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1.
Transplant Proc ; 51(6): 1773-1778, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31255355

RESUMO

INTRODUCTION: Accepting donors with renal lesion amenable for pre-transplant management with no suspected long-term harm seems to expand the live-donor pool. We aimed to assess the long-term outcome of live-donor renal transplantation with incidentally discovered renal angiomyolipoma (AML) during routine evaluation of donors. PATIENTS AND METHODS: A retrospective evaluation of incidentally discovered AML, during live-related-donor evaluation, was performed. The tumor criteria were retrieved. In cases with exophytic tumor, a back-table, partial nephrectomy was done with frozen section to exclude malignancy. Endophytic lesions were kept in situ and transplanted. Both donor and recipient were followed up by periodic imaging. RESULTS: Among 2925 cases, 6 AML with a median volume of 0.96 (range, 0.5-2) cm2 were identified. The median recipients' age was 21 (range, 10-38) years and the median donors' age was 48 (range, 45-50). Two AML were exophytic and back-table partial nephrectomy was performed, while 4 were endophytic and kept in situ, and the kidney was transplanted. After a median follow-up of 82 (range, 25-150) months, 4 patients were alive with functioning grafts and 2 resumed hemodialysis 5 and 7 years after transplantation. There was no evidence of increase in the AML size or newly developed AML in the grafts. All donors were alive with normal renal function (mean ± standard deviation, serum creatinine was 0.9 ± 0.2 mg/dL) and none developed new AML in the remaining kidney. CONCLUSION: Incidentally discovered AML during live-donor evaluation is not a contraindication of donation after proper counseling of the couples and regular, periodic follow-up.


Assuntos
Angiomiolipoma/diagnóstico , Seleção do Doador , Neoplasias Renais/diagnóstico , Transplante de Rim/efeitos adversos , Nefrectomia/efeitos adversos , Coleta de Tecidos e Órgãos/efeitos adversos , Adolescente , Adulto , Idoso , Criança , Contraindicações de Procedimentos , Feminino , Humanos , Achados Incidentais , Rim/cirurgia , Transplante de Rim/métodos , Doadores Vivos , Masculino , Pessoa de Meia-Idade , Nefrectomia/métodos , Estudos Retrospectivos , Coleta de Tecidos e Órgãos/métodos , Transplantes/cirurgia , Resultado do Tratamento , Adulto Jovem
2.
BJU Int ; 2019 Apr 04.
Artigo em Inglês | MEDLINE | ID: mdl-30946525

RESUMO

OBJECTIVES: To assess the effect of tolterodine in the treatment of nocturnal urinary incontinence (NUI) after ileal orthotopic neobladder (ONB). PATIENTS AND METHODS: This is a prospective randomised placebo-controlled crossover study (clinicaltrials.gov: NCT02877901). Patients with NUI after ONB were randomly allocated into two equal groups. Group T received 4 mg extended-release tolterodine at bed-time and Group P received placebo for 4 weeks followed by 2 weeks of washout, then crossed over to the alternate therapy for 4 weeks. Patients were assessed by the number of pads used per night (PPN) and with the Arabic version of the International Consultation on Incontinence Modular Questionnaire-Short Form (ICIQ-SF) at both phases of the study. The outcomes were the rate of NUI improvement and medication adverse events. RESULTS: Out of 172 patients, 150 and 122 patients were evaluated at both phases of the study. The mean ICIQ-SF scores and PPN were significantly decreased in Group T compared to Group P in both study phases (P < 0.001). In Group T, 15 (10%) and 11 (9%) patients became dry after the first allocation and crossover, respectively. In Group T, 60 (77.9%) patients reported improvement vs four (5.5%) in Group P (P < 0.001) after the first allocation. Similarly, 46 (73%) and seven (11.9%) patients showed improvement in groups T and P after the crossover, respectively (P < 0.001). Dry mouth occurred in 31 (20.8%) patients. CONCLUSIONS: Tolterodine seems to be a good choice for treatment of NUI after radical cystectomy and ONB. However, further studies are needed to delineate the long-term effects and the associated urodynamic characteristics.

3.
Urol Oncol ; 37(3): 179.e9-179.e18, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30448030

RESUMO

PURPOSE: We aimed at this study to test the value of immediate postoperative intravesical epirubicin instillation in intermediate and high-risk non-muscle-invasive bladder cancer patients. MATERIALS AND METHODS: After approval of Institutional Review Board, 260 patients were randomly allocated into 2 groups, including transurethral resection of bladder tumor (TURBT) alone in control group and TURBT plus immediate postoperative epirubicin (50 mg) in test group. Patients were monitored for postoperative complications. Adjuvant instillation therapy was administered according to risk categorization. Patients were followed every 3 months by cystourethroscopy and urine cytology. The primary end points were recurrence, progression, and/or death from cancer. RESULTS: Of the 260 patients, 236 were eligible and followed for a mean of 29 months. The 2 study groups were comparable regarding perioperative baseline demographic criteria. There was no statistically significant difference between the 2 groups regarding recurrence rate (27.1% vs. 26.2%), interval to first recurrence (16.3 ± 6.6 vs. 16.4 ± 6.4 months) or progression rate to muscle invasion (8.5% vs. 5.9%). Site, size, and number of recurrences were also comparable between the 2 groups. Recurrences and progression-free survival were comparable between the 2 groups (Log-rank P = 0.88 and 0.47, respectively). Postoperative complications were all low-grade according to modified Dindo-Clavian system, with no significant difference in their rate between the 2 groups. CONCLUSIONS: Immediate post-TURBT epirubicin instillation is ineffective in intermediate and high-risk non-muscle-invasive bladder cancer. It neither prolongs time to recurrence and/or progression nor reduces number of recurrences. We advocate strict specification of patient and tumor criteria in which immediate instillation is indicated.

