Retrograde pyelography before radical nephroureterectomy for upper tract urothelial carcinoma is associated with intravesical tumor recurrence

ABSTRACT Purpose: To investigate the association between preoperative retrograde pyelography (RGP), conducted to evaluate upper tract urothelial carcinoma (UTUC), and intravesical recurrence (IVR) after radical nephroureterectomy (RNU). Materials and Methods: Of 114 patients that underwent RNU, 72 patients without preoperative ureteroscopy and a history of bladder tumor were selectively enrolled. Variables associated with IVR were identified. Results: RGP was performed at a mean duration of 24.9 days prior to RNU in 41 (56.1%) of study subjects. During the mean follow-up period of 64.5 months, IVRs were identified in 32 (44.4%) patients at 22.3±18.8 (mean±SD) months after RNU. Despite similar tumor characteristics in the RGP and non-RGP groups, the incidence of IVR was considerably higher in the RGP group (63.4%) than in the non-RGP group (19.4%, p <0.001). The following variables differed significantly between the IVR and non-IVR groups: age (64.6±8.51 vs. 59.6±9.65 years), tumor location (lower or upper; 53.1% vs. 20%), tumor invasiveness (> pT2; 53.1% vs. 17.5%), preoperative hemoglobin (12.8±1.36 vs. 13.9±1.65), preoperative creatinine (1.29±0.32 vs. 1.11±0.22), and preoperative RGP (81.3% vs. 37.5%), respectively. Multivariate Cox regression model showed that tumor location (p=0.020, HR=2.742), preoperative creatinine level (p=0.004, HR=6.351), and preoperative RGP (p=0.045, HR=3.134) independently predicted IVR. Conclusion: Given the limitations of retrospective single-center series, performance of RGP before RNU was shown to have a negative effect on IVR after surgery.

Retrograde pyelography before radical nephroureterectomy for upper tract urothelial carcinoma is associated with intravesical tumor recurrence.

PURPOSE: To investigate the association between preoperative retrograde pyelography (RGP), conducted to evaluate upper tract urothelial carcinoma (UTUC), and intravesical recurrence (IVR) after radical nephroureterectomy (RNU). MATERIALS AND METHODS: Of 114 patients that underwent RNU, 72 patients without preoperative ureteroscopy and a history of bladder tumor were selectively enrolled. Variables associated with IVR were identified. RESULTS: RGP was performed at a mean duration of 24.9 days prior to RNU in 41 (56.1%) of study subjects. During the mean follow-up period of 64.5 months, IVRs were identified in 32 (44.4%) patients at 22.3±18.8 (mean±SD) months after RNU. Despite similar tumor characteristics in the RGP and non-RGP groups, the incidence of IVR was considerably higher in the RGP group (63.4%) than in the non-RGP group (19.4%, p <0.001). The following variables differed significantly between the IVR and non-IVR groups: age (64.6±8.51 vs. 59.6±9.65 years), tumor location (lower or upper; 53.1% vs. 20%), tumor invasiveness (> pT2; 53.1% vs. 17.5%), preoperative hemoglobin (12.8±1.36 vs. 13.9±1.65), preoperative creatinine (1.29±0.32 vs. 1.11±0.22), and preoperative RGP (81.3% vs. 37.5%), respectively. Multivariate Cox regression model showed that tumor location (p=0.020, HR=2.742), preoperative creatinine level (p=0.004, HR=6.351), and preoperative RGP (p=0.045, HR=3.134) independently predicted IVR. CONCLUSION: Given the limitations of retrospective single-center series, performance of RGP before RNU was shown to have a negative effect on IVR after surgery.

