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Parrao D, Lizana N, Saavedra C, Larrañaga M, Lindsay CB, San Francisco IF, Bravo JC. Active Surveillance in Non-Muscle Invasive Bladder Cancer, the Potential Role of Biomarkers: A Systematic Review. Curr Oncol 2024; 31:2201-2220. [PMID: 38668066 PMCID: PMC11048875 DOI: 10.3390/curroncol31040163] [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: 03/15/2024] [Revised: 04/05/2024] [Accepted: 04/11/2024] [Indexed: 04/28/2024] Open
Abstract
Bladder cancer (BC) is the tenth most common cause of cancer worldwide and is the thirteenth leading cause of cancer mortality. The non-muscle invasive (NMI) variant represents 75% of cases and has a mortality rate of less than 1%; however, it has a high recurrence rate. The gold standard of management is transurethral resection in the case of new lesions. However, this is associated with significant morbidity and costs, so the reduction of these procedures would contribute to reducing complications, morbidity, and the burden to the health system associated with therapy. In this clinical scenario, strategies such as active surveillance have emerged that propose to manage low-risk BC with follow-up; however, due to the low evidence available, this is a strategy that is underutilized by clinicians. On the other hand, in the era of biomarkers, it is increasingly known how to use them as a tool in BC. Therefore, the aim of this review is to provide to clinical practitioners the evidence available to date on AS and the potential role of biomarkers in this therapeutic strategy in patients with low-grade/risk NMIBC. This is the first review linking use of biomarkers and active surveillance, including 29 articles.
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Affiliation(s)
- Diego Parrao
- School of Medicine, University of O’Higgins, Rancagua 282000, Chile; (D.P.); (N.L.); (C.S.)
| | - Nemecio Lizana
- School of Medicine, University of O’Higgins, Rancagua 282000, Chile; (D.P.); (N.L.); (C.S.)
| | - Catalina Saavedra
- School of Medicine, University of O’Higgins, Rancagua 282000, Chile; (D.P.); (N.L.); (C.S.)
| | - Matías Larrañaga
- Department of Urology, Libertador Bernardo O’Higgins Regional Hospital, Rancagua 282000, Chile;
| | - Carolina B. Lindsay
- Research Department, Libertador Bernardo O’Higgins Regional Hospital, Rancagua 282000, Chile;
| | - Ignacio F. San Francisco
- Division of Urologic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA;
| | - Juan Cristóbal Bravo
- Department of Urology, Libertador Bernardo O’Higgins Regional Hospital, Rancagua 282000, Chile;
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Kallidonis P, Peteinaris A, Ortner G, Pagonis K, Adamou C, Vagionis A, Liatsikos E, Somani B, Tokas T. Transurethral resection of bladder tumor: A systematic review of simulator-based training courses and curricula. Asian J Urol 2024; 11:1-9. [PMID: 38312823 PMCID: PMC10837651 DOI: 10.1016/j.ajur.2022.08.005] [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: 02/22/2022] [Accepted: 08/08/2022] [Indexed: 01/13/2023] Open
Abstract
Objective Transurethral resection of bladder tumor is one of the most common everyday urological procedures. This kind of surgery demands a set of skills that need training and experience. In this review, we aimed to investigate the current literature to find out if simulators, phantoms, and other training models could be used as a tool for teaching urologists. Methods A systematic review was performed according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses statement and the recommendations of the European Association of Urology guidelines for conducting systematic reviews. Fifteen out of 932 studies met our inclusion criteria and are presented in the current review. Results The UroTrainer (Karl Storz GmbH, Tuttlingen, Germany), a virtual reality training simulator, achieved positive feedback and an excellent face and construct validity by the participants. The inspection of bladder mucosa, blood loss, tumor resection, and procedural time was improved after the training, especially for inexperienced urologists and medical students. The construct validity of UroSim® (VirtaMed, Zurich, Switzerland) was established. SIMBLA simulator (Samed GmbH, Dresden, Germany) was found to be a realistic and useful tool by experts and urologists with intermediate experience. The test objective competency model based on SIMBLA simulator could be used for evaluating urologists. The porcine model of the Asian Urological Surgery Training and Education Group also received positive feedback by the participants that tried it. The Simulation and Technology Enhanced Learning Initiative Project had an extraordinary face and content validity, and 60% of participants would like to use the simulators in the future. The 5-day multimodal training curriculum "Boot Camp" in the United Kingdom achieved an increase of the level of confidence of the participants that lasted months after the project. Conclusion Simulators and courses or curricula based on a simulator training could be a valuable learning tool for any surgeon, and there is no doubt that they should be a part of every urologist's technical education.
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Affiliation(s)
| | | | - Gernot Ortner
- Department of Urology and Andrology, General Hospital Hall I.T., Hall in Tirol, Austria
| | | | | | | | - Evangelos Liatsikos
- Department of Urology, University Hospital of Rion, Patras, Greece
- Medical University of Vienna, Vienna, Austria
| | - Bhaskar Somani
- Department of Urology, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Theodoros Tokas
- Department of Urology and Andrology, General Hospital Hall I.T., Hall in Tirol, Austria
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Breyer J, Eckstein M, Sikic D, Wezel F, Roghmann F, Brehmer M, Wirtz RM, Jarczyk J, Erben P, Bahlinger V, Goldschmidt F, Fechner G, Chen J, Paxinos E, Bates M, Haas M, Zengerling F, Bolenz C, Burger M, Hartmann A, Kriegmair MC. Xpert bladder cancer monitor to predict the need for a second TURB (MoniTURB trial). Sci Rep 2023; 13:15437. [PMID: 37723173 PMCID: PMC10507065 DOI: 10.1038/s41598-023-42088-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 09/05/2023] [Indexed: 09/20/2023] Open
Abstract
To determine whether Xpert bladder cancer monitor, a noninvasive PCR-based biomarker test, can predict the need for 2nd transurethral resection of the bladder (TURB) better than clinical assessment. Patients scheduled for TURB were prospectively screened. After initial TURB, patients were assigned to 2nd TURB or follow-up cystoscopy at 3 months (FU) by clinicians' discretion. Central urine cytology and Xpert monitor tests were performed prior to the 1st TURB and 2nd TURB or FU, respectively. Statistical analysis to compare clinical assessment and Xpert monitor comprised sensitivity (SENS), specificity (SPEC), NPV and PPV. Of 756 screened patients, 171 were included (114 with 2nd TURB, 57 with FU). Residual tumors were detected in 34 patients who underwent 2nd TURB, and recurrent tumors were detected in 2 patients with FU. SENS and SPEC of Xpert monitor were 83.3% and 53.0%, respectively, PPV was 32.6% and NPV was 92.1%. Clinical risk assessment outperformed Xpert monitor. In patients with pTa disease at initial TURB, Xpert monitor revealed a NPV of 96%. Xpert monitor was not superior than clinical assessment in predicting the need for 2nd TURB. It might be an option to omit 2nd TURB for selected patients with pTa disease.
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Affiliation(s)
- Johannes Breyer
- Department of Urology, Caritas St. Josef Medical Center, University of Regensburg, Landshuter Str. 65, 93053, Regensburg, Germany.
