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Arch Esp Urol ; 73(1): 32-40, 2020 Jan.
Artigo em Espanhol | MEDLINE | ID: mdl-31950921

RESUMO

OBJECTIVE: To compare peri-operative and mid-term oncological outcomes between Open radical cystectomy (ORC) and Laparoscopic radical cystectomy (LRC). METHODS: A retrospective cohort was assembled, in which 182 patients had been subjected consecutively to Radical Cystectomy (RC) for treatment of muscle-invasive bladder cancer (MIBC) between 2000 and 2010 in a single center. Two cohorts were included: ORC (n=83) and LRC (n=99). All the RCs were performed by the same surgeon. Perioperatory complications were registered according to Clavien-Dindo classification. We evaluated recurrence-free survival, cancer-specific survival and association between the surgical technique performed and disease recurrence, with co-variable adjustment. RESULTS: Clinical and pathologic characteristics were similar for both groups. Significant differences were observed between the two groups, regarding blood loss, operative time and hospitalization days (p<0.04). The ORC group displayed 27 (32.5%) Clavien I-II cases, vs. 11 (11.1%) in the LRC group. Four Clavien≥III (4.8%) complications were reported in the ORC, vs. 7 (7%) in the LRC group (NS). Mean follow-up time for patients without recurrence was 23 months (12-48). A total of 60 patients (72.3%) showed recurrence in the ORC group, compared to 59 (59.6%) in the LRC group. Cumulative cancer-specific mortality index, stratified by surgical technique, was similar between both groups (p.-0.9). CONCLUSIONS: Based on our experience, LRC showed advantages in intraoperative bleeding and length of hospital stay with no difference in major complications between both groups. Mid-term oncological control, regarding local recurrence and cancer-specific survival, showed no significant difference between LRC and ORC in the management of MIBC.


Assuntos
Cistectomia , Laparoscopia , Neoplasias da Bexiga Urinária , Cistectomia/métodos , Humanos , Recidiva Local de Neoplasia , Estudos Retrospectivos , Resultado do Tratamento , Neoplasias da Bexiga Urinária/cirurgia
3.
Arch Esp Urol ; 73(1): 41-46, 2020 Jan.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-31950922

RESUMO

INTRODUCTION: The standard of care in muscle invasive bladder cancer is radical cystectomy; however; transurethral resection (TUR) followed by external radiotherapy and systemic chemotherapy demonstrates comparable results with radical cystectomy in terms of local control and survival rates. OBJECTIVES: To evaluate our results of multimodality bladder preservation therapy (BPT) in patients who had muscle-invasive bladder cancer and were reluctant to radical cystectomy. METHODS: The retrospective analysis of twenty-three patients with stage T2 transitional cell bladder cancer that were consecutively treated with BPT was performed. Treatment strategy included radical TUR followed by 3 cycles of cisplatin, gemcitabine combination, and radiotherapy of 64 Gy as adjuvant treatment. The Kaplan-Meier survival estimates and log rank were calculated. RESULTS: Median follow-up time was 58 (15-158) months. Disease-free survival (DFS) and five year overall survival (OS) rates for 23 patients were 55.9% and 63.9%, respectively. Cancer-specific OS was 67%. There were no grade 3 or higher complications. CONCLUSIONS: Our small patient group suggests that BPT can be safely applied in selected cases with bladder cancer or in patients that refused radical cystectomy.


