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Tandon M, Chakraborty S, Barkondaj B, Choudhury S, Pal DK. Role of multiparametric MRI in predicting muscle invasiveness in urinary bladder neoplasms with pathological correlations. Urologia 2024; 91:55-60. [PMID: 37886848 DOI: 10.1177/03915603231204078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2023]
Abstract
Urinary bladder cancer (BC) is one of the most frequent malignancies and the ninth most common malignancy worldwide. The objective of this study is to assess the role of multiparametric magnetic resonance imaging (mp-MRI) in predicting the invasiveness of urinary bladder space occupying lesions. Thirty-five patients diagnosed with bladder masses underwent an mp-MRI study. The results of three image sets were analysed and compared with the histopathological results as a reference standard: T2-weighted image (T2WI) plus dynamic contrast-enhanced (DCE), T2WI plus diffusion-weighted images (DWI), and mp-MRI, including T2WI plus DWI and DCE. The diagnostic accuracy of mp-MRI was evaluated using receiver operating characteristic curve analysis. We discovered a highly significant correlation between muscle invasiveness as staged by HPE (Histopathological examination) and mp-MRI utilising a VI-RADS score >3 (p 0.001) with a sensitivity of 100% and a specificity of 85.7%. With a diagnostic accuracy of 77.14%, a sensitivity of 92.31%, a specificity of 72.72%, a positive predictive value of 66.67%, and a negative predictive value of 94.11%, In terms of muscle invasiveness, there is good concordance between HPE staging and mp-MRI utilising the VI-RADS score. The mean apparent diffusion coefficient (ADC) values were higher in low grades than in high grades. The ROC curve study revealed a very strong correlation between HPE grade and ADC (p = 0.045). In 77.14% of patients, Mp-MRI correctly identified the local T stage. Mp-MRI is imaging biomarker for invasiveness and grade of tumour. The tumours with high grade are more invasive. However, the diagnostic accuracy of mp-MRI in determining muscle invasiveness is not very high and it overstages the disease in some cases (33.3%). Its clinical usefulness in determining muscle invasiveness before TURBT and histopathological examination can be questioned.
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Affiliation(s)
- Mrinal Tandon
- Department of Urology, IPGME&R, Kolkata, West Bengal, India
| | | | | | - Sunirmal Choudhury
- Department of urology, Medical College Hospital, Kolkata, West Bengal, India
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2
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Conroy S, Hubbard R, Noon AP, Hussain SA, Griffin J, Kennish S, Catto JWF. Case of the month from the University of Sheffield, UK: Expediting definitive treatment in patients with invasive bladder cancer: an MRI-guided pathway. BJU Int 2022; 129:691-694. [PMID: 35633131 PMCID: PMC9328312 DOI: 10.1111/bju.15730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 03/22/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Samantha Conroy
- Academic Urology Unit, Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK.,Department of Urology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Rachel Hubbard
- Department of Radiology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Aidan P Noon
- Department of Urology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Syed A Hussain
- Academic Oncology Unit, Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
| | - Jon Griffin
- Department of Histopathology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Steven Kennish
- Department of Radiology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - James W F Catto
- Academic Urology Unit, Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK.,Department of Urology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
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3
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Hensley PJ, Bree KK, Brooks N, Matulay J, Li R, Nogueras González GM, Navai N, Grossman HB, Dinney CP, Kamat AM. Time interval from transurethral resection of bladder tumour to bacille Calmette-Guérin induction does not impact therapeutic response. BJU Int 2021; 128:634-641. [PMID: 33783950 DOI: 10.1111/bju.15413] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To investigate bacille Calmette-Guérin (BCG) tolerability and response with respect to the timing of BCG administration after transurethral resection of bladder tumour (TURBT) in patients with non-muscle-invasive bladder cancer (NMIBC). PATIENTS AND METHODS A review of patients with NMIBC at our institution managed with at least 'adequate BCG' (defined by the United States Food and Drug Administration as at least five of six induction instillations, with two additional instillations comprising either maintenance or repeat induction) at our institution from 2000 to 2018 was performed. Time from TURBT to first instillation of induction BCG was stratified by quartile and analysed as a continuous variable. Kaplan-Meier and log-rank tests analysed differences in recurrence-free (RFS) and progression-free survival (PFS). Cox proportional hazards regression models identified associations between risk factors and survival outcomes. RESULTS A total of 518 patients received adequate BCG at a median (range) of 26 (6-188) days from TURBT. Overall, 45 patients (9%) developed BCG intolerance at a median (range) 12 (7-33) instillations. When time from TURBT to BCG was stratified into quartiles, there was no difference with respect BCG intolerance (P = 0.966), RFS (P = 0.632) or PFS (P = 0.789). On both uni- and multivariate regression analysis for RFS and PFS, time from TURBT to BCG was not a significant predictor when analysed by quartile or as a continuous variable (the hazard ratio for RFS was 1.00, 95% confidence interval [CI] 0.99-1.00, P = 0.449; and for PFS was 0.99, 95% CI 0.98-1.00, P = 0.074). CONCLUSION The rates of tolerability and response to adequate BCG are not predicated by the timing of induction BCG instillation after TURBT. Early administration in properly selected patients is safe and delays do not affect therapeutic response.
