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1.
Transl Androl Urol ; 10(6): 2750-2761, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-34295760

RESUMO

Background: The aim of this systematic review was to identify the current endoscopic surveillance strategies in use across the world and to determine whether these were sufficient or if any recommendations for changes in the guidelines could be made. This review focused on the cystoscopic follow-up of non-muscle invasive bladder cancer (NMIBC) patients and muscle invasive bladder cancer (MIBC) patients who had undergone bladder sparing treatments. Methods: A literature search was carried out on Medline and Embase using OVID gateway according to a pre-defined protocol. Systematic screening of the identified studies was carried out by two authors. Quality assessment was performed using the Joanna Briggs critical appraisal tools. Data was extracted on various aspects including the follow-up regime utilised, patients included, outcomes investigated and a summary of the results. The studies were compared in a narrative nature. Results: A total of 2,604 studies were identified from the search strategy, of which 14 were deemed suitable for inclusion following the screening process. The studies identified were from nine countries and were mainly observational or qualitative. There was a huge variation in the follow-up regimes utilised within the studies with no clear consensus as to which regime was the most suitable. However, all studies utilised an initial cystoscopy at three months post-TURBT. No studies were identified which investigated the endoscopic follow-up strategies for MIBC patients who opted for bladder conservation with chemoradiation. Conclusions: There is no universally accepted protocol for endoscopic follow-up of patients with NMIBC bladder cancer. Guidance on cystoscopic monitoring of bladder in patients who have undergone chemoradiation for MIBC is also lacking.

2.
Inquiry ; 58: 469580211030217, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34271831

RESUMO

Bladder cancer (BC) is the 10th most common malignancy worldwide and the patient experience is found to be worse than that for patients diagnosed with other cancer types. We aimed to develop a wellbeing intervention to help improve the bladder cancer patient experience by ameliorating their health-related Quality of Life (HRQoL). We followed the 3 phases of the modified Medical Research Council (MRC) Framework for development of complex interventions. Following a systematic review of the literature on mental, sexual, and physical wellbeing, we conducted discussion groups with patients and healthcare professionals on these 3 themes. A consultation phase was then conducted with all relevant stakeholders to co-design a wellbeing intervention as part of a feasibility study. A pragmatic wellbeing feasibility trial was designed based on the hypothesis that a wellbeing program will increase patient awareness and attendance to services available to them and will better support their needs to improve HRQoL. The primary feasibility endpoints are patient attendance to the services offered and changes in HRQoL. The principle of patient centered care has strengthened the commitment to provide a holistic approach to support BC patients. In this study, we developed a wellbeing intervention in collaboration with patients and healthcare professionals to meet an unmet need in terms of the BC patient experience.


Assuntos
Qualidade de Vida , Neoplasias da Bexiga Urinária , Estudos de Viabilidade , Pessoal de Saúde , Humanos , Avaliação de Resultados da Assistência ao Paciente , Neoplasias da Bexiga Urinária/terapia
3.
BJUI Compass ; 2(2): 97-104, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33821256

RESUMO

Objectives: To determine the safety of urological admissions and procedures during the height of the COVID-19 pandemic using "hot" and "cold" sites. The secondary objective is to determine risk factors of contracting COVID-19 within our cohort. Patients and methods: A retrospective cohort study of all consecutive patients admitted from March 1 to May 31, 2020 at a high-volume tertiary urology department in London, United Kingdom. Elective surgery was carried out at a "cold" site requiring a negative COVID-19 swab 72-hours prior to admission and patients were required to self-isolate for 14-days preoperatively, while all acute admissions were admitted to the "hot" site.Complications related to COVID-19 were presented as percentages. Risk factors for developing COVID-19 infection were determined using multivariate logistic regression analysis. Results: A total of 611 patients, 451 (73.8%) male and 160 (26.2%) female, with a median age of 57 (interquartile range 44-70) were admitted under the urology team; 101 (16.5%) on the "cold" site and 510 (83.5%) on the "hot" site. Procedures were performed in 495 patients of which eight (1.6%) contracted COVID-19 postoperatively with one (0.2%) postoperative mortality due to COVID-19. Overall, COVID-19 was detected in 20 (3.3%) patients with two (0.3%) deaths. Length of stay was associated with contracting COVID-19 in our cohort (OR 1.25, 95% CI 1.13-1.39). Conclusions: Continuation of urological procedures using "hot" and "cold" sites throughout the COVID-19 pandemic was safe practice, although the risk of COVID-19 remained and is underlined by a postoperative mortality.

