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Sun X, Liu C, Zhang C, Zhang Z. Nomogram for predicting postoperative ileus after radical cystectomy and urinary diversion: a retrospective single-center study. Ann Med 2024; 56:2329125. [PMID: 38498939 PMCID: PMC10949833 DOI: 10.1080/07853890.2024.2329125] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 02/23/2024] [Indexed: 03/20/2024] Open
Abstract
OBJECTIVE To predict the incidence of postoperative ileus in bladder cancer patients after radical cystectomy. METHODS We retrospectively analyzed the perioperative data of 452 bladder cancer patients who underwent radical cystectomy with urinary diversion at the Second Hospital of Tianjin Medical University between 2016 and 2021. Univariate and multivariate logistic regression were used to identify the risk factors for postoperative ileus. Finally, a nomogram model was established and verified based on the independent risk factors. RESULTS Our study revealed that 96 patients (21.2%) developed postoperative ileus. Using multivariate logistic regression analysis, we found that the independent risk factors for postoperative ileus after radical cystectomy included age > 65.0 years, high or low body mass index, constipation, hypoalbuminemia, and operative time. We established a nomogram prediction model based on these independent risk factors. Validation by calibration curves, concordance index, and decision curve analysis showed a strong correlation between predicted and actual probabilities of occurrence. CONCLUSION Our nomogram prediction model provides surgeons with a simple tool to predict the incidence of postoperative ileus in bladder cancer patients undergoing radical cystectomy.
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Affiliation(s)
- Xiaoyu Sun
- Department of Urology, Tianjin Institute of Urology, The Second Hospital of Tianjin Medical University, Tianjin, China
| | - Chang Liu
- Department of Urology, Renmin Hospital of Wuhan Economic and Technological Development Zone (Hannan), Wuhan, China
| | - Changwen Zhang
- Department of Urology, Tianjin Institute of Urology, The Second Hospital of Tianjin Medical University, Tianjin, China
| | - Zhihong Zhang
- Department of Urology, Tianjin Institute of Urology, The Second Hospital of Tianjin Medical University, Tianjin, China
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Park JY, Yu J, Kim CS, Kim YK. Reply for Comment on: Vitamin C and catheter-related bladder discomfort after transurethral resection of bladder tumor. J Clin Anesth 2024; 95:111445. [PMID: 38492452 DOI: 10.1016/j.jclinane.2024.111445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Accepted: 03/10/2024] [Indexed: 03/18/2024]
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
| | - Chan-Sik Kim
- 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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Staniorski CJ, Yu M, Sharbaugh D, Stencel MG, Myrga JM, Davies BJ, Yabes JG, Jacobs B. Predictors of persistent opioid use in bladder cancer patients undergoing radical cystectomy: A SEER-Medicare analysis. Urol Oncol 2024; 42:220.e21-220.e29. [PMID: 38565428 DOI: 10.1016/j.urolonc.2024.03.010] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Revised: 12/19/2023] [Accepted: 03/10/2024] [Indexed: 04/04/2024]
Abstract
PURPOSE To evaluate patient and provider characteristics that predict persistent opioid use following radical cystectomy for bladder cancer including non-opioid naïve patients. METHODS Patients undergoing cystectomy between July 2007 and December 2015 were identified using the SEER-Medicare database. Opioid exposure was identified before and after cystectomy using Medicare Part D data. Multivariable analyses were used to identify predictors of the primary outcomes: persistent opioid use (prescription 3-6 months after surgery) and postoperative opioid prescriptions (within 30 days of surgery). Secondary outcomes included physician prescribing practices and rates of persistent opioid use in their patient cohorts. RESULTS A total of 1,774 patients were included; 29% had prior opioid exposure. Compared to opioid-naïve patients, non-opioid naïve patients were more frequently younger, Black, and living in less educated communities. The percentage of persistent postoperative use was 10% overall and 24% in non-opioid naïve patients. Adjusting for patient factors, opioid naïve individuals were less likely to develop persistent use (OR 0.23) while a 50-unit increase in oral morphine equivalent per day prescribed following surgery nearly doubled the likelihood of persistent use (OR 1.98). Practice factors such as hospital size, teaching affiliation, and hospital ownership failed to predict persistent use. 29% of patients filled an opioid prescription postoperatively. Opioid naïve patients (OR 0.13) and those cared for at government hospitals (OR 0.59) were less likely to fill an opioid script along with those residing in the Northeast. Variability between physicians was seen in prescribing practices and rates of persistent use. CONCLUSIONS Non-opioid naïve patients have higher rates of post-operative opioid prescription than opioid-naïve patients. Physician prescribing practices play a role in persistent use, as initial prescription amount predicts persistent use even in non-opioid naïve patients. Significant physician variation in both prescribing practices and rates of persistent use suggest a role for standardizing practices.
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Affiliation(s)
- Christopher J Staniorski
- Division of Health Services Research, Department of Urology, University of Pittsburgh Medical Center, Kaufmann Medical Building 3471 Fifth Ave, Suite 700, Pittsburgh, PA 15213.
| | - Michelle Yu
- Division of Health Services Research, Department of Urology, University of Pittsburgh Medical Center, Kaufmann Medical Building 3471 Fifth Ave, Suite 700, Pittsburgh, PA 15213
| | - Danielle Sharbaugh
- Division of Health Services Research, Department of Urology, University of Pittsburgh Medical Center, Kaufmann Medical Building 3471 Fifth Ave, Suite 700, Pittsburgh, PA 15213
| | - Michael G Stencel
- Department of Urology, Charleston Area Medical Center, 3100 MacCorkle Ave Se Suite 602, Charleston, WV 25304
| | - John M Myrga
- Division of Health Services Research, Department of Urology, University of Pittsburgh Medical Center, Kaufmann Medical Building 3471 Fifth Ave, Suite 700, Pittsburgh, PA 15213
| | - Benjamin J Davies
- Division of Health Services Research, Department of Urology, University of Pittsburgh Medical Center, Kaufmann Medical Building 3471 Fifth Ave, Suite 700, Pittsburgh, PA 15213
| | - Jonathan G Yabes
- Division of Health Services Research, Department of Urology, University of Pittsburgh Medical Center, Kaufmann Medical Building 3471 Fifth Ave, Suite 700, Pittsburgh, PA 15213; Division of Internal Medicine, Department of Medicine, University of Pittsburgh Medical Center, 1218 Scaife Hall, 3550 Terrace Street, Pittsburgh, PA 15261
| | - Bruce Jacobs
- Division of Health Services Research, Department of Urology, University of Pittsburgh Medical Center, Kaufmann Medical Building 3471 Fifth Ave, Suite 700, Pittsburgh, PA 15213
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Song W, Yu J, Jeong BC. ASO Author Reflections: Advancing Early Outcome Assessment in Robot-Assisted Radical Cystectomy: RARC Tetrafecta. Ann Surg Oncol 2024; 31:3908-3909. [PMID: 38536582 DOI: 10.1245/s10434-024-15169-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Accepted: 02/25/2024] [Indexed: 05/09/2024]
Affiliation(s)
- Wan Song
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jiwoong Yu
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Byong Chang Jeong
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
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David J, Pathak RA. Editorial comment for "Surgeon-administered regional nerve blocks during radical cystectomy: a feasibility study". Int Urol Nephrol 2024; 56:1937-1938. [PMID: 38289543 DOI: 10.1007/s11255-024-03956-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Accepted: 01/06/2024] [Indexed: 05/14/2024]
Affiliation(s)
- Justin David
- Department of Urology, Mayo Clinic, Jacksonville, FL, USA
| | - Ram A Pathak
- Department of Urology, Mayo Clinic, Jacksonville, FL, USA.
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Contieri R, Tan WS, Grajales V, Hensley PJ, Martini A, Bree K, Myers A, Nogueras-Gonzalez G, Navai N, Dinney CP, Guo C, Kamat AM. Influence of lamina propria invasion extension on T1 high-grade non-muscle-invasive bladder cancer in patients undergoing BCG or radical cystectomy. BJU Int 2024; 133:733-741. [PMID: 38374533 DOI: 10.1111/bju.16293] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2024]
Abstract
OBJECTIVE To evaluate the prognostic value of T1 substaging in patients treated with bacillus Calmette-Guérin (BCG) or immediate radical cystectomy (iRC). MATERIALS AND METHODS We performed an institutional review board-approved retrospective study analysing non-muscle-invasive bladder cancer (NMIBC) patients with pT1 disease treated with either BCG or iRC between 2000 and 2020. Lamina propria (LP) invasion characteristics were extracted from the pathology report. The Kaplan-Meier method was used to calculate overall survival (OS), cancer-specific survival (CSS) and metastasis-free survival (MFS). Multivariable Cox models were used to determine the association between progression-free survival (PFS) and characteristics in the BCG cohort. A logistic regression model explored the relationship between T1 substaging and upstaging to >pT2 at iRC. RESULTS A total of 411 T1 high-grade patients were identified. LP invasion characteristics were as follows: not specified: 115 (28%); focal/superficial (F/S): 147 (35.8%); and extensive/multifocal (E/M): 149 (36.2%). Overall, 303 patients (73.7%) received BCG, and 108 patients (26.3%) underwent iRC. The median (interquartile range) follow-up was 53 (32-96) months. Patients with E/M LP invasion were significantly more likely to undergo iRC (34% vs. 19%; P = 0.003). Patients with E/M LP invasion showed poorer MFS and CSS compared to those with F/S LP invasion when treated with BCG but not when treated with iRC. Among BCG-treated patients, progression occurred in 41 patients and E/M LP invasion was independently associated with progression after BCG (hazard ratio 5.3, 95% confidence interval [CI] 2.2-13.1; P < 0.001). T1 substaging was not associated with upstaging at RC (odds ratio 3.15, 95% CI 0.82-12.12; P = 0.095). CONCLUSIONS Extensive/multifocal LP invasion was associated with poor PFS, MFS and CSS in patients treated with BCG. T1 substaging provides valuable prognostic information and should be reported in pathology reports.
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Affiliation(s)
- Roberto Contieri
- Department of Urology, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Wei Shen Tan
- Department of Urology, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Valentina Grajales
- Department of Urology, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Patrick J Hensley
- Department of Urology, University of Kentucky College of Medicine, Lexington, Kentucky, USA
| | - Alberto Martini
- Department of Urology, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Kelly Bree
- Department of Urology, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Amanda Myers
- Department of Urology, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | | | - Neema Navai
- Department of Urology, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Colin P Dinney
- Department of Urology, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Charles Guo
- Department of Pathology, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Ashish M Kamat
- Department of Urology, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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Enlund M, Hållberg H, Berglund A, Sherif A, Enlund A, Bergkvist L. Long-term Survival after Volatile or Propofol General Anesthesia for Bladder Cancer Surgery: A Retrospective National Registry Cohort Study. Anesthesiology 2024; 140:1126-1133. [PMID: 38466217 DOI: 10.1097/aln.0000000000004969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/12/2024]
Abstract
BACKGROUND Prospective interventional trials and retrospective observational analyses provide conflicting evidence regarding the relationship between propofol versus inhaled volatile general anesthesia and long-term survival after cancer surgery. Specifically, bladder cancer surgery lacks prospective clinical trial evidence. METHODS Data on bladder cancer surgery performed under general anesthesia between 2014 and 2021 from the National Quality Registry for Urinary Tract and Bladder Cancer and the Swedish Perioperative Registry were record-linked. Overall survival was compared between patients receiving propofol or inhaled volatile for anesthesia maintenance. The minimum clinically important difference was defined as a 5-percentage point difference in 5-yr survival. RESULTS Of 7,571 subjects, 4,519 (59.7%) received an inhaled volatile anesthetic, and 3,052 (40.3%) received propofol for general anesthesia maintenance. The two groups were quite similar in most respects but differed in American Society of Anesthesiologists Physical Status and tumor stage. Propensity score matching was used to address treatment bias. Survival did not differ during follow-up (median, 45 months [interquartile range, 33 to 62 months]) in the full unmatched cohort nor after 1:1 propensity score matching (3,052 matched pairs). The Kaplan-Meier adjusted 5-yr survival rates in the matched cohort were 898 of 3,052, 67.5% (65.6 to 69.3%) for propofol and 852 of 3,052, 68.5% (66.7 to 70.4%) for inhaled volatile general anesthesia, respectively (hazard ratio, 1.05 [95% CI, 0.96 to 1.15]; P = 0.332). A sensitivity analysis restricted to 1,766 propensity score-matched pairs of patients who received only one general anesthetic during the study period did not demonstrate a difference in survival; Kaplan-Meier adjusted 5-yr survival rates were 521 of 1,766, 67.1% (64.7 to 69.7%) and 482 of 1,766, 68.9% (66.5 to 71.4%) for propofol and inhaled volatile general anesthesia, respectively (hazard ratio, 1.09 [95% CI, 0.97 to 1.23]; P = 0.139). CONCLUSIONS Among patients undergoing bladder cancer surgery under general anesthesia, there was no statistically significant difference in long-term overall survival associated with the choice of propofol or an inhaled volatile maintenance. EDITOR’S PERSPECTIVE
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Affiliation(s)
- Mats Enlund
- Center for Clinical Research Uppsala University, Västmanland Hospital, Västerås, Sweden; Department of Anesthesia and Intensive Care, Västmanland Hospital, Västerås, Sweden; ESAIC Onco Anaesthesiology Research Group, EuroPeriscope, Brussels, Belgium
| | | | | | - Amir Sherif
- Umeå University, Umeå University Hospital, Umeå, Sweden
| | - Anna Enlund
- Center for Clinical Research Uppsala University, Västmanland Hospital, Västerås, Sweden
| | - Leif Bergkvist
- Center for Clinical Research Uppsala University, Västmanland Hospital, Västerås, Sweden
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Basile G, Pradere B, Lenfant L, Rouprêt M, Seisen T. Re: Katharina Brück, Richard P. Meijer, Joost L. Boormans, et al. Disease-free Survival of Patients with Muscle-invasive Bladder Cancer Treated with Radical Cystectomy Versus Bladder-preserving Therapy: A Nationwide Study. Int J Radiat Oncol Biol Phys. In press. https://doi.org/10.1016/j.ijrobp.2023.07.027. Eur Urol Oncol 2024; 7:637-638. [PMID: 37978023 DOI: 10.1016/j.euo.2023.10.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 10/10/2023] [Indexed: 11/19/2023]
Affiliation(s)
- Giuseppe Basile
- Department of Urology, IRCCS San Raffaele Hospital, Milan, Italy
| | - Benjamin Pradere
- Department of Urology UROSUD, La Croix Du Sud Hospital, Quint Fonsegrives, France; Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Louis Lenfant
- GRC 5 Predictive Onco-Urology, Sorbonne University, Department of Urology, Pitié-Salpêtrière Hospital, AP-HP, Paris, France
| | - Morgan Rouprêt
- GRC 5 Predictive Onco-Urology, Sorbonne University, Department of Urology, Pitié-Salpêtrière Hospital, AP-HP, Paris, France
| | - Thomas Seisen
- GRC 5 Predictive Onco-Urology, Sorbonne University, Department of Urology, Pitié-Salpêtrière Hospital, AP-HP, Paris, France.
