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1.
Adv Clin Exp Med ; 30(1): 77-82, 2021 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-33529510

RESUMEN

BACKGROUND: Bladder cancer is one of the most common cancers in Europe and is mostly found in men. Cystectomy is the treatment for invasive tumors that infiltrate the muscle of the bladder. This procedure is associated with a large number of complications. Eligibility for surgical treatment is important, because surgery may shorten the patient's life. The main prognostic factor is the severity of the disease, but less specific factors can be very helpful in selecting the form of treatment. OBJECTIVES: To identify and analyze factors affecting significantly the survival in patients undergoing radical cystectomy (RC). MATERIAL AND METHODS: A retrospective analysis of a group of 129 patients treated at the Department of Urology and Urological Oncology of University Hospital in Wroclaw (Poland) was carried out. Furthermore, information about the results of laboratory tests from the medical records (blood count, creatinine concentration, etc.) was obtained. The follow-up was performed twice during the postoperative period. The Kaplan-Meier method was used to determine overall survival (OS) curves and statistical significance was assessed using log-rank test. RESULTS: A statistically significant correlation between preoperative serum creatinine level and OS was found. The OS was significantly shorter in patients with higher serum creatinine levels (log-rank test; p = 0.002). The patients were divided into different groups to exclude the relationship between the elevated creatinine concentration and the local disease advancement. The analysis was performed in patients with and without hydronephrosis. In both groups, creatinine levels above the acceptable range were associated with a shorter survival. CONCLUSIONS: Due to the high perioperative mortality, mainly in patients with advanced disease, it is necessary to develop the qualification process for surgical treatment. The awareness of the relationship between elevated creatinine levels and worse prognosis seems to be helpful.


Asunto(s)
Cistectomía , Neoplasias de la Vejiga Urinaria , Creatinina , Cistectomía/efectos adversos , Humanos , Polonia , Pronóstico , Estudios Retrospectivos , Neoplasias de la Vejiga Urinaria/cirugía
2.
Hinyokika Kiyo ; 67(1): 37-41, 2021 Jan.
Artículo en Japonés | MEDLINE | ID: mdl-33535296

RESUMEN

A 69-year-old man presented with gross hematuria. Cystoscopy revealed a large papillary tumor occupying the bladder. Magnetic resonance imaging showed a large bladder tumor more than 8cm in maximum diameter,suspected to be muscle-invasive disease. We performed the 1st transurethral resection of bladder tumor (TURBT) for the main purpose of pathological confirmation. Histopathological findings of the resected specimens showed urothelial carcinoma,low grade pTa. We performed subsequent treatments with TURBT twice,resulting in complete resection. The histopathological findings showed the same results as those of the 1st TURBT conclusively,which was consistent with non-muscle-invasive bladder cancer. He received intravesical instillation of pirarubicin eight times in total and has remained free from recurrence for more than 26 months after the final TURBT.


Asunto(s)
Neoplasias de la Vejiga Urinaria , Administración Intravesical , Anciano , Cistectomía , Humanos , Masculino , Músculos , Recurrencia Local de Neoplasia , Neoplasias de la Vejiga Urinaria/diagnóstico por imagen , Neoplasias de la Vejiga Urinaria/tratamiento farmacológico , Neoplasias de la Vejiga Urinaria/cirugía
3.
Urologe A ; 60(2): 169-177, 2021 Feb.
Artículo en Alemán | MEDLINE | ID: mdl-33432371

RESUMEN

BACKGROUND: In surgical fields there has been a perceivable paradigm shift during the last decade concerning patient pre- and rehabilitation. Current literature suggests close interdisciplinary collaboration after complex procedures such as radical cystectomy in order to optimize perioperative patient care for the benefit of "fast-track" surgery. OBJECTIVES: To compose a catalogue of standardized measures after radical cystectomy based on guidelines set by the ERAS®-Society. RESULTS: The protocol commences with preoperative education in order to improve the physical and psychological condition of the patient. Crucial aspects in peri- and postoperative patient care are gentle surgical technique, adequate pain management, early mobilization and oral food intake, early removal of drains and foreign material and a seamless return to normal, daily life. CONCLUSIONS: Prospective data analysis will be the next step in order to establish the effectiveness of the protocol especially regarding postoperative complications and median duration of hospital stay.


