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2.
Urol Clin North Am ; 48(1): 45-50, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33218593

RESUMO

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


Assuntos
Cistectomia/métodos , Procedimentos Cirúrgicos Robóticos/métodos , Neoplasias da Bexiga Urinária/cirurgia , Bexiga Urinária/cirurgia , Cistectomia/tendências , Humanos , Seleção de Pacientes , Assistência Perioperatória , Procedimentos Cirúrgicos Robóticos/tendências
3.
Urol Clin North Am ; 48(1): 51-70, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33218594

RESUMO

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


Assuntos
Cistectomia/métodos , Procedimentos Cirúrgicos Robóticos/métodos , Neoplasias da Bexiga Urinária/cirurgia , Bexiga Urinária/cirurgia , Derivação Urinária/métodos , Cistectomia/estatística & dados numéricos , Recuperação Pós-Cirúrgica Melhorada , Previsões , Humanos , Curva de Aprendizado , Procedimentos Cirúrgicos Robóticos/estatística & dados numéricos , Derivação Urinária/estatística & dados numéricos , Derivação Urinária/tendências
4.
Medicine (Baltimore) ; 99(52): e23645, 2020 Dec 24.
Artigo em Inglês | MEDLINE | ID: mdl-33350743

RESUMO

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


Assuntos
Neoplasias da Bexiga Urinária/cirurgia , Teorema de Bayes , Cistectomia , Humanos , Laparoscopia , Procedimentos Cirúrgicos Robóticos
5.
Rev Med Suisse ; 16(717): 2339-2342, 2020 Dec 02.
Artigo em Francês | MEDLINE | ID: mdl-33263959

RESUMO

Radical cystectomy with urinary diversion is the surgical treatment of invasive bladder cancer. Functional impairment is another indication. Robotic technique slowly started 15 years ago but its benefit remains questionable. We present the results of around thirty patients who underwent robotic cystectomy (RC) between 2016 and 2019 and were compared to an open cystectomy (OC) group. While this series is finishing its implementation phase, the results show that RC is equivalent to OC in terms of oncologic control as well as for the overall complication rate. Moreover, blood loss and the hospital length of stay are inferior for RC patients. These results participate to the actual trend towards putative further validation of RC.


Assuntos
Cistectomia/métodos , Procedimentos Cirúrgicos Robóticos/métodos , Padrão de Cuidado , Neoplasias da Bexiga Urinária/cirurgia , Derivação Urinária/métodos , Humanos , Resultado do Tratamento
6.
Arch Esp Urol ; 73(10): 929-933, 2020 12.
Artigo em Espanhol | MEDLINE | ID: mdl-33269711

RESUMO

BCG is currently the standard of care in intermediate and high risk non-invasive bladder tumors. In high-risk patients treated with BCG up to 30% will recurand 10% will progress within 2 years. Oncological outcomes with bladder preserving strategies are limited so radical cystectomy is recommended after BCG failure. Some promising treatments, such as check point inhibitors (PD1, PDL-1), are being studied for non-responders to BCG. Knowing the management of critical situations during BCG treatment its crucial in daily practice and clinical trials design. The aim of this study is to present these definitions and to remember some important aspect sof BCG management.


Assuntos
Vacina BCG , Neoplasias da Bexiga Urinária , Adjuvantes Imunológicos/uso terapêutico , Administração Intravesical , Vacina BCG/uso terapêutico , Cistectomia , Progressão da Doença , Humanos , Invasividade Neoplásica , Recidiva Local de Neoplasia , Neoplasias da Bexiga Urinária/cirurgia
7.
Arch Esp Urol ; 73(10): 945-953, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-33269713

RESUMO

Non-muscle invasive bladder cancer (NMIBC) is a highly heterogeneous disease that hides classes of patients who behave significantly differently under a favorable overall prognosis facade. Individual risk stratification and good decision making improve the patient outcomes. To date, radical cystectomy remains the treatment of choice in particularly aggressive subsets of disease, also due to the lack of proven alternative bladder-sparing strategies.Cancer immunotherapy, by inhibiting the PD-1/PD-L1axis, has shown durable efficacy in the treatment of advanced and metastatic unresectable urothelial carcinoma, and is studied with great interest in early disease settings. The updated data of the KEYNOTE-057 study have recently promoted the United States (US) Food and Drug Administration (FDA) approval of pembrolizumabin patients with CIS-containing BCG-unresponsive NMIBC. This significant step forward paves the way to a new window of therapeutic opportunities, while underlining new needs and questions to be addressed.