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Montorsi F, Rosiello G, Gandaglia G, Salonia A, Briganti A. Re: David D'Andrea, Francesco Soria, Rodolfo Hurle, et al. En Bloc Versus Conventional Resection of Primary Bladder Tumor (eBLOC): A Prospective, Multicenter, Open-label, Phase 3 Randomized Controlled Trial. Eur Urol Oncol. In press. https://doi.org/10.1016/j.euo.2023.07.010. Eur Urol Oncol 2024; 7:636. [PMID: 37951819 DOI: 10.1016/j.euo.2023.10.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Accepted: 10/09/2023] [Indexed: 11/14/2023]
Affiliation(s)
- Francesco Montorsi
- Unit of Urology, Division of Experimental Oncology, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Giuseppe Rosiello
- Unit of Urology, Division of Experimental Oncology, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy.
| | - Giorgio Gandaglia
- Unit of Urology, Division of Experimental Oncology, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Andrea Salonia
- Unit of Urology, Division of Experimental Oncology, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Alberto Briganti
- Unit of Urology, Division of Experimental Oncology, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
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Djaladat H, Ghoreifi A, Tejura T, Miranda G, Cai J, Sheybaee Moghaddam F, Aldana I, Sotelo R, Gill I, Bhanvadia S, Schuckman A, Desai M, Aron M, Daneshmand S, Duddalwar V. Prophylactic Use of Biologic Mesh in Ileal Conduit (PUBMIC): A Randomized Clinical Trial. J Urol 2024; 211:743-753. [PMID: 38620056 DOI: 10.1097/ju.0000000000003902] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 02/26/2024] [Indexed: 04/17/2024]
Abstract
PURPOSE We assessed the effect of prophylactic biologic mesh on parastomal hernia (PSH) development in patients undergoing cystectomy and ileal conduit (IC). MATERIALS AND METHODS This phase 3, randomized, controlled trial (NCT02439060) included 146 patients who underwent cystectomy and IC at the University of Southern California between 2015 and 2021. Follow-ups were physical exam and CT every 4 to 6 months up to 2 years. Patients were randomized 1:1 to receive FlexHD prophylactic biological mesh using sublay intraperitoneal technique vs standard IC. The primary end point was time to radiological PSH, and secondary outcomes included clinical PSH with/without surgical intervention and mesh-related complications. RESULTS The 2 arms were similar in terms of baseline clinical features. All surgeries and mesh placements were performed without any intraoperative complications. Median operative time was 31 minutes longer in patients who received mesh, yet with no statistically significant difference (363 vs 332 minutes, P = .16). With a median follow-up of 24 months, radiological and clinical PSHs were detected in 37 (18 mesh recipients vs 19 controls) and 16 (8 subjects in both arms) patients, with a median time to radiological and clinical PSH of 8.3 and 15.5 months, respectively. No definite mesh-related adverse events were reported. Five patients (3 in the mesh and 2 in the control arm) required surgical PSH repair. Radiological PSH-free survival rates in the mesh and control groups were 74% vs 75% at 1 year and 69% vs 62% at 2 years. CONCLUSIONS Implementation of biologic mesh at the time of IC construction is safe without significant protective effects within 2 years following surgery.
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Affiliation(s)
- Hooman Djaladat
- Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, California
- Catherine and Joseph Aresty Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Alireza Ghoreifi
- Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, California
- Catherine and Joseph Aresty Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Tapas Tejura
- Radiology Department, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Gus Miranda
- Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, California
- Catherine and Joseph Aresty Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Jie Cai
- Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, California
- Catherine and Joseph Aresty Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Farshad Sheybaee Moghaddam
- Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, California
- Catherine and Joseph Aresty Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Ileana Aldana
- Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, California
- Catherine and Joseph Aresty Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Rene Sotelo
- Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, California
- Catherine and Joseph Aresty Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Inderbir Gill
- Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, California
- Catherine and Joseph Aresty Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Sumeet Bhanvadia
- Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, California
- Catherine and Joseph Aresty Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Anne Schuckman
- Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, California
- Catherine and Joseph Aresty Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Mihir Desai
- Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, California
- Catherine and Joseph Aresty Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Monish Aron
- Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, California
- Catherine and Joseph Aresty Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Siamak Daneshmand
- Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, California
- Catherine and Joseph Aresty Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Vinay Duddalwar
- Radiology Department, Keck School of Medicine, University of Southern California, Los Angeles, California
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11
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Khetrapal P, Bains PS, Jubber I, Ambler G, Williams NR, Brew-Graves C, Sridhar A, Ta A, Kelly JD, Catto JWF. Digital Tracking of Patients Undergoing Radical Cystectomy for Bladder Cancer: Daily Step Counts Before and After Surgery Within the iROC Randomised Controlled Trial. Eur Urol Oncol 2024; 7:485-493. [PMID: 37852921 DOI: 10.1016/j.euo.2023.09.021] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Revised: 09/11/2023] [Accepted: 09/25/2023] [Indexed: 10/20/2023]
Abstract
BACKGROUND Efforts to improve recovery after radical cystectomy (RC) are needed. OBJECTIVE To investigate wrist-worn wearable activity trackers in RC participants. DESIGN, SETTING, AND PARTICIPANTS An observational cohort study was conducted within the iROC randomised trial. INTERVENTION Patients undergoing RC at nine cancer centres wore wrist-based trackers for 7 days (d) at intervals before and after surgery. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Step counts were compared with participant and operative features, and recovery outcomes. RESULTS AND LIMITATIONS Of 308 participants, 284 (92.2%) returned digital activity data at baseline (median 17 d [interquartile range: 8-32] before RC), and postoperatively (5 [5-6] d) and at weeks 5 (43 [38-43] d), 12 (94 [87-106] d), and 26 (192 [181-205] d) after RC. Compliance was affected by the time from surgery and a coronavirus disease 2019 pandemic lockdown (return rates fell to 0-7%, chi-square p < 0.001). Step counts dropped after surgery (mean of 28% of baseline), before recovering at 5 weeks (wk) (71% of baseline) and 12 wk (95% of baseline; all analysis of variance [ANOVA] p < 0.001). Baseline step counts were not associated with postoperative recovery or death. Patients with extended hospital stays had reduced postoperative step counts, with a difference of 2.2 d (95% confidence interval: 0.856-3.482 d) between the lowest third and highest two-third tertiles (linear regression analysis; p < 0.001). Additionally, they spent less time out of the hospital within 90 d of RC (80.3 vs 74.3 d, p = 0.013). Lower step counts at 5, 12, and 26 wk were seen in those seeking medical help and needing readmission (ANOVA p ≤ 0.002). CONCLUSIONS Baseline step counts were not associated with recovery. Lower postoperative step counts were associated with longer length of stay at the hospital and postdischarge readmissions. Studies are required to determine whether low step counts can identify patients at a risk of developing complications. PATIENT SUMMARY Postoperative step counts appear to be a promising tool to identify patients in the community needing medical help or readmission. More work is needed to understand which measures are most useful and how best to collect these.
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Affiliation(s)
- Pramit Khetrapal
- Division of Surgery & Interventional Science, University College London, London, UK; Department of Urology, University College London Hospital, London, UK
| | - Parasdeep S Bains
- Division of Clinical Medicine, School of Medicine & Population Health, University of Sheffield, Sheffield, UK
| | - Ibrahim Jubber
- Division of Clinical Medicine, School of Medicine & Population Health, University of Sheffield, Sheffield, UK; Department of Urology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Gareth Ambler
- Department of Statistical Science, University College London, London, UK
| | - Norman R Williams
- Surgical & Interventional Trials Unit (SITU), Division of Surgery & Interventional Science, University College London, London, UK
| | - Chris Brew-Graves
- UCL Centre for Medical Imaging, Division of Medicine, University College London, London, UK
| | - Ashwin Sridhar
- Department of Urology, University College London Hospital, London, UK
| | - Anthony Ta
- Department of Urology, University College London Hospital, London, UK
| | - John D Kelly
- Division of Surgery & Interventional Science, University College London, London, UK; Department of Urology, University College London Hospital, London, UK
| | - James W F Catto
- Division of Surgery & Interventional Science, University College London, London, UK; Division of Clinical Medicine, School of Medicine & Population Health, University of Sheffield, Sheffield, UK; Department of Urology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK.
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12
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Czech AK, Gronostaj K, Frydrych J, Polok K, Fronczek J, Dudek P, Belch L, Chlosta M, Choragwicki D, Dymowski T, Ostachowski M, Piatek-Koziej K, Przydacz M, Pyrkosz P, Wiatr T, Wrozek M, Chlosta PL. The assessment of bladder cancer resectability with bimanual palpation: A prospective study in laparoscopy and open cystectomy patients. Urol Oncol 2024; 42:176.e1-176.e7. [PMID: 38508941 DOI: 10.1016/j.urolonc.2024.02.006] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 01/27/2024] [Accepted: 02/18/2024] [Indexed: 03/22/2024]
Abstract
PURPOSE To evaluate the value of examination under anesthesia (EUA) in the assessment of bladder resectability during cystectomy. MATERIALS AND METHODS This prospective study included consecutive patients undergoing cystectomy for bladder cancer at a single center between June 2017 and October 2020. EUA was conducted before cystectomy by two urologists who assessed the bladder for limited mobility. One examiner was blinded to the imaging results. Soft tissue surgical margin status in the pathological evaluation of a cystectomy specimen served as a measure of resectability. We used multivariable logistic regression models to assess whether EUA performed by blinded or non-blinded examiners is associated with soft tissue positive surgical margins (PSMs) and to calculate the fraction of new information added by such an examination in addition to selected clinical variables. RESULTS Among the 134 patients analyzed, limited bladder mobility was indicated by the blinded and non-blinded examiners in 23 (17.2%) and 21 (15.7%) cases, respectively. PSMs were identified in 22 (16.4%) patients, more often in patients with limited bladder mobility as assessed by the blinded (odds ratio [OR] 6.7; 95% confidence interval [CI], 1.9-24.2) and non-blinded examiners (OR 12.9; 95% CI, 2.9-57.5). The fraction of new information added by the blinded and non-blinded examiners was 48.6% and 57.7%, respectively. The enrichment of patients who underwent pure laparoscopic cystectomy (n = 102; 76%) and the inclusion of patients for emergent surgery may limit the generalizability of our findings. CONCLUSIONS The identification of limited bladder mobility during preoperative EUA yielded prognostic information on surgical margin status. Our findings suggest that EUA has the potential to provide valuable insights in the assessment of bladder resectability. However, further research in a larger cohort of patients is warranted to validate and expand on these findings.
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Affiliation(s)
- Anna K Czech
- Department of Urology, Jagiellonian University Medical College, Krakow, Poland.
| | - Katarzyna Gronostaj
- Department of Urology, Jagiellonian University Medical College, Krakow, Poland
| | - Jakub Frydrych
- Department of Urology, Jagiellonian University Medical College, Krakow, Poland
| | - Kamil Polok
- Center for Intensive Care and Perioperative Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Jakub Fronczek
- Center for Intensive Care and Perioperative Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Przemyslaw Dudek
- Department of Urology, Jagiellonian University Medical College, Krakow, Poland
| | - Lukasz Belch
- Department of Urology, Jagiellonian University Medical College, Krakow, Poland
| | - Marcin Chlosta
- Department of Urology, Jagiellonian University Medical College, Krakow, Poland
| | - Dominik Choragwicki
- Department of Urology, Jagiellonian University Medical College, Krakow, Poland
| | - Tomasz Dymowski
- Department of Urology, Jagiellonian University Medical College, Krakow, Poland
| | - Mateusz Ostachowski
- Department of Urology, Jagiellonian University Medical College, Krakow, Poland
| | | | - Mikołaj Przydacz
- Department of Urology, Jagiellonian University Medical College, Krakow, Poland
| | - Pawel Pyrkosz
- Department of Urology, Jagiellonian University Medical College, Krakow, Poland
| | - Tomasz Wiatr
- Department of Urology, Jagiellonian University Medical College, Krakow, Poland
| | - Marcin Wrozek
- Department of Urology, Jagiellonian University Medical College, Krakow, Poland
| | - Piotr L Chlosta
- Department of Urology, Jagiellonian University Medical College, Krakow, Poland
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Ślusarczyk A. ASO Author Reflections: Changes in the Urinary Microbiome After Transurethral Resection of Nonmuscle-Invasive Bladder Cancer: Insights from a Prospective Observational Study. Ann Surg Oncol 2024; 31:3910-3911. [PMID: 38602577 PMCID: PMC11076312 DOI: 10.1245/s10434-024-15248-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Accepted: 03/07/2024] [Indexed: 04/12/2024]
Affiliation(s)
- Aleksander Ślusarczyk
- Department of General, Oncological and Functional Urology, Medical University of Warsaw, Warsaw, Poland.
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14
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Li R, Nocera L, Rose KM, Raggi D, Naidu S, Mercinelli C, Cigliola A, Tateo V, Patanè D, Grass GD, Gilbert SM, Sexton WJ, Bandini M, Moschini M, Briganti A, Montorsi F, Spiess PE, Necchi A. Comparative Effectiveness of Neoadjuvant Pembrolizumab Versus Cisplatin-based Chemotherapy or Upfront Radical Cystectomy in Patients with Muscle-invasive Urothelial Bladder Cancer. Eur Urol Oncol 2024; 7:614-624. [PMID: 38184473 DOI: 10.1016/j.euo.2023.12.008] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 11/21/2023] [Accepted: 12/23/2023] [Indexed: 01/08/2024]
Abstract
BACKGROUND Recent progresses in the use of immune checkpoint inhibitor (ICI) have challenged the therapeutic standards in patients with muscle-invasive urothelial bladder carcinoma (MIBC). OBJECTIVE To compare neoadjuvant pembrolizumab followed by radical cystectomy (RC) versus neoadjuvant chemotherapy (NAC) and RC or upfront RC, according to cisplatin eligibility. DESIGN, SETTING, AND PARTICIPANTS We conducted two separate analyses for cisplatin-eligible and cisplatin-ineligible cT2-4N0M0 MIBC patients. We used a propensity score adjustment that relied on inverse probability of treatment-weighting (IPTW). INTERVENTION Pembrolizumab within the PURE-01 trial, and NAC and RC or upfront RC from a high-volume tertiary care referral center. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS The primary endpoint in both analyses was event-free survival (EFS), defined as freedom from recurrence, and/or death from any cause indexed from the date of treatment initiation or RC. The secondary endpoints included EFS in propensity score-matched patients, pathologic response rate, and recurrence-free survival (RFS) after RC. RESULTS AND LIMITATIONS A total of 458 patients who underwent RC, with or without NAC, at Moffitt Cancer Center between October 2005 and October 2020, and 146 patients enrolled in PURE-01 were analyzed. In cisplatin-ineligible patients, EFS was superior in those receiving pembrolizumab (p < 0.001). The estimated 3-yr EFS was 77.8% (95% confidence interval [CI]: 63.5-95.2) for pembrolizumab and RC, and 36.1% (95% CI: 28.6-45.5) for upfront RC. EFS remained superior in those receiving neoadjuvant ICI (NICI) following IPTW (p < 0.001). In cisplatin-eligible patients, EFS was superior in those receiving pembrolizumab and RC (p < 0.001). The estimated 3-yr EFS was 86.9% (95% CI: 80.9-93.3) for pembrolizumab and 63.5% (95% CI: 56.5-71.4) for NAC. EFS remained superior in those receiving NICI following IPTW (p < 0.001). Pathologic responses and RFS in pembrolizumab-treated patients were also superior to those in NAC-treated patients. Results are limited by the retrospective nature of the study. CONCLUSIONS In the first ever reported comprehensive comparison of outcomes between neoadjuvant ICI and NAC, followed by RC, or upfront RC, we report increased responses and improved oncologic outcomes with neoadjuvant ICI in patients with MIBC. PATIENT SUMMARY We compared the results obtained from the use of pembrolizumab and radical cystectomy with standard-of-care treatments in patients with bladder carcinoma infiltrating the muscle layer. We reported increased response and survival rates possibilities with the use of immunotherapy, anticipating the possibility to set new therapeutic standards in these patients, pending the results of ongoing randomized studies.