- BRIDGE (Bladder Cancer Research Initiative for Drug Targets Germany) Consortium E.V., Mannheim, Germany.
| | - Markus Eckstein
- Institute of Pathology, Comprehensive Cancer Center EMN, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
- BRIDGE (Bladder Cancer Research Initiative for Drug Targets Germany) Consortium E.V., Mannheim, Germany
| | - Danijel Sikic
- Department of Urology and Pediatric Urology, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany
- BRIDGE (Bladder Cancer Research Initiative for Drug Targets Germany) Consortium E.V., Mannheim, Germany
| | - Felix Wezel
- Department of Urology and Pediatric Urology, University Hospital Ulm, Ulm, Germany
- BRIDGE (Bladder Cancer Research Initiative for Drug Targets Germany) Consortium E.V., Mannheim, Germany
| | - Florian Roghmann
- Department of Urology, Marien Hospital, Ruhr-University Bochum, Herne, Germany
- BRIDGE (Bladder Cancer Research Initiative for Drug Targets Germany) Consortium E.V., Mannheim, Germany
| | - Mirco Brehmer
- Department of Urology, Marien Hospital, Ruhr-University Bochum, Herne, Germany
| | - Ralph M Wirtz
- Stratifyer Molecular Pathology GmbH, Cologne, Germany
- Institute of Pathology, St. Elisabeth Hospital Köln-Hohenlind, Cologne, Germany
- BRIDGE (Bladder Cancer Research Initiative for Drug Targets Germany) Consortium E.V., Mannheim, Germany
| | - Jonas Jarczyk
- Department of Urology and Urosurgery, University Hospital Mannheim Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
- BRIDGE (Bladder Cancer Research Initiative for Drug Targets Germany) Consortium E.V., Mannheim, Germany
| | - Philipp Erben
- Department of Urology and Urosurgery, University Hospital Mannheim Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
- BRIDGE (Bladder Cancer Research Initiative for Drug Targets Germany) Consortium E.V., Mannheim, Germany
| | - Veronika Bahlinger
- Institute of Pathology, Comprehensive Cancer Center EMN, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
- BRIDGE (Bladder Cancer Research Initiative for Drug Targets Germany) Consortium E.V., Mannheim, Germany
| | - Franziska Goldschmidt
- Department of Urology and Pediatric Urology, University Hospital Bonn, Bonn, Germany
- BRIDGE (Bladder Cancer Research Initiative for Drug Targets Germany) Consortium E.V., Mannheim, Germany
| | - Guido Fechner
- Department of Urology and Pediatric Urology, University Hospital Bonn, Bonn, Germany
- BRIDGE (Bladder Cancer Research Initiative for Drug Targets Germany) Consortium E.V., Mannheim, Germany
| | - Jack Chen
- Biostatistics, Cepheid Inc., Sunnyvale, CA, USA
| | - Ellen Paxinos
- Medical and Scientific Affairs, Cepheid Inc., Sunnyvale, CA, USA
| | - Michael Bates
- Medical and Scientific Affairs, Cepheid Inc., Sunnyvale, CA, USA
| | - Maximilian Haas
- Department of Urology, Caritas St. Josef Medical Center, University of Regensburg, Landshuter Str. 65, 93053, Regensburg, Germany
- BRIDGE (Bladder Cancer Research Initiative for Drug Targets Germany) Consortium E.V., Mannheim, Germany
| | - Friedemann Zengerling
- Department of Urology and Pediatric Urology, University Hospital Ulm, Ulm, Germany
- BRIDGE (Bladder Cancer Research Initiative for Drug Targets Germany) Consortium E.V., Mannheim, Germany
| | - Christian Bolenz
- Department of Urology and Pediatric Urology, University Hospital Ulm, Ulm, Germany
- BRIDGE (Bladder Cancer Research Initiative for Drug Targets Germany) Consortium E.V., Mannheim, Germany
| | - Maximilian Burger
- Department of Urology, Caritas St. Josef Medical Center, University of Regensburg, Landshuter Str. 65, 93053, Regensburg, Germany
- BRIDGE (Bladder Cancer Research Initiative for Drug Targets Germany) Consortium E.V., Mannheim, Germany
| | - Arndt Hartmann
- Institute of Pathology, Comprehensive Cancer Center EMN, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
- BRIDGE (Bladder Cancer Research Initiative for Drug Targets Germany) Consortium E.V., Mannheim, Germany
| | - Maximilian C Kriegmair
- Department of Urology and Urosurgery, University Hospital Mannheim Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
- BRIDGE (Bladder Cancer Research Initiative for Drug Targets Germany) Consortium E.V., Mannheim, Germany
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Boca B, Caraiani C, Telecan T, Pintican R, Lebovici A, Andras I, Crisan N, Pavel A, Diosan L, Balint Z, Lupsor-Platon M, Buruian MM. MRI-Based Radiomics in Bladder Cancer: A Systematic Review and Radiomics Quality Score Assessment. Diagnostics (Basel) 2023; 13:2300. [PMID: 37443692 DOI: 10.3390/diagnostics13132300] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 06/30/2023] [Accepted: 07/03/2023] [Indexed: 07/15/2023] Open
Abstract
(1): Background: With the recent introduction of vesical imaging reporting and data system (VI-RADS), magnetic resonance imaging (MRI) has become the main imaging method used for the preoperative local staging of bladder cancer (BCa). However, the VI-RADS score is subject to interobserver variability and cannot provide information about tumor cellularity. These limitations may be overcome by using a quantitative approach, such as the new emerging domain of radiomics. (2) Aim: To systematically review published studies on the use of MRI-based radiomics in bladder cancer. (3) Materials and Methods: We performed literature research using the PubMed MEDLINE, Scopus, and Web of Science databases using PRISMA principles. A total of 1092 papers that addressed the use of radiomics for BC staging, grading, and treatment response were retrieved using the keywords "bladder cancer", "magnetic resonance imaging", "radiomics", and "textural analysis". (4) Results: 26 papers met the eligibility criteria and were included in the final review. The principal applications of radiomics were preoperative tumor staging (n = 13), preoperative prediction of tumor grade or molecular correlates (n = 9), and prediction of prognosis/response to neoadjuvant therapy (n = 4). Most of the developed radiomics models included second-order features mainly derived from filtered images. These models were validated in 16 studies. The average radiomics quality score was 11.7, ranging between 8.33% and 52.77%. (5) Conclusions: MRI-based radiomics holds promise as a quantitative imaging biomarker of BCa characterization and prognosis. However, there is still need for improving the standardization of image preprocessing, feature extraction, and external validation before applying radiomics models in the clinical setting.
