Platinum-based adjuvant chemotherapy for upper tract urothelial carcinoma: a change of paradigm? A meta-analysis of aggregate data.

We performed a systematic review and meta-analysis to evaluate the role of platinum-based adjuvant chemotherapy (AC) in upper tract urothelial carcinoma. Eligible studies were identified using Pubmed/Medline, Cochrane library, Embase and meeting abstracts. Outcomes of interest included: overall survival (OS), cancer-specific survival (CSS) and disease-free survival (DFS). Platinum-based AC was associated with improved DFS, while the benefit in OS and CSS was not statistically significant compared to observation. Conversely, platinum-based AC showed a modest OS benefit in an analysis combing multivariable HRs with estimated HRs from Kaplan-Meier curves. Our results suggest that platinum-based AC is associated with improved DFS and a modest OS benefit in patients with locally advanced urothelial carcinomas.

Tumor de vías excretoras urinarias superiores. Presentación de caso / Upper urinary excretory tract tumor. A case report

RESUMEN Los tumores del tracto urinario superior representan menos del 5 % de todas las neoplasias uroteliales, con un porcentaje de recurrencia superior al 90 % y una supervivencia a los 5 años que oscila entre el 30-60 %. Por tales razones se presenta el caso de un paciente de 79 años que fue ingresado en el Hospital General Universitario Dr. Gustavo Aldereguía Lima de Cienfuegos, con un cuadro clínico caracterizado por hematuria, sin otra sintomatología. Mediante estudios imagenológicos le fue diagnosticado un tumor en la pelvis del riñón derecho. Se realizó tratamiento quirúrgico, practicándose una nefrectomía total, cuyo resultado histológico fue un carcinoma de células transicionales grado II con infiltración a planos musculares. La evolución clínica fue favorable luego de un año de la cirugía. Podemos concluir que en el diagnóstico precoz tienen un papel fundamental las imágenes tomográficas, pues permitieron identificar un tumor de las vías excretoras urinarias superiores en pelvis renal derecha. Se trazó una estrategia terapéutica inicialmente quirúrgica y a continuación quimioterapia; se logró una evolución satisfactoria y contribuir a la sobrevida de este paciente.

ABSTRACT Upper urinary tract tumors represent less than 5% of all urothelial neoplasms, with a recurrence rate greater than 90% and a 5-year survival that ranges from 30-60%. Therefore a 79-years-old patient was admitted to the Dr. Gustavo Aldereguía Lima University General Hospital in Cienfuegos, with a medical history characterized by hematuria, without other symptoms. Through imaging studies, he was diagnosed with a tumor in the pelvis of the right kidney. Surgical treatment was performed and a total nephrectomy was performed, the histological result of which was a grade II transitional cell carcinoma with infiltration to the muscular planes. The clinical evolution was favorable one year after surgery. We conclude that tomographic images play a fundamental role in early diagnosis, since they allowed the identification of a tumor of the upper urinary excretory tract in the right renal pelvis. A therapeutic strategy was initially designed for surgery and then chemotherapy; a satisfactory evolution was achieved and contributes to the survival of this patient.

Identification of underserved areas for urologic cancer care.