4.
Urol Oncol ; 36(1): 10.e7-10.e14, 2018 01.
Artigo em Inglês | MEDLINE | ID: mdl-29055518

RESUMO

BACKGROUND: To evaluate the impact of salvage therapy (ST) on overall survival (OS) in recurrent primary urethral cancer (PUC). PATIENTS: A series of 139 patients (96 men, 43 women; median age = 66, interquartile range: 57-77) were diagnosed with PUC at 10 referral centers between 1993 and 2012. The modality of ST of recurrence (salvage surgery vs. radiotherapy) was recorded. Kaplan-Meier analysis with log-rank was used to estimate the impact of ST on OS (median follow-up = 21, interquartile range: 5-48). RESULTS: The 3-year OS for patients free of any recurrence (I), with solitary or concomitant urethral recurrence (II), and nonurethral recurrence (III) was 86.5%, 74.5%, and 48.2%, respectively (P = 0.002 for I vs. III and II vs. III; P = 0.55 for I vs. II). In the 80 patients with recurrences, the modality of primary treatment of recurrence was salvage surgery in 30 (37.5%), salvage radiotherapy (RT) in 8 (10.0%), and salvage surgery plus RT in 5 (6.3%) whereas 37 patients did not receive ST for recurrence (46.3%). In patients with recurrences, those who underwent salvage surgery or RT-based ST had similar 3-year OS (84.9%, 71.6%) compared to patients without recurrence (86.7%, P = 0.65), and exhibited superior 3-year OS compared to patients who did not undergo ST (38.0%, P<0.001 compared to surgery, P = 0.045 to RT-based ST, P = 0.29 for surgery vs. RT-based ST). CONCLUSIONS: In this study, patients who underwent ST for recurrent PUC demonstrated improved OS compared to those who did not receive ST and exhibited similar survival to those who never developed recurrence after primary treatment.


Assuntos
Terapia de Salvação/métodos , Neoplasias Uretrais/radioterapia , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/patologia , Prognóstico , Taxa de Sobrevida , Neoplasias Uretrais/mortalidade , Neoplasias Uretrais/patologia
5.
Arab J Urol ; 15(2): 110-114, 2017 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-29071139

RESUMO

OBJECTIVES: To validate the Arabic version of the Functional Assessment of Cancer Therapy-Bladder (FACT-Bl) questionnaire in Egyptian patients who underwent radical cystectomy (RC) and orthotopic neobladder (ONB) construction. PATIENTS SUBJECTS AND METHODS: The English version of the FACT-Bl was translated into the Arabic language using multi-step process by two urologist and two independent translators. The Arabic version was validated by inviting 90 patients who underwent RC and ONB and 72 normal individuals to complete the questionnaire. The reliability of the questionnaire was tested for internal consistency using the Cronbach's α test. Inter-domain association was tested by Spearman's correlation coefficient. The discrimination validity was measured by comparing the scores in RC patients and in normal individuals using the Mann-Whitney U-test and independent sample t-test. RESULTS: Internal consistency was high for all domains. There was high correlation between all domains. This high internal consistency and good correlation was maintained when assessment included patients with <7.5 and those with ≥7.5 years follow-up. Discrimination validation was confirmed by the statistically significant lower scores of all domains in the studied patients in comparison to the controls. CONCLUSION: The Arabic version of the FACT-Bl is a reliable and validated instrument that can be used to evaluate health-related quality of life in patients after RC and ONB.

6.
Urology ; 110: 98-103, 2017 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-28893633

RESUMO

OBJECTIVE: To compare recovery outcomes between laparoscopic donor nephrectomy (LDN) and open donor nephrectomy within a specified enhanced recovery program (ERP) for left kidney donations. PATIENTS AND METHODS: A phase III randomized trial was conducted between January 2013 and June 2015; eligible left-side donors were randomized to laparoscopic or open donor nephrectomy in a 1:1 ratio with recovery optimized within a standardized ERP. The primary outcome was patient-reported measure of physical fatigue, as measured by the physical fatigue domain of the translated Multidimensional Fatigue Inventory 20. Secondary outcomes included other donor recovery outcomes, postoperative pain scores, hospital stay, perioperative complications, and graft outcomes. RESULTS: A total of 224 donors (laparoscopy, n = 113; open surgery, n = 111) were randomly allocated. Six weeks postoperatively, physical fatigue domain scores in Multidimensional Fatigue Inventory 20 were significantly lower in the LDN group (mean: laparoscopy, 8.2 ± 3.2 vs open surgery, 13.05 ± 2.9) (P = .007). Median total hospital stay was also significantly shorter in the LDN group (median: laparoscopy, 2; interquartile range, 1-5 vs open surgery, 4; interquartile range, 2-9 days) (P = .002). LDN was associated with less pain scores and less non-opioid analgesic requirements. Warm ischemia times were not significantly different in both groups (mean: laparoscopy, 2.5 ± 0.8 vs open surgery, 2.2 ± 0.6) (P = .431). CONCLUSION: Even when optimized within an ERP, LDN was associated with less general and physical fatigue and better physical function at 6 weeks postoperatively when compared with open surgery for left kidney donations.