Asunto(s)
Cistectomía , Neoplasias de la Vejiga Urinaria , Centros Médicos Académicos , Recuperación Mejorada Después de la Cirugía , Humanos , Tiempo de Internación , Complicaciones Posoperatorias/prevención & control , Estudios Prospectivos , Neoplasias de la Vejiga Urinaria/cirugía
4.
Urologe A ; 60(2): 151-161, 2021 Feb.
Artículo en Alemán | MEDLINE | ID: mdl-33481063

RESUMEN

Radical cystectomy (RC) is the standard treatment for nonmetastatic muscle-invasive urothelial carcinoma of the urinary bladder. It is associated with relevant morbidity and mortality. After RC, the 5­year overall survival rate is approximately 60%. In the context of the present work, quality parameters of RC divided into oncological/functional criteria and freedom from complications are identified and summarized. A PubMed search was performed. In addition to early criteria such as negative surgical margins, performance of pelvic lymphadenectomy, creation of a continent urinary diversion or preservation of sexual function, long-term criteria were identified such as the absence of higher-grade postoperative complications, recurrence-free survival and the preservation of health-related quality of life. The early criteria are suitable for individualized therapy planning, whereas the long-term criteria can be used for quality monitoring.


Asunto(s)
Neoplasias de la Vejiga Urinaria , Derivación Urinaria , Cistectomía , Humanos , Calidad de Vida , Resultado del Tratamiento , Neoplasias de la Vejiga Urinaria/cirugía
5.
Urologe A ; 60(2): 162-168, 2021 Feb.
Artículo en Alemán | MEDLINE | ID: mdl-33439288

RESUMEN

BACKGROUND: Radical cystectomy is associated with considerable morbidity and mortality. Based on the solid evidence in colorectal surgery, fast-track/ERAS® (Enhanced Recovery After Surgery) protocols have been developed to improve the perioperative management of patients undergoing radical cystectomy. OBJECTIVES: To review the literature and guidelines and evaluate the evidence regarding the different components of ERAS® protocols. MATERIALS AND METHODS: Systemic literature search and evaluation of relevant guidelines. RESULTS: The majority of ERAS® recommendations for radical cystectomy are based on extrapolations of abdominal surgery studies. Four randomized, controlled trials and one ERAS® guideline were published for radical cystectomy. ERAS® seems to shorten length of stay without increasing the complication rate. Key elements are no bowel preparation, no nasogastric tube, optimized fluid substitution, multimodal pain management, early mobilization, and oral diet. CONCLUSIONS: Implementation of ERAS® requires multidisciplinary collaboration. Individualization of an ERAS® program, identification of the most important components and adaption to the specific needs of radical cystectomy patients are future goals.


Asunto(s)
Cistectomía , Neoplasias de la Vejiga Urinaria , Recuperación Mejorada Después de la Cirugía , Humanos , Tiempo de Internación , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/prevención & control , Neoplasias de la Vejiga Urinaria/cirugía
6.
Urologe A ; 60(2): 247-258, 2021 Feb.
Artículo en Alemán | MEDLINE | ID: mdl-33398384

RESUMEN

With around 30,000 new cases annually bladder cancer (BC) is one of the most frequent cancers in Germany and the incidence is associated with advanced age and nicotine use. Urothelial carcinoma is the most frequent histological variant of BC in Central Europe. Nonmuscle-invasive BC can be resected endourologically and treated with intravesical instillation therapy. In the case of progression to nonmetastatic muscle-invasive disease radical cystectomy with accompanying neoadjuvant or adjuvant chemotherapy can be curative. Systemic treatment is the standard of care in metastatic disease. Although immunotherapy has made great progress in recent years, palliative chemotherapy remains the gold standard in first-line treatment. The armamentarium is continuously evolving: systemic immunotherapy is currently being investigated in nonmuscle-invasive BC as well as in perioperative and maintenance treatment after first-line chemotherapy and several studies are testing new targeted agents in palliative systemic therapy. This article gives an overview of current innovations and the expected paradigm shift in systemic treatment of BC.


