Operative management in patients with upper tract urothelial carcinoma in Iceland: a population-based study.

OBJECTIVE: Radical nephroureterectomy is the standard treatment of organ-confined upper tract urothelial carcinoma (UTUC). The objective of this study was to investigate survival and bladder recurrence rate in Icelandic patients with UTUC who underwent radical nephroureterctomy (RNU) or other procedures with curative intent. MATERIAL AND METHODS: All patients who were diagnosed with UTUC in Iceland from 2003 to 2016 and treated with curative intent were included in the study. Information on patients was obtained retrospectively from patients' medical records and from the Icelandic Cause of Death Registry. RESULTS: Overall 63 patients underwent a procedure for UTUC with curative intent in Iceland during the study period. The median age was 71 years and the majority were male (65%). In 50 patients (79%), the tumor was a primary UTUC. The most common procedure was RNU (78%) and eight patients (13%) underwent a kidney-sparing procedure. No patient died within 90 d of surgery. Twenty-eight patients (44%) had pathological stage T2 or higher, whereas 35 patients (56%) had pathological stage T1 or lower. The median follow-up time was 98.8 months . During the follow-up time 25 patients (40%) were diagnosed with recurrence in the bladder. Five-year cancer-specific survival (CSS) was 67%. CONCLUSIONS: This population-based study shows that the oncologic outcome in Icelandic patients with UTUC is similar to what has been reported in other countries. Bladder recurrence rate is high and can hopefully be reduced by improvements in surgical and intravesical instillation treatment. Possibly more kidney-sparing surgeries could have been done during the study period; however, careful selection for those procedures is mandatory.

Radical cystectomy in the treatment of bladder cancer in Iceland: A population-based study.

OBJECTIVE: Radical cystectomy (RC) is the standard treatment for muscle-invasive bladder cancer. Postoperative complications are reported to be as high as 65%. The objective of this study was to investigate complications and survival in Icelandic patients with bladder cancer who underwent RC. MATERIALS AND METHODS: All patients who had bladder cancer and underwent RC in Iceland from 2003 to 2012 were included. Information was obtained retrospectively from patients' medical records and from the Icelandic Cause of Death Registry. Complications were classified according to the Clavien-Dindo classification system. The Kaplan-Meier method was used in the survival analysis. Only patients with transitional cell carcinoma (TCC) were included in the survival analysis. RESULTS: Overall, 108 patients (male 81%, median age 68 years) underwent the procedure during the study period and 100 of them had TCC. Ileal conduit was performed in 86% of procedures and orthotopic neobladder in 14%. The median operation time was 266 min and the median blood loss during the procedure was 1000 ml. No patient died within 30 days of surgery, but one patient (0.9%) died within 90 days of surgery from complications of the surgery. Complications were reported for 62 patients (57%) overall. Major complications (Clavien 3-5) were reported in 32 patients (29%), and 30 patients (28%) had only minor complications (Clavien 1-2). Twenty-four patients (22%) had to undergo reoperation. Overall 5 year survival was 54%. CONCLUSION: Morbidity after RC is high but similar to that seen in other studies. Long-term survival of Icelandic patients is comparable to that in neighboring countries.

[Reoperations on lower urinary tract due to foreign body after urinary incontinence surgery]. / Enduraderdir á nedri thvagfaerum sökum ótila eftir fyrri thvaglekaadgerdir.

OBJECTIVE: The usage of non-absorbable synthetic materials in female incontinence surgery could give rise to serious complications. The aim of this study was to describe results of reoperations due to foreign body near or within lower urinary tract in female patients previously undergoing stress incontinence surgery. MATERIAL AND METHODS: This was a retrospective study of patients referred to the author with miscellaneous symptoms after stress incontinence surgery. The reoperations were performed in the period March 1996 to May 2004. All patients were followed after reoperation. Results are given as median, minimum and maximum value. RESULTS: Ten patients with median age 59,5 (28-82) years were reoperated between half and 56 months from the primary operation. Urinary infection, pain, incontinence and various lower urinary tract symptoms were the most common symptoms. Nine patients were diagnosed by cystoscopy. Four had previously undergone tension-free vaginal tape surgery (TVT), four needle suspension surgery and two retropubic colposuspension. Seven were reoperated with open retropubic surgery, in two cases TVT was removed below urethra and non-absorbable suture was removed transvaginally in one patient. Foreign body was within the lower urinary tract in seven cases. In three cases, transurethral endoscopic removal of foreign body was performed without long-term success and further surgery needed. The overall results of the reoperations was very satisfying in terms of complete removal of foreign bodies and regress of symptoms. Convalescence was uneventful and only one patient got superficial skin infection. No other complications occurred. None has needed further reoperations in the follow-up period (6-78 months). CONCLUSIONS: Complications after usage of non-absorbable material in stress incontinence surgery could be serious and give chronic urinary symptoms. It is very important for the surgeon to be aware of this in all patients having unsuccessful recovery after incontinence surgery.