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Affiliation(s)
- Roger Li
- Department of Genitourinary Oncology, Moffitt Cancer Center, Tampa, FL, USA.
| | - Luigi Nocera
- Department of Urology, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Kyle M Rose
- Department of Genitourinary Oncology, Moffitt Cancer Center, Tampa, FL, USA
| | - Daniele Raggi
- Department of Medical Oncology, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Shreyas Naidu
- Department of Genitourinary Oncology, Moffitt Cancer Center, Tampa, FL, USA
| | - Chiara Mercinelli
- Department of Medical Oncology, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Antonio Cigliola
- Department of Medical Oncology, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Valentina Tateo
- Department of Medical Oncology, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Damiano Patanè
- Department of Medical Oncology, IRCCS Ospedale San Raffaele, Milan, Italy
| | - G Daniel Grass
- Department of Genitourinary Oncology, Moffitt Cancer Center, Tampa, FL, USA
| | - Scott M Gilbert
- Department of Genitourinary Oncology, Moffitt Cancer Center, Tampa, FL, USA
| | - Wade J Sexton
- Department of Genitourinary Oncology, Moffitt Cancer Center, Tampa, FL, USA
| | - Marco Bandini
- Department of Urology, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Marco Moschini
- Department of Urology, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Alberto Briganti
- Department of Urology, IRCCS Ospedale San Raffaele, Milan, Italy; Department of Medical Oncology, IRCCS Ospedale San Raffaele, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Francesco Montorsi
- Department of Urology, IRCCS Ospedale San Raffaele, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Philippe E Spiess
- Department of Genitourinary Oncology, Moffitt Cancer Center, Tampa, FL, USA
| | - Andrea Necchi
- Department of Genitourinary Oncology, Moffitt Cancer Center, Tampa, FL, USA; Vita-Salute San Raffaele University, Milan, Italy
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Pellegrino F, Martini A, Falagario UG, Rautiola J, Russo A, Mertens LS, Di Gianfrancesco L, Bravi CA, Vollemaere J, Abdeen M, Moschini M, Mendrek M, Kjøbli E, Buse S, Wijburg C, Touzani A, Ploussard G, Antonelli A, Schwenk L, Ebbing J, Vasdev N, Froelicher G, John H, Canda AE, Balbay MD, Stoll M, Edeling S, Berquin C, Van Praet C, Leyh-Bannurah SR, Siemer S, Stoeckle M, Mottrie A, D'Hondt F, Crestani A, Porreca A, Briganti A, Montorsi F, van der Poel H, Dacaestecker K, Gaston R, Hosseini A, Wiklund NP. How can we reduce morbidity after robot-assisted radical cystectomy with intracorporeal neobladder? A report on postoperative complications by the European Association of Urology Robotic Urology Section Scientific Working Group. BJU Int 2024; 133:673-677. [PMID: 38511350 DOI: 10.1111/bju.16283] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/22/2024]
Affiliation(s)
- Francesco Pellegrino
- Division of Oncology/Unit of Urology, URI, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Department of Urology, Karolinska University Hospital, Solna, Sweden
- Department of Urology, La Croix du Sud Hospital, Quint Fonsegrives, France
| | - Alberto Martini
- Department of Molecular Medicine and Surgery, Karolinska institute, Stockholm, Sweden
| | - Ugo Giovanni Falagario
- Department of Urology and Organ Transplantation, University of Foggia, Foggia, Italy
- Department of Urology, Clinique Saint Augustin, Bordeaux, France
| | - Juhana Rautiola
- Department of Urology, La Croix du Sud Hospital, Quint Fonsegrives, France
| | - Antonio Russo
- Department of Urology, IRCCS Ospedale San Raffaele, Milan, Italy
- Department of Urology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Laura S Mertens
- Oncological Urology, IRCCS Veneto Institute of Oncology, Padua, Italy
| | | | - Carlo Andrea Bravi
- Orsi Academy, Ghent, Belgium
- Department of Urology, The Royal Marsden NHS Foundation Trust, London, UK
- Department of Urology and Pediatric Urology, Saarland University, Homburg/Saar, Germany
| | - Jonathan Vollemaere
- Department of Urology, Urologic Oncology and Robot-assisted Surgery, St. Antonius Hospital, Gronau, Germany
| | - Muhammad Abdeen
- Department of Urology, Urologic Oncology and Robot-assisted Surgery, St. Antonius Hospital, Gronau, Germany
| | - Marco Moschini
- Division of Oncology/Unit of Urology, URI, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Department of Urology, Karolinska University Hospital, Solna, Sweden
| | - Mikolaj Mendrek
- Department of Urology, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Eirik Kjøbli
- Department of Urology, Alfried Krupp Krankenhaus, Essen, Germany
| | - Stephan Buse
- Department of Urology, Rijnstate Hospital, Arnhem, The Netherlands
| | - Carl Wijburg
- Department of Urology, International Center of Oncology, Casablanca, Morocco
| | - Alae Touzani
- Department of Urology, University of Verona, Verona, Italy
- Department of Molecular Medicine and Surgery, Karolinska institute, Stockholm, Sweden
| | - Guillaume Ploussard
- Department of Molecular Medicine and Surgery, Karolinska institute, Stockholm, Sweden
| | | | - Laura Schwenk
- Department of Urology, Hertfordshire and Bedfordshire Urological Cancer Centre, Lister Hospital, Stevenage, UK
| | - Jan Ebbing
- Department of Urology, Hertfordshire and Bedfordshire Urological Cancer Centre, Lister Hospital, Stevenage, UK
| | - Nikhil Vasdev
- Department of Urology, Cantonal Hospital Winterthur, Winterthur, Switzerland
| | - Gabriel Froelicher
- Department of Urology, Koç University School of Medicine, Istanbul, Turkey
| | - Hubert John
- Department of Urology, Koç University School of Medicine, Istanbul, Turkey
| | - Abdullah Erdem Canda
- RMK AIMES (Rahmi M. Koç Academy of Interventional Medicine, Education and Simulation), Istanbul, Turkey
- Department of Urology, American Hospital, Istanbul, Turkey
| | - Mevlana Derya Balbay
- Department of Urology, Vinzenz Hospital, Hannover, Germany
- RMK AIMES (Rahmi M. Koç Academy of Interventional Medicine, Education and Simulation), Istanbul, Turkey
| | - Marcel Stoll
- Department of Urology, Ghent University Hospital, Ghent, Belgium
| | | | - Camille Berquin
- Department of Urology, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Charles Van Praet
- Department of Urology, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | | | - Stefan Siemer
- Department of Urology, Urologic Oncology and Robot-assisted Surgery, St. Antonius Hospital, Gronau, Germany
| | - Michael Stoeckle
- Department of Urology, Urologic Oncology and Robot-assisted Surgery, St. Antonius Hospital, Gronau, Germany
| | - Alexander Mottrie
- Orsi Academy, Ghent, Belgium
- Department of Urology, The Royal Marsden NHS Foundation Trust, London, UK
| | - Frederiek D'Hondt
- Orsi Academy, Ghent, Belgium
- Department of Urology, The Royal Marsden NHS Foundation Trust, London, UK
| | | | | | - Alberto Briganti
- Division of Oncology/Unit of Urology, URI, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Department of Urology, Karolinska University Hospital, Solna, Sweden
| | - Francesco Montorsi
- Division of Oncology/Unit of Urology, URI, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Department of Urology, Karolinska University Hospital, Solna, Sweden
| | - Hendrik van der Poel
- Oncological Urology, IRCCS Veneto Institute of Oncology, Padua, Italy
- Department of Urology, AZ Maria Middelares Hospital, Ghent, Belgium
| | - Karel Dacaestecker
- Department of Urology, Amsterdam University Medical Centers, Amsterdam, The Netherlands
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Richard Gaston
- Department of Urology, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Abolfazl Hosseini
- Department of Urology, La Croix du Sud Hospital, Quint Fonsegrives, France
| | - N Peter Wiklund
- Vita-Salute San Raffaele University, Milan, Italy
- Department of Urology and Organ Transplantation, University of Foggia, Foggia, Italy
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Alfarizi ZY, Subekti E, Danarto, Yuri P. A rare case of spontaneous bladder wall abscess mimicking bladder tumour in young women. BMC Urol 2024; 24:109. [PMID: 38762447 DOI: 10.1186/s12894-024-01497-6] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Accepted: 05/10/2024] [Indexed: 05/20/2024] Open
Abstract
INTRODUCTION Abscess of the bladder wall is a rare urological disorder, with a few cases recorded in the literature. The finding of a bladder wall mass via computed tomography (CT) imaging in a visiting patient is the subject of this report. CASE DISCUSSION A 37-year-old woman with persistent pain in the suprapubic area and lower urinary tract symptoms was examined as a case study. Through a CT scan revealed an inhomogeneous structure in the anteroinferior part of the right bladder. A cystoscopy procedure followed by transurethral resection was performed to remove the mass, which was found to be an abscess. A Foley catheter with irrigation was administered after surgery, and the patient goes home in three days. CONCLUSION the patient had no symptoms or discomfort in the lower urinary tract after follow-up. Despite the rarity of bladder wall abscesses, cystoscopy can be used to aid diagnosis. Transurethral resection of bladder wall can reduce the mass and eliminate the possibility of malignancy.
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Affiliation(s)
- Zico Yusuf Alfarizi
- Urology Division, Department of Surgery, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada / Dr. Sardjito Hospital, Jl. Kesehatan No.1, Yogyakarta, 55281, Indonesia
| | - Eko Subekti
- Urology Division, Department of Surgery, Regional General Banyumas Hospital, Jl. Rumah Sakit No.1, Karangpucung, Kejawar, Kec. Banyumas, Kabupaten Banyumas, Jawa Tengah, 53192, Indonesia
| | - Danarto
- Urology Division, Department of Surgery, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada / Dr. Sardjito Hospital, Jl. Kesehatan No.1, Yogyakarta, 55281, Indonesia
| | - Prahara Yuri
- Urology Division, Department of Surgery, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada / Dr. Sardjito Hospital, Jl. Kesehatan No.1, Yogyakarta, 55281, Indonesia.
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17
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Scilipoti P, Liedberg F, Garmo H, Wilberg Orrason A, Stattin P, Westerberg M. Risk of prostate cancer death in men diagnosed with prostate cancer at cystoprostat-ectomy. A nationwide population-based study. Scand J Urol 2024; 59:98-103. [PMID: 38738332 DOI: 10.2340/sju.v59.40001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Accepted: 04/02/2024] [Indexed: 05/14/2024]
Abstract
BACKGROUND AND AIMS One out of three men who undergo cystoprostatectomy for bladder cancer is diagnosed with incidental prostate cancer (PCa) at histopathological examination. Many of these men are PSA tested as part of their follow-up, but it is unclear if this is needed. The aim of this study was to assess the risk of PCa death in these men and the need of PSA-testing during follow-up. METHODS Between 2002 and 2020, 1,554 men were diagnosed with PCa after cystoprostatectomy performed for non-metastatic bladder cancer and registered in the National Prostate Cancer Register (NPCR) of Sweden. We assessed their risk of death from PCa, bladder cancer and other causes up to 15 years after diagnosis by use of data in The Cause of Death Register. The use of androgen deprivation therapy (ADT) as a proxy for PCa progression was assessed by fillings in The Prescribed Drug Register. RESULTS Fifteen years after diagnosis, cumulative incidence of death from PCa was 2.6% (95% CI 2.3%-2.9%), from bladder cancer 32% (95% CI: 30%-34%) and from other causes 40% (95% CI: 36%-44%). Only 35% of men with PCa recorded as primary cause of death in The Cause of Death Register had started ADT before date of death, indicating sticky-diagnosis bias with inflated risk of PCa death. CONCLUSIONS For a large majority of men diagnosed with incidental PCa at cystoprostatectomy performed for bladder cancer, the risk of PCa death is very small so there is no rationale for PSA testing during follow-up.
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Affiliation(s)
- Pietro Scilipoti
- Division of Experimental Oncology/Unit of Urology, IRCCS Ospedale San Raffaele, Milan, Italy; Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Fredrik Liedberg
- Department of Urology Skåne University Hospital, Malmö, Sweden; Institution of Translational Medicine, Lund University, Malmö, Sweden
| | - Hans Garmo
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | | | - Pär Stattin
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Marcus Westerberg
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden.
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18
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Choi J, Lee J, Hwang YB, Jeong BC, Lee S, Ku JH, Nam JK, Kim W, Lee JY, Hong SH, Rha KH, Han WK, Ham WS, Kang SG, Kang SH, Oh JJ, Lee YG, Kwon TG, Kim TH, Jeon SH, Lee SH, Park SY, Yoon YE, Lee YS. Preoperative smoking and robot-assisted radical cystectomy outcomes & complications in multicenter KORARC database. Sci Rep 2024; 14:10550. [PMID: 38719836 PMCID: PMC11078966 DOI: 10.1038/s41598-024-61005-6] [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] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Accepted: 04/30/2024] [Indexed: 05/12/2024] Open
Abstract
To investigate the influence of preoperative smoking history on the survival outcomes and complications in a cohort from a large multicenter database. Many patients who undergo radical cystectomy (RC) have a history of smoking; however, the direct association between preoperative smoking history and survival outcomes and complications in patients with muscle-invasive bladder cancer (MIBC) who undergo robot-assisted radical cystectomy (RARC) remains unexplored. We conducted a retrospective analysis using data from 749 patients in the Korean Robot-Assisted Radical Cystectomy Study Group (KORARC) database, with an average follow-up duration of 30.8 months. The cohort was divided into two groups: smokers (n = 351) and non-smokers (n = 398). Propensity score matching was employed to address differences in sample size and baseline demographics between the two groups (n = 274, each). Comparative analyses included assessments of oncological outcomes and complications. After matching, smoking did not significantly affect the overall complication rate (p = 0.121). Preoperative smoking did not significantly increase the occurrence of complications based on complication type (p = 0.322), nor did it increase the readmission rate (p = 0.076). There were no perioperative death in either group. Furthermore, preoperative smoking history showed no significant impact on overall survival (OS) [hazard ratio (HR) = 0.87, interquartile range (IQR): 0.54-1.42; p = 0.589] and recurrence-free survival (RFS) (HR = 1.12, IQR: 0.83-1.53; p = 0.458) following RARC for MIBC. The extent of preoperative smoking (≤ 10, 10-30, and ≥ 30 pack-years) had no significant influence on OS and RFS in any of the categories (all p > 0.05). Preoperative smoking history did not significantly affect OS, RFS, or complications in patients with MIBC undergoing RARC.
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Affiliation(s)
- Joongwon Choi
- Department of Urology, Chung-Ang University Gwangmyeong Hospital, Chung-Ang University College of Medicine, Gwangmyeong, Korea
| | - Jooyoung Lee
- Department of Applied Statistics, Chung-Ang University, Seoul, Korea
| | - Yu Been Hwang
- Department of Applied Statistics, Chung-Ang University, Seoul, Korea
| | - Byong Chang Jeong
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sangchul Lee
- Department of Urology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Ja Hyeon Ku
- Department of Urology, Seoul National University College of Medicine, Seoul, Korea
| | - Jong Kil Nam
- Department of Urology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Wansuk Kim
- Department of Urology, Ewha Womans University Mokdong Hospital, Seoul, Korea
| | - Ji Youl Lee
- Department of Urology, Seoul St. Mary's Hospital, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Sung Hoo Hong
- Department of Urology, Seoul St. Mary's Hospital, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Koon Ho Rha
- Department of Urology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Woong Kyu Han
- Department of Urology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Won Sik Ham
- Department of Urology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Sung Gu Kang
- Department of Urology, Korea University College of Medicine, Seoul, Korea
| | - Seok Ho Kang
- Department of Urology, Korea University College of Medicine, Seoul, Korea
| | - Jong Jin Oh
- Department of Urology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Young Goo Lee
- Department of Urology, Hallym University School of Medicine, Seoul, Korea
| | - Tae Gyun Kwon
- Department of Urology, Kyungpook National University School of Medicine, Daegu, Korea
| | - Tae-Hwan Kim
- Department of Urology, Kyungpook National University School of Medicine, Daegu, Korea
| | - Seung Hyun Jeon
- Department of Urology, KyungHee University College of Medicine, Seoul, Korea
| | - Sang Hyub Lee
- Department of Urology, KyungHee University College of Medicine, Seoul, Korea
| | - Sung Yul Park
- Department of Urology, Hanyang University College of Medicine, Seoul, Korea
| | - Young Eun Yoon
- Department of Urology, Hanyang University College of Medicine, Seoul, Korea
| | - Yong Seong Lee
- Department of Urology, Chung-Ang University Gwangmyeong Hospital, Chung-Ang University College of Medicine, Gwangmyeong, Korea.
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19
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Çanakcı C, Özkaptan O, Dinçer E, Ipek OM, Dalgıç G, Sahan A. Perioperative Outcomes of Open Extra-peritoneal Versus Laparoscopic Radical Cystoprostatectomy: A single Center Comparative Study. Urol J 2024; 21:175-181. [PMID: 38629198 DOI: 10.22037/uj.v21i03.7937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 03/17/2024] [Indexed: 05/08/2024]
Abstract
PURPOSE To compare 90-day perioperative complications and pathological outcomes between laparoscopic radical cystectomy (LRC) and extraperitoneal radical cystectomy (EORC) approaches. MATERIALS AND METHODS All operations were performed in a single high-volume tertiary referee center by the same surgical team.Males ≥ 18 years with pre-cystectomy clinical T1-T3 disease and having undergone an ileal conduit were included. Exclusion criteria included patients with inflammatory bowel disease, previous pelvic and/or abdominal irradiation, neo-adjuvant chemotherapy, and/or clinical T4 disease. Perioperative outcomes such as operative time, estimated blood loss, transfusion rate, hospital stay, and 90-day complications were evaluated. The recovery duration of regular bowel activity, mean stool passage,and ileus rates were recorded. RESULTS A total of 221 patients met the inclusion criteria(81 LRC and 130 EORC). Demographics and preoperative parameters were comparable. Intraoperative estimated blood lossfavored LRC by a median of 450 mL (200-900) P=.021) vs. a median of 700 mL (300-2900) for EORC. The transfusion rate did not differ between the two groups; %14.8 (N=12) for the LRC and %20.8 (N=27) for EORC (P=.37). The median hospital stay was 9 (4-49) days for EORC and 8 (4-29) days for LRC (P=.011). The need for analgesics to control pain through an epidural catheter was higher for EORC (P=.042). There was no difference in overall complication rates (P=.47). CONCLUSION Although LRC appears to have a slight advantage over EORC, both techniques yield satisfactory results in regard to ileus rates and 90-day perioperative complications.
