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Shoaydarov MA, Martov AG, Andronov AS, Dutov SV, Pominalnaya VM. [Experience in the use of confocal laser endomicroscopy for the diagnosis of bladder papillary tumors]. Urologiia 2023:99-106. [PMID: 37401712] [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] [Subscribe] [Scholar Register] [Indexed: 07/05/2023]
Abstract
INTRODUCTION Visual confirmation of suspicious changes in the urinary tract mucosa is the cornerstone in the diagnosis of urothelial cancer. However, with bladder tumors, it is impossible to obtain histopathological data during cystoscopy both in white light and in photodynamic and narrow-spectrum modes, as well as with computerized chromoendoscopy. Confocal laser endomicroscopy (probe-based confocal laser endomicroscopy - pCLE) is an optical imaging technique that provides high-resolution in vivo imaging and real-time evaluation of urothelial lesions. AIM To assess the diagnostic capabilities of pCLE in papillary bladder tumors and compare its results with standard pathomorphological study. MATERIALS AND METHODS A total of 38 patients (27 men, 11 women, aged 41-82 years) with primary bladder tumors diagnosed on the imaging methods were included in the study. For the diagnosis and treatment, all patients underwent transurethral resection (TUR) of the bladder. When a standard white light cystoscopy with assessment of the entire urothelium, 10% sodium fluorescein was administrated intravenously as a contrast dye. pCLE was performed with CystoFlexTMUHD 2.6 mm (7.8 Fr) probe, which was passed through the 26 Fr resectoscope using a telescope bridge to visualize normal and pathological urothelial lesions. A laser with a wavelength of 488 nm and a speed of 8 to 12 frames per second allowed to obtain an endomicroscopic image. These images were compared with standard histopathological analysis using hematoxylin-eosin (H&E) staining of tumor fragments removed during TUR of the bladder. RESULTS Based on real-time pCLE, 23 patients had a diagnosis of low-grade urothelial carcinoma, while in 12 patients the endomicroscopic picture corresponded to high-grade urothelial carcinoma, 2 patients had typical changes for inflammatory process and 1 case of carcinoma in situ was suspected, which was confirmed by histopathological study. Endomicroscopic images demonstrated clear differences between normal bladder mucosa and high- and low-grade tumors. In the normal urothelium, the larger umbrella cells are located most superficially, followed by smaller intermediate cells, as well as the lamina propria with blood vessels network. In contrast, low-grade urothelial carcinoma is characterized by denser, normal-shaped small cells located superficially than a central fibrovascular core. High-grade urothelial carcinoma exhibits markedly irregular cell architecture and cellular pleomorphism. CONCLUSION pCLE is a promising new method for in-vivo diagnosing of bladder cancer. Our results show its potential for endoscopic determination of the histological characteristics of bladder tumors and the ability to differentiate between benign and malignant processes, as well as the histological grade of tumor cells.
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Affiliation(s)
- M A Shoaydarov
- GBUZ City clinical hospital named after D.D. Pletnev of the Health Department c. Moscow, Moscow, Russia
- Department of Urology and Andrology of A.I. Burnazyan SRC FMBC, FMBA of Russia, Moscow, Russia
- Medical Scientific and Educational Center of Lomonosov Moscow State University, Moscow, Russia
- Loginov Moscow Clinical Scientific Center of Moscow Health Department, Moscow, Russia
| | - A G Martov
- GBUZ City clinical hospital named after D.D. Pletnev of the Health Department c. Moscow, Moscow, Russia
- Department of Urology and Andrology of A.I. Burnazyan SRC FMBC, FMBA of Russia, Moscow, Russia
- Medical Scientific and Educational Center of Lomonosov Moscow State University, Moscow, Russia
- Loginov Moscow Clinical Scientific Center of Moscow Health Department, Moscow, Russia
| | - A S Andronov
- GBUZ City clinical hospital named after D.D. Pletnev of the Health Department c. Moscow, Moscow, Russia
- Department of Urology and Andrology of A.I. Burnazyan SRC FMBC, FMBA of Russia, Moscow, Russia
- Medical Scientific and Educational Center of Lomonosov Moscow State University, Moscow, Russia
- Loginov Moscow Clinical Scientific Center of Moscow Health Department, Moscow, Russia
| | - S V Dutov
- GBUZ City clinical hospital named after D.D. Pletnev of the Health Department c. Moscow, Moscow, Russia
- Department of Urology and Andrology of A.I. Burnazyan SRC FMBC, FMBA of Russia, Moscow, Russia
- Medical Scientific and Educational Center of Lomonosov Moscow State University, Moscow, Russia
