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INTRODUCTION: The aim of residency is to acquire medical skills and abilities. One didactic model is "Peyton's four-step approach". The aim of the present study was to develop and evaluate a modified Peytonian approach for group interactions. The aim was to develop a course for the acquisition of practical skills and training assistants in suture techniques for urology. METHODS: A prospective study was conducted with a total of 38 participants and 6 tutors. In a modified four-step Peytonian approach, various suturing and knotting techniques were taught in a structured manner. Tutors evaluated the procedural activity using observation sheets. In addition, the learning method was evaluated by the participants and the tutors at the end of the course. In order to check the long-term learning success, a renewed survey of the participants was conducted after 6 months. RESULTS: 80% of the participants rated the modified teaching method as useful and 83% of the tutors rated the procedural implementation as good. Fluid movement sequences were difficult independent of the technique taught. After 6 months, the participants significantly improved their procedural skills in all techniques that were taught. CONCLUSION: This paper defines a four-step Peyton-based approach to teaching practical skills such as suturing and knotting used in urological training. The modified teaching method improved practical skills used in urology. This method should be considered in continuing education to promote self-confidence and increase the competence in surgical skills.
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Educação de Graduação em Medicina , Internato e Residência , Urologia , Competência Clínica , Currículo , Humanos , Estudos ProspectivosRESUMO
As useful and necessary as radiotherapy may be, it is associated with irreversible long-term adverse effects including loss of bladder function. In the majority of cases the small bowel, sigmoid rectum and ureter are also affected. The extent of injury depends on the irradiated area, the applied dose and the quality of application. Three factors are essential when choosing a urinary diversion: the length of functional ureter, the position of the bowel outside of the irradiated area and the type of diversion. A continent diversion is best performed through a ascending-transverse or transverse-descending colon pouch. The efferent segment is diverted through the umbilicus. The simplest technique for an incontinent diversion is a conduit using the ascending colon or the right colon flexure. If the length of the ureter does not suffice for such a conduit, the ideal solution is a transverse conduit, as this conduit can be attached to both renal pelves, while simultaneously allowing free choice of the lateral location of the stoma. In case of an exenteration, a double stoma on one side of the body should be avoided in order to prevent maintenance issues.
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Pelve Menor/efeitos da radiação , Pelve/efeitos da radiação , Lesões por Radiação , Derivação Urinária , Colo , Humanos , UreterRESUMO
In multivariate analysis, GS of the regular prostatectomy specimen was the only statistically significant parameter for pT2R1 prostate cancer.
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Female genital mutilation (FGM) is the ritualistic removal of parts of the external female genitalia. The extent of mutilation as well as the age at which it is performed vary depending on ethnicity. We recognise four forms of mutilation based on the extent of tissue resection, ranging from clitridectomy to resection of the entire soft tissue of the external genitalia. The vast majority of the estimated 200 million mutilated women live in Africa and the Middle and Far East. Due to migration an estimated 150,000 mutilated women live in Germany to date. In approximately 30% of cases FGM leads to urologic complications and the chances of urologists facing these complications is rapidly increasing. The focus lies on chronic infections, pain syndromes and obstructed micturition with all associated late complications. This situation is made more complex if any neighbouring organs were damaged during the mutilation.
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Circuncisão Feminina/efeitos adversos , Clitóris/cirurgia , Doenças Urogenitais Femininas/etiologia , Retenção Urinária , Infecções Urinárias , Clitóris/lesões , Feminino , Alemanha , HumanosRESUMO
BACKGROUND: In Germany, radical cystectomy with urinary diversion is the primary therapeutic option for localized muscle invasive urothelial bladder cancer. Modifications in the pre-, peri-, and postoperative phase have significantly improved outcomes. OBJECTIVES: Different factors and parameters are directly associated with patients' outcome. An overview on how to best approach this procedure is provided in this article. MATERIALS AND METHODS: The data regarding preparation and the procedure for the radical cystectomy followed by urinary diversion are separately analyzed. RESULTS: During the preoperative phase, Fast Track and ERAS (Enhanced Recovery after Surgery) concepts should be an integral part of therapeutic management. Different aspects of such models are presented and discussed. Comorbidities such as diabetes mellitus, hypertension, malnutrition or anemia should also be treated early. In the perioperative phase, optimized fluid management and close interaction with the anesthesiologist are needed. Use of vasopressors during surgery and controlled hypotension (about 80â¯mmâ¯Hg) help reduce perioperative blood loss. Blood product use should be minimized. The use of epidural anesthesia to improve the stress reaction of the body improves pain management and functional recovery. Radical cystectomy is associated with the best oncological outcome, preserving functional structures to maintain a good quality of life. Nerve-sparing procedures in men and women should be used where appropriate. The use of robotic assisted radical cystectomy (RARC) is also discussed. CONCLUSION: The ileum conduit is still the most common urinary diversion worldwide. However, numerous other urinary diversions to provide patients with the highest quality of life are available. Centers with a high case load seem to be associated with an improved outcome.
