Is the laser mightier than the sword? A comparative study for the urethrotomy.

PURPOSE: The knife is the most common used instrument for endoscopic urethrotomy. Unfortunately, there are high recurrence rates; it is thought that a laser reduces those rates. We compared the two techniques in this retrospective study. MATERIALS AND METHODS: Between 2010 and 2014, 127 patients were operated on with the knife (KG) and for 65 patients, the laser (LG) was used. We scored the complexity of the stricture using the UREThRAL stricture score (USS) and we scored if a treatment was successful. A failure was determined as recurrence, but also starting clean intermittent catheterization was stated as failure. RESULTS: There was no difference in USS between the two groups (KG: 5.7 vs LG: 6.0); the laser was more often used in a patient with a recurrence stricture (25.2 vs 43.1%). No difference was found in postoperative increase in flow-rate (9.5 vs 10.5 ml/sec), the number of complications (all Clavien I and one Clavien III in the KG) or the failure rate (58.3 vs 68.8%). When looked separately at patients treated for primary stricture and for a recurrence (96.7 vs 91.2%), no differences were found. CONCLUSION: There were no significant differences between knife and laser. With costs taken in consideration, we would advise treatment with the knife. Our results also show a high failure rate, especially in the recurrence group. Therefore, in case of recurrence, an open reconstruction should be considered.

Prognostic factors for survival in patients with recurrence of muscle invasive bladder cancer after treatment with curative intent.

UNLABELLED: Prognostic factors for survival after recurrent MIBC are unknown and were evaluated using a population-based series of 1409 MIBC patients. 330 Patients who underwent RC or RT with curative intent and who suffered from recurrence were selected. Multivariable survival analyses were performed. Clinicopathological factors that predict survival after recurrence are recurrence location, treatment for recurrence and age at recurrence diagnosis. PURPOSE: We conducted this study to evaluate the prognostic factors for survival among patients with recurrent muscle-invasive bladder cancer (MIBC) after initial treatment with curative intent. PATIENTS AND METHODS: Clinical data were collected from a population-based series of 1409 patients with MIBC. We selected 330 patients who underwent radical cystectomy (RC) or radiotherapy (RT) for urothelial carcinoma with curative intent and who experienced recurrence. Multivariate survival analyses were performed with death from MIBC as the endpoint. Covariates were gender, time to recurrence, age at diagnosis of recurrence, recurrence multiplicity, localization, and treatment for recurrence. Analyses were performed separately for patients initially treated with RC (i-RC) or external beam radiotherapy (i-EBRT). RESULTS: Patients with recurrence after i-RC showed a 1- and 3-year survival of 17% and 6%, respectively. Localization and treatment for recurrence were significantly associated with survival. Patients with recurrence after i-EBRT showed a 1- and 3-year survival of 31% and 12%, respectively. Age at diagnosis of recurrence, localization, and treatment for recurrence were significantly associated with survival. CONCLUSION: This study confirms the extremely poor prognosis after recurrence of MIBC in patients initially treated with surgery or RT. Clinicopathologic factors that predict survival after disease recurrence are location of recurrence, treatment for recurrence, and age at diagnosis of recurrence. Improved diagnosis of primary MIBC to detect extravesical disease and more effective therapeutic approaches to target recurrent MIBC are needed.