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Affiliation(s)
- Cengiz Çanakcı
- Department of Urology, Health Sciencies University, Kartal Dr. Lutfi Kirdar City Hospital, Istanbul/TURKEY.
| | - Orkunt Özkaptan
- Department of Urology, Health Sciencies University, Kartal Dr. Lutfi Kirdar City Hospital, Istanbul/TURKEY.
| | - Erdinç Dinçer
- Department of Urology, Health Sciencies University, Kartal Dr. Lutfi Kirdar City Hospital, Istanbul/TURKEY.
| | - Osman Murat Ipek
- Department of Urology, Health Sciencies University, Kartal Dr. Lutfi Kirdar City Hospital, Istanbul/TURKEY.
| | - Gürkan Dalgıç
- Department of Urology, Health Sciencies University, Kartal Dr. Lutfi Kirdar City Hospital, Istanbul/TURKEY.
| | - Ahmet Sahan
- Department of Urology, Medicana Hospital, Bursa/TURKEY.
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20
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Saunders KE, Gerken N, Khani F, Williamson SR, Wobker SE. Current gross examination and reporting patterns of post-neoadjuvant chemotherapy cystectomy specimens: Is it time for a standardized approach? Am J Clin Pathol 2024; 161:483-489. [PMID: 38240078 DOI: 10.1093/ajcp/aqad176] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 11/28/2023] [Indexed: 05/03/2024] Open
Abstract
OBJECTIVES Neoadjuvant chemotherapy (NACT) is recommended for muscle-invasive bladder cancer, and robust treatment response may result in lack of grossly identifiable tumor in the cystectomy specimen. Current gross examination and reporting protocols, however, do not include specific guidance on the approach to these specimens. METHODS A Qualtrics survey was disseminated by email and X (formerly Twitter). Responses from pathologists and pathologists' assistants (PAs) were included. The survey interrogated demographics, practice settings, prevalence of NACT use, approach to gross examination, and reporting practices in the setting of both grossly visible tumor or ulcer bed and the complete absence of a gross lesion. RESULTS Based on 55 respondents' experience, identifying gross tumor occurred less frequently than tumor or ulcer bed (40% vs 71%). Lack of identification of any gross lesions was estimated to occur in 29% of cases. Gross examination practices were relatively consistent in cases with residual gross tumor or gross tumor bed, with agreement that gross tumor should be submitted as 1 block per centimeter (66%), and tumor or ulcer bed should be submitted in its entirety (97%). Gross examination practices appeared more varied when no gross lesions were identified. Overall, most responders stated they "definitely" or "maybe" support a standardized gross examination (89%) and reporting (96%) protocol. CONCLUSIONS With the increased use of NACT, lack of any gross lesion leads to inconsistent gross examination techniques. This study provides insight into the current approach to examination of post-NACT cystectomies and suggests that a desire exists among pathologists and pathologists' assistants for more standardized practice.
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Affiliation(s)
- Katherine E Saunders
- Department of Pathology and Laboratory Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, US
| | - Nicola Gerken
- Department of Pathology and Laboratory Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, US
| | - Francesca Khani
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY, US
| | - Sean R Williamson
- Robert J. Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, OH, US
| | - Sara E Wobker
- Department of Pathology and Laboratory Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, US
- UNC Lineberger Comprehensive Cancer Center, Chapel Hill, NC, US
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21
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Thalmann GN. Robot-assisted Radical Cystectomy with Intracorporeal Urinary Diversion Versus Open Radical Surgery: All Is in the Eye of the Beholder. Eur Urol 2024; 85:431-432. [PMID: 38413301 DOI: 10.1016/j.eururo.2024.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Accepted: 02/12/2024] [Indexed: 02/29/2024]
Affiliation(s)
- George N Thalmann
- Department of Urology, William-Fabry-Haus Inselspital, University of Bern, Bern, Switzerland.
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22
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Qin F, Wu J. Impact of sarcopenia on outcomes of bladder cancer undergoing radical cystectomy: A systematic review and meta-analysis. Scott Med J 2024; 69:26-36. [PMID: 38424743 DOI: 10.1177/00369330241234690] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
OBJECTIVE To provide synthesized evidence on the association between sarcopenia and risk of mortality, recurrence and postoperative complications in patients with bladder cancer and undergoing radical cystectomy (RC). METHODS Only studies with observational design that investigated the association between sarcopenia and outcomes of interest among patients with bladder cancer undergoing RC were included. The outcomes of interest were mortality, recurrence, and postoperative complications. The systematic search was conducted using three large databases, that is, PubMed, EMBASE, and Scopus. A random effects model was used for the analysis and pooled effect sizes were reported as odds ratio (OR) or hazards ratio (HR) along with 95% confidence intervals (CIs). RESULTS A total of 21 studies with 4997 patients were included. Compared to non-sarcopenic subjects, those with sarcopenia had increased risk of all-cause mortality (HR 1.45, 95% CI: 1.32, 1.61), cancer-specific mortality (HR 1.74, 95% CI: 1.49, 2.03) and a lower recurrence free survival (HR 1.84, 95% CI: 1.30, 2.62). Patients with sarcopenia also had higher risk of developing complications within 90 days postoperatively (OR 1.77, 95% CI: 1.23, 2.55). CONCLUSION Sarcopenia among patients with bladder cancer and managed using RC is associated with adverse survival outcomes and an increased risk of postoperative complications.
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Affiliation(s)
- Fanyi Qin
- Department of Operating Room, Tumor Hospital of Nantong University & Nantong Tumor Hospital, Nantong, Jiangsu Province, China
| | - Jiacheng Wu
- Department of Urology, Tumor Hospital of Nantong University & Nantong Tumor Hospital, Nantong, Jiangsu Province, China
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23
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Kang H, Suh J, You D, Jeong IG, Hong B, Hong JH, Ahn H, Lim B. Risk factors for failing to complete gemcitabine-cisplatin neoadjuvant chemotherapy in muscle invasive bladder cancer patients. Investig Clin Urol 2024; 65:256-262. [PMID: 38714516 PMCID: PMC11076801 DOI: 10.4111/icu.20230389] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 01/17/2024] [Accepted: 01/23/2024] [Indexed: 05/10/2024] Open
Abstract
PURPOSE We evaluated the risk factors associated with failure to complete gemcitabine-cisplatin (GP) neoadjuvant chemotherapy (NAC) for muscle-invasive bladder cancer (MIBC). MATERIALS AND METHODS In total, 231 patients with MIBC treated with NAC before undergoing radical cystectomy between 2013 and 2022 participated in this study. Logistic regression analysis was performed to assess the relationship between the likelihood of incomplete NAC and clinical and demographic variables, including age, sex, hypertension (HTN), diabetes mellitus (DM), prechemotherapy glomerular filtration rate, clinical T stage, clinical N stage, and body mass index (BMI). RESULTS Of 231 patients, 209 (90.5%) and 22 (9.5%) completed and discontinued the NAC course, respectively. The mean age was 66.13±9.15, 65.63±9.07, and 70.86±8.66 years for the total sample, continuation, and discontinuation groups, respectively (p=0.010). No significant inter-group differences in sex, HTN, height, weight, BMI, pre-chemotherapy glomerular filtration rate, clinical T stage, or clinical N stage were observed. According to the results of the multivariable analysis, age (odds ratio [OR] 1.076, 95% confidence interval [CI] 1.013-1.143, p=0.018) and the presence of DM (OR 2.541, 95% CI 1.028-6.281, p=0.043) were significantly associated with NAC discontinuation. CONCLUSIONS Thus, older age and presence of DM are potential risk factors for GP NAC discontinuation in patients with MIBC. Further studies are required to validate our findings and develop strategies to minimize the rate of GP NAC discontinuation in this population.
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Affiliation(s)
- Homin Kang
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jungyo Suh
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Dalsan You
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - In Gab Jeong
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Bumsik Hong
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jun Hyuk Hong
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hanjong Ahn
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Bumjin Lim
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
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24
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Fang AM, Hayek O, Kaylor JM, Peyton CC, Ferguson JE, Nix JW, Rais-Bahrami S. Postoperative Outcomes and Analgesic Requirements of Single-Port vs Multiport Robotic-Assisted Radical Cystectomy. J Endourol 2024; 38:438-443. [PMID: 38468557 DOI: 10.1089/end.2023.0553] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/13/2024] Open
Abstract
Objective: To compare outcomes in patients undergoing robotic-assisted radical cystectomy (RARC) with urinary diversion for bladder cancer with either the single-port (SP) or multiport (MP) robotic platform. Methods: All patients who underwent SP and MP RARC at our institution between January 2018 and January 2023 were retrospectively reviewed. Postoperative analgesia was administered by a departmentwide narcotic stewardship protocol, and inpatient and outpatient narcotic use was tracked. The available preoperative clinical, operative, and postoperative outcomes were analyzed using t-test, chi-square, and Fischer exact statistical measures. Kaplan-Meier analysis with log-rank testing was used to determine the freedom from high-grade (Clavien-Dindo grade ≥3) postoperative complications stratified by SP or MP robotic use. Results: Overall, 96 patients underwent RARC with urinary diversion at our institution, with 49 MP and 47 SP procedures performed. Preoperative clinical parameters including age, body mass index, prior abdominal surgery, and use of neoadjuvant chemotherapy were similar between the two groups. Patients undergoing SP RARC had a shorter operative time (386.0 ± 90.9 minutes vs 453.6 ± 94.8 minutes, p < 0.01) and faster return of bowel function (3.4 ± 1.4 days vs 4.5 ± 2.2 days, p < 0.01). However, both cohorts had similar length of hospitalization, postoperative narcotic use, pathologic staging, and rate of positive surgical margin. Within 3 months postoperatively, both cohorts had a similar high-grade complication, hospital readmission, and cancer recurrence rate. Conclusions: The SP robot allows a safe alternative surgical approach for RARC and offers similar postoperative outcomes compared to the MP robot.
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Affiliation(s)
- Andrew M Fang
- Department of Urology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Omar Hayek
- Department of Urology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - John Michael Kaylor
- Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Charles C Peyton
- Department of Urology, University of Alabama at Birmingham, Birmingham, Alabama, USA
- O'Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - James E Ferguson
- Department of Urology, University of Alabama at Birmingham, Birmingham, Alabama, USA
- O'Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Jeffrey W Nix
- Department of Urology, University of Alabama at Birmingham, Birmingham, Alabama, USA
- O'Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Soroush Rais-Bahrami
- Department of Urology, University of Alabama at Birmingham, Birmingham, Alabama, USA
- O'Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, Alabama, USA
- Department of Radiology, University of Alabama at Birmingham, Birmingham, Alabama, USA
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25
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Greenberg DR, Rhodes S, Bhambhvani HP, Gago LC, Schaeffer EM, Meeks JJ, Brannigan RE, Shoag JE, Halpern JA. The association between frailty, hypogonadism, and postoperative outcomes among men undergoing radical cystectomy. Urol Oncol 2024; 42:161.e9-161.e16. [PMID: 38262867 DOI: 10.1016/j.urolonc.2024.01.012] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 12/25/2023] [Accepted: 01/08/2024] [Indexed: 01/25/2024]
Abstract
INTRODUCTION Hypogonadism is associated with frailty, lower health-related quality of life, decreased muscle mass, and premature mortality, which may predispose patients to poor postoperative outcomes. We aimed to determine the prevalence of hypogonadism in men undergoing radical cystectomy (RC) and whether hypogonadism and frailty are associated with adverse postoperative outcomes. MATERIALS AND METHODS The IBM MarketScan database was used to identify men who underwent RC between 2012 and 2021. Frailty was determined using published Hospital Frailty Risk Score ranges. Patients were considered to have hypogonadism if diagnosed within 5 years prior to RC. Length of stay (LOS), complications, emergency department (ED) visits and inpatient readmissions were compared. Sub-group analysis of men with hypogonadism was performed to determine the effect of testosterone replacement therapy (TRT) on clinical outcomes. RESULTS Among 3,727 men who underwent RC, 226 (6.1%) had a diagnosis of hypogonadism. Overall, 565 (15.2%) men were low-risk frailty, 2,214 (59.4%) intermediate-risk frailty, and 948 (25.4%) were high-risk frailty, and men with hypogonadism were significantly more frail compared to men without hypogonadism (P = 0.027). There was no significant difference in LOS, complications, or rate of ED visits and inpatient readmissions between cohorts (P > 0.05). However, high-risk frailty was associated with an increased risk of 90-day ED visit (HR 1.19, 95%CI 1.00-1.41, P = 0.049) and 90-day readmission (HR 1.60, 95%CI 1.29-1.97, P < 0.001) after RC. Among men with hypogonadism, 58 (25.7%) were on TRT. There was no significant difference in frailty, LOS, complications, or 90-day ED visits or 90-day inpatient readmissions between patient with hypogonadism prescribed TRT and those without TRT. CONCLUSIONS These findings suggest that hypogonadism and preoperative frailty may be important to evaluate prior to undergoing RC.
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Affiliation(s)
- Daniel R Greenberg
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL.
| | - Stephen Rhodes
- University Hospitals Cleveland Medical Center, Cleveland, OH
| | - Hriday P Bhambhvani
- Department of Urology, Weill Cornell Medicine James Buchanan Brady Foundation, New York, NY
| | - Luis C Gago
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Edward M Schaeffer
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Joshua J Meeks
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Robert E Brannigan
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Jonathan E Shoag
- Department of Urology, Case Western Reserve University School of Medicine, Cleveland, OH
| | - Joshua A Halpern
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL
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26
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Baust JM, Corcoran A, Robilotto A, Katz A, Santucci K, Van Buskirk RG, Baust JG, Snyder KK. Evaluation of a New Cystoscopic Cryocatheter and Method for the In Situ Destruction of Bladder Cancer: Preliminary In Vivo Study. J Endourol 2024; 38:513-520. [PMID: 38279787 PMCID: PMC11057528 DOI: 10.1089/end.2023.0635] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2024] Open
Abstract
Purpose: To assess the ability to deliver full-thickness bladder wall cryoablation through a cystoscopic approach using a new closed-loop 6F cryocatheter and thermal dose-controlled protocol. Materials and Methods: Evaluations were conducted using a chronic porcine model wherein 10 lesions/animal were created throughout the bladder (bladder wall, trigone region, ureteral orifice, and distal ureter). A 6F cryocatheter was passed through the working channel of a flexible cystoscope. Single 1- and 1.5-minute freeze protocols in a saline environment were evaluated and resultant lesion size was determined. A laparoscopic approach was utilized to observe the transmural extension of the ice propagation. Results: Studies demonstrated the generation of transmural lesions characterized by full-thickness histologic necrosis after freezing for 1.5 minutes regardless of tissue thickness (range 2-12 mm). All animals were found to have good overall health (maintained weight, appetite, mobility, and energy levels) throughout the recovery period. No significant deviations were noted in complete blood count and serum chemistry bloodwork except for elevated creatine kinase levels. Importantly, no fistulas or perforations were noted. Conclusions: The cryocatheter was able to rapidly and effectively freeze the bladder wall through a cystoscopic approach. The results showed the ability to consistently ablate an ∼1 cm diameter and up to 1.2 cm deep using a single 1.5-minute freeze protocol. Analysis of the ablation efficacy revealed ∼80% destruction within the frozen mass. Although further testing and refinement are needed, these studies demonstrate the potential of this new approach to provide a next-generation strategy for the treatment of bladder cancer.
