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Barone B, Napolitano L, Reccia P, Calace FP, De Luca L, Olivetta M, Stizzo M, Rubinacci A, Della Rosa G, Lecce A, Romano L, Sciorio C, Spirito L, Mattiello G, Vastarella MG, Papi S, Calogero A, Varlese F, Tataru OS, Ferro M, Del Biondo D, Napodano G, Vastarella V, Lucarelli G, Balsamo R, Fusco F, Crocetto F, Amicuzi U. Advances in Urinary Diversion: From Cutaneous Ureterostomy to Orthotopic Neobladder Reconstruction-A Comprehensive Review. J Pers Med 2024; 14:392. [PMID: 38673019 PMCID: PMC11051023 DOI: 10.3390/jpm14040392] [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: 03/15/2024] [Revised: 04/01/2024] [Accepted: 04/06/2024] [Indexed: 04/28/2024] Open
Abstract
Bladder cancer ranks as the 10th most prevalent cancer globally with an increasing incidence. Radical cystectomy combined with urinary diversion represents the standard treatment for muscle-invasive bladder cancer, offering a range of techniques tailored to patient factors. Overall, urinary diversions are divided into non-continent and continent. Among the first category, cutaneous ureterostomy and ileal conduit represent the most common procedures while in the second category, it could be possible to describe another subclassification which includes ureterosigmoidostomy, continent diversions requiring catheterization and orthotopic voiding pouches and neobladders. In this comprehensive review, urinary diversions are described in their technical aspects, providing a summary of almost all alternatives to urinary diversion post-radical cystectomy.
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Affiliation(s)
- Biagio Barone
- Division of Urology, Department of Surgical Sciences, AORN Sant’Anna e San Sebastiano, 81100 Caserta, Italy; (F.F.); (U.A.)
| | - Luigi Napolitano
- Department of Neurosciences and Reproductive Sciences and Odontostomatology, University of Naples Federico II, 80131 Naples, Italy; (L.N.); (A.R.); (G.D.R.); (A.L.); (L.R.); (G.M.); (S.P.); (F.C.)
| | - Pasquale Reccia
- Urology Unit, AORN Ospedali dei Colli, Monaldi Hospital, 80131 Naples, Italy; (P.R.); (F.P.C.); (R.B.)
| | - Francesco Paolo Calace
- Urology Unit, AORN Ospedali dei Colli, Monaldi Hospital, 80131 Naples, Italy; (P.R.); (F.P.C.); (R.B.)
| | - Luigi De Luca
- Division of Urology, Department of Surgical Multispecialty, AORN Antonio Cardarelli, 80131 Naples, Italy;
| | - Michelangelo Olivetta
- Urology Unit, Gaetano Fucito Hospital, AOU San Giovanni di Dio e Ruggi d’Aragona, 84085 Mercato San Severino, Italy;
| | - Marco Stizzo
- Urology Unit, Department of Woman, Child and General and Specialized Surgery, University of Campania Luigi Vanvitelli, 80131 Naples, Italy; (M.S.); (L.S.)
| | - Andrea Rubinacci
- Department of Neurosciences and Reproductive Sciences and Odontostomatology, University of Naples Federico II, 80131 Naples, Italy; (L.N.); (A.R.); (G.D.R.); (A.L.); (L.R.); (G.M.); (S.P.); (F.C.)
| | - Giampiero Della Rosa
- Department of Neurosciences and Reproductive Sciences and Odontostomatology, University of Naples Federico II, 80131 Naples, Italy; (L.N.); (A.R.); (G.D.R.); (A.L.); (L.R.); (G.M.); (S.P.); (F.C.)
| | - Arturo Lecce
- Department of Neurosciences and Reproductive Sciences and Odontostomatology, University of Naples Federico II, 80131 Naples, Italy; (L.N.); (A.R.); (G.D.R.); (A.L.); (L.R.); (G.M.); (S.P.); (F.C.)
| | - Lorenzo Romano
- Department of Neurosciences and Reproductive Sciences and Odontostomatology, University of Naples Federico II, 80131 Naples, Italy; (L.N.); (A.R.); (G.D.R.); (A.L.); (L.R.); (G.M.); (S.P.); (F.C.)
| | | | - Lorenzo Spirito
- Urology Unit, Department of Woman, Child and General and Specialized Surgery, University of Campania Luigi Vanvitelli, 80131 Naples, Italy; (M.S.); (L.S.)
| | - Gennaro Mattiello
- Department of Neurosciences and Reproductive Sciences and Odontostomatology, University of Naples Federico II, 80131 Naples, Italy; (L.N.); (A.R.); (G.D.R.); (A.L.); (L.R.); (G.M.); (S.P.); (F.C.)
