City Hospital, Department of Radiology, Turkey
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21
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Adjuvant therapies for non-muscle-invasive bladder cancer: advances during BCG shortage. World J Urol 2022; 40:1111-1124. [PMID: 35083522 DOI: 10.1007/s00345-021-03908-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 12/07/2021] [Indexed: 02/07/2023] Open
Abstract
Non-muscle-invasive bladder cancer (NMIBC) represents a significant global therapeutic challenge, particularly in the era of Bacillus Calmette-Guérin (BCG) shortage. High-risk NMIBC can progress to muscle invasive or metastatic disease in 25% of patients. Optimal treatment selection, according to risk stratification, is imperative. International guidelines slightly differ in their categorisation of low, intermediate and high-risk NMIBC. Nonetheless, a single post-operative instillation of chemotherapy with Mitomycin C (MMC) or Gemcitabine improves relapse-free survival (RFS) in low-risk NMIBC. Induction and maintenance intravesical BCG remains the historical gold standard for patients with intermediate or high-risk NMIBC. However, clinicians may be forced to consider alternatives given the current BCG shortage. Both intravesical MMC and Gemcitabine have been associated with similar efficacy to BCG, albeit in smaller studies. MMC may also be manipulated using a variety of methods to potentiate its effects. BCG treatment delivery may also be modified without affecting efficacy through dose reduction and abbreviation or omission of maintenance therapy. Preliminary data also highlight that directly proceeding to radical cystectomy may not adversely affect long-term quality of life measures. Access to new systemic and intravesical therapies must be prioritised for patients with BCG recurrent or unresponsive disease. When used in conjunction with molecularly defined biomarkers, these agents herald the potential for improved survival outcomes and alleviation of the current BCG shortage.
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22
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Wilson J, Drach D, Zanghi J, Siegert J. Improving practice patterns in patients with newly diagnosed bladder masses treated with transurethral resection. J Osteopath Med 2022; 122:169-173. [PMID: 35073474 DOI: 10.1515/jom-2021-0157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Accepted: 12/01/2021] [Indexed: 11/15/2022]
Abstract
CONTEXT Transurethral resection (TUR) is the mainstay for diagnosis, staging, and treatment of both high-grade and low-grade nonmuscle invasive bladder cancer (NMIBC). It is reported that 51% of initial transurethral resection of bladder tumors (iTURBT) does not contain muscle, which results in higher rates of clinical upstaging on repeat transurethral resection (reTUR) and worse oncologic outcomes. Presence of muscle on iTURBT specimen and performing reTUR within 6 weeks in high-risk NMIBC aids in accurate staging and, therefore, guides proper treatment. OBJECTIVES This study aimed to assess and improve TURBT quality by making surgeons aware of their practice patterns and setting improvement goals. METHODS Patients who received TURBT for a newly diagnosed bladder mass were analyzed by retrospective chart review for 9 months prior to quality improvement (QI) intervention. Data were collected pertaining to muscle presence/absence on biopsy, pathology of the tumor, risk stratification, whether reTUR was indicated, and time to reTUR. The primary endpoints were the presence of muscle on initial TURBT, whether a reTUR was performed when clinically indicated, and time to reTUR. Tumors requiring reTUR were defined as being HGT1 or HGTa >3 cm. The QI intervention, physician education, was then implemented by presenting initial performance results to the physicians, and a second dataset was then collected by prospective analysis for another 9 months to assess for changes in practice patterns. A total of 101 patients receiving TURBT were reviewed, including 52 patients prior to and 49 patients following QI intervention. Patients with a history of, or treatment for, bladder cancer were excluded, along with those without assessment of muscle on pathological analysis. Fisher's exact test was utilized to determine differences in categorical data by comparing each of the following groups prior to and following QI intervention: percent of muscle presence on iTURBT, percent reTUR performed when indicated, and mean time to reTUR in days. A p<0.05 was considered statistically significant. RESULTS After comparing the TURBT results before and after our QI intervention, we found a significant improvement in the number of patients receiving a reTUR when indicated, with 5/13 (38.5%) before compared to 15/19 (78.9%) after, p=0.03. The number of specimens on iTURBT with muscle present were not significantly different, with 38/52 (73.1%) before and 33/49 (67.3%) after, p=0.66. The average time to reTUR before (32.4 days; n=5; range, 21-50 days) and after (42.4 days; n=15; range, 11-77 days) QI intervention was also not significantly different, p=0.28. CONCLUSIONS Our data suggest that critical analysis of physician practice patterns followed by education and setting improvement goals can significantly impact clinical practices and improve quality of care. Future studies will be performed to determine the impact that these changes have on oncologic outcomes.
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Affiliation(s)
- Joshua Wilson
- Midwestern University Chicago College of Osteopathic Medicine, Downers Grove, IL, USA
| | - Daniel Drach
- Midwestern University Chicago College of Osteopathic Medicine, Downers Grove, IL, USA
| | - Joseph Zanghi
- Department of Urology, Franciscan Health Olympia Fields, Olympia Fields, IL, USA
| | - James Siegert
- Clinical Assistant Professor of Surgery, Department of Urology, Franciscan Health Olympia Fields, Olympia Fields, IL, USA
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Regnier S, Califano G, Elalouf V, Albisinni S, Aziz A, Di Trapani E, Krajewski W, Mari A, D'Andrea D, Pradère B, Soria F, Afferi L, Moschini M, Ouzaid I, Xylinas E. Restaging transurethral resection in ta high-grade nonmuscle invasive bladder cancer: a systematic review. Curr Opin Urol 2022; 32:54-60. [PMID: 34812200 DOI: 10.1097/mou.0000000000000949] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW The role of a re-transurethral resection (TUR) is clearly demonstrated in T1 high-grade nonmuscle invasive bladder cancer. However, its role remains controversial for Ta high-risk tumors and the recent European guidelines stated that the second look procedure could be avoided for these patients despite harboring a high-risk of both disease recurrence and progression. We aimed to evaluate the added benefit on staging, response to bacillus Calmette-Guérin and oncological outcomes of re-TUR in patients with Ta high-grade nonmuscle invasive bladder cancer. RECENT FINDINGS Overall, we identified 15 studies, including 3912 patients from which 743 harbored Ta high-grade disease. Delay between first and second TUR was ranging from 2 to 12 weeks (median 5.6 weeks). The rate of residual disease was 52.8% (range 17-67%). The rate of overall upstaging to T1 and muscle-invasive disease were 10.9 and 4.7%, respectively. Although there was a trend toward improvement of recurrence-free survival outcomes, no definitive conclusions can be drawn due to the retrospective design of the studies included. SUMMARY Residual tumor is common after initial TUR for Ta high-grade. Re-TUR is useful in reducing the rates of residual disease, may improve staging, response to bacillus Calmette-Guérin and oncological outcomes.