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Affiliation(s)
- Patrick J Hensley
- Department of Urology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Kelly K Bree
- Department of Urology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Nathan Brooks
- Department of Urology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Justin Matulay
- Department of Urology, Levine Cancer Institute, Atrium Health, Charlotte, NC, USA
| | - Roger Li
- Department of Genitourinary Oncology, Moffitt Cancer Center, Tampa, FL, USA
| | | | - Neema Navai
- Department of Urology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Herbert B Grossman
- Department of Urology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Colin P Dinney
- Department of Urology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Ashish M Kamat
- Department of Urology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Park J, Yu J, Hong JH, Hwang J, Kim Y. Head elevation and laryngeal mask airway Supreme insertion: A randomized controlled trial. Acta Anaesthesiol Scand 2021; 65:343-350. [PMID: 33174199 DOI: 10.1111/aas.13742] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 10/23/2020] [Accepted: 11/02/2020] [Indexed: 12/30/2022]
Abstract
BACKGROUND A laryngeal mask airway (LMA) is usually inserted by conventional 7 cm head elevation. However, little is known about the association of head elevation degree and LMA insertion. We hypothesized that 14 cm head elevation would increase the first attempt success rate of LMA Supreme insertion compared with conventional 7 cm head elevation in patients undergoing transurethral resection of bladder tumour. METHODS Patients were randomly allocated to the high group (n = 55, 14 cm head elevation) or the control group (n = 55, conventional 7 cm head elevation). The primary outcome was the first attempt success rate of LMA Supreme insertion. RESULTS The first attempt success rate was significantly higher in the high group than in the control group (53 [96.4%] vs 40 [72.7%], P = .001, relative risk = 1.30, 95% confidence interval [CI] = 1.12-1.57, absolute risk reduction = 23.7%). Fibreoptic bronchoscope grade 4 (ie optimal position of the LMA) was significantly higher in the high group (35 [64.8%] vs 18 [36.7%], P = .004, relative risk = 1.76, 95% CI = 1.16-2.68, absolute risk reduction = 30.9%). CONCLUSIONS Head elevation of 14 cm height increased the first attempt success rate of LMA Supreme insertion and fibreoptic bronchoscopic grade in patients undergoing transurethral resection of bladder tumour. High head elevation can be an effective option for successful LMA Supreme insertion. Trial Registry Number: Clinicaltrials.gov (NCT04229862).