Assuntos
Transplante de Rim , Laparoscopia , Nefrectomia , Coleta de Tecidos e Órgãos/métodos , Humanos , Complicações Pós-Operatórias/epidemiologia , Recuperação de Função Fisiológica
7.
Urol Oncol ; 35(12): 671.e11-671.e16, 2017 12.
Artigo em Inglês | MEDLINE | ID: mdl-28843339

RESUMO

PURPOSE: To investigate the long-term cumulative incidence of chronic urinary retention (CUR) after radical cystectomy (RC) and orthotopic neobladder (ONB) in women and the possible risk factors. MATERIAL AND METHODS: We retrospectively analyzed a prospectively evaluated cohort of women for whom RC and ONB were performed. Patients in CUR were evaluated for the cumulative incidence of CUR using Kaplan-Meier curve and for the possible risk factors using log rank and Cox regression analysis. RESULTS: A total of 234 women with mean age ± SD of 52.3 ± 9 years and a median (range) of follow-up of 92 (12-247) months were included. The incidence of CUR increased with time, where 12 (5.2%), 21 (8.97%), 35 (14.9%), 53 (22.6%), and 56 (24%) patients started clean intermittent catheterization in 1, 2, 2 to 5 years, 5 to 10 years, and after 10 years of follow-up, respectively. In univariate and multivariate analysis, diabetes mellitus and urethral Kock pouch were independent predictors of CUR development (HR [95% CI] = 2.45 [1.2-5.1], and 2.1 [1.05-4.2], P = 0.01 and 0.03, respectively). Genital- sparing RC and surgical modification to provide pouch back support were independent factors that reduce CUR development (HR [95% CI] = 9.3 [1.25-69.9], and 2.1 [1.19-3.9], P = 0.02 and 0.01, respectively). CONCLUSION: The incidence of CUR after RC and ONB in women increases with time even after 10 years of follow-up. Presence of diabetes mellitus increases the risk of CUR development. Genital-sparing RC and modification to prevent CUR reduced the likelihood of CUR development.


Assuntos
Cistectomia/métodos , Neoplasias da Bexiga Urinária/cirurgia , Derivação Urinária/métodos , Coletores de Urina , Retenção Urinária/diagnóstico , Adulto , Doença Crônica , Cistectomia/efeitos adversos , Feminino , Humanos , Estimativa de Kaplan-Meier , Pessoa de Meia-Idade , /estatística & dados numéricos , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Derivação Urinária/efeitos adversos , Retenção Urinária/etiologia
8.
Int Urol Nephrol ; 49(8): 1327-1334, 2017 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-28501912

RESUMO

PURPOSE: To evaluate the long-term renal function outcome of management of retroperitoneal fibrosis (RPF)-induced ureteral obstruction. METHODS: Thirty-six patients with idiopathic RPF-induced ureteral obstruction were classified according to the management type into two groups, group A; managed by indwelling JJ stent and group B managed by ureterolysis and omental wrapping (UOR). The primary outcome was to define the long-term outcome of management on RF. It was evaluated by changes in serum creatinine and estimated GFR (eGFR) using Modification of Diet in Renal Disease equation where 20% changes in eGFR is considered significant. The second outcome is to compare the outcomes between both groups. RESULTS: After 27.5 (1-124) months, median (range) follow-up, median (range) serum creatinine increased significantly from 1.5 (0.8-8.1) to 1.6 (1-12.1) mg/dl (p value =0.04) and eGFR showed non-statistical significant reduction from 43 (5-110) to 41 (5-88) ml/min/1.73 m2 (p value =0.3). Eight (22.2%), 12 (34.4%) and 16 (44.4%) patients showed stable, increased and decreased eGFR. Group A showed statistically significant increased serum creatinine and insignificant decreased eGFR (p value =0.04 and 0.09), while group B showed statistically insignificant changes in serum creatinine and eGFR (p value =0.5 and 0.9). In group B, nine (21.4%) renal units are still harboring JJ stents. CONCLUSION: For idiopathic RPF, UOR avoided indwelling ureteral stents in 78.6% of renal units with apparent better long-term renal function outcome.


Assuntos
Fibrose Retroperitoneal/complicações , Stents , Obstrução Ureteral/fisiopatologia , Obstrução Ureteral/cirurgia , Adulto , Creatinina/sangue , Feminino , Seguimentos , Taxa de Filtração Glomerular , Humanos , Masculino , Pessoa de Meia-Idade , Insuficiência Renal Crônica/etiologia , Estudos Retrospectivos , Fatores de Tempo , Obstrução Ureteral/etiologia
9.
Minerva Urol Nefrol ; 69(3): 262-270, 2017 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-27681660