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Affiliation(s)
- John M. Baust
- CPSI Biotech, Research & Development, Owego, New York, USA
- Vesana, Inc., Research & Development, Owego, New York, USA
| | - Anthony Corcoran
- Department of Urology, NYU Langone Hospital Long Island, Mineola, New York, USA
- Vesana, Inc., Research & Development, Owego, New York, USA
| | - Anthony Robilotto
- CPSI Biotech, Research & Development, Owego, New York, USA
- Vesana, Inc., Research & Development, Owego, New York, USA
| | - Aaron Katz
- Department of Urology, NYU Langone Hospital Long Island, Mineola, New York, USA
- Vesana, Inc., Research & Development, Owego, New York, USA
| | - Kimberly Santucci
- CPSI Biotech, Research & Development, Owego, New York, USA
- Vesana, Inc., Research & Development, Owego, New York, USA
| | - Robert G. Van Buskirk
- CPSI Biotech, Research & Development, Owego, New York, USA
- Vesana, Inc., Research & Development, Owego, New York, USA
- Center for Translational Stem Cell and Tissue Engineering, Binghamton University, Binghamton, New York, USA
- Department of Biological Sciences, Binghamton University, Binghamton, New York, USA
| | - John G. Baust
- Vesana, Inc., Research & Development, Owego, New York, USA
- Center for Translational Stem Cell and Tissue Engineering, Binghamton University, Binghamton, New York, USA
- Department of Biological Sciences, Binghamton University, Binghamton, New York, USA
| | - Kristi K. Snyder
- CPSI Biotech, Research & Development, Owego, New York, USA
- Vesana, Inc., Research & Development, Owego, New York, USA
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27
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Cheng WC, Heng HG, Cheng HY, Lin KY, Chen KS. Findings of an Extraluminal Leiomyosarcoma of the Urinary Bladder in a Dog. J Am Anim Hosp Assoc 2024; 60:109-113. [PMID: 38662998 DOI: 10.5326/jaaha-ms-7386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/15/2024] [Indexed: 05/07/2024]
Abstract
A 9 yr old male miniature poodle presented with acute diarrhea, vomiting, and a distended abdomen. A large and firm mass was palpated in the caudal abdomen. Radiography showed a large soft-tissue mass in the mid ventral abdomen. The mass was mildly contrast-enhancing and in contact with the right cranial aspect of the bladder on computed tomography. The mass was heterogeneous with minimal blood flow on Doppler examination. Surgery confirmed its origin of the urinary bladder, and it was diagnosed leiomyosarcoma on pathology. This is the first report of extraluminal leiomyosarcoma of the bladder wall with imaging characteristics using various modalities.
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Affiliation(s)
- Wan-Ching Cheng
- From the Department of Veterinary Medicine, Veterinary Medical Teaching Hospital (W.-C.C., H.-Y.C., K.-S.C.), College of Veterinary Medicine, National Chung, Hsing University, Taichung City, Taiwan
| | | | - Hsin-Yeh Cheng
- From the Department of Veterinary Medicine, Veterinary Medical Teaching Hospital (W.-C.C., H.-Y.C., K.-S.C.), College of Veterinary Medicine, National Chung, Hsing University, Taichung City, Taiwan
| | - Kuan-Yin Lin
- James & Herriot Animal Hospital, Taichung City, Taiwan (K.-Y.L.)
| | - Kuan-Sheng Chen
- From the Department of Veterinary Medicine, Veterinary Medical Teaching Hospital (W.-C.C., H.-Y.C., K.-S.C.), College of Veterinary Medicine, National Chung, Hsing University, Taichung City, Taiwan
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28
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Kim DH, Choi MS, Choi JH, Lee C, Jeh SU, Kam SC, Hwa JS, Hyun JS, Choi SM. Correlation between urine cytology results on the day after overnight continuous saline irrigation following transurethral resection of bladder tumor and bladder tumor recurrence. Investig Clin Urol 2024; 65:279-285. [PMID: 38714518 PMCID: PMC11076798 DOI: 10.4111/icu.20230284] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 10/26/2023] [Accepted: 01/22/2024] [Indexed: 05/10/2024] Open
Abstract
PURPOSE To investigate the relationship between urine cytology results after overnight continuous saline irrigation (OCSI) following transurethral resection of bladder tumor (TURBT) and bladder tumor recurrence in non-muscle invasive bladder cancer (NMIBC). MATERIALS AND METHODS A retrospective study was conducted on patients diagnosed with NMIBC between 2016 and 2020 after undergoing TURBT at our hospital. All patients received OCSI following TURBT and had urine cytology test at postoperative 1 day. Urine cytology was classified into three groups: Negative, low-grade urothelial neoplasm (LGUN)+atypical urothelial cells (AUC), and suspicious for high-grade urothelial carcinoma (SHGUC)+high-grade urothelial carcinoma (HGUC). Recurrence-free survival (RFS) in each group was compared using the Kaplan-Meier method. Univariable and multivariable Cox regression analyses were performed to evaluate independent prognostic factors. RESULTS A total of 172 patients were included in this study. Based on urine cytology group (after OCSI), RFS did not reach the median value in the Negative group. In the LGUN+AUC group, the median RFS was 615.00 days. In the SHGUC+HGUC group, the median RFS was 377.00 days. In survival analysis, the Negative group had a longer RFS than the SHGUC+HGUC group (p=0.013). However, Cox regression analysis showed that SHGUC+HGUC was not an independent prognostic factor for recurrence. CONCLUSIONS Urine cytology results after OCSI following TURBT in NMIBC were associated with bladder tumor recurrence. Specifically, SHGUC or HGUC in urine cytology after OCSI showed earlier recurrence than negative cases. However, further research is needed to accurately determine whether it is an independent prognostic factor.
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Affiliation(s)
- Dae Hyun Kim
- Department of Urology, Gyeongsang National University Hospital, Gyeongsang National University College of Medicine, Jinju, Korea
- Institute of Health Science, Gyeongsang National University, Jinju, Korea
| | - Min Sung Choi
- Department of Urology, Gyeongsang National University Hospital, Gyeongsang National University College of Medicine, Jinju, Korea
- Institute of Health Science, Gyeongsang National University, Jinju, Korea
| | - Jae Hwi Choi
- Department of Urology, Gyeongsang National University Hospital, Gyeongsang National University College of Medicine, Jinju, Korea
- Institute of Health Science, Gyeongsang National University, Jinju, Korea
| | - Chunwoo Lee
- Institute of Health Science, Gyeongsang National University, Jinju, Korea
- Department of Urology, Gyeongsang National University Changwon Hospital, Gyeongsang National University College of Medicine, Changwon, Korea
| | - Seong Uk Jeh
- Department of Urology, Gyeongsang National University Hospital, Gyeongsang National University College of Medicine, Jinju, Korea
- Institute of Health Science, Gyeongsang National University, Jinju, Korea
| | - Sung Chul Kam
- Institute of Health Science, Gyeongsang National University, Jinju, Korea
- Department of Urology, Gyeongsang National University Changwon Hospital, Gyeongsang National University College of Medicine, Changwon, Korea
| | - Jeong Seok Hwa
- Department of Urology, Gyeongsang National University Hospital, Gyeongsang National University College of Medicine, Jinju, Korea
- Institute of Health Science, Gyeongsang National University, Jinju, Korea
| | - Jae Seog Hyun
- Department of Urology, Gyeongsang National University Hospital, Gyeongsang National University College of Medicine, Jinju, Korea
- Institute of Health Science, Gyeongsang National University, Jinju, Korea
| | - See Min Choi
- Department of Urology, Gyeongsang National University Hospital, Gyeongsang National University College of Medicine, Jinju, Korea
- Institute of Health Science, Gyeongsang National University, Jinju, Korea.
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29
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Cao B, Li Q, Xu P, Zhang Y, Cai S, Rao S, Zeng M, Dai Y, Jiang S, Zhou J. Vesical Imaging-Reporting and Data System (VI-RADS) as a grouping imaging biomarker combined with a decision-tree mode to preoperatively predict the pathological grade of bladder cancer. Clin Radiol 2024; 79:e725-e735. [PMID: 38360514 DOI: 10.1016/j.crad.2024.01.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 01/12/2024] [Accepted: 01/22/2024] [Indexed: 02/17/2024]
Abstract
AIM To investigate whether the Vesical Imaging-Reporting and Data System (VI-RADS) could be used to develop a new non-invasive preoperative grade-prediction system to partially predict high-grade bladder cancer (HG-BC). MATERIALS AND METHODS The present study enrolled 89 primary BC patients prospectively from March 2022 to June 2023. Receiver operating characteristic (ROC) curve analysis was performed to evaluate the diagnostic performance of VI-RADS for predicting HG-BC and muscle-invasive bladder cancer (MIBC) in the entire group. In the low VI-RADS (≤2) group, the decision tree-based method was used to obtain significant predictors and construct the decision-tree model (DT model). The performance of the DT model and low VI-RADS scores for predicting HG-BC was determined using ROC, calibration, and decision curve analyses. RESULTS At a cut-off of ≥3, the specificity and positive predictive value of VI-RADS for predicting HG-BC in the entire group was 100%, and the area under the ROC curve (AUC) was 0.697. Among 65 patients with low VI-RADS scores, the DT model showed an AUC of 0.884 in predicting HG-BC compared to 0.506 for low VI-RADS scores. Calibration and decision curve analyses showed that the DT model performed better than the low VI-RADS scores. CONCLUSION Most VI-RADS scores ≥3 correspond to HG-BCs. VI-RADS could be used as a grouping imaging biomarker for a pathological grade-prediction procedure, which in combination with the DT model for low VI-RADS (≤2) populations, would provide a potential preoperative non-invasive method of predicting HG-BC.
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Affiliation(s)
- B Cao
- Department of Radiology, Shanghai Institute of Medical Imaging, Zhongshan Hospital, Fudan University, Shanghai, China; Department of Radiology, Shanghai Geriatric Medical Center, Shanghai, China
| | - Q Li
- Department of Radiology, Shanghai Institute of Medical Imaging, Zhongshan Hospital, Fudan University, Shanghai, China
| | - P Xu
- Department of Urology, Xuhui Hospital, Fudan University, Shanghai, China
| | - Y Zhang
- MR Collaboration, Central Research Institute, United Imaging Healthcare, Shanghai, China
| | - S Cai
- Department of Radiology, Shanghai Institute of Medical Imaging, Zhongshan Hospital, Fudan University, Shanghai, China
| | - S Rao
- Department of Radiology, Shanghai Institute of Medical Imaging, Zhongshan Hospital, Fudan University, Shanghai, China; Department of Radiology, Shanghai Geriatric Medical Center, Shanghai, China
| | - M Zeng
- Department of Radiology, Shanghai Institute of Medical Imaging, Zhongshan Hospital, Fudan University, Shanghai, China; Department of Radiology, Shanghai Geriatric Medical Center, Shanghai, China
| | - Y Dai
- MR Collaboration, Central Research Institute, United Imaging Healthcare, Shanghai, China
| | - S Jiang
- Department of Urology, Zhongshan Hospital, Fudan University, Shanghai, China; Department of Urology, Zhongshan Hospital Wusong Branch, Fudan University, Shanghai, China.
| | - J Zhou
- Department of Radiology, Fudan University Zhongshan Hospital Xiamen Branch, Xiamen, China; Xiamen Municipal Clinical Research Center for Medical Imaging, Xiamen, China; Xiamen Key Clinical Specialty for Radiology, Xiamen, China.
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Choi J, Kim KH, Kim HS, Yoon HS, Kim JH, Kim JW, Lee YS, Choi SY, Chang IH, Ko YH, Song W, Jeong BC, Nam JK. Comparative analysis of recurrence rates between intravesical gemcitabine and bacillus Calmette-Guérin induction therapy following transurethral resection of bladder tumors in patients with intermediate- and high-risk bladder cancer: A retrospective multicenter study. Investig Clin Urol 2024; 65:248-255. [PMID: 38714515 PMCID: PMC11076792 DOI: 10.4111/icu.20230313] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 01/03/2024] [Accepted: 03/04/2024] [Indexed: 05/10/2024] Open
Abstract
PURPOSE This study investigated the efficacy of intravesical gemcitabine as an alternative to bacillus Calmette-Guérin (BCG) therapy. MATERIALS AND METHODS Data were retrospectively collected across seven institutions from February 1999 to May 2023. Inclusion criteria included patients with intermediate- or high-risk non-muscle invasive bladder cancer (NMIBC) who underwent transurethral resection of bladder tumors (TURBT) and received at least four sessions of intravesical gemcitabine or BCG induction therapy. Patient characteristics, complete remission (CR), occurrence, and progression rates were compared. RESULTS In total, 149 patients were included in this study (gemcitabine, 63; BCG, 86). No differences were apparent between the two groups in baseline characteristics, except for the follow-up period (gemcitabine, 9.2±5.9 months vs. BCG, 43.9±41.4 months, p<0.001). There were no consistent significant differences observed between the two groups in the 3-month (gemcitabine, 98.4% vs. BCG, 95.3%; p=0.848), 6-month (94.9% vs. 90.0%, respectively; p=0.793) and 1-year CR rates (84.2% vs. 83.3%, respectively; p=0.950). Also, there was no significant statistical difference in progression-free survival between the two groups (p=0.953). The occurrence rates of adverse events were similar between the groups (22.2% vs. 22.1%; p=0.989); however, the rate of Clavien-Dindo grade 2 or higher was significantly higher in the BCG group (1.6% vs. 16.3%, respectively; p<0.001). CONCLUSIONS Intravesical gemcitabine demonstrated efficacy comparable to BCG therapy for the first year in patients with intermediate- and high-risk NMIBC. However, long-term follow-up studies are warranted.
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Affiliation(s)
- Joongwon Choi
- Department of Urology, Chung-Ang University Gwangmyeong Hospital, Chung-Ang University College of Medicine, Gwangmyeong, Korea
| | - Kyung Hwan Kim
- Department of Urology, Pusan National University Hospital, School of Medicine, Pusan National University, Busan, Korea
| | - Hyung Suk Kim
- Department of Urology, Dongguk University Ilsan Medical Center, Dongguk University College of Medicine, Goyang, Korea
| | - Hyun Sik Yoon
- Department of Urology, Dongguk University Ilsan Medical Center, Dongguk University College of Medicine, Goyang, Korea
| | - Jung Hoon Kim
- Department of Urology, Chung-Ang University Gwangmyeong Hospital, Chung-Ang University College of Medicine, Gwangmyeong, Korea
| | - Jin Wook Kim
- Department of Urology, Chung-Ang University Gwangmyeong Hospital, Chung-Ang University College of Medicine, Gwangmyeong, Korea
| | - Yong Seong Lee
- Department of Urology, Chung-Ang University Gwangmyeong Hospital, Chung-Ang University College of Medicine, Gwangmyeong, Korea
| | - Se Young Choi
- Department of Urology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
| | - In Ho Chang
- Department of Urology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
| | - Young Hwii Ko
- Department of Urology, Yeungnam University College of Medicine, Daegu, Korea
| | - Wan Song
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Byong Chang Jeong
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jong Kil Nam
- Department of Urology, Pusan National University Yangsan Hospital, School of Medicine, Pusan National University, Yangsan, Korea.
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Chang KC, Hung SF. Re: Clinical impact of detrusor muscle in en bloc resection for T1 bladder cancer. Yanagisawa T, Sato S, Hayashida Y, Okada Y, Fukuokaya W, Iwatani K, et al. J Urol Oncol. 2023;41(12):484.e7-484.e15. Urol Oncol 2024; 42:155. [PMID: 38326213 DOI: 10.1016/j.urolonc.2024.01.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Accepted: 01/13/2024] [Indexed: 02/09/2024]
Affiliation(s)
- Kuo-Chen Chang
- Department of Anesthesiology, Far-Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Shun-Fa Hung
- Division of Urology, Department of Surgery, Far Eastern Memorial Hospital, New Taipei City, Taiwan; Department of Urology, National Taiwan University Hospital and College of Medicine, National Taiwan University, Taipei, Taiwan.