| | - Maria Giovanna Vastarella
- Gynaecology Unit, Department of Woman, Child and General and Specialized Surgery, University of Campania Luigi Vanvitelli, 80131 Naples, Italy;
| | - Salvatore Papi
- Department of Neurosciences and Reproductive Sciences and Odontostomatology, University of Naples Federico II, 80131 Naples, Italy; (L.N.); (A.R.); (G.D.R.); (A.L.); (L.R.); (G.M.); (S.P.); (F.C.)
| | - Armando Calogero
- Department of Advanced Biomedical Sciences, Section of General Surgery, University of Naples Federico II, 80131 Naples, Italy; (A.C.); (F.V.)
| | - Filippo Varlese
- Department of Advanced Biomedical Sciences, Section of General Surgery, University of Naples Federico II, 80131 Naples, Italy; (A.C.); (F.V.)
| | - Octavian Sabin Tataru
- Department of Simulation Applied in Medicine, The Institution Organizing University Doctoral Studies (I.O.S.U.D.), George Emil Palade University of Medicine, Pharmacy, Sciences, and Technology from Târgu Mureș, 540142 Târgu Mureș, Romania;
| | - Matteo Ferro
- Department of Urology, European Institute of Oncology (IEO) IRCCS, 20141 Milan, Italy;
| | - Dario Del Biondo
- Department of Urology, Ospedale del Mare, ASL NA1 Centro, 80147 Naples, Italy; (D.D.B.); (G.N.)
| | - Giorgio Napodano
- Department of Urology, Ospedale del Mare, ASL NA1 Centro, 80147 Naples, Italy; (D.D.B.); (G.N.)
| | - Vincenzo Vastarella
- Department of Translational Medical Sciences, University of Campania Luigi Vanvitelli, 80131 Naples, Italy;
- Division of Cardiology, Cardiovascular Department, AORN Sant’Anna e San Sebastiano, 81100 Caserta, Italy
| | - Giuseppe Lucarelli
- Urology, Andrology and Kidney Transplantation Unit, Department of Emergency and Organ Transplantation, University of Bari, 70124 Bari, Italy;
| | - Raffaele Balsamo
- Urology Unit, AORN Ospedali dei Colli, Monaldi Hospital, 80131 Naples, Italy; (P.R.); (F.P.C.); (R.B.)
| | - Ferdinando Fusco
- Division of Urology, Department of Surgical Sciences, AORN Sant’Anna e San Sebastiano, 81100 Caserta, Italy; (F.F.); (U.A.)
- Urology Unit, Department of Woman, Child and General and Specialized Surgery, University of Campania Luigi Vanvitelli, 80131 Naples, Italy; (M.S.); (L.S.)
| | - Felice Crocetto
- Department of Neurosciences and Reproductive Sciences and Odontostomatology, University of Naples Federico II, 80131 Naples, Italy; (L.N.); (A.R.); (G.D.R.); (A.L.); (L.R.); (G.M.); (S.P.); (F.C.)
| | - Ugo Amicuzi
- Division of Urology, Department of Surgical Sciences, AORN Sant’Anna e San Sebastiano, 81100 Caserta, Italy; (F.F.); (U.A.)
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2
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Domínguez García A, Muñoz Rodríguez J, Prats López J, Almirall Daly J, Centeno Álvarez C, de Verdonces Roman L, Pla Terradellas C, Serra Aracil X. Metabolic acidosis after ileal urinary diversion and radical cystectomy. Do we know as much as we think we do? A systematic review. Actas Urol Esp 2023; 47:195-210. [PMID: 36427800 DOI: 10.1016/j.acuroe.2022.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Revised: 10/10/2022] [Accepted: 10/11/2022] [Indexed: 05/05/2023]
Abstract
Urine contact with the mucosa of the urinary diversion (UD) after radical cystectomy (RC) produces different ion exchanges that favor the development of metabolic acidosis (MA). This phenomenon is a frequent cause of hospital readmission and short/long-term complications. We performed a systematic review of MA in RCs with ileal UD, analyzing its prevalence, diagnosis, risk factors and treatment. We systematically searched Pubmed® and Cochrane Library for original articles published before May 2022 according to PRISMA guidelines. A total of 421 articles were identified. We selected 25 studies that met the inclusion criteria involving 5811 patients. Obtaining precise data on the prevalence of MA is difficult, largely due to the heterogeneity of the diagnostic criteria used given the diversity of studies analyzed. Development of MA is multifactorial. In the early period, MA is more prevalent in patients with UD with longer ileal segments, better urinary continence, and impaired renal function. Age and diabetes are risk factors associated with MA in later periods. MA is the most common cause of second or more hospital readmissions. Prophylaxis with oral bicarbonate for three months in patients at risk could improve these results. Although MA after ileal UD is a well-known condition, this review highlights the need to implement homogeneous criteria for the diagnosis, follow-up, and treatment, in addition to protocolizing prevention/prophylaxis strategies in patients at risk.