4.
Eur Urol Focus ; 2021 Feb 15.
Artigo em Inglês | MEDLINE | ID: mdl-33602641

RESUMO

CONTEXT: Management of non-muscle-invasive bladder cancer (NMIBC) is costly and associated with negative health-related quality-of-life effects, in part because of the frequent need for repeated transurethral resections under general/regional anaesthesia. Outpatient-based diathermy or laser ablation is another option, but evidence for its efficacy is mixed and its use is controversial. OBJECTIVE: To systematically review evidence regarding the efficacy and safety of outpatient diathermy and laser ablation for the treatment of recurrent NMIBC. EVIDENCE ACQUISITION: The EMBASE, MEDLINE/PubMed, and Cochrane Library were searched from inception to June 26, 2020. All studies evaluating the use of diathermy or laser ablation for bladder tumours (new or recurrent) in an outpatient setting under local anaesthetic were included. Two reviewers independently screened all articles, searched the reference lists of retrieved articles, and performed the data extraction. The quality of evidence and risk of bias were assessed using the GRADE and ROBINS-I tools. EVIDENCE SYNTHESIS: The search yielded 1328 studies. After excluding duplicates, 1319 titles and abstracts were screened and 17 studies (1584 patients) were eligible for inclusion in the final review. The majority of patients had small, low-grade tumours, but there was heterogeneity in the inclusion criteria. Overall, laser ablation and diathermy resulted in mean recurrence rates of 47% and 32% at follow-up of 22-38 mo, respectively, with a mean progression rate of 3-12% (low certainty of evidence). Both procedures were well tolerated, with low pain scores and low periprocedural complication rates (moderate certainty of evidence). CONCLUSIONS: Outpatient diathermy and laser ablation have good short-term efficacy in patients with low-grade NMIBC and reduce the need for intervention under general/regional anaesthesia. The procedures are well tolerated with low complication rates. The overall certainty of evidence is low, with heterogeneity between studies and methodological limitations. However, we have highlighted the need for randomised trials with long-term follow-up using standardised risk classification and outcome measures. Despite these limitations, the findings will aid in patient counselling regarding this less invasive treatment option that avoids the morbidity of transurethral resection. PATIENT SUMMARY: Outpatient diathermy and laser ablation have good success rates in treating recurrent low-grade bladder tumours in the short term, avoiding the need for more invasive procedures under general/regional anaesthesia, with low rates of side effects. Further studies are needed to determine whether these treatments remain safe and effective in the long term.

5.
PLoS One ; 16(1): e0243136, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33507907

RESUMO

OBJECTIVES: There is an increased awareness of the effect of a bladder cancer diagnosis and its treatments on the mental wellbeing of patients. However, few studies have evaluated the efficacy, feasibility and acceptability of interventions to improve this mental wellbeing. This systematic review is the first phase of the Medical Research Council Framework for developing complex interventions and provides an overview of the published mental wellbeing interventions that could be used to design an intervention specific for BC patients. METHODS: This review was conducted in accordance with the PRISMA guidelines in January 2019 and studies were identified by conducting searches for Medline, the Cochrane Central Register of Controlled Trials and Ovid Gateway. All included studies met the following criteria: mental wellbeing interventions of adults with medically confirmed diagnosis of any type of urological cancer, reported outcomes for specific HRQoL domains including psychological factors. The quality of evidence was assessed according to Down and Black 27-item checklist. RESULTS: A total of 15,094 records were collected from the literature search and 10 studies matched the inclusion and exclusion criteria. Of these, nine interventions were for patients with prostate cancer and one for patients with kidney cancer. No studies were found for other urological cancers. Depression was the most commonly reported endpoint measured. Of the included studies with positive efficacy, three were group interventions and two were couple interventions. In the group interventions, all showed a reduction in depressive symptoms and in the couple interventions, there was a reduction in depressive symptoms and a favourable relationship cohesion. The couple interventions were the most feasible and acceptable, but further research was required for most of the studies. CONCLUSION: While awareness of the importance of mental wellbeing in bladder cancer patients is growing, this systematic literature review highlights the gap of feasible and acceptable interventions for this patient population.


