Sarcopenia is an independent predictor of survival in patients undergoing radical cystectomy for bladder cancer: a single-centre, retrospective study.

Introduction: This study aimed to determine whether sarcopenia is a predictor of overall survival (OS) and cancer-specific survival (CSS) in patients with bladder cancer (BC) undergoing radical cystectomy (RC). Material and methods: Patients who underwent radical cystectomy for BC between September 2016 and June 2022 were retrospectively reviewed. Patients underwent digital computed tomography (CT) scans of the abdomen and pelvis. The skeletal muscle index (SMI) was used to assess sarcopenia using CT images. OS and CSS were estimated using Kaplan-Meier curves. Predictors of CSS and OS were analysed using univariate and multivariate Cox regression models. Results: Of the 84 reviewed patients, 45 (53.6%) had sarcopenia. The median follow-up period for survivors was 70 months. Patients with sarcopenia were older and had a lower BMI, but other preoperative clinical and laboratory parameters were similar to those of patients without sarcopenia. During follow-up, 57 (67.9%) patients died, 39 (46.4%) due to BC. In addition, patients with sarcopenia had worse 5-year OS (24.4% vs 41.0%, p = 0.036) and CSS (35.6% vs 61.5%, p = 0.012) than non-sarcopenic patients. The findings indicate that sarcopenia is an independent predictor of increased CSS (HR, 2.841; p = 0.003) and overall mortality (HR, 2.465; p = 0.004) in multivariate analysis. Conclusions: The results of this study support the view that sarcopenia is an important risk factor for predicting CSS and OS in BC patients undergoing RC.

Ventral onlay buccal mucosa graft urethroplasty for female urethral stricture improves female sexual functions.

Female urethroplasty provides excellent results with high success rates in the treatment of female urethral stricture (FUS), but sexual functions after urethroplasty is another concern and have not been adequately investigated. We aimed to evaluate changes in the sexual functions of patients undergoing ventral onlay buccal mucosa graft urethroplasty (VOBMGU). We retrospectively evaluated 18 patients who underwent VOBMGU supported with a Martius labial fat pad flap (MLFPF) in our tertiary referral centre, between 2019 and 2021. After excluding patients who were sexually inactive and those with missing postoperative data, 13 patients were included. Surgical outcomes were assessed with uroflowmetry, the American Urological Association symptom score (AUA-SS), and Urogenital Distress Inventory (UDI)-6. Short Form-36 (SF-36) was used to evaluate the quality of life (QoL). Sexual function was assessed using the Female Sexual Function Index (FSFI) both preoperatively and at 6 months following surgery. The median age was 50 (IQR:44-62) years. There was no surgical failure, and none of the patients developed incontinence or stricture recurrence during a median follow-up of 30 (IQR:12-30) months. The median maximum flow rate increased from 9.2 (IQR:5-11.5) to 19 (IQR:17.35-27.10) ml/s (p = 0.001), the median post-void residual (PVR) volume decreased from 80 (IQR:0-205) to 20 (IQR:10-45) ml (p = 0.021), the median AUA-SS decreased from 19 (IQR:14-22) to 6 (IQR:4-8) (p = 0.001), and the median UDI-6 score decreased from 12 (IQR:6.5-16) to 4 (IQR:2-9) (p = 0.008) postoperatively. Bodily pain and general health perception domains and the physical component summary score were significantly improved in the SF-36 (p = 0.015, 0.022, and 0.009, respectively). The median total FSFI score increased from 17.40 (IQR:1.95-23.65) to 22.60 (IQR:5-24.95) postoperatively (p = 0.004). Improvements were observed in all domains (p < 0.05) except the arousal (p = 0.058) and pain (p = 0.104) domains of the FSFI. We concluded that VOBMGU has good early functional results and improves female sexual function.

Can pelvic diameter measurement have an effect on surgical outcomes in radical cystectomy?

OBJECTIVE: To determine the effectiveness of pelvis diameters in determining postoperative outcomes in men who underwent open radical cystectomy + urinary diversion, it is aimed to predict the factors that may affect the operative difficulty and possible surgical outcomes before the operation. METHODS: A total of 79 radical cystectomy patients operated in our institution with preoperative computed tomography (CT) were included the study. Pelvic dimensions; symphysis angle (SA), upper conjugate, lower conjugate, pelvic depth, apical depth (AD), interspinous distance (ISD), bone femoral width and soft tissue width were measured by preoperative CT. ISD index were defined as ISD/AD. Postoperative outcomes and indicators of operative difficulty were recorded. Regression analyses were used to predict perioperative and postoperative outcomes. RESULTS: Total of 96 complications were observed in 52 of the 79 patients in ninety days (65,8%) with a mean age of 68.25 years. There were significant correlations between SA and body mass index (BMI) with operative time (p = 0.006, p < 0.001; respectively). For estimated blood loss, there were significant correlations between preoperative hematocrit (p = 0,031). Analysis of multivariate logistic regression revealed that higher Charlson comorbidity index (CCI) and BMI were found to be significant predictors for major complications while CCI, pathological T stage and ISD index are prominent predictors for surgical margin positivity. CONCLUSIONS: Pelvic dimensions are not significant with minor or major complications. However, operative time may be associated with SA. Also, narrow and deep pelvis may increase the risk of positive surgical margins.

The effect of recurrent direct vision internal urethrotomy for short anterior urethral strictures on the disease course and the predictors of treatment failure.

INTRODUCTION: The objective of this study was to investigate the disease course after direct vision internal urethrotomy (DVIU) for short anterior urethral strictures. METHODS: We retrospectively analyzed 94 patients who underwent DVIU of the anterior urethra. Patients' age, etiology, length and localization of the strictures, total number of DVIU procedures, comorbidities, and other data were evaluated. RESULTS: The mean age of the patients was 67.2 years. The mean followup duration was 27.1 months. Recurrence was observed in 27.6% of the patients. Recurrence had occurred in these patients at a mean of 12 months. Both the comorbidity score (rs=0.395; p<0.001) and the urinary tract infection (UTI) score (rs=0.492; p<0.001) had significant correlation with the recurrence. In patients with recurrent urethral stricture, as the number of DVIU increased, the length and number of the urethral stricture increased as well. Patients with recurrence had a single stricture in the first DVIU procedure, while the number of strictures increased to a mean of two in the second and/or third DVIU procedures. CONCLUSION: DVIU is an effective treatment method in short anterior urethral stricture if it has been applied as a first intervention. However, if the stricture recurs, repeated DVIU application appears to be a negative predictive factor. The presence of perioperative treated UTI, smoking, and total number of comorbidities were negative predictive factors for the recurrence of urethral stricture. The disadvantages of our study is that it is retrospective, it includes a low number of patients, and the followup period is short.