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Affiliation(s)
- A Domínguez García
- Servicio de Urología, Hospital Universitari Parc Taulí, Universitat Autònoma de Barcelona (UAB), Sabadell, Barcelona, Spain.
| | - J Muñoz Rodríguez
- Servicio de Urología, Hospital Universitari Parc Taulí, Universitat Autònoma de Barcelona (UAB), Sabadell, Barcelona, Spain
| | - J Prats López
- Servicio de Urología, Hospital Universitari Parc Taulí, Universitat Autònoma de Barcelona (UAB), Sabadell, Barcelona, Spain
| | - J Almirall Daly
- Servicio de Nefrología, Hospital Universitari Parc Taulí, Universitat Autònoma de Barcelona (UAB), Sabadell, Barcelona, Spain
| | - C Centeno Álvarez
- Servicio de Urología, Hospital Universitari Parc Taulí, Universitat Autònoma de Barcelona (UAB), Sabadell, Barcelona, Spain
| | - L de Verdonces Roman
- Servicio de Urología, Hospital Universitari Parc Taulí, Universitat Autònoma de Barcelona (UAB), Sabadell, Barcelona, Spain
| | - C Pla Terradellas
- Servicio de Urología, Hospital Universitari Parc Taulí, Universitat Autònoma de Barcelona (UAB), Sabadell, Barcelona, Spain
| | - X Serra Aracil
- Servicio de Cirugía General y Digestiva, Hospital Universitari Parc Taulí, Universitat Autònoma de Barcelona (UAB), Sabadell, Barcelona, Spain
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Domínguez García A, Muñoz Rodríguez J, Prats López J, Almirall Daly J, Centeno Álvarez C, de Verdonces Roman L, Pla Terradellas C, Serra Aracil X. Acidosis metabólica tras cistectomía radical con derivación urinaria ileal. ¿Sabemos tanto como creemos? Revisión sistemática. Actas Urol Esp 2023. [DOI: 10.1016/j.acuro.2022.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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Butea-Bocu MC, Müller G, Brock O, Otto U. [Metabolic acidosis in neobladder patients : Risk factors and treatment options]. Urologe A 2021; 60:617-623. [PMID: 33884463 DOI: 10.1007/s00120-021-01523-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/10/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND In cystectomy patients who underwent neobladder creation, the intestinal mucosa of the neobladder is in constant contact with urine, which may result in chronic metabolic acidosis (CMA) due to specific absorption capabilities of the intestinal mucosa. Despite being a prevalent comorbidity, the risk factors for CMA and its diagnostic parameters are poorly understood. OBJECTIVES This review examines the risk factors associated with the development of CMA and their prevalence in patients with a neobladder. MATERIALS AND METHODS We conducted a systematic literature search using the PubMed database to detect studies about the topics CMA and neobladder that were published between 2000 and 2020. The prevalence and risk factors for CMA in neobladder patients were assessed by reviewing 23 studies. RESULTS Acidosis is most prevalent during the first year after surgery (25-70%). Risk factors are renal failure, high continence, old age and diabetes mellitus. CONCLUSIONS The prevalence of CMA is at its highest during the early postoperative period for neobladder patients, so for this time period, weekly diagnostic investigations are recommended according to the German S3-guidelines for the "Früherkennung, Diagnose, Therapie und Nachsorge des Harnblasenkarzinomsent für Neoblasepatienten". Blood gas tests should not only be used to analyze the pH value but also to detect and counteract acid-base imbalance issues in time. The recommended normalization of serum bicarbonate levels with oral bicarbonate follows patient-specific therapy strategies.
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Affiliation(s)
- Marius Cristian Butea-Bocu
- Urologisches Kompetenzzentrum für die Rehabilitation - UKR, Kliniken Hartenstein, Dr.-Herbert-Kienle-Str. 6, 34537, Bad Wildungen, Deutschland.