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Affiliation(s)
- Sophie Regnier
- Urology Department, Bichat-Claude Bernard Hospital, Assistance-Publique Hôpitaux de Paris, Paris University, Paris, France
| | - Gianluigi Califano
- Urology Department, Bichat-Claude Bernard Hospital, Assistance-Publique Hôpitaux de Paris, Paris University, Paris, France
- Urology Unit, Department of Neurosciences, Reproductive Sciences and Odontostomatology, Federico II University of Naples, Naples, Italy
| | - Vincent Elalouf
- Urology Department, Hôpital Privé Claude Galien, Ramsay Santé, Quincy-Sous-Sénart, France
| | - Simone Albisinni
- Urology Department, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Atiqullah Aziz
- Urology Department, München Klinik Bogenhausen, Munich, Germany
| | | | - Wojciech Krajewski
- Department of Urology and Oncological Urology, Wrocław Medical University, Wrocław, Poland
| | - Andrea Mari
- Urology Department, Careggi Hospital, University of Florence, Florence, Italy
| | - David D'Andrea
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Benjamin Pradère
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Francesco Soria
- Urology Division, Department of Surgical Sciences, University of Studies of Torino, Turin, Italy
| | - Luca Afferi
- Department of Urology, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Marco Moschini
- Department of Medical Oncology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Idir Ouzaid
- Urology Department, Bichat-Claude Bernard Hospital, Assistance-Publique Hôpitaux de Paris, Paris University, Paris, France
| | - Evanguelos Xylinas
- Urology Department, Bichat-Claude Bernard Hospital, Assistance-Publique Hôpitaux de Paris, Paris University, Paris, France
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Varma R, Deb A, Roy D, Ahmed A. Closed-loop audit of muscle sampling in Trans-Urethral Resection of Bladder Tumour. JOURNAL OF CLINICAL UROLOGY 2021. [DOI: 10.1177/20514158211049980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction: Our experience with the presence of detrusor muscle (DM) following Trans-Urethral Resection of Bladder Tumour (TURBT). Objectives: To evaluate the presence of DM in primary TURBT specimens as a quality improvement exercise in Frimley Park Hospital, UK. And to assess if the level of the surgeon has impact on outcomes. Methods: Retrospective and prospective analysis of the electronic records from a single urology centre, servicing a group of urologists. Data collected over three consecutive audit loops between January 2014 and May 2018. Results: A total of 301 cases were performed under the care of seven consultant urologists. Analysis revealed a significant improvement in the overall quality of resections from 39% to 66% (50–84% for intermediate and high grade) after the introduction of the following interventions: (1) analysis and improved awareness of current practice; (2) introduction of European Association of Urology (EAU) guidelines by separating samples and sending a second specimen pot marked as bladder tumour base to look for DM; (3) dedicated urologists with an interest in bladder cancer performing en-bloc resection technique in appropriate cases. Conclusion: Through our closed-loop audits, we have demonstrated a considerable improvement in the quality of resections, resulting in accurate staging from the initial resection. This could in turn lead to improved over all prognoses and negating the need for re-resection in all cases of high-risk non-muscle invasive bladder cancer (NMIBC). Level of evidence: 3
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25
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Feng C, Wang Y, Dan G, Zhong Z, Karaman MM, Li Z, Hu D, Zhou XJ. Evaluation of a fractional-order calculus diffusion model and bi-parametric VI-RADS for staging and grading bladder urothelial carcinoma. Eur Radiol 2021; 32:890-900. [PMID: 34342693 DOI: 10.1007/s00330-021-08203-2] [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: 03/09/2021] [Revised: 05/30/2021] [Accepted: 06/30/2021] [Indexed: 12/24/2022]
Abstract
OBJECTIVES To evaluate the feasibility of high b-value diffusion-weighted imaging (DWI) for distinguishing non-muscle-invasive bladder cancer (NMIBC) from muscle-invasive bladder cancer (MIBC) and low- from high-grade bladder urothelial carcinoma using a fractional-order calculus (FROC) model as well as a combination of FROC DWI and bi-parametric Vesical Imaging-Reporting and Data System (VI-RADS). METHODS Fifty-eight participants with bladder urothelial carcinoma were included in this IRB-approved prospective study. Diffusion-weighted images, acquired with 16 b-values (0-3600 s/mm2), were analyzed using the FROC model. Three FROC parameters, D, β, and μ, were used for delineating NMIBC from MIBC and for tumor grading. A receiver operating characteristic (ROC) analysis was performed based on the individual FROC parameters and their combinations, followed by comparisons with apparent diffusion coefficient (ADC) and bi-parametric VI-RADS based on T2-weighted images and DWI. RESULTS D and μ were significantly lower in the MIBC group than in the NMIBC group (p = 0.001 for each), and D, β, and μ all exhibited significantly lower values in the high- than in the low-grade tumors (p ≤ 0.011). The combination of D, β, and μ produced the highest specificity (85%), accuracy (78%), and the area under the ROC curve (AUC, 0.782) for distinguishing NMIBC and MIBC, and the best sensitivity (89%), specificity (86%), accuracy (88%), and AUC (0.892) for tumor grading, all of which outperformed the ADC. The combination of FROC parameters with bi-parametric VI-RADS improved the AUC from 0.859 to 0.931. CONCLUSIONS High b-value DWI with a FROC model is useful in distinguishing NMIBC from MIBC and grading bladder tumors. KEY POINTS • Diffusion parameters derived from a FROC diffusion model may differentiate NMIBC from MIBC and low- from high-grade bladder urothelial carcinomas. • Under the condition of a moderate sample size, higher AUCs were achieved by the FROC parameters D (0.842) and μ (0.857) than ADC (0.804) for bladder tumor grading with p ≤ 0.046. • The combination of the three diffusion parameters from the FROC model can improve the specificity over ADC (85% versus 67%, p = 0.031) for distinguishing NMIBC and MIBC and enhance the performance of bi-parametric VI-RADS.
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Affiliation(s)
- Cui Feng
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Qiaokou District, Wuhan, 430030, China.,Center for MR Research, University of Illinois at Chicago, MC-707, Suite 1A, 1801 West Taylor Street, Chicago, IL, 60612, USA
| | - Yanchun Wang
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Qiaokou District, Wuhan, 430030, China
| | - Guangyu Dan
- Center for MR Research, University of Illinois at Chicago, MC-707, Suite 1A, 1801 West Taylor Street, Chicago, IL, 60612, USA.,Department of Bioengineering, University of Illinois at Chicago, Chicago, IL, USA
| | - Zheng Zhong
- Center for MR Research, University of Illinois at Chicago, MC-707, Suite 1A, 1801 West Taylor Street, Chicago, IL, 60612, USA.,Department of Bioengineering, University of Illinois at Chicago, Chicago, IL, USA
| | - M Muge Karaman
- Center for MR Research, University of Illinois at Chicago, MC-707, Suite 1A, 1801 West Taylor Street, Chicago, IL, 60612, USA.,Department of Bioengineering, University of Illinois at Chicago, Chicago, IL, USA
| | - Zhen Li
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Qiaokou District, Wuhan, 430030, China
| | - Daoyu Hu
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Qiaokou District, Wuhan, 430030, China.
| | - Xiaohong Joe Zhou
- Center for MR Research, University of Illinois at Chicago, MC-707, Suite 1A, 1801 West Taylor Street, Chicago, IL, 60612, USA. .,Department of Bioengineering, University of Illinois at Chicago, Chicago, IL, USA. .,Department of Radiology, University of Illinois at Chicago, Chicago, IL, USA. .,Department of Neurosurgery, University of Illinois at Chicago, Chicago, IL, USA.
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26
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Mao X, Zhou Z, Cui Y, Zhang Y, Yang M. Outcomes and Complications of Bipolar vs. Monopolar Energy for Transurethral Resection of Bladder Tumors: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Front Surg 2021; 8:583806. [PMID: 34150834 PMCID: PMC8206278 DOI: 10.3389/fsurg.2021.583806] [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: 07/16/2020] [Accepted: 04/20/2021] [Indexed: 11/25/2022] Open
Abstract
Background: Bipolar and monopolar transurethral resections have a stable status for non-muscle invasive bladder cancer (NMIBC). We conducted a meta-analysis to analyze the outcomes and complications of bipolar vs. monopolar energy for transurethral resection of bladder tumors (TURB). Methods: The Preferred Reporting Items for Systematic Reviews and Meta-analyses was followed. Based on the Population, Intervention, Comparator, Outcomes, and Study Designs (PICOS) strategy, randomized controlled trials were searched in MEDLINE, EMBASE, and the Cochrane Controlled Trials Register. The reference lists of the associated articles were also retrieved. The data were calculated by Rev Man v5.3.0. Results: Eleven publications containing an amount of 2, 099 patients were involved in the study. Two groups did not show a significant difference in the mean age and the number of bladder tumors. The results showed that m-TURB had a greater decrease in postoperative hemoglobin level [mean difference (MD) −0.26, 95% confidence interval (CI) −0.48 to −0.04, P = 0.02] and sodium level (MD −0.36, 95% CI −0.62 to −0.10, P = 0.007) compared with b-TURB. B-TURB spent relatively little in hospitalization time (MD −0.52, 95% CI −0.88 to −0.15, P = 0.005) than m-TURB with the exception of operation time (P = 0.47) and catheterization time (P = 0.19). B-TURB did not show a significant difference in the incidence rate of obturator reflex (P = 0.10), bladder perforation (P = 0.32), postoperative blood transfusion (P = 0.28), and clot retention (P = 0.21) compared with the b-TURB group. Besides, there were no significant difference in terms of muscle tissue sampling (P = 0.43), recurrence-free survival at 6 months (P = 0.68) and 12 months (P = 0.78). Conclusions: B-TURB was more effective than m-TURB in minimizing intraoperative or postoperative bleeding with the smaller loss of hemoglobin and the shorter hospitalization time for patients with NMIBC.
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Affiliation(s)
- Xin Mao
- Department of Urology, Affiliated Hospital of Qingdao University, Qingdao, China
| | - Zhongbao Zhou
- Department of Urology, Beijing TianTan Hospital, Capital Medical University, Beijing, China
| | - Yuanshan Cui
- Department of Urology, Beijing TianTan Hospital, Capital Medical University, Beijing, China.,Department of Urology, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, China
| | - Yong Zhang
- Department of Urology, Beijing TianTan Hospital, Capital Medical University, Beijing, China
| | - Mingshan Yang
- Department of Urology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
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Fan J, Wu K, Zhang N, Yang T, Liu N, Jiang Y, Bai X, Wang X, He D. Green-light laser en bloc resection versus conventional transurethral resection for initial non-muscle-invasive bladder cancer: A randomized controlled trial. Int J Urol 2021; 28:855-860. [PMID: 34013615 DOI: 10.1111/iju.14592] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 04/11/2021] [Indexed: 12/21/2022]
Abstract
OBJECTIVE To compare the safety and outcomes between green-light laser en bloc resection and transurethral resection of bladder tumor. METHODS A single-center, randomized controlled trial was carried out from August 2014 to September 2018. Patients with initial non-muscle-invasive bladder cancer were randomized to green-light laser en bloc resection or transurethral resection of bladder tumor. The primary outcomes were pathological findings and perioperative events. The secondary outcome was tumor recurrence. RESULTS A total of 233 patients were randomized to the transurethral resection of bladder tumor group (117 patients) and the green-light laser en bloc resection group (116 patients). The resection time was longer in the green-light laser en bloc resection group (P = 0.022); however, no differences were identified in overall operative time (P = 0.255). Nine patients (7.7%) had an obturator nerve reflex during transurethral resection of bladder tumor. The estimated volume of blood loss was significantly lower in the green-light laser en bloc resection group (P = 0.012). The green-light laser en bloc resection group had a higher rate of T1 bladder cancer (P = 0.031). A total of 104 patients (89.7%) treated with green-light laser en bloc resection had detrusor muscle presence in the specimen, whereas 37 (31.9%) patients had the presence of muscularis mucosae, which was significantly higher than the corresponding number of transurethral resection of bladder tumor patients (P = 0.005 and 0.002, respectively). After a median follow-up period of 48 months, just five patients had tumor recurrence (three in the transurethral resection of bladder tumor group and two in the green-light laser en bloc resection group), and there was no difference between these two groups. CONCLUSIONS Compared with transurethral resection of bladder tumor, green-light laser en bloc resection is more effective due to less obturator nerve reflex and the same recurrence rate. Most importantly, green-light laser en bloc resection can provide better tumor specimens for pathological examinations.