BACKGROUND: The delivery of urologic oncology care is susceptible to regional variation. In the current study, the authors sought to define patterns of care for patients undergoing genitourinary cancer surgery to identify underserved areas for urologic cancer care in Washington State. METHODS: The authors accessed the Washington State Comprehensive Hospital Abstract Reporting System from 2003 through 2007. They identified patients undergoing radical prostatectomy, radical cystectomy (RC), partial nephrectomy (PN), radical nephrectomy, and transurethral resection of the prostate (TURP). TURP was included for comparison as a reference procedure indicative of access to urologic care. Hospital service areas (HSAs) are where the majority of local patients are hospitalized; hospital referral regions (HRR) are where most patients receive tertiary care. The authors created multivariate hierarchical logistic regression models to examine patient and HSA characteristics associated with the receipt of urologic oncology care out of the HRR for each procedure. RESULTS: Greater than one-half of patients went out of their HRR in 7 HSAs (11%) for radical prostatectomy, 3 HSAs (5%) for radical nephrectomy, 10 HSAs (15%) for PN, and 14 HSAs (22%) for RC. No HSAs had high export rates for TURP. Few patient factors were found to be associated with surgical care out of the HRR. High-export HSAs for PN and RC exhibited lower socioeconomic characteristics than low-export HSAs, adjusting for HSA population, race, and HSA procedure rates for PN and RC. CONCLUSIONS: Patients living in areas with lower socioeconomic status have a greater need to travel for complex urologic surgery. Consideration of geographic delineation in the delivery of urologic oncology care may aid in regional quality improvement initiatives.

Use of intraoperative cell-salvage for autologous blood transfusions in metastatic spine tumour surgery: a systematic review.

Metastatic spine tumour surgery (MSTS) and metastatic musculoskeletal tumour surgery (MMTS) are associated with substantial blood loss. Allogeneic blood transfusion is the present method used to replenish this blood. Intraoperative cell salvage (IOCS) is a viable alternative, but is contraindicated in tumour surgery because of the risk of tumour dissemination. Use of IOCS-leucocyte depletion filter (LDF) allows removal of tumour cells from blood salvaged during oncological surgery. However, no reports exist on use of IOCS in MSTS or MMTS. We systematically reviewed studies on IOCS in oncological surgery to investigate whether sufficient evidence exists to support its use in MSTS or MMTS.

Distinguishing characteristics of urothelial carcinoma in kidney transplant recipients between China and Western countries.

OBJECTIVE: To identify significant distinctive characteristics of urothelial carcinoma (UC) in kidney transplant recipients between China and Western countries and investigate probable tumor screening and treatment factors contributing to these differences. METHODS: Renal transplant recipients from 1998 to 2011 in our institution diagnosed with UC were included in this study. Our data on tumor incidence, clinical characteristics, and outcomes were compared with literature reports. RESULTS: Among 2572 renal transplant recipients identified, 24 (0.93%) experienced UC, including 10 men and 14 women of overall mean age of 49.3 ± 11.6 years at transplantation and 53.5 ± 9.5 years at tumor detection. The Chinese traditional herbal intake mainly focused on 2 preparations: Aristolochic acid and rhubarb (the latter was mainly used in patients with chronic renal impairment) in 20 people. There were 21 (87.5%) cases of upper (UTUC) 5 cases of bilateral, and 13 cases of multifocal urinary tract urothelial carcinoma. Four subjects died owing to tumor progression at 4-63 months postoperatively. CONCLUSIONS: UC in renal transplant recipients shared notable characteristics in China with widespread herb intake: UTUC predominance; multifocal and bilateral organ involvement; high rates of recurrence, progression, and dissemination, in contrast with bladder tumor dominance in Western countries. As a consequence, we suggest that bilateral nephroureterectomy should be performed prophylactically in high-risk patients, especially those with a long history of Chinese herb intake. The relationship of rhubarb consumption to UC in renal transplant recipients should be noted and evaluated.

A prospective randomized multicenter study of Turkish Society of Urooncology comparing two different mechanical bowel preparation methods for radical cystectomy.