Assuntos
Saúde Mental , Neoplasias da Bexiga Urinária/psicologia , Humanos , Qualidade de Vida , Resultado do Tratamento
6.
Eur Urol Focus ; 7(3): 638-643, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-32622667

RESUMO

BACKGROUND: Little has been reported on urological complications of total pelvic exenteration (TPE) for locally advanced or recurrent rectal cancer. OBJECTIVE: To assess urological reconstructive outcomes and adverse events in this setting. DESIGN, SETTING, AND PARTICIPANTS: A total of 104 patients underwent TPE from 2004 to 2016 in this single-centre, retrospective study. Electronic and paper records were evaluated for data extraction. Mean follow-up was 36.5 mo. INTERVENTION: TPE. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Urological complications were analysed using two-tailed t and chi-square tests, binary logistic regression analysis. RESULTS AND LIMITATIONS: Sixty-three (61%) patients received radiotherapy prior to TPE. Incontinent diversions included ileal conduit (n = 95), colonic conduits (n = 4), wet colostomy (n = 1), and cutaneous ureterostomy (n = 1). Three patients had a continent diversion. The overall urological complication rate was 54%. According to Clavien-Dindo classification, 30 patients, five patients, and one patient had grade III, IV, and V complications, respectively. The commonest complication was urinary tract infection (in 32 [31%] patients). Anastomotic leaks were seen in 14 (13%) cases, of which eight (8%) were urinary leaks. Fistulas were seen in three (3%) patients, involving the urinary system. A return to theatre was required in 12 (12%) patients. Ureteroenteric strictures were seen in seven (7%). No differences were seen in urological outcomes in patients with primary or recurrent rectal cancer (p = 0.69), or by radiation status (p = 0.24). The main limitation is the retrospective nature of the study. CONCLUSIONS: TPE is complex with recognised high risk of morbidity. In this cohort, there was no significant difference in outcomes between primary and recurrent disease, and surgery after radiation. PATIENT SUMMARY: In this study, we assessed urological complications following total pelvic exenteration. Urinary complications affected more than half of patients. Urinary tract infection is the commonest risk. Approximately one-third of patients required surgical, radiological, or endoscopic intervention ± intensive care admission. Radiation prior to the operation did not affect urinary complications.

7.
BMJ Case Rep ; 13(12)2020 Dec 21.
Artigo em Inglês | MEDLINE | ID: mdl-33370935

RESUMO

We report the case of a 35-year-old woman who presented with recurrent macroscopic haematuria and known diagnosis of Klippel-Trenaunay syndrome. Imaging and cystoscopy identified an extensive venous malformation involving a large area of the bladder wall. Holmium laser therapy was ineffective at obtaining symptom control. Following a multidisciplinary team meeting, transvenous sclerotherapy with sodium tetradecyl sulphate was performed under image guidance. A reduction in venous density was observed on cystoscopy and the patient has had complete resolution of symptoms within 6 weeks and continued to be asymptomatic up to 24-month follow-up. We propose that transvenous sclerotherapy is considered first-line treatment in this clinical setting.


Assuntos
Hematúria/terapia , Síndrome de Klippel-Trenaunay-Weber/complicações , Escleroterapia/métodos , Malformações Vasculares/terapia , Veias/patologia , Administração Intravenosa , Adulto , Cistoscopia , Feminino , Hematúria/etiologia , Humanos , Síndrome de Klippel-Trenaunay-Weber/terapia , Lasers de Estado Sólido/uso terapêutico , Angiografia por Ressonância Magnética , Soluções Esclerosantes/administração & dosagem , Tetradecilsulfato de Sódio/administração & dosagem , Resultado do Tratamento , Bexiga Urinária/irrigação sanguínea , Bexiga Urinária/diagnóstico por imagem , Bexiga Urinária/patologia , Malformações Vasculares/diagnóstico , Malformações Vasculares/etiologia , Malformações Vasculares/patologia , Veias/diagnóstico por imagem , Veias/efeitos dos fármacos
8.
BMC Cancer ; 20(1): 920, 2020 Sep 25.
Artigo em Inglês | MEDLINE | ID: mdl-32977748