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Affiliation(s)
- Jinhai Fan
- Department of Urology, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Kaijie Wu
- Department of Urology, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Nan Zhang
- Department of Urology, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Tao Yang
- Department of Urology, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Nan Liu
- Department of Urology, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Yumei Jiang
- Department of Urology, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Xiaojing Bai
- Department of Urology, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Xinyang Wang
- Department of Urology, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Dalin He
- Department of Urology, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
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28
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Blindheim AJ, Fosså SD, Babigumira R, Andreassen BK. The use of reTURB in T1 bladder cancer: a Norwegian population-based study. Scand J Urol 2021; 55:268-274. [PMID: 33998957 DOI: 10.1080/21681805.2021.1917652] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
AIM To evaluate the use of repeat transurethral resection of the bladder (reTURB) in stage T1 bladder cancer and its impact on treatment and survival in a Norwegian population-based cohort. MATERIAL AND METHODS 1130 patients registered at the Cancer Registry of Norway between 2008 and 2012 with primary urothelial T1 cancer were included. Information on surgical and medical procedures was provided by the Norwegian Patient Registry. Descriptive statistics were used to evaluate characteristics of patients receiving reTURB or not within 12 weeks from primary TURB (primTURB). Survival models identified risk factors and estimated cause-specific survival rates (CSS) adjusted for sex, age, WHO grade, concomitant cis and detrusor muscle at primTURB and treatment. RESULTS The 648 (57%) T1 patients with reTURB were significantly younger and had more WHO high grade tumors compared to those without reTURB. Of 275 patients without detrusor muscle at primTURB 114 (41%) had no reTURB. Of reTURB patients, 45 (7%) had muscle invasive tumor, 110 (17%) T1 and 378 (58%) Ta, cis or T0. Two-thirds of 81 patients receiving early cystectomy after reTURB had T1 or muscle invasive bladder cancer at reTURB. ReTURB did not impact adjusted CSS, but patients with T1 at reTURB had significantly lower CSS than those with < T1 conditions. CONCLUSIONS Almost half of the T1 patients did not undergo reTURB as recommended in guidelines. We show that reTURB makes the histology result more reliable with impact on both treatment and survival. Our results support the use of reTURB as recommended by EAU guidelines.
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Affiliation(s)
- Augun Jodis Blindheim
- Department of Clinical and Molecular Medicine, St. Olavs Hospital, Trondheim, Norway.,Norwegian University of Science and Technology (NTNU), Trondheim, Norway.,Clinic of Surgery, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Sophie Dorothea Fosså
- Department of Oncology, Medical Faculty, Oslo University Hospital & University of Oslo, Oslo, Norway
| | - Ronnie Babigumira
- Department of Research, Cancer Registry of Norway, Institute for Population-based Research, Oslo, Norway
| | - Bettina Kulle Andreassen
- Department of Research, Cancer Registry of Norway, Institute for Population-based Research, Oslo, Norway
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Sung HH, Scherr DS, Slaton J, Liu H, Feeny KL, Lingley-Papadopoulos C, Gearheart J, Zara JM, Lerner SP. Phase II multi-center trial of optical coherence tomography as an adjunct to white light cystoscopy for intravesical real time imaging and staging of bladder cancer. Urol Oncol 2021; 39:434.e23-434.e29. [PMID: 33934964 DOI: 10.1016/j.urolonc.2021.03.026] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 03/14/2021] [Accepted: 03/29/2021] [Indexed: 02/08/2023]
Abstract
BACKGROUND Optical coherence tomography (OCT) is a novel imaging modality that provides microstructural information of different tissue layers using near-infrared light. This prospective, multicenter phase II trial aimed to assess the accuracy of OCT-assisted cystoscopy for bladder tumor staging. METHODS Patients with primary or recurrent bladder tumors (Ta,T1) identified by outpatient cystoscopy were included. The primary objective was to assess the accuracy and positive predictive value of for determining tumor stage ≥T1 correlated by histopathology. 72 suspicious lesions from 63 patients were eligible to analyze in the study. All suspected lesions were evaluated with conventional cystoscopy, interpreted in real-time using OCT, and then resected. All results were compared to pathology. A total of 363 OCT images of tumor and normal mucosa in 25 patients were obtained to evaluate diagnostic efficacy of the computer-aided texture analysis algorithm. RESULTS Sensitivity and specificity for predicting invasive tumors (≥ T1, n = 17) were 58.8% and 92.7% for cystoscopy, 64.7% and 100% for OCT-assisted cystoscopy, respectively. Accuracy of cystoscopy and OCT-assisted cystoscopy for predicting invasive tumor was 84.7% and 91.7% (P = 0.063), respectively. Cystoscopy and OCT-assisted cystoscopy correctly predicted T stage in 52/72 and 59/72 cases, respectively (P = 0.016). Cystoscopy missed 2 more invasive tumors than OCT-assisted cystoscopy. Cystoscopy (14.3%, 1/7) and OCT-assisted cystoscopy (28.6%, 2/7) showed relatively low sensitivity in detecting muscle invasion. Computer aided texture analysis demonstrated 75.1% sensitivity, 64.0% specificity, and 74.4% accuracy for differentiating tumor and normal urothelium. CONCLUSION OCT-assisted cystoscopy is a real time noninvasive and simple procedure that enhanced the accuracy of staging bladder tumors and prediction of any tumor invasion. Though the study did not meet the prespecified primary endpoint, OCT imaging is a promising adjunct to cystoscopy that may supplement intraoperative decision-making during transurethral resection of bladder tumors and additional prospective studies are warranted.
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Affiliation(s)
- Hyun Hwan Sung
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea; Scott Department of Urology, Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston, TX
| | - Douglas S Scherr
- Department of Urology, New York Presbyterian Hospital, Weill Cornell Medicine, New York, NY
| | - Joel Slaton
- Department of Urology, University of Minnesota, Minneapolis, MIN
| | - Hao Liu
- Department of Biostatistics, Indiana University School of Medicine, Indiana University Simon Cancer Center, Indianapolis, IN
| | | | | | - John Gearheart
- School of Engineering & Applied Science, The George Washington University, Washington, DC
| | - Jason M Zara
- School of Engineering & Applied Science, The George Washington University, Washington, DC
| | - Seth P Lerner
- Scott Department of Urology, Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston, TX.
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Abstract
The cornerstone for diagnosis and treatment of bladder and upper tract urothelial carcinoma involves surgery. Transurethral resection of bladder tumors forms the basis of further management. Radical cystectomy for invasive bladder carcinoma provides good oncologic outcomes. However, it can be a morbid procedure, and advances such as minimally invasive surgery and early recovery after surgery need to be incorporated into routine practice. Diagnostic ureteroscopy for upper tract carcinoma is needed in cases of doubt after cytology and imaging studies. Low-risk cancers can be managed with conservative endoscopic surgery without compromising oncological outcomes; however, high-risk disease necessitates radical nephroureterectomy.
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31
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Tripathi MC, Faisal Masood P, Sood R, Singla A, Khattar N, Manasa T, Singh R. A prospective study comparing side-firing KTP laser enucleation vs bipolar transurethral resection of bladder tumor for small bladder tumors in an outpatient setting. Cent European J Urol 2021; 74:215-221. [PMID: 34336241 PMCID: PMC8318012 DOI: 10.5173/ceju.2021.0012.r1] [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: 01/18/2021] [Revised: 03/17/2021] [Accepted: 03/30/2021] [Indexed: 11/22/2022] Open
Abstract
Introduction Laser therapy provides an alternative option for treating non-muscle-invasive bladder cancer. The clinical evidence for potassium-titanyl-phosphate (KTP) laser en bloc resection is still limited. Here, we evaluated the efficacy, safety profile, and outcomes of side-firing KTP laser enucleation with bipolar transurethral resection of bladder tumor (TURBT) in carefully selected patients with small bladder tumors in an office setting. Material and methods A total of 83 patients with small bladder tumors were treated with either side-firing KTP laser enucleation (Group A; n = 40) or bipolar TURBT (Group B; n = 43). Intraoperative and postoperative parameters of interest were recorded and analyzed as per the study so as to evaluate the efficacy, safety profile, and outcome of KTP laser enucleation. Results The mean enucleation time was 23 ±5.24 min in Group A and the mean operative time was 21.98 ±4.77 min in Group B (p = 0.207). Group A had a lower risk of obturator reflex (0 vs 8; p = 0.005) and lesser amount of irrigation used intraoperatively as compared to Group B (6.2 ±0.61 L vs 7.65 ±0.75 L; p <0.0001). There were no perioperative complications. The recurrence rate at 6 months was none in Group A and 2.3% in Group B. Conclusions The present study shows that, in patients with small bladder tumors (<3 cm), KTP laser enucleation is an effective and feasible alternative to bipolar TURBT in an office setting and can be carried out safely with comparable treatment outcomes, lesser use of irrigation fluid and lower risk of obturator reflex. However, further studies in larger cohorts are warranted.