Asunto(s)
Carcinoma de Células Transicionales , Neoplasias de la Vejiga Urinaria , Carcinoma de Células Transicionales/tratamiento farmacológico , Quimioterapia Adyuvante , Cistectomía , Europa (Continente) , Alemania , Humanos , Neoplasias de la Vejiga Urinaria/cirugía
7.
Urol Clin North Am ; 48(1): 45-50, 2021 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-33218593

RESUMEN

"The robotic approach for radical cystectomy has become increasingly adopted by the urologic oncology community, as it has been shown to have equivalent oncologic outcomes with shorter hospital stay and fewer perioperative transfusions. Consensus guidelines from expert surgeons have been published to provide guidance on all aspects of how to implement the robotic approach in the urologic oncology clinic."


Asunto(s)
Cistectomía/métodos , Procedimientos Quirúrgicos Robotizados/métodos , Neoplasias de la Vejiga Urinaria/cirugía , Vejiga Urinaria/cirugía , Cistectomía/tendencias , Humanos , Selección de Paciente , Atención Perioperativa , Procedimientos Quirúrgicos Robotizados/tendencias
8.
Urol Clin North Am ; 48(1): 51-70, 2021 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-33218594

RESUMEN

Robotic-assisted radical cystectomy has gained increasing popularity over the past decade. Initially, the procedure was performed with extracorporeal urinary diversion given the technical challenges of the intracorporeal approach. Since then, innovative techniques have been described to facilitate bowel manipulation, assess ureteral and mesenteric vasculature, and perform ureteroenteric and urethro-ileal anastomosis. Overcoming the learning curve associated with intracorporeal urinary diversion can lead to decreased blood loss, shorter operative times, and faster convalescence, particularly with enhanced recovery protocols. Herein we review technical points, complications, outcomes, and future innovations in intracorporeal urinary diversion."


Asunto(s)
Cistectomía/métodos , Procedimientos Quirúrgicos Robotizados/métodos , Neoplasias de la Vejiga Urinaria/cirugía , Vejiga Urinaria/cirugía , Derivación Urinaria/métodos , Cistectomía/estadística & datos numéricos , Recuperación Mejorada Después de la Cirugía , Predicción , Humanos , Curva de Aprendizaje , Procedimientos Quirúrgicos Robotizados/estadística & datos numéricos , Derivación Urinaria/estadística & datos numéricos , Derivación Urinaria/tendencias
9.
J Urol ; 205(1): 94-99, 2021 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-32716672

RESUMEN

PURPOSE: Treatment for muscle invasive bladder cancer includes radical cystectomy, a major surgery that can be associated with significant toxicity. Limited data exist related to changes in patient global health status and recovery following radical cystectomy. We used geriatric assessment to longitudinally compare health related impairments in older and younger patients with muscle invasive bladder cancer who undergo radical cystectomy. MATERIALS AND METHODS: Older and younger patients (70 or older and younger than 70 years) with muscle invasive bladder cancer undergoing radical cystectomy at an academic institution were enrolled between 2012 and 2019. Patients completed the geriatric assessment before radical cystectomy, and 1, 3 and 12 months after radical cystectomy. For each geriatric assessment measure the Wilcoxon rank sum test was used to compare score distribution between age groups at each time point. The Wilcoxon signed rank test was used to compare distributions between time points within each age group. RESULTS: A total of 80 patients (42 younger and 38 older) were enrolled. Before radical cystectomy 78% of patients were impaired on at least 1 geriatric assessment measure. Both age groups had worsening physical function and nutrition at 1 month after radical cystectomy, with older patients having a greater decline in function than younger patients. Both groups recovered to baseline at 3 months after radical cystectomy and maintained this status at 1 year. CONCLUSIONS: High rates of impairments were found across age groups in the short term after radical cystectomy, followed by recovery to baseline.