| | - Guido Müller
- Urologisches Kompetenzzentrum für die Rehabilitation - UKR, Kliniken Hartenstein, Dr.-Herbert-Kienle-Str. 6, 34537, Bad Wildungen, Deutschland
| | - Oliver Brock
- Urologisches Kompetenzzentrum für die Rehabilitation - UKR, Kliniken Hartenstein, Dr.-Herbert-Kienle-Str. 6, 34537, Bad Wildungen, Deutschland
| | - Ullrich Otto
- Urologisches Kompetenzzentrum für die Rehabilitation - UKR, Kliniken Hartenstein, Dr.-Herbert-Kienle-Str. 6, 34537, Bad Wildungen, Deutschland
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Joensen UN, Maibom SL, Poulsen AM. Surgical Management of Muscle Invasive Bladder Cancer: A Review of Current Recommendations. Semin Oncol Nurs 2021; 37:151104. [PMID: 33541734 DOI: 10.1016/j.soncn.2020.151104] [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: 12/01/2022]
Abstract
OBJECTIVE To provide a narrative overview of contemporary surgical management of muscle-invasive bladder cancer with focus on radical cystectomy and urinary tract reconstruction. DATA SOURCES International guidelines and a search for articles in PubMed, Medline, and Cochrane Database for single and collaborative studies on surgical management of muscle-invasive bladder cancer. CONCLUSION Patients diagnosed with muscle invasive bladder cancer often have complex treatment and care needs. For those who undergo radical cystectomy as the curative treatment, there is a considerable risk of general complications after major surgery and short- and long-term complications specific to reconstruction of the urinary tract after radical cystectomy. Contemporary care focuses on perioperative optimization to lower rates of major complications, enhanced recovery protocols, and focus on rehabilitation and cancer survivorship. IMPLICATIONS FOR NURSING PRACTICE Nurses are integral members of the multidisciplinary team around patients undergoing surgery for muscle-invasive bladder cancer, and are in a position to coordinate pathways for these patients who often have complex care needs because of preexisting comorbidity and limited personal resources that impede recovery after major surgery and cancer survivorship.
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Affiliation(s)
- Ulla Nordström Joensen
- Department of Urology, University Hospital of Copenhagen, Rigshospitalet, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
| | - Sophia Liff Maibom
- Department of Urology, University Hospital of Copenhagen, Rigshospitalet, Denmark
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Rouanne M, Gaillard F, Meunier ME, Soorojebally Y, Phan H, Slimani-Thevenet H, Jannot AS, Neuzillet Y, Friedlander G, Froissart M, Botto H, Houillier P, Lebret T, Courbebaisse M. Measured glomerular filtration rate (GFR) significantly and rapidly decreases after radical cystectomy for bladder cancer. Sci Rep 2020; 10:16145. [PMID: 32999403 PMCID: PMC7528003 DOI: 10.1038/s41598-020-73191-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Accepted: 09/07/2020] [Indexed: 11/09/2022] Open
Abstract
Precise determination of glomerular filtration rate (GFR) is essential for the management of patients with muscle-invasive bladder cancer (MIBC). We aim to describe the early evolution of measured GFR (mGFR) after radical cystectomy and urinary diversion (RCUD) and to identify risk factors for GFR decline. GFR measurement using 51Cr-EDTA continuous infusion, estimated GFR (eGFR) from five published equations and renal scintigraphy with split renal function determination were performed before and 6 months after RCUD. Chronic Kidney Disease (mGFR < 60 mL/min/1.73 m2) and GFR stages were defined according to the KDIGO guidelines using mGFR. Twenty-seven patients (men 85%, median age 65, IQR 59; 68 years) were included. A total of 20 (74%) patients experienced significant mGFR decline at 6 months postoperatively. Median mGFR decreased from 84.1 pre-operatively (IQR 65.3; 97.2) to 69.9 mL/min/1.73 m2 (IQR 55.0; 77.9) 6 months after surgery (p < 0.001). Thirteen (48%) patients had a progression to a worse GFR stage. Of the 22 patients without pre-operative CKD, 5 (23%) developed post-operative CKD. Diabetes mellitus was more frequent in patients in the highest tertile of relative mGFR decline (44% vs. 11%, p = 0.02) and platinum-based adjuvant chemotherapy tended to be more frequently used in these patients (44% vs. 17%, p = 0.06). Importantly, pre-operative weight was independently and negatively associated with post-operative mGFR and with mGFR slope in multivariable analyses. In this prospective series, we demonstrated that early and significant mGFR decline occurred after RCUD and perioperative platinum-based chemotherapy, especially in patients with diabetes mellitus and overweight.