Assuntos
Carcinoma de Células de Transição , Neoplasias da Bexiga Urinária , Carcinoma de Células de Transição/terapia , Cistectomia , Humanos , Imunoterapia , Neoplasias da Bexiga Urinária/terapia
8.
Arch Esp Urol ; 73(10): 954-960, 2020 12.
Artigo em Espanhol | MEDLINE | ID: mdl-33269714

RESUMO

OBJECTIVES: Bladder cancer is a frequent, chemosensitive disease and has shown good outcomes on several chemotherapy regimens over last 60 years. However, very little improvement has been shown in terms of overall survival and side-effects decrease. EVIDENCE ACQUISITION: A review on manuscripts published in English and Spanish from 1949 including the terms chemotherapy and bladder cancer has been performed. EVIDENCE SYNTHESIS: Locally advanced or metastatic bladder cancer chemotherapy was initially introduced for metastasis management. The utilization of cisplatin base regimens has shown superiority over single therapy. The most commonly used regimens are cisplatine-metotrexate-vinblastine, metotrexate-vinblatine-adriamicine-cisplatin y gemcitabine-cisplatin. Neoadjuvant chemotherapy has shown to provide a minimal overall survival advantage, based on level 1 evidence. Neoadjuvant chemotherapy utilizes the same cisplatin-based regimens. Neoadjuvant chemotherapy is underutilized due to the inability to identify non-responders. Adjuvant chemotherapy is more controversial due to the lack of strong evidence. It is used when neoadjuvant chemotherapy has been utilized and the cystectomy pathology report is locally advanced. The best outcomes are for low-volume node positive patients.In bladder preservation protocols (aiming to decreased morbidity associated with cystectomy and chemotherapy), several regimens have been utilized in combination with radiation therapy. No standardized treatmentis available as no comparisons with cystectomy have been done. CONCLUSION: Chemotherapy has been utilized for several decades in muscle invasive bladder cancer without any major survival improvements or decreaseon side-effects. That is the rational why the treatment regimen are widely different amongst groups without a standard treatment.


Assuntos
Neoplasias da Bexiga Urinária , Protocolos de Quimioterapia Combinada Antineoplásica , Quimioterapia Adjuvante , Cisplatino/uso terapêutico , Cistectomia , Humanos , Músculos , Terapia Neoadjuvante , Invasividade Neoplásica , Resultado do Tratamento , Neoplasias da Bexiga Urinária/tratamento farmacológico , Neoplasias da Bexiga Urinária/cirurgia
9.
Arch Esp Urol ; 73(10): 961-970, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-33269715

RESUMO

INTRODUCTION: With increasing survival from bladder cancer, quality of life, should be one of the main goals following radical cystectomy and bilateral pelvic lymph node dissection (PLND). This techniqueis associated with significant morbidity, which may have a critical effect on quality of life. Concerns about functional outcomes, such as continence, potency, and sexual function in women, play a role in decision making for urologists and younger patients with muscle-invasive bladder cancer. Several modifications to the classic radical cystectomy technique, include preservation of genital or pelvic organs, developing in the improvement of postoperative continence, potency rates and sexual functionin female patients. OBJECTIVE: This review summarizes the organ-sparing cystectomy techniques and its functional and oncological outcomes. EVIDENCE ACQUISITION: A PubMed-based literature search was conducted up to April 2020. We selected the most recent and relevant original articles, metanalysis and reviews that have provided relevant information to guide organ-sparing cystectomy techniques and its functional and oncological outcomes. EVIDENCE SYNTHESIS: In this review, we discuss selection criteria for male and female patients, organ-sparing cystectomy surgical techniques and its functional and oncological outcomes. CONCLUSIONS: Radical cystectomy is associated with significant morbidity, which may have a critical effect on quality of life. Preservation of genital or pelvic organsin men and women, yield better sexual outcomes compared to radical cystectomy without compromising oncological outcomes in well selected patients. But no one of these techniques can be recommended over the classical standard radical cystectomy. Large-scale of prospective and multi-institutional studies are needed to conclude which patients are suitable for these techniques.


