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Guven S, Colecchia M, Oltulu P, Bonfante G, Enikeev D, Esen H, Herrmann T, Lusuardi L, Micali S, Somani B, Skolarikos A, Breda A, Liatsikos E, Redorta JP, Gozen AS. How do endoscopic bladder tumor resection techniques affect pathology practice? EAU Section of Uro-Technology (ESUT) and Uropathology (ESUP) survey. World J Urol 2023; 41:2617-2625. [PMID: 35567624 DOI: 10.1007/s00345-022-04022-2] [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: 01/22/2022] [Accepted: 04/19/2022] [Indexed: 10/18/2022] Open
Abstract
PURPOSE We aimed to examine how different endoscopic bladder tumor resection techniques affect pathologists' clinical practice patterns. METHODS An online survey including 28 questions clustered in four main sections was prepared by the ESUT ERBT Working Group and released to the pathologists working in the institutions of experts of the ESUT Board and the working groups and experts in the uropathology working group. A descriptive analysis was performed using the collected data. RESULTS Sixty-eight pathologists from 23 countries responded to the survey. 37.3% of the participants stated that they always report the T1 sub-staging. Of those who gave sub-staging, 61.3% used T1a, b. 85.2% think that en bloc samples provide spatial orientation faster than piecemeal samples, and 60% think en bloc samples are timesaving during an inspection. 55.7% stated that whether the tissue sample is en bloc or piecemeal is essential. 57.4% think en bloc sample reduces turnaround time and is cost-effective for 44.1%. A large number of pathologists find that the pathology examination of piecemeal samples has a longer learning curve. CONCLUSION The survey shows that pathologists think that they can diagnose faster, accurately, and cost-effectively with ERBT samples, but they do not often encounter them in practice. Moreover, en bloc samples may be a better choice in pathology resident training. Evidence from real-life observational pathology practice and clinical research can reveal the current situation more clearly and increase awareness on proper treatment in endoscopic management of bladder tumors.
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Affiliation(s)
- Selcuk Guven
- Urology Department, Meram School of Medicine, Necmettin Erbakan University, Konya, Turkey
| | | | - Pembe Oltulu
- Pathology Department, Meram School of Medicine, Necmettin Erbakan University, Konya, Turkey
| | - Giulia Bonfante
- Urology Department, University of Modena and Reggio Emilia, Modena, Italy
| | - Dmitry Enikeev
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
| | - Hasan Esen
- Pathology Department, Meram School of Medicine, Necmettin Erbakan University, Konya, Turkey
| | - Thomas Herrmann
- Department of Urology, Spital Thurgau AG, Frauenfeld, Switzerland
| | - Lukas Lusuardi
- Department of Urology, General Hospital Bolzano, Bolzano, Italy
| | - Salvatore Micali
- Urology Department, University of Modena and Reggio Emilia, Modena, Italy
| | - Bashkar Somani
- Department of Urology, University Hospital Southampton NHS Trust, Southampton, UK
| | - Andreas Skolarikos
- Department of Urology, National and Kapodistrian University of Athens, Athens, Greece
| | - Alberto Breda
- Department of Urology, Fundacion Puigvert, UniversitatAutonoma de Barcelona, Barcelona, Spain
| | | | - Joan Palou Redorta
- Department of Urology, Fundacion Puigvert, UniversitatAutonoma de Barcelona, Barcelona, Spain
| | - Ali Serdar Gozen
- SLK Kliniken Urology Department, Teaching Hospital of Heidelberg University, Heilbronn, Germany.