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Li X, Huang J, Ji P. Comment on 'Robot-assisted radical cystectomy with intracorporeal urinary diversion: an updated systematic review and meta-analysis of its differential effect on effectiveness and safety'. Int J Surg 2024; 110:3114-3115. [PMID: 38363993 DOI: 10.1097/js9.0000000000001210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Accepted: 02/04/2024] [Indexed: 02/18/2024]
Affiliation(s)
- Xinyi Li
- Stomatological Hospital of Chongqing Medical University
- Chongqing Key Laboratory of Oral Diseases and Biomedical Sciences
- Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Chongqing, People's Republic of China
| | - Jiao Huang
- Stomatological Hospital of Chongqing Medical University
- Chongqing Key Laboratory of Oral Diseases and Biomedical Sciences
- Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Chongqing, People's Republic of China
| | - Ping Ji
- Stomatological Hospital of Chongqing Medical University
- Chongqing Key Laboratory of Oral Diseases and Biomedical Sciences
- Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Chongqing, People's Republic of China
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Unterrainer LM, Eismann L, Lindner S, Gildehaus FJ, Toms J, Casuscelli J, Holzgreve A, Kunte SC, Cyran CC, Menold P, Karl A, Unterrainer M, Ledderose ST, Stief CG, Bartenstein P, Kretschmer A, Schulz GB. [ 68 Ga]Ga-FAPI-46 PET/CT for locoregional lymph node staging in urothelial carcinoma of the bladder prior to cystectomy: initial experiences from a pilot analysis. Eur J Nucl Med Mol Imaging 2024; 51:1786-1789. [PMID: 38236427 PMCID: PMC11043110 DOI: 10.1007/s00259-024-06595-z] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Accepted: 01/01/2024] [Indexed: 01/19/2024]
Abstract
INTRODUCTION [68 Ga]Ga-FAPI-46 PET/CT is a novel hybrid imaging method that previously showed additional diagnostic value in the assessment of distant urothelial carcinoma lesions. We hypothesized that patients with bladder cancer benefit from [68 Ga]Ga-FAPI-46 PET/CT prior to radical cystectomy for locoregional lymph node staging. MATERIALS AND METHODS Eighteen patients underwent [68 Ga]Ga-FAPI-46 PET/CT for evaluation of lymph node (LN) status in predefined LN regions. Two hundred twenty-nine intraoperatively removed LN served as histopathological reference standard. RESULTS Urothelial carcinoma (UC) spread was found in ten LN in seven different regions (14.3%). Hereby, [68 Ga]Ga-FAPI-46 PET/CT was positive in four out of seven regions (57.1%) and showed significantly increased FAPI uptake compared to non-pathological regions. In the remaining three out of seven (42.9%) regions, [68 Ga]Ga-FAPI-46 PET/CT was rated negative since no pathological increased FAPI uptake was detected or the proximity of the urinary tract prevented a differentiation from physiological uptake. CT was inconspicuous in these three regions. In total, two FAP-positive LN regions were found without histopathological counterpart. Overall, sensitivity, specificity, positive predictive value, and negative predictive value were 57.1%, 95.2%, 66.7%, and 93.0% for PET imaging. CONCLUSION In summary, this innovative [68 Ga]Ga-FAPI-46 PET/CT method showed high specificity and negative predictive value in patients with bladder UC with a future potential to optimize therapy planning.
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Affiliation(s)
- Lena M Unterrainer
- Department of Nuclear Medicine, LMU University Hospital, LMU Munich, Munich, Germany.
- Ahmanson Translational Theranostics Division, Department of Molecular and Medical Pharmacology, David Geffen School of Medicine, UCLA, Los Angeles, USA.
| | - Lennert Eismann
- Department of Urology, LMU University Hospital, LMU Munich, Munich, Germany
| | - Simon Lindner
- Department of Nuclear Medicine, LMU University Hospital, LMU Munich, Munich, Germany
| | - Franz-Josef Gildehaus
- Department of Nuclear Medicine, LMU University Hospital, LMU Munich, Munich, Germany
| | - Johannes Toms
- Department of Nuclear Medicine, LMU University Hospital, LMU Munich, Munich, Germany
| | | | - Adrien Holzgreve
- Department of Nuclear Medicine, LMU University Hospital, LMU Munich, Munich, Germany
| | - Sophie C Kunte
- Department of Nuclear Medicine, LMU University Hospital, LMU Munich, Munich, Germany
| | - Clemens C Cyran
- Department of Radiology, LMU University Hospital, LMU Munich, Munich, Germany
| | - Paula Menold
- Department of Urology, Krankenhaus Barmherzige Brüder, Munich, Germany
| | - Alexander Karl
- Department of Urology, Krankenhaus Barmherzige Brüder, Munich, Germany
| | - Marcus Unterrainer
- Department of Nuclear Medicine, LMU University Hospital, LMU Munich, Munich, Germany
- Die RADIOLOGIE, Munich, Germany
| | | | - Christian G Stief
- Department of Urology, LMU University Hospital, LMU Munich, Munich, Germany
| | - Peter Bartenstein
- Department of Nuclear Medicine, LMU University Hospital, LMU Munich, Munich, Germany
| | - Alexander Kretschmer
- Department of Urology, LMU University Hospital, LMU Munich, Munich, Germany
- Janssen Research and Development, Los Angeles, USA
| | - Gerald B Schulz
- Department of Urology, LMU University Hospital, LMU Munich, Munich, Germany
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Wei Z, Xv Y, Liu H, Li Y, Yin S, Xie Y, Chen Y, Lv F, Jiang Q, Li F, Xiao M. A CT-based deep learning model predicts overall survival in patients with muscle invasive bladder cancer after radical cystectomy: a multicenter retrospective cohort study. Int J Surg 2024; 110:2922-2932. [PMID: 38349205 DOI: 10.1097/js9.0000000000001194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 01/31/2024] [Indexed: 05/16/2024]
Abstract
BACKGROUND Muscle invasive bladder cancer (MIBC) has a poor prognosis even after radical cystectomy (RC). Postoperative survival stratification based on radiomics and deep learning (DL) algorithms may be useful for treatment decision-making and follow-up management. This study was aimed to develop and validate a DL model based on preoperative computed tomography (CT) for predicting postcystectomy overall survival (OS) in patients with MIBC. METHODS MIBC patients who underwent RC were retrospectively included from four centers, and divided into the training, internal validation, and external validation sets. A DL model incorporated the convolutional block attention module (CBAM) was built for predicting OS using preoperative CT images. The authors assessed the prognostic accuracy of the DL model and compared it with classic handcrafted radiomics model and clinical model. Then, a deep learning radiomics nomogram (DLRN) was developed by combining clinicopathological factors, radiomics score (Rad-score) and deep learning score (DL-score). Model performance was assessed by C-index, KM curve, and time-dependent ROC curve. RESULTS A total of 405 patients with MIBC were included in this study. The DL-score achieved a much higher C-index than Rad-score and clinical model (0.690 vs. 0.652 vs. 0.618 in the internal validation set, and 0.658 vs. 0.601 vs. 0.610 in the external validation set). After adjusting for clinicopathologic variables, the DL-score was identified as a significantly independent risk factor for OS by the multivariate Cox regression analysis in all sets (all P <0.01). The DLRN further improved the performance, with a C-index of 0.713 (95% CI: 0.627-0.798) in the internal validation set and 0.685 (95% CI: 0.586-0.765) in external validation set, respectively. CONCLUSIONS A DL model based on preoperative CT can predict survival outcome of patients with MIBC, which may help in risk stratification and guide treatment decision-making and follow-up management.
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Affiliation(s)
| | | | | | | | - Siwen Yin
- Department of Urology, Chongqing University Fuling Hospital
| | | | - Yong Chen
- Department of Urology, Chongqing University Fuling Hospital
| | - Fajin Lv
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University
| | - Qing Jiang
- Department of Urology, The Second Affiliated Hospital of Chongqing Medical University
| | - Feng Li
- Department of Urology, Chongqing University Three Gorges Hospital, Chongqing, People's Republic of China
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Tanaka T, Yamasaki K, Nofuji S, Maehana T, Shindo T, Kyoda Y, Hashimoto K, Kobayashi K, Masumori N. Development and preliminary evaluation of a novel procedure for creation of an ileal conduit stoma aimed at preventing parastomal hernia. Int J Urol 2024; 31:512-518. [PMID: 38238898 DOI: 10.1111/iju.15394] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 01/04/2024] [Indexed: 05/05/2024]
Abstract
OBJECTIVES Our previous study suggested that the operative procedure is critical for the development of parastomal hernia. We developed a novel procedure for the creation of an ileal conduit stoma to prevent parastomal hernia. Herein we evaluate the efficacy and safety of the procedure. METHODS A total of 113 Japanese patients underwent radical cystectomy and ileal conduit diversion for bladder cancer from January 2017 through December 2021 at our institution. After excluding those with incomplete data, 103 patients consisting of 46 (44.7%) with the conventional procedure and 57 (55.3%) with the novel procedure were consecutively enrolled. The main points of the novel procedure are as follows: (1) the passage of the ileal conduit is ≤2.4 cm in diameter in principle; (2) the posterior rectus sheath and peritoneum are vertically incised 2 cm laterally from the middle of the stoma site to make an oblique passage for the ileal conduit; and (3) the anterior rectus sheath and posterior rectus sheath with peritoneum are fixed to the ileal conduit separately. RESULTS Radiography-based parastomal hernia was observed in 11 patients (10.7%) with a median follow-up of 22.0 months. The incidences of parastomal hernia were 3.5% and 19.6% in the novel and the conventional procedure groups, respectively (p = 0.011). The former had a significantly lower cumulative incidence of parastomal hernia (p = 0.008, log-rank test). No specific complications associated with the procedure were observed. CONCLUSIONS The results of the preliminary cohort study suggest that the novel procedure is safe and effective for the prevention of parastomal hernia.
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Affiliation(s)
- Toshiaki Tanaka
- Department of Urology, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, Japan
| | - Koji Yamasaki
- Department of Urology, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, Japan
| | - Seisuke Nofuji
- Department of Urology, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, Japan
| | - Takeshi Maehana
- Department of Urology, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, Japan
| | - Tetsuya Shindo
- Department of Urology, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, Japan
| | - Yuki Kyoda
- Department of Urology, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, Japan
| | - Kohei Hashimoto
- Department of Urology, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, Japan
| | - Ko Kobayashi
- Department of Urology, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, Japan
| | - Naoya Masumori
- Department of Urology, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, Japan
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Yanagisawa T, Miki J, Sato S, Takahashi H, Shariat SF, Kimura T. Reply to Shun-Fa Hung's Letter to the editor regarding the article "Clinical impact of detrusor muscle in en bloc resection for T1 bladder cancer". Urol Oncol 2024; 42:156-157. [PMID: 38388245 DOI: 10.1016/j.urolonc.2024.01.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2024]
Affiliation(s)
- Takafumi Yanagisawa
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan; Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria.
| | - Jun Miki
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Shun Sato
- Department of Pathology, The Jikei University School of Medicine, Tokyo, Japan
| | - Hiroyuki Takahashi
- Department of Pathology, The Jikei University School of Medicine, Tokyo, Japan
| | - Shahrokh F Shariat
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia; Hourani Center for Applied Scientific Research, Al-Ahliyya Amman University, Amman, Jordan; Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX; Department of Urology, Second Faculty of Medicine, Charles University, Prague, Czech Republic; Department of Urology, Weill Cornell Medical College, New York, NY; Karl Landsteiner Institute of Urology and Andrology, Vienna, Austria
| | - Takahiro Kimura
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
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Zhu W, Wu L, Xie W, Zhang G, Gu Y, Hou Y, He Y. Comparison of morbidity and mortality after radical cystectomy between individuals older and younger than 80 years: a systematic review and meta-analysis. Int Urol Nephrol 2024; 56:1525-1535. [PMID: 38095810 DOI: 10.1007/s11255-023-03897-3] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 11/23/2023] [Indexed: 04/09/2024]
Abstract
OBJECTIVE To compare outcomes related to survival and post-operative complications in individuals older and younger than 80 years with bladder cancer undergoing radical cystectomy (RC). METHODS We conducted a systematic search using three large databases: PubMed, EMBASE, and Scopus. We included observational studies comparing outcomes between individuals older than 80 years and younger patients undergoing RC. The outcomes of interest included overall survival, disease-specific survival, progression-free survival, and risk of post-operative complications. We applied a random effects model for the analysis and reported pooled effect sizes as odds ratios (ORs) or hazards ratios (HRs) along with 95% confidence intervals. RESULTS We analyzed 21 studies. Our results show that individuals older than 80 years had higher risks of mortality at 30 days (OR 2.82; 95% CI 1.97, 4.04), 90 days (OR 3.34; 95% CI 2.61, 4.27), 12 months (HR 3.03; 95% CI 2.64, 3.49), and 24 months (HR 3.54; 95% CI 2.27, 5.50) of the post-operative follow-up than younger individuals. In addition, individuals older than 80 years also had poor 5-year survivals (HR 2.17; 95% CI 1.64, 2.88), an increased risk of 5-year cancer-specific mortality (HR 1.58; 95% CI 1.24, 2.03), poor 5-year recurrence free survivals (HR 1.49; 95% CI 1.07, 2.08), and high complications risks (OR 1.20; 95% CI 1.02, 1.42) when compared to younger patients. CONCLUSION Individuals older than 80 years undergoing RC are likely to have poor survival-related outcomes and increased complications risks. Pre-planned comprehensive geriatric assessments (CGAs) may be needed to offer better peri- and post-operative care to improve the outcomes in this patient population.
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Affiliation(s)
- Wei Zhu
- Department of Urology, The First Hospital of Jiaxing andThe Affiliated Hospital of Jiaxing University, 1882 Zhonghuan South Road, Jiaxing City, 314000, Zhejiang Province, China
| | - Lingfeng Wu
- Department of Urology, The First Hospital of Jiaxing andThe Affiliated Hospital of Jiaxing University, 1882 Zhonghuan South Road, Jiaxing City, 314000, Zhejiang Province, China
| | - Wenhua Xie
- Department of Urology, The First Hospital of Jiaxing andThe Affiliated Hospital of Jiaxing University, 1882 Zhonghuan South Road, Jiaxing City, 314000, Zhejiang Province, China
| | - Gaoyue Zhang
- Department of Urology, The First Hospital of Jiaxing andThe Affiliated Hospital of Jiaxing University, 1882 Zhonghuan South Road, Jiaxing City, 314000, Zhejiang Province, China
| | - Yanqin Gu
- Department of Urology, The First Hospital of Jiaxing andThe Affiliated Hospital of Jiaxing University, 1882 Zhonghuan South Road, Jiaxing City, 314000, Zhejiang Province, China
| | - Yansong Hou
- Department of Urology, The First Hospital of Jiaxing andThe Affiliated Hospital of Jiaxing University, 1882 Zhonghuan South Road, Jiaxing City, 314000, Zhejiang Province, China
| | - Yi He
- Department of Urology, The First Hospital of Jiaxing andThe Affiliated Hospital of Jiaxing University, 1882 Zhonghuan South Road, Jiaxing City, 314000, Zhejiang Province, China.
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Wang XJ, Qiu X. A case of primary small-cell neuroendocrine carcinoma of the bladder. Asian J Surg 2024; 47:2421-2422. [PMID: 38242786 DOI: 10.1016/j.asjsur.2024.01.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 01/11/2024] [Indexed: 01/21/2024] Open
Affiliation(s)
- Xiao Juan Wang
- Department of Imaging, Shandong Linglong Yingcheng Hospital, Zhaoyuan, Yantai, China
| | - Xuan Qiu
- Department of Faculty Surgery, St. Petersburg State University, Saint Petersburg, 199106, Russia; Department of Surgery, Shandong Linglong Yingcheng Hospital, Zhaoyuan, Yantai, China.