OBJECTIVE: To investigate the outcomes and complication rates of urinary diversion using mechanical bowel preparation (BP) with 3 day conventional and limited BP method through a standard perioperative care plan. MATERIALS AND METHODS: This study was designed as a prospective randomized multicenter trial. All patients were randomized to 2 groups. Patients in standard 3-day BP protocol received diet restriction, oral antibiotics to bowel flora, oral laxatives, and saline enemas over a 3-day period, whereas limited the BP arm received liberal use of liquid diet, sodium phosphate laxative, and self administered enema the day before surgery. All patients received same perioperative treatment protocol. The endpoints for the assessment of outcome were anastomotic leakage, wound infection, wound dehiscence, intraperitoneal abscess, peritonitis, sepsis, ileus, reoperation, and mortality. Bowel function recovery, including time to first bowel movement, time to first oral intake, time to regular oral intake, and length of hospital stay were also assessed. RESULTS: Fifty-six patients in 3-day BP and 56 in limited BP arm were evaluable for the study end points. Postoperatively, 1 patient in limited BP and 2 patients in 3-day BP arm died. There was no statistical difference in any of the variables assessed throughout the study, however, a favorable return of bowel function and time to discharge as well as lower complication rate were observed in limited BP group. CONCLUSIONS: Regarding all endpoints, including septic and nonseptic complications, current clinical research offers no evidence to show any advantage of 3-day BP over limited BP.

The role of religion and spirituality in psychological distress prior to surgery for urologic cancer.

The present study examined the associations between religion and spirituality (R/S), presurgical distress, and other psychosocial factors such as engagement coping, avoidant coping, and social support. Participants were 115 men scheduled for surgery for urologic cancer. Before surgery, participants completed scales measuring intrinsic religiosity, organized religious activity, and nonorganized religious activity (IR, ORA, NORA); social support (Medical Outcomes Study Social Support Survey); and distress (Impact of Event Scale [IES], Perceived Stress Scale [PSS], Brief Symptom Inventory-18 [BSI-18], and Profile of Mood States [POMS]). R/S was positively associated with engagement coping. Social support was positively associated with engagement coping and inversely associated with POMS and PSS scores. Engagement coping was positively associated with IES and BSI scores, and avoidant coping was positively associated with all distress measures. R/S moderated the association between engagement coping and IES scores, such that the association between engagement coping and IES was not significant for men with high R/S scores (greater religious belief). R/S moderated the association between social support and distress; the inverse association between social support and PSS and POMS scores was only significant for men who scored high on R/S. This study replicated findings from previous studies suggesting that engagement and avoidant types of coping can lead to increased distress prior to surgery. Although R/S was associated with engagement coping, it was not associated with any of the distress measures. The finding that R/S moderated the associations between engagement coping and distress and social support and distress suggests that the association between R/S, coping style, social support, and adjustment to stressful life situations is not simplistic, and indirect associations should be explored.

Braquiterapia en urología pediátrica: ¿una mejor alternativa con menos secuelas? / Brachytherapy in pediatric urology: a better alternative with les sequels?

El rabdomiosarcoma (RMS) representa el 3° tumor sólido extracraneal pediátrico. El uso de braquiterapia nos ha dado una nueva herramienta en el tratamiento de esta patología. En este trabajo queremos reportar la experiencia del uso de cirugía más conservadora asociada a braquiterapia en pacientes con RMS urológicos. Método: Revisión de todos los casos del año 2004-2011 de RMS urológicos manejados con braquiterapia postoperatoria y/o intraoperatoria, asociado a quimioterapia (QMT) preoperatoria. Resultados: En los 8 años de estudio hubo 6 RMS; se incluyen 5pacientes dado que uno fue RMS testicular que no requirió radioterapia. Caso 1: Masculino de 2 años RMS embrionario Grupo IV Estadio 4 de próstata, con QMT según protocolo y braquiterapia en la semana 24 de QMT. Lleva 76 meses libre de enfermedad. Caso 2: Masculino de 5 años, RMS embrionario Grupo lll Estadio 2 en vejiga, con QMT preoperatoria (12 semanas), cirugía con resección de tumor en cara anterior de vejiga y braquiterapia; completó esquema QMT. Lleva 30 meses libre de enfermedad, sin alteraciones miccionales. Caso 3: Masculino de 7 años, RMS embrionario Grupo lll Estadio 3 de próstata, con QMT según protocolo y braquiterapia en la semana 22 de QMT. Lleva 17meses libre de enfermedad, función vesical e intestinal normal. Caso 4: Femenino de 4 años, RMSbotroide Grupo lll Estadio 1 de vagina, con quimioterapia preoperatoria (12 semanas), cirugia y braquiterapia postquirúrgica, completó esquema de QMT. Lleva 4 meses libre de enfermedad, sin alteración miccional ni intestinal. Caso 5: Femenino de 2 años, RMS embrionario Grupo lll Estadio 3de psoas con compromiso de vejiga, con cirugía, QMT según protocolo y radioterapia externa; pre-sentó recidiva local, por lo que inicia QMT, cirugía resectiva del tumor en cara posterior de vejiga y uréter derecho + radioterapia intraoperatoria con cono. Lleva 2 meses libre de enfermedad. Sin alteración miccional ni intestinal...