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Carcinoma de Células de Transição/cirurgia , Cistectomia/métodos , Complicações Pós-Operatórias/cirurgia , Neoplasias da Bexiga Urinária/cirurgia , Derivação Urinária/métodos , Carcinoma de Células de Transição/patologia , Carcinoma de Células de Transição/secundário , Feminino , Alemanha , Humanos , Metástase Linfática , Masculino , Complicações Pós-Operatórias/patologia , Qualidade de Vida , Resultado do Tratamento , Neoplasias da Bexiga Urinária/patologiaRESUMO
Fournier's gangrene is a rapidly progressing necrotizing fasciitis restricted to the perineal and genital regions. Although rare, it is an acute life-threatening disease, requiring rapid radical surgical debridement and antibiotic treatment, resulting in large soft tissue defects. Various reconstructive methods for defect coverage are applied to satisfactorily reconstitute functionality and esthetics.
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Gangrena de Fournier/cirurgia , Pênis/cirurgia , Procedimentos de Cirurgia Plástica/métodos , Antibacterianos/uso terapêutico , Endarterite/cirurgia , Gangrena de Fournier/diagnóstico , Gangrena de Fournier/mortalidade , Humanos , Masculino , Períneo/cirurgia , Escroto/cirurgia , Retalhos Cirúrgicos/cirurgiaRESUMO
BACKGROUND: One of the major challenges in prostate cancer (PCa) treatment is distinguishing insignificant PCa from those forms that need active treatment. We evaluated the impact of PSA isoforms on risk stratification in patients with low-risk PCa as well as in active surveillance (AS) candidates who underwent radical prostatectomy. METHODS: A total of 112 patients with biopsy confirmed Gleason score (GS) 6 PCa of four different international institutions were prospectively enrolled in the study. Blood withdrawal was performed the day before radical prostatectomy. In addition, patients were classified according to the EAU and NCCN criteria for AS candidates. PSA, free PSA (fPSA) and proPSA were measured using dual monoclonal antibody sandwich immunoassays. In addition, the Prostate Health Index (PHI=proPSA/fPSA × âPSA) was calculated. Final histology of the radical prostatectomy specimens was correlated to PSA, its isoforms and PHI. RESULTS: Serum proPSA levels were significantly elevated in those patients with an upgrade in final histology (GS⩾7). In addition, higher proPSA levels were predictive for extraprostatic extension (⩾pT3a) as well as for positive surgical margins. Interestingly, PHI had an even higher predictive power when compared with proPSA alone concerning GS upgrading, extraprostatic extension and surgical margins in both the total and the AS patient group. CONCLUSION: We showed in a multicenter study that proPSA is a valuable biomarker to detect patients with aggressive PCa in a cohort of GS 6 patients, who would benefit from active tumor therapy. Combining proPSA with the standard markers PSA and fPSA using PHI further increases the predictive accuracy significantly. Moreover, our data support the use of PHI for monitoring PCa patients under AS.