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Yao Q, Jiang H, Niu H, Hu G, Cao J, Xue B. Rotatable Bi-Channel En Bloc Resection of Bladder Tumor for Non-Muscle-Invasive Bladder Cancer in an Ex Vivo Porcine Model. Cancers (Basel) 2023; 15:4255. [PMID: 37686531 PMCID: PMC10486726 DOI: 10.3390/cancers15174255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 08/21/2023] [Accepted: 08/23/2023] [Indexed: 09/10/2023] Open
Abstract
En bloc resection of bladder tumor (ERBT) is a promising alternative for non-muscle-invasive bladder cancer management. However, the tumor characteristics and surgeon's experience influence its application. Therefore, in this pilot study, we developed a technique called "rotatable bi-channel en bloc resection of bladder tumor (RBC-ERBT)" and assessed its feasibility, efficacy, and safety compared with those of conventional ERBT. In an ex vivo porcine bladder model, 160 bladder lesions of varying morphologies (exophytic and flat) and sizes (1 and 2 cm) were created and evenly distributed across different locations. A total of 160 procedures were performed, with the ERBT and RBC-ERBT group each exhibiting 80 lesions. RBC-ERBT had a significantly higher technical success rate than ERBT (98.8% vs. 77.5%) for exophytic and flat lesions of both sizes and dome lesions. The procedure time was significantly shorter in the RBC-ERBT group, particularly for flat lesions, lesions with a 2 cm diameter, and lesions located at the dome. RBC-ERBT had a significantly lower piecemeal resection rate than ERBT (0% vs. 18.8%). The incidence of perforation or detrusor muscle sampling did not differ between the groups. Compared with conventional ERBT, RBC-ERBT offered improved success rates, reduced resection times, and effective management of challenging lesions.
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Affiliation(s)
- Qiu Yao
- Department of Urology, The Second Affiliated Hospital of Soochow University, Suzhou 215004, China; (Q.Y.); (G.H.)
| | - Huizhong Jiang
- Department of Operating Room, The Second Affiliated Hospital of Soochow University, Suzhou 215004, China;
| | - Hui Niu
- Department of Pathology, The Second Affiliated Hospital of Soochow University, Suzhou 215004, China;
| | - Guangmo Hu
- Department of Urology, The Second Affiliated Hospital of Soochow University, Suzhou 215004, China; (Q.Y.); (G.H.)
| | - Jianlong Cao
- Department of General Surgery, Zhangjiagang Second People’s Hospital, Zhangjiagang 215633, China;
| | - Boxin Xue
- Department of Urology, The Second Affiliated Hospital of Soochow University, Suzhou 215004, China; (Q.Y.); (G.H.)
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Marquardt A, Richterstetter M, Taubert H, Hartmann A, Wullich B, Lieb V, Bellut L, Wach S, Apel H. Reduced Recurrence Rates Are Associated with Photodynamic Diagnostics Compared to White Light after Extended Transurethral Resection of Bladder Tumors. Life (Basel) 2022; 12:life12050641. [PMID: 35629309 PMCID: PMC9143752 DOI: 10.3390/life12050641] [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: 04/01/2022] [Revised: 04/19/2022] [Accepted: 04/24/2022] [Indexed: 11/16/2022] Open
Abstract
One pillar in treating non-muscle-invasive bladder cancer (NMIBC) is the complete and high-quality transurethral resection of the primary tumor (TURBT). However, even after a high-quality primary resection, the residual tumor risk is considerable, thus requiring a re-TURBT. Resections performed with the aid of a photodynamic diagnostics report improved recurrence-free survival rates and increased detection rates of carcinoma in situ (CIS). This monocentric retrospective study reports on patients treated with an extended TURBT procedure using conventional white-light cystoscopy or photodynamic diagnostics (PDD). Only patients undergoing a TURBT resection for their primary tumor were included in the statistical analysis. Recurrence-free survival and overall survival were the clinical endpoints. Mann−Whitney U tests and chi-squared tests were used for descriptive intergroup comparisons. The associations with overall survival and recurrence-free survival were determined by univariate and multivariate analyses. The test results were considered significant when p was < 0.05. In comparison to conventional white-light cystoscopy, PDD increased the detection rates of CIS (p = 0.004) and tumor multifocality (p = 0.005) and led to reduced residual tumor incidence at the primary resection site (p < 0.001). Likewise, tumor recurrence rates were reduced in the PDD cohort (p < 0.001). Patient age and the presence of residual tumor at the primary resection site were identified as independent predictors of overall survival. For recurrence-free survival, only the PDD resection method was an independent predictor (HR = 0.43; p < 0.001). In summary, we demonstrated that the utilization of PDD techniques was associated with improved detection rates of CIS and multifocal tumors and with reduced recurrence rates. The extended resection protocol allowed us to determine that PDD resections lead to a reduced residual tumor rate at the initial resection site. This residual tumor state at the resection site, determined by extended TURBT, became an independent predictor of long-term survival. On the other hand, the PDD technique was confirmed as the only independent predictor of recurrence-free survival.