The rhabdomyosarcoma (RMS) represents the 3m’ extracraneal solid tumor in children. Brachytherapy use has given a new tool in this disease treatment. In this investigation we want to report the experience of conservative surgery associated to brachytherapy in patients with urological RMS. Method: Retrospective review of all the urological RMS cases between the years 2004-2011managed with postoperative and or intraoperative brachytherapy, associated to preoperative chemotherapy ( CM T). Results: ln a 8 year period there were 6 RMS; 5 are included because one case was a testicular RMS that did not required radiotherapy. Case 1: Two years old male children, prostatic group l V stage 4 embryonal RMS, with CMT according to protocol and brachytherapy in the 24”’ week of CMT Has been 76 months free of disease. Case 2: Five years old boy, bladder group lll stage 2embryonal RMS, with preoperative CMT (12 weeks), surgery including resection of tumor in the bladder anterior wall and brachytherapy,‘ Completed CMT protocol. Has been 30 months free of disease, without voiding disorders. Case 3: Seven years old boy, prostatic group lll stage 3 embryonal RMS, with CMT according to protocol and brachytherapy in 22'“ CMT week. Has been 17 months free of disease, normal bladder and intestinal function. Case 4: Four years old girl, vagina group lll stage 1botyroid RMS, with preoperative CMT (12 weeks), resective surgery and post-operative brachytherapy, completed CMT according to protocol. Has been 4 months free of disease, without voiding or intestinal disorders. Case 5: Two years old girl, psoas compromising bladder group llI stage 3 embryonal RMS, with surgery, CMT according to protocol and external radiotherapy. Presented local recurrence reason why initiates new CMT protocol, resective posterior wall bladder and right ureter surgery intraoperative radiotherapy cone. Has been 2 months free of disease. Without voiding or intestinal...

Prostatic nephrogenic adenoma. Case report.

OBJECTIVE: We present a case of prostatic urethra nephrogenic adenoma as an incidental finding following transurethral resection of the prostate. METHOD/RESULT: It is an incidental diagnosis of nephrogenic adenoma of prostatic urethra in a 50-year-old male operated for benign prostatic hyperplasia by means of transurethral resection. CONCLUSIONS: Nephrogenic adenoma is an infrequent and benign lesion of the urinary tract, associated with a previous history of trauma or irritation on the urothelium. Predisposing factors include infections, calculi, surgery, trauma and kidney transplantation.

Manejo percutáneo de tumores de células transicionales de la pelvis renal: serie de casos y revisión de la literatura / Percutaneous treatment of renal pelvis transitional cell tumors: case series and review of the literature

