Interruption of BCG Therapy for NMIBC During COVID-19 Crisis, Dilemma in Its Continuation: a Review of Available Evidence and Suggested Management Strategies

The COVID-19 disease, caused by SARS-CoV-2 virus, has been one of the worst pandemics ever to hit the human mankind. Undoubtedly the start of the second wave of COVID-19 has literally ripped apart the hearts of millions of people. Cancer patients have been left of the beaten track to their fate, with no access to treatments. Intravesical BCG instillation is the standard of care for patients with non-muscle invasive bladder cancer (NMIBC). Several patients were in the middle of their treatment regimen when this pandemic struck. As slowly the word is recuperating from concussion effect of this pandemic and routine health services are being restored, uro-oncologist will face a unique scenario with respect to intravesical BCG therapy i.e., whether to restart the course of BCG therapy or to continue course from where it was interrupted. There are no studies in literature to directly answer this peculiar question and to resolve this dilemma. So, we in this review article propose to explore the literature for the most appropriate therapeutic regimen for these patients with interruption of intravesical BCG therapy. We plan to divide the patients with interruption to BCG therapy into the following three groups:Group 1: Patients who had interruption during the induction period.Group 2: Patients who completed the induction course but maintenance course could not be started.Group 3: Patients who had interruption during maintenance phase of BCG therapy. We will compile the recent recommendations by NCCN, AUA, and EAU for the administration of intravesical BCG in non-muscle invasive bladder cancer. We herein want to review the literature to propose the most appropriate strategy, its safety profile for these subsets of patients.

Supplementary Information

The online version contains supplementary material available at 10.1007/s13193-023-01742-8.

Bilateral renal aspergillosis with a fungal cast masquerading as renal malignancy

Invasive isolated renal aspergilloma in an immunocompetent host is rare, and few cases have been reported in the literature. It is a unique entity encountered by a urologist that can lead to catastrophic complications like end-stage renal disease. Infective pathology may closely resemble renal mass, and timely, appropriate investigations are obligatory for early intervention. This case report highlights the importance of strong consideration of renal fungal infections in the differential diagnosis of a renal mass with atypical radiological findings in an immunocompetent host. Meticulous decision-making and appropriate management help to prevent disastrous sequelae.

Surgical management of renal cell carcinoma invading the liver - a case report and systematic review

<b>Introduction:</b> Renal cell cancer (RCC) is one of the most lethal malignancies, accounting for 2.2% of all cancer diagnoses [1] </br></br> <b> Aim:</b> This study aims to perform the first systematic review of the operative techniques of simultaneous radical nephrectomy with hepatic resection for renal cell carcinoma (RCC) with direct hepatic extension. We also report a case of collecting duct RCC invading the liver who underwent simultaneous nephrectomy with hepatic resection. </br></br> <b>Materials and methods:</b> We searched the articles between the years 1991 and 1st April 2021 in English in PubMed, EMBASE, and Scopus databases. Case reports, case series, and matched cohort studies were included. Eligible studies reported on renal mass characteristics with the nature of extension, histopathological features, operative manoeuvres, and outcomes.Data were extracted as per Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines. </br></br> <b>Results:</b> The initial search strategy yielded 148 articles of which six articles were selected for review. The mean size of tumour was >10 cm, with the mean age of the patients being 51-67 years. All cases had RCC with direct extension to the liver, and all underwent simultaneous nephrectomy with liver resection. The most common histological type was clear cell carcinoma. The mean blood loss was 3.3 litres, and the mean hospital stay was 9.75 days. </br></br> <b>Conclusion:</b> This review shows that the invasion to surrounding structures, including the liver, by RCC is not so common, and it poses a treatment challenge for the clinician. Currently, en bloc surgical removal with anatomical or non-anatomical resection of the liver is the only modality that provides the best chance of control for the RCC with direct hepatic extension.

Acquired scrotal lymphangiectasia, a long-term sequela of penile carcinoma: diagnosis an enigma

Acquired lymphangiectasia is an unique entity encountered by an urologist which is marked by occlusion of lymphatics associated with abnormal permanent dilation of cutaneous lymphatics. There is presence of thin-walled ectatic vessels in the superficial and mid dermis, which develops later in life. Trauma, infection, radiation or surgery are important causes of this rare aetiology. Diagnosis is always demanding, as it closely resembles many benign aetiology. Meticulous decision-making and appropriate treatment should be chosen for the management.

Efficacy and safety of percutaneous nephrolithotomy in patients with chronic kidney disease: Outcomes from a tertiary care center

BACKGROUND

The management of renal stone disease in the presence of chronic kidney disease is a challenging scenario, both in terms of surgical safety as well as perioperative outcomes. The aim of the present study is to study the efficacy, safety, and outcomes of percutaneous nephrolithotomy in patients with chronic kidney disease.

MATERIALS AND METHODS

A prospective study was conducted including adult patients with renal stone disease and a creatinine clearance of <90ml/min (Stage 2 CKD or more) who underwent percutaneous nephrolithotomy. Pre-operative and post-operative serum creatinine and glomerular filtration rates were compared. Patients were divided into CKD stages 1-5 having creatinine clearance >90ml/min, 60-90ml/min, 30-60ml/min, 15-30ml/min and <15ml/min respectively. Based on up migration or down migration of CKD stages, patients were classified as improved, deteriorated or stable. Peri-operative complications and outcomes were also compared.

RESULTS

A total of 185 patients with CKD stage less than or equal to 2 underwent PCNL. The mean age of the patients was 43.24+/-14.32 years. The mean preoperative estimated glomerular filtration rate was 62.88±23.42mL/min/1.73m2. Pre-operative CKD stage distribution was as follows: stage 2-121(65.4%), stage 3-34(18.4%), stage 4-24(13%) and stage 5-6(3.2%). On last follow-up of patients, the mean creatinine was 1.07±0.65 mg/dL and the mean eGFR was 82.75±31.22 mL/min/1.73m2. The median change in creatinine and mean change in GFR was 0.23 (0.16-0.27) g/dL and 19.87 ± 19.77 mL/min/1.73 m2 respectively. Improvement in kidney function with a stage down migration was seen in 115 cases(62.2%), slight improvement with no change in stage in 69 cases(37.3%) and deterioration of CKD stage was present in one case(0.5%).

CONCLUSION

Percutaneous nephrolithotomy is associated with favourable functional outcomes in chronic kidney disease patients including severe CKD(stage IV and V). Improvement or stabilization of CKD stage was seen in 99.5% patients post PCNL.

Neoadjuvant Therapy for Cisplatin Ineligible Muscle Invasive Bladder Cancer Patients: A Review of Available Evidence

Neoadjuvant chemotherapy followed by radical cystectomy is the standard of care for muscle invasive non-metastatic bladder cancer patients. While cisplatin based neoadjuvant chemotherapy has been recommended, systemic therapy in a neoadjuvant setting for cisplatin ineligible patients still needs to be addressed. Various strategies like split dosing cisplatin chemotherapy, carboplatin based chemotherapy and taxanes based chemotherapy have been tried as neoadjuvant therapy for cisplatin ineligible patients. Immunotherapy is a promising tool in this regard with a need for the development of predictive and prognostic biomarkers which can bring out the true potential of these immunotherapeutic agents.