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Ceasar RC, Ladi-Seyedian SS, Escobar D, Han J, Koh K, Porten S, Chu C, Gould EE, Bhanvadia S. "I think my vagina is still there?": Women's perspectives on sexual function and dysfunction following radical cystectomy for bladder cancer, a qualitative study. J Sex Med 2024; 21:464-470. [PMID: 38491395 DOI: 10.1093/jsxmed/qdae025] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 01/22/2024] [Accepted: 01/28/2024] [Indexed: 03/18/2024]
Abstract
BACKGROUND Women's sexual health after radical cystectomy is an important but poorly understood aspect of bladder cancer survivorship. Dedicated investigation is needed to elucidate patient perceptions on sexual function and dysfunction in this setting. AIMS In this study we sought to qualitatively examine women's perceptions and experiences of sexual health following radical cystectomy for bladder cancer. METHODS We conducted one-on-one qualitative telephone interviews with 40 women who underwent radical cystectomy in the past 6 months to 5 years and signed a research consent form to be contacted for future studies. We examined women's experiences of engaging in sexual activity after surgery and their attitudes toward sex and body image. We audio recorded, transcribed, and coded the interviews using ATLAS.ti software and applied grounded theory methods for analysis. OUTCOMES For data that emerged during the qualitative interviews that was related to lack of knowledge about how physical and psychological sexual health would be affected after surgery, we reviewed and discussed transcripts that enabled coding of the data into emerging topic areas. RESULTS Our analysis yielded 4 main themes. (1) Women reported receiving little to no information from providers about female sexual dysfunction prior to or after radical cystectomy. Women wished they had been provided more information about female sexual dysfunction from their clinicians, including strategies for postoperative self-pleasure and nonintercourse methods of sexual pleasure with partners. (2) Women shared that they were not sexually active following surgery due to physical and mental barriers. (3) When women did try to engage in sex, they described feeling disappointed that it did not feel the same as prior to surgery. (4) Some women found that physical therapy helped them to physically and mentally recover their strength to engage in sexual activity again. CLINICAL IMPLICATIONS Clinicians must directly address sexual health concerns with patients who undergo radical cystectomy. STRENGTHS AND LIMITATIONS This study has several key strengths. Investigation into women's sexual function and dysfunction addresses a gap in understanding of this component of women's health-related quality of life after radical cystectomy, which represents an unmet need. The large number of interviews conducted as well as the in-depth information obtained through one-on-one interviews are additional strengths. This study also has limitations, including possible shortcomings of telephone interviews compared with in-person interviews. However, telephone interviews were beneficial because the interviews took place during the COVID-19 pandemic and spared patients from extra visits or from having to travel long distances to the respective medical centers. Other possible limitations were that patients may have been reluctant to share all of their experiences and that patients who underwent urostomies, also termed ileal conduits, were overrepresented in this study compared with women who underwent continent urine diversions, which allow greater control over urine output. CONCLUSION Broadening the understanding of sexual health beyond sexual intercourse to encompass sexuality and self-pleasure can provide clinicians, patients, and their families with more effective preparation and strategies to care for an essential aspect of their wellbeing.
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Affiliation(s)
- Rachel Carmen Ceasar
- Department of Population and Public Health Sciences, University of Southern California, Keck School of Medicine, 1845 N Soto St, Los Angeles, CA 90032, United States
| | - Seyedeh-Sanam Ladi-Seyedian
- Department of Urology, Norris Comprehensive Cancer Center, University of Southern California, 1441 Eastlake Ave, Los Angeles, CA 90033, United States
| | - Domenique Escobar
- Department of Urology, University of California, San Francisco, 400 Parnassus Ave, San Francisco, CA 94143, United States
| | - Jullet Han
- Department of Urology, Norris Comprehensive Cancer Center, University of Southern California, 1441 Eastlake Ave, Los Angeles, CA 90033, United States
| | - Kailyn Koh
- Department of Urology, Norris Comprehensive Cancer Center, University of Southern California, 1441 Eastlake Ave, Los Angeles, CA 90033, United States
| | - Sima Porten
- Department of Urology, University of California, San Francisco, 400 Parnassus Ave, San Francisco, CA 94143, United States
| | - Carissa Chu
- Department of Urology, University of California, San Francisco, 400 Parnassus Ave, San Francisco, CA 94143, United States
| | - Erin E Gould
- Department of Population and Public Health Sciences, University of Southern California, Keck School of Medicine, 1845 N Soto St, Los Angeles, CA 90032, United States
| | - Sumeet Bhanvadia
- Department of Urology, Norris Comprehensive Cancer Center, University of Southern California, 1441 Eastlake Ave, Los Angeles, CA 90033, United States
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Liedberg F, Hagberg O, Aljabery F, Andrén O, Falini V, Gårdmark T, Ströck V, Jerlström T. Cystectomy for bladder cancer in Sweden - short-term outcomes after centralization. Scand J Urol 2024; 59:84-89. [PMID: 38685576 DOI: 10.2340/sju.v59.40120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Accepted: 04/15/2024] [Indexed: 05/02/2024]
Abstract
OBJECTIVE Radical cystectomy (RC) for bladder cancer is associated with an inherent risk of complications and even postoperative mortality. The number of hospitals performing RC has decreased in Sweden over time, and since a formal regional centralization in 2017 cystectomy care is currently provided by nine hospitals. MATERIAL AND METHODS In the Swedish National Urinary Bladder Cancer Register (SNRUBC) 90-day complications after RC have been registered with high coverage since 2012. Descriptive data and short-term outcomes were compared in relation to centralization of the cystectomy care by stratifying data before (2012-2016) and after (2017-2023). RESULTS Out of all 4,638 cystectomies, 2,738 (59%) were performed after the centralization in 2017 and onwards. The median age at RC increased from 71 (Inter Quartile Range [IQR] 65-76) to 73 (IQR 67-77) years, and the proportion of patients with comorbidity (American Society of Anesthesiologists [ASA] 3 or 4) increased from 32% to 37% after the centralization (p < 0.001). The number of patients suffering from high-grade complications within 90 days of surgery corresponding to Clavien grade three were 345 (18%) and 407 (15%), and corresponding to Clavien grade four 61 (3%) and 64 (2%) before and after centralization, respectively. Reoperations within 90 days of RC decreased from 234/1,900 (12%) to 208/2,738 (8%) (p < 0.001), and 90-day mortality decreased from 84/1,900 (4%) to 85/2,738 (3%) (p = 0.023) before and after centralization, respectively. CONCLUSION After the centralization of the cystectomy-care in Sweden, older patients and individuals with more extensive comorbidity were offered RC whereas 90-day mortality and the proportion of patients subjected to reoperations within 90 days of surgery decreased without increasing waiting times.
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Affiliation(s)
- Fredrik Liedberg
- Department of Urology Skåne University Hospital, Malmö, Sweden; Institution of Translational Medicine, Lund University, Malmö, Sweden.
| | - Oskar Hagberg
- Institution of Translational Medicine, Lund University, Malmö, Sweden
| | - Firas Aljabery
- Department of Clinical and Experimental Medicine, Division of Urology, Linköping, University, Linköping, Sweden
| | - Ove Andrén
- Section of Urology, Department of Surgery, Skellefteå Hospital, Sweden
| | | | - Truls Gårdmark
- Department of Clinical Sciences, Danderyd Hospital, Karolinska Institute, Stockholm, Sweden
| | - Viveka Ströck
- Department of Urology, Sahlgrenska University Hospital and Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Tomas Jerlström
- Department of Urology, School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
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Pellegrino F, Leni R, Basile G, Rosiello G, Re C, Scilipoti P, De Angelis M, Longoni M, Avesani G, Quarta L, Zaurito P, Cattafi F, Burgio G, Gandaglia G, Montorsi F, Briganti A, Moschini M. Peri- and post-operative outcomes of robot-assisted radical cystectomy after the implementation of the EAU guidelines recommendations for collecting and reporting complications at a high-volume referral center. World J Urol 2024; 42:270. [PMID: 38679650 DOI: 10.1007/s00345-024-04970-x] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Accepted: 03/31/2024] [Indexed: 05/01/2024] Open
Abstract
PURPOSE No studies relied on a standardized methodology to collect postoperative complications after robot-assisted radical cystectomy (RARC). The aim of our study was to evaluate peri- and post-operative outcomes of patients undergoing RARC adhering to the European Association of Urology (EAU) recommendations for reporting surgical outcomes and using a long postoperative follow-up. MATERIALS AND METHODS 246 patients who underwent RARC with intracorporal urinary diversion at a single tertiary referral center with a postoperative follow-up ≥ 1 year for survivors. Postoperative outcomes were collected prospectively by interviews done by medical doctors. Complications were scored using the Clavien-Dindo classification (CD), grouped by type and severity (severe: CD score ≥ 3). We described peri- and post-operative outcomes and complication chronological distribution. RESULTS Overall, 16 (6.5%) and 225 patients (91%) experienced intraoperative and postoperative complications, respectively. Moreover, 139 (57%) experienced severe complications. The most common any-grade and severe complications were infectious (72%) and genitourinary (35%), respectively. Overall, 52% of complications (358/682) occurred within 10 days from surgery, and 51% of severe complications (106/207) occurred within 35 days. However, 13% of complications (90/682) and 28% of severe complications (59/207) occurred 3 months after surgery. The earliest complications were fever of unknown origins and paralytic ileus (median time-to-complication [mTTC]: 4 days), the latest complications were urinary tract infection (mTTC: 40 days) and hydronephrosis/ureteral obstruction (mTTC: 70 days). CONCLUSIONS The rate of postoperative complications after RARC is > 90% when a standardized collection method and a long follow-up is implemented. These results should be used to identify potential areas of improvement and for preoperative patient counseling.
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Affiliation(s)
- Franceso Pellegrino
- Department of Urology and Division of Experimental Oncology/Unit of Urology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy.
| | - Riccardo Leni
- Department of Urology and Division of Experimental Oncology/Unit of Urology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Giuseppe Basile
- Department of Urology and Division of Experimental Oncology/Unit of Urology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Giuseppe Rosiello
- Department of Urology and Division of Experimental Oncology/Unit of Urology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Chiara Re
- Department of Urology and Division of Experimental Oncology/Unit of Urology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Pietro Scilipoti
- Department of Urology and Division of Experimental Oncology/Unit of Urology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Mario De Angelis
- Department of Urology and Division of Experimental Oncology/Unit of Urology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Mattia Longoni
- Department of Urology and Division of Experimental Oncology/Unit of Urology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Giulio Avesani
- Department of Urology and Division of Experimental Oncology/Unit of Urology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Leonardo Quarta
- Department of Urology and Division of Experimental Oncology/Unit of Urology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Paolo Zaurito
- Department of Urology and Division of Experimental Oncology/Unit of Urology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Francesco Cattafi
- Department of Urology and Division of Experimental Oncology/Unit of Urology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Giusy Burgio
- Department of Urology and Division of Experimental Oncology/Unit of Urology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Giorgio Gandaglia
- Department of Urology and Division of Experimental Oncology/Unit of Urology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Francesco Montorsi
- Department of Urology and Division of Experimental Oncology/Unit of Urology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Alberto Briganti
- Department of Urology and Division of Experimental Oncology/Unit of Urology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Marco Moschini
- Department of Urology and Division of Experimental Oncology/Unit of Urology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
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Zhang R, Jia S, Zhai L, Wu F, Zhang S, Li F. Predicting preoperative muscle invasion status for bladder cancer using computed tomography-based radiomics nomogram. BMC Med Imaging 2024; 24:98. [PMID: 38678222 PMCID: PMC11055285 DOI: 10.1186/s12880-024-01276-7] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Accepted: 04/19/2024] [Indexed: 04/29/2024] Open
Abstract
OBJECTIVES The aim of the study is to assess the efficacy of the established computed tomography (CT)-based radiomics nomogram combined with radiomics and clinical features for predicting muscle invasion status in bladder cancer (BCa). METHODS A retrospective analysis was conducted using data from patients who underwent CT urography at our institution between May 2018 and April 2023 with urothelial carcinoma of the bladder confirmed by postoperative histology. There were 196 patients enrolled in all, and each was randomized at random to either the training cohort (n = 137) or the test cohort (n = 59). Eight hundred fifty-one radiomics features in all were retrieved. For feature selection, the significance test and least absolute shrinkage and selection operator (LASSO) approaches were utilized. Subsequently, the radiomics score (Radscore) was obtained by applying linear weighting based on the selected features. The clinical and radiomics model, as well as radiomics-clinical nomogram were all established using logistic regression. Three models were evaluated using analysis of the receiver operating characteristic curve. An area under the curve (AUC) and 95% confidence intervals (CI) as well as specificity, sensitivity, accuracy, negative predictive value, and positive predictive value were included in the analysis. Radiomics-clinical nomogram's performance was assessed based on discrimination, calibration, and clinical utility. RESULTS After obtaining 851 radiomics features, 12 features were ultimately selected. Histopathological grading and tortuous blood vessels were included in the clinical model. The Radscore and clinical histopathology grading were among the final predictors in the unique nomogram. The three models had an AUC of 0.811 (95% CI, 0.742-0.880), 0.845 (95% CI, 0.781-0.908), and 0.896 (95% CI, 0.846-0.947) in the training cohort and in the test cohort they were 0.808 (95% CI, 0.703-0.913), 0.847 (95% CI, 0.739-0.954), and 0.887 (95% CI, 0.803-0.971). According to the DeLong test, the radiomics-clinical nomogram's AUC in the training cohort substantially differed from that of the clinical model (AUC: 0.896 versus 0.845, p = 0.015) and the radiomics model (AUC: 0.896 versus 0.811, p = 0.002). The Delong test in the test cohort revealed no significant difference among the three models. CONCLUSIONS CT-based radiomics-clinical nomogram can be a useful tool for quantitatively predicting the status of muscle invasion in BCa.
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Affiliation(s)
- Rui Zhang
- Department of Radiology, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, 441021, Hubei, China
| | - Shijun Jia
- Department of Radiology, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, 441021, Hubei, China
| | - Linhan Zhai
- Department of Radiology, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, 441021, Hubei, China
| | - Feng Wu
- Department of Radiology, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, 441021, Hubei, China
| | - Shuang Zhang
- Department of Radiology, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, 441021, Hubei, China.
| | - Feng Li
- Department of Radiology, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, 441021, Hubei, China.
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Rewari H, Wadhwa P, Talwar H, Taneja D. Anastomosing haemangioma of adrenal gland: an unusual vascular tumour. BMJ Case Rep 2024; 17:e259092. [PMID: 38670570 PMCID: PMC11057196 DOI: 10.1136/bcr-2023-259092] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2024] Open
Abstract
With only 15 reported cases, anastomosing haemangioma of adrenal is a rare entity and usually presents as adrenal incidentaloma. A hypertensive, diabetic, non-smoker man in his late 60s presented with irritative voiding symptoms. On evaluation, he was found to have a urinary bladder mass and left adrenal incidentaloma measuring 8 cm. Metabolic evaluation confirmed it to be non-functional.The patient underwent transurethral resection of bladder tumour with left laparoscopic adrenalectomy. Intraoperatively, the adrenal tumour was highly vascular with multiple feeder vessels. Grossly it was soft, encapsulated with focal grey-brown areas. Microscopically, most of adrenal gland was replaced by anastomosing proliferating capillary vessels within framework of non-endothelial supporting cells reminiscent of splenic sinusoids. The tumour was positive for CD-31, CD-34, Glut-1 and SMA.Anastomosing haemangioma is a benign entity but it must be differentiated from angiosarcoma. Characteristic imaging features are not yet defined and is, therefore, difficult to diagnose preoperatively.
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Affiliation(s)
- Harshit Rewari
- Kidney and Urology Institute, Medanta - The Medicity, Gurugram, Haryana, India
| | - Pankaj Wadhwa
- Kidney and Urology Institute, Medanta - The Medicity, Gurugram, Haryana, India
| | | | - Divya Taneja
- Department of Histopathology, Medanta - The Medicity, Gurugram, Haryana, India
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Ben-David R, Pellegrino F, Alerasool P, Tillu N, Lavallee E, Attalla K, Waingankar N, John SP, Mehrazin R, Moschini M, Martini A, Edeling S, Briganti A, Montorsi F, Wiklund P. Robotic-assisted radical cystectomy with cutaneous ureterostomies: a contemporary multicenter analysis. World J Urol 2024; 42:251. [PMID: 38652316 DOI: 10.1007/s00345-024-04942-1] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Accepted: 03/20/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND Robotic-assisted radical cystectomy (RARC) offers decreased blood loss during surgery, shorter hospital length of stay, and lower risk for thromboembolic events without hindering oncological outcomes. Cutaneous ureterostomies (UCS) are a seldom utilized diversion that can be a suitable alternative for a selected group of patients with competing co-morbidities and limited life expectancy. OBJECTIVE To describe operative and perioperative characteristics as well as oncological outcomes for patients that underwent RARC + UCS. METHODS Patients that underwent RARC + UCS during 2013-2023 in 3 centers (EU = 2, US = 1) were identified in a prospectively maintained database. Baseline characteristics, pathological, and oncological outcomes were analyzed. Descriptive statistics and survival analysis were performed using R language version 4.3.1. RESULTS Sixty-nine patients were included. The median age was 77 years (IQR 70-80) and the median follow-up time was 11 months (IQR 4-20). Ten patients were ASA 4 (14.5%). Nine patients underwent palliative cystectomy (13%). The median operation time was 241 min (IQR 202-290), and the median hospital stay was 8 days (IQR 6-11). The 30-day complication rate was 55.1% (grade ≥ 3a was 14.4%), and the 30-day readmission rate was 17.4%. Eleven patients developed metastatic recurrence (15.9%), and 14 patients (20.2%) died during the follow-up period. Overall survival at 6, 12, and 24 months was 84%, 81%, and 73%, respectively. CONCLUSIONS RARC + UCS may offer lower complication and readmission rates without the need to perform enteric anastomosis, it can be considered in a selected group of patients with competing co-morbidities, or limited life expectancy. Larger prospective studies are necessary to validate these results.