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Calicreínas/sangue , Antígeno Prostático Específico/sangue , Neoplasias da Próstata/sangue , Precursores de Proteínas/sangue , Adulto , Idoso , Humanos , Masculino , Pessoa de Meia-Idade , Gradação de Tumores , Estudos Prospectivos , Próstata/patologia , Próstata/cirurgia , Prostatectomia , Neoplasias da Próstata/patologia , Neoplasias da Próstata/cirurgia , Resultado do TratamentoRESUMO
AIM: To differentiate uric acid from non-uric acid renal stones based on their spectral attenuation values. MATERIALS AND METHODS: The present study was approved by the institutional review board and the need for informed consent was waived. Thirty-three consecutive patients (21 men, 12 women; mean age 55 years) with symptomatic urolithiasis underwent dual-energy computed tomography (DECT) using a second-generation dual-source CT system. Stone composition was assessed by means of chemical analysis after extraction or spontaneous expulsion. The composition of one stone was considered to represent all remaining stones in patients presenting with more than one stone. Image-domain virtual monoenergetic images were generated from the dual-energy datasets. One radiologist evaluated stone attenuation values from 40 to 190 keV; attenuation curves were created and 40/190 keV attenuation ratios calculated. Qualitative evaluation of the spectral attenuation curves was also performed. Imaging findings were compared with laboratory results. RESULTS: Sixty-two stones were considered in 33 patients (mean diameter 6.5 mm). Fifteen of the 62 stones were mainly composed of uric acid and 47/62 of cysteine or calcium oxalates/phosphates. Forty to 190 keV attenuation ratios were significantly lower for uric acid stones (mean 0.87±0.3) than for non-uric acid stones (mean 3.80±0.6; p<0.0001). Accuracy was 100% with a cut-off value of 1.76. Qualitative analysis of spectral attenuation curves showed unique shapes for uric acid and non-uric acid stones. CONCLUSIONS: Spectral CT quantitatively and qualitatively differentiates uric acid from non-uric acid stones.
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Cálculos Renais/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Ácido Úrico , Diagnóstico Diferencial , Feminino , Humanos , Cálculos Renais/química , Masculino , Pessoa de Meia-Idade , Intensificação de Imagem Radiográfica , Estudos Retrospectivos , Tomografia Computadorizada por Raios X/métodos , Ácido Úrico/análiseRESUMO
Radical cystectomy (RC) with bilateral pelvic lymph node dissection constitutes the gold standard treatment for muscle-invasive and high-risk non-muscle-invasive urothelial carcinoma of the bladder refractory to instillation therapy. Although radical cystectomy is performed with curative intent, the overall 5-year survival has been reported to be as low as 62% in the current literature. Various clinico-pathological parameters determine post-RC outcome, but besides these, the role of comorbidity has gained increasing attention and can be quantified with various comorbidity scores. We here review the most recent data on comorbidity scores and performance indices, which have been assessed in patients, undergoing RC and highlight their clinical implications.
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Adenocarcinoma/mortalidade , Adenocarcinoma/cirurgia , Carcinoma de Células Escamosas/mortalidade , Carcinoma de Células Escamosas/cirurgia , Carcinoma de Células de Transição/mortalidade , Carcinoma de Células de Transição/cirurgia , Cistectomia , Neoplasias da Bexiga Urinária/mortalidade , Neoplasias da Bexiga Urinária/cirurgia , Adulto , Comorbidade , Feminino , Alemanha , Nível de Saúde , Humanos , Masculino , Fatores de Risco , Análise de SobrevidaRESUMO
PURPOSE: Radical cystectomy (RC) can be associated with significant blood loss, whereas many patients are presenting with anemia preoperatively. To date, there is a lack of data addressing the impact of preoperative anemia (PA) on survival of patients undergoing RC for urothelial carcinoma of the bladder (UCB). METHODS: This retrospective multicenter study includes 684 patients with UCB undergoing RC with pelvic lymph node dissection. The median follow-up was 50 (IQR 29,78) months. Anemia was defined in line with the WHO classification (hemoglobin (Hb): male ≤13 g/dL, female ≤12 g/dL) and based on contemporary gender- and age-adjusted classification (Hb: white male aged <60 years: ≤13.7 g/dL; ≥60 years: ≤13.2 g/dL; white female of all ages ≤12.2 g/dL). Univariable and multivariable Cox regression analyses were used to assess the effects of PA on oncological outcomes. RESULTS: A total of 269 (39.3 %) and 302 (44.2 %) patients were anemic according to the WHO classification versus contemporary classification. Age, increased ECOG performance status, advanced tumor stages, lymph node metastasis, positive surgical margin and anemia were associated with disease recurrence (DR), cancer-specific mortality (CSM) and all-cause mortality (ACM). In multivariable analysis, anemia was an independent predictor of DR, CSM and ACM (WHO and/or contemporary classification). Blood transfusion was significantly associated with ACM in both classifications of anemia. CONCLUSIONS: PA is significantly associated with worse oncological outcome in patients undergoing RC. Based on the additional unfavorable influence of blood transfusion, this emphasizes the importance of early diagnosis and correction of anemia and implementation of alternative methods of blood volume management.