Asunto(s)
Cistectomía/efectos adversos , Fragilidad/diagnóstico , Evaluación Geriátrica/estadística & datos numéricos , Calidad de Vida , Neoplasias de la Vejiga Urinaria/cirugía , Adulto , Factores de Edad , Anciano , Anciano de 80 o más Años , Recuperación Mejorada Después de la Cirugía , Femenino , Fragilidad/etiología , Fragilidad/prevención & control , Humanos , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Periodo Posoperatorio , Periodo Preoperatorio , Estudios Retrospectivos , Vejiga Urinaria/patología , Vejiga Urinaria/cirugía , Neoplasias de la Vejiga Urinaria/patología
10.
J Urol ; 205(1): 174-182, 2021 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-32856988

RESUMEN

PURPOSE: There is a lack of data on true long-term functional outcome of orthotopic bladder substitution. The primary study objective was to report our 35-year clinical experience. MATERIALS AND METHODS: Since October 1985, 259 male patients from a large single center radical cystectomy series with complete followup of more than 60 months (median 121, range 60-267) without recurrence, irradiation or undiversion that might have affected the functional outcome, were included. RESULTS: Median age at radical cystectomy and at survey was 63 (range 23-81) and 75 (range 43-92) years, respectively. Overall 87% of patients voided spontaneously and residual-free. This rate decreased with increasing age at the time of surgery (less than 50 years old 94%, 70 years old or older 82%). Overall day/nighttime continence rates were 90%/82%. These rates decreased with increasing age at the time of surgery from 100%/88% to 87%/80%. The overall pad-free rate was 71%/47%. Bicarbonate use decreased from 51% (5 years) to 19% (25 years). Patients with a followup of more than 20 years had the lowest rate of residual urine and clean intermittent catheterization (0.0%) as well as use of more than 1 pad at daytime/nighttime (6.3%/12.5%) and mucus obstruction (0.0%). Serum creatinine showed only the age related increase. The surgical complication rate was 27% and correlated inversely with functional results (chi-squared 11.227, p <0.005), even when the younger age at the time of surgery (younger than 60 years) was related to higher rates of surgical complications (chi-squared 6.80, p <0.05). CONCLUSIONS: The ileal neobladder represents an excellent long-term option for urinary diversion with an acceptable complication rate.


Asunto(s)
Íleon/cirugía , Complicaciones Posoperatorias/epidemiología , Neoplasias de la Vejiga Urinaria/cirugía , Derivación Urinaria/efectos adversos , Incontinencia Urinaria/epidemiología , Reservorios Urinarios Continentes/efectos adversos , Adulto , Factores de Edad , Anciano , Anciano de 80 o más Años , Cistectomía/efectos adversos , Femenino , Estudios de Seguimiento , Humanos , Incidencia , Pañales para la Incontinencia/estadística & datos numéricos , Cateterismo Uretral Intermitente/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/diagnóstico , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/terapia , Estudios Prospectivos , Índice de Severidad de la Enfermedad , Resultado del Tratamiento , Vejiga Urinaria/patología , Vejiga Urinaria/cirugía , Neoplasias de la Vejiga Urinaria/patología , Derivación Urinaria/métodos , Incontinencia Urinaria/diagnóstico , Incontinencia Urinaria/etiología , Incontinencia Urinaria/terapia , Adulto Joven
11.
Arch Ital Urol Androl ; 92(4)2020 Dec 17.
Artículo en Inglés | MEDLINE | ID: mdl-33348951

RESUMEN

OBJECTIVE: Overview of bladder cancer (BC) management in Italy during the first month of the COVID-19 pandemic (March 2020) with head to head comparison of the data from March 2019, considered "usual activity" period. The aim is to analyze performance of different Italian Centers in North, Center and South, with a special eye for Lombardy (the Italian epicenter). PATIENTS AND METHODS: During April 2020, a survey containing 14 multiple-choice questions focused on general staffing and surgical activity related to BC during the months of March 2019 and March 2020 was sent to 32 Italian Centers. Statistical analysis was performed using IBM SPSS Statistics (v26) software. A Medline search was performed, in order to attempt a comparative analysis with published papers. RESULTS: 28 Centers answered, for a response rate of 87.5%. Most of the urology staff in the Lombardy region were employed in COVID wards (p = 0.003), with a statistically significant reduction in the number of radical cystectomies (RC) performed during that time (p = 0.036). The total amount of RC across Italy remained the same between 2019 and 2020, however there was an increase in the number of surgeries performed in the Southern region. This was most likely due to travel restrictions limiting travel the North. The number of Trans-Urethral Resection of Bladder Tumors (TURBT) (p = 0.046) was higher in Academic Centers (AC) in 2020 (p = 0.037). CONCLUSIONS: The data of our survey, although limited, represents a snap shot of the management of BC during the first month of the COVD-19 pandemic, which posed a major challenge for cancer centers seeking to provide care during an extremely dynamic clinical and political situation which requires maximum flexibility to be appropriately managed.