RESUMO

BACKGROUND: Bladder cancer (BC) is the 9th most common cancer worldwide, but little progress has been made in improving patient outcomes over the last 25 years. The King's Health Partners (KHP) BC biobank was established to study unanswered, clinically relevant BC research questions. Donors are recruited from the Urology or Oncology departments of Guy's Hospital (UK) and can be approached for consent at any point during their treatment pathway. At present, patients with bladder cancer are approached to provide their consent to provide blood, urine and bladder tissue. They also give access to medical records and linkage of relevant clinical and pathological data across the course of their disease. Between June 2017 and June 2019, 531 out of 997 BC patients (53.3%) gave consent to donate samples and data to the Biobank. During this period, the Biobank collected fresh frozen tumour samples from 90/178 surgical procedures (of which 73 were biopsies) and had access to fixed, paraffin embedded samples from all patients who gave consent. Blood and urine samples have been collected from 38 patients, all of which were processed into component derivatives within 1 to 2 h of collection. This equates to 193 peripheral blood mononuclear cell vials; 238 plasma vials, 224 serum vials, 414 urine supernatant vials and 104 urine cell pellets. This biobank population is demographically and clinically representative of the KHP catchment area. CONCLUSION: The King's Health Partners BC Biobank has assembled a rich data and tissue repository which is clinically and demographically representative of the local South East London BC population, making it a valuable resource for future BC research.


Assuntos
Bancos de Espécimes Biológicos/normas , Neoplasias da Bexiga Urinária/diagnóstico , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
9.
BMC Urol ; 20(1): 64, 2020 Jun 03.
Artigo em Inglês | MEDLINE | ID: mdl-32493286

RESUMO

BACKGROUND: Bladder cancer (BC) treatment can have a detrimental effect on the sexual organs of patients and yet assessment of sexual health needs has been greatly overlooked for these patients compared to those who have undergone other cancer therapies. METHODS: This review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines in July 2019. Studies were identified by conducting searches for Medline (using the PubMed interface), the Cochrane Central Register of Controlled Trials (CENTRAL) and Ovid Gateway (Embase and Ovid) using a list of defined search terms. RESULTS: 15 out of 37 studies included men only, 10 studies women only and 11 both sexes. Most participants were aged 50 to 65 years. Most studies (n = 34) focused on muscle invasive BC and only three on non-muscle invasive BC. Measurements of sexual dysfunction, including erection, ejaculation, firmness and desire, were the most commonly used measurements to report sexual health in men. In women, lubrification/dryness, desire, orgasm and dyspareunia were the most commonly reported. Twenty-one studies evaluated sexual dysfunction based on validated questionnaires, two with a non-validated questionnaire and through interviewing participants. CONCLUSION: While recognition of the importance of the inclusion of psychometric measurements to assess sexual health is growing, there is a lack of consistent measures to assess sexual health in BC. With the focus on QoL arising in cancer survivorship, further studies are needed to develop, standardize and implement use of sexual health questionnaires with appropriate psychometrics and social measures to evaluate QoL in BC patients. TRIAL REGISTRATION: "PROSPERO does not currently accept registrations for scoping reviews, literature reviews or mapping reviews. PROSPERO is therefore unable to accept your application or provide a registration number. This decision should not stop you from submitting your project for publication to a journal."


Assuntos
Necessidades e Demandas de Serviços de Saúde , Disfunções Sexuais Fisiológicas/etiologia , Saúde Sexual , Neoplasias da Bexiga Urinária/complicações , Neoplasias da Bexiga Urinária/terapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
10.
Clin Genitourin Cancer ; 18(3): e315-e323, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-31911120

RESUMO

INTRODUCTION: We compared retrograde extraperitoneal open radical cystoprostatectomy (REORC) and robot-assisted radical cystoprostatectomy with intracorporeal diversion (iRARC) and have reported the early perioperative outcomes. PATIENTS AND METHODS: REORC and iRARC were each performed at a different tertiary high-volume center in 2 countries. Men aged ≥ 18 years with precystectomy clinical stage T1-T3 disease were included. Patients with previous major pelvic and/or intra-abdominal surgery, those who had undergone previous pelvic and/or abdominal irradiation, women, and patients with clinical stage T4 disease were excluded. All cases were managed according to a standardized enhanced recovery after surgery protocol, and all the patients had undergone ileal conduit urinary diversion. Bowel recovery was one of the main endpoints; thus, the intervals to passing flatus, tolerating oral feeding, and bowel opening were determined. The operative time, estimated blood loss, intraoperative complications, length of hospital stay, postcystectomy tumor type, stage, margin status, lymph node yield, and 30- and 90-day complications were analyzed. RESULTS: We performed a retrospective analysis of prospectively collected data from October 2016 to December 2018 of 99 patients, 50 of whom had undergone REORC and 49 iRARC. The demographic data and preoperative parameters were comparable between the 2 groups. REORC resulted in a significantly shorter mean operative time (P < .001), significantly greater mean estimated blood loss (P < .001), and greater percentage of patients requiring blood transfusion (98% vs. 12.24%). No significant differences in the length of stay were observed (P = .412). The rate of prolonged postoperative ileus was 16% and 18.4% in the REORC and iRARC groups, respectively (P = .3). Differences in the interval to passing flatus, tolerating solid oral intake, and bowel opening were not statistically significant between the 2 groups (P = .423, P = .770, and P = .700, respectively). No statistically significant difference was observed in the postcystectomy pathologic outcomes and overall and major complications rates at 30 and 90 days. CONCLUSION: REORC resulted in quicker bowel recovery and a shorter length of stay compared with conventional open procedures, with advantages comparable to those realized with iRARC. Thus, REORC can be adopted as the preferred open approach at institutions without surgical robots available.