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Affiliation(s)
- Mahesh Chandra Tripathi
- Department of Urology and Renal Transplant, Atal Bihari Vajpayee Institute of Medical Sciences & Dr. Ram Manohar Lohia Hospital, New Delhi, India
| | - Pirzada Faisal Masood
- Department of Urology and Renal Transplant, Atal Bihari Vajpayee Institute of Medical Sciences & Dr. Ram Manohar Lohia Hospital, New Delhi, India
| | - Rajeev Sood
- Department of Urology and Renal Transplant, Atal Bihari Vajpayee Institute of Medical Sciences & Dr. Ram Manohar Lohia Hospital, New Delhi, India
| | - Anurag Singla
- Department of Urology and Renal Transplant, Atal Bihari Vajpayee Institute of Medical Sciences & Dr. Ram Manohar Lohia Hospital, New Delhi, India
| | - Nikhil Khattar
- Department of Urology, Medanta the Medicity, Gurugram, India
| | - T Manasa
- Department of Urology and Renal Transplant, Atal Bihari Vajpayee Institute of Medical Sciences & Dr. Ram Manohar Lohia Hospital, New Delhi, India
| | - Rajpal Singh
- Department of Anesthesia, Atal Bihari Vajpayee Institute of Medical Sciences & Dr. Ram Manohar Lohia Hospital, New Delhi, India
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Akcay A, Yagci AB, Celen S, Ozlulerden Y, Turk NS, Ufuk F. VI-RADS score and tumor contact length in MRI: A potential method for the detection of muscle invasion in bladder cancer. Clin Imaging 2021; 77:25-36. [PMID: 33639497 DOI: 10.1016/j.clinimag.2021.02.026] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2020] [Revised: 02/06/2021] [Accepted: 02/14/2021] [Indexed: 12/09/2022]
Abstract
BACKGROUND Vesical Imaging Reporting and Data System (VI-RADS) is a useful tool for evaluating muscle layer invasion of bladder cancer (BCa) on magnetic resonance imaging (MRI). PURPOSE To evaluate the diagnostic performance of bladder MRI to detect the muscle layer invasion of BCa using VI-RADS score and quantitative MRI parameters. METHODS Preoperative bladder MRI was performed in 73 BCa patients. Two observers independently evaluated the MR blinded to histopathological data and classified the tumors according to VI-RADS criteria. Moreover, the quantitative parameters (maximum tumor diameter; Dmax, tumor contact length; TCL, and tumor apparent diffusion coefficient; ADC values) were independently measured by observers. The diagnostic performance of the VI-RADS score and quantitative values were evaluated by using receiver operating characteristic (ROC) analysis. Interobserver agreement was evaluated using the weighted-kappa coefficient (κ). RESULTS For the VI-RADS score, the AUC (area under the curve) was 0.968 and accuracy was 90.4% for Observer 1, and AUC was 0.953, accuracy was 89% for Observer 2. The AUC of TCL, TCL/DMax, and ADC values was 0.918, 0.675, and 0.832. In patients with a VI-RADS score ≥ 3, when a threshold value of TCL > 19.5 mm is used as complementary to the VI-RADS score, the accuracy of MRI for Observer-1 increases 100% and 97.26% for Observer-2. There was a good-excellent agreement between the observers in assessing the VI-RADS scores and quantitative parameters. CONCLUSION Evaluation of bladder MRI using both VI-RADS criteria and TCL is successful and highly reproducible for detecting muscle layer invasion in patients with BCa.
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Affiliation(s)
- Ahmet Akcay
- Department of Radiology, University of Pamukkale, Kinikli, 20100 Denizli, Turkey
| | - Ahmet Baki Yagci
- Department of Radiology, University of Pamukkale, Kinikli, 20100 Denizli, Turkey
| | - Sinan Celen
- Department of Urology, University of Pamukkale, Kinikli, 20100 Denizli, Turkey
| | - Yusuf Ozlulerden
- Department of Urology, University of Pamukkale, Kinikli, 20100 Denizli, Turkey.
| | - Nilay Sen Turk
- Department of Pathology, University of Pamukkale, Kinikli, 20100 Denizli, Turkey
| | - Furkan Ufuk
- Department of Radiology, University of Pamukkale, Kinikli, 20100 Denizli, Turkey.
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33
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Sim KC, Sung DJ. Role of magnetic resonance imaging in tumor staging and follow-up for bladder cancer. Transl Androl Urol 2021; 9:2890-2907. [PMID: 33457263 PMCID: PMC7807353 DOI: 10.21037/tau-19-671] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Urothelial carcinoma of the bladder is a common urologic malignancy. Complex factors, such as local stage, tumor grade, biologic potential, and various conditions, can affect the treatment strategy for bladder cancer. However, the local stage-in particular, the presence or absence of muscle invasion-significantly influences decisions regarding treatment strategy. The role of cystoscopy for screening, diagnosis, and transurethral resection cannot be overlooked. The importance of local staging with magnetic resonance imaging is increasing; magnetic resonance imaging of the bladder is considered a useful staging modality. Moreover, a radiologic reporting system for evaluating and scoring muscle invasion of bladder cancer was recently released. This system is based on multiparametric magnetic resonance imaging and is also expected to be feasible for post-treatment follow-up of bladder cancer. In this review, we discuss the role of magnetic resonance imaging in the local staging of urothelial carcinoma of the urinary bladder and post-treatment imaging. In addition, several technical aspects for obtaining appropriate quality magnetic resonance images of the bladder will be discussed.
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Affiliation(s)
- Ki Choon Sim
- Department of Radiology, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Deuk Jae Sung
- Department of Radiology, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
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Transurethral resection of bladder tumor and the need for re-transurethral resection of bladder tumor: time to change our practice? Curr Opin Urol 2020; 30:370-376. [PMID: 32205809 DOI: 10.1097/mou.0000000000000751] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
PURPOSE OF REVIEW To summarize the current knowledge on the role of repeated transurethral resection of the bladder (re-TURBT) at the light of recently published trials that indicate the possibility to safely avoid it in well selected patients. RECENT FINDINGS Recently published trials tried to predict the histology of re-TURBT with the aim of improving patients' selection for this procedure. The en bloc resection technique seems to improve the quality of the resection, thereby diminishing and even eliminating the risk of upstaging and the residual disease rate after TURBT. Moreover, the introduction of multiparametric MRI (mpMRI) in bladder cancer showed initial promising results and aims, in the next future, to play a role in the selection of patients for re-TURBT. SUMMARY International guidelines agree to recommend re-TURBT in case of incomplete first resection and in T1 tumors. Conversely, the performance of re-TURBT in case of high-grade/high-risk Ta or in case of absence of detrusor muscle in TURBT specimen remains a matter of debate. Re-TURBT aims to reduce the risk of understaging the disease and to remove residual disease in case of persistent nonmuscle invasive bladder cancer. Actually, upstaging at re-TURBT is not a negligible event in T1 tumors (8-15%), while is quite uncommon in case of Ta tumors (0.4%). Residual disease at re-TURBT is usually found in the majority of patients (55-60%) and seems to impact oncological outcomes, even if recent evidence mitigated its relevance as prognostic factor.
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35
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Abstract
The goals of transurethral resection of bladder tumour (TURBT) are to identify and eradicate visualized bladder tumour if technically safe and feasible and to obtain a specimen of satisfactory quality to enable accurate histological diagnosis. In the setting of high grade bladder tumour this generally entails the inclusion of detrusor muscle and assessment for the presence of associated carcinoma in situ (CIS), lymphovascular involvement or any variant form of bladder cancer. This will assist in determining risk stratification and prognostication of the bladder cancer and guides further treatment planning. Conversely, if suboptimal TURBT is performed there will be detrimental consequences on patient outcomes in regards to undergrading or understaging, increased recurrence or progression, and subsequently need for further treatments including more invasive interventions. This review article firstly summarises the key principles and complications of TURBT, as well as significance of re-TURBT. We also discuss a number of modifications and advances in detection technology and resection techniques that have shown to improve perioperative as well as pathological and oncological outcomes of bladder cancer. They include enhanced cystoscopy such as blue light cystoscopy (BLC), narrow band imaging (NBI) and en bloc resection of bladder tumour (ERBT) technique using various types of energy source.