Asunto(s)
/epidemiología , Pandemias , Neoplasias de la Vejiga Urinaria/cirugía , Encuestas de Atención de la Salud/estadística & datos numéricos , Hospitales/provisión & distribución , Humanos , Italia/epidemiología , Factores de Tiempo , Procedimientos Quirúrgicos Urológicos Masculinos/estadística & datos numéricos
12.
Medicine (Baltimore) ; 99(52): e23645, 2020 Dec 24.
Artículo en Inglés | MEDLINE | ID: mdl-33350743

RESUMEN

BACKGROUND: We have performed the direct and network meta-analysis to evaluate the safety and efficacy of robot-assisted (RARC) versus laparoscopic (LRC) versus open radical cystectomy (ORC) for bladder cancer (BCa). METHODS: A systematic search of PubMed, Cochrane Library, and Embase was performed up until Dec 20, 2019. Outcome indexes include oncologic outcomes (the recurrence rate, mortality), pathologic outcomes (lymph node yield (LNY), positive lymph node (PLN), positive surgical margins (PSM)), perioperative outcomes (operating time (OP), estimated blood loss (EBL), blood transfusion rate, the length of hospital stay (LOS) and the time to regular diet) and postoperative 90-day complications. RESULTS: We have analyzed 6 RCTs, 23 prospective studies, and 25 retrospective studies (54 articles: 6382 patients). On one hand, the direct meta-analysis shows RARC is better than LRC or ORC. On the other hand, the clinical effects of the recurrence rate, Morbidity, PSM, LNY, PLN, and postoperative 90-day complications of RARC, LRC and ORC are all no statistical significance by network meta-analysis. Moreover, the probability rank shows that the comprehensive rank of RARC is better than LRC or ORC. The clinical effects of OP, EBL, LOS, blood transfusion rate and the time to regular diet are all statistical significance by network meta-analysis. There are ORC > LRC > RARC in the EBL ranking. Patients with RARC exhibited a decrease of LOS compared to those with LRC or ORC. Patients with RARC exhibited a decrease in blood transfusion rate and the time to regular diet compared to those with ORC. Patients with ORC exhibited an increase of OP compared to those with RARC or LRC. The heterogeneity tests of most studies are < 50%. Most studies have no publication bias and the quality of the selected studies is good. CONCLUSION: The direct meta-analysis and network meta-analysis suggest that RARC is better than LRC or ORC according to comprehensive analysis. However, we need a large sample size and more high-quality studies to verify and improve in the further.


Asunto(s)
Neoplasias de la Vejiga Urinaria/cirugía , Teorema de Bayes , Cistectomía , Humanos , Laparoscopía , Procedimientos Quirúrgicos Robotizados
13.
Actas urol. esp ; 44(10): 659-664, dic. 2020. tab, graf
Artículo en Español | IBECS | ID: ibc-195508

RESUMEN

INTRODUCCIÓN Y OBJETIVO: La coronavirus disease 2019 (COVID-19) ha ocasionado una pandemia de repercusión mundial que obligó a tomar medidas sociopolíticas, como la declaración del estado de alarma en España. Paralelamente se llevó a cabo la reestructuración de las actividades e infraestructuras médico-quirúrgicas pediátricas, con la consecuente suspensión de la actividad quirúrgica no urgente de Urología Pediátrica. Analizamos la repercusión de la pandemia COVID-19 sobre la actividad quirúrgica en una sección de Urología Pediátrica, así como las complicaciones quirúrgicas, según la clasificación de Clavien-Dindo. MATERIALES Y MÉTODOS: Se procedió a la revisión sistemática de los datos epidemiológicos, clínicos y quirúrgicos, incluyendo las complicaciones y reingresos de todos los pacientes intervenidos en la sección de Urología Pediátrica desde la declaración del estado de alarma hasta el levantamiento del mismo. Para su estudio se procedió a la división en cinco bloques temporales acorde a las fases de desescalada. RESULTADOS: Se realizaron 49 intervenciones quirúrgicas en 45 pacientes (ocho previos a la implantación de las fases de desescalada). La patología con prioridad alta fue la más frecuente en las primeras fases, siendo la estenosis de la unión pieloureteral (EPU) la más prevalente. Se registraron cuatro complicaciones (8,8%), ninguna de ellas de origen respiratorio. CONCLUSIONES: Las recomendaciones de la EAU para la reanudación de la actividad quirúrgica han permitido una correcta, segura y gradual transición al ritmo quirúrgico habitual en Urología Pediátrica. La clasificación de Clavien-Dindo es útil y válida para su aplicación en esta sección. No se han registrados complicaciones respiratorias que pudiesen ser atribuibles a la situación pandémica


