ABSTRACT
BACKGROUND: Follow-up for non-muscle invasive bladder cancer (NMIBC) is a challenge for urologists that has not been finally resolved. The intensity of follow-up is based on the recurrence and progression behavior of the tumor as well as the patient's individual situation. MATERIALS AND METHODS: The following article focuses on the current data situation, the valid German S3 guideline and the available instruments for the detection of relapses and progression, taking into account tumor stages and degree of malignancy. RESULTS: Urethrocystoscopy, imaging and urine cytology are generally recommended, but the recommendations appear to be too extensive in the case of so-called intermediate risk profiles. Depending on the situation, urine markers could optimize follow-up, although results from prospective randomized studies are still pending. CONCLUSIONS: The current follow-up of NMIBC is invasive, carries the risk of side effects and increases costs. In the absence of scientific evidence, recommendations for follow-up for NMIBC are naturally based on expert opinion. In the opinion of the authors, overdiagnosis is currently taking place particularly in patients with an intermediate risk profile. The first prospective, marker-based studies are ongoing and will be helpful in the near future to improve the data situation relevant to urological practice.
Subject(s)
Urinary Bladder Neoplasms , Cystoscopy , Follow-Up Studies , Humans , Neoplasm Invasiveness , Neoplasm Recurrence, Local/diagnosis , Prospective Studies , Urinary Bladder Neoplasms/diagnosis , Urinary Bladder Neoplasms/therapyABSTRACT
We describe the previously unknown case of segmental testicular infarction as an iatrogenic complication of intravenous immunoglobulin administration in a patient with multifocal motor neuropathy.
Subject(s)
Immunoglobulins, Intravenous/administration & dosage , Immunoglobulins, Intravenous/adverse effects , Infarction/chemically induced , Infarction/diagnosis , Motor Neuron Disease/drug therapy , Testis/blood supply , Diagnosis, Differential , Humans , Infarction/surgery , Injections, Intravenous , Male , Middle Aged , Motor Neuron Disease/complications , Testis/drug effects , Testis/surgery , Treatment OutcomeABSTRACT
BACKGROUND: We analyzed complications associated with urinary diversion after radical cystectomy (RC) and ileal conduit (IC) for bladder cancer (BCa). PATIENTS AND METHODS: A total of 305 BCa patients after RC with IC were included in the study (June 2003-December 2010). IC complications (peristomal hernia, IC stenosis, stenosis of the ureteral anastomosis, IC bleeding, urolithiasis, urinary infections, and renal insufficiency) were identified according to the Clavien-Dindo classification (CDC). Kaplan-Meier plots were generated. Uni- and multivariable Cox regression analyses with backward selection for prediction of high-grade complications (CDC ≥ III) and IC revision surgery were conducted; covariates included age, previous abdominal/pelvic radiation, body mass index (BMI), previous abdominal/pelvic surgery, comorbidities, and advanced tumor stage. RESULTS: An IC complication (CDC ≥ I) or a high-grade IC complication (CDC ≥ III) was experienced by 32.7 and 13.4 % of our cohort: 14.8 %, 4.3 %, 4.6 % developed a peristomal hernia, IC stenosis, stenosis of the ureteral anastomosis, respectively. IC revision was required by 10.5 % of patients (median follow-up 19.5 months, IQR 7-47 months). The estimated rate of IC complications at 5 years was 52 % (CDC ≥ I) and 22 % (CDC ≥ III). The final model of the multivariable analysis showed that patients with a history of previous radiation (HR 4.33), a BMI ≥ 30 (HR 2.24), or longer duration of surgery (HR 1.01; all p < 0.05) were at higher risk for IC revision surgery. A BMI ≥ 30 (HR 2.49, p = 0.011) was a risk factor for high-grade complications. CONCLUSION: The risk of experiencing a high-grade IC complication is moderate. Previous radiation, obesity, and comorbidities represent risk factors for IC revision surgery. Moreover, obesity is a risk factor for high-grade complications.