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Affiliation(s)
- Lawrence H C Kim
- Department of Urology, Westmead Hospital, Sydney, Australia.,Discipline of Surgery, Sydney Medical School, University of Sydney, Sydney, Australia
| | - Manish I Patel
- Department of Urology, Westmead Hospital, Sydney, Australia.,Discipline of Surgery, Sydney Medical School, University of Sydney, Sydney, Australia
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36
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Herr H. Improving the Quality of Transurethral Resection of Bladder Tumor: Urologist, Audit Thyself. Eur Urol Oncol 2020; 4:20-21. [PMID: 33172795 DOI: 10.1016/j.euo.2020.10.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 10/15/2020] [Indexed: 11/26/2022]
Affiliation(s)
- Harry Herr
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
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37
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Panebianco V, Pecoraro M, Del Giudice F, Takeuchi M, Muglia VF, Messina E, Cipollari S, Giannarini G, Catalano C, Narumi Y. VI-RADS for Bladder Cancer: Current Applications and Future Developments. J Magn Reson Imaging 2020; 55:23-36. [PMID: 32939939 DOI: 10.1002/jmri.27361] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 08/25/2020] [Accepted: 08/27/2020] [Indexed: 01/07/2023] Open
Abstract
Bladder cancer (BCa) is among the ten most frequent cancers globally. It is the tumor with the highest lifetime treatment-associated costs, and among the tumors with the heaviest impacts on postoperative quality of life. The purpose of this article is to review the current applications and future perspectives of the Vesical Imaging Reporting and Data System (VI-RADS). VI-RADS is a newly developed scoring system aimed at standardization of MRI acquisition, interpretation, and reporting for BCa. An insight will be given on the BCa natural history, current MRI applications for local BCa staging with assessment of muscle invasiveness, and clinical implications of the score for disease management. Future applications include risk stratification of nonmuscle invasive BCa, surveillance, and prediction and monitoring of therapy response. LEVEL OF EVIDENCE: 3 TECHNICAL EFFICACY STAGE: 2.
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Affiliation(s)
- Valeria Panebianco
- Department of Radiological Sciences, Oncology and Pathology, Sapienza/Policlinico Umberto I, Rome, Italy
| | - Martina Pecoraro
- Department of Radiological Sciences, Oncology and Pathology, Sapienza/Policlinico Umberto I, Rome, Italy
| | - Francesco Del Giudice
- Department of Maternal-Infant and Urological Sciences, Sapienza/Policlinico Umberto I, Rome, Italy
| | | | - Valdair F Muglia
- Department of Medical Images, Radiation Therapy and Oncohematology, Ribeirao Preto Medical School, University of Sao Paulo, Ribeirao Preto, Brazil
| | - Emanuele Messina
- Department of Radiological Sciences, Oncology and Pathology, Sapienza/Policlinico Umberto I, Rome, Italy
| | - Stefano Cipollari
- Department of Radiological Sciences, Oncology and Pathology, Sapienza/Policlinico Umberto I, Rome, Italy
| | - Gianluca Giannarini
- Urology Unit, Academic Medical Centre "Santa Maria della Misericordia", Udine, Italy
| | - Carlo Catalano
- Department of Radiological Sciences, Oncology and Pathology, Sapienza/Policlinico Umberto I, Rome, Italy
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38
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Lee SH, Mahendran R, Tham SM, Thamboo TP, Chionh BJ, Lim YX, Tsang WC, Wu QH, Chia JY, Tay MHW, Goh BYS, Chen KW, Mallari JZ, Periaswami R, Raman L, Choo SN, Kioh DYQ, Chiong E, Esuvaranathan K, Chan ECY. Tryptophan-kynurenine ratio as a biomarker of bladder cancer. BJU Int 2020; 127:445-453. [PMID: 32794357 DOI: 10.1111/bju.15205] [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: 12/11/2022]
Abstract
OBJECTIVES To investigate plasma and urinary kynurenine (KYN)-tryptophan (TRP) ratios in bladder cancer, expression of indoleamine 2,3-dioxygenase 1 (IDO1) in relation to tryptophan 2,3-dioxygenase (TDO2) in bladder tumour, and the correlation of KYN-TRP ratio with bladder tumour burden. METHODS Metabotyping of the TRP-KYN metabolic axis was performed via a clinical case-control study. Expression of IDO1 and TDO2 was measured in human biopsied tissues. Correlational experiments between KYN-TRP ratio and bladder tumour were performed using a murine orthotopic prostate-specific antigen (PSA)-secreting MB49 bladder cancer model. RESULTS We established for the first time that plasma TRP level was significantly decreased, while both plasma and urinary KYN-TRP ratios were significantly higher in bladder cancer patients, and expression level of IDO1 but not TDO2 was increased in human bladder tumour. We reported the positive correlation between IDO1 expression, KYN-TRP ratio, normalized PSA to creatinine, and bladder tumour burden in the murine model. CONCLUSION Kynurenine-tryptophan ratio is a promising surveillance biomarker for bladder cancer, but would require further validation before clinical translation.
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Affiliation(s)
- Sze Han Lee
- Department of Pharmacy, National University of Singapore, Singapore City, Singapore
| | - Ratha Mahendran
- Department of Surgery, National University of Singapore, Singapore City, Singapore
| | - Sin Mun Tham
- Department of Surgery, National University of Singapore, Singapore City, Singapore
| | | | - Billy Jianhao Chionh
- Department of Pharmacy, National University of Singapore, Singapore City, Singapore
| | - Yi Xin Lim
- Department of Pharmacy, National University of Singapore, Singapore City, Singapore
| | - Woon Chau Tsang
- Department of Pathology, National University Health System, Singapore City, Singapore
| | - Qing Hui Wu
- Department of Pathology, National University Health System, Singapore City, Singapore
| | - Jun Yang Chia
- Department of Pathology, National University Health System, Singapore City, Singapore
| | - Melissa Hui Wen Tay
- Department of Pathology, National University Health System, Singapore City, Singapore
| | - Benjamin Yen Seow Goh
- Department of Pathology, National University Health System, Singapore City, Singapore
| | - Kelven Weijing Chen
- Department of Pathology, National University Health System, Singapore City, Singapore
| | - Jeane Zepeda Mallari
- Department of Pathology, National University Health System, Singapore City, Singapore
| | - Revathi Periaswami
- Department of Surgery, National University of Singapore, Singapore City, Singapore
| | - Lata Raman
- Department of Surgery, National University of Singapore, Singapore City, Singapore
| | - Shoa Nian Choo
- Department of Urology, National University Health System, Singapore City, Singapore
| | - Dorinda Yan Qin Kioh
- Department of Pharmacy, National University of Singapore, Singapore City, Singapore
| | - Edmund Chiong
- Department of Surgery, National University of Singapore, Singapore City, Singapore.,Department of Pathology, National University Health System, Singapore City, Singapore
| | - Kesavan Esuvaranathan
- Department of Surgery, National University of Singapore, Singapore City, Singapore.,Department of Pathology, National University Health System, Singapore City, Singapore
| | - Eric Chun Yong Chan
- Department of Pharmacy, National University of Singapore, Singapore City, Singapore
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Del Giudice F, Leonardo C, Simone G, Pecoraro M, De Berardinis E, Cipollari S, Flammia S, Bicchetti M, Busetto GM, Chung BI, Gallucci M, Catalano C, Panebianco V. Preoperative detection of Vesical Imaging-Reporting and Data System (VI-RADS) score 5 reliably identifies extravesical extension of urothelial carcinoma of the urinary bladder and predicts significant delayed time to cystectomy: time to reconsider the need for primary deep transurethral resection of bladder tumour in cases of locally advanced disease? BJU Int 2020; 126:610-619. [PMID: 32783347 DOI: 10.1111/bju.15188] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVES (I) To determine Vesical Imaging-Reporting and Data System (VI-RADS) score 5 accuracy in predicting locally advanced bladder cancer (BCa), so as to potentially identify those patients who could avoid the morbidity of deep transurethral resection of bladder tumour (TURBT) in favour of histological sampling-TUR prior to radical cystectomy (RC). (II) To explore the predictive value of VI-RADS score 5 on time-to-cystectomy (TTC) outcomes. PATIENTS AND METHODS We retrospectively reviewed patients' ineligible or refusing cisplatin-based combination neoadjuvant chemotherapy who underwent multiparametric magnetic resonance imaging (mpMRI) of the bladder prior to staging TURBT followed by RC for muscle-invasive BCa. Sensitivity, specificity, positive and negative predictive values (PPV, NPV) were calculated for VI-RADS score 5 vs. score 2-4 cases to assess the accuracy of mpMRI for extravesical BCa detection (≥pT3). VI-RADS score performance was assessed by receiver operating characteristics curve analysis. A Κ statistic was calculated to estimate mpMRI and pathological diagnostic agreement. The risk of delayed TTC (i.e. time from initial BCa diagnosis of >3 months) was assessed using multivariable logistic regression model. RESULTS A total of 149 T2-T4a, cN0-M0 patients (VI-RADS score 5, n = 39 vs VI-RADS score 2-4, n = 110) were examined. VI-RADS score 5 demonstrated sensitivity, specificity, PPV and NPV, in detecting extravesical disease of 90.2% (95% confidence interval [CI] 84-94.3), 98.1% (95% CI 94-99.6), 94.9% (95% CI 89.6-97.6) and 96.4% (95% CI 91.6-98.6), respectively. The area under the curve was 94.2% (95% CI 88.7-99.7) and inter-reader agreement was excellent (Κinter 0.89). The mean (SD) TTC was 4.2 (2.3) and 2.8 (1.1) months for score 5 vs 2-4, respectively (P < 0.001). VI-RADS score 5 was found to independently increase risk of delayed TTC (odds ratio 2.81, 95% CI 1.20-6.62). CONCLUSION The VI-RADS is valid and reliable in differentiating patients with extravesical disease from those with muscle-confined BCa before TURBT. Detection of VI-RADS score 5 was found to predict significant delay in TTC independently from other clinicopathological features. In the future, higher VI-RADS scores could potentially avoid the morbidity of extensive primary resections in favour of sampling-TUR for histology. Further prospective, larger, and multi-institutional trials are required to validate clinical applicability of our findings.