Assuntos
Carcinoma de Células de Transição , Cistectomia , Tratamentos com Preservação do Órgão , Neoplasias da Bexiga Urinária , Carcinoma de Células de Transição/patologia , Carcinoma de Células de Transição/terapia , Terapia Combinada , Cistectomia/métodos , Intervalo Livre de Doença , Humanos , Invasividade Neoplásica , Estudos Retrospectivos , Taxa de Sobrevida , Resultado do Tratamento , Bexiga Urinária/cirurgia , Neoplasias da Bexiga Urinária/patologia , Neoplasias da Bexiga Urinária/cirurgia
4.
Urology ; 135: 64-65, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31895682
5.
Urology ; 135: 106-110, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31626857

RESUMO

OBJECTIVE: To examine long- and short-term outcomes using cell salvage with a commercially available leukocyte depletion filter following radical cystectomy in an oncologic population. MATERIALS AND METHODS: One hundred and fifty-seven patients, 87 of whom received a cell salvage transfusion, were retrospectively identified from chart review. Ninety-day outcomes as well as long-term mortality and cancer recurrence data were collected. Chi-square, Student's t, or Mann-Whitney U tests were used as appropriate. Multivariable regressions of survival were performed with a Cox proportional-hazards model. RESULTS: Those who received a cell salvage transfusion did not show any differences in rate of cancer recurrence (23%) vs those who did not receive a cell salvage transfusion (24%; P = .85). There were also no differences noted in mortality rates between the 2 populations (12% vs 17%; P = .36). Furthermore, no differences were noted in postoperative complication rates, length of hospital stay, 90-day culture positive infections or readmissions (P >.05). CONCLUSION: There are no significant differences in short-term or long-term patient outcomes between those who did and did not receive an intraoperative cell salvage transfusion. Cell salvage transfusions with a leukocyte depletion filter are safe and effective methods to reduce the need for allogeneic blood transfusions while controlling for the theoretical risk of metastatic spread.


Assuntos
Perda Sanguínea Cirúrgica/prevenção & controle , Transfusão de Sangue Autóloga/efeitos adversos , Cistectomia/efeitos adversos , Recidiva Local de Neoplasia/epidemiologia , Recuperação de Sangue Operatório/efeitos adversos , Neoplasias da Bexiga Urinária/cirurgia , Idoso , Idoso de 80 Anos ou mais , Transfusão de Sangue Autóloga/métodos , Feminino , Filtração/instrumentação , Seguimentos , Humanos , Tempo de Internação/estatística & dados numéricos , Procedimentos de Redução de Leucócitos/instrumentação , Leucócitos/patologia , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/etiologia , Inoculação de Neoplasia , Recuperação de Sangue Operatório/instrumentação , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Análise de Sobrevida , Resultado do Tratamento , Neoplasias da Bexiga Urinária/mortalidade , Neoplasias da Bexiga Urinária/patologia
6.
Urology ; 135: 57-65, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31618656

RESUMO

OBJECTIVE: To evaluate differences in the incidence of benign ureteroenteric stricture, we compared stricture rates of robot-assisted radical cystectomy (RARC) and open radical cystectomy (ORC) using Surveillance, Epidemiology, and End Results-Medicare data. METHODS: We identified 332 RARC and 1449 ORC performed between 2009 and 2014 to determine stricture rates at 6, 12, and 24 months following surgery. We defined ureteroenteric stricture as the need for procedural intervention. Additionally, we compared the incidence of stricture diagnosis. Multivariable proportional hazards regression was performed to determine factors associated with stricture development. RESULTS: The incidence of ureteroenteric stricture at 6 and 12 months was higher for RARC vs ORC at 12.1% vs 7.0% (P < .01) and 15.0% vs 9.5% (P = .01), respectively. RARC vs ORC stricture incidence at 2 years did not differ significantly at 14.6% vs 11.4% (P = .29). Similarly, the stricture diagnosis rates were significantly lower following ORC at 6, 12, and 24 months (P < .05). In adjusted analysis, RARC (HR 1.64, 95%CI 1.23-2.19) and preoperative hydronephrosis (HR 1.51, 95% CI 1.17-1.94) were associated with the development of stricture. Higher hospital volume was associated with a lower risk of stricture (HR 0.40, 95%CI 0.26-0.63). CONCLUSION: RARC is associated with a higher rate of ureteroenteric stricture diagnosis and intervention on a population-based level that is mitigated by higher hospital volume. A significant study limitation is inability to differentiate extracorporeal vs intracorporeal diversion. However, a stricture complication compounds the financial burden of care and efforts must be pursued to improve this surgical outcome.