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Anemia/patologia , Neoplasias da Bexiga Urinária/patologia , Neoplasias da Bexiga Urinária/cirurgia , Idoso , Transfusão de Sangue/métodos , Cistectomia/métodos , Feminino , Humanos , Excisão de Linfonodo/métodos , Metástase Linfática/patologia , Masculino , Recidiva Local de Neoplasia/patologia , Estudos Retrospectivos , Resultado do TratamentoRESUMO
The increased use of abdominal cross-sectional imaging has contributed to a greater detection of incidental small renal masses. Treatment options for localized disease renal cell carcinoma include radical nephrectomy or partial nephrectomy (PN), the former being preferred for treatment of early-stage tumors. The most adopted technique for follow-up imaging is contrast-enhanced computed tomography (CT), whose findings can cause uncertainty and unnecessary repetition of examinations. Our purpose is to describe CT findings after PN and to describe evolution in time of such images.
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Carcinoma de Células Renais/cirurgia , Neoplasias Renais/cirurgia , Néfrons/diagnóstico por imagem , Tratamentos com Preservação do Órgão/métodos , Complicações Pós-Operatórias/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Carcinoma de Células Renais/diagnóstico por imagem , Meios de Contraste , Humanos , Intensificação de Imagem RadiográficaRESUMO
OBJECTIVES: To show the wide spectrum of computed tomography (CT) findings in blunt renal trauma and to correlate them with consequent therapeutic implications. METHODS: This article is the result of a literature review and our personal experience in a level II trauma centre. Here we describe, discuss and illustrate the possible CT findings in blunt renal trauma, and we correlate them with the American Association for the Surgery of Trauma (AAST) classification and their therapeutic implications. RESULTS: CT findings following blunt renal trauma can be grouped into 15 main categories, 12 of them directly correlated with the AAST classification and 3 of them not mentioned in it. Non-operative management, which includes the "watchful waiting" approach, endourological treatments and endovascular treatments, is nowadays widely adopted in blunt renal trauma, and surgery is limited to haemodynamically unstable patients and a minority of haemodynamically stable patients. CONCLUSIONS: The interpretation of CT findings in blunt renal trauma may be improved and made faster by the knowledge of their therapeutic consequences. TEACHING POINTS: ⢠The majority of blunt renal injuries do not require surgical treatment. ⢠CT findings in blunt renal injury must be evaluated considering their therapeutic consequences. ⢠Some CT findings in blunt renal trauma are not included in the AAST classification.
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PURPOSE: To predict biochemical recurrence respecting the natural course of pT2 prostate cancer with positive surgical margin (R1) and no adjuvant/neoadjuvant therapy. METHODS: A multicenter data analysis of 956 patients with pT2R1N0/Nx tumors was performed. Patients underwent radical prostatectomy between 1994 and 2009. No patients received neoadjuvant or adjuvant therapy. All prostate specimens were re-evaluated according to a well-defined protocol. The association of pathological and clinical features, in regard to BCR, was calculated using various statistical tests. RESULTS: With a mean follow-up of 48 months, BCR was found in 25.4 %. In univariate analysis, multiple parameters such as tumor volume, PSA, Gleason at positive margin were significantly associated with BCR. However, in multivariate analysis, Gleason score (GS) of the prostatectomy specimen was the only significant parameter for BCR. Median time to recurrence for GS ≤ 6 was not reached; 5-year BCR-free survival was 82 %; and they were 127 months and 72 % for GS 3+4, 56 months and 54 % for GS 4 + 3, and 27 months and 32 % for GS 8-10. The retrospective approach is a limitation of our study. CONCLUSIONS: Our study provides data on the BCR in pT2R1-PCa without adjuvant/neoadjuvant therapy and thus a rationale for an individual's risk stratification. The data support patients and physicians in estimating the individual risk and timing of BCR and thus serve to personalize the management in pT2R1-PCa.