Assuntos
Cistectomia , Neoplasias da Bexiga Urinária , Feminino , Humanos , Masculino , Estudos Prospectivos , Qualidade de Vida , Resultado do Tratamento , Neoplasias da Bexiga Urinária/cirurgia
10.
Arch Esp Urol ; 73(10): 971-985, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-33269716

RESUMO

OBJECTIVES: Fifty percent of muscle-invasive bladder cancer (MIBC) patients succumb from metastatic disease despite radical cystectomy (RC). Neoadjuvant chemotherapy (NAC) and adjuvant chemotherapy (ACT) randomized clinical trials (RCT) investigated whether peri-operative chemotherapy improves survival. More recently, immune checkpoint inhibitors (ICI) are explored as peri-operative single agent, ICI-ICI or ICI-chemotherapy combinations. Our goal is to provide the status of neoadjuvant and adjuvant treatment in MIBC. METHODS: The literature on NAC and ACT trials in MIBC was reviewed. RESULTS: Since the 1980s, NAC RCTs were performed in cisplatin-fit patients, mainly using cisplatin combination chemotherapy. Meta-analyses indicated a small, but significant 5% improvement in overall survival in T2-T4N0M0 MIBC patients. Mostly MVAC or gemcitabine-cisplatin (GC) regimens were used without clear benefit of one regimen over the other. NAC value in N+MIBC is not established and predictive value of associated~25-40% complete downstaging (pathologically confirmed complete regression, pCR) not unequivocally demonstrated. Adjuvant cisplatin-based chemotherapy RCTs were smaller, some prematurely stopped for poor accrual, and underpowered to demonstrate clear statistical evidence for a 5% overall survival advantage in pT3-T4N1-3M0 MIBC. Novel neoadjuvant immune checkpoint inhibitors, alone or with chemotherapy, phase 2 trials demonstrate down staging and encouraging clinical results. CONCLUSIONS: Neoadjuvant MVAC or GC in cT2-T4N0 MIBC patients fit for cisplatin is still recommended based on OS benefit shown in meta-analyses, butreal-world adherence to NAC is low as ~40-50% ofpatients are unfit for cisplatin. The value of neoadjuvant treatment in node-positive MIBC is not clearly demonstrated requiring more accurate clinical staging and prospective studies. Adjuvant cisplatin-based chemotherapy may be considered in selected, chemo-naïve pT3-T4N+patients. Results from prospective checkpoint inhibitor immunotherapy RCTs are needed before immunotherapy becomes a recommended alternative for peri-operative treatment. Molecular tumour subtyping will support selecting novel agents for neoadjuvant or adjuvant strategies.


Assuntos
Terapia Neoadjuvante , Neoplasias da Bexiga Urinária , Protocolos de Quimioterapia Combinada Antineoplásica , Quimioterapia Adjuvante , Cisplatino/uso terapêutico , Cistectomia , Humanos , Músculos , Invasividade Neoplásica , Estudos Retrospectivos , Neoplasias da Bexiga Urinária/tratamento farmacológico , Neoplasias da Bexiga Urinária/cirurgia
11.
Arch Esp Urol ; 73(10): 986-995, 2020 12.
Artigo em Espanhol | MEDLINE | ID: mdl-33269717