- Loginov Moscow Clinical Scientific Center of Moscow Health Department, Moscow, Russia
| | - V M Pominalnaya
- GBUZ City clinical hospital named after D.D. Pletnev of the Health Department c. Moscow, Moscow, Russia
- Department of Urology and Andrology of A.I. Burnazyan SRC FMBC, FMBA of Russia, Moscow, Russia
- Medical Scientific and Educational Center of Lomonosov Moscow State University, Moscow, Russia
- Loginov Moscow Clinical Scientific Center of Moscow Health Department, Moscow, Russia
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Maisch P, Koziarz A, Vajgrt J, Narayan V, Kim MH, Dahm P. Blue versus white light for transurethral resection of non-muscle invasive bladder cancer. BJU Int 2022; 130:730-740. [PMID: 35238145 DOI: 10.1111/bju.15723] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 02/19/2022] [Accepted: 02/28/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To assess the effects of blue light-enhanced transurethral resection of bladder tumor (TURBT) compared to white light-based TURBT in the treatment of non-muscle invasive bladder cancer (NMIBC). METHODS Based on a published protocol we performed a systematic search of multiple databases from their inception to March 2021. We included randomized controlled trials (RCTs) comparing blue light (BL) TURBT to white light (WL) TURBT. Our meta-analysis is based on a random-effect model. We assessed the quality of evidence on a per-outcome basis according to the Grades of Recommendation, Assessment, Development and Evaluation (GRADE) approach. RESULTS We included 16 randomized controlled trials involving a total of 4325 participants in this review. BL TURBT may reduce the risk of disease recurrence over time (hazard ratio (HR) 0.66, 95% confidence interval (CI) 0.54 to 0.81; low certainty evidence) depending on baseline risk. For participants with low-, intermediate-, and high-risk NMIBC, this corresponded to 48 (66 fewer to 27 fewer), 109 (152 fewer to 59 fewer), and 147 (211 fewer to 76 fewer) fewer recurrences per 1000 participants when compared to WL TURBT, respectively. BL TURBT may also reduce the risk of disease progression over time (HR 0.65, 95% CI 0.50 to 0.84; low-certainty evidence) depending on baseline risk. For participants with low-, intermediate-, and high-risk NMIBC, this corresponded to 1 (1 fewer to 0 fewer), 17 (25 fewer to 8 fewer), and 56 (81 fewer to 25 fewer) fewer progressions per 1000 participants when compared to WL TURBT, respectively. CONCLUSIONS Our findings suggest a favorable impact of BL TURBT on the risk of disease recurrence and progression; however, whether this risk reduction is clinically relevant greatly depends on the baseline risk of patients. We did not find an increase in severe surgical complications with BL cystoscopy, and we did not find any trial evidence on other, non-surgical adverse events.
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Affiliation(s)
- Philipp Maisch
- Department of Urology, University of Ulm, Ulm, Germany.,Department of Urology, Rechts der Isar Medical Center, Technical University of Munich, Munich, Germany
| | - Alex Koziarz
- Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Jon Vajgrt
- University of Minnesota Medical School, Minneapolis, MN, USA
| | - Vikram Narayan
- Department of Urology, Emory University, Atlanta, Georgia, USA
| | - Myung Ha Kim
- Yonsei Wonju Medical Library, Yonsei University Wonju College of Medicine, Wonju, Korea, South
| | - Philipp Dahm
- Urology Section, Minneapolis VA Health Care System, Minneapolis, Minnesota, USA.,Department of Urology, University of Minnesota, Minneapolis, Minnesota, USA
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Defidio L, Antonucci M, Castellani D, Civitella A, Esperto F, Scarpa RM. Transurethral Resection of Bladder Tumor: Electrosurgical and Laser. J Endourol 2021; 35:S46-S51. [PMID: 34499543 DOI: 10.1089/end.2020.1068] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 11/12/2022] Open
Abstract
Transurethral resection of bladder tumor (TURBT) is still the gold standard for the diagnosis, treatment, and staging of nonmuscle invasive bladder cancer. En bloc resection of bladder tumor (EBRT) has been recently introduced to overcome the limitations of conventional TURBT. EBRT potential advantages are (1) complete resection, (2) a more precise and controlled resection (potentially fewer complications), (3) better sample orientation for histopathology analysis, (4) presence of detrusor in the specimen, and (5) less tumor seeding on normal urothelium by tumor fragments. This article aimed to present a step-by-step technique of conventional TURBT and EBRT with thulium laser support. We also aimed to provide tips and tricks for a correct surgical procedure and postoperative patient care. Finally, clinical outcomes of TURBT versus EBRT were reviewed.