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Affiliation(s)
- Jun‐Young Park
- Department of Anesthesiology and Pain Medicine Asan Medical Center University of Ulsan College of Medicine Seoul Republic of Korea
| | - Jihion Yu
- Department of Anesthesiology and Pain Medicine Asan Medical Center University of Ulsan College of Medicine Seoul Republic of Korea
| | - Jun Hyuk Hong
- Department of Urology Asan Medical Center University of Ulsan College of Medicine Seoul Republic of Korea
| | - Jai‐Hyun Hwang
- Department of Anesthesiology and Pain Medicine Asan Medical Center University of Ulsan College of Medicine Seoul Republic of Korea
| | - Young‐Kug Kim
- Department of Anesthesiology and Pain Medicine Asan Medical Center University of Ulsan College of Medicine Seoul Republic of Korea
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5
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Del Giudice F, Leonardo C, Simone G, Pecoraro M, De Berardinis E, Cipollari S, Flammia S, Bicchetti M, Busetto GM, Chung BI, Gallucci M, Catalano C, Panebianco V. Preoperative detection of Vesical Imaging-Reporting and Data System (VI-RADS) score 5 reliably identifies extravesical extension of urothelial carcinoma of the urinary bladder and predicts significant delayed time to cystectomy: time to reconsider the need for primary deep transurethral resection of bladder tumour in cases of locally advanced disease? BJU Int 2020; 126:610-619. [PMID: 32783347 DOI: 10.1111/bju.15188] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVES (I) To determine Vesical Imaging-Reporting and Data System (VI-RADS) score 5 accuracy in predicting locally advanced bladder cancer (BCa), so as to potentially identify those patients who could avoid the morbidity of deep transurethral resection of bladder tumour (TURBT) in favour of histological sampling-TUR prior to radical cystectomy (RC). (II) To explore the predictive value of VI-RADS score 5 on time-to-cystectomy (TTC) outcomes. PATIENTS AND METHODS We retrospectively reviewed patients' ineligible or refusing cisplatin-based combination neoadjuvant chemotherapy who underwent multiparametric magnetic resonance imaging (mpMRI) of the bladder prior to staging TURBT followed by RC for muscle-invasive BCa. Sensitivity, specificity, positive and negative predictive values (PPV, NPV) were calculated for VI-RADS score 5 vs. score 2-4 cases to assess the accuracy of mpMRI for extravesical BCa detection (≥pT3). VI-RADS score performance was assessed by receiver operating characteristics curve analysis. A Κ statistic was calculated to estimate mpMRI and pathological diagnostic agreement. The risk of delayed TTC (i.e. time from initial BCa diagnosis of >3 months) was assessed using multivariable logistic regression model. RESULTS A total of 149 T2-T4a, cN0-M0 patients (VI-RADS score 5, n = 39 vs VI-RADS score 2-4, n = 110) were examined. VI-RADS score 5 demonstrated sensitivity, specificity, PPV and NPV, in detecting extravesical disease of 90.2% (95% confidence interval [CI] 84-94.3), 98.1% (95% CI 94-99.6), 94.9% (95% CI 89.6-97.6) and 96.4% (95% CI 91.6-98.6), respectively. The area under the curve was 94.2% (95% CI 88.7-99.7) and inter-reader agreement was excellent (Κinter 0.89). The mean (SD) TTC was 4.2 (2.3) and 2.8 (1.1) months for score 5 vs 2-4, respectively (P < 0.001). VI-RADS score 5 was found to independently increase risk of delayed TTC (odds ratio 2.81, 95% CI 1.20-6.62). CONCLUSION The VI-RADS is valid and reliable in differentiating patients with extravesical disease from those with muscle-confined BCa before TURBT. Detection of VI-RADS score 5 was found to predict significant delay in TTC independently from other clinicopathological features. In the future, higher VI-RADS scores could potentially avoid the morbidity of extensive primary resections in favour of sampling-TUR for histology. Further prospective, larger, and multi-institutional trials are required to validate clinical applicability of our findings.