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Affiliation(s)
- Bianca Boca
- Department of Radiology, "George Emil Palade", University of Medicine, Pharmacy, Science and Technology of Targu Mures, 540139 Targu Mures, Romania
- Department of Medical Imaging and Nuclear Medicine, "Iuliu Hațieganu" University of Medicine and Pharmacy Cluj-Napoca, 400012 Cluj-Napoca, Romania
| | - Cosmin Caraiani
- Department of Medical Imaging and Nuclear Medicine, "Iuliu Hațieganu" University of Medicine and Pharmacy Cluj-Napoca, 400012 Cluj-Napoca, Romania
| | - Teodora Telecan
- Department of Urology, "Iuliu Hațieganu" University of Medicine and Pharmacy Cluj-Napoca, 400012 Cluj-Napoca, Romania
- Department of Urology, Clinical Municipal Hospital, 400139 Cluj-Napoca, Romania
| | - Roxana Pintican
- Department of Radiology, "Iuliu Hațieganu" University of Medicine and Pharmacy Cluj-Napoca, 400012 Cluj-Napoca, Romania
| | - Andrei Lebovici
- Department of Radiology, "Iuliu Hațieganu" University of Medicine and Pharmacy Cluj-Napoca, 400012 Cluj-Napoca, Romania
| | - Iulia Andras
- Department of Urology, "Iuliu Hațieganu" University of Medicine and Pharmacy Cluj-Napoca, 400012 Cluj-Napoca, Romania
- Department of Urology, Clinical Municipal Hospital, 400139 Cluj-Napoca, Romania
| | - Nicolae Crisan
- Department of Urology, "Iuliu Hațieganu" University of Medicine and Pharmacy Cluj-Napoca, 400012 Cluj-Napoca, Romania
- Department of Urology, Clinical Municipal Hospital, 400139 Cluj-Napoca, Romania
| | - Alexandru Pavel
- Department of Radiology, "George Emil Palade", University of Medicine, Pharmacy, Science and Technology of Targu Mures, 540139 Targu Mures, Romania
| | - Laura Diosan
- Department of Computer Science, Faculty of Mathematics and Computer Science, "Babes-Bolyai" University, 400157 Cluj-Napoca, Romania
| | - Zoltan Balint
- Department of Biomedical Physics, Faculty of Physics, "Babes-Bolyai" University, 400084 Cluj-Napoca, Romania
| | - Monica Lupsor-Platon
- Department of Medical Imaging and Nuclear Medicine, "Iuliu Hațieganu" University of Medicine and Pharmacy Cluj-Napoca, 400012 Cluj-Napoca, Romania
- Department of Radiology, Regional Institute of Gastroenterology and Hepatology "Prof. Dr. Octavian Fodor", 400162 Cluj-Napoca, Romania
| | - Mircea Marian Buruian
- Department of Radiology, "George Emil Palade", University of Medicine, Pharmacy, Science and Technology of Targu Mures, 540139 Targu Mures, Romania
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Teoh JYC, Cho CL, Chan RCK, Liu K, Zhao H, Giannarini G, Enikeev D, Ng CF, Teoh AYB. A proof-of-concept study on endoscopic ultrasound-guided biopsy of detrusor muscle in porcine bladders. Front Oncol 2023; 13:1160463. [PMID: 37333813 PMCID: PMC10272740 DOI: 10.3389/fonc.2023.1160463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 05/23/2023] [Indexed: 06/20/2023] Open
Abstract
Introduction Conventionally, we rely on transurethral resection of bladder tumour (TURBT) for local staging of muscle-invasive bladder cancer (MIBC). However, the procedure is limited by its staging inaccuracy which may delay the definitive treatment of MIBC. Methods We conducted a proof-of concept study on endoscopic ultrasound (EUS)-guided biopsy of detrusor muscle in porcine bladders. Five porcine bladders were used in this experiment. Upon EUS, four layers of tissue including the mucosa (hypoechoic), submucosa (hyperechoic), detrusor muscle (hypoechoic) and serosa (hyperechoic) could be identified. Results A total of 37 EUS-guided biopsies were taken from 15 sites (three sites per bladder), and the mean number of biopsies taken from each site was 2.47±0.64. Among the 37 biopsies, 30 of them (81.1%) obtained detrusor muscle in the biopsy specimen. For the per biopsy site analysis, detrusor muscle was obtained in 73.3% if only one biopsy was taken, and 100% if two or more biopsies were taken from the same biopsy site. Overall, detrusor muscle was successfully obtained from all 15 biopsy sites (100%). No bladder perforation was observed throughout all biopsy processes. Conclusion EUS-guided biopsy of the detrusor muscle could be performed during the initial cystoscopy session, thus expediting the histological diagnosis and subsequent treatment of MIBC.
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Affiliation(s)
- Jeremy Yuen-Chun Teoh
- S.H. Ho Urology Centre, Department of Surgery, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
- Urothelial Carcinoma Working Group, European Association of Urology – Young Academic Urologists (EAU-YAU), Arnhem, Netherlands
| | - Chak-Lam Cho
- S.H. Ho Urology Centre, Department of Surgery, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Ronald Cheong-Kin Chan
- Department of Anatomical and Cellular Pathology, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Kang Liu
- S.H. Ho Urology Centre, Department of Surgery, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Hongda Zhao
- S.H. Ho Urology Centre, Department of Surgery, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Gianluca Giannarini
- Urology Unit, “Santa Maria della Misericordia” University Hospital, Udine, Italy
| | - Dmitry Enikeev
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
- Department of Urology, Medical University of Vienna, Vienna, Austria
| | - Chi-Fai Ng
- S.H. Ho Urology Centre, Department of Surgery, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Anthony Yuen-Bun Teoh
- Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
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Demirel E, Dilek O. Can automated CT body composition analysis predict high-grade Clavien-Dindo complications in patients with RCC undergoing partial and radical nephrectomy? Scott Med J 2023; 68:63-67. [PMID: 36946071 DOI: 10.1177/00369330231166122] [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: 03/23/2023]
Abstract
INTRODUCTION This study investigated the relationship between body tissue composition analysis and complications according to the Clavien-Dindo classification in patients with renal cell carcinoma (RCC) who underwent partial (PN) or radical nephrectomies (RN). METHODS We obtained all data of 210 patients with RCC from the 2019 Kidney and Kidney Tumor Segmentation Challenge (C4KC-KiTS) dataset and obtained radiological images from the cancer image archive. Body composition was assessed with automated artificial intelligence software using the convolutional network segmentation technique from abdominal computed tomography images. We included 125 PN and 63 RN in the study. The relationship between body fat and muscle tissue distribution and complications according to the Clavien-Dindo classification was evaluated between these two groups. RESULTS Clavien-Dindo 3A and higher (high grade) complications were developed in 9 of 125 patients who underwent PN and 7 of 63 patients who underwent RN. There was no significant difference between all body composition values between patients with and without high-grade complications. CONCLUSION This study showed that body muscle-fat tissue distribution did not affect patients with 3A and above complications according to the Clavien-Dindo classification in patients who underwent nephrectomy due to RCC.