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Affiliation(s)
- Mathieu Rouanne
- Department of Urology, Hôpital Foch, Université Paris-Saclay, 40, Rue Worth, 92150, Suresnes, France. .,UVSQ-Université Paris-Saclay, Paris, France.
| | - François Gaillard
- Department of Physiology, Functional Explorations Unit, Hôpital Européen Georges Pompidou, Paris, France
| | - Matthias E Meunier
- Department of Urology, Hôpital Foch, Université Paris-Saclay, 40, Rue Worth, 92150, Suresnes, France
| | - Yanish Soorojebally
- Department of Urology, Hôpital Foch, Université Paris-Saclay, 40, Rue Worth, 92150, Suresnes, France.,UVSQ-Université Paris-Saclay, Paris, France
| | - Hoang Phan
- Department of Biostatistics, Hôpital Européen Georges Pompidou, Paris, France
| | | | - Anne-Sophie Jannot
- Department of Biostatistics, Hôpital Européen Georges Pompidou, Paris, France
| | - Yann Neuzillet
- Department of Urology, Hôpital Foch, Université Paris-Saclay, 40, Rue Worth, 92150, Suresnes, France.,UVSQ-Université Paris-Saclay, Paris, France
| | - Gérard Friedlander
- Department of Physiology, Functional Explorations Unit, Hôpital Européen Georges Pompidou, Paris, France.,INSERM U1151-CNRS UMR8253, Paris, France.,Université Paris Descartes, Paris, France
| | - Marc Froissart
- Clinical Research Center and Trial Unit, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Henry Botto
- Department of Urology, Hôpital Foch, Université Paris-Saclay, 40, Rue Worth, 92150, Suresnes, France
| | - Pascal Houillier
- Department of Physiology, Functional Explorations Unit, Hôpital Européen Georges Pompidou, Paris, France.,INSERM U1151-CNRS UMR8253, Paris, France.,INSERM U1138, CNRS ERL8228, Paris, France
| | - Thierry Lebret
- Department of Urology, Hôpital Foch, Université Paris-Saclay, 40, Rue Worth, 92150, Suresnes, France.,UVSQ-Université Paris-Saclay, Paris, France
| | - Marie Courbebaisse
- Department of Physiology, Functional Explorations Unit, Hôpital Européen Georges Pompidou, Paris, France.,Department of Nuclear Medicine, Hôpital Européen Georges Pompidou, Paris, France.,INSERM U1151-CNRS UMR8253, Paris, France
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Su X, Wu K, Wang S, Su W, Li C, Li B, Mao X. The impact of orthotopic neobladder vs ileal conduit urinary diversion after cystectomy on the survival outcomes in patients with bladder cancer: A propensity score matched analysis. Cancer Med 2020; 9:7590-7600. [PMID: 32869540 PMCID: PMC7571812 DOI: 10.1002/cam4.3404] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 08/01/2020] [Accepted: 08/02/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Bladder cancer (BCa) is the most common urinary malignancy. The standard surgical treatment for patients with muscle-invasive BCa is cystectomy plus urinary diversion. Ileal conduit (IC) or orthotopic neobladder (ON), which have different indications, are the most commonly performed urinary diversions. METHODS AND MATERIALS We sampled 5480 BCa patients from the Surveillance, Epidemiology, and End Results (SEER) database from 2004 to 2015. Kaplan-Meier method with the log-rank test was used to assess cancer-specific survival (CSS) and overall survival (OS). Univariate and multivariate Cox's proportional hazard model was conducted to evaluate the hazard ratio of cancer-specific mortality and all-cause mortality before and after propensity score matching (PSM). RESULTS We identified 5480 patients who received radical cystectomy (RC) plus IC (n = 5071) or ON (n = 409) with a median follow-up period of 33 months (interquartile range, 13-78 months). Patients in the ON group tended to be male and younger, with a higher percentage of married individuals, early pathological T stage, lymphadenectomy, and non-radiotherapy (all P < .05). After 1:1 PSM, 409 matched pairs were selected. Univariate and multivariate analysis showed that the ON group had better CSS and OS probabilities than the IC group in the overall cohort [hazard ratio (HR): 0.692, 95% confidence intervals (CI): 0.576-0.831, P < .001; HR: 0.677, 95% CI: 0.579-0.793, P < .001 respectively]. However, subgroup analysis revealed that only patients with pathological T2 stage benefited from ON diversion after PSM in the context of CSS (P = .016) and OS (P <.001). CONCLUSIONS Young, married, and male patients with early pathological T stage, especially T2 stage, were more suitable to receive RC plus ON surgery, which could improve their probability of survival.