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Affiliation(s)
- Alexander Marquardt
- Department of Urology and Pediatric Urology, University Hospital Erlangen, Friedrich-Alexander Universität Erlangen, Krankenhausstrasse 12, 91054 Erlangen, Germany; (A.M.); (M.R.); (H.T.); (B.W.); (V.L.); (L.B.); (H.A.)
| | - Mario Richterstetter
- Department of Urology and Pediatric Urology, University Hospital Erlangen, Friedrich-Alexander Universität Erlangen, Krankenhausstrasse 12, 91054 Erlangen, Germany; (A.M.); (M.R.); (H.T.); (B.W.); (V.L.); (L.B.); (H.A.)
| | - Helge Taubert
- Department of Urology and Pediatric Urology, University Hospital Erlangen, Friedrich-Alexander Universität Erlangen, Krankenhausstrasse 12, 91054 Erlangen, Germany; (A.M.); (M.R.); (H.T.); (B.W.); (V.L.); (L.B.); (H.A.)
- Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), 91054 Erlangen, Germany;
| | - Arndt Hartmann
- Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), 91054 Erlangen, Germany;
- Institute of Pathology, University Hospital Erlangen, Friedrich-Alexander Universität Erlangen, Krankenhausstrasse 8-10, 91054 Erlangen, Germany
| | - Bernd Wullich
- Department of Urology and Pediatric Urology, University Hospital Erlangen, Friedrich-Alexander Universität Erlangen, Krankenhausstrasse 12, 91054 Erlangen, Germany; (A.M.); (M.R.); (H.T.); (B.W.); (V.L.); (L.B.); (H.A.)
- Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), 91054 Erlangen, Germany;
| | - Verena Lieb
- Department of Urology and Pediatric Urology, University Hospital Erlangen, Friedrich-Alexander Universität Erlangen, Krankenhausstrasse 12, 91054 Erlangen, Germany; (A.M.); (M.R.); (H.T.); (B.W.); (V.L.); (L.B.); (H.A.)
- Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), 91054 Erlangen, Germany;
| | - Laura Bellut
- Department of Urology and Pediatric Urology, University Hospital Erlangen, Friedrich-Alexander Universität Erlangen, Krankenhausstrasse 12, 91054 Erlangen, Germany; (A.M.); (M.R.); (H.T.); (B.W.); (V.L.); (L.B.); (H.A.)
- Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), 91054 Erlangen, Germany;
| | - Sven Wach
- Department of Urology and Pediatric Urology, University Hospital Erlangen, Friedrich-Alexander Universität Erlangen, Krankenhausstrasse 12, 91054 Erlangen, Germany; (A.M.); (M.R.); (H.T.); (B.W.); (V.L.); (L.B.); (H.A.)
- Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), 91054 Erlangen, Germany;
- Correspondence: ; Tel.: +49-9131-8542658; Fax: +49-9131-8523374
| | - Hendrik Apel
- Department of Urology and Pediatric Urology, University Hospital Erlangen, Friedrich-Alexander Universität Erlangen, Krankenhausstrasse 12, 91054 Erlangen, Germany; (A.M.); (M.R.); (H.T.); (B.W.); (V.L.); (L.B.); (H.A.)
- Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), 91054 Erlangen, Germany;
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Mulawkar PM, Sharma G, Tamhankar A, Shah U, Raheem R. Role of Macroscopic Image Enhancement in Diagnosis of Non-Muscle-Invasive Bladder Cancer: An Analytical Review. Front Surg 2022; 9:762027. [PMID: 35265660 PMCID: PMC8898829 DOI: 10.3389/fsurg.2022.762027] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 01/17/2022] [Indexed: 11/18/2022] Open
Abstract
Early diagnosis of non-muscle-invasive bladder cancer (NMIBC) is of paramount importance to prevent morbidity and mortality due to bladder cancer. Although white light imaging (WLI) cystoscopy has long been considered the gold standard in the diagnosis of bladder cancer, it can miss lesions in a substantial percentage of patients and is very likely to miss carcinoma in situ and dysplasia. Tumor margin detection by WLI can be inaccurate. Moreover, WLI could, sometimes, be inadequate in distinguishing inflammation and malignancy. To improve the diagnostic efficacy of cystoscopy, various optical image enhancement modalities have been studied. These image enhancement modalities have been classified as macroscopic, microscopic, or molecular. Photodynamic diagnosis (PDD), narrow band imaging (NBI), and Storz image 1 S enhancement (formerly known as SPIES) are macroscopic image enhancement modalities. A relevant search was performed for literature describing macroscopic image enhancement modalities like PDD, NBI, and image 1 S enhancement. The advantages, limitations, and usefulness of each of these in the diagnosis of bladder cancer were studied. Photodynamic diagnosis requires intravesical instillation of a photosensitizing agent and a special blue light cystoscope system. PDD has been shown to be more sensitive than WLI in the detection of bladder cancer. It is superior to WLI in the detection of flat lesions. Bladder tumor resection (TURBT) by PDD results in more complete resection and reduced recurrence rates. PDD-guided TURBT may have some role in reducing the risk of progression. Narrow band imaging provides increased contrast between normal and abnormal tissues based on neovascularization, thereby augmenting WLI. NBI requires a special light source. There is no need for intravesical contrast instillation. NBI is superior to WLI in the detection of bladder cancer. The addition of NBI to WLI improves the detection of flat lesions like carcinoma in situ. NBI is not useful in predicting invasive tumors or grades of tumors. NBI-directed TURBT reduces recurrence rates and recurrence free survival. But its efficacy in retarding progression is unproven. Image 1 S-enhancement utilizes software-based image enhancement modes without the need for a special light source or intravesical contrast instillation. This system provides high-quality images and identifies additional abnormal-looking areas. Another advantage of this system is simultaneous side-by-side visualization of WLI and enhanced image, providing WLI images as the control for comparison. As with PDD, S-enhancement produces a lower rate of a missed bladder cancer diagnosis. The system significantly improves the diagnosis of NMIBC. The sensitivity and negative predictive value of image 1 S enhancement increase with the increase in cancer grade. A negative test by S-enhancement effectively rules out NMIBC. All the image enhancement modalities have proven their utility in improving detection and short-term cancer control. But none of these modalities have proven their utility in delaying progression, or in long-term cancer control. Cancer progression and long-term control are governed by the biological nature of cancer cells. Early detection by optical enhancement may not be of utility in this regard. Well-designed studies are needed to establish the efficacy of these modalities in the evaluation of patients with bladder cancer. The last word, in this regard, is yet to be written.
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Affiliation(s)
- Prashant Motiram Mulawkar
- Department of Urology, Tirthankar Superspeciality Hospital, Akola, India
- Tutor in Urology, University of Edinburgh, Edinburgh, United Kingdom
- *Correspondence: Prashant Motiram Mulawkar
| | | | | | - Utsav Shah
- Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
| | - Rickaz Raheem
- Milton Keynes University Hospital, Eaglestone, United Kingdom
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O'Sullivan S, Janssen M, Holzinger A, Nevejans N, Eminaga O, Meyer CP, Miernik A. Explainable artificial intelligence (XAI): closing the gap between image analysis and navigation in complex invasive diagnostic procedures. World J Urol 2022; 40:1125-1134. [PMID: 35084542 PMCID: PMC8791809 DOI: 10.1007/s00345-022-03930-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 11/30/2021] [Indexed: 12/24/2022] Open
Abstract
Literature review Cystoscopy is the gold standard for initial macroscopic assessments of the human urinary bladder to rule out (or diagnose) bladder cancer (BCa). Despite having guidelines, cystoscopic findings are diverse and often challenging to classify. The extent of the false negatives and false positives in cystoscopic diagnosis is currently unknown. We suspect that there is a certain degree of under-diagnosis (like the failure to detect malignant tumours) and over-diagnosis (e.g. sending the patient for unnecessary transurethral resection of bladder tumors with anesthesia) that put the patient at risk. Conclusions XAI robot-assisted cystoscopes would help to overcome the risks/flaws of conventional cystoscopy. Cystoscopy is considered a less life-threatening starting point for automation than open surgical procedures. Semi-autonomous cystoscopy requires standards and cystoscopy is a good procedure to establish a model that can then be exported/copied to other procedures of endoscopy and surgery. Standards also define the automation levels—an issue for medical product law. These cystoscopy skills do not give full autonomy to the machine, and represent a surgical parallel to ‘Autonomous Driving’ (where a standard requires a human supervisor to remain in the ‘vehicle’). Here in robotic cystoscopy, a human supervisor remains bedside in the ‘operating room’ as a ‘human‐in‐the‐loop’ in order to safeguard patients. The urologists will be able to delegate personal- and time-consuming cystoscopy to a specialised nurse. The result of automated diagnostic cystoscopy is a short video (with pre-processed photos from the video), which are then reviewed by the urologists at a more convenient time.