INTRODUCTION AND OBJECTIVE: The coronavirus disease 2019 (COVID-19) has caused a pandemic of global impact that forced social-political measures to be taken, such as the declaration of the state of alarm in Spain. At the same time, the reorganization of the pediatric medical-surgical activities and infrastructures was carried out, with the consequent suspension of the non-urgent surgical activity of Pediatric Urology. We analyzed the impact of the COVID-19 pandemic on surgical activity in a Pediatric Urology division, as well as surgical complications according to the Clavien-Dindo classification. MATERIALS AND METHODS: A systematic review of epidemiological, clinical and surgical data was carried out, including complications and readmissions of all patients operated on in the division of Pediatric Urology within the duration of the state of alarm. Five time periods have been created according to the de-escalation phases. RESULTS: Forty-nine surgical procedures were carried out on 45 patients (8 prior to the implementation of the de-escalation phases). High priority pathologies were the most frequent in the first phases, being the ureteropelvic junction (UPJ) obstruction the most prevalent. Four complications were recorded (8.8%), none of them were respiratory. CONCLUSIONS: The EAU recommendations for the resumption of surgical activity have allowed a correct, safe and gradual transition to the routine surgical activity in Pediatric Urology. The Clavien-Dindo classification is useful and valid for application in this division. No respiratory complications have been reported that could be attributable to the pandemic situation


Asunto(s)
Humanos , Masculino , Femenino , Lactante , Preescolar , Niño , Infecciones por Coronavirus/epidemiología , Pandemias , Complicaciones Posoperatorias/clasificación , Betacoronavirus , Procedimientos Quirúrgicos Urológicos/efectos adversos , Readmisión del Paciente , Complicaciones Posoperatorias/epidemiología , Neoplasias de la Próstata/cirugía , Síndrome del Abdomen en Ciruela Pasa/cirugía , Estudios Retrospectivos , Rabdomiosarcoma Embrionario/cirugía , Neoplasias de la Vejiga Urinaria/cirugía , Procedimientos Quirúrgicos Urológicos/estadística & datos numéricos , Servicio de Urología en Hospital , España/epidemiología
14.
Urologiia ; (5): 54-60, 2020 Nov.
Artículo en Ruso | MEDLINE | ID: mdl-33185348

RESUMEN

INTRODUCTION: Robot-assisted radical cystectomy (RARC) with intracorporeal neobladder formation is a complex surgical procedure. AIM: To describe the main stages of RARC and to analyze its short-term results. MATERIALS AND METHODS: RARC with ileocystoplasty was performed in 16 patients, most of whom were men (n=14). In 15 patients, the indication for surgery was bladder cancer (BCa), while one patient has radiation-induced sigmoid fistula with a formation of small, contracted bladder. During radical cystectomy (RC), the lower ureters were dissected, followed by posterior dissection of the bladder with mobilization from both sides to the pelvic fascia, clipping and transection of the vesical pedicles, and suturing of the dorsal venous complex with urethral dissection. After pelvic lymph node dissection, 40 cm of the ileum was resected, after that two distal segments of 15 cm were U-shaped, and a 1.5 cm incision was made in the lower part of the bowel, followed by a formation of the urethral anastomosis. Then bowel segments were detubularized, and continuous suture on the posterior and anterior walls of the neobladder was done. Ureters were implanted in the proximal tubular part of the resected colon according to the Nesbit technique. RESULTS: The mean operation time was 380 minutes. The blood loss ranged from 80 to 200 ml; however, blood transfusion was not performed. Complications during 30-days after RARC were observed in 7 (43.7%) patients, including 4 (25%) of class I-II according to Clavien - Dindo, and 3 (18.7%) of class III-IV. In patients with leakage at the uretero- intestinal anastomosis (n=2) and urethro-neobladder anastomosis (n=1), percutaneous drainage was performed, which allowed to resolve these complications. There were no cases of bowel obstruction. One patient with gastrointestinal bleeding required blood transfusion. The 90-day late complications occurred in 6 (37.5%) patients, including 2 cases of upper urinary tract infection. One patient died of acute myocardial infarction. CONCLUSION: RARC is a contemporary minimally invasive method for muscle-invasive BCa. Stepwise approach to RARC with intracorporeal neobladder formation may reduce the operation time and the rate of complications.