RESUMO

Radical cystectomy remains as gold standard for treatment of muscle-invasive bladder cancer. Radical cystectomy has a high morbidity and mortalityas sociated even with the new anesthetic and surgical techniques. Some patients are still not candidates for this major surgery. Besides, some patients reject radical cystectomy. Bladder preservation strategies were develop aiming to decrease morbidity and mortality related to major surgery. Bladder preservation allow for improved quality of life and similar oncologic control rates. Radical cystectomy remains as gold standard for treatment of muscle-invasive bladder cancer. Radical cystectomy has a high morbidity and mortality associated even with the new anesthetic and surgical techniques. Some patients are still not candidates for this major surgery. Besides, some patients reject radical cystectomy. Bladder preservation strategies were develop aiming to decrease morbidity and mortality related to major surgery. Bladder preservation allow for improved quality of life and similar oncologic control rates.Bladder preservation has historically been used in 2clinical scenarios: 1) Patients unable to under go a radicalcystectomy due to comorbidities o patients that rejectradical cystectomy, and 2) patients that are offeredbladder preservation strategies with and oncologicalsafety and curative intent.This is the real scenario for bladder preservation, thefirst scenario belongs to palliation, not cure.In the current manuscript, we will review the bladderpreservation strategies for muscle invasive bladdercancer, specially focusing on trimodal therapy (recommendedby international guidelines) and tetramodaltherapy.


Assuntos
Neoplasias da Bexiga Urinária , Terapia Combinada , Cistectomia , Humanos , Músculos , Invasividade Neoplásica , Qualidade de Vida , Resultado do Tratamento , Neoplasias da Bexiga Urinária/cirurgia
12.
Arch Esp Urol ; 73(10): 1016-1022, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-33269720

RESUMO

In the last decades, only few improvements have been made in the comprehension of bladder cancer tumor leading to few improvements in the development of new diagnostic and therapeutic approaches.However, in the last years several step forwards in the field of precision medicine have been made. In this review we focused on some of these elements such as the available biomarkers, the role of enhanced transurethral resection of the bladder and the role of the molecular classification in defining prognosis and therapeutic approaches in bladder cancer patients. Although several progresses have been made, at the time none of the existing biomarkers appear to be able to safely avoid the need of cystoscopy during the follow up of bladder cancer patients. However, these biomarkers representan important tool to follow up patients with a less invasive methods and in the near future might be able to substitute the need of cystoscopy. Enhanced transurethral resection technique can in some cases reduce the risk of recurrence during follow up, although its impact on survival outcomes is still under debate. Transurethral resection of the bladder represents a fundamental diagnostic and therapeutic step in the management of bladder cancer and these techniques can successfully improve its outcomes. Finally, the molecular classification of the bladder cancer represents one of the most exciting novelty in this field, improving consistently the knowledge of bladder cancer. Improvements regarding prognoses and therapeutics can be achieved although data stil need validation.


Assuntos
Carcinoma de Células de Transição , Neoplasias da Bexiga Urinária , Carcinoma de Células de Transição/cirurgia , Cistectomia , Humanos , Invasividade Neoplásica , Recidiva Local de Neoplasia , Medicina de Precisão , Neoplasias da Bexiga Urinária/cirurgia
13.
Hinyokika Kiyo ; 66(10): 347-349, 2020 Oct.
Artigo em Japonês | MEDLINE | ID: mdl-33271648

RESUMO

A 26-year-old man visited our hospital with a complaint of macrohematuria. Cystoscopy revealed a nodular tumor around the right ureteral orifice. Transurethral resection of bladder tumor was performed, and the tumor was pathologically diagnosed as the nested variant of urothelial carcinoma (NVUC). Radical cystectomy and modified Studer orthotopic neobladder reconstruction were performed. The pathological stage was pT2a, pN2. The patient received 2 courses of adjuvant chemotherapy consisting of gemcitabine and cisplatin. The patient is currently free from disease at 31 months after the treatment. To our knowledge, this case report represents the youngest case of NVUC.


Assuntos
Carcinoma de Células de Transição , Neoplasias da Bexiga Urinária , Adulto , Carcinoma de Células de Transição/cirurgia , Cistectomia , Humanos , Masculino , Pacientes , Neoplasias da Bexiga Urinária/cirurgia
14.
Hinyokika Kiyo ; 66(11): 393-395, 2020 Nov.
Artigo em Japonês | MEDLINE | ID: mdl-33271656

RESUMO

A 70-year-old woman was diagnosed with bladder cancer (muscle invasive adenocarcinoma) via transurethral resection of bladder tumor in 2013. A month after the procedure, she underwent total cystectomy and ileal conduit diversion. Histopathological diagnosis was adenocarcinoma pTis pN0. In 2019, a computed tomography showed multiple nodules, each up to 1 cm in diameter, mainly in the right lower lobe. Metastatic lung cancer was suspected. She underwent thorascopic partial resection of the right lung, and was diagnosed with primary pulmonary cryptococcosis.