Assuntos
Cistectomia/efeitos adversos , Complicações Pós-Operatórias/epidemiologia , Procedimentos Cirúrgicos Robóticos/efeitos adversos , Obstrução Ureteral/epidemiologia , Derivação Urinária/efeitos adversos , Idoso , Idoso de 80 Anos ou mais , Anastomose Cirúrgica/efeitos adversos , Carcinoma de Células de Transição/cirurgia , Constrição Patológica/epidemiologia , Constrição Patológica/etiologia , Constrição Patológica/cirurgia , Cistectomia/métodos , Feminino , Humanos , Incidência , Intestinos/cirurgia , Masculino , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Fatores de Risco , Procedimentos Cirúrgicos Robóticos/métodos , Resultado do Tratamento , Ureter/cirurgia , Obstrução Ureteral/etiologia , Obstrução Ureteral/cirurgia , Neoplasias da Bexiga Urinária/cirurgia , Derivação Urinária/métodos
7.
Urology ; 135: 44-49, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31586570

RESUMO

OBJECTIVE: To examine the use of in-hospital pharmacologic thromboprophylaxis (PTP) in patients undergoing radical cystectomy between 2004 and 2014 and to assess the risk of venous thromboembolism (VTE) across the study period. MATERIAL AND METHODS: We identified 8322 patients without contraindications to PTP undergoing radical cystectomy in the US using the Premier Healthcare Database. Nonparametric Wilcoxon type test for trend was employed to examine the trend of PTP utilization across the study period. Ensuing, we employed multivariable logistic regression and generalized linear regression models to examine the odds of receiving PTP and the risk of being diagnosed with VTE, respectively. RESULTS: Based on VTE risk-stratification, the majority of patients (87.8%) qualified as "high-risk." Across the study period the use of PTP increased (Odds ratio 1.02, 95% confidence interval (CI) 1.00-1.03, P = .044), but remained underutilized as the maximum percentage of patients receiving in-hospital PTP did not exceed 58.6%. The risk of VTE did not vary across the study period (risk ratio 0.97, 95%CI 0.92-1.02, P = .178). CONCLUSION: Utilization of PTP increased throughout the study period, while the risk of VTE did not change. Future studies are necessary to improve implementation of guideline-driven care, as PTP remained underutilized throughout the study period.


Assuntos
Anticoagulantes/administração & dosagem , Cistectomia/efeitos adversos , Fidelidade a Diretrizes/tendências , Complicações Pós-Operatórias/prevenção & controle , Tromboembolia Venosa/prevenção & controle , Adolescente , Adulto , Idoso , Feminino , Fidelidade a Diretrizes/estatística & dados numéricos , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Guias de Prática Clínica como Assunto , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Neoplasias da Bexiga Urinária/cirurgia , Tromboembolia Venosa/epidemiologia , Tromboembolia Venosa/etiologia , Adulto Jovem
9.
Int J Cancer ; 146(2): 542-552, 2020 01 15.
Artigo em Inglês | MEDLINE | ID: mdl-31584197