Synchronous presentation of muscle-invasive urothelial carcinoma of bladder and peritoneal malign mesothelioma

ABSTRACT Introduction Cancer is one of the most important leading cause of death in man and woman in the world. The occurrence of new cancer has become more frequent in recent years due to strict screening protocols and occupational and environmental exposure to carcinogens. The incidence of secondary malignancies has also increased due to close medical follow-up and advanced age. Herein, we report a case and its management diagnosed as synchronous peritoneal malignant mesothelioma and muscle-invasive urothelial carcinoma. Case Description A 71-year-old male presented with macroscopic hematuria and abdominal distension increasing gradually. A contrast enhanced computerized tomography demonstrated bladder mass and diffuse ascites with nodular peritoneal thickening and umbilical mass. He was treated with the multidisciplinary team working including urologist, medical oncologist and general surgeon. Conclusions To our knowledge, this is the first case of peritoneal malign mesothelioma with synchronous muscle-invasive urothelial carcinoma. Because of the rarity of this condition, there is still no consensus on the definitive treatment protocols, yet. Individualized treatment with multidisciplinary close follow-up might improve the survival outcomes.

Synchronous presentation of muscle-invasive urothelial carcinoma of bladder and peritoneal malign mesothelioma.

INTRODUCTION: Cancer is one of the most important leading cause of death in man and woman in the world. The occurrence of new cancer has become more frequent in recent years due to strict screening protocols and occupational and environmental exposure to carcinogens. The incidence of secondary malignancies has also increased due to close medical follow-up and advanced age. Herein, we report a case and its management diagnosed as synchronous peritoneal malignant mesothelioma and muscleinvasive urothelial carcinoma.

Is [F-18]-fluorodeoxyglucose FDG-PET/CT better than ct alone for the preoperative lymph node staging of muscle invasive bladder cancer?

OBJECTIVE: To evaluate whether the use of [F-18]-FDG-PET/CT can accurately predict pelvic lymph node metastasis in patients with muscle invasive TCC of the bladder undergoing radical cystectomy. MATERIALS AND METHODS: Fifteen patients with muscle invasive bladder cancer had undergone FDG-PET/CT scan from the skull base to the mid-thighs after IV injection of 6.5MBq (Mega-Becquerel)/Kg of FDG. After intravenous hydration IV furosemide was given to overcome the difficulties posed by urinary excretion of 18F-FDG. PET/ CT data were analyzed as PET and CT images studied separately as well as fused PET/ CT images. The imaging findings were correlated with the histopathology of the nodes (gold standard). RESULTS: CT and FDG-PET had demonstrated positive lymph nodes in 9 & 8 patients respectively. Among the 15 patients 3 had documented metastasis on histopathology. Both CT and PET could detect the nodes in all these 3 patients (100% sensitivity). Nodes were histologically negative amongst 6&5 patients who had node involvement by CT and PET respectively. Therefore, specificity, positive predictive value (PPV) & negative predictive value (NPV) for CT and PET/CT were 50%, 33.3%, 100% and 58.3%, 37.5%, 100% respectively. CONCLUSION: The theoretical advantage of this cutting edge technology for whole body imaging has not been translated into clinical practice as we found minimal advantage of combined FDG-PET/CT over CT alone for nodal staging of muscle invasive bladder cancer. This may be due to substantial overlap between standardized uptake values (SUVs) from active inflammatory processes with those of malignant lesion.

Is [F-18]-fluorodeoxyglucose FDG-PET/CT better than ct alone for the preoperative lymph node staging of muscle invasive bladder cancer?

ABSTRACT Objective: To evaluate whether the use of [F-18]-FDG-PET/CT can accurately predict pelvic lymph node metastasis in patients with muscle invasive TCC of the bladder undergoing radical cystectomy. Materials and Methods: Fifteen patients with muscle invasive bladder cancer had undergone FDG-PET/CT scan from the skull base to the mid-thighs after IV injection of 6.5MBq (Mega-Becquerel)/Kg of FDG. After intravenous hydration IV furosemide was given to overcome the difficulties posed by urinary excretion of 18F-FDG. PET/CT data were analyzed as PET and CT images studied separately as well as fused PET/CT images. The imaging findings were correlated with the histopathology of the nodes (gold standard). Results: CT and FDG-PET had demonstrated positive lymph nodes in 9 & 8 patients respectively. Among the 15 patients 3 had documented metastasis on histopathology. Both CT and PET could detect the nodes in all these 3 patients (100% sensitivity). Nodes were histologically negative amongst 6&5 patients who had node involvement by CT and PET respectively. Therefore, specificity, positive predictive value (PPV) & negative predictive value (NPV) for CT and PET/CT were 50%, 33.3%, 100% and 58.3%, 37.5%, 100% respectively. Conclusion: The theoretical advantage of this cutting edge technology for whole body imaging has not been translated into clinical practice as we found minimal advantage of combined FDG-PET/CT over CT alone for nodal staging of muscle invasive bladder cancer. This may be due to substantial overlap between standardized uptake values (SUVs) from active inflammatory processes with those of malignant lesion.