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Affiliation(s)
- Xiaohong Su
- Department of Urology, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Kaihui Wu
- Department of Urology, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Shuo Wang
- Department of Urology, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Wei Su
- Department of Urology, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Chuanyin Li
- Department of Urology, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Bingkun Li
- Department of Urology, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Xiangming Mao
- Department of Urology, Zhujiang Hospital, Southern Medical University, Guangzhou, China
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8
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[Optimizing the management of bladder cancer in older patients]. Prog Urol 2019; 29:849-864. [PMID: 31771768 DOI: 10.1016/j.purol.2019.08.273] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 08/08/2019] [Accepted: 08/19/2019] [Indexed: 11/22/2022]
Abstract
AIM To define and present potential improvements for the management of bladder cancer in older patients. METHOD Bibliographical search was performed from the Medline bibliographic database (NLM Pubmed tool) and Embase focused on: bladder cancer, treatment, BCG, chemotherapy, cystectomy, and elderly. RESULTS The oncological principles of medico-surgical management of bladder cancer do not differ according to age. On the other hand, the patient comorbidities have been likely to alter the tolerance of these treatments. At the NMIBC stages, no adaptation of the standard treatment has demonstrated any interest. At the MIBC stages, the prognosis was improved by geriatric multidisciplinary perioperative management. CONCLUSION The indications and principles of surgical treatments must be identical regardless of the patient age. At the NMIBC stages, adjuvant therapy, including BCG therapy, should not be questioned because of the age of the patient. On the other hand, at the localized MIBC stages, neoadjuvant and adjuvant chemotherapy should not be considered as a standard and their indications assessed individually after geriatric assessment.
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9
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Kretschmer A, Grimm T, Buchner A, Grimm J, Grabbert M, Jokisch F, Schneevoigt BS, Apfelbeck M, Schulz G, Bauer RM, Stief CG, Karl A. Prognostic Features for Objectively Defined Urinary Continence after Radical Cystectomy and Ileal Orthotopic Neobladder in a Contemporary Cohort. J Urol 2016; 197:210-215. [PMID: 27506691 DOI: 10.1016/j.juro.2016.08.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/02/2016] [Indexed: 11/26/2022]
Abstract
PURPOSE We objectively quantified daytime and nocturnal continence rates, and defined predictive features for favorable continence outcomes after radical cystectomy and orthotopic ileal neobladder creation. MATERIALS AND METHODS At 1 institution 1,012 cystectomies were performed between 2004 and 2015. Questionnaires evaluating the continence status were sent to 244 patients. To objectify postoperative urine loss daytime and nocturnal pad tests were performed. Continence was defined as the need for up to 1 safety pad and urine loss 10 gm or less per test. Predefined associative features were tested for an influence on continence outcomes. Statistical analysis was done with the Fisher exact and Mann-Whitney U tests, and linear logistic regression models. Significance was considered at p <0.05. RESULTS A total of 188 patients (77.0%) returned the questionnaires. Median followup was 61 months. Median daytime pad use was 1 pad per day (range 0 to 9). Median daily urine loss based on standardized pad testing was 8 gm (range 0 to 2,400). During the night a median of 1 pad (range 0 to 7) was used and median nocturnal urine loss was 28.5 gm (range 0 to 1,220). The continence rate was 54.3% during the day and 36.3% at night. On multivariate analysis good preoperative ECOG (Eastern Cooperative Oncology Group) status (OR 2.987, p = 0.010), retained sensation of bladder filling (OR 6.462, p = 0.003) and preoperative coronary heart disease (OR 0.036, p = 0.002) were independent predictors of daytime success. Based on preoperative risk factors a simple predictive score for daytime continence was created (AUC 0.725, p <0.001). CONCLUSIONS Continence rates after orthotopic ileal neobladder creation are lower than previously described when objective continence definitions are applied. Patients with good performance status, without coronary heart disease and with retained sensation of orthotopic ileal neobladder filling have better daytime continence outcomes.
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Affiliation(s)
- Alexander Kretschmer
- Department of Urology, Ludwig-Maximilians-University Munich, Germany; Department of Urological Sciences, University of British Columbia, Vancouver, British Columbia, Canada.
