Blood loss associated with radical cystectomy: a prospective, randomized study comparing Impact LigaSure vs. stapling device.

OBJECTIVES: Radical cystectomy (RC) is associated with significant blood loss and transfusion requirement. We performed a prospective, randomized trial to compare blood loss, operative time, and cost using 2 different and commonly employed approaches to tissue ligation and division during RC: mechanical (stapler device) and electrosurgical (heat-sealing device). METHODS AND MATERIALS: Eighty patients undergoing RC for urothelial bladder carcinoma were randomized to use of either an Endo GIA Stapler or Impact LigaSure device for tissue ligation and division. Primary outcomes were blood loss, operative time, and device costs. Data were analyzed with Wilcoxon rank sum test and Welch 2-sample t test. RESULTS: There were no significant demographic or preoperative differences between the cohorts. Mean estimated blood loss was similar between the electrosurgical (687 ml) and stapler (708 ml) arms (P = 0.850). There were no significant differences between cohorts when comparing operative times or transfusion requirement. There was a significant increase in the mean number of adjunctive suture ligatures used in the stapling device arm (3.0 vs. 1.5, P = 0.047). Total device costs were significantly lower with the LigaSure compared with the GIA Stapler ($625.00 vs. $1490.10, P<0.001). There were no complications attributable to either device. CONCLUSIONS: This prospective, randomized study demonstrates no significant difference in blood loss, transfusion requirement, or safety between mechanical vs. electrosurgical control of the vascular pedicles. The LigaSure device, however, is significantly less costly than the GIA Stapler and required fewer additional measures for hemostasis.

Bladder cancer.

PURPOSE OF REVIEW: To review the diagnosis and management of all stages of bladder cancer with an emphasis on studies and developments within the last year. RECENT FINDINGS: Cystoscopy remains the mainstay in the detection and surveillance of bladder cancer, though fluorescent light may enhance detection as well as prolong recurrence-free survival. Urine cytology remains the gold standard for diagnosis and surveillance of bladder cancer; however, there are continued efforts in the development of urinary bladder cancer markers. Transurethral resection and instillation of perioperative chemotherapy remains the treatment of choice for superficial bladder cancer in most patients. Data supports the use of intravesical Bacillus Calmette-Guerin (including a maintenance regimen) for those at high risk for disease progression. Radical cystectomy with thorough pelvic lymphadenectomy remains the gold standard for management of muscle invasive disease. Research on the use of laparoscopy, robot-assisted laparoscopy, the effect on patient's health-related quality of life, and the potential role for bladder preservation strategies is ongoing. The value of neoadjuvant versus adjuvant chemotherapy around the time of cystectomy is still debated, though the best level-one evidence supports the use of neoadjuvant methotrexate, vinblastine, doxorubicin, and cisplatin followed by cystectomy. Platinum-based chemotherapeutic agents are most commonly used in the community setting. Work is ongoing to develop new regimens, especially in patients who cannot take cisplatin. Research in the development of targeted therapies alone or in combination with chemotherapeutic regimens continues and will hopefully broaden our treatment strategy for patients with advanced/metastatic disease. SUMMARY: We are encouraged by the progress in bladder cancer diagnosis and management; however, continued research is needed in order to improve the lives of our patients with this disease.

Study characteristics of abstracts presented at the annual meetings of the southeastern section of the American Urological Association (1996-2005).

PURPOSE: We determined study characteristics, authorship and institutional origin of studies presented in abstract form at the Southeastern Section of the American Urological Association annual meetings and identified predictors of full text publication. MATERIALS AND METHODS: All abstracts of poster and podium presentations from the Southeastern Section of the American Urological Association annual meetings from 1996 to 2005 were reviewed. A standardized evaluation form was developed and tested in 2 subsets of 50 abstracts, and then applied by 2 individual reviewers with specific coding instructions. Predictor variables analyzed included study origin, design, topic, domain, presentation form, number of patients, reporting of statistical analysis and gender. Univariate and multivariate analysis was applied using SPSS version 14.0. RESULTS: A total of 1,195 abstracts were found eligible for review. The mean number of abstracts presented per year was 120 +/- 16 (range 107 to 146). In clinical studies (1,068) approximately three-quarters of the abstracts reported case series (801, 75.0%). Cohort studies accounted for 11.2% of the abstracts and 4.0% were randomized controlled trials or systematic reviews/meta-analyses. Median followup was 64 months (range 17 to 126) and the overall publication rate was 33.5%. First and senior female authorship were identified in 6.2% (74) and 5.4% (64) of abstracts presented, respectively. CONCLUSIONS: A majority of studies presented at the Southeastern Section of the American Urological Association annual meetings continue to represent small case series that may not be well suited to guide clinical decision making. Only a third of studies are subsequently published in the peer reviewed literature. The percentage of abstracts with female authorship remains low suggesting that increased efforts to involve women in urological research are indicated.