Assessment of the accuracy of biparametric MRI/TRUS fusion-guided biopsy for index tumor evaluation using postoperative pathology specimens.

BACKGROUND: Multiparametric MRI (mpMRI) is widely used for the diagnosis, surveillance, and staging of prostate cancer. However, it has several limitations, including higher costs, longer examination times, and the use of gadolinium-based contrast agents. This study aimed to investigate the accuracy of preoperatively assessed index tumors (ITs) using biparametric MRI (bpMRI)/transrectal ultrasound (TRUS) fusion biopsy compared with radical prostatectomy (RP) specimens. METHODS: We included 113 patients diagnosed with prostate cancer through bpMRI/TRUS fusion-guided biopsies of lesions with a Prostate Imaging Reporting and Data System (PI-RADS) category ≥ 3. These patients underwent robot-assisted laparoscopic radical prostatectomy (RARP) at our institution between July 2017 and March 2023. We examined the localization of preoperative and postoperative ITs, the highest Gleason score (GS), and tumor diameter in these patients. RESULTS: The preoperative cT stage matched the postoperative pT stage in 53 cases (47%), while 31 cases (27%) were upstaged, and 29 cases (26%) were downstaged (Weighted Kappa = 0.21). The preoperative and postoperative IT localizations were consistent in 97 cases (86%). The concordance rate between Gleason groups in targeted biopsies and RP specimens was 51%, with an upgrade in 25 cases (23%) and a downgrade in 27 cases (25%) (Weighted Kappa = 0.42). The maximum diameter of the IT and the maximum cancer core length on biopsy were correlated with the RP tumor's maximum diameter (p < 0.001 for both). CONCLUSION: The diagnostic accuracy of bpMRI/TRUS fusion biopsy is comparable to mpMRI, suggesting that it can be a cost-effective and time-saving alternative.

Assessment of long-term quality of life in patients with orthotopic neobladder followed for more than 5 years.

INTRODUCTION: We analyzed the general health QOL (GH-GOL), urinary QOL, and sexual QOL in patients with orthotopic neobladder who were followed for more than 5 years. MATERIALS AND METHODS: Eighty-six (male 78, female 8) patients who underwent orthotopic neobladder and followed for more than 5 years were enrolled in this study. QOL regarding general health and urinary function were surveyed by SF-36 and ICSmaleSF, respectively. Sexual function was assessed by International Index of Erectile Function (IIEF-5). Satisfaction with urinary and sexual function was evaluated by visual analogue scale (VAS). RESULTS: On overall analysis by SF-36, 2 categories (role-physical functioning and role-emotional functioning) showed significantly lower scores, although bodily pain showed a better than average score for Japanese people of the same age. While patients who required clean intermittent catheterizaion (CIC) or had daytime incontinence presented worse scores in several categories on SF-36, the presence of enuresis did not affect SF-36 score. ICSmaleSF survey showed that voiding symptoms significantly impaired QOL in patients who required CIC and incontinence symptoms significantly impaired QOL in patients who had daytime incontinence and enuresis. With regard to sexual function, most patients (88%) had lost sexual function. On VAS, satisfaction with urinary function was 5.63, and sexual function was only 0.98. CONCLUSIONS: Although GH-QOL was generally well maintained, the presence of CIC or daytime incontinence impaired GH-QOL. Most were not satisfied with their level of sexual function 5 years after orthotopic neobladder construction.

Orthotopic sigmoid neobladder after radical cystectomy: assessment of complications, functional outcomes and quality of life in 82 Japanese patients.

OBJECTIVES: To retrospectively review our clinical experience with sigmoid neobladder reconstruction. PATIENTS AND METHODS: The study included 82 consecutive Japanese patients (64 men and 18 women) with bladder cancer who had a radical cystectomy and orthotopic sigmoid neobladder created using the modified technique described previously. Complications, functional outcomes and health-related quality of life (HRQL, using the Short-Form 36 instrument) were evaluated in 80 patients with a mean follow-up of 55 months, after excluding two who died perioperatively. RESULTS: There were 45 early complications in 28 patients, including wound infection in 16, ileus in nine and pyelonephritis in eight, with 19 late complications in 15, including neobladder stone in five, uretero-intestinal stricture in four and entero-urethral stricture in four. Of the 80 patients, 73 could void spontaneously, and daytime and night-time continence were achieved in 69 and 46, respectively. The mean maximum flow rate, voided volume and postvoid residual were 18.6 mL/s, 345.3 mL and 24.5 mL, respectively. Severe hyperchloraemic metabolic acidosis occurred in three patients, but none of them developed hypovitaminosis of B(12). The HRQL survey after surgery showed no significant differences in five of the eight scale scores between the 80 patients with a sigmoid neobladder and an age-matched control population in Japan. Furthermore, there were no significant differences in any variables assessed in this study between men and women patients. CONCLUSIONS: The modified sigmoid neobladder provides satisfactory clinical outcomes after radical cystectomy.

Assessment of voiding function of orthotopic neobladders in elderly patients with long-term survival.

OBJECTIVE: To compare the voiding status in elderly patients (aged >or=80 years) with that in younger patients undergoing orthotopic neobladder substitution during long-term survival. PATIENTS AND METHODS: The voiding status was assessed in 111 patients (ileal neobladder in 62, ascending colonic neobladder in 14, sigmoid colonic neobladder in 21 and ileocolonic neobladder in 14) who lived for >5 years after radical cystectomy with an orthotopic neobladder, using a self-completed questionnaire and uroflowmetry. According to the age at the time of these assessments, patients were divided into two groups (group 1, <80 years, 94; group 2, >or=80 years, 17). The voiding status was compared between the groups. RESULTS: In all, 78 patients (92%) in group 1 and 16 (94%) in group 2 were capable of spontaneous voiding. In group 1 and 2, respectively, daytime continence was achieved by 67 (74%) and 12 (75%) patients, but night-time continence was achieved by 54 (60%) and six (38%), although the difference was not statistically significant. In groups 1 and 2, respectively, the median maximum flow rate was 13.3 and 11.7 mL/s and the median postvoid residual urine volume was 19 and 18 mL. The only statistically significant difference was for voiding posture, assessed in men. CONCLUSIONS: There was no significant difference in voiding status of patients with orthotopic neobladders except for voiding posture between patients aged <80 or carefully selected elderly patients aged >or=80 years during long-term survival. However, night-time continence might be clinically worse in the elderly than in the younger group.

Assessment of microheterogeneity of blood flow in the rat urinary bladder by high-resolution digital radiography.

OBJECTIVES: To assess high-resolution digital radiography for measuring blood flow and thus examine the microheterogeneity of bladder microcirculation in a rat model. MATERIALS AND METHODS: Microheterogeneity of blood flow in both mucosa and detrusor muscle of eight anaesthetized rats was investigated using an imaging technique with very high spatial resolution (0.1 x 0.1 mm(2)) using digital radiography combined with the deposition of (3)H-labelled desmethylimipramine. The spatial pattern of blood flow was quantified by the coefficient of variation of the regional flow (CV = sd/mean). RESULTS Muscle blood flow was less than mucous blood flow (muscle : mucosa, 2.9 : 5) in the empty bladder. In the muscle layer the blood flow distribution was more heterogeneous than that in the mucosa, with a mean (sd) CV in muscle and mucosa of 0.33 (0.033) and 0.16 (0.019), respectively (P < 0.001) at the capillary level. CONCLUSION: There was a heterogeneous distribution of blood flow in the microcirculation to capillary vessels in the muscular layer, possibly reflecting a difference in dynamic blood flow of regional perfusion of the emptied bladder.