| | - Tobias Grimm
- Department of Urology, Ludwig-Maximilians-University Munich, Germany
| | - Alexander Buchner
- Department of Urology, Ludwig-Maximilians-University Munich, Germany
| | - Julia Grimm
- Department of Urology, Ludwig-Maximilians-University Munich, Germany
| | - Markus Grabbert
- Department of Urology, Ludwig-Maximilians-University Munich, Germany
| | - Friedrich Jokisch
- Department of Urology, Ludwig-Maximilians-University Munich, Germany
| | | | - Maria Apfelbeck
- Department of Urology, Ludwig-Maximilians-University Munich, Germany
| | - Gerald Schulz
- Department of Urology, Ludwig-Maximilians-University Munich, Germany
| | - Ricarda M Bauer
- Department of Urology, Ludwig-Maximilians-University Munich, Germany
| | - Christian G Stief
- Department of Urology, Ludwig-Maximilians-University Munich, Germany
| | - Alexander Karl
- Department of Urology, Ludwig-Maximilians-University Munich, Germany
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Internal versus external ureteric stents for uretero-ileal anastomosis after laparoscopic radical cystectomy with orthotopic neobladder: A prospective comparative study. Arab J Urol 2016; 14:136-42. [PMID: 27493809 PMCID: PMC4963168 DOI: 10.1016/j.aju.2016.03.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Revised: 03/01/2016] [Accepted: 03/29/2016] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To prospectively compare the use of external ureteric stents with internal JJ stenting of the uretero-ileal anastomosis in patients undergoing laparoscopic radical cystectomy (LRC) with a Y-shaped ileal orthotopic neobladder (ON). PATIENTS AND METHODS The study included 69 patients undergoing LRC with ON. Patients were grouped according to the type of uretero-ileal stents used. An external ureteric stent was used in Group A (33 patients) and a JJ stent was used in Group B (36). We prospectively compared the duration of hospital stay, the incidence of short- and intermediate-term complications in the two study groups. RESULTS The mean (SD) follow-up periods were 29.18 (3.94) and 28.19 (3.37) months for patients in Groups A and B, respectively. Perioperative patient characteristics were comparable in the two study groups. The use of JJ stenting was associated with a shorter hospital stay compared with external stenting, at a mean (SD) of 14.63 (3.74) and 6.8 (3.03) days in Groups A and B, respectively (P < 0.001). The incidence of urinary leakage was comparable in the two study groups, at 6.1% in Group A vs 8.3% in Group B (P = 1.0). Strictures of the uretero-ileal anastomosis occurred in two patients (6%) in Group A and confirmed by intravenous urography. All strictures were treated with antegrade JJ fixation. CONCLUSION JJ stents could be used as an effective alternative to external ureteric stents to support the uretero-ileal anastomosis. JJ stenting is associated with a shorter hospital stay and similar complication rates compared with external stenting in patients undergoing LRC with ON.
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Alfred Witjes J, Lebret T, Compérat EM, Cowan NC, De Santis M, Bruins HM, Hernández V, Espinós EL, Dunn J, Rouanne M, Neuzillet Y, Veskimäe E, van der Heijden AG, Gakis G, Ribal MJ. Updated 2016 EAU Guidelines on Muscle-invasive and Metastatic Bladder Cancer. Eur Urol 2016; 71:462-475. [PMID: 27375033 DOI: 10.1016/j.eururo.2016.06.020] [Citation(s) in RCA: 1051] [Impact Index Per Article: 131.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Accepted: 06/13/2016] [Indexed: 12/20/2022]
Abstract
CONTEXT Invasive bladder cancer is a frequently occurring disease with a high mortality rate despite optimal treatment. The European Association of Urology (EAU) Muscle-invasive and Metastatic Bladder Cancer (MIBC) Guidelines are updated yearly and provides information to optimise diagnosis, treatment, and follow-up of this patient population. OBJECTIVE To provide a summary of the EAU guidelines for physicians and patients confronted with muscle-invasive and metastatic bladder cancer. EVIDENCE ACQUISITION An international multidisciplinary panel of bladder cancer experts reviewed and discussed the results of a comprehensive literature search of several databases covering all sections of the guidelines. The panel defined levels of evidence and grades of recommendation according to an established classification system. EVIDENCE SYNTHESIS Epidemiology and aetiology of bladder cancer are discussed. The proper diagnostic pathway, including demands for pathology and imaging, is outlined. Several treatment options, including bladder-sparing treatments and combinations of treatment modalities (different forms of surgery, radiation therapy, and chemotherapy) are described. Sequencing of these modalities is discussed. Potential indications and contraindications, such as comorbidity, are related to treatment choice. There is a new paragraph on organ-sparing approaches, both in men and in women, and on minimal invasive surgery. Recommendations for chemotherapy in fit and unfit patients are provided including second-line options. Finally, a follow-up schedule is provided. CONCLUSIONS The current summary of the EAU Muscle-invasive and Metastatic Bladder Cancer Guidelines provides an up-to-date overview of the available literature and evidence dealing with diagnosis, treatment, and follow-up of patients with metastatic and muscle-invasive bladder cancer. PATIENT SUMMARY Bladder cancer is an important disease with a high mortality rate. These updated guidelines help clinicians refine the diagnosis and select the appropriate therapy and follow-up for patients with metastatic and muscle-invasive bladder cancer.