Introducción: El carcinoma de células transicionales de la vía urinaria superior es una condición poco frecuente. Poseen un alto porcentaje de recidivas y las alternativas terapéuticas son numerosas. El gold standard terapéutico es la nefroureterectomía radical. Ésta se asocia a una mayor incidencia de insuficiencia renal y muerte por condiciones relacionadas a ésta. Actualmente se encuentran en desarrollo varias terapias con preservación renal, técnicas mínimamente invasivas entre las cuales las principales son la resección por vía percutánea y la resección endoscópica por ureter o nefros copia. Material y método: presentamos una serie de casos de cuatro pacientes portadores de CCT-VUS sometidos a tratamiento percutáneo. Resultados: el tamaño tumoral promedio fue de 14,5 mm (8–20 mm), tres de ellos presentaron lesiones no invasoras y uno de ellos una lesión invasora. No hubo mayores complicaciones, el sangrado promedio fue de 225 cc, ningún paciente requirió de transfusiones de hemoderivados y la estadía hospitalaria de 3,75 días en promedio. Sólo uno de los paciente requirió de tratamiento complementario (tumor invasor), siendo sometido a una nefroureterectomía radical laparoscópica. Actualmente todos los pacientes se encuentran en remisión completa con un tiempo de seguimiento promedio de 50,25 meses (34-61). Conclusiones: el tratamiento percutaneo de los CCT-VUS es una alternativa válida, asociada a una baja taza de complicaciones y segura desde el punto de vista oncológico.

Introduction: Transitional cell carcinoma of the upper urinary tract is an uncommon disease. They have a high percentage of recurrences and the therapeutic approaches are numerous. The treatment gold standard is radical nephrouretherectomy. This is associated with a higher incidence of chronic renal failure y dead from associated conditions. Actually, various nephron sparring therapies are in development. The main techniques are the percutaneous resection and the ureteroscopic resection. Matherials and methods: we present a case series of four patients diagnosed with transitional cell carcinoma of the upper urinary tract treated by a percutaneous approach. Results: mean tumor size was 14.5 mm (8–20 mm), three of them had superficial tumors and one of them invasive ones. There was no mayor complications, average bleeding was 225 cc, no patient needed blood transfusions and mean hospitalization time was 3.75 days. Only one patient required complementary treatment (patient with invasive tumor), being treated with laparoscopic radical nephrouretherectomy. Actually all patients are at complete response to treatment, with an average follow up time of 50.25 months (34-61).Conclusions: percutaneous approach for transitional cell carcinoma of the upper urinary tract is a valid treatment option, associated with a low complications rate and safe form an oncological view. Key words: transitional cell carcinoma of the upper urinary tract, percutaneous surgery, chronic renal failure.

De novo urothelial carcinoma in kidney transplant patients with end-stage aristolochic acid nephropathy in China.

OBJECTIVE: Aristolochic acid nephropathy (AAN) is a progressive renal interstitial fibrosis disease that was initially reported among a Belgian cohort of about 50 patients after the intake of diet pills containing the Chinese herb Aristolochia fangchi. In addition to renal disease, foci of AAN show increased incidences of urothelial carcinomas (UC). Immunosuppression is associated with an increased risk for the development of different malignancies. Our aim was to examine the outcomes of UC among patients with AAN after transplantation in China, the cradle of this traditional medicine. PATIENTS AND METHODS: We performed a retrospective evaluation of the charts and pathology reports of 1612 renal transplant recipients treated at our 2 institutions. RESULTS: From January 1998 to December 2006, we performed cadaveric kidney transplantations in 17 patients with AAN, all of whom were treated with cyclosporine plus azathioprine or mycophenolate mofetil plus prednisone. One-year graft survival was 100%. During the mean follow-up of 57 months (range, 21-108 months), 9 recipients (52.9%) developed UC, compared with a 0.46% prevalence of urinary tract tumors among other Chinese kidney transplant recipients. The age at which the diagnosis was made ranged from 39 to 66 years (mean, 53.6 +/- 6.8 years). Among the 9 patients with UC, 8 cases (88.9%) involved the upper urinary tract: bilateral, 3 cases, 37.5%; unilateral, 5 cases, 62.5%. In 1 patient only a bladder tumor was detected. Two patients showed the bladder, synchronous bilateral ureter, and pelvis to be involved. All patients with UC underwent surgical treatment, recovering uneventfully with functioning grafts after tumor excision, except 1 patient who underwent nephrectomy of the transplanted kidney. Six patients (75%) experienced recurrences during the follow-up period. Three patients died within a mean of 20 months (range, 1-42 months) after tumor excision. CONCLUSIONS: The risk for UC is increased among patients with AAN after transplantation. Regular screening for early detection of malignancy is mandatory. Longer follow-up and results from other transplant centers are needed to further investigate the relationship between AAN and UC among renal transplant patients.