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Affiliation(s)
- Reuben Ben-David
- Department of Urology, Icahn School of Medicine at Mount Sinai Hospital, 1425 Madison Avenue, New York, NY, USA.
| | - Francesco Pellegrino
- Division of Oncology/Unit of Urology, IRCCS San Raffaele Hospital, Urological Research Institute, Milan, Italy
| | - Parissa Alerasool
- The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai Hospital, New York, NY, USA
| | - Neeraja Tillu
- Department of Urology, Icahn School of Medicine at Mount Sinai Hospital, 1425 Madison Avenue, New York, NY, USA
| | - Etienne Lavallee
- Department of Urology, Icahn School of Medicine at Mount Sinai Hospital, 1425 Madison Avenue, New York, NY, USA
| | - Kyrollis Attalla
- Department of Urology, Icahn School of Medicine at Mount Sinai Hospital, 1425 Madison Avenue, New York, NY, USA
| | - Nikhil Waingankar
- Department of Urology, Icahn School of Medicine at Mount Sinai Hospital, 1425 Madison Avenue, New York, NY, USA
| | - Sfakianos P John
- Department of Urology, Icahn School of Medicine at Mount Sinai Hospital, 1425 Madison Avenue, New York, NY, USA
| | - Reza Mehrazin
- Department of Urology, Icahn School of Medicine at Mount Sinai Hospital, 1425 Madison Avenue, New York, NY, USA
| | - Marco Moschini
- Division of Oncology/Unit of Urology, IRCCS San Raffaele Hospital, Urological Research Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Alberto Martini
- Division of Oncology/Unit of Urology, IRCCS San Raffaele Hospital, Urological Research Institute, Milan, Italy
- Department of Urology, MD Anderson Cancer Center, Houston, TX, USA
| | | | - Alberto Briganti
- Division of Oncology/Unit of Urology, IRCCS San Raffaele Hospital, Urological Research Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Francesco Montorsi
- Division of Oncology/Unit of Urology, IRCCS San Raffaele Hospital, Urological Research Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Peter Wiklund
- Department of Urology, Icahn School of Medicine at Mount Sinai Hospital, 1425 Madison Avenue, New York, NY, USA
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Oh CH, Cho SB, Lee HJ, Kwon H, Hwang YG. Migration of double-J ureteral stent in patients with ureteroileal anastomosis stricture undergoing radical cystectomy and orthotopic neobladder: Analysis risk factors of stent migration. Medicine (Baltimore) 2024; 103:e37765. [PMID: 38640312 PMCID: PMC11030022 DOI: 10.1097/md.0000000000037765] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Revised: 02/29/2024] [Accepted: 03/08/2024] [Indexed: 04/21/2024] Open
Abstract
The objective was to evaluate the incidence and degree of double-J ureteral stent (DJUS) migration. Additionally, we aimed to investigate the risk factors associated with stent migration in the orthotopic neobladder group. In this retrospective study, 61 consecutive patients were included; 35 patients (45 DJUS placements) underwent radical cystectomy with orthotopic neobladder and 26 patients (35 DJUS placements) underwent urinary bladder without cystectomy between July 2021 and March 2023. All the patients were treated with a DJUS for ureteric strictures. The technical success rate was 100% in each group. The DJUS migration was significantly higher in the orthotopic neobladder group, with 22 of 45 cases (48.9%), compared to the urinary bladder group, which had 4 of 35 cases (11.4%) (P ≤ .001). Among the patients in the orthotopic neobladder group who experienced DJUS migration, stent dysfunction occurred in 18 cases (81.8%), which was statistically significant (P = .003). Multivariate logistic regression analysis revealed that only the size of the DJUS was significantly and positively associated with migration (odds ratio:10.214, P = .010). DJUS migration can easily occur in patients undergoing radical cystectomy and orthotopic neobladder, and smaller stent sizes are associated with a higher incidence of migration.
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Affiliation(s)
- Chang Hoon Oh
- Department of Radiology, Ewha Womans University Mokdong Hospital, College of Medicine, Ewha Womans University, Seoul, Republic of Korea
| | - Soo Buem Cho
- Department of Radiology, Ewha Womans University Seoul Hospital, College of Medicine, Ewha Womans University, Seoul, Republic of Korea
| | - Hyo Jeong Lee
- Department of Radiology, Ewha Womans University Mokdong Hospital, College of Medicine, Ewha Womans University, Seoul, Republic of Korea
| | - Hyeyoung Kwon
- Department of Radiology, Chungnam National University Hospital, Chungnam National Uvinersity School of Medicine, Daejeon, Republic of Korea
| | - Yeok Gu Hwang
- Department of Orthopedic Surgery, Ewha Womans University Seoul Hospital, College of Medicine, Ewha Womans University, Seoul, Republic of Korea
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Hanna P, Zabell J, Konety B, Warlick C. Perioperative complications and oncological outcomes of open versus robotic-assisted radical cystectomy: a propensity score-matched study. World J Urol 2024; 42:220. [PMID: 38587653 DOI: 10.1007/s00345-024-04907-4] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Accepted: 02/24/2024] [Indexed: 04/09/2024] Open
Abstract
PURPOSE To conduct a comparative effectiveness analysis between robot-assisted radical cystectomy (RARC) and open approach (ORC). MATERIALS AND METHODS A retrospective cohort study was conducted involving all patients undergoing radical cystectomy and urinary diversion for invasive bladder cancer at our institution from 2010 to 2018. Of a total 296 patients, we matched ORC and RARC cases based on age, BMI, Charlson comorbidity index, pathological TN staging of the tumor, prior radiotherapy, and type of diversion. The perioperative complications and oncological outcomes were compared. RESULTS Eighty-nine patients were matched in the ORC and RARC groups. The median operative time was longer in RARC group (430 min) than that of ORC group (372 min) (p = 0.03); however, the median estimated blood loss (EBL) was significantly lower in RARC group (500 ml) than that of ORC (700 ml) (p < 0.0001). The median length of hospital stay (LOS) was significantly reduced in the RARC group (7 days) compared to the ORC group (8 days) (p = 0.02). There were no significant differences between both groups in 30- and 90-day postoperative complications (p = 0.3 and p = 0.2, respectively). A total of 68 deaths (38.2%) were observed, of which 36 (40.4%) were in ORC group while 32 (36%) were in RARC group (p = 0.5). The results were comparable in both groups regarding 5-year survival rate and cancer-specific survival (p = 0.3 and p = 0.1, respectively). CONCLUSION RARC showed better perioperative outcomes in the form of less EBL and shortened LOS compared to ORC group. However, both RARC and ORC provide similar postoperative oncologic control, in terms of similar positive surgical margins, cancer-specific rates, and 5-year survival rates.
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Affiliation(s)
- Peter Hanna
- Department of Urology, University of Minnesota, Minneapolis, MN, USA.
- Department of Urology, Aswan University, Aswan, Egypt.
| | - Joseph Zabell
- Department of Urology, University of Minnesota, Minneapolis, MN, USA
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Avudaiappan AP, Prabhakar P, Eldefrawy A, Caso J, Manoharan M. CLO24-074: Impact of Neoadjuvant Chemotherapy on Survival and Pathological Response Among Octogenarians Who Underwent Radical Cystectomy for Muscle-Invasive Bladder Cancer. J Natl Compr Canc Netw 2024; 22:CLO24-074. [PMID: 38580261 DOI: 10.6004/jnccn.2023.7203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/07/2024]
Affiliation(s)
| | - Pushan Prabhakar
- 1Miami Cancer Institute, Baptist Health South Florida, Miami, FL
| | - Ahmed Eldefrawy
- 1Miami Cancer Institute, Baptist Health South Florida, Miami, FL
- 2Herbert Wertheim College of Medicine, Miami, FL
| | - Jorge Caso
- 1Miami Cancer Institute, Baptist Health South Florida, Miami, FL
- 2Herbert Wertheim College of Medicine, Miami, FL
| | - Murugesan Manoharan
- 1Miami Cancer Institute, Baptist Health South Florida, Miami, FL
- 2Herbert Wertheim College of Medicine, Miami, FL
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Swinton M, Devi A, Song YP, Hoskin P, Choudhury A. Beyond surgery: bladder preservation and the role of systemic treatment in localised muscle-invasive bladder cancer. World J Urol 2024; 42:210. [PMID: 38573431 PMCID: PMC10994870 DOI: 10.1007/s00345-024-04892-8] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 02/15/2024] [Indexed: 04/05/2024] Open
Abstract
Over the last two to three decades the non-surgical curative management of bladder cancer has significantly progressed. Increasing evidence supports the use of bladder preservation as an alternative to radical cystectomy (RC) for localised muscle-invasive bladder cancer (MIBC). Radiosensitisation with chemotherapy or hypoxia modification improves the efficacy of radiotherapy. Systemic treatments play an important role in the management of localised MIBC with the benefit of neoadjuvant chemotherapy prior to radical treatment well established. The use of immune checkpoint inhibitors (ICIs) in the radical treatment of bladder cancer, their safe combination with radical radiotherapy regimens and whether the addition of ICIs improve rates of cure are outstanding questions beginning to be answered by ongoing clinical trials. In this narrative review, we discuss the current evidence for bladder preservation and the role of systemic treatments for localised MIBC.
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Affiliation(s)
- Martin Swinton
- Christie Hospital NHS Foundation Trust, Manchester, UK
- University of Manchester, Manchester, UK
| | - Aarani Devi
- Christie Hospital NHS Foundation Trust, Manchester, UK
| | - Yee Pei Song
- Christie Hospital NHS Foundation Trust, Manchester, UK
| | - Peter Hoskin
- Christie Hospital NHS Foundation Trust, Manchester, UK
- University of Manchester, Manchester, UK
| | - Ananya Choudhury
- Christie Hospital NHS Foundation Trust, Manchester, UK.
- University of Manchester, Manchester, UK.
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Lee S, Yoon Y, Suh J, You D, Hong B, Hong JH, Ahn H, Jeong IG, Lim B. Association of preoperative sarcopenia with the long-term prognosis of patients with bladder cancer undergoing radical cystectomy. J Cancer Res Clin Oncol 2024; 150:173. [PMID: 38568255 PMCID: PMC10991012 DOI: 10.1007/s00432-024-05705-6] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Accepted: 03/15/2024] [Indexed: 04/05/2024]
Abstract
PURPOSE This retrospective study aimed to assess the correlation between preoperative sarcopenia and long-term oncologic outcomes in patients undergoing radical cystectomy for bladder cancer. METHODS We included 528 patients who underwent radical cystectomy for bladder cancer between 2000 and 2010 at Asan Medical Center, Seoul, Korea. Preoperative skeletal muscle mass was quantified by analyzing computed tomography images at the third lumbar vertebra. Sarcopenia was defined based on the skeletal muscle index. We evaluated various clinical and pathological factors to analyze the association between sarcopenia and long-term oncologic outcomes. RESULTS The median follow-up time was 104 months. Sarcopenia was identified in 37.9% of the patients. Although no significant differences were observed in traditional pathological factors between the sarcopenic and non-sarcopenic groups, sarcopenia was significantly associated with worse oncologic outcomes. Compared to the non-sarcopenic groups, the sarcopenic group had lower overall survival rates (52.0% vs. 67.1% at 5 years, 35.5% vs. 52.7% at 10 years) and higher cancer-specific mortality (63.3% vs. 74.3% at 5 years, 50.7% vs. 67.4% at 10 years). Multivariable Cox regression analysis demonstrated that sarcopenia was an independent predictor of cancer-specific survival (hazard ratio: 1.49, 95% confidence interval: 1.11-2.01, p = 0.008), alongside body mass index, tumor stage, lymph node metastasis, and lymphovascular invasion. CONCLUSION Sarcopenia was significantly associated with poor cancer-specific survival in patients undergoing radical cystectomy for bladder cancer. Detecting sarcopenia may assist in preoperative risk stratification and long-term management after radical cystectomy.
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Affiliation(s)
- Sangmin Lee
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea
| | - Youngjoon Yoon
- Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea
| | - Jungyo Suh
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea
| | - Dalsan You
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea
| | - Bumsik Hong
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea
| | - Jun Hyuk Hong
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea
| | - Hanjong Ahn
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea
| | - In Gab Jeong
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea
| | - Bumjin Lim
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea.
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Jaganmurugan R, Arora A, Chandankhede U, Prakash G, Bakshi G, Joshi A, Menon S, Murthy V, Pal M. Prognostic Significance of Lymph Node Density in Pathological Node Positive Urothelial Carcinoma of the Bladder -Upfront Surgery and Post Neoadjuvant Chemotherapy Cohorts. Clin Genitourin Cancer 2024; 22:385-393. [PMID: 38245435 DOI: 10.1016/j.clgc.2023.12.009] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Revised: 12/15/2023] [Accepted: 12/16/2023] [Indexed: 01/22/2024]
Abstract
AIM To validate the role of lymph node density as a prognostic marker in patients undergoing primary surgery and postneoadjuvant therapy in pathological node-positive urothelial bladder carcinoma. MATERIALS AND METHODS Retrospective analysis of 503 patients who underwent radical cystectomy from 2006 to 2019 for muscle-invasive urothelial bladder carcinoma, of which 152 patients with pathological node-positive disease were analyzed. Demographic details, pathological findings, treatment details, disease-free, and overall survival were documented. X tile program analysis was used to divide patients with positive lymph nodes into 3 groups: LD1: <= 7, LD2 :>7 to <15, LD3: >15, and the optimal cut-off value obtained was 15%. To evaluate the impact of lymph node ratio, patients with positive lymph nodes into 3 categories for each cut-off point estimation method, the application generates the histogram, Kaplan-Meier plot and calculates hazard ratio, confidence intervals and P-values. Univariate and multivariate cox regression analysis was done with a P-value of <.05, considered significant. RESULTS One hundred fifty-two patients (30.2%) had pathological nodal metastasis, with 87 of them having perinodal extension. Ninety-six underwent primary surgery, and 56 were postneoadjuvant chemotherapy. The median follow-up was 55.42 months. 68 of the 152 node-positive patients died of the disease. Median number of lymph nodes removed was 17.11. Lymph node density divided into tertiles were LD1 <7%, LD2 7-<15%, LD3 >15% showed 5-year RFS 40.5%,29.3%, 22.6% and 5 year OS was 55.5%, 42.4%,32.1% respectively. Cox regression analysis showed that age less than 55 years ,higher tumor stage, lymphovascular invasion, and higher lymph node ratio were significant in univariate and multivariate analysis. The lymph node density cut-off value of 15% was substantial among node-positive patients (P = .027), and subgroup analysis in upfront surgery with the adjuvant treatment group and postneoadjuvant chemotherapy group was also significant (P =.021). CONCLUSION Pathological higher T stage, Age <55 years, Lymphovascular invasion, adjuvant chemotherapy , adjuvant radiation treatment and lymph node density had prognostic significance in both cohorts of patients who underwent upfront surgery and neoadjuvant chemotherapy. Lymph node density cut-off value of <15% was prognostically significant.
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Affiliation(s)
- Ramamurthy Jaganmurugan
- Department of Surgical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Amandeepsingh Arora
- Division of Urooncology, Department of Surgical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Udhay Chandankhede
- Division of Urooncology, Department of Surgical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Gagan Prakash
- Division of Urooncology, Department of Surgical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Ganesh Bakshi
- Division of Urooncology, Department of Surgical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Amit Joshi
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Santhosh Menon
- Department of Pathology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Vedang Murthy
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Mahendra Pal
- Division of Urooncology, Department of Surgical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India.
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