Assuntos
Cistectomia/mortalidade , Laparoscopia/mortalidade , Excisão de Linfonodo/mortalidade , Assistência Perioperatória , Prostatectomia/mortalidade , Procedimentos Cirúrgicos Robóticos/mortalidade , Neoplasias da Bexiga Urinária/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Prospectivos , Estudos Retrospectivos , Taxa de Sobrevida , Neoplasias da Bexiga Urinária/patologia
11.
Eur Urol ; 77(1): 110-118, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31740072

RESUMO

BACKGROUND: The long-term oncological outcomes of laparoscopic (LRC) and robotic-assisted radical cystectomy (RARC) are still maturing compared with open radical cystectomy (ORC). OBJECTIVE: To evaluate the 5-yr oncological outcomes of patients recruited into the randomised trial of Open, Laparoscopic and Robot Assisted Cystectomy (CORAL) and extracorporeal urinary diversion. DESIGN, SETTING, AND PARTICIPANTS: A review of prospectively maintained database of 60 patients with muscle-invasive bladder cancer (MIBC) or high-risk nonmuscle-invasive bladder cancer (HRNMIBC) who were previously randomised in the CORAL trial to receive ORC, RARC, or LRC. This trial was designed to compare the perioperative and early oncological outcomes of these techniques. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: The outcomes of interest included 5-yr recurrence-free survival (RFS), cancer-specific survival (CSS), and overall survival (OS). Kaplan-Meier curves were used to plot the recurrence and survival data. The curves between RFS, CSS, and OS were compared using the log-rank test. A two-sided p value <0.05 was considered significant. Results were analysed on the basis of intention to treat. RESULTS AND LIMITATIONS: A total of 60 patients with either MIBC (n=38) or HRNMIBC (n=21) were randomised in the CORAL trial to receive ORC, RARC, or LRC. The 5-yr RFS was 60%, 58%, and 71%; 5-yr CSS was 64%, 68%, and 69%; and 5-yr OS was 55%, 65%, and 61% for ORC, RARC, and LRC, respectively. There was no significant difference in RFS, CSS, and OS between the three surgical arms. The principal limitation is the small sample size. CONCLUSIONS: There was no difference in 5-yr RFS, CSS, and OS rates of patients who underwent ORC, RARC, and LRC for management of bladder cancer. Minimally invasive techniques achieved equivalent oncological outcomes to the gold standard of ORC. However, the study was based at a single institution with a small sample size. PATIENT SUMMARY: Patients who agreed to participate in the randomised trial of either open, laparoscopic, or robotic-assisted radical cystectomy for bladder cancer did not have different cancer outcomes at 5yr.


Assuntos
Cistectomia/métodos , Laparoscopia , Procedimentos Cirúrgicos Robóticos , Neoplasias da Bexiga Urinária/cirurgia , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Invasividade Neoplásica , Estudos Prospectivos , Fatores de Tempo , Resultado do Tratamento , Neoplasias da Bexiga Urinária/patologia
12.
Eur Urol Oncol ; 3(2): 239-249, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-31668714