RESUMO

BACKGROUND: Enough data about health related quality of life (HRQOL) after radical cystectomy (RC) and urinary diversion (UD) in women is still lacking. The objectives are to evaluate HRQOL in women after RC and orthotopic neobladder (ONB) versus ileal loop conduit (IC) and to assess the impact of urinary continence. METHODS: The study included 145 women who underwent RC and came for routine follow-up. HRQOL was assessed by two questionnaires (EORTC-QLQ-C30and FACT-Bl). ONB group was stratified to: totally continent, with nocturnal incontinence (NI) and patients in chronic urinary retention (CUR) and maintained on CIC. The orthotopic group (as a whole and its 3 subgroups) was compared to IC. RESULTS: ONB group included 22 continent women, 35 with NI and 27 in CUR and on CIC. There were no statistically significant differences between ONB and IC groups in all domains of the two questionnaires. However, continent women showed statistically significant better most of EORTC-QLQ-C30 scales and emotional well-being, functional well-being, bladder cancer subscale and FACT-Bl total Score (P˂0.05) than IC group. Similarly, women in CUR showed statistically significant better global health and physical functioning EORTC-QLQ-C30 scores (P values=0.0001, 0.01) and all domains of FACT-Bl. On the other hand, women with NI showed statistically significant lower values in all domains of the EORTC-QLQ-C30 and FACT-Bl than IC group. CONCLUSIONS: In women, HRQOL is better after ONB than IC as long as continence status is preserved. If incontinence is expected, IC may be a better option for UD.


Assuntos
Cistectomia/métodos , Enurese Noturna/fisiopatologia , Cistectomia/efeitos adversos , Feminino , Humanos , Pessoa de Meia-Idade , Qualidade de Vida , Resultado do Tratamento , Derivação Urinária/efeitos adversos , Derivação Urinária/métodos , Retenção Urinária/fisiopatologia
10.
Urol Int ; 97(2): 134-41, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27462702

RESUMO

INTRODUCTION: The study aimed to investigate oncological outcomes of patients with concomitant bladder cancer (BC) and urethral carcinoma. METHODS: This is a multicenter series of 110 patients (74 men, 36 women) diagnosed with urethral carcinoma at 10 referral centers between 1993 and 2012. Kaplan-Meier analysis was used to investigate the impact of BC on survival, and Cox regression multivariable analysis was performed to identify predictors of recurrence. RESULTS: Synchronous BC was diagnosed in 13 (12%) patients, and the median follow-up was 21 months (interquartile range 4-48). Urethral cancers were of higher grade in patients with synchronous BC compared to patients with non-synchronous BC (p = 0.020). Patients with synchronous BC exhibited significantly inferior 3-year recurrence-free survival (RFS) compared to patients with non-synchronous BC (63.2 vs. 34.4%; p = 0.026). In multivariable analysis, inferior RFS was associated with clinically advanced nodal stage (p < 0.001), proximal tumor location (p < 0.001) and synchronous BC (p = 0.020). CONCLUSION: The synchronous presence of BC in patients diagnosed with urethral carcinoma has a significant adverse impact on RFS and should be an impetus for a multimodal approach.


Assuntos
Neoplasias Primárias Múltiplas , Neoplasias Uretrais , Neoplasias da Bexiga Urinária , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias Primárias Múltiplas/diagnóstico , Neoplasias Primárias Múltiplas/mortalidade , Neoplasias Primárias Múltiplas/terapia , Prognóstico , Estudos Retrospectivos , Resultado do Tratamento , Neoplasias Uretrais/diagnóstico , Neoplasias Uretrais/mortalidade , Neoplasias Uretrais/terapia , Neoplasias da Bexiga Urinária/diagnóstico , Neoplasias da Bexiga Urinária/mortalidade , Neoplasias da Bexiga Urinária/terapia
11.
Biol Trace Elem Res ; 174(2): 280-286, 2016 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-27147435

RESUMO

The role of heavy metals and trace elements (HMTE) in the development of some cancers has been previously reported. Bladder carcinoma is a frequent malignancy of the urinary tract. The most common risk factors for bladder cancer are exposure to industrial carcinogens, cigarette smoking, gender, and possibly diet. The aim of this study was to evaluate HTME concentrations in the cancerous and adjacent non-cancerous tissues and compare them with those of normal cadaveric bladder. This prospective study included 102 paired samples of full-thickness cancer and adjacent non-cancerous bladder tissues of radical cystectomy (RC) specimens that were histologically proven as invasive bladder cancer (MIBC). We used 17 matched controls of non-malignant bladder tissue samples from cadavers. All samples were processed and evaluated for the concentration of 22 HMTE by using Inductively Coupled Plasma Optical Emission Spectrometry (ICP-OES). Outcome analysis was made by the Mann-Whitney U, chi-square, Kruskal-Wallis, and Wilcoxon signed ranks tests. When compared with cadaveric control or cancerous, the adjacent non-cancerous tissue had higher levels of six elements (arsenic, lead, selenium, strontium, zinc, and aluminum), and when compared with the control alone, it had a higher concentration of calcium, cadmium, chromium, potassium, magnesium, and nickel. The cancerous tissue had a higher concentration of cadmium, lead, chromium, calcium, potassium, phosphorous, magnesium, nickel, selenium, strontium, and zinc than cadaveric control. Boron level was higher in cadaveric control than cancerous and adjacent non-cancerous tissue. Cadmium level was higher in cancerous tissue with node-positive than node-negative cases. The high concentrations of cadmium, lead, chromium, nickel, and zinc, in the cancerous together with arsenic in the adjacent non-cancerous tissues of RC specimens suggest a pathogenic role of these elements in BC. However, further work-up is needed to support this conclusion by the application of these HMTE on BC cell lines.