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Affiliation(s)
- Francesco Del Giudice
- Department of, Departments of, Maternal-Infant and Urological Sciences, "Sapienza" University of Rome, Policlinico Umberto, Hospital, Rome, Italy.,Department of Urology, Stanford University, School of Medicine, Stanford, CA, USA
| | - Costantino Leonardo
- Department of, Departments of, Maternal-Infant and Urological Sciences, "Sapienza" University of Rome, Policlinico Umberto, Hospital, Rome, Italy
| | - Giuseppe Simone
- Department of Urology, "Regina Elena" National Cancer Institute, IRCCS, Rome, Italy
| | - Martina Pecoraro
- Department of Radiological Sciences, Oncology & Pathology, "Sapienza" University of Rome, Policlinico Umberto, Hospital, Rome, Italy
| | - Ettore De Berardinis
- Department of, Departments of, Maternal-Infant and Urological Sciences, "Sapienza" University of Rome, Policlinico Umberto, Hospital, Rome, Italy
| | - Stefano Cipollari
- Department of Radiological Sciences, Oncology & Pathology, "Sapienza" University of Rome, Policlinico Umberto, Hospital, Rome, Italy
| | - Simone Flammia
- Department of, Departments of, Maternal-Infant and Urological Sciences, "Sapienza" University of Rome, Policlinico Umberto, Hospital, Rome, Italy
| | - Marco Bicchetti
- Department of Radiological Sciences, Oncology & Pathology, "Sapienza" University of Rome, Policlinico Umberto, Hospital, Rome, Italy
| | - Gian Maria Busetto
- Department of, Departments of, Maternal-Infant and Urological Sciences, "Sapienza" University of Rome, Policlinico Umberto, Hospital, Rome, Italy
| | - Benjamin I Chung
- Department of Urology, Stanford University, School of Medicine, Stanford, CA, USA
| | - Michele Gallucci
- Department of, Departments of, Maternal-Infant and Urological Sciences, "Sapienza" University of Rome, Policlinico Umberto, Hospital, Rome, Italy
| | - Carlo Catalano
- Department of Radiological Sciences, Oncology & Pathology, "Sapienza" University of Rome, Policlinico Umberto, Hospital, Rome, Italy
| | - Valeria Panebianco
- Department of Radiological Sciences, Oncology & Pathology, "Sapienza" University of Rome, Policlinico Umberto, Hospital, Rome, Italy
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40
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Mariappan P, Johnston A, Padovani L, Clark E, Trail M, Hamid S, Hollins G, Simpson H, Thomas BG, Hasan R, Bhatt J, Ahmad I, Nandwani GM, Mitchell IDC, Hendry D. Enhanced Quality and Effectiveness of Transurethral Resection of Bladder Tumour in Non-muscle-invasive Bladder Cancer: A Multicentre Real-world Experience from Scotland's Quality Performance Indicators Programme. Eur Urol 2020; 78:520-530. [PMID: 32690321 DOI: 10.1016/j.eururo.2020.06.051] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 06/22/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Clinical outcomes from non-muscle-invasive bladder cancer (NMIBC) are partly determined by the quality of initial interventions. To improve and standardise treatment for cancer, Scotland implemented a national Quality Performance Indicator (QPI) programme for bladder cancer (BC). OBJECTIVE To evaluate compliance with specific quality indicators (QIs) related to transurethral resection of bladder tumour (TURBT) and to understand clinical outcomes from NMIBC following the introduction of the QPI programme. DESIGN, SETTING, AND PARTICIPANTS Within a robust governance framework, 12 mandatory evidence-based QPIs were implemented nationally in April 2014. We report prospectively collected data for all new BC patients (between April 2014 and March 2017). We include follow-up data for 2689 patients. INTERVENTION The TURBT-related QPIs were (1) using a bladder diagram, (2) single post-TURBT instillation of mitomycin C (SPI-MMC), (3) detrusor muscle (DM) in the specimen, and (4) early re-TURBT in high-risk NMIBC. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS We measured compliance with these QPIs and (1) recurrence rate at first follow-up cystoscopy (RRFFC), (2) rates of residual cancer, and (3) pT2 cancer at re-TURBT. Associations between QPI compliance, tumour features, and outcomes were assessed with multivariable logistic regression models. RESULTS AND LIMITATIONS Among 4246 new BC patients, SPI-MMC was used in 67% (2029/3023) NMIBC patients. In 1860 NMIBC patients undergoing TURBT, RRFFC, rate of residual cancer, and rate of pT2 at re-TURBT were 13% (116/888), 33% (212/653), and 2.9% (19/653), respectively. SPI-MMC was associated with lower RRFFC, independent of all variables including hospital volume and surgeon. Presence of DM in the specimen halved the likelihood of residual disease in pT1 cancers. The main limitation is the lack of a pre-QPI introduction cohort for comparison. CONCLUSIONS The implementation of a QI programme in Scotland appears to facilitate high-quality TURBT, which in a real-world setting is associated with low early recurrence/residual cancer and accurate pathological staging. PATIENT SUMMARY Following the first 3 yr of implementing a novel Quality Performance Indicator (QPI) programme in Scotland, we assessed compliance and outcomes in non-muscle-invasive bladder cancer. Evaluating over 4000 new bladder cancer patients, we found that the QPI programme was associated with low recurrence and accurate staging following the initial transurethral resection of bladder tumour.
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Affiliation(s)
- Paramananthan Mariappan
- Edinburgh Bladder Cancer Surgery, Department of Urology, Western General Hospital, Edinburgh, UK; University of Edinburgh, Edinburgh, UK.
| | - Allan Johnston
- Department of Urology, Queen Elizabeth University Hospital, Glasgow, UK
| | - Luisa Padovani
- Edinburgh Bladder Cancer Surgery, Department of Urology, Western General Hospital, Edinburgh, UK
| | | | - Matthew Trail
- Department of Urology, Ninewells Hospital, Dundee, UK
| | - Sami Hamid
- Department of Urology, Ninewells Hospital, Dundee, UK
| | | | - Helen Simpson
- Department of Urology, Victoria Hospital, Kirkcaldy, UK
| | - Benjamin G Thomas
- Edinburgh Bladder Cancer Surgery, Department of Urology, Western General Hospital, Edinburgh, UK; Department of Urology, Borders General Hospital, Melrose, UK
| | - Rami Hasan
- Department of Urology, University Hospital Ayr, Ayr, UK
| | - Jaimin Bhatt
- Department of Urology, Queen Elizabeth University Hospital, Glasgow, UK
| | - Imran Ahmad
- Department of Urology, Queen Elizabeth University Hospital, Glasgow, UK
| | | | | | - David Hendry
- Department of Urology, Queen Elizabeth University Hospital, Glasgow, UK
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Hwang MJ, Kamat AM, Dinney CP, Czerniak B, Guo CC. Bladder Cancer Involving Smooth Muscle of Indeterminate Type or Muscularis Mucosae in Transurethral Biopsy Specimens. Am J Clin Pathol 2020; 154:208-214. [PMID: 32253420 DOI: 10.1093/ajcp/aqaa030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES Bladder cancers invading the muscularis mucosae (MM) are treated differently from those invading the muscularis propria (MP). However, it may be difficult to determine the type of smooth muscle in transurethral resection (TUR) or biopsy specimens. We aimed to investigate the clinicopathologic features of bladder cancers involving smooth muscle of indeterminate type (SMIT) in TUR specimens in comparison with those invading the MM. METHODS We identified 103 patients with bladder cancer involving SMIT (n = 27) or the MM (n = 76) in TUR specimens. All patients underwent subsequent restaging TUR or cystectomy. RESULTS Bladder cancer with SMIT invasion showed a significantly higher rate of MP invasion in the subsequent specimens than those invading the MM (52% vs 29%). Lack of MP in the TUR specimens had a significantly higher risk of MP invasion in the subsequent specimens than those with the MP (61% vs 40%). The overall survival time for patients with SMIT invasion was significantly shorter than those with MM invasion. CONCLUSIONS Bladder cancers with SMIT invasion in TUR specimens show more frequent cancer upstaging in the subsequent specimens and a poorer clinical outcome than those invading the MM, which highlights the importance of a cancer restaging procedure for these patients.