Papiloma invertido. Aportación de dos casos y revisión de la literatura / Inverted papilloma. Report of two cases and bibliographic review

Objetivo: El papiloma invertido es una rara lesión polipoidea del urotelio, conocida como entidad diferente desde 1963, desde cuando escasamente se han publicado más de 100 casos en la literatura. Aunque su potencial maligno es todavía desconocido, existen varias publicaciones científicas en las que se denota. Métodos: Presentamos dos casos de papiloma invertido y hacemos una detallada revisión de la literatura científica al respecto. Resultados: Ambos pacientes fueron diagnosticados por el servicio de Anatomía Patológica de papiloma invertido, siguiendo controles periódicos posteriores y no apareciendo recidivas en ninguno de los dos casos, a los 24 y 18 meses de seguimiento respectivamente. Conclusiones: La posibilidad de que el papiloma invertido sea una lesión con potencial maligno debe ser en todo caso considerada y sugerimos que los pacientes con este diagnóstico sean sometidos a los exámenes urológicos de seguimiento en cualquier neoplasia vesical (AU)

Objective: Inverted papilloma is a rare polypoid lesion of the urothelium, known as a different entity since 1963. Not many more than 100 cases have been published. Although its malignant potential is still unknown, several scientific publications have noted it. Methods: We report to cases of inverted papilloma and perform a detailed bibliographic review. Results: Both patients were diagnosed by the Pathology Department and entered periodic follow-up visits, being free of recurrence at 24 and 18 months respectively. Conclusions: The possibility that inverted papilloma is a lesion with malignant potential should be considered in every case, and we suggest that patients with this diagnosis should enter a follow-up protocol like any bladder neoplasia (AU)

¿Es necesario resecar siempre las recidivas de los tumores vesicales superficiales en el momento del diagnostico?: comunicación preliminar / Is it necessary to treat always the relapses of superficial bladder tumour at the moment of diagnosis?: preliminary communication

Introducción: Valorar la conducta expectante en las recidivas del tumor vesical superficial (TVS) mediante la observación post-diagnóstico y su implicancia clínica. Material y métodos: De 112 pacientes diagnosticados de TVS, entre 1/1998 y 12/2003, se manejó con observación a 13, luego del diagnóstico cistoscópico de recidiva, hasta la decisión de tratamiento de las mismas. Los controles se realizaron con cistoscopia flexible cada 3 meses. En los 13 pacientes se contabilizaron 15 eventos de observación (2 veces en 2 pacientes). La decisión de observar y/o resecar se basó en la variación del aspecto, tamaño o número de los tumores y en la presencia o no de síntomas. Se analizaron las características clínico-patológicas, y la evolución de las mismas. Resultados: La edad media fue de 74,6 años (rangos 47–91). El tiempo medio de observación fue de 5,76 meses (rangos 3–17).Entre los tumores previos a la observación y los post-observación, de los 15 eventos, en 12 que representa el80% no hubo progresión en grado o estadio. En los 3 restantes se constató progresión en grado y estadio en 2 y sólo de estado en 1.En ningún caso hubo progresión a tumor infiltrante ni aparición de tumor en TUS. Conclusión: Por mínima progresión, ninguna a tumor infiltrante y escasa clínica, las recidivas podrían ser manejadas durante un tiempo con observación, disminuyendo la morbilidad y el coste asociados a la RTU (AU)