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Affiliation(s)
| | | | - Daniele Castellani
- Urology Division, Azienda Ospedaliero-Universitaria Ospedali Riuniti di Ancona, Università Politecnica delle Marche, Ancona, Italy
| | - Angelo Civitella
- Department of Urology, Campus Biomedico University of Rome, Rome, Italy
| | - Francesco Esperto
- Department of Urology, Campus Biomedico University of Rome, Rome, Italy
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Startsev VY, Asfandiyarov PR, Kolmakov AY. [Parasitic disease of urinary tract system (on the example of schistosomiasis)]. Urologiia 2018:35-38. [PMID: 30575347] [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] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
INTRODUCTION The globalization observed in the modern world contributes to the increasing rate of the delivery of "exotic" bacterial and parasitic infections from the tropic countries to Russia and the European countries. AIM To analyze the modern early diagnostic tools of premalignant changes and malignant tumors of urinary bladder of schistosome origin in the residents of endemic areas. MATERIALS AND METHODS The current study included an analysis of examination and treatment of 181 patients with bladder schistosomiasis who lived in Benguela province in Angola. In 39 cases (21.5%) bladder cancer associated with schistosomiasis was detected. All patients were undergone to surgical treatment. 142 patients (78.5%) were divided into two groups. In Group 1 (n=74) patients had uncomplicated bladder schistosomiasis and in Group II (n=68) the patients with granulomatous inflammatory changes in the urinary bladder were included. RESULTS The patients with bladder schistosomiasis (n=142) were undergone to outpatient examination. In 38 cases (26.8%) the cytologic study of urinary sediment (CSUS) revealed the schistosomes eggs. With ultrasound study, the specific granulomatous changes in the mucous membrane of urinary bladder were detected in 28 cases (19.7%) while hydronephrosis, calcifications and thickening of bladder wall was diagnosed in 7 (4.9%), 10 (7%) and 99 (69.7%) patients, respectively. During cystoscopy the granulomatous changes in the bladder were found in 68 cases (47.9%). In Group I patients received "Praziquantel" in combination with oral antibiotic therapy, which resulted in resolution of gross hematuria and dysuria. All patients in Group II (n=68) were also administered antibacterial and antiprotozoal therapy. An additional 35 patients (24.6%) were undergone to transurethral bladder resection. Of 33 patients in Group II (23.2%) who received only antibacterial and antiprotozoal therapy the granulomas persisted in 7 cases (4.9%) and, therefore, TURB was performed. The subsequent studies showed the regression of the lesions in these patients. CONCLUSION CSUS and ultrasound study are not sufficient for diagnosis of bladder schistosomiasis. Cystoscopy is recommended for all patients, since it allows to evaluate bladder volume and to determine the indications for TURB in addition to antiprotozoal and antibacterial therapy.
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Affiliation(s)
- V Yu Startsev
- Department of Oncology, pediatric oncology and radiation therapy of FGBOU VO North-Western State Medical University named after I.I. Mechnikov, Saint Petersburg, Russia
- Department of Urology of SBEI HPE Altai state medical university of the Russian Ministry of Health, Astrakhan, Russia
| | - P R Asfandiyarov
- Department of Oncology, pediatric oncology and radiation therapy of FGBOU VO North-Western State Medical University named after I.I. Mechnikov, Saint Petersburg, Russia
- Department of Urology of SBEI HPE Altai state medical university of the Russian Ministry of Health, Astrakhan, Russia
| | - A Y Kolmakov
- Department of Oncology, pediatric oncology and radiation therapy of FGBOU VO North-Western State Medical University named after I.I. Mechnikov, Saint Petersburg, Russia
- Department of Urology of SBEI HPE Altai state medical university of the Russian Ministry of Health, Astrakhan, Russia
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Kluth LA, Xylinas E, Crivelli JJ, Passoni N, Comploj E, Pycha A, Chrystal J, Sun M, Karakiewicz PI, Gontero P, Lotan Y, Chun FKH, Fisch M, Scherr DS, Shariat SF. Obesity is associated with worse outcomes in patients with T1 high grade urothelial carcinoma of the bladder. J Urol 2013; 190:480-6. [PMID: 23376707 DOI: 10.1016/j.juro.2013.01.089] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/24/2013] [Indexed: 12/21/2022]
Abstract
PURPOSE To our knowledge the impact of body mass index on oncologic outcomes in nonmuscle invasive bladder cancer has not been evaluated. We hypothesized that higher body mass index is associated with worse outcomes in patients with clinical primary T1 high grade urothelial carcinoma of the bladder. MATERIALS AND METHODS We retrospectively analyzed data from 892 patients with primary nonmuscle invasive bladder cancer from 7 centers. Patients were treated with transurethral resection of the bladder with or without intravesical therapy. Body mass index was analyzed as a continuous and a categorical variable (nonobese-body mass index less than 30 kg/m(2) vs obese-body mass index 30 kg/m(2) or greater). Disease progression was defined as the development of T2 or higher tumor stage. RESULTS Median followup was 42.8 months (IQR 56). Of the patients 44.3% were obese and median body mass index was 29.2 kg/m(2) (IQR 8). On univariable analyses higher body mass index and age were associated with an increased risk of disease recurrence, progression, cancer specific mortality and any cause mortality (all p ≤ 0.001). On multivariable analyses that adjusted for the effects of gender, concomitant carcinoma in situ, tumor size, number of tumors and intravesical therapy, higher body mass index and age remained independent predictors of disease recurrence, progression, cancer specific mortality and any cause mortality (all p <0.05). This study was limited by its design (ie lack of data on repeat transurethral resection of the bladder and intravesical therapy protocol). CONCLUSIONS Patients diagnosed with clinical T1 high grade urothelial carcinoma of the bladder who are obese have worse cancer specific outcomes compared to their nonobese counterparts. Further work is needed to improve our understanding of clinical T1 high grade outcomes in the growing population of obese patients.
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Affiliation(s)
- Luis A Kluth
- Department of Urology, Weill Cornell Medical College, New York Presbyterian Hospital, New York, New York 10065, USA
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