Assuntos
Criptococose , Neoplasias Pulmonares , Neoplasias da Bexiga Urinária , Derivação Urinária , Idoso , Cistectomia , Feminino , Humanos , Neoplasias da Bexiga Urinária/cirurgia
15.
Einstein (Sao Paulo) ; 18: eAO5628, 2020.
Artigo em Inglês, Português | MEDLINE | ID: mdl-33295426

RESUMO

OBJECTIVE: To analyze mortality rates and hospitalization data after radical cystectomy in each public healthcare center in São Paulo in the last decade, considering the number of surgeries performed at each center. METHODS: This study included patients from the Departamento de Informática do Sistema Único de Saúde from the state of São Paulo, who underwent radical cystectomy between 2008 and 2018. Data analyzed included organization name, number of procedures/year, in-hospital death rates and hospital length of stay. RESULTS: A total of 1,377 radical cystectomies were registered in the public health system in São Paulo, between 2008-2018. A total of 91 institutions performed at least one radical cystectomy in the decade analyzed. The number of radical cystectomies performed per organization during the years analyzed ranged from one to 161. Only 45.6% of patients were operated in organizations that performed more than five radical cystectomies yearly. A total of 684 patients were operated in organizations with higher surgical volume. There were 117 in-hospital deaths, representing an 8.5% mortality rate for the state of São Paulo during the last decade. Whereas highest volume organizations (>6 radical cystectomies/year) had a mortality rate of 6.1%, the lowest volume (<1 radical cystectomy /year) had a 17.5% in-hospital mortality rate. CONCLUSION: There was a strong relation between organization volume of radical cystectomy and in-hospital mortality rate after radical cystectomy in São Paulo from 2008-2018. Unfortunately, we could not observe a trend toward centralization of such complex procedures, as it has occurred in developed countries during the last decades.


Assuntos
Cistectomia , Mortalidade Hospitalar , Hospitalização , Humanos , Neoplasias da Bexiga Urinária/cirurgia
16.
Medicine (Baltimore) ; 99(45): e23032, 2020 Nov 06.
Artigo em Inglês | MEDLINE | ID: mdl-33157954

RESUMO

RATIONALE: Primitive neuroectodermal tumor (PNET) of the urinary bladder is a highly aggressive tumor with high local recurrence and distant metastasis rates in cases of incomplete excision. We report a case of a young female patient, in whom early laparoscopic radical cystectomy combined with standard lymph node dissection and a modified vincristine, doxorubicin hydrochloride, and cyclophosphamide (VAC) chemotherapy regimen was controversial. Because PNET of the urinary bladder is a rare malignancy, the standard treatment regimen has not yet been established. It is not clear whether surgery combined with postoperative chemotherapy for PNET patients may be superior to surgery alone on long term survival. PATIENT CONCERNS: The patient was a 45-year-old Chinese woman who complained of lower urinary tract symptoms, including urgency, frequency, and difficulty in urination, for 2 months. DIAGNOSES: PNET. INTERVENTIONS: The patient underwent laparoscopic radical cystectomy and standard lymph node dissection, combined with modified VAC chemotherapy regimens. OUTCOMES: After undergoing radical surgery in 2018, the patient completed 6 courses of adjuvant chemotherapy. Abdominal and thorax computed tomography scanning was performed 3, 6, 9, and 12 months after the surgery was completely free of tumor. The patient is still alive with no signs of recurrent disease 2 years after diagnosis. LESSONS: Radical surgery and standard lymphadenectomy combined with adjuvant chemotherapy may be essential to improve the prognosis of PNET of the urinary bladder.