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Affiliation(s)
- Emin Demirel
- Department of Radiology, Emirdag City of Hospital, Afyonkarahisar, Turkey
| | - Okan Dilek
- Department of Radiology, University of Health Sciences, Adana City Training and Research Hospital, Adana, Turkey
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Pan TT, Li SQ, Dai Y, Qi JX. Observation of complications assessed by Clavien-Dindo classification in different endoscopic procedures of benign prostatic hyperplasia: An observational study. Medicine (Baltimore) 2023; 102:e32691. [PMID: 36637957 PMCID: PMC9839300 DOI: 10.1097/md.0000000000032691] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
The Clavien-Dindo classification (CDC) was widely used in the assessment of surgical complications, but some inconsistencies always existed in urological literature. This study was aimed to report complications of the transurethral resection of the prostate (TURP), plasmakinetic resection of the prostate (PKRP), and holmium laser enucleation of the prostate (HoLEP) by using a more detailed way under the framework of CDC. A total of 623 eligible cases underwent endoscopic procedures from January 2018 and December 2020 were divided into the TURP group (212 cases), the PKRP group (208 cases), and the HoLEP group (203 cases) according to the surgical type. Patients' surgical complications assessed by the CDC were compared among the 3 groups. The operation time, intraoperative irrigation volume, postoperative irrigation time and volume, decrease in hemoglobin and sodium, postoperative catheterization time, visual analogue scale, hospital stay of the PKEP group and the HoLEP group were significantly less than those of the TURP group, and the decrease in hemoglobin and visual analogue scale in the HoLEP group were significantly lower than those in the PKEP group (all P < .05). The electrolyte disturbance, urinary tract irritation, and patients with grade II of CDC in the PKRP group were significantly lower than those in the TURP group; The electrolyte disturbance, lower abdominal pain, urinary tract irritation, intraoperative hemorrhage, secondary hemorrhage, clot retention, patients with grade I, II, III of CDC in the HoLEP group were significantly lower than those in the TURP group, and the urinary tract irritation, grade I, II of CDC in the HoLEP group was significantly lower than that in the PKRP group (all P < .05). The CDC should be recommended because of the enhanced insight into surgical complications, and the HoLEP should be given a priority for Benign prostatic hyperplasia (BPH) surgical treatment in terms of the merits in surgical characteristics and complications.
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Affiliation(s)
- Ting-ting Pan
- Department of Urology, The First People’s Hospital of Linping District, Hangzhou City, Zhejiang Province, China
- *Correspondence: Ting-ting Pan, Department of Urology, The First People’s Hospital of Linping District, No.369, Yingbin Road, Nanyuan Street, Linping District, Hangzhou City 311100, Zhejiang Province, China (e-mail: )
| | - Sheng-Qun Li
- Department of Urology, The First People’s Hospital of Linping District, Hangzhou City, Zhejiang Province, China
| | - Ya Dai
- Department of Urology, The First People’s Hospital of Linping District, Hangzhou City, Zhejiang Province, China
| | - Jia-Xian Qi
- Department of Urology, The First People’s Hospital of Linping District, Hangzhou City, Zhejiang Province, China
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Sunabe M, Hoshi T, Niisato E. Respiratory distress associated with acute hydrothorax during transurethral electrocoagulation: a case report. BMC Anesthesiol 2022; 22:37. [PMID: 35105305 PMCID: PMC8809017 DOI: 10.1186/s12871-022-01575-y] [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: 05/03/2021] [Accepted: 01/25/2022] [Indexed: 11/23/2022] Open
Abstract
Background In patients undergoing abdominal radiotherapy or transurethral surgery, bladder perforations are a possible complication. Likewise, pleural effusions due to a pleuroperitoneal leak caused by either a congenital or acquired diaphragmatic defect can also occur. We report a case in which a saline solution, which migrated into the abdominal cavity from a bladder perforation during transurethral electrocoagulation, further formed bilateral pleural effusions and caused rapid ventilation failure. Case presentation A patient undergoing radiation therapy and hormone therapy for prostate cancer underwent emergency surgery for electrocoagulation due to hematuria and a rapid drop in hemoglobin. The surgery began under general anesthesia, and we first noticed an increase in airway pressure and a decrease in dynamic lung compliance, followed by abdominal distension. Based on readouts from the respiratory mechanics monitor, we suspected lung abnormalities and performed a pulmonary ultrasound, leading to a diagnosis of bilateral pleural effusions, which we then drained. Conclusions Respiratory mechanics monitoring is simple and can be performed at all times during anesthesia, and when combined with pulmonary ultrasound, diagnoses can be made quickly and prevent deaths. Supplementary Information The online version contains supplementary material available at 10.1186/s12871-022-01575-y.
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Affiliation(s)
- Mei Sunabe
- Department of Anesthesiology and Critical Care Medicine, Ibaraki Prefectural Central Hospital, 6528 Koibuchi, Kasama, Ibaraki, 309-1793, Japan
| | - Takuo Hoshi
- Department of Anesthesiology and Critical Care Medicine, Ibaraki Clinical Education and Training Center, University of Tsukuba, 6528 Koibuchi, Kasama, Ibaraki, 309-1793, Japan.
| | - Emina Niisato
- Department of Anesthesiology and Critical Care Medicine, Ibaraki Prefectural Central Hospital, 6528 Koibuchi, Kasama, Ibaraki, 309-1793, Japan
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Warli SM, Andy A, Prapiska FF, Siregar GP, Sihombing B. Poor prognosis of urothelial carcinoma in patients presented with persistent paraneoplastic leukocytosis with anemia. Urol Ann 2022; 14:328-331. [PMID: 36505981 PMCID: PMC9731199 DOI: 10.4103/ua.ua_187_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 05/10/2022] [Indexed: 12/15/2022] Open
Abstract
Introduction Paraneoplastic leukocytosis is a rare manifestation of urological cancer. This condition is well associated with the poor prognosis in other solid tumors. Anemia is the most common hematological manifestation of cancer, affecting 40%-64% of patients with cancer. This condition is also well associated with a poor prognosis. The goal of this research is to determine the clinical presentation and fate of individuals with urothelial carcinoma who have persistent paraneoplastic leukocytosis and anemia. Methods From January 2014 to December 2020, a retrospective cohort of patients with a histological result of urothelial carcinoma was collected. Data were extracted from a single National Cancer Center Hospital in Indonesia. Persistent leukocytosis is defined as a leukocyte count ≥20,000/mL on at least two occasions with a minimum interval of 30 days. Anemia is defined using the WHO definition of anemia. Urinalysis, chest X-ray, and other blood tests were performed to exclude other probable causes of leukocytosis. Results Thirteen of 123 patients screened presented with persistent paraneoplastic leukocytosis and anemia. All patients presented with bladder cancer, with two patients (15.4%) presented with a mixed histological urothelial carcinoma. During the trial, all of the patients died, with a median survival of 20 days after the beginning of paraneoplastic leukocytosis with anemia. Conclusions Persistent paraneoplastic leukocytosis and anemia in a patient with urothelial carcinoma are a rare condition that is associated to a poor prognosis and a lower median overall survival time.