RESUMO

CONTEXT: The complexity of bladder cancer diagnosis and staging results in delays in definitive treatment of muscle-invasive bladder cancer by radical cystectomy. OBJECTIVE: This systematic review and meta-analyses aim to assess the impact of delays in radical cystectomy. EVIDENCE ACQUISITION: A systematic review was conducted by searching Medline and Ovid Gateway using protocol-driven search terms in August 2019, with no time limit on the studies included. The identified studies were assessed according to strict criteria and using the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist and Risk of Bias in Non-randomised Studies-of Interventions (ROBINS-I) tool. Meta-analyses were conducted based on the type of delay. Random-effect models were used whereby the presence of a delay was the exposure variable and overall survival was the outcome of interest, for which pooled hazard ratios were calculated. EVIDENCE SYNTHESIS: Nineteen studies were eligible for inclusion (17 532 patients), of which 10 were included in the meta-analyses. A longer delay between bladder cancer diagnosis and radical cystectomy resulted in a pooled hazard ratio of 1.34 (95% confidence interval [CI]: 1.18-1.53) for overall death. For a delay between transurethral resection and cystectomy, we found a pooled hazard ratio of 1.18 (95% CI: 0.99-1.41) for overall death. A pooled hazard ratio of 1.04 (95% CI: 0.93-1.16) was calculated for a longer delay between neoadjuvant chemotherapy and radical cystectomy. CONCLUSIONS: A delay in radical cystectomy after diagnosis was found to have a significantly detrimental effect on overall survival for bladder cancer patients. However, there was huge heterogeneity in how a delay was defined. PATIENT SUMMARY: In this review, we investigated the effect of a delay in radical treatment on survival. This review highlights the importance of scheduling radical cystectomies in a timely manner whilst monitoring factors such as comorbidities and scheduling, in order to treat patients requiring radical cystectomy without delay.


Assuntos
Cistectomia/métodos , Neoplasias da Bexiga Urinária/cirurgia , Humanos , Análise de Sobrevida , Neoplasias da Bexiga Urinária/mortalidade
14.
BJU Int ; 124(3): 418-423, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-30740862

RESUMO

OBJECTIVES: To determine if the presence of non-urothelial variant histology (NUVH) is associated with a poorer prognosis following radical cystectomy (RC) compared to pure urothelial carcinoma (PUC). PATIENTS AND METHODS: A prospectively maintained database of all patients undergoing RC at a high-volume regional tertiary bladder cancer service between January 2010 and January 2017 was retrospectively analysed looking for patients with NUVH. Multivariate Cox proportional hazards regression analysis was used to determine disease recurrence, overall survival and bladder cancer-specific survival, as well as lymph node positivity. Association of tumour stage was determined using chi-squared analysis. RESULTS: In total, 430 patients underwent RC of which 73 (17%) had NUVH and 357 (83%) had PUC. The median (range) follow-up was 45.0 (8.5-100.2) months. The presence of NUVH was associated with both increased overall (hazard ratio [HR] 1.86, 95% confidence interval [CI] 1.21-2.85) and bladder cancer-specific mortality (HR 1.81, 95% CI 1.91-3.01), as well as disease recurrence (HR 1.71, 95% CI 1.06-2.75) in multivariate analysis. Squamous cell variant was also associated with increased overall mortality (HR 1.91, 95% CI 1.16-3.13), cancer-specific mortality (HR 2.03, 95% CI 1.21-3.42) and disease recurrence (HR 2.08, 95% CI 1.23-3.52), although this was not seen in other variant subtypes. Lymph node positivity was not associated with NUVH in multivariate analysis (HR 1.28, 95% CI 0.59-2.75), but NUVH was associated with advanced tumour stage on chi-squared analysis (P < 0.001). CONCLUSION: Our results showed a risk of shorter survival in NUVH compared to PUC. This suggests NUVH as an independent predictor of worse outcomes. As a result, patients with NUVH should be counselled preoperatively that overall and disease-specific outcomes are worse postoperatively and about the possible need for adjuvant treatment.


Assuntos
Cistectomia/mortalidade , Neoplasias da Bexiga Urinária , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/epidemiologia , Estudos Retrospectivos , Resultado do Tratamento , Neoplasias da Bexiga Urinária/mortalidade , Neoplasias da Bexiga Urinária/patologia , Neoplasias da Bexiga Urinária/cirurgia
15.
World J Urol ; 37(2): 367-372, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-29934671