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Calicreínas/sangue , Recidiva Local de Neoplasia/sangue , Recidiva Local de Neoplasia/diagnóstico , Antígeno Prostático Específico/sangue , Prostatectomia , Neoplasias da Próstata/sangue , Neoplasias da Próstata/cirurgia , Adulto , Idoso , Humanos , Masculino , Pessoa de Meia-Idade , Gradação de Tumores , Estadiamento de Neoplasias , Neoplasia Residual , Neoplasias da Próstata/patologia , Estudos Retrospectivos , Resultado do TratamentoRESUMO
BACKGROUND: Benign prostate syndrome (BPS) is a common phenomenon in the aging male. Transurethral resection of the prostate (TURP) remains the international standard of care for -patients requiring surgical intervention for BPS. Although the voiding improvement following TURP is well-documented, controversy exists regarding its effect on post-operative sexual function. In this study we investigated the possible influence of individual surgeons on clinical voiding parameters and post-operative sexual function after TURP. PATIENTS/MATERIALS AND METHODS: We analyzed 123 patients with a mean age of 70 years (46-88 years) who had undergone TURP secondary to BPS. To evaluate the clinical parameters, patients completed the IPSS and IIEF-15 questionnaires preoperatively and 1 year postoperatively. Additional parameters including urinary flow and post voiding residual volume were also collected. RESULTS: A statistically significant improvement in voiding function was noted postoperatively. The mean IPSS improved from 19.35 to 6.49 (p<0.05). Objective flow parameters also improved; Qmax 10.43-19.46 mL/s (p<0.05) and residual volume 95-11 mL (p<0.05). The mean pre-operative prostate volume was 41.8 cm³. The mean resected tissue weight was 21.1 g. The pa-tients showed no significant change in the frequency of their sexual activity following TURP, however IIEF-15 sexual function and erectile function scores declined mildly. This was statistically significant with pre-op IIEF-15=30.52 and post-op 26.24 (p<0.05). Comparing individual surgeons, no statistically significant difference was noted in IPSS and IIEF-15 functional outcome scores. Although significant differences existed in the total amount of resected tissue, the percentage of resected adenoma in relation to total prostate volume was not statistically significant. CONCLUSION: Overall, IPSS scores improved significantly following TURP and sexual function scored declined mildly. We detected no influence between surgeons on clinical voiding parameters and postoperative sexual function after TURP using the IPSS and IIEF-15 questionnaires.
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Competência Clínica , Disfunção Erétil/etiologia , Complicações Pós-Operatórias/etiologia , Hiperplasia Prostática/cirurgia , Ressecção Transuretral da Próstata/métodos , Retenção Urinária/etiologia , Idoso , Idoso de 80 Anos ou mais , Disfunção Erétil/prevenção & controle , Feminino , Seguimentos , Alemanha , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/prevenção & controle , Qualidade de Vida , Inquéritos e Questionários , Retenção Urinária/prevenção & controle , UrodinâmicaRESUMO
BACKGROUND: The European Organization for Research and Treatment of Cancer (EORTC) risk tables and the Spanish Urological Club for Oncological Treatment (CUETO) scoring model are the two best-established predictive tools to help decision making for patients with non-muscle-invasive bladder cancer (NMIBC). The aim of the current study was to assess the performance of these predictive tools in a large multicentre cohort of NMIBC patients. METHODS: We performed a retrospective analysis of 4689 patients with NMIBC. To evaluate the discrimination of the models, we created Cox proportional hazard regression models for time to disease recurrence and progression. We incorporated the patients calculated risk score as a predictor into both of these models and then calculated their discrimination (concordance indexes). We compared the concordance index of our models with the concordance index reported for the models. RESULTS: With a median follow-up of 57 months, 2110 patients experienced disease recurrence and 591 patients experienced disease progression. Both tools exhibited a poor discrimination for disease recurrence and progression (0.597 and 0.662, and 0.523 and 0.616, respectively, for the EORTC and CUETO models). The EORTC tables overestimated the risk of disease recurrence and progression in high-risk patients. The discrimination of the EORTC tables was even lower in the subgroup of patients treated with BCG (0.554 and 0.576 for disease recurrence and progression, respectively). Conversely, the discrimination of the CUETO model increased in BCG-treated patients (0.597 and 0.645 for disease recurrence and progression, respectively). However, both models overestimated the risk of disease progression in high-risk patients. CONCLUSION: The EORTC risk tables and the CUETO scoring system exhibit a poor discrimination for both disease recurrence and progression in NMIBC patients. These models overestimated the risk of disease recurrence and progression in high-risk patients. These overestimations remained in BCG-treated patients, especially for the EORTC tables. These results underline the need for improving our current predictive tools. However, our study is limited by its retrospective and multi-institutional design.