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Affiliation(s)
- Syah Mirsya Warli
- Department of Urology, Faculty of Medicine, Universitas Sumatera Utara – Universitas Sumatera Utara Hospital, Medan, Indonesia,Address for correspondence: Dr. Syah Mirsya Warli, Department of Urology, Faculty of Medicine, Universitas Sumatera Utara – Universitas Sumatera Utara Hospital, Medan, Indonesia. E-mail:
| | - Andy Andy
- Department of Surgery, Division of Urology, Faculty of Medicine, Universitas Sumatera Utara – Haji Adam Malik General Hospital, Medan, Indonesia
| | - Fauriski Febrian Prapiska
- Department of Surgery, Division of Urology, Faculty of Medicine, Universitas Sumatera Utara – Haji Adam Malik General Hospital, Medan, Indonesia
| | - Ginanda Putra Siregar
- Department of Surgery, Division of Urology, Faculty of Medicine, Universitas Sumatera Utara – Haji Adam Malik General Hospital, Medan, Indonesia
| | - Bungaran Sihombing
- Department of Surgery, Division of Urology, Faculty of Medicine, Universitas Sumatera Utara – Haji Adam Malik General Hospital, Medan, Indonesia
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10
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Zhang XJ, Zhu ZJ, Wu JJ. Application of Clavien-Dindo Classification System for Complications of Minimally Invasive Percutaneous Nephrolithotomy. JOURNAL OF HEALTHCARE ENGINEERING 2021; 2021:5361415. [PMID: 34956571 PMCID: PMC8694994 DOI: 10.1155/2021/5361415] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Accepted: 11/22/2021] [Indexed: 11/18/2022]
Abstract
Objective To investigate the clinical applications of the Clavien-Dindo classification system (CDCS) in the assessment of perioperative complications in minimally invasive percutaneous nephrolithotomy (MPCNL). Methods Totally, 390 patients with renal stones in our hospital from March 2015 to March 2020 were included for this study and then were divided into observation group (complication group, 78 cases) and control group (noncomplication group, 312 cases) according to the incidence of perioperative complications in CDCS. Single factor analysis and multivariate logistic regression analysis were used to analyze the risk factors of the perioperative complications of MPCNL. Results The total incidence of complication in the 390 cases with MPCNL was 20.00% (78 cases) according to CDCS, among which the incidence of complications at grades I, II, III, IV, and V was 6.92% (27 cases), 8.21% (32 cases), 2.82% (11 cases), 1.79% (7 cases), and 0.26% (1 case), respectively. The proportion of patients, that aged >60 years, complicated with comorbidities, sophisticated calculi, the preoperative albumin level (<35 g/L), the operation time (>180 minutes), intraoperative bleeding volume (>300 mL), and hospitalization time (>7 days) in the observation group was significantly higher than that in the control group ((75.64% vs. 61.86%, 38.46% vs. 24.36%, 83.33% vs. 69.55%, 83.33% vs. 69.55%, 70.51% vs. 30.76%, 53.85% vs. 36.54%, and 60.26% vs. 43.27%), all P < 0.05). Multivariate logistic regression analysis showed that gender, associated comorbidities, preoperative albumin level, calculus complexity, operation time, and intraoperative bleeding volume (>300 mL) were correlated with the occurrence of complications (P ≤ 0.001, 0.001, 0.001, 0.001, 0.003, and 0.001 respectively). Conclusion The CDCS can give standard and more comparative criteria for the assessment of perioperative complications, which will provide reference data for reducing complications and ensuring safety profiles in these high-risk patients.
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Affiliation(s)
- Xiao-Jun Zhang
- Department of Urology Surgery, The Affiliated Xiangshan Hospital of Wenzhou Medical University, Ningbo, Zhejiang Province 315700, China
| | - Zheng-Jie Zhu
- Department of Urology Surgery, The Affiliated Xiangshan Hospital of Wenzhou Medical University, Ningbo, Zhejiang Province 315700, China
| | - Jun-Jie Wu
- Department of Urology Surgery, The Affiliated Xiangshan Hospital of Wenzhou Medical University, Ningbo, Zhejiang Province 315700, China
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11
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Rehme C, Fritsch B, Thomas L, Istin S, Burchert C, Hummel B, Baleanu-Curaj B, Reis H, Szarvas T, Ruebben H, Hadaschik B, Niedworok C. Clinical outcome and quality of life in octogenarian patients with muscle-invasive urothelial carcinoma of the bladder treated with radical cystectomy or transurethral resection of the bladder tumor: a retrospective analysis of 143 patients. Int Urol Nephrol 2021; 54:71-79. [PMID: 34817753 PMCID: PMC8732805 DOI: 10.1007/s11255-021-03073-5] [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: 08/31/2021] [Accepted: 11/18/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE To compare clinical outcome and quality of life (QoL) in octogenarian patients with muscle-invasive urothelial carcinoma (MIBC) either treated by radical cystectomy (RC) or transurethral resection of the tumor (TURBT). METHODS We identified octogenarian patients with MIBC in our institutions since 2005. Clinical treatment outcomes and QoL were analyzed. Uni- and multivariable Cox regression analyses, two-tailed Wilcoxon test, Mann-Whitney test and Fisher's exact test were assessed as appropriate. QoL was evaluated using FACT-G (Functional Assessment of Cancer Therapy-General) questionnaire. RESULTS 143 patients were identified (RC: 51 cases, TURBT: 92 cases). Mean follow-up was 14 months (0-100 months). Median overall survival (OS) was 12 months in the RC group and 7 months in the TURBT group. TURBT and low preoperative hemoglobin were independent risk factors for reduced cancer-specific survival (CSS) (TURBT: p = 0.019, Hb: p = 0.008) and OS (TURBT: p = 0.026, Hb: p = 0.013) in multivariable analyses. Baseline QoL was low throughout the whole cohort. There was no difference in baseline FACT-G scoring comparing RC and TURBT (FACT-G total score (median): RC 43.7/108 vs. TURBT 44.0/108, p = 0.7144). Increased FACT-G questionnaire scoring was assessed for RC patients (median percentage score change RC 22.9%, TURBT 2.3%, p < 0.0001). CONCLUSION RC and TURBT are feasible treatment options for MIBC in octogenarian patients. In our cohort, RC was associated with increased CSS, OS and QoL. QoL in general was low throughout the whole cohort. Interdisciplinary decision-making has to be improved for these critically ill patients.
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Affiliation(s)
- Christian Rehme
- Department of Urology, University Hospital Essen, University of Duisburg-Essen, Hufelandstr. 52, 45147, Essen, Germany
| | - Beatrix Fritsch
- Department of Urology, University Hospital Essen, University of Duisburg-Essen, Hufelandstr. 52, 45147, Essen, Germany
| | - Luca Thomas
- Department of Urology, University Hospital Essen, University of Duisburg-Essen, Hufelandstr. 52, 45147, Essen, Germany
| | - Stefan Istin
- Department of Urology, Hermann-Josef-Hospital, Erkelenz, Germany
| | - Carolin Burchert
- Department of Urology, Hermann-Josef-Hospital, Erkelenz, Germany
| | - Bastian Hummel
- Department of Urology, Hermann-Josef-Hospital, Erkelenz, Germany
| | | | - Henning Reis
- Institute of Pathology, University Hospital Essen, University of Duisburg-Essen, Hufelandstr. 52, 45147, Essen, Germany
| | - Tibor Szarvas
- Department of Urology, University Hospital Essen, University of Duisburg-Essen, Hufelandstr. 52, 45147, Essen, Germany.,Department of Urology, Semmelweis University, Budapest, Hungary
| | - Herbert Ruebben
- Department of Urology, Helios Hospital Duisburg, Duisburg, Germany
| | - Boris Hadaschik
- Department of Urology, University Hospital Essen, University of Duisburg-Essen, Hufelandstr. 52, 45147, Essen, Germany
| | - Christian Niedworok
- Department of Urology, University Hospital Essen, University of Duisburg-Essen, Hufelandstr. 52, 45147, Essen, Germany. .,Department of Urology, Hermann-Josef-Hospital, Erkelenz, Germany.