RESUMO

PURPOSE: We report the perioperative outcomes and complications after transition from extracorporeal urinary diversion (ECUD) to intracorporeal urinary diversion (ICUD) following robot-assisted radical cystectomy (RARC). METHODS: Analysis of data from a prospectively maintained institutional review board-approved database of 180 patients treated with cystectomy at our institution from April 2015 to October 2017 was performed. 127 patients underwent RARC and received an ileal conduit. Only five patients received a neobladder after RARC and were excluded from analysis. RESULTS: 68 patients had extracorporeal and 59 intracorporeal ileal conduit after RARC. There were no significant differences in patient demographics and oncological characteristics between the two groups. Of note, intracorporeal ileal conduit was associated with significantly reduced median total operative times (330 vs 375 min, p = 0.019), reduced median estimated blood loss (300 vs 425 ml, p < 0.035) and lower 30-day overall complication rates (48.4 vs 71.4%, p = 0.008) when compared to extracorporeal diversion. However, the median length of stay, 30-90-day complication rates, mortality rates and ureteroileal anastomotic stricture rates were similar in both groups. The median operative time for RARC and intracorporeal ileal conduit was significantly shorter in the second cohort of 29 cases compared to the first 30 cases (300 vs 360 min, p = 0.004). Other outcomes were similar in both cohorts. CONCLUSION: In our experience, transition from extracorporeal to intracorporeal diversion after RARC is safe, technically feasible and benefits from shorter operative times, reduced estimated blood loss, and lower 30-day overall complication rates.


Assuntos
Perda Sanguínea Cirúrgica/estatística & dados numéricos , Carcinoma de Células de Transição/cirurgia , Cistectomia/métodos , Complicações Pós-Operatórias/epidemiologia , Procedimentos Cirúrgicos Robóticos/métodos , Neoplasias da Bexiga Urinária/cirurgia , Derivação Urinária/métodos , Idoso , Carcinoma de Células de Transição/patologia , Feminino , Humanos , Excisão de Linfonodo , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Pelve , Neoplasias da Bexiga Urinária/patologia
16.
J Endourol Case Rep ; 4(1): 129-132, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30131977

RESUMO

Background: Congenital diaphragmatic hernia is a rare condition describing a developmental defect of the diaphragm. It is managed surgically in the neonatal period by reduction of the herniated viscera followed by repair of the defect. We present a laparoscopic repair of a Bochdalek diaphragmatic hernia recurrence with retrieval and nephropexy of a migrated kidney with reduced function from its ectopic thoracic position. The complexities of managing this rare occurrence and lessons from this surgical challenge are discussed. Case Presentation: A 21-year-old primigravida presented with a 3-day history of right upper quadrant pain and increasing dyspnea. Of note, she had undergone a congenital right-sided diaphragmatic hernia repair as an infant. An MRI revealed a recurrent diaphragmatic defect with ectopic migration of the right kidney and bowel into an intrathoracic position. Due to worsening dyspnea, she underwent prompt laparoscopic repair of her recurrent diaphragmatic hernia. Subsequently, she underwent a planned cesarean section to control her intra-abdominal pressures and reduce the risk of hernia repair failure. Conclusion: Raised intra-abdominal pressures during pregnancy in patients with prior congenital hernia repair can result in recurrence and migration of peritoneal and retroperitoneal contents into the chest. In cases of renal unit migration, the primary concern must be to restore the anatomical position of a functioning kidney. Multidisciplinary specialist involvement in a tertiary referral base is crucial to an effective outcome.

17.
Arab J Urol ; 16(3): 307-313, 2018 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30140466

RESUMO

Objective: To investigate whether a totally intracorporeally radical cystectomy (RC) can be considered the new 'gold standard' in bladder cancer, as open RC (ORC) is the current 'gold standard' for surgical treatment of muscle-invasive and high-grade non-muscle-invasive bladder cancer. However, robot-assisted radical cystectomy (RARC) is becoming the preferred surgical approach in many centres as it seems to maintain the oncological control of open surgery whilst offering improved perioperative benefits. Materials and methods: A review of the literature was conducted using the Pubmed/MEDLINE, ISI Web of Knowledge and Cochrane Databases to identify studies that included both ORC and RARC with intracorporeal and extracorporeal urinary diversion (UD) published up to July 2017. Results: Evidence from four single-centre randomised controlled trials and now the multicentre Randomized Trial of Open versus Robotic Cystectomy (RAZOR) trial demonstrate the oncological equivalence of RARC to ORC. The only convincing evidence for the superiority of RARC is in the area of blood loss and transfusion rates. However, the UD procedure in these trials was performed extracorporeally and, to realise the full benefits of RARC, a totally intracorporeal approach is needed. Intracorporeal UDs (ICUDs) have been shown to be technically feasible by a few expert centres and have demonstrated some improved short-term perioperative outcomes compared to extracorporeal UDs. Conclusions: Although initial outcomes appear promising, RARC with ICUD is far from gaining 'gold standard' status. Further studies are needed to confirm that outcomes are reproducible widely. Furthermore, the benefits of a totally intracorporeal approach must be confirmed in randomised controlled trials.