Objective: To asses the expectant management superficial recurrent bladder tumours. Material and methods: Between Jan 1998 and Dec 2003, 112 patients were diagnosed of superficial bladder tumour. 13 patients were observed after the diagnosis of tumour relapse until the decision to perform a transurethral resection. We analysed the clinical and pathological features. The patients were controlled with flexible cystoscopy every 3 months approximately. Of the 13 patients we count 15 observation events, (2 times in 2 patients). The decision between to treat or continue with observation was based in changes of appearance, size or number of tumours and presence of hematuria. Results: With a mean age of 74,6 years (47-91). The mean observation time was 5,76 months (3-71) . In the group of tumours previous to the observation period, in 12 events (10 patients) that means 80% any progression in grade or stage was observed. In the other 3 events we observed progression in grade and stage in 2 and only stage in 1. In any case we observed progression to invasive bladder tumour neither upper urinary tract tumour. Conclusions: Due to the low risk of progression, we believe that immediate eradication is not always necessary, thus reducing the adverse impact of repeat resections (AU)

[Indication and limitation of endoscopic surgery against urological cancer].

Endoscopic surgery in the urological field begins with cystoscopy and transurethral resection, and it develops into laparoscopic surgery. The indication of laparoscopic surgery for a malignant tumor also gradually expands. It is virtually impossible to search for urological cancer using laparoscopic procedures. In particular, out laparoscopic nephrectomy for renal cancer and transurethral resection for bladder cancer used widely in Japan. In the future, laparoscopic partial nephrectomy and the laparoscopic procedure for adrenal cancer and prostate cancer are considered to become widespread.

[The use of alimentary antioxidants in diet therapy of geriatric patients during the period of the surgical treatment]. / Ispol'zovanie alimentarnykh antioksidantov v dietoterapii geriatricheskikh bol'nykh v period khirurgicheskogo lecheniia.

Analysis of actual feeding of 277 geriatric patients suffering from urology disease. The patients had a combined deficient of vitamin A, vitamin C, vitamin of the B group, beta-capotene and mineral substances. Diets 1a, 1, 5, 7, 9, 15 could not provide daily needs for antioxidant nutrients. Antioxidant and antiinflammatory effects of the dietary supplement containing natural antioxidants in 122 oncourology patients after operation was indicated. So there was reason to fortify diets of patients with antioxidant dietary supplement during the period of surgical treatment.

Use of predeposit autologous blood and intraoperative autotransfusion in urologic cancer surgery.

A total of 20 patients underwent major urologic cancer surgery with the combined use of predeposit autologous blood and intraoperative autotransfusion with the Haemonetics Cell Saver. The estimated blood loss ranged from 400 to 2,000 mL (mean 1,208 mL). Total transfusion requirements for the 20 patients were 85.5 units of which 82.5 (96%) were autologous. Predeposit autologous blood accounted for 53 percent, intraoperative autotransfusion blood 43 percent, and homologous blood 4 percent of the total transfusion requirements. Of the 20 patients in the study, only 1 received homologous blood. There were no complications related to either modality of autotransfusion. Our data suggest that using the combined modalities of predeposit autologous blood donation and intraoperative autotransfusion, major urologic cancer surgery can be performed without homologous blood in most cases.

Autotransfusion and blood conservation in urologic oncology.

Autotransfusion is the reinfusion of the patient's own blood. Currently utilized forms include preoperative donation, perioperative hemodilution, and intraoperative salvage. The principal benefit of autotransfusion is a reduction in the complications associated with receipt of homologous blood products. Principal among these are febrile reactions, allergic and hemolytic reactions, alloimmunization, and the transmission of hepatitis and acquired immune deficiency syndrome. An additional benefit in the management of cancer patients is the avoidance of transfusion induced immunosuppression. Predeposit autologous transfusion is a simple and safe method to reduce patient's requirements for exogenous blood. Although well suited for cancer patients, predeposit programs remain underutilized with only 5% participation. Perioperative hemodilution can be a valuable adjunct in selected patients. Although the presence of malignancy has been regarded as a contraindication to the use of intraoperative autotransfusion, preliminary reports suggest that intraoperative autotransfusion can be safely used in patients undergoing surgery for urologic malignancies.