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12
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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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13
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Kim N, Moon SK, You MW, Lim JW. Recurrence of Subepithelial Non-Muscle Invasive Bladder Cancer Following Transurethral Resection: A Case Report. JOURNAL OF THE KOREAN SOCIETY OF RADIOLOGY 2021; 82:715-720. [PMID: 36238798 PMCID: PMC9432446 DOI: 10.3348/jksr.2020.0108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 07/17/2020] [Accepted: 08/09/2020] [Indexed: 11/17/2022]
Abstract
Transurethral resection (TUR) is the gold standard treatment of non-muscle invasive bladder cancers. Recurrence occurs in approximately half of the patients with bladder cancer after initial TUR. Most recurrent bladder cancers present as polypoid masses with intraluminal growth originating from the mucosa. To the best of our knowledge, there has been no report on imaging findings of recurrent bladder cancers located within the subepithelial and intramural layers. Recurrent cancers within the intramural layer are difficult to detect with cystoscopy; they are also difficult to remove surgically. Imaging studies reveal the most important indicators for diagnosing subepithelial recurrent cancers. Here, we present a rare case of a recurrent bladder cancer within the subepithelial layer detected on imaging.
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Affiliation(s)
- Nokjung Kim
- Department of Radiology, Kyung Hee University Hospital, Seoul, Korea
| | - Sung Kyoung Moon
- Department of Radiology, Kyung Hee University Hospital, Seoul, Korea
| | - Myung-won You
- Department of Radiology, Kyung Hee University Hospital, Seoul, Korea
| | - Joo Won Lim
- Department of Radiology, Kyung Hee University Hospital, Seoul, Korea
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14
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[OUTCOMES OF BLADDER CANCER IN NONAGENARIANS]. Nihon Hinyokika Gakkai Zasshi 2021; 112:58-64. [PMID: 35444082 DOI: 10.5980/jpnjurol.112.58] [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: 11/08/2022]
Abstract
(Objectives) We evaluated the chronological change in the number and proportion of elderly patients with bladder cancer. We also retrospectively investigated the clinical outcomes of bladder cancer in patients of ≥90 years of age. (Patients and methods) We evaluated the chronological change in the number and proportion of patients of ≥90 years of age who were clinically diagnosed with bladder cancer and who underwent transurethral resection of a bladder tumor (TUR-BT) at our hospital between 2008 and 2018. We also assessed the clinicopathological factors, perioperative outcomes, and clinical outcomes in bladder cancer patients of ≥90 years of age. (Results) The number and proportion of bladder cancer patients of ≥90 years of age increased with time. A total of 39 patients of ≥90 years of age underwent TUR-BT at our hospital, among whom 22 were diagnosed with primary bladder cancer. The median age was 91 years. No grade ≥III complications were observed after TUR-BT. Two out of 6 with pT1 disease underwent second TUR-BT. Two out of 7 with pT1 disease or carcinoma in situ received intravesical BCG therapy. Six deaths were observed during the study period, 2 of which were due to bladder cancer. At 1 and 3 years after TUR-BT, the overall survival rates of the 22 patients were 80.4% and 68.9%, respectively. (Conclusions) The number and proportion of elderly patients with bladder cancer increased with time. The current standard of care including second TUR-BT and intravesical BCG therapy for high-risk non-muscle invasive bladder cancer was underutilized in nonagenarians.
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15
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Roumiguié M, Xylinas E, Brisuda A, Burger M, Mostafid H, Colombel M, Babjuk M, Palou Redorta J, Witjes F, Malavaud B. Consensus Definition and Prediction of Complexity in Transurethral Resection or Bladder Endoscopic Dissection of Bladder Tumours. Cancers (Basel) 2020; 12:cancers12103063. [PMID: 33092240 PMCID: PMC7589904 DOI: 10.3390/cancers12103063] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Revised: 10/05/2020] [Accepted: 10/06/2020] [Indexed: 12/24/2022] Open
Abstract
Simple Summary Transurethral resection of bladder tumours may be technically challenging. Complexity was defined by consensus from the literature by a panel of ten senior urologists as “any TURBT/En-bloc dissection that results in incomplete resection and/or prolonged surgery (>1 h) and/or significant (Clavien-Dindo ≥ 3) perioperative complications”. Patient and tumour’s characteristics that suggested to by the panel to relate to complex surgery were collected and then ranked by Delphi consensus. They were tested in the prediction of complexity in 150 clinical scenarios. After univariate and logistic regression analyses, significant characteristics were organized into a checklist that predicts complexity. Receiver operating characteristics (ROC) curves of the regression model and the corresponding calibration curve showed adequate discrimination (AUC = 0.916) and good calibration. The resulting Bladder Complexity Checklist can be used to deliver optimal preoperative information and personalise the organisation of surgery. Abstract Ten senior urologists were interrogated to develop a predictive model based on factors from which they could anticipate complex transurethral resection of bladder tumours (TURBT). Complexity was defined by consensus. Panel members then used a five-point Likert scale to grade those factors that, in their opinion, drove complexity. Consensual factors were highlighted through two Delphi rounds. Respective contributions to complexity were quantitated by the median values of their scores. Multivariate analysis with complexity as a dependent variable tested their independence in clinical scenarios obtained by random allocation of the factors. The consensus definition of complexity was “any TURBT/En-bloc dissection that results in incomplete resection and/or prolonged surgery (>1 h) and/or significant (Clavien-Dindo ≥ 3) perioperative complications”. Logistic regression highlighted five domains as independent predictors: patient’s history, tumour number, location, and size and access to the bladder. Receiver operating characteristic (ROC) analysis confirmed good discrimination (AUC = 0.92). The sum of the scores of the five domains adjusted to their regression coefficients or Bladder Complexity Score yielded comparable performance (AUC = 0.91, C-statistics, p = 0.94) and good calibration. As a whole, preoperative factors identified by expert judgement were organized to quantitate the risk of a complex TURBT, a crucial requisite to personalise patient information, adapt human and technical resources to individual situations and address TURBT variability in clinical trials.