Assuntos
Cistectomia/métodos , Tumores Neuroectodérmicos Primitivos/diagnóstico , Neoplasias da Bexiga Urinária/patologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Protocolos de Quimioterapia Combinada Antineoplásica/normas , Quimioterapia Adjuvante/métodos , Criança , Terapia Combinada , Ciclofosfamida/normas , Dactinomicina/normas , Feminino , Humanos , Laparoscopia/métodos , Excisão de Linfonodo/métodos , Masculino , Pessoa de Meia-Idade , Tumores Neuroectodérmicos Primitivos/tratamento farmacológico , Tumores Neuroectodérmicos Primitivos/cirurgia , Resultado do Tratamento , Vincristina/normas
18.
JAMA ; 324(19): 1980-1991, 2020 Nov 17.
Artigo em Inglês | MEDLINE | ID: mdl-33201207

RESUMO

Importance: Bladder cancer is a common malignancy in women and is the fourth most common malignancy in men. Bladder cancer ranges from unaggressive and usually noninvasive tumors that recur and commit patients to long-term invasive surveillance, to aggressive and invasive tumors with high disease-specific mortality. Observations: Advanced age, male sex, and cigarette smoking contribute to the development of bladder cancer. Bladder tumors can present with gross or microscopic hematuria, which is evaluated with cystoscopy and upper tract imaging depending on the degree of hematuria and risk of malignancy. Non-muscle-invasive tumors are treated with endoscopic resection and adjuvant intravesical therapy, depending on the risk classification. Enhanced cystoscopy includes technology used to improve the detection of tumors and can reduce the risk of recurrence. Patients with high-risk non-muscle invasive tumors that do not respond to adjuvant therapy with the standard-of-care immunotherapy, bacille Calmette-Guérin (BCG), constitute a challenging patient population to manage and many alternative therapies are being studied. For patients with muscle-invasive disease, more aggressive therapy with radical cystectomy and urinary diversion or trimodal therapy with maximal endoscopic resection, radiosensitizing chemotherapy, and radiation is warranted to curb the risk of metastasis and disease-specific mortality. Treatment of patients with advanced disease is undergoing rapid changes as immunotherapy with checkpoint inhibitors, targeted therapies, and antibody-drug conjugates have become options for certain patients with various stages of disease. Conclusions and Relevance: Improved understanding of the molecular biology and genetics of bladder cancer has evolved the way localized and advanced disease is diagnosed and treated. While intravesical BCG has remained the mainstay of therapy for intermediate and high-risk non-muscle-invasive bladder cancer, the therapeutic options for muscle-invasive and advanced disease has expanded to include immunotherapy with checkpoint inhibition, targeted therapies, and antibody-drug conjugates.


Assuntos
Antineoplásicos/uso terapêutico , Vacina BCG/uso terapêutico , Cistectomia , Imunoterapia , Neoplasias da Bexiga Urinária/terapia , Administração Intravesical , Terapia Combinada , Cistectomia/efeitos adversos , Cistectomia/métodos , Cistoscopia , Feminino , Humanos , Masculino , Mutação , Invasividade Neoplásica , Fatores de Risco , Bexiga Urinária/cirurgia , Neoplasias da Bexiga Urinária/diagnóstico , Neoplasias da Bexiga Urinária/genética , Neoplasias da Bexiga Urinária/patologia
19.
Georgian Med News ; (306): 7-10, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-33130637

RESUMO

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


Assuntos
Neoplasias da Bexiga Urinária , Coletores de Urina , Cistectomia , Humanos , Íleo/cirurgia , Masculino , Neoplasias da Bexiga Urinária/cirurgia , Urodinâmica
20.
Pan Afr Med J ; 36: 369, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33235646

RESUMO

Sarcomatoid carcinomas of the bladder represent a tiny part of bladder tumors and are characterized by a high potential for malignancy. Very aggressive and affecting mainly men, these tumors present both a urothelial and sarcomatoid contingent. The treatment of these tumors is not well codified given the rarity of cases reported in the literature, however, it seems that the treatment is essentially based on radical cystectomy with extensive pelvic lymph node dissection. We report the experience of our departement in the management of this type of tumor in a series of five cases collected over a period of 8 years.


Assuntos
Carcinossarcoma/patologia , Cistectomia , Neoplasias da Bexiga Urinária/patologia , Adulto , Idoso , Carcinossarcoma/cirurgia , Humanos , Excisão de Linfonodo , Masculino , Pessoa de Meia-Idade , Neoplasias da Bexiga Urinária/cirurgia
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