Outcome of small versus big capacity Hautmann neobladder reconstruction: A prospective randomized study - a 5-year follow up.

BACKGROUND: Orthotopic urinary diversion is the preferred diversion after cystectomy. Neobladder reconstruction with a longer ileum segment (60 cm) is advantageous for obtaining a large capacity and continence at the beginning; however, the long-term risk of residual urine, chronic infection, and the need for intermittent catheterization is more pronounced with the neobladder constructed with a longer ileal segment compared to the neobladder tailored from the shorter ileal segment. OBJECTIVE: To establish the differences in the functional outcome of a shorter (< 45 cm) and longer (⩾ 45 cm) ileal segment usage in the reconstruction of the Hautmann ileal neobladder following the radical cystectomy. METHODS: Between July 2013 and September 2015, 121 patients with muscle-invasive bladder cancer underwent radical cystectomy and Hautmann ileal neobladder reconstruction. Patients were divided into two groups, depending on the length of the ileum used for the diversion creation: < 45 cm of the ileum was used in the first group and ⩾ 45 cm in the second group. Five-year follow-up was performed at 1, 3, 6, and 9 months and 1 and 5 years. The main measured outcomes were functional outcomes and the quality of life. The evaluation included clinical, laboratory, and QLQ-C30 questionnaires. Statistical analysis was performed using descriptive statistics, Mann-Whitney U test, Kolmogorov-Smirnov test, ANOVA, and chi-squared tests. RESULTS: Patients with a smaller neobladder had a better quality of life, and higher global health status scale score. Thirteen early and 21 late complications developed in 10 and 17 patients, respectively. There were significant differences in the need for clean intermittent self-catheterization (CIC) between the two groups: smaller-volume pouch patients had statistically decreased need for CIC in 5 year follow-up compared to larger-volume pouch patients (χ2 test = 8.245; df = 1; P= 0.004). Eighteen percent of patients with smaller neobladders had urinary tract infections in 5 years, compared to 35% with larger neobladders (χ2 test = 4.447; df = 1; P= 0.034). CONCLUSION: Minimizing the length of the ileal segment needed for Hautmann neobladder reconstruction is feasible and provides better long-term results than larger-volume neobladders.

Comparison of the effectiveness of two combinations of antibiotic used for perioperative prophylactic therapy during radical cystectomy: A retrospective cohort study.

INTRODUCTION: This retrospective cohort study aimed to compare primary and secondary outcomes of patients undergoing radical cystectomy according to two different perioperative antimicrobial therapy protocols in 2016. METHODS: In this single-center, retrospective cohort study, we investigated data of 104 patients undergoing radical cystectomy due to bladder cancer from January 1, 2016, to December 31, 2016. According to perioperative antimicrobial prophylaxis, patients were divided into two groups: 48 patients received piperacillin/tazobactam 3x4.5 g intravenously (IV) combined with metronidazole 3x500 mg IV, and 56 patients received ceftriaxone 1x2 g IV combined with metronidazole 3x500 mg IV. All patients received the first dose of antibiotics 24 hours prior to the operative procedure, and it continued over the next 48 hours after the procedure. We analyzed and compared data from various primary and secondary outcomes for both groups of patients. RESULTS: In the group of patients receiving the combination of the piperacillin/tazobactam with metronidazole, the length of postoperative hospitalization was shorter (14 vs. 16 days, Z=2.24957 p=0.02383), leukocyte blood count on the first postoperative day was lower (9.80 vs. 11.15, p=0.01384), and hospital-acquired pneumonia was less common (2.08% vs. 12.5%, p=0.04688) than in the group receiving a combination of ceftriaxone and metronidazole. CONCLUSIONS: In radical cystectomy, perioperative antimicrobial prophylaxis protocol using piperacillin/tazobactam combined with metronidazole proved to be more effective than the combination of ceftriaxone with metronidazole.

Association of Triiodothyronine Levels With Prostate Cancer Histopathological Differentiation and Tumor Stage.

BACKGROUND/AIM: The aim of this study was to determine the association between total triiodothyronine (T3), free fraction of thyroxin (FT4), and thyrotropin (TSH) levels with prostate cancer histopathological features. PATIENTS AND METHODS: Blood samples from 140 patients with prostate cancer were analyzed preoperatively and stratified according to postoperative histopathological differentiation. The first group (N=62) included patients with prostate cancer Grade Groups (GG) 1-2, while the second group (N=63) included patients with prostate cancer GG 3-5. RESULTS: T3 levels were significantly higher in patients with prostate cancer GG 3-5 (p=0.047). There was no significant difference in the FT4 and TSH levels between the two groups (p=0.680 and 0.801, respectively). T3 levels were positively correlated with tumor percentage involvement (TPI) (p=0.002), and pT stage (p=0.047) on definitive pathology. CONCLUSION: Higher T3 levels are associated with several indicators of prostate cancer histopathological aggressiveness.

POLYSEROSITIS AND SEVERE SEPSIS AFTER OPEN SUPRAPUBIC RADICAL PROSTATECTOMY: A CASE REPORT.

- Infections are well-known complications of radical prostatectomy. In the United States and Europe, the rates of surgical site infections are generally less than 1% and of other infections up to 3%. We report a case of a 62-year-old man who developed severe sepsis with renal insufficiency, paralytic ileus and polyserositis after radical prostatectomy, as a consequence of probable quinolone-resistant bacterial infection. Computed tomography of the abdomen and chest showed polyserositis with bilateral pleural and peritoneal effusions. Treatment with meropenem and other supportive measures resulted in good clinical outcome. This case suggested that severe sepsis with exudative polyserositis was probably caused by mobilization of an infective agent (bacterium) during bladder neck dissection as part of open radical prostatectomy.