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Affiliation(s)
- Mathieu Roumiguié
- Department of Urology, Institut Universitaire du Cancer, 31059 Toulouse CEDEX 9, France;
| | | | - Antonin Brisuda
- Department of Urology, 2nd Faculty of Medicine, Charles University, Teaching Hospital Motol, 15006 Prague, Czech Republic; (A.B.); (M.B.)
| | - Maximillian Burger
- St. Josef, Klinik für Urologie, Caritas-Krankenhaus, 93053 Regensburg, Germany;
| | - Hugh Mostafid
- Department of Urology, Royal Surrey County Hospital, Surrey, Guildford GU2 7RF, UK;
| | - Marc Colombel
- Department of Urology, Hôpital Edouard Herriot, 69437 Lyon, France;
| | - Marek Babjuk
- Department of Urology, 2nd Faculty of Medicine, Charles University, Teaching Hospital Motol, 15006 Prague, Czech Republic; (A.B.); (M.B.)
| | | | - Fred Witjes
- Department of Urology, Radboud UMC, 6525 GA Nijmegen, The Netherlands;
| | - Bernard Malavaud
- Department of Urology, Institut Universitaire du Cancer, 31059 Toulouse CEDEX 9, France;
- Correspondence:
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16
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Poletajew S, Ilczuk T, Krajewski W, Niemczyk G, Cyran A, Białek Ł, Radziszewski P, Górnicka B, Kryst P. Bladder perforation during transurethral resection of bladder tumour is not a result of a deficient structure of the bladder wall. World J Surg Oncol 2020; 18:216. [PMID: 32814580 PMCID: PMC7439624 DOI: 10.1186/s12957-020-01992-8] [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: 05/12/2020] [Accepted: 08/06/2020] [Indexed: 01/05/2023] Open
Abstract
Background Transurethral resection of the bladder tumour (TUR) is associated with a risk of bladder perforation. The underlying mechanisms and risk factors are not fully understood. The aim of this study was to determine if the bladder wall structure affects the risk of bladder perforation during TUR. Methods Fifteen patients who underwent TUR complicated by a bladder perforation (group 1) and fifteen matched controls who underwent uncomplicated TUR (group 2) were retrospectively enrolled in this morphological analysis. Surgical specimens were collected from all participating patients to describe the quality and architecture of urothelium and bladder submucosa. Immunohistochemical studies were performed with primary mouse anti-human E-cadherin, beta-catenin, type IV collagen, cytokeratin 20 and epithelial membrane antigen antibodies. The intensity of the immunohistochemical reaction was assessed using an immunoreactive score (IRS). Ultrastructural examinations were performed by transmission electron microscopy. The microscopic assessment was focused on the intensity of fibrosis in the bladder submucosa and the presence of degenerative changes in the urothelium. Results Patients’ age, sex distribution, tumour diameters, surgeon experience or cancer stage did not differ between study groups. The immunohistochemical analysis did not reveal statistically significant differences between group 1 and group 2. From a clinical point of view, ultrastructural analysis by electron microscopy showed a higher rate of severe fibrosis in group 1 (63.6% vs. 38.5%), with no differences in the rate and degree of urothelial changes. However, these differences were not statistically significant (p = 0.32). Conclusions Bladder perforation during TUR is not a result of a deficient structure of the bladder wall. Based on available evidence, the surgical technique seems to play the most important role in its prevention.
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Affiliation(s)
- Sławomir Poletajew
- Second Department of Urology, Centre of Postgraduate Medical Education, 80 Cegłowska St., 00809, Warsaw, Poland.
| | - Tomasz Ilczuk
- Department of Pathology, Medical University of Warsaw, Warsaw, Poland
| | - Wojciech Krajewski
- Department of Urology and Oncological Urology, Wrocław Medical University, Wrocław, Poland
| | - Grzegorz Niemczyk
- Department of General, Oncological and Functional Urology, Medical University of Warsaw, Warsaw, Poland
| | - Agata Cyran
- Department of Pathology, Medical University of Warsaw, Warsaw, Poland
| | - Łukasz Białek
- First Department of Urology, Centre of Postgraduate Medical Education, Warsaw, Poland
| | - Piotr Radziszewski
- Department of General, Oncological and Functional Urology, Medical University of Warsaw, Warsaw, Poland
| | - Barbara Górnicka
- Department of Pathology, Medical University of Warsaw, Warsaw, Poland
| | - Piotr Kryst
- Second Department of Urology, Centre of Postgraduate Medical Education, 80 Cegłowska St., 00809, Warsaw, Poland
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17
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Poletajew S, Krajewski W, Gajewska D, Sondka-Migdalska J, Borowik M, Buraczyński P, Dzięgała M, Łykowski M, Przudzik M, Tukiendorf A, Woźniak R, Bar K, Jabłonowski Z, Roslan M, Słojewski M, Zdrojowy R, Radziszewski P, Dziobek K. Prediction of the risk of surgical complications in patients undergoing monopolar transurethral resection of bladder tumour - a prospective multicentre observational study. Arch Med Sci 2020; 16:863-870. [PMID: 32542089 PMCID: PMC7286316 DOI: 10.5114/aoms.2019.88430] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2019] [Accepted: 04/21/2019] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION The aim of the study was to identify predictors of surgical complications of transurethral resection of bladder tumour (TURBT). MATERIAL AND METHODS We prospectively recruited 983 consecutive patients undergoing TURBT within 7 months in six academic institutions. All patients were followed up from the surgery up to 30 days postoperatively with at least one telephone contact at the end of the observation. The primary study endpoint was any intra- or postoperative surgical complication. For the identification of predictors of complications, univariate and multivariate logistic regression models were used. Trial registration: ClinicalTrials.gov (NCT03029663). Registered 24 January 2017. RESULTS Surgical complications were noticed in 228 (23.2%) patients, including 83 (8.4%) patients with more than one complication and 33 cases of Clavien-Dindo grade 3 complications (3.3%). The most common in-hospital complications were bleeding (n = 139, 14.1%) and bladder perforation (n = 46, 4.7%). In a multivariate analysis, nicotine use, high ASA score, and the presence of high-grade tumour were the most significant predictors of high-grade complications. The stage of the disease was the strongest predictor of bleeding, while the presence of muscle in the specimen and resident surgeon were the strongest predictors for bladder perforation. CONCLUSIONS TURBT poses a significant risk of surgical complications, the majority of which are of low grade.
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Affiliation(s)
- Sławomir Poletajew
- Department of General, Oncological, and Functional Urology, Medical University of Warsaw, Warsaw, Poland
| | - Wojciech Krajewski
- Department of Urology and Oncological Urology, Wroclaw Medical University, Wroclaw, Poland
- Corresponding author: Wojciech Krajewski PhD, Department of Urology and Oncological Urology, Wrocław Medical University, 213 Borowska St, 50-556 Wrocław, Poland, Phone: +48 691 510 609, E-mail:
| | - Dominika Gajewska
- Department of Urology and Urological Oncology, Pomeranian Medical University, Szczecin, Poland
| | | | - Michał Borowik
- Department of Urology, University of Warmia and Mazury, Olsztyn, Poland
| | - Paweł Buraczyński
- Department of Urology and Urologic Oncology, Medical University of Lublin, Lublin, Poland
| | - Mateusz Dzięgała
- Department of Urology and Oncological Urology, Wroclaw Medical University, Wroclaw, Poland
| | - Marcin Łykowski
- Department of General, Oncological, and Functional Urology, Medical University of Warsaw, Warsaw, Poland
| | - Maciej Przudzik
- Department of Urology, University of Warmia and Mazury, Olsztyn, Poland
| | | | - Rafał Woźniak
- Chair of Statistics and Econometrics, Faculty of Economic Sciences, University of Warsaw, Warsaw, Poland
| | - Krzysztof Bar
- Department of Urology and Urologic Oncology, Medical University of Lublin, Lublin, Poland
| | | | - Marek Roslan
- Department of Urology, University of Warmia and Mazury, Olsztyn, Poland
| | - Marcin Słojewski
- Department of Urology and Urological Oncology, Pomeranian Medical University, Szczecin, Poland
| | - Romuald Zdrojowy
- Department of Urology and Oncological Urology, Wroclaw Medical University, Wroclaw, Poland
| | - Piotr Radziszewski
- Department of General, Oncological, and Functional Urology, Medical University of Warsaw, Warsaw, Poland
| | - Konrad Dziobek
- Maria Sklodowska-Curie Memorial Cancer Centre and Institute of Oncology, Krakow Branch, Krakow, Poland
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Maheshwari PN, Pore AP, Patil SR, Okwi N. Transurethral En bloc Excision of Pediatric Bladder Tumor using Holmium Laser. J Indian Assoc Pediatr Surg 2019; 24:203-205. [PMID: 31258271 PMCID: PMC6568143 DOI: 10.4103/jiaps.jiaps_244_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 12-year-old male child, during evaluation of chronic constipation, was incidentally diagnosed to have a fronded bladder growth. Transurethral en bloc excision of the tumor was achieved using holmium laser. Histopathology confirmed it to be an inflammatory pseudotumor. This case is reported for its unusual presentation and management by holmium laser.