RESUMO

Our previous researches have identified immunoevasive subtype muscle-invasive bladder cancer (MIBC) characterized with immune cells infiltration patterns. Our study explored the clinical significance, immunoregulatory role and therapeutic value of intratumoral IL22-producing cells in MIBC. Two hundred and fifty-nine formalin-fixed paraffin-embedded MIBC samples and 83 freshly resected MIBC tissues and 391 TCGA MIBC samples were retrospectively evaluated. Immunohistochemistry and flow cytometry were applied to identify immune cell infiltration and functional status. In vitro intervention studies were to test the therapeutic and predictive potential of IL22+ cells. Our data revealed patients with high IL22+ cells infiltration suffered poor overall survival and recurrence-free survival in both training and validation cohorts. Only pT2 patients of combined cohort with low IL22+ cells infiltration gained survival benefits from adjuvant chemotherapy (ACT) significantly. Besides, immune contexture featured with increased pro-tumor cells and immunosuppressive cytokines was identified in patients with high IL22+ cells density. The expression pattern of exhausted and effector markers in CD8+ T cells from high IL22+ cells subgroup indicated their dysfunctional status. Importantly, nivolumab showed tumor-killing efficacy in tumors with high IL22+ cells infiltration, and immunosuppressive contexture with CD8+ T cells exhaustion was abrogated in tumors treated with anti-IL22 antibody. In summary, IL22+ cells infiltration determined immunosuppressive contexture with CD8+ T cell dysfunction. Tumor-infiltrating IL22+ cells could be used as an independent marker to predict prognosis and ACT responses. IL22+ cells infiltration possessed the potential to be a favorable predictor for nivolumab application and IL22 blockade could be a novel therapeutic strategy in MIBC.


Assuntos
Antineoplásicos Imunológicos/farmacologia , Interleucinas/metabolismo , Nivolumabe/farmacologia , Evasão Tumoral/efeitos dos fármacos , Neoplasias da Bexiga Urinária/terapia , Idoso , Antineoplásicos Imunológicos/uso terapêutico , Linfócitos T CD8-Positivos/imunologia , Quimioterapia Adjuvante/métodos , Cistectomia , Intervalo Livre de Doença , Feminino , Seguimentos , Humanos , Interleucinas/imunologia , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Invasividade Neoplásica/imunologia , Invasividade Neoplásica/patologia , Nivolumabe/uso terapêutico , Prognóstico , Estudos Retrospectivos , Evasão Tumoral/imunologia , Bexiga Urinária/citologia , Bexiga Urinária/imunologia , Bexiga Urinária/patologia , Neoplasias da Bexiga Urinária/imunologia , Neoplasias da Bexiga Urinária/patologia
10.
Urologe A ; 59(1): 27-31, 2020 Jan.
Artigo em Alemão | MEDLINE | ID: mdl-31858164

RESUMO

Renal transplantations in augmented bladders or urinary diversions are rare, accounting for only 1-2% of all renal transplantations. In most cases a dysfunctional lower urinary tract is the cause of end-stage renal disease in these patients; therefore recovery of the lower urinary tract is mandatory for long-term graft survival. Usually, urinary diversion is timed several months prior to renal transplantation. Beside renal transplantations into an ileum conduit, renal transplantations in continent urinary diversions have become increasingly popular. The most frequent complications are bacteriuria and urinary tract infections, which usually do not lead to graft loss when treated correctly with antibiotics. Long-term outcome of renal transplantations in urinary diversions is comparable to transplantations in healthy native bladders.


Assuntos
Falência Renal Crônica/cirurgia , Transplante de Rim , Neoplasias da Bexiga Urinária/cirurgia , Derivação Urinária , Cistectomia , Humanos , Falência Renal Crônica/etiologia , Derivação Urinária/efeitos adversos
11.
Int Braz J Urol ; 46(1): 108-115, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31851467

RESUMO

OBJECTIVE: Cystectomy with urinary diversion is the gold standard for muscle invasive bladder cancer. It also may be performed as part of pelvic exenteration for non-urologic malignancy, neurogenic bladder dysfunction, and chronic conditions that result in a non-functional bladder (e.g., interstitial cystitis, radiation cystitis). Our objective is to describe the surgical technique of urinary diversion using large intestine as a conduit whilst creating an end colostomy, thereby avoiding a primary bowel anastomosis and to show its applicability with respect to urologic conditions. MATERIALS AND METHODS: We retrospectively reviewed five cases from a single institution that utilized the described method of urinary diversion with large intestine. We describe operative times, hospital length of stay (LOS), and describe post-operative complications. RESULTS: Five patients with a variety of urologic and oncologic pathology underwent the described procedures. Their operative times ranged from 5 hours to 11 hours and one patient experienced a Clavien III complication. CONCLUSION: We describe five patients who underwent this procedure for various medical indications, and describe their outcomes, and believe dual diversion of urinary and gastrointestinal systems with colon as a urinary conduit to be an excellent surgical option for the appropriate surgical candidate.