Carcinoma de células de transição da pelve renal em uma cadela - relato de caso / Transitional cell carcinoma of renal pelvis in a bitch - case report / Carcinoma de células de transición en pelvis renal de una perra-relato del caso

Em cães, os tumores renais primários são raros, sendo mais frequentes os carcinomas renais. Os tumores renais podem ser classificados segundo sua origem como tubular renal, nefroblásticos, não epiteliais e de células de transição. Este último tipo pode se originar tanto no ureter quanto na pelve renal. O objetivo deste trabalho é relatar um caso de uma fêmea da espécie canina, SRD, de nove anos de idade, não castrada, atendida no setor de cirurgia de um Hospital Veterinário Escola. Ao exame ultrassonográfico de abdômen, visibilizou-se uma massa em região mesogástrica direita. O ovário e o rim direitos não foram visualizados. A paciente foi submetida a laparotomia exploratória, seguida de nefrectomia e ovariossalpingo-histerectomia. O exame histopatológico da formação confirmou o diagnóstico de carcinoma de células de transição de pelve renal.(AU)

Primary renal tumors in dogs are rare; among these, renal carcinomas are the most frequent. Renal tumors may be classified according to their origin as renal tubular, nephroblastic, non-epithelial and transitional cell carcinomas. The latter can originate either in the ureter or in the renal pelvis. This work reports the case of a non-neutered nine-year-old female mongrel assisted by the Surgery Sector of a Veterinary Hospital. Ultrasound examination of the abdomen disclosed a mass in the right mesogastric region. The ovary and right kidney could not be visualized. The patient underwent exploratory laparotomy, followed by nephrectomy and hysterectomy with salpingo-oophorectomy. Histopathology confirmed the diagnosis of transitional cell carcinoma of renal pelvis.(AU)

Los tumores renales primarios son raros en perros, siendo los carcinomas las neoplasias más frecuentes. Los tumores renales pueden ser clasificados según su origen como tumores del túbulo renal, nefrablásticos, no epiteliales y de células de transición. Este último tipo puede originarse tanto en el uréter como en la pelvis renal. El objetivo de este trabajo es relatar un caso de una hembra canina, mestiza, de nueve años de edad, no castrada, que fue atendida en el sector de cirugía de un Hospital Veterinario Escuela, a la que durante la ecografía abdominal, se le detectó una masa en región mesogástrica derecha. El ovario y el riñón derechos no pudieron ser visualizados. Se le realizó una laparotomía exploratoria y posterior nefrectomía y ovariohisterectomia. El examen histopatológico de la formación confirmó la presencia de un carcinoma de células de transición de pelvis renal.(AU)

Carcinoma de células de transição da pelve renal em uma cadela - relato de caso / Transitional cell carcinoma of renal pelvis in a bitch - case report / Carcinoma de células de transición en pelvis renal de una perra-relato del caso

Em cães, os tumores renais primários são raros, sendo mais frequentes os carcinomas renais. Os tumores renais podem ser classificados segundo sua origem como tubular renal, nefroblásticos, não epiteliais e de células de transição. Este último tipo pode se originar tanto no ureter quanto na pelve renal. O objetivo deste trabalho é relatar um caso de uma fêmea da espécie canina, SRD, de nove anos de idade, não castrada, atendida no setor de cirurgia de um Hospital Veterinário Escola. Ao exame ultrassonográfico de abdômen, visibilizou-se uma massa em região mesogástrica direita. O ovário e o rim direitos não foram visualizados. A paciente foi submetida a laparotomia exploratória, seguida de nefrectomia e ovariossalpingo-histerectomia. O exame histopatológico da formação confirmou o diagnóstico de carcinoma de células de transição de pelve renal.