Asunto(s)
Procedimientos Quirúrgicos Robotizados , Robótica , Estructuras Creadas Quirúrgicamente , Neoplasias de la Vejiga Urinaria , Derivación Urinaria , Cistectomía/efectos adversos , Humanos , Masculino , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/cirugía , Procedimientos Quirúrgicos Robotizados/efectos adversos , Resultado del Tratamiento , Neoplasias de la Vejiga Urinaria/cirugía , Derivación Urinaria/efectos adversos
15.
Georgian Med News ; (306): 7-10, 2020 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-33130637

RESUMEN

The main treatment for muscle-invasive bladder cancer is radical cystectomy with creation of an artificial intestinal bladder with restoration of transurethral urination is recognized as the best method of urine derivation. Aim - to study the urodynamic features of the artificial bladder. The main study group consisted of 57 patients with invasive bladder cancer who underwent radical cystoprostatectomy with ileocystoplasty in several specialized centers. The artificial bladder, formed from the terminal ileum, shows the original results of an urodynamic study, not similar to the data obtained with various pathologies of the bladder. Patients with severe atony of the neobladder were noted, which potentiated chronic mycotic insufficiency with elements of obstruction and required periodic catheterization. Some patients whose main complaint was urinary incontinence in the daytime and at night, according to the KUDI, demonstrated elements of the lack of overactivity, which can also be the cause of incontinence and requires further study of pathogenetic features and possible correction methods.


Asunto(s)
Neoplasias de la Vejiga Urinaria , Reservorios Urinarios Continentes , Cistectomía , Humanos , Íleon/cirugía , Masculino , Neoplasias de la Vejiga Urinaria/cirugía , Urodinámica
16.
Medicine (Baltimore) ; 99(43): e22893, 2020 Oct 23.
Artículo en Inglés | MEDLINE | ID: mdl-33120837

RESUMEN

Radical cystectomy is considered the standard treatment for patients with muscle-invasive bladder tumors and has high postoperative complication rates among urological surgeries. High-risk patients, defined as those ≥45 years of age with history of coronary artery disease, stroke, or peripheral artery disease or those ≥65 years of age, can have a higher incidence of cardiac complications. Therefore, we evaluated the incidence, risk factors, and outcomes of myocardial injury after non-cardiac surgery (MINS) in high-risk patients who underwent radical cystectomy.This retrospective observational study analyzed 248 high-risk patients who underwent radical cystectomy. MINS was defined as serum troponin I concentration ≥0.04 mg/L within postoperative 3 days. The risk factors for MINS were evaluated by multivariate logistic regression analysis. Postoperative outcomes were evaluated. The 1-year survival after radical cystectomy was also compared between patients who developed MINS (MINS group) and those who did not (non-MINS group) by Kaplan-Meier analysis.MINS occurred in 35 patients (14.1%). Multivariate logistic regression analysis showed that early diastolic transmitral filling velocity (E)/early diastolic septal mitral annular velocity (E') ratio (odds ratio = 1.102, 95% confidence interval [1.009-1.203], P = .031) and large volume blood transfusion (odds ratio = 2.745, 95% confidence interval [1.131-6.664], P = .026) were significantly associated with MINS in high-risk patients who underwent radical cystectomy. Major adverse cardiac events and 1-year mortality were significantly higher in the MINS group than in the non-MINS group (17.1% vs 6.1%, P = .035; 28.6% vs 12.7%, P = .021, respectively). Kaplan-Meier analysis showed significantly lower 1-year survival in the MINS group than in the non-MINS group (P = .010).MINS occurred in 14.1% of patients. High E/E' ratio and large volume blood transfusion were risk factors for MINS in high-risk patients who underwent radical cystectomy. Postoperative major adverse cardiac events and 1-year mortality were significantly higher in the MINS group than in the non-MINS group. Preoperative evaluation of risk factors for MINS may provide useful information to detect cardiovascular complications after radical cystectomy in high-risk patients.