18.
Urology ; 122: 1-9, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30036617

RESUMO

Radiotherapy is widely used as a curative treatment for pelvic malignancies. The location of these organs leads to unavoidable exposure of the bladder, urethra, and distal ureters to radiation and may cause subsequent development of radiation cystitis, fistulae, strictures, and secondary malignancy. As cancer survival improves, an ever-increasing number of patients is living with the long-term complications of radiotherapy. Symptoms are not only debilitating for the patient but also pose a treatment challenge to the urologist. This review provides a comprehensive overview of the pathophysiology, clinical presentation, and current management strategies for the urologic complications following pelvic radiotherapy.


Assuntos
Órgãos em Risco/efeitos da radiação , Neoplasias Pélvicas/radioterapia , Lesões por Radiação/epidemiologia , Doenças Urológicas/terapia , Sobreviventes de Câncer/estatística & dados numéricos , Humanos , Lesões por Radiação/etiologia , Ureter/efeitos da radiação , Uretra/efeitos da radiação , Bexiga Urinária/efeitos da radiação , Doenças Urológicas/diagnóstico , Doenças Urológicas/epidemiologia , Doenças Urológicas/etiologia
19.
Nat Rev Urol ; 14(9): 565-574, 2017 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-28675174

RESUMO

Muscle-invasive bladder cancer is an aggressive disease associated with high morbidity and mortality. Radical cystectomy is the mainstay of treatment and has evolved since the first reported cystectomy in 1887 to include pelvic lymph node dissection and the creation of increasingly sophisticated urinary diversions, such as neobladders and pouches, which enable patients to maintain continence. Pioneering work in the 1970s established the therapeutic activity of cisplatin in patients with bladder cancer and resulted in the introduction of cisplatin-based neoadjuvant chemotherapy, which led to the first improvement in survival outcomes in decades. Other notable advances include the development of bladder-sparing protocols, which combine surgery, chemotherapy, and radiotherapy. Molecular profiling of bladder cancer has helped to enhance our understanding of tumour biology and identify several therapeutic targets, such as programmed death (PD-1) and its ligand programmed cell death ligand 1 (PD-L1). Over the past 3 years, immune checkpoint inhibitors targeting the PD-1-PD-L1 axis have demonstrated the ability to achieve durable objective responses in trials of patients with metastatic disease. If the current momentum continues, immunotherapy is poised to change the landscape of muscle-invasive bladder cancer treatment, promising improved survival outcomes for patients with this disease.


Assuntos
Músculo Liso/patologia , Neoplasias da Bexiga Urinária/patologia , Neoplasias da Bexiga Urinária/terapia , Bexiga Urinária/patologia , Antineoplásicos/uso terapêutico , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Quimioterapia Adjuvante , Cisplatino/uso terapêutico , Cistectomia , Humanos , Excisão de Linfonodo , Terapia Neoadjuvante , Invasividade Neoplásica , Pelve , Radioterapia Adjuvante , Resultado do Tratamento , Neoplasias da Bexiga Urinária/imunologia , Neoplasias da Bexiga Urinária/mortalidade
20.
Urology ; 107: e3-e4, 2017 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-28577928

RESUMO

A 47-year-old man presented to the urology department with visible hematuria. He was found to have a high-grade non-muscle-invasive transitional cell carcinoma of the bladder and was subsequently treated with intravesical Bacillus Calmette-Guérin instillations. On routine surveillance computed tomography scan following treatment, he was found to have multiple rounded areas of low density in the right kidney, suspicious for renal malignancy. He underwent renal biopsy that revealed necrotizing granulomatous inflammation suggestive of mycobacterial infection. He was successfully treated with antituberculosis therapy.


Assuntos
Vacina BCG/efeitos adversos , Carcinoma de Células de Transição/tratamento farmacológico , Estadiamento de Neoplasias , Tuberculose Renal/induzido quimicamente , Neoplasias da Bexiga Urinária/tratamento farmacológico , Administração Intravesical , Vacina BCG/administração & dosagem , Biópsia , Carcinoma de Células de Transição/diagnóstico , Humanos , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios X , Tuberculose Renal/diagnóstico , Neoplasias da Bexiga Urinária/diagnóstico
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