Assuntos
Metais Pesados/metabolismo , Oligoelementos/metabolismo , Neoplasias da Bexiga Urinária/metabolismo , Bexiga Urinária/metabolismo , Idoso , Cadáver , Linhagem Celular Tumoral , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Bexiga Urinária/patologia , Neoplasias da Bexiga Urinária/patologia , Neoplasias da Bexiga Urinária/terapia
12.
J Urol ; 196(3): 757-62, 2016 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-27063853

RESUMO

PURPOSE: We performed a prospective comparison of the use of twinkling color Doppler ultrasound and noncontrast computerized tomography in the diagnosis of renal colic in emergency room patients. MATERIALS AND METHODS: A total of 815 consecutive adult patients with suspected renal colic presented to the emergency room and were evaluated immediately with color Doppler ultrasound and noncontrast computerized tomography. The site, side and maximum transverse diameter of the stones were assessed. The patients were followed for 4 to 8 weeks. RESULTS: Of 815 patients 723 (88.72%) had ureteral stones, 60 (7.36%) had kidney stones and 32 (3.93%) had pain from extra-urinary causes. Mean patient age was 37.17±11 years. Of the 723 patients with ureteral stones 619 (85.6%) were male and 104 (14.4%) were female. The stones were located on the right side in 340 (47%) patients and on the left side in 383 (53%). Color Doppler ultrasound successfully identified the stones in 702 (97.1%) patients and failed in 21 (2.9%). Noncontrast computerized tomography confirmed stones in 720 (99.6%) patients and was negative in 3 (0.4%). The diagnosis was 166 (23%) upper ureter stones, 63 (8.7%) in the middle and 494 (68.3%) in the lower ureter. The color Doppler ultrasound results were significantly affected by the stone site and maximum transverse diameter (p = 0.03 and 0.007, respectively). CONCLUSIONS: The initial use of color Doppler ultrasound in the emergency room has led to the diagnosis and characterization of ureteral stones in the majority of patients. Color Doppler ultrasound results were comparable to those of the concomitant use of noncontrast computerized tomography. Therefore, color Doppler ultrasound can replace noncontrast computerized tomography in the emergency room.


Assuntos
Cálculos Renais/complicações , Rim/diagnóstico por imagem , Cólica Renal/diagnóstico , Tomografia Computadorizada por Raios X/métodos , Ultrassonografia Doppler em Cores/métodos , Ureter/diagnóstico por imagem , Cálculos Ureterais/complicações , Adulto , Diagnóstico Diferencial , Feminino , Seguimentos , Humanos , Cálculos Renais/diagnóstico , Masculino , Medição da Dor/métodos , Estudos Prospectivos , Cólica Renal/etiologia , Reprodutibilidade dos Testes , Cálculos Ureterais/diagnóstico
13.
World J Urol ; 34(1): 97-103, 2016 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-25981402

RESUMO

PURPOSE: To evaluate risk factors for survival in a large international cohort of patients with primary urethral cancer (PUC). METHODS: A series of 154 patients (109 men, 45 women) were diagnosed with PUC in ten referral centers between 1993 and 2012. Kaplan-Meier analysis with log-rank test was used to investigate various potential prognostic factors for recurrence-free (RFS) and overall survival (OS). Multivariate models were constructed to evaluate independent risk factors for recurrence and death. RESULTS: Median age at definitive treatment was 66 years (IQR 58-76). Histology was urothelial carcinoma in 72 (47 %), squamous cell carcinoma in 46 (30 %), adenocarcinoma in 17 (11 %), and mixed and other histology in 11 (7 %) and nine (6 %), respectively. A high degree of concordance between clinical and pathologic nodal staging (cN+/cN0 vs. pN+/pN0; p < 0.001) was noted. For clinical nodal staging, the corresponding sensitivity, specificity, and overall accuracy for predicting pathologic nodal stage were 92.8, 92.3, and 92.4 %, respectively. In multivariable Cox-regression analysis for patients staged cM0 at initial diagnosis, RFS was significantly associated with clinical nodal stage (p < 0.001), tumor location (p < 0.001), and age (p = 0.001), whereas clinical nodal stage was the only independent predictor for OS (p = 0.026). CONCLUSIONS: These data suggest that clinical nodal stage is a critical parameter for outcomes in PUC.


Assuntos
Adenocarcinoma/terapia , Carcinoma de Células Escamosas/terapia , Carcinoma de Células de Transição/terapia , Neoplasias Uretrais/terapia , Adenocarcinoma/mortalidade , Adenocarcinoma/patologia , Fatores Etários , Idoso , Carcinoma de Células Escamosas/mortalidade , Carcinoma de Células Escamosas/patologia , Carcinoma de Células de Transição/mortalidade , Carcinoma de Células de Transição/patologia , Estudos de Coortes , Intervalo Livre de Doença , Feminino , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Prognóstico , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Fatores de Risco , Taxa de Sobrevida , Neoplasias Uretrais/mortalidade , Neoplasias Uretrais/patologia
14.
Eur Urol ; 69(2): 231-44, 2016 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-26091833