Asunto(s)
Cistectomía/efectos adversos , Isquemia Miocárdica/etiología , Troponina I/sangre , Neoplasias de la Vejiga Urinaria/cirugía , Anciano , Anciano de 80 o más Años , Transfusión Sanguínea/estadística & datos numéricos , Estudios de Casos y Controles , Cistectomía/mortalidad , Femenino , Humanos , Incidencia , Estimación de Kaplan-Meier , Masculino , Isquemia Miocárdica/epidemiología , Isquemia Miocárdica/metabolismo , Estadificación de Neoplasias/métodos , Complicaciones Posoperatorias/epidemiología , República de Corea/epidemiología , Estudios Retrospectivos , Factores de Riesgo , Neoplasias de la Vejiga Urinaria/complicaciones , Neoplasias de la Vejiga Urinaria/patología
17.
Hinyokika Kiyo ; 66(9): 313-317, 2020 Sep.
Artículo en Japonés | MEDLINE | ID: mdl-32988169

RESUMEN

A 74-year-old man presented with further treatment for muscle invasive small cell carcinoma of the bladder. After three courses of neoadjuvant chemotherapy with cisplatine + etoposide (EP), total cystectomy was performed. The pathological findings revealed small cell carcinoma of the bladder (ypT2N0M0). Eleven months after the operation, thoracoabdominal computed tomography (CT) showed right pelvic lymph node metastasis. He underwent 9 courses of EP chemotherapy, and everolimus, finally, Amrubicin was administered. Amrubicin might be useful for small cell carcinoma of the bladder.


Asunto(s)
Carcinoma de Células Pequeñas/diagnóstico por imagen , Carcinoma de Células Pequeñas/tratamiento farmacológico , Neoplasias de la Vejiga Urinaria/diagnóstico por imagen , Neoplasias de la Vejiga Urinaria/tratamiento farmacológico , Neoplasias de la Vejiga Urinaria/cirugía , Anciano , Cistectomía , Etopósido , Humanos , Masculino
18.
Anticancer Res ; 40(10): 5861-5868, 2020 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-32988916

RESUMEN

AIM: To evaluate our experience with radical radiotherapy and chemotherapy in patients with muscle-invasive bladder cancer. PATIENTS AND METHODS: The study consisted of 27 patients treated with cisplatin-based chemoradiation (CCRT), 48 treated with radiation alone (RT), and 42 with locally advanced disease treated with neoadjuvant chemotherapy and radiation (neoCRT). RESULTS: The incidence of acute grade 3 or more genitourinary (GU) toxicity in the RT, CCRT and neoCRT groups was: 25%, 11% and 19%, respectively (p=0.029). The 3-year freedom from grade 2 or more GU toxicity was: 81%, 89%, 54%, respectively (p=0.36). The long-term outcomes of 3-year local control, overall survival, and disease-free survival were as follows: RT group: 74%, 61% and 55%; CCRT group: 76%, 76% and 56%; neoCRT group: 31%, 43% and 18%, respectively. CONCLUSION: The preferable bladder-conserving approach is CRT, however RT alone might also be an option for appropriately selected patients. NeoCRT for those with locally advanced tumors remain unsatisfactory; adequate selection of patients for radical treatment is of importance.


Asunto(s)
Cisplatino/uso terapéutico , Músculo Esquelético/patología , Neoplasias de la Vejiga Urinaria/tratamiento farmacológico , Neoplasias de la Vejiga Urinaria/radioterapia , Anciano , Anciano de 80 o más Años , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Quimioradioterapia/efectos adversos , Terapia Combinada , Supervivencia sin Enfermedad , Femenino , Humanos , Masculino , Persona de Mediana Edad , Terapia Neoadyuvante/métodos , Invasividad Neoplásica/patología , Neoplasias de la Vejiga Urinaria/patología , Neoplasias de la Vejiga Urinaria/cirugía
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