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Affiliation(s)
- Michael J Hwang
- Departments of Pathology, The University of Texas MD Anderson Cancer Center, Houston
| | - Ashish M Kamat
- Departments of Urology, The University of Texas MD Anderson Cancer Center, Houston
| | - Colin P Dinney
- Departments of Urology, The University of Texas MD Anderson Cancer Center, Houston
| | - Bogdan Czerniak
- Departments of Pathology, The University of Texas MD Anderson Cancer Center, Houston
| | - Charles C Guo
- Departments of Pathology, The University of Texas MD Anderson Cancer Center, Houston
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Abstract
OBJECTIVE. The purpose of this article is to review the natural history and management of bladder cancer, with insight into MRI applications for the assessment of muscle invasiveness of bladder cancer using the newly developed Vesical Imaging Reporting and Data System (VI-RADS) score. CONCLUSION. Multiparametric MRI and the VI-RADS score have been consistently validated across several different institutions as appropriate tools for local staging of bladder cancer and have been proven to contribute to the diagnostic workup and management of urinary bladder cancer.
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Maheshwari PN, Arora AM, Sane MS, Jadhao VG. Safety, feasibility, and quality of holmium laser en-bloc resection of nonmuscle invasive bladder tumors - A single-center experience. Indian J Urol 2020; 36:106-111. [PMID: 32549661 PMCID: PMC7279102 DOI: 10.4103/iju.iju_348_19] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2019] [Revised: 03/18/2020] [Accepted: 03/18/2020] [Indexed: 12/18/2022] Open
Abstract
Introduction: Conventional transurethral resection of bladder tumor (cTURBT), despite its piecemeal resection and associated limitations, remains the most widely practiced technique of TURBT. Resecting the tumor in a single piece would avoid most of the drawbacks of cTURBT. Our objective was to assess the feasibility, safety, and quality of Holmium (Ho) laser en-bloc resection (ERBT) for nonmuscle-invasive bladder cancer (NMIBC). Materials and Methods: We retrospectively studied 67 patients who underwent Ho laser EBRT for primary NMIBC. Data were collected regarding tumor size, number and location, intraoperative complications, and postoperative course. Patients were grouped as first 20, next 20 (21–40), and last 27 cases to assess how the quality of resection improved with increasing experience. Results: The mean tumor size was 28.7 ± 7.9 mm, with 34.3% of the patients having a tumor larger than 3 cm. While 43 patients (64.17%) had a single tumor, the rest had multiple tumors, ranging from 2 to 9 in number. The mean total duration of resection was 38.7 ± 11.6 min. No case required conversion to cTURBT. No patient experienced obturator reflex or bladder perforation. Detrusor muscle was present in 85.07% of the resections. With increasing experience, requirement for bladder irrigation and the incidence of postoperative clot evacuation decreased (P < 0.0001 and P = 0.31, respectively), and the detrusor-positive rate in the specimen increased (P = 0.24). The mean duration of catheterization was 1.76 ± 0.54 days. Conclusion: Ho laser ERBT is safe and feasible for complete resection of NMIBCs with no risk of obturator-nerve reflex and a high rate of detrusor-positive specimens.
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Affiliation(s)
| | | | - Mahesh S Sane
- Department of Urology, Fortis Hospital Mulund, Mumbai, Maharashtra, India
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Chang DTS, Picardo A. Repeat transurethral resection is still an essential tool in treating non-muscle invasive bladder cancer: the Western Australian experience. Bladder (San Franc) 2020; 7:e42. [PMID: 32775484 PMCID: PMC7401982 DOI: 10.14440/bladder.2020.814] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 03/18/2020] [Accepted: 03/24/2020] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES To determine the rate of residual disease and under-staging after primary transurethral resection (TUR) of bladder tumors (TURBT) in tertiary hospitals in Western Australia. METHODS A retrospective study was performed evaluating all patients with TaHG (stage Ta, high-grade), T1LG (stage T1, low-grade) or T1HG (stage T1, high-grade) bladder cancer on primary TURBT conducted between January 1, 2012 and December 31, 2017 at the four largest metropolitan public hospitals in Western Australia. Only patients who underwent repeat resection within 3 months from initial resection were included. Those with previous history of bladder cancer, incomplete follow-up data and visibly incomplete initial resection were excluded. Baseline patient demographics, macroscopic clearance at initial resection, and disease data at initial and repeat resections were recorded. RESULTS Sixty-seven patients with a median age of 71 years were included in this study. At initial resection, T1HG was the most common disease stage (64.2%) and detrusor muscle was present in 82.1% of initial resections. At repeat resection, 41.8% of cases had residual disease. The rate of upstaging to muscle-invasive bladder cancer was 3.0%. Patients treated by operators with five or less years of formal training did not have a significantly different rate of residual disease from patients treated by operators with more than five years of experience. CONCLUSIONS Repeat TUR should remain an essential practice due to high rates of residual disease and a small risk of tumor under-staging. The presence of detrusor muscle and macroscopic clearance should not be used as surrogates for adequacy of resection or consideration of avoiding a repeat TUR, even for TaHG disease.
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Del Giudice F, Barchetti G, De Berardinis E, Pecoraro M, Salvo V, Simone G, Sciarra A, Leonardo C, Gallucci M, Catalano C, Catto JW, Panebianco V. Prospective Assessment of Vesical Imaging Reporting and Data System (VI-RADS) and Its Clinical Impact on the Management of High-risk Non–muscle-invasive Bladder Cancer Patients Candidate for Repeated Transurethral Resection. Eur Urol 2020; 77:101-109. [DOI: 10.1016/j.eururo.2019.09.029] [Citation(s) in RCA: 84] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Accepted: 09/24/2019] [Indexed: 10/25/2022]
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Suh J, Jung JH, Jeong CW, Kwak C, Kim HH, Ku JH. Clinical Significance of Pre-treated Neutrophil-Lymphocyte Ratio in the Management of Urothelial Carcinoma: A Systemic Review and Meta-Analysis. Front Oncol 2019; 9:1365. [PMID: 31921631 PMCID: PMC6927426 DOI: 10.3389/fonc.2019.01365] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Accepted: 11/19/2019] [Indexed: 12/13/2022] Open
Abstract
Purpose: We performed a study-level meta-analysis to summarize the current evidence on the correlation between pretreatment neutrophil-to-lymphocyte ratios (NLR) and oncological outcomes in each type of management for urothelial carcinoma. Method: All articles published until February 2017 in PubMed, Scopus, and EMBASE database were collected and reviewed. The current evidence on correlations between pretreatment NLR and oncological outcomes in each type of management for urothelial carcinoma, including transurethral resection of bladder tumor (TURBT), radical cystectomy (RCx), chemotherapy (CTx), and nephroureterectomy (NUx), were summarized. Results: Thirty-eight studies containing clinical information on 16,379 patients were analyzed in this study. Pooled hazard ratios (HR) and odds ratios (OR) with 95% confidence intervals were calculated after weighing each study. Heterogeneity among the studies and publication bias were assessed. Pretreatment NLR was significantly associated with muscle invasiveness (OR: 4.27), recurrence free survival (RFS, HR: 2.32), and progression-free survival (PFS, HR: 2.45) in TURBT patients. In the RCx patients, high NLR was negatively associated with both disease status (extravesical extension and lymph-node positivity, OR: 1.14 and 1.43, respectively) and oncological outcomes [overall survival (OS), PFS], and cancer specific survival (CSS, HR: 1.18, 1.12, and 1.35, respectively). Pretreatment NLR was negatively correlated with pathologic downstaging (OR: 0.79) and positively correlated with PFS (HR: 1.30) and OS (HR: 1.44) in CTx patients. For patients who underwent NUx, pretreatment NLR was significantly associated with OS (HR: 1.72), PFS (HR: 1.63), and CSS (HR: 1.68). Conclusions: Pretreatment NLR is a useful biomarker for disease aggressiveness, oncological outcome, and treatment response in the management of patients with urothelial carcinoma. More evidence is needed to clarify these results.
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Affiliation(s)
- Jungyo Suh
- Department of Urology, Seoul National University College of Medicine, Seoul, South Korea
- Department of Urology, Seoul Metropolitan Government- Seoul National University Boramae Medical Center, Seoul, South Korea
| | - Jae Hyun Jung
- Department of Urology, Seoul National University College of Medicine, Seoul, South Korea
| | - Chang Wook Jeong
- Department of Urology, Seoul National University College of Medicine, Seoul, South Korea
| | - Cheol Kwak
- Department of Urology, Seoul National University College of Medicine, Seoul, South Korea
| | - Hyeon Hoe Kim
- Department of Urology, Seoul National University College of Medicine, Seoul, South Korea
| | - Ja Hyeon Ku
- Department of Urology, Seoul National University College of Medicine, Seoul, South Korea
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Akand M, Muilwijk T, Cornelissen J, Van Bruwaene S, Vander Eeckt K, Baekelandt F, Mattelaer P, Van Reusel R, Van Cleynenbreugel B, Joniau S, Van Der Aa F. Development of a Prospective Data Registry System for Non-muscle-Invasive Bladder Cancer Patients Incorporated in the Electronic Patient File System. Front Oncol 2019; 9:1402. [PMID: 31921659 PMCID: PMC6917611 DOI: 10.3389/fonc.2019.01402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Accepted: 11/27/2019] [Indexed: 11/26/2022] Open
Abstract
Purpose: To develop a prospective non-muscle-invasive bladder cancer (NMIBC) data registry by generating NMIBC-specific electronic case report forms (eCRFs) in our institution's electronic patient file system, and to report on the development and implementation of a prospective multicentric registry. Methods: Templates for data collection, including clinical outcome parameters and quality indicators, were developed in InfoPath™ as an eCRF and were incorporated in our hospital's electronic patient file system. Quality parameters for managing NMIBC patients that were identified by comprehensive literature review were included in the eCRFs. Three separate eCRFs were developed for the management of NMIBC patients: surgery report, bladder instillation form, and multidisciplinary team form. Results: In August 2013, we started a Flemish prospective clinical and pathological data registry for all patients undergoing transurethral resection of bladder tumor (TURBT) for NMIBC in four participating hospitals, three of which continued using this to date. Three more hospitals started enrolling in 2017, 2018, and 2019, respectively. Written reports of the registered clinical actions are automatically generated within the electronic medical file. When urologists complete these eCRFs, an automated ready-to-send letter to the general practitioner is generated. Up till May 2019, 2,756 TURBTs in 2,419 patients are included in the dataset. Currently, we are recruiting over 600 TURBTs every year. Conclusions: Easy-to-use eCRFs were developed and included in the electronic patient file system. This registration tool was implemented in 7 hospitals, 6 of which are still using it today. The register harvests important clinical data, while performing routine clinical practice. The data will be used to analyze real-life data of NMIBC patients, to challenge the existing guidelines, to create novel risk stratification tools, and to develop, monitor and validate quality parameters for NMIBC management.