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Neoplasias da Bexiga Urinária/patologia , Idoso , Estudos de Coortes , Progressão da Doença , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Invasividade Neoplásica , Recidiva Local de Neoplasia/patologia , Ensaios Clínicos Controlados Aleatórios como Assunto , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Resultado do Tratamento , Neoplasias da Bexiga Urinária/tratamento farmacológico , Urotélio/patologiaRESUMO
INTRODUCTION: The aim of the study was to assess the strength of the online tool RiskCheck Bladder Cancer©, version 5.0 (RCBC) for early detection of bladder cancer (BC). MATERIALS AND METHODS: RCBC was evaluated retrospectively based on the data of 241 patients, of which 141 were suffering from BC. Statistical analysis was performed by descriptive statistics, nonparametric group comparison, classification tree analysis and ROC analysis. RESULTS: ROC analysis of the risk classification showed a sensitivity of 71.6%, a specificity of 56.5%, a positive predictive value of 67.8%, a negative predictive value of 52% and an accuracy of 63.5%. BC risk factors ranked by importance are time of smoking (p < 0.0001), gender (within the nonsmoking group: p < 0.009), occupational toxin exposure (within the group <35 years of smoking: p < 0.048) and amount of consumed cigarettes resulting in a 95% association with BC (within the group >35 years of smoking: p < 0.0001). CONCLUSIONS: The high predictive power of RCBC for the identification of asymptomatic patients living under risk could be demonstrated.
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Diagnóstico por Computador/métodos , Detecção Precoce de Câncer/métodos , Neoplasias da Bexiga Urinária/diagnóstico , Idoso , Idoso de 80 Anos ou mais , Algoritmos , Feminino , Humanos , Internet , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Valor Preditivo dos Testes , Curva ROC , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Sensibilidade e Especificidade , Fatores Sexuais , Fumar/efeitos adversos , SoftwareRESUMO
Henoch-Schönlein purpura (HSP) is the most common form of an immunological systemic vasculitis of childhood. The classic clinical symptoms include purpuric rash, abdominal pain, arthralgias, and haematuria, but the spectrum of HSP may vary to very rare forms. This article reports on an 8-year-old girl with a Henoch-Schönlein purpura (HSP) which resulted in an obstructive bladder mass and subsequent urinary retention. This is the first case reported in the literature, describing such a course.
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Vasculite por IgA/complicações , Vasculite por IgA/diagnóstico , Doenças da Bexiga Urinária/diagnóstico , Doenças da Bexiga Urinária/etiologia , Obstrução do Colo da Bexiga Urinária/diagnóstico , Obstrução do Colo da Bexiga Urinária/etiologia , Retenção Urinária/diagnóstico , Retenção Urinária/etiologia , Biópsia , Criança , Cistite/diagnóstico , Cistite/etiologia , Cistite/patologia , Cistoscopia , Diagnóstico Diferencial , Feminino , Hematúria/diagnóstico , Hematúria/etiologia , Hematúria/patologia , Humanos , Vasculite por IgA/patologia , Bexiga Urinária/patologia , Doenças da Bexiga Urinária/patologia , Obstrução do Colo da Bexiga Urinária/patologia , Retenção Urinária/patologiaRESUMO
The use of oral mucosa for urethral stricture repair has become the standard approach in reconstructive urethral surgery. Compared to other tissues oral mucosa shows several advantages, such as simple harvesting, good urine tolerance and low harvesting morbidity. For defects of the male bulbar urethra measuring 2 cm or longer, urethral reconstruction with oral mucosa is the procedure of choice. The oral mucosa graft can be used as an inlay or as an onlay graft. Most repairs can be completed in one stage but for complex strictures two stages are needed.