Assuntos
Colo Sigmoide/cirurgia , Colostomia/métodos , Derivação Urinária/métodos , Adulto , Anastomose Cirúrgica , Cistectomia/métodos , Humanos , Tempo de Internação , Masculino , Ilustração Médica , Pessoa de Meia-Idade , Duração da Cirurgia , Reprodutibilidade dos Testes , Resultado do Tratamento , Doenças da Bexiga Urinária/cirurgia
13.
J Urol ; 203(1): 159-163, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31441673

RESUMO

PURPOSE: Patients who undergo cystectomy due to bladder cancer can elect an ileal conduit or a neobladder for urinary diversion. Decision regret related to this choice is an important and undesirable patient reported outcome. Our objective was to compare the severity of decision regret experienced by patients with a neobladder vs an ileal conduit. MATERIALS AND METHODS: We analyzed data from a longitudinal cohort study of patients who underwent cystectomy from 2013 to 2015. We applied multivariable linear regression to examine associations of the urinary diversion method (neobladder vs ileal conduit) with decision regret measured with the DRS (Decision Regret Scale) 6 and 18 months after cystectomy. Covariates included demographic and clinical characteristics, health care utilization and complications after cystectomy, quality of life and factors related to the decision making process, including informed and shared decision making, and goal concordance. RESULTS: Of the 192 patients in our cohort 141 received an ileal conduit and 51 received a neobladder. We observed no significant difference in the DRS score in patients with a neobladder vs an ileal conduit at 6 or 18 months (b=-1.28, 95% CI -9.07-6.53, vs b=-1.55, 95% CI -12.48-9.38). However, informed decision making was negatively related to decision regret at 6 and 18 months (b=-13.08, 95% CI -17.05--9.11, and b=-8.54, 95% CI -4.26--2.63, respectively). Quality of life was negatively associated with decision regret at 18 months (b=-5.50, 95% CI -8.95--2.03). CONCLUSIONS: Patients treated with cystectomy who were more informed about bladder reconstruction options experienced less regret independent of the method selected. Efforts to inform and prepare patients for the bladder reconstruction decision may help prevent decision regret.


Assuntos
Cistectomia , Tomada de Decisões , Neoplasias da Bexiga Urinária/cirurgia , Derivação Urinária/métodos , Feminino , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Invasividade Neoplásica , Medidas de Resultados Relatados pelo Paciente , Satisfação do Paciente , Qualidade de Vida , Neoplasias da Bexiga Urinária/patologia
14.
J Urol ; 203(1): 57-61, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31600114

RESUMO

PURPOSE: We sought to determine the trend of neoadjuvant chemotherapy use for nonmetastatic muscle invasive urothelial bladder cancer and whether it is associated with adverse perioperative morbidity after robot-assisted radical cystectomy. MATERIALS AND METHODS: We retrospectively reviewed the IRCC (International Robotic Cystectomy Consortium) database between 2006 and 2017. After excluding patients with nonmuscle invasive bladder cancer the patients were divided into 2 groups, including those who did vs did not receive neoadjuvant chemotherapy. Data were reviewed for demographics, preoperative, operative and 90-day perioperative outcomes. We used the Cochran-Armitage trend test to assess trends of neoadjuvant chemotherapy associations with high grade and overall complications with time. Multivariate stepwise regression analyses were done to determine whether neoadjuvant chemotherapy was associated with prolonged operative time, 90-day postoperative complications, readmissions, reoperations and mortality after robot-assisted radical cystectomy. RESULTS: A total of 298 patients (26%) received neoadjuvant chemotherapy. These patients were younger (age 67 vs 69 years, p=0.01) and more frequently had an ASA™ (American Society of Anesthesiologists™) score of 3 or greater (62% vs 55%, p=0.02) and pathological T3 stage or greater disease (28% vs 22%, p=0.04). The use of neoadjuvant chemotherapy increased significantly from 10% in 2006 to 2007 to 42% in 2016 to 2017 (p <0.01). On multivariate analysis neoadjuvant chemotherapy was not significantly associated with prolonged operative time, hospital stay, 90-day postoperative complications, reoperation or mortality. Neoadjuvant chemotherapy was associated with 90-day readmissions after robot-assisted radical cystectomy (OR 5.90, 95% CI 3.30-10.90, p <0.01). CONCLUSIONS: Neoadjuvant chemotherapy utilization has significantly increased in the last decade. It was not associated with perioperative surgical morbidity after robot-assisted radical cystectomy.