RESUMO

CONTEXT: The European Association of Urology non-muscle-invasive bladder cancer (NMIBC) guidelines recommend that all low- and intermediate-risk patients receive a single immediate instillation of chemotherapy after transurethral resection of the bladder (TURB), but its use remains controversial. OBJECTIVE: To identify which NMIBC patients benefit from a single immediate instillation. EVIDENCE ACQUISITION: A systematic review and individual patient data (IPD) meta-analysis of randomized trials comparing the efficacy of a single instillation after TURB with TURB alone in NMIBC patients was carried out. EVIDENCE SYNTHESIS: A total of 13 eligible studies were identified. IPD were obtained for 11 studies randomizing 2278 eligible patients, 1161 to TURB and 1117 to a single instillation of epirubicin, mitomycin C, pirarubicin, or thiotepa. A total of 1128 recurrences, 108 progressions, and 460 deaths (59 due to bladder cancer [BCa]) occurred. A single instillation reduced the risk of recurrence by 35% (hazard ratio [HR]: 0.65; 95% confidence interval [CI], 0.58-0.74; p<0.001) and the 5-yr recurrence rate from 58.8% to 44.8%. The instillation did not reduce recurrences in patients with a prior recurrence rate of more than one recurrence per year or in patients with an European Organization for Research and Treatment of Cancer (EORTC) recurrence score ≥5. The instillation did not prolong either the time to progression or death from BCa, but it resulted in an increase in the overall risk of death (HR: 1.26; 95% CI, 1.05-1.51; p=0.015; 5-yr death rates 12.0% vs 11.2%), with the difference appearing in patients with an EORTC recurrence score ≥5. CONCLUSIONS: A single immediate instillation reduced the risk of recurrence, except in patients with a prior recurrence rate of more than one recurrence per year or an EORTC recurrence score ≥5. It does not prolong either time to progression or death from BCa. The instillation may be associated with an increase in the risk of death in patients at high risk of recurrence in whom the instillation is not effective or recommended. PATIENT SUMMARY: A single instillation of chemotherapy immediately after resection reduces the risk of recurrence in non-muscle-invasive bladder cancer; however, it should not be given to patients at high risk of recurrence due to its lack of efficacy in this subgroup.


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/administração & dosagem , Carcinoma de Células de Transição/patologia , Carcinoma de Células de Transição/terapia , Recidiva Local de Neoplasia/prevenção & controle , Neoplasias da Bexiga Urinária/patologia , Neoplasias da Bexiga Urinária/terapia , Administração Intravesical , Carcinoma de Células de Transição/mortalidade , Progressão da Doença , Doxorrubicina/administração & dosagem , Doxorrubicina/análogos & derivados , Epirubicina/administração & dosagem , Humanos , Mitomicina/administração & dosagem , Estadiamento de Neoplasias , Ensaios Clínicos Controlados Aleatórios como Assunto , Fatores de Risco , Taxa de Sobrevida , Tiotepa/administração & dosagem , Fatores de Tempo , Neoplasias da Bexiga Urinária/mortalidade
15.
Urol Oncol ; 33(5): 204.e17-23, 2015 May.
Artigo em Inglês | MEDLINE | ID: mdl-25744654

RESUMO

OBJECTIVES: To evaluate risk factors for urethral recurrence (UR) in women with neobladder. MATERIAL AND METHODS: From 1994 to 2011, 297 women (median age = 54 y; interquartile range: 47-57) underwent radical cystectomy with ileal neobladder for bladder cancer in 4 centers. None of the patients had bladder neck involvement at preoperative assessment. Univariable and multivariable analyses were used to estimate recurrence-free survival and overall survival. The median follow-up was 64 months (interquartile range: 25-116). RESULTS: Of the 297 patients, 81 developed recurrence (27%). The 10- and 15-year recurrence-free survival rates were 66% and 66%, respectively. The 10- and 15-year overall survival rates were 57% and 55%, respectively. UR occurred in 2 patients (0.6%) with solitary urethral, 4 (1.2%) with concomitant urethral and distant recurrence, and 1 with concomitant urethral and local recurrence (0.3%). Bladder tumors were located at the trigone in 27 patients (9.1%). None of these patients developed UR. Lymph node tumor involvement was present in 60 patients (20.2%). On univariable and multivariable analyses, pathologic tumor and nodal stage were independent predictors for the overall risk of recurrence. UR was associated with a positive final urethral margin status (P<0.001) whereas no significant associations were found for carcinoma in situ, pathologic tumor and nodal stage, and bladder trigone involvement. CONCLUSIONS: In this series, only 0.6% of women developed solitary UR. A positive final urethral margin was associated with an increased risk of UR. Women with involvement of the bladder trigone were not at higher risk of UR.