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Affiliation(s)
- Francesco Del Giudice
- Department of, Departments of, Maternal-Infant and Urological Sciences, "Sapienza" University of Rome, Policlinico Umberto, Hospital, Rome, Italy.,Department of Urology, Stanford University, School of Medicine, Stanford, CA, USA
| | - Costantino Leonardo
- Department of, Departments of, Maternal-Infant and Urological Sciences, "Sapienza" University of Rome, Policlinico Umberto, Hospital, Rome, Italy
| | - Giuseppe Simone
- Department of Urology, "Regina Elena" National Cancer Institute, IRCCS, Rome, Italy
| | - Martina Pecoraro
- Department of Radiological Sciences, Oncology & Pathology, "Sapienza" University of Rome, Policlinico Umberto, Hospital, Rome, Italy
| | - Ettore De Berardinis
- Department of, Departments of, Maternal-Infant and Urological Sciences, "Sapienza" University of Rome, Policlinico Umberto, Hospital, Rome, Italy
| | - Stefano Cipollari
- Department of Radiological Sciences, Oncology & Pathology, "Sapienza" University of Rome, Policlinico Umberto, Hospital, Rome, Italy
| | - Simone Flammia
- Department of, Departments of, Maternal-Infant and Urological Sciences, "Sapienza" University of Rome, Policlinico Umberto, Hospital, Rome, Italy
| | - Marco Bicchetti
- Department of Radiological Sciences, Oncology & Pathology, "Sapienza" University of Rome, Policlinico Umberto, Hospital, Rome, Italy
| | - Gian Maria Busetto
- Department of, Departments of, Maternal-Infant and Urological Sciences, "Sapienza" University of Rome, Policlinico Umberto, Hospital, Rome, Italy
| | - Benjamin I Chung
- Department of Urology, Stanford University, School of Medicine, Stanford, CA, USA
| | - Michele Gallucci
- Department of, Departments of, Maternal-Infant and Urological Sciences, "Sapienza" University of Rome, Policlinico Umberto, Hospital, Rome, Italy
| | - Carlo Catalano
- Department of Radiological Sciences, Oncology & Pathology, "Sapienza" University of Rome, Policlinico Umberto, Hospital, Rome, Italy
| | - Valeria Panebianco
- Department of Radiological Sciences, Oncology & Pathology, "Sapienza" University of Rome, Policlinico Umberto, Hospital, Rome, Italy
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6
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Poletajew S, Krajewski W, Stelmach P, Adamowicz J, Nowak Ł, Moschini M, Zapała P, Drewa T, Paradysz A, Radziszewski P, Zdrojowy R, Kryst P. En-bloc resection of urinary bladder tumour - a prospective controlled multicentre observational study. Wideochir Inne Tech Maloinwazyjne 2021; 16:145-50. [PMID: 33786128 DOI: 10.5114/wiitm.2020.95399] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2020] [Accepted: 03/02/2020] [Indexed: 11/17/2022] Open
Abstract
Introduction Transurethral resection of bladder tumour (TURBT) is one of the most commonly performed urologic procedures. Because of the shortcomings of conventional TURBT, the en-bloc resection concept was created. Aim To analyse the influence of en-bloc technique on surgical and oncological outcomes of TURBT performed with electric current. Material and methods This non-randomized, prospective controlled multicentre study enrolled 427 consecutive patients undergoing TURBT performed by five experienced endourologists in five academic institutions. Choice of procedure was at the discretion of the surgeon. The vast majority of patients underwent monopolar resection. The en-bloc procedure was performed with Collin's knife or the classic resection loop. Study end-points were surgery, catheterization and hospitalization time, presence of muscularis propria (MP) in the specimen and 3-month recurrence-free survival (RFS). Results The study included 427 (274 conventional TURBT vs. 153 en-bloc) patients with mean age of 69 years (range: 18-99). There were more cases with MP present in the specimen in the en-bloc group (91.3% vs. 75.5%; p < 0.001). Surgery and hospitalization times were statistically shorter in the en-bloc group (both p < 0.05). A borderline significant difference was noted when the number of residual tumours in reTURBTs was analysed, with fewer cases of residual tumour in the en-bloc group (p = 0.051). RFS at 3 months was higher in the en-bloc group (88.4% vs. 80.1%; p = 0.027). After propensity score matching, differences in MP presence, hospitalization time and 3-month RFS status remained statistically significant. Conclusions When compared to conventional TURBT, en-bloc resection of bladder tumour is associated with higher percentage of MP presence in histopathological specimen, higher 3-month RFS and shorter hospitalization time.