Primary renal tumors in dogs are rare; among these, renal carcinomas are the most frequent. Renal tumors may be classified according to their origin as renal tubular, nephroblastic, non-epithelial and transitional cell carcinomas. The latter can originate either in the ureter or in the renal pelvis. This work reports the case of a non-neutered nine-year-old female mongrel assisted by the Surgery Sector of a Veterinary Hospital. Ultrasound examination of the abdomen disclosed a mass in the right mesogastric region. The ovary and right kidney could not be visualized. The patient underwent exploratory laparotomy, followed by nephrectomy and hysterectomy with salpingo-oophorectomy. Histopathology confirmed the diagnosis of transitional cell carcinoma of renal pelvis.

Los tumores renales primarios son raros en perros, siendo los carcinomas las neoplasias más frecuentes. Los tumores renales pueden ser clasificados según su origen como tumores del túbulo renal, nefrablásticos, no epiteliales y de células de transición. Este último tipo puede originarse tanto en el uréter como en la pelvis renal. El objetivo de este trabajo es relatar un caso de una hembra canina, mestiza, de nueve años de edad, no castrada, que fue atendida en el sector de cirugía de un Hospital Veterinario Escuela, a la que durante la ecografía abdominal, se le detectó una masa en región mesogástrica derecha. El ovario y el riñón derechos no pudieron ser visualizados. Se le realizó una laparotomía exploratoria y posterior nefrectomía y ovariohisterectomia. El examen histopatológico de la formación confirmó la presencia de un carcinoma de células de transición de pelvis renal.

Urothelial carcinoma in a pyelocaliceal diverticulum discovered by magnetic resonance urography.

Neither computed tomography (CT) nor intravenous pyelography (IVP) alone can diagnose tumors of renal pelvic diverticula, but magnetic resonance urography (MRU) can obtain accurate preoperative information.

Laparoscopic assisted radical cystoprostatectomy with Y-shaped orthotopic ileal neobladder constructed with non-absorbable titanium staples through a 5 cm Pfannensteil incision.

INTRODUCTION: We performed a laparoscopic radical cystoprostatectomy followed by constructing a Y-shaped reservoir extra-corporeally with titanium staples through a 5-cm muscle-splitting Pfannenstiel incision. SURGICAL TECHNIQUE: Upon completion of the extirpative part of the operation, the surgical specimen was entrapped and removed intact through a 5-cm Pfannenstiel incision. Through the extraction incision, the distal ileum was identified and a 40 cm segment isolated. With the aid of the laparoscope, the ureters were brought outside the abdominal cavity and freshened and spatulated for approximately 1.5-cm. Bilateral double J ureteral stents were then inserted up to the renal pelvis and the ureters were directly anastomosed to the open ends of the limbs of the neobladder. Following this, the isolated intestinal segment was arranged in a Y shape with two central segments of 14 cm and two limbs of 6 cm. The two central segments were brought together and detubularized, with two sequential firings of 80 x 3.5 mm and 60 x 3.5 mm non-absorbable mechanical stapler (Multifire GIA--US Surgical) inserted through an opening made at the lowest point of the neobladder on its anti-mesenteric border. The neobladder was reinserted inside the abdominal cavity and anastomosed to the urethra with intracorporeal laparoscopic free-hand suturing. CONCLUSION: Although this procedure is feasible and the preliminary results encouraging, continued surveillance is necessary to determine the lithiasis-inducing potential of these titanium staples within the urinary tract.

[Simultaneous renal cell carcinoma and transitional cell carcinoma of the bladder. A case report]. / Carcinoma de célula renal y carcinoma transicional de vejiga simultáneos. Informe de un caso.

Herein we describe a case of renal cell carcinoma at the base of a giant right renal cyst coexisting with transitional cell carcinoma. The humoral, radiographic, endoscopic and CT findings are presented, as well as treatment and the results achieved at one year follow-up.