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Affiliation(s)
- Murat Akand
- Department of Urology, University Hospitals Leuven, Leuven, Belgium
- Department of Urology, School of Medicine, Selçuk University, Konya, Turkey
| | - Tim Muilwijk
- Department of Urology, University Hospitals Leuven, Leuven, Belgium
| | - Jan Cornelissen
- Department of Urology, University Hospitals Leuven, Leuven, Belgium
| | | | | | | | | | | | | | - Steven Joniau
- Department of Urology, University Hospitals Leuven, Leuven, Belgium
| | - Frank Van Der Aa
- Department of Urology, University Hospitals Leuven, Leuven, Belgium
- *Correspondence: Frank Van Der Aa
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Abstract
Stage T1 bladder cancers invade the lamina propria of the bladder and, despite sharing many of the genetic features of muscle-invasive bladder cancers, are classified as non-muscle-invasive or 'superficial' tumours. Yet, patients with T1 bladder cancer have an overall mortality of 33% and a cancer-specific mortality of 14% at three years after diagnosis, suggesting that these patients have a high risk of progression and, accordingly, require meticulous surgery, endoscopic surveillance and clinical decision-making. We hypothesize that the variability in the outcomes of patients with T1 bladder cancer is a result of both tumour heterogeneity and pathological staging, as well as inconsistencies in risk stratification, endoscopic resection and schedules of delivery of BCG. Owing to limitations in clinical staging, patients with T1 bladder cancer are at risk of both undertreatment with persistent use of BCG despite recurrence, and overtreatment with early cystectomy. Understanding the molecular features of T1 bladder cancers and how they respond to BCG therapy could improve biomarkers for risk stratification to align therapy with biological risk.
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Sarli N, Del Giudice G, De S, Dietrich MS, Herrell SD, Simaan N. Preliminary Porcine In Vivo Evaluation of a Telerobotic System for Transurethral Bladder Tumor Resection and Surveillance. J Endourol 2019; 32:516-522. [PMID: 29587537 DOI: 10.1089/end.2018.0119] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION Transurethral resection of bladder tumors (TURBTs) can be a challenging procedure, primarily due to limitations in tooltip dexterity, visualization, and lack of tissue depth information. A transurethral robotic system was developed to revolutionize TURBTs by addressing some of these limitations. The results of three pilot in vivo porcine studies using the novel robotic system are presented and potential improvements are proposed based on experimental observations. MATERIALS AND METHODS A transvesical endoscope with a mounted optically tracked camera was placed through the bladder of the swine under general anesthesia. Simulated bladder lesions were created by injecting HistoGel processing gel mixed with blue dye, transabdominally, into various locations in the bladder wall under endoscopic visualization. A 7-degree-of-freedom (DoF) robot was then used for transurethral resection/ablation of these simulated tumors. An independent 2-DoF distal laser arm (DLA) was deployed through the robot for laser ablation and was assisted by a manually controlled gripper for en bloc resection attempts. RESULTS Lesions were created and ablated using our novel endoscopic robot in the swine bladder. Full accessibility of the bladder, including the bladder neck and dome, was demonstrated without requiring bladder deflation or pubic compression. Simulated lesions were ablated using the holmium laser. En bloc resection was demonstrated using the DLA and a manual grasper. CONCLUSION Feasibility of robot-assisted en bloc resection was demonstrated. Main challenges were lack of depth perception and visual occlusion induced by the transvesical endoscope. Recommendations are given to enhance robot-assisted TURBTs. Lessons learned through these pilot swine studies verify the feasibility of robot-assisted TURBTs while informing designers about critical aspects needed for future clinical deployment.
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Affiliation(s)
- Nima Sarli
- 1 Department of Mechanical Engineering, Vanderbilt University , Nashville, Tennessee.,2 Vanderbilt Institute for Surgery and Engineering (VISE) , Vanderbilt University, Nashville, Tennessee
| | - Giuseppe Del Giudice
- 1 Department of Mechanical Engineering, Vanderbilt University , Nashville, Tennessee.,2 Vanderbilt Institute for Surgery and Engineering (VISE) , Vanderbilt University, Nashville, Tennessee
| | - Smita De
- 2 Vanderbilt Institute for Surgery and Engineering (VISE) , Vanderbilt University, Nashville, Tennessee.,3 Department of Urologic Surgery, Vanderbilt University Medical Center , Nashville, Tennessee
| | - Mary S Dietrich
- 4 School of Nursing, Vanderbilt University , Nashville, Tennessee.,5 Department of Biostatistics, School of Medicine, Vanderbilt University , Nashville, Tennessee
| | - Stanley Duke Herrell
- 2 Vanderbilt Institute for Surgery and Engineering (VISE) , Vanderbilt University, Nashville, Tennessee.,3 Department of Urologic Surgery, Vanderbilt University Medical Center , Nashville, Tennessee
| | - Nabil Simaan
- 1 Department of Mechanical Engineering, Vanderbilt University , Nashville, Tennessee.,2 Vanderbilt Institute for Surgery and Engineering (VISE) , Vanderbilt University, Nashville, Tennessee
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Czech AK, Gronostaj K, Frydrych J, Fronczek J, Przydacz M, Wiatr T, Curyło Ł, Dudek P, Gąsowski J, Chłosta PL. Identification of potential prognostic factors for absence of residual disease in the second resection of T1 bladder cancer. Cent European J Urol 2019; 72:252-257. [PMID: 31720026 PMCID: PMC6830483 DOI: 10.5173/ceju.2019.1908] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Revised: 08/22/2019] [Accepted: 09/02/2019] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION The aim of this single centre retrospective study was to analyse the results of second resection (repeat transurethral resection of bladder tumour - reTURBT) after a macroscopically complete resection of T1 urothelial bladder tumour and to identify prognostic factors for absence of residual disease (T0) in the second resection of T1 bladder cancer. MATERIAL AND METHODS Patients with T1 bladder cancer diagnosed in a macroscopically complete initial resection who underwent second resection within 12 weeks were included into the retrospective analysis. Based on the presence or absence of residual disease, patients were grouped for further analysis. Univariate and multivariable logistic regressions were performed to identify potential prognostic factors. RESULTS Among the 139 patients who met the inclusion criteria, 96 (69.1%) had no residual disease (T0) and 43 (30.9%) had residual disease in the second resection (including muscle invasive bladder cancer in 2.2%). Adjusted odds ratios (OR) of T0 status obtained from the final model were as follows: detrusor muscle presence in the first resection (OR 3.05; 95% CI 1.12-8.35, p = 0.03), immediate post-operative intravesical mitomycin C administration after the first TURBT (OR 2.52, 95% CI 1.12-5.68; p = 0.03) and primary bladder cancer setting (OR 2.45, 95% CI 1.10-5.47; p = 0.03). CONCLUSIONS Our results add evidence regarding the importance of detrusor muscle presence in the first TURBT. Identification of predictors of T0 status at second resection could help design prospective studies assessing the possibility to avoid re-resection in selected patients with T1 bladder cancer without compromising oncological outcomes.
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Affiliation(s)
| | - Katarzyna Gronostaj
- Department of Urology, Jagiellonian University Medical College, Cracow, Poland
| | - Jakub Frydrych
- Department of Urology, Jagiellonian University Medical College, Cracow, Poland
| | - Jakub Fronczek
- Department of Intensive Care and Perioperative Medicine, Jagiellonian University Medical College, Cracow, Poland
| | - Mikołaj Przydacz
- Department of Urology, Jagiellonian University Medical College, Cracow, Poland
| | - Tomasz Wiatr
- Department of Urology, Jagiellonian University Medical College, Cracow, Poland
| | - Łukasz Curyło
- Department of Urology, Jagiellonian University Medical College, Cracow, Poland
| | - Przemysław Dudek
- Department of Urology, Jagiellonian University Medical College, Cracow, Poland
| | - Jerzy Gąsowski
- Department of Internal Medicine and Gerontology, Jagiellonian University Medical College, Cracow, Poland
| | - Piotr L. Chłosta
- Department of Urology, Jagiellonian University Medical College, Cracow, Poland
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