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7
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Taskovska M, Kreft ME, Smrkolj T. Current and innovative approaches in the treatment of non-muscle invasive bladder cancer: the role of transurethral resection of bladder tumor and organoids. Radiol Oncol 2020; 54:135-43. [PMID: 32374292 DOI: 10.2478/raon-2020-0025] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2020] [Accepted: 01/30/2020] [Indexed: 11/20/2022] Open
Abstract
Background Bladder cancer is the 7th most common cancer in men. About 75% of all bladder cancer are non-muscle invasive (NMIBC). The golden standard for definite diagnosis and first-line treatment of NMIBC is transurethral resection of bladder tumour (TURB). Historically, the monopolar current was used first, today bipolar current is preferred by most urologists. Following TURB, depending on the tumour grade, additional intravesical chemo- or/and immunotherapy is indicated, in order to prevent recurrence and need for surgical resection. Development of new technologies, molecular and cell biology, enabled scientists to develop organoids - systems of human cells that are cultivated in the laboratory and have characteristics of the tissue from which they were harvested. In the field of urologic cancers, the organoids are used mainly for studying the course of different diseases, however, in the field of bladder cancer the data are scarce. Conclusions Different currents - monopolar and bipolar, have different effect on urothelium, that is important for oncological results and pathohistological interpretation. Specimens of bladder cancer can be used for preparation of organoids that are further used for studying carcinogenesis. Bladder organoids are step towards personalised medicine, especially for testing effectiveness of chemo-/immunotherapeutics.
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8
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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9
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Suarez-Ibarrola R, Soria F, Abufaraj M, D'Andrea D, Preto M, Gust KM, Briganti A, Shariat SF, Gontero P. Surgical checklist impact on recurrence-free survival of patients with non-muscle-invasive bladder cancer undergoing transurethral resection of bladder tumour. BJU Int 2018; 123:646-650. [PMID: 30248235 DOI: 10.1111/bju.14557] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To evaluate the impact of an eight-item surgical checklist (SC) on the recurrence-free survival (RFS) of patients with non-muscle-invasive bladder cancer (NMIBC) undergoing transurethral resection of bladder tumour (TURBT). PATIENTS AND METHODS A group of urologists at two tertiary referral centres, with expertise in bladder cancer, identified eight critical items that should be performed in every high-quality TURBT. An eight-item SC was prospectively implemented into clinical practice and the operative reports of TURBTs performed before and after implementation were reviewed. Results from both institutions were combined to estimate the impact of introducing the SC on oncological outcomes. Multivariable logistic and Cox hazards regression analyses were performed to evaluate the impact of the SC on the presence of detrusor muscle in the TURBT specimen and on RFS, respectively. RESULTS The operative reports of 266 TURBTs performed after the SC implementation were reviewed and compared to those of 281 TURBTs performed prior to the SC introduction. The SC was independently associated with a significant improvement in RFS (P = 0.02). However, the introduction of the SC was not significantly associated with the presence of detrusor muscle in the surgical specimen (P = 0.4). CONCLUSION The use of an eight-item SC during TURBT in clinical practice increases the quality of operative reports thereby potentially improving individualised risk-stratification and care resulting in lower disease recurrence rates. Therefore, the introduction of a SC can be recommended to enhance oncological outcomes by improving surgical standardisation and operative reporting.
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Affiliation(s)
- Rodrigo Suarez-Ibarrola
- Department of Urology and Comprehensive Cancer Center, Vienna General Hospital, Medical University of Vienna, Vienna, Austria
| | - Francesco Soria
- Department of Urology and Comprehensive Cancer Center, Vienna General Hospital, Medical University of Vienna, Vienna, Austria.,Division of Urology, University of the Studies of Turin, AOU Città della Salute e della Scienza di Torino Presidio Molinette, Turin, Italy
| | - Mohammad Abufaraj
- Department of Urology and Comprehensive Cancer Center, Vienna General Hospital, Medical University of Vienna, Vienna, Austria.,Division of Urology, Department of Special Surgery, Jordan University Hospital, The University of Jordan, Amman, Jordan
| | - David D'Andrea
- Department of Urology and Comprehensive Cancer Center, Vienna General Hospital, Medical University of Vienna, Vienna, Austria
| | - Mirko Preto
- Division of Urology, University of the Studies of Turin, AOU Città della Salute e della Scienza di Torino Presidio Molinette, Turin, Italy