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Affiliation(s)
| | - Anant P Pore
- Department of Urology, Fortis Hospital Mulund, Mumbai, Maharashtra, India
| | - Saurabh R Patil
- Department of Urology, Fortis Hospital Mulund, Mumbai, Maharashtra, India
| | - Nick Okwi
- Department of Urology, Fortis Hospital Mulund, Mumbai, Maharashtra, India.,Department of Surgery, Busitema University of Health Sciences, Mbale, Uganda
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Panach-Navarrete J, Valls-González L, Sánchez-Cano E, Medina-González M, Castelló-Porcar A, Martínez-Jabaloyas JM. Comparison of three different antibiotic protocols in transurethral resection of bladder tumour and the possible infectious risk factors: A non-randomized, prospective study. Can Urol Assoc J 2018; 12:E466-E674. [PMID: 29989880 DOI: 10.5489/cuaj.5207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION We sought to investigate three different antibiotic protocols in transurethral resection of a bladder tumour (TURBT), and the possible infectious risk factors of this surgery. METHODS We conducted a non-randomized, prospective study, gathering cases of patients in whom TURBT had been performed. The sample was divided into three groups based on those who received antibiotics as: a single preoperative dose (Group A); a preoperative dose, plus a long protocol during the hospitalization (Group B); a preoperative dose, plus a long protocol during the hospitalization, plus five days at home (Group C). Intra- and postoperative data that could be relevant to infections was gathered. RESULTS A total of 219 patients were included. In the multivariate analysis, it was observed that the patients in Group A were more prone to re-hospitalization due to fever than were those from Group C (odds ratio [OR] 11.13; p=0.03). Furthermore, the cases with tumour necrosis and those who entered surgery with a urinary catheter were more prone to have a temperature above 37.5°C (OR6.74; p=0.02 and OR6.4; p=0.04, respectively), as well as have an increased risk per every additional tumour in the cystoscopy (OR 1.32; p=0.01). Those who received mitomycin had a lower chance of a positive urine culture (OR 0.29; p=0.01), contrary to those patients with over two days of hospitalization (OR 4.11; p<0.01) and those who entered surgery with a urinary catheter (OR 12.35; p=0.02). CONCLUSIONS Those patients that only received a single dose of antibiotic before TURBT may have an increased risk of re-hospitalization due to fever in comparison to those who received prolonged antibiotic protocols. In addition, there are perioperative factors in this surgery that predict the risk of infectious complications.
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Affiliation(s)
- Jorge Panach-Navarrete
- Department of Urology, University Clinic Hospital of Valencia and Facultat de Medicina i Odontologia, Universitat de València, Valencia, Spain
| | - Lorena Valls-González
- Department of Urology, University Clinic Hospital of Valencia and Facultat de Medicina i Odontologia, Universitat de València, Valencia, Spain
| | - Eduardo Sánchez-Cano
- Department of Urology, University Clinic Hospital of Valencia and Facultat de Medicina i Odontologia, Universitat de València, Valencia, Spain
| | - María Medina-González
- Department of Urology, University Clinic Hospital of Valencia and Facultat de Medicina i Odontologia, Universitat de València, Valencia, Spain
| | - Ana Castelló-Porcar
- Department of Urology, University Clinic Hospital of Valencia and Facultat de Medicina i Odontologia, Universitat de València, Valencia, Spain
| | - José María Martínez-Jabaloyas
- Department of Urology, University Clinic Hospital of Valencia and Facultat de Medicina i Odontologia, Universitat de València, Valencia, Spain
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Srivastava A, Bansal A, Sureka SK, Yadav P, Srivastava D, Jena R, Singh UP, Vashishtha S, Ansari MS, Kapoor R. A retrospective analysis of complications of laparoscopic left donor nephrectomy using the Kocak's modification of Clavien-Dindo system. Indian J Urol 2018; 34:133-139. [PMID: 29692507 PMCID: PMC5894286 DOI: 10.4103/iju.iju_111_17] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Introduction: Kocak described a modification of Clavien-Dindo classification system (CDCS) for reporting procedure-related complications in laparoscopic donor nephrectomy (LDN). We used the Kocak modification in grading and reporting the severity of complications in patients who underwent LDN and in evaluating various parameters that predict them. Methods: In all, 1430 patients who underwent left LDN from 2000 to 2016 were included in this study. All data was retrospectively collected and analyzed for complications occurring in the postoperative period. All complications were classified according to the four grades of Kocak-modified CDCS. Results: 124 patients (8.6%) suffered a total of 235 postoperative complications. Most of the complications were Grade I and Grade II (Grade I: 79.5% [n = 187] and Grade II 16.2% [n = 38]), 2.5% of the complications were Grade III (n = 6) and Kocak Grade IVa complications occurred in three patients. There was one death (Grade IVb: 0.4%, overall mortality rate: 0.06%). The incidence of complications was significantly greater for male patients, those with body mass index ≥25 kg/m2, and if the operating surgeon had ≤ 1 year of experience in performing LDN surgery. Conclusion: LDN is a safe procedure with low morbidity. The rate of complications is 8.6% and most of these complications are of low grade. The use of a standardized system for reporting the complications of LDN allows appropriate comparison between reported data.
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Affiliation(s)
- Aneesh Srivastava
- Department of Urology and Renal Transplant, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Ankur Bansal
- Department of Urology and Renal Transplant, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Sanjoy K Sureka
- Department of Urology and Renal Transplant, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Priyank Yadav
- Department of Urology and Renal Transplant, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Devarshi Srivastava
- Department of Urology and Renal Transplant, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Rahul Jena
- Department of Urology and Renal Transplant, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Uday P Singh
- Department of Urology and Renal Transplant, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Saurabh Vashishtha
- Department of Urology and Renal Transplant, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - M S Ansari
- Department of Urology and Renal Transplant, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Rakesh Kapoor
- Department of Urology and Renal Transplant, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
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