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Affiliation(s)
- J Alfred Witjes
- Department of Urology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
| | - Thierry Lebret
- Hôpital Foch, Department of Urology, University of Versailles-Saint-Quentin-en-Yvelines, Suresnes, France
| | - Eva M Compérat
- Department of Pathology, Hôpital La Pitié Salpetrière, UPMC, Paris, France
| | - Nigel C Cowan
- Radiology Department, Queen Alexandra Hospital, Portsmouth, UK
| | - Maria De Santis
- University of Warwick, Cancer Research Unit, Coventry, UK; Queen Elizabeth Hospital, Birmingham, UK
| | - Harman Maxim Bruins
- Department of Urology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Virginia Hernández
- Department of Urology, Hospital Universitario Fundación Alcorcón, Madrid, Spain
| | | | - James Dunn
- Department of Urology, Derriford Hospital, Plymouth, UK
| | - Mathieu Rouanne
- Hôpital Foch, Department of Urology, University of Versailles-Saint-Quentin-en-Yvelines, Suresnes, France
| | - Yann Neuzillet
- Hôpital Foch, Department of Urology, University of Versailles-Saint-Quentin-en-Yvelines, Suresnes, France
| | - Erik Veskimäe
- Department of Urology, Tampere University Hospital, Tampere, Finland
| | | | - Georgios Gakis
- Department of Urology, Eberhard-Karls University, Tübingen, Germany
| | - Maria J Ribal
- Department of Urology, Hospital Clinic, University of Barcelona, Barcelona, Spain
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Stapled orthotopic ileal neobladder after radical cystectomy for bladder cancer: Functional results and complications over a 20-year period. Eur J Surg Oncol 2016; 42:412-8. [DOI: 10.1016/j.ejso.2015.11.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2015] [Revised: 11/02/2015] [Accepted: 11/13/2015] [Indexed: 11/24/2022] Open
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Harraz AM, Mosbah A, El-Assmy A, Gad H, Shaaban AA. Renal function evaluation in patients undergoing orthotopic bladder substitution: a systematic review of literature. BJU Int 2014; 114:484-95. [PMID: 24447517 DOI: 10.1111/bju.12632] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Renal function (RFn) after orthotopic bladder substitution (OBS) is a critical point to be assessed. We performed a systematic review of MEDLINE for full length peer reviewed English articles from the year 2000 till January 2013. We included only original articles and excluded reviews, editorials and replies and abstracts presented in conferences. The outcome is formulated in research questions; what is the status of RFn after OBS? Which is better, the direct free-refluxing or anti-refluxing ureteroileal anastomosis (UIA) techniques? Studies reporting RFn as secondary outcome were also reported. A total of 129 publications were reviewed for full text and only 41 were included in this review. All studies were of low level of evidence and grade of recommendations. Only 3 randomized controlled trials were included and were of poor quality. Renal function after OBS was poorly described in the literature with no universal definition about RFn deterioration or outcome with no consensus on the best evaluation method. Urinary obstruction, chemotherapy and pyelonephritis appeared significant factors but with insufficient evidence. There is a universal trend to use the free refluxing technique for UIA to avoid complications of anti-refluxing techniques. However, the anti-reflux technique proved acceptable outcome in experienced hands. There is marked heterogeneity and underestimation of RFn evaluation among reported outcomes after OBS with most publications reporting the incidence of UIA and pyelonephritis with paucity reporting absolute figures about RFn measurements. In conclusion, urinary tract obstruction remains the main factor of RFn deterioration after OBS. Methods evaluating RFn, definitions of RFn outcome and factors predicting it are poorly studied in the literature and the current evidence is relatively weak to draw solid conclusions. Further well-designed studies and consensus about method of assessment and definitions of RFn are warranted.
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Affiliation(s)
- Ahmed M Harraz
- Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
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Rouanne M, Legrand G, Neuzillet Y, Ghoneim T, Cour F, Letang N, Yonneau L, Hervé JM, Botto H, Lebret T. Long-Term Women-Reported Quality of Life After Radical Cystectomy and Orthotopic Ileal Neobladder Reconstruction. Ann Surg Oncol 2014; 21:1398-404. [DOI: 10.1245/s10434-013-3458-8] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2013] [Indexed: 01/08/2023]
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Zhong S, Zhu Z, Wang X, Pan C, Chen S, Shen Z. RETRACTED: Modified U-shaped ileal neobladder after radical cystectomy: Assessment of functional outcomes and complications in Chinese patients. Urol Oncol 2013; 31:1683-8. [DOI: 10.1016/j.urolonc.2012.05.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2012] [Revised: 05/25/2012] [Accepted: 05/29/2012] [Indexed: 10/28/2022]
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Martin LCE, Abah U, Bean E, Gupta S. Metabolic acidosis: neo-considerations for general surgeons. Ann R Coll Surg Engl 2012; 94:e249-50. [PMID: 23131216 PMCID: PMC3954307 DOI: 10.1308/003588412x13373405387456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Hyperchloraemic metabolic acidosis is a documented complication of neobladder formation. However, it usually improves with time and is mild. Severe and persistent metabolic acidosis may manifest when patients undergo further surgery for other reasons. Neobladder formation following radical cystectomy or cystoprostatectomy is becoming increasingly common, and surgeons treating patients with neobladders should recognise and treat metabolic acidosis with intravenous fluids and bicarbonate.
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