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Affiliation(s)
- S O'Sullivan
- Department of Urology, University Hospital of Münster (UKM), Muenster, Germany.
| | - M Janssen
- Department of Urology, University Hospital of Münster (UKM), Muenster, Germany
| | - Andreas Holzinger
- Human-Centered AI Lab, Institute for Medical Informatics/Statistics, Medical University of Graz, Graz, Austria
- xAI Lab, Alberta Machine Intelligence Institute, University of Alberta, Edmonton, Canada
| | - Nathalie Nevejans
- AI Responsible Chair, Research Center in Law, Ethics and Procedures, Faculty of Law of Douai, University of Artois, Arras, France
| | - O Eminaga
- Department of Urology, Stanford University School of Medicine, Stanford, CA, USA
- Center for Artificial Intelligence in Medicine and Imaging, Stanford University School of Medicine, Stanford, CA, USA
| | - C P Meyer
- Urology Clinic, Ruhr‑University of Bochum, Bochum, Germany
| | - Arkadiusz Miernik
- Department of Urology, Faculty of Medicine, University of Freiburg-Medical Centre, Freiburg, Germany
- RaVeNNA 4Pi-Consortium of the German Federal Ministry of Education and Research (BMBF), Freiburg, Germany
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Bonfante G, Puliatti S, Sighinolfi MC, Eissa A, Ciarlariello S, Ferrari R, Ticonosco M, Goezen AS, Guven S, Rassweiler J, Bianchi G, Rocco B, Micali S. A survey-based study on the spread of en-bloc resection of bladder tumors among IEA and ESUT members. Minerva Urol Nephrol 2021; 73:413-416. [PMID: 34494413 DOI: 10.23736/s2724-6051.21.04627-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Giulia Bonfante
- Department of Urology, University of Modena and Reggio Emilia, Modena, Italy -
| | - Stefano Puliatti
- Department of Urology, University of Modena and Reggio Emilia, Modena, Italy.,ORSI Academy, Melle, Belgium.,Department of Urology, Onze Lieve Vrouwe Hospital, Aalst, Belgium
| | - Maria C Sighinolfi
- Department of Urology, University of Modena and Reggio Emilia, Modena, Italy
| | - Ahmed Eissa
- Department of Urology, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Silvia Ciarlariello
- Department of Urology, University of Modena and Reggio Emilia, Modena, Italy
| | - Riccardo Ferrari
- Department of Urology, University of Modena and Reggio Emilia, Modena, Italy
| | - Marco Ticonosco
- Department of Urology, University of Modena and Reggio Emilia, Modena, Italy
| | - Ali Serdar Goezen
- Department of Urology, SLK-Kliniken Heilbronn, University of Heidelberg, Heidelberg, Germany
| | - Selcuk Guven
- Department of Urology, Necmettin Erbakan University, Meram School of Medicine, Konya, Turkey
| | - Jens Rassweiler
- Department of Urology, SLK-Kliniken Heilbronn, University of Heidelberg, Heidelberg, Germany
| | - Giampaolo Bianchi
- Department of Urology, University of Modena and Reggio Emilia, Modena, Italy
| | - Bernardo Rocco
- Department of Urology, University of Modena and Reggio Emilia, Modena, Italy
| | - Salvatore Micali
- Department of Urology, University of Modena and Reggio Emilia, Modena, Italy
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Mumm JN, Eismann L, Rodler S, Vilsmaier T, Zehni AZ, Apfelbeck M, Pfitzinger PL, Volz Y, Chaloupka M, Bauer RM, Stief CG, Staehler M. Listening to Music during Outpatient Cystoscopy Reduces Pain and Anxiety and Increases Satisfaction: Results from a Prospective Randomized Study. Urol Int 2021; 105:792-798. [PMID: 34280934 DOI: 10.1159/000517275] [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: 11/28/2020] [Accepted: 04/22/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND This study investigates the effect of classical music, music of patients' own choice, or no music on pain reduction during elective cystoscopy. OBJECTIVES The aim of the study was to describe the effect of listening to classical music, music of patients' own choice, or no music on patient's pain and satisfaction rates when carrying out an elective cystoscopy and the effect on the assessment capability of the performing urologist. DESIGN, SETTING, AND PARTICIPANTS This randomized trial included 127 patients undergoing elective cystoscopy at the Urological Department of the University Clinic of Munich between June 2019 and March 2020. Outcome Measurements and Statistical Analysis: Patients were assigned randomly to 3 groups: group I: listening to standardized classical music (n = 35), group II: listening to music according to the patients' choice (n = 34), and control group III: no music (n = 44). Prior to cystoscopy, anxiety levels were assessed by the Beck Anxiety Inventory (BAI). The Visual Analog Scale (VAS, range 1-100) was used for a self-assessment of pain, discomfort, and satisfaction. Statistical analysis was done with Spearman's rank correlation and t-tests. RESULTS AND LIMITATIONS The median age was 63 (range 27-91) years. The duration of cystoscopy was 5.7 (1-30) min. Patients had undergone a median of 2.3 cystoscopies in the past. Between giving informed consent and cystoscopy, patients had to wait for a median of 64 (0-260) min. The median VAS pain score was significantly lower in group I at 1.7 and group II at 2.3 versus 5.2 in the control group III (p < 0.001). The control group III had significantly worse pain and patient satisfaction rates compared with groups I and II. Group I had a significant lower VAS pain score than groups II and III (p < 0.001). Classical music also increased the assessment capability of the preforming urologist. CONCLUSIONS Listening to music during elective cystoscopy significantly reduces pain and distress and leads to higher patient and surgeon satisfaction. We recommend listening to classical music or music chosen by the patients during outpatient flexible/rigid cystoscopy in daily clinical routine. Patient Summary: In this study, we found that patients who listened to classical music or music of their own choice while undergoing a cystoscopy showed significant reduction of pain and distress.
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Affiliation(s)
- Jan-Niclas Mumm
- Department of Urology, Ludwig-Maximlians-University Munich (LMU), Munich, Germany
| | - Lennert Eismann
- Department of Urology, Ludwig-Maximlians-University Munich (LMU), Munich, Germany
| | - Severin Rodler
- Department of Urology, Ludwig-Maximlians-University Munich (LMU), Munich, Germany
| | - Theresa Vilsmaier
- Department of Gynacology, Ludwig-Maximlians-University Munich (LMU), Munich, Germany
| | - Alaleh Zati Zehni
- Department of Gynacology, Ludwig-Maximlians-University Munich (LMU), Munich, Germany
| | - Maria Apfelbeck
- Department of Urology, Ludwig-Maximlians-University Munich (LMU), Munich, Germany
| | - Paulo L Pfitzinger
- Department of Urology, Ludwig-Maximlians-University Munich (LMU), Munich, Germany
| | - Yannic Volz
- Department of Urology, Ludwig-Maximlians-University Munich (LMU), Munich, Germany
| | - Michael Chaloupka
- Department of Urology, Ludwig-Maximlians-University Munich (LMU), Munich, Germany
| | - Ricarda M Bauer
- Department of Urology, Ludwig-Maximlians-University Munich (LMU), Munich, Germany
| | - Christian G Stief
- Department of Urology, Ludwig-Maximlians-University Munich (LMU), Munich, Germany
| | - Michael Staehler
- Department of Urology, Ludwig-Maximlians-University Munich (LMU), Munich, Germany
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Graffeille V, Verhoest G, Gryn A, Kammerer-Jacquet SF, Alimi Q, Beauval JB, Beuzit L, Pradère B, Thoulouzan M, Khene ZE, Guille F, Rioux-Leclercq N, Mathieu R, Gamé X, Bensalah K, Soulié M, Roumiguié M, Peyronnet B. Complete Transurethral Resection before Radical Cystectomy May Improve Oncological Outcomes. Urol Int 2021; 106:122-129. [PMID: 33626547 DOI: 10.1159/000512053] [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] [Received: 06/21/2020] [Accepted: 10/04/2020] [Indexed: 11/19/2022]
Abstract
OBJECTIVES The objective of this study was to assess the impact of complete transurethral resection of bladder tumors (TURBTs) before radical cystectomy on pathological and oncological outcomes of patients with muscle-invasive bladder cancer (MIBC) and high-risk non-MIBC. MATERIALS AND METHODS The charts of all patients who underwent radical cystectomy for bladder cancer in 2 academic departments of urology between 1996 and 2016 were retrospectively reviewed. Patients were divided into 2 groups according to the completeness of the last endoscopic resection before radical cystectomy: macroscopically complete transurethral resection (complete) or macroscopically incomplete transurethral