Assuntos
Quimioterapia Adjuvante , Cistectomia , Terapia Neoadjuvante , Procedimentos Cirúrgicos Robóticos , Neoplasias da Bexiga Urinária/tratamento farmacológico , Neoplasias da Bexiga Urinária/cirurgia , Idoso , Antineoplásicos/uso terapêutico , Humanos , Masculino , Duração da Cirurgia , Readmissão do Paciente/estatística & dados numéricos , Complicações Pós-Operatórias , Reoperação/estatística & dados numéricos , Estudos Retrospectivos , Taxa de Sobrevida , Neoplasias da Bexiga Urinária/mortalidade , Neoplasias da Bexiga Urinária/patologia
17.
F1000Res ; 82019.
Artigo em Inglês | MEDLINE | ID: mdl-31824647

RESUMO

Cystectomy and urinary bladder substitution are rare in children but may be necessary in some cases of bladder exstrophy, in the setting of malignancy, or in other settings in which the bladder is severely dysfunctional. This article details advances in surgical techniques in creating continent urinary diversions in this specialized pediatric population.


Assuntos
Extrofia Vesical , Bexiga Urinária , Derivação Urinária , Coletores de Urina , Criança , Cistectomia , Humanos
18.
Zhonghua Yi Xue Za Zhi ; 99(46): 3612-3616, 2019 Dec 10.
Artigo em Chinês | MEDLINE | ID: mdl-31826581

RESUMO

Objective: To investigate the influencing factors of ureteroenteric strictures (UES) in patients undergoing laparoscopic radical cystectomy plus urinary diversion (UD). Method: A total of 412 patients who underwent UD after radical prostatectomy from January 2008 to December 2016 were retrospectively included in this study. Age, gender, body mass index (BMI), diversion type, time to diagnosis of UES, duration of ureteral stent, postoperative complications, including urinary tract infections, ureteroenteric leakage and UES were collected. Kaplan-Meier curves were used to describe time to developing UES. Prognostic factors of UES were analyzed using COX proportional hazard regression model. Result: Median follow-up time was 37 (IQR 17-120) months. A total of 59 patients (70 sides) developed UES, including 34 cases on the left side, 14 cases on the right side and 11 cases on both sides, following UD after radical cystectomy. The median time to diagnosis of UES was 7 (IQR 4-11) months. The total incidence of UES was 14.3%. The incidence of UES was 10.9%, 13.3% and 14.1% at 1, 3 and 5 years after UD, respectively. Cox proportional hazard regression model analysis demonstrated that BMI≥25kg·m(-2) (P=0.008), ureteroenteric leakage (P=0.001) and urinary tract infections (P=0.037) were the independent risk factors associated with UES following UD after radical cystectomy. Conclusion: The incidence rate of UES following UD after radical cystectomy was relatively high, which occurs more common on the left side. Obese patients, combined with ureteroenteric leakage, urinary tract infection after UD, are more likely to develop into UES.


Assuntos
Laparoscopia , Neoplasias da Bexiga Urinária , Derivação Urinária , Constrição Patológica , Cistectomia , Humanos , Masculino , Complicações Pós-Operatórias , Estudos Retrospectivos
19.
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