Assuntos
Cistectomia/métodos , Neoplasias da Bexiga Urinária/patologia , Bexiga Urinária/patologia , Adulto , Idoso , Feminino , Humanos , Pessoa de Meia-Idade , Recidiva Local de Neoplasia , Estudos Retrospectivos , Fatores de Risco , Taxa de Sobrevida , Neoplasias da Bexiga Urinária/mortalidade , Neoplasias da Bexiga Urinária/cirurgia , Adulto Jovem
16.
Urol Int ; 94(1): 45-9, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-25171129

RESUMO

INTRODUCTION: The incidence, treatment, and outcome of urethral recurrence (UR) after radical cystectomy (RC) for muscle-invasive bladder cancer with orthotopic neobladder in women have rarely been addressed in the literature. PATIENTS AND METHODS: A total of 12 patients (median age at recurrence: 60 years) who experienced UR after RC with an orthotopic neobladder were selected for this study from a cohort of 456 women from participating institutions. The primary clinical and pathological characteristics at RC, including the manifestation of the UR and its treatment and outcome, were reviewed. RESULTS: The primary bladder tumors in the 12 patients were urothelial carcinoma in 8 patients, squamous cell carcinoma and adenocarcinoma in 1 patient each, and mixed histology in 2 patients. Three patients (25%) had lymph node-positive disease at RC. The median time from RC to the detection of UR was 8 months (range 4-55). Eight recurrences manifested with clinical symptoms and 4 were detected during follow-up or during a diagnostic work-up for clinical symptoms caused by distant metastases. Treatment modalities were surgery, chemotherapy, radiotherapy, and bacillus Calmette-Guérin urethral instillations. Nine patients died of cancer. The median survival after the diagnosis of UR was 6 months. CONCLUSIONS: UR after RC with an orthotopic neobladder in females is rare. Solitary, noninvasive recurrences have a favorable prognosis when detected early. Invasive recurrences are often associated with local and distant metastases and have a poor prognosis.


Assuntos
Adenocarcinoma/cirurgia , Carcinoma de Células Escamosas/cirurgia , Cistectomia/métodos , Recidiva Local de Neoplasia , Estruturas Criadas Cirurgicamente , Neoplasias da Bexiga Urinária/cirurgia , Bexiga Urinária/cirurgia , Urotélio/patologia , Adenocarcinoma/mortalidade , Adenocarcinoma/patologia , Adulto , Idoso , Carcinoma de Células Escamosas/mortalidade , Carcinoma de Células Escamosas/patologia , Europa (Continente) , Feminino , Humanos , Metástase Linfática , Pessoa de Meia-Idade , Invasividade Neoplásica , Reoperação , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento , Bexiga Urinária/patologia , Neoplasias da Bexiga Urinária/mortalidade , Neoplasias da Bexiga Urinária/patologia , Urotélio/efeitos dos fármacos , Urotélio/efeitos da radiação , Urotélio/cirurgia
17.
Int J Urol ; 21(10): 999-1004, 2014 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-24861882

RESUMO

OBJECTIVES: To report a high-volume institution experience with salvage techniques for vascular accidents during live donor renal allotransplantation. METHODS: Between March 1976 and January 2011, 2208 recipients underwent live donor renal allotransplantation. A retrospective review of recipients with vascular accidents - renal artery thrombosis and renal vein thrombosis - was carried out. Salvage procedures were recorded and their outcomes were assessed. RESULTS: A total of 23 (1%) vascular accidents occurred, including renal artery thrombosis and renal vein thrombosis in 19 (0.8%) and four (0.18%) recipients, respectively. All renal artery thrombosis patients were treated by open revascularization and the graft was salvaged in 12 patients (63%). Two renal vein thrombosis events were resolved by percutaneous catheter-directed thrombolytic therapy. Of the other two allografts, one was salvaged by thrombectomy and revascularization, and the other was lost. On univariable analysis, older recipients (P = 0.003), pretransplant hypertension (P = 0.001), more human leukocyte antigen mismatches (≥3; P = 0.036), shorter ischemia time (≤45 min; P = 0.004) and longer time to diagnosis (>3.5 days; P = 0.013) were significantly associated with non-salvage of the graft after vascular accidents. Nevertheless, none of these variables were significant on the multivariable analysis. Over a median follow up of 35 months, the median (range) serum creatinine was 2 mg/dL (range 0.8-8.8 mg/dL), and 11 (79%) recipients were living with functioning grafts. CONCLUSIONS: Despite the devastating complications, vascular accidents are salvageable and revascularization is crucial for graft salvage. Angiographic percutaneous techniques are viable alternatives for renal vein thrombosis.


Assuntos
Sobrevivência de Enxerto , Transplante de Rim/efeitos adversos , Obstrução da Artéria Renal/terapia , Veias Renais , Terapia de Salvação , Terapia Trombolítica , Trombose/terapia , Adolescente , Adulto , Fatores Etários , Aloenxertos , Criança , Creatinina/sangue , Feminino , Sobrevivência de Enxerto/imunologia , Antígenos HLA , Humanos , Hipertensão/complicações , Doadores Vivos , Masculino , Pessoa de Meia-Idade , Obstrução da Artéria Renal/diagnóstico , Obstrução da Artéria Renal/etiologia , Estudos Retrospectivos , Trombectomia , Trombose/diagnóstico , Trombose/etiologia , Fatores de Tempo , Isquemia Quente , Adulto Jovem
18.
Int J Urol ; 21(9): 887-92, 2014 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-24684718