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Mucosa Bucal/transplante , Procedimentos de Cirurgia Plástica/métodos , Estreitamento Uretral/patologia , Estreitamento Uretral/cirurgia , Procedimentos Cirúrgicos Urológicos Masculinos/métodos , Humanos , MasculinoRESUMO
OBJECTIVE: A second transurethral resection of the bladder (TURB) is recommended for high-grade bladder cancer (BC) yet yields negative results in over half of the cases. Aim of this study was to identify prognostic indicators of a positive second TURB or the need for a subsequent cystectomy. MATERIALS AND METHODS: The study cohort consisted of 101 patients with high-risk BC (T1G2-3, TaG3, Carcinoma in situ) who underwent second TURB after complete first resection. Age, gender, stage, grade, carcinoma in situ (Cis), tumour number, size, localization, surgeon experience and bladder wash cytology before the second TURB were considered as potential prognostic factors of positive histology at second TURB or the need for subsequent cystectomy. RESULTS: The mean follow-up period was 23.8 months. The study cohort was comprised of 82 males and 17 females. Cytology on bladder wash urine was performed in 85/101 patients and in 39 was negative; 55.5 % of second TURB specimens were negative. The rate of upstaging to ≥T2 was 4.9 %. Cis (OR 8.4; 95 % CI 1.3-54.2; p = 0.03) and positive cytology (OR 6.8; 95 % CI 2.3-19.9; p = <0.01) were independent prognostic factors of a residual tumour in the second TURB. Cytology also correlated with clinical need for cystectomy in the follow-up (HR 6.5; 95 % CI 1.3-30.5; p = 0.02). CONCLUSIONS: CIS and positive cytology prior to second TURB increased the risk of a positive second TURB specimen. A positive cytology also increases the risk of the subsequent need for cystectomy.
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Carcinoma in Situ/diagnóstico , Carcinoma in Situ/cirurgia , Carcinoma de Células de Transição/patologia , Carcinoma de Células de Transição/cirurgia , Neoplasias da Bexiga Urinária/diagnóstico , Neoplasias da Bexiga Urinária/cirurgia , Urina/citologia , Urotélio/patologia , Idoso , Idoso de 80 Anos ou mais , Carcinoma in Situ/patologia , Estudos de Coortes , Cistectomia , Citodiagnóstico , Feminino , Seguimentos , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Neoplasia Residual , Prognóstico , Estudos Prospectivos , Fatores de Risco , Sensibilidade e Especificidade , Ressecção Transuretral da Próstata , Neoplasias da Bexiga Urinária/patologiaRESUMO
BACKGROUND: In pT1-T3N0 urothelial carcinoma of the bladder (UCB) patients, multi-modal therapy is inconsistently recommended. The aim of the study was to develop a prognostic tool to help decision-making regarding adjuvant therapy. METHODS: We included 2145 patients with pT1-3N0 UCB after radical cystectomy (RC), naive of neoadjuvant or adjuvant therapy. The cohort was randomly split into development cohort based on the US patients (n=1067) and validation cohort based on the Europe patients (n=1078). Predictive accuracy was quantified using the concordance index. RESULTS: With a median follow-up of 45 months, 5-year recurrence-free and cancer-specific survival estimates were 68% and 73%, respectively. pT-stage, ge, lymphovascular invasion, and positive margin were significantly associated with both disease recurrence and cancer-specific mortality (P-values ≤ 0.005). The accuracies of the multivariable models at 2, 5, and 7 years for predicting disease recurrence were 67.4%, 65%, and 64.4%, respectively. Accuracies at 2, 5, and 7 years for predicting cancer-specific mortality were 69.3%, 66.4%, and 65.5%, respectively. We developed competing-risk, conditional probability nomograms. External validation revealed minor overestimation. CONCLUSION: Despite RC, a significant number of patients with pT1-3N0 UCB experience disease recurrence and ultimately die of UCB. We developed and externally validated competing-risk, conditional probability post-RC nomograms for prediction of disease recurrence and cancer-specific mortality.