| | - Kilian M Gust
- Department of Urology and Comprehensive Cancer Center, Vienna General Hospital, Medical University of Vienna, Vienna, Austria.,Karl Landsteiner Institute of Urology and Andrology, Vienna, Austria
| | - Alberto Briganti
- Department of Urology, Urological Research Institute, San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy
| | - Shahrokh F Shariat
- Department of Urology and Comprehensive Cancer Center, Vienna General Hospital, Medical University of Vienna, Vienna, Austria.,Karl Landsteiner Institute of Urology and Andrology, Vienna, Austria.,Department of Urology, Weill Cornell Medical College, New York Presbyterian Hospital, New York, NY, USA.,Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Paolo Gontero
- Division of Urology, University of the Studies of Turin, AOU Città della Salute e della Scienza di Torino Presidio Molinette, Turin, Italy
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10
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Barnes SC, Shepherd DE, Espino DM, Bryan RT, Viney R, Patel P. Design of an improved surgical instrument for the removal of bladder tumours. Proc Inst Mech Eng H 2016; 230:579-87. [PMID: 27075816 DOI: 10.1177/0954411916640580] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Accepted: 02/29/2016] [Indexed: 11/15/2022]
Abstract
The aim of this work was to design an add-on instrument that could potentially decrease the recurrence of non-muscle invasive bladder cancer. The current surgical approach permits spilled tumour cells to disseminate within the bladder, re-implant and cause tumour recurrence. An add-on instrument has been designed in the form of an opening cone intended to provide space for surgery and yet reduce tumour cell spillage and dissemination. A prototype was manufactured using the shape memory metal Nitinol which was activated using an electrical current to facilitate opening and supplemented with latex to provide a sealed environment. The prototype was tested in comparable surgical conditions utilising porcine bladder wall and blue dye to simulate tumour cells. It was demonstrated that the vast majority of dye was retained within the device, supporting the proposed aim.
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Affiliation(s)
- Spencer C Barnes
- Department of Mechanical Engineering, University of Birmingham, Birmingham, UK
| | - Duncan Et Shepherd
- Department of Mechanical Engineering, University of Birmingham, Birmingham, UK
| | - Daniel M Espino
- Department of Mechanical Engineering, University of Birmingham, Birmingham, UK
| | - Rik T Bryan
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - Richard Viney
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK Department of Urology, Queen Elizabeth Hospital Birmingham, Birmingham, UK
| | - Prashant Patel
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK Department of Urology, Queen Elizabeth Hospital Birmingham, Birmingham, UK
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Gan C, Patel A, Fowler S, Catto J, Rosario D, O'Brien T. Snapshot of transurethral resection of bladder tumours in the United Kingdom Audit (STUKA). BJU Int 2013; 112:930-5. [PMID: 24053417 DOI: 10.1111/bju.12235] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To determine the quality of transurethral resection of bladder tumour (TURBT) in the UK. To evaluate the utility of a novel 'snapshot' methodology in carrying out national audits. PATIENTS AND METHODS Every consultant Urologist in the UK was asked to contribute details of their first patient with a new bladder cancer treated with TURBT after midnight of 31st January 2010. Responses were received from 192 consultants. RESULTS The median (range) time from referral to first Urology appointment was 11 (0-161) days, and the median (range) time from first appointment to TURBT was 27 (1-588) days. In all, 12 (6.3%) patients underwent photodynamic diagnosis-assisted TURBT and 119 patients (61%) received a dose of Mitomycin C after TURBT. The rate of major complications was low, with five incidences (2.6%) of bladder perforation. There was no record of muscle present in resected specimens in 40 cases (20.8%) and resection was considered incomplete in 26 cases (13.5%). In all, 31 patients (16.1%) underwent early re-resection with residual tumour or carcinoma in situ detected in 17 cases, although no tumour was upstaged. Of the 37 patients classified with intermediate-risk non-muscle-invasive bladder cancer (NMIBC), there were nine recurrences (24.3%) at 3 months, and 13 recurrences (35.1%) at 1 year. Newly presenting MIBC managed with currently available treatments has a high mortality rate of 33.3% at 1 year. CONCLUSIONS The quality of TURBT in the UK is high. Areas for improvement include the timeliness of diagnosis and treatment, and improved care of patients with intermediate-risk NMIBC and MIBC. The 'snapshot' methodology is promising but widening participation is a priority.
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Affiliation(s)
- Christine Gan
- British Association of Urological Surgeons Section of Oncology
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