RESUMO

OBJECTIVES: To assess health-related quality of life, and the impact of night-time incontinence and chronic urinary retention on health-related quality of life in women with bladder cancer after radical cystectomy and orthotopic neobladder. METHODS: The study included 74 women who underwent radical cystectomy and orthotopic neobladder, and completed 1 year of follow up. Health-related quality of life was evaluated using the questionnaires of the European Organization for Research and Treatment of Cancer-Quality of Life Questionnaire and the Functional Assessment of Cancer Therapy bladder cancer-specific form. Health-related quality of life was compared with an age-matched control group. The impact of night-time incontinence and chronic urinary retention on health-related quality of life was assessed. RESULTS: The study group included 18 completely continent patients with spontaneous voiding, 29 with night-time incontinence and 27 with chronic urinary retention. The study group was statistically significantly lower in all domains of health-related quality of life than the control group. In all domains of the European Organization for Research and Treatment of Cancer-Quality of Life Questionnaire and Functional Assessment of Cancer Therapy bladder cancer-specific form, completely continent women were comparable with those with chronic urinary retention. Women with night-time incontinence had a significantly worse health-related quality of life than completely continent women, shown by the mean global health score (P = 0.038), social functioning score (P = 0.012), pain European Organization for Research and Treatment of Cancer-Quality of Life Questionnaire score (P = 0.04), and functional well-being Functional Assessment of Cancer Therapy bladder cancer-specific form (P = 0.049) score. CONCLUSIONS: After radical cystectomy and orthotopic neobladder in women, health-related quality of life is lower than that of the normal population. Night-time incontinence has a negative impact on social life and most domains of health-related quality of life. Thus, night-time incontinence has a higher social impact than chronic urinary retention.


Assuntos
Cistectomia , Complicações Pós-Operatórias/etiologia , Qualidade de Vida , Neoplasias da Bexiga Urinária/cirurgia , Derivação Urinária , Incontinência Urinária/etiologia , Retenção Urinária/etiologia , Adulto , Idoso , Feminino , Humanos , Pessoa de Meia-Idade , Estudos Retrospectivos
19.
Scand J Urol ; 48(5): 460-5, 2014 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-24694181

RESUMO

OBJECTIVE: The aims of this study were to report the diagnosis, treatment and functional consequences of postcaesarean section vesicouterine fistula (VUF), and to investigate the need for hysterectomy. MATERIAL AND METHODS: The study included 22 cases with VUF after caesarean section (mean age 30.5 years) between 1999 and September 2012. Total urinary incontinence was found in seven women, occasional incontinence in 15 and cyclic haematuria in 17. VUF was diagnosed by ascending cystography in 14 patients and by computed tomography/magnetic resonance imaging in six. Cystoscopy revealed VUF in all women. VUF repair was conducted by a transabdominal approach. The bladder was opened, the fistula was defined, a circumferential bladder incision was made around the fistula and the fistulous tract was excised. The uterine rent and bladder were closed with omentum interposition. RESULTS: Mean follow-up was 2.8 years (range 0.5-7 years). The repair was successful in all women. Hysterectomy was needed in only one case with dysfunctional uterine bleeding and an enlarged uterus. The incontinence disappeared in all cases. The menstrual cycle became regular after a mean of 5 months in all women who retained their uterus. Five women became pregnant and had a successful delivery after 2-3 years. All women were able to have sexual intercourse after 2 weeks. CONCLUSIONS: Cystoscopy was the mainstay of diagnosis of VUF in the current study. Imaging was not able to show very small fistulae. Unless otherwise indicated, there is no need to remove the uterus even if the fistula is large. Although the repair is challenging, it was successful in all cases and pregnancy is possible after repair.


Assuntos
Cesárea/efeitos adversos , Fístula/diagnóstico , Fístula/cirurgia , Histerectomia , Fístula da Bexiga Urinária/diagnóstico , Fístula da Bexiga Urinária/cirurgia , Doenças Uterinas/diagnóstico , Doenças Uterinas/cirurgia , Adulto , Feminino , Fístula/etiologia , Humanos , Estudos Retrospectivos , Fístula da Bexiga Urinária/etiologia , Doenças Uterinas/etiologia , Adulto Jovem
20.
Urol Ann ; 5(2): 103-8, 2013 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-23798868

RESUMO

CONTEXT: Bacillus Calmette-Guerin (BCG) therapy is the standard treatment for nonmuscle-invasive bladder cancer (NMIBC). However, its toxicity is a major concern. AIM: If we reduce the number of BCG doses by half and replace the second half with epirubicin, we may have a lower toxicity while maintaining the same efficacy of BCG. To test this hypothesis, we conducted this study as an update of our previous report. SETTING AND DESIGN: The study included 607 patients with Ta and T1 NMIBC between January 1994 and December 2008. MATERIALS AND METHODS: After transurethral resection of bladder tumor (TURBT), the patients received weekly doses of 120 mg BCG alternating with 50 mg epirubicin for six weeks (three weekly doses of each). Maintenance was given. Recurrence, progression rates, and toxicity were assessed. End points were progression, recurrence, and cancer-specific survival. RESULTS: A total of 532 patients were eligible for evaluation (mean age: 58 years; median follow-up: 45 months). Of these, 291 (55%) were free, 157 (29.5%) showed recurrence, and 84 (15.8%) showed muscle-invasive progression. Toxicity developed in 221 patients. These were mild in the majority (167), whereas 10 developed hematuria, 30 severe cystitis, and five systemic complications. The rate of permanent therapy discontinuation was 3.8%. STATISTICAL ANALYSIS USED: SPSS package version 16 and Kaplan-Meier curves were used to evaluate survival. CONCLUSIONS: Reducing the frequency of BCG instillations by half and replacing the second half with epirubicin results in a similar efficacy and a lower toxicity compared with historical cases receiving BCG alone. However, further trials are required to support these results.

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