resection (incomplete). The primary end point was the recurrence-free survival (RFS). Secondary end points included cancer-specific survival (CSS) and rates of pT0 and downstaging. RESULTS Out of 486 patients included for analysis, the TURBT immediately preceding radical cystectomy was considered macroscopically complete in 253 patients (52.1%) and incomplete in 233 patients (47.9%). In multivariate analysis, macroscopically complete TURBT was the strongest predictor of both pT0 disease (OR = 3.1; p = 0.02) and downstaging (OR = 7.1; p < 0.0001). After a median follow-up of 41 months, macroscopically complete TURBT was associated with better RFS (5-year RFS: 57 vs. 37%; p < 0.0001) and CSS (5-year CSS: 70.8 vs. 54.5%; p = 0.002). In multivariate analysis adjusting for multifocality, weight of endoscopic resection specimen, cT4 stage on preoperative imaging, interval between endoscopic resection and radical cystectomy, neoadjuvant chemotherapy, pT stage, and associated carcinoma in situ, macroscopically complete endoscopic resection remained the main predictor of better RFS (HR = 0.4; p = 0.0003) and the only preoperative factor associated with CSS (HR = 0.5; p = 0.01). CONCLUSION A macroscopically complete TURBT immediately preceding radical cystectomy may improve pathological and oncological outcomes in patients with MIBC and high-risk MIBC.
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Affiliation(s)
- Vivien Graffeille
- Department of Urology, University Hospital of Rennes, Rennes, France,
| | - Grégory Verhoest
- Department of Urology, University Hospital of Rennes, Rennes, France
| | - Alexandre Gryn
- Department of Urology, University Hospital of Toulouse, Toulouse, France
| | | | - Quentin Alimi
- Department of Urology, University Hospital of Rennes, Rennes, France
| | | | - Luc Beuzit
- Department of Radiology, University Hospital of Rennes, Rennes, France
| | - Benjamin Pradère
- Department of Urology, University Hospital of Rennes, Rennes, France
| | | | - Zine Eddine Khene
- Department of Urology, University Hospital of Rennes, Rennes, France
| | - François Guille
- Department of Urology, University Hospital of Rennes, Rennes, France
| | | | - Romain Mathieu
- Department of Urology, University Hospital of Rennes, Rennes, France
| | - Xavier Gamé
- Department of Urology, University Hospital of Toulouse, Toulouse, France
| | - Karim Bensalah
- Department of Urology, University Hospital of Rennes, Rennes, France
| | - Michel Soulié
- Department of Urology, University Hospital of Toulouse, Toulouse, France
| | - Mathieu Roumiguié
- Department of Urology, University Hospital of Toulouse, Toulouse, France
| | - Benoit Peyronnet
- Department of Urology, University Hospital of Rennes, Rennes, France
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[Enhanced imaging in urological endoscopy]. Urologe A 2020; 60:8-18. [PMID: 33301070 DOI: 10.1007/s00120-020-01400-9] [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: 11/16/2020] [Indexed: 10/22/2022]
Abstract
White light cystoscopy and the concise documentation of pathological findings are standard diagnostic procedures in urology. Additional imaging modalities and technical innovations may support clinicians in the detection of bladder tumors. Modern endoscopy systems provide ultra-high-resolution imaging and the option of digital contrast enhancement. Photodynamic diagnostics and narrow band imaging are well-established in clinical routine and have shown significant benefits in the detection of bladder cancer. By means of multispectral imaging, different modalities can now be combined in real-time. Probe-based procedures such as optical coherence tomography (OCT) or Raman spectroscopy can further contribute to advanced imaging through an "optical biopsy" which may primarily improve diagnostics in the upper urinary tract. The aim of all techniques is to optimize the detection rate in order to achieve a more accurate diagnosis, resection and lower recurrence rates. Current research projects aim to digitalize the documentation of endoscopy and also make it more patient- and user-friendly. In the future, the use of image processing and artificial intelligence may automatically support the surgeon during endoscopy.
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