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1.
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
2.
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
3.
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
4.
Actas urol. esp ; 43(10): 568-572, dic. 2019. tab
Artigo em Espanhol | IBECS | ID: ibc-185264

RESUMO

Introducción y objetivos: El estudio se realizó con el objetivo de identificar los factores de riesgo de la formación de cálculos en el tracto urinario superior en pacientes con derivación urinaria tras cistectomía radical (CR). Materiales y métodos: Se recogieron los datos de todos los pacientes con derivación después de la CR tratados en nuestro centro desde enero del 2005 hasta diciembre del 2013. Se incluyeron 3tipos de derivaciones diferentes: neovejiga ortotópica (NO: 168 pacientes), conducto ileal (CI: 93 pacientes) o ureterostomía cutánea (UC: 104 pacientes). Se realizó análisis de regresión logística univariante y multivariante para identificar los predictores independientes de formación de cálculos en el tracto superior. Resultados: Se incluyó a 365 pacientes tratados consecutivamente (316 hombres, 49 mujeres). Con una mediana de seguimiento de 48 meses (rango 12-65 meses), 36 pacientes (9,9%) desarrollaron cálculos en el tracto superior. Entre ellos, 26 (72,2%), 5 (13,9%) y 5 (13,9%) pacientes fueron tratados mediante NO, CI y UC, respectivamente. Veinticinco pacientes presentaron cálculos renales y 11, cálculos ureterales. La cirugía mínimamente invasiva (litotricia endoscópica con láser mediante abordaje anterógrado o retrógrado en 24 casos, nefrolitotomía percutánea en 9 casos y litotricia con ondas de choque en 3 casos) se realizó con éxito en todos los casos. En el análisis uni y multivariante de regresión logística, se encontró que las variables diabetes mellitus, la hipertensión, la infección del tracto urinario (ITU), la estenosis de la anastomosis y el tipo de derivación se asocian positivamente con la formación de cálculos en el tracto urinario superior. Conclusiones: Podemos afirmar que la diabetes mellitus, la hipertensión, la ITU, la estenosis de la anastomosis y el tipo de derivación son variables predictoras de la formación de cálculos en el tracto superior


Introduction and objectives: The study was conducted to identify the risk factors of upper tract stone formation in patients with diversions after radical cystectomy (RC). Materials and methods: All patients with diversion after RC were collected in our center from January 2005 to December 2013. Three different common diversions were included: Orthotopic neobladder (ON: 168 patients), Ileal Conduit (IC: 93 patients) or Ureterocutaneostomy (UC: 104 patients). Univariable and multivariable logistic regression analysis were conducted to identify the independent predictors of stone formation in the upper tract. Results: A total of 365 consecutive patients (316 males, 49 females) were included. At a median follow-up of 48 months (range 12-65 months), 36 patients (9.9%) developed upper tract stone. Among them, 26 (72.2%), 5 (13.9%) and 5 (13.9%) patients underwent ON, IC and UC, respectively. 25 patients had renal stone and 11 ureter stone. Minimally invasive operations (endoscopic laser lithotripsy via the anterograde or retrograde approach in 24 cases, percutaneous nephrolithotomy in 9 cases and shock wave lithotripsy in 3 cases) were carried out successfully in all stone cases. On univariable and multivariable logistic regression analysis, diabetes mellitus, hypertension, urinary tract infection (UTI), anastomotic stenosis and types of diversions (P < .05) were positively associated with upper tract stone formation. Conclusion: The variable predictors of upper tract stone may contain diabetes mellitus, hypertension, UTI, anastomotic stenosis and types of diversión


Assuntos
Humanos , Masculino , Feminino , Idoso , Cálculos Urinários/complicações , Fatores de Risco , Cistectomia/métodos , Derivação Urinária/métodos , Cistectomia/efeitos adversos , Análise de Regressão , Ureterostomia/métodos , Cálculos Urinários/diagnóstico por imagem , Tomografia por Emissão de Pósitrons
5.
Medicine (Baltimore) ; 98(48): e18000, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31770212

RESUMO

RATIONALE: Bladder cancer (BC) is commonly diagnosed in the urinary system and the most common subtype is transitional urothelial carcinoma (TCC). Even with the best treatment, tumor recurrence and metastases always occur. While clinicians commonly observe the metastases to pelvic lymph nodes, liver, lung, and bone, it may infrequently spread to some uncommon locations. PATIENT CONCERNS: The patient was a 67-year-old man with a diagnosis of high-grade TCC with squamous differentiation in the bladder and prostate. Subsequently, radical cystoprostatectomy, adjuvant radiotherapy, and chemotherapy were performed. However, he felt intermittent right scrotal pain about 1 year later. DIAGNOSIS: Ultrasound strongly suggested a testicular neoplasm of right testis, but the left was normal. INTERVENTIONS: The patient underwent a right radical orchiectomy and histopathology confirmed testicular metastatic neoplasm from bladder. Moreover, further examination with positron emission tomography revealed no visible distant spread of the urothelial carcinoma. OUTCOMES: No signs of tumor recurrence or distant metastasis were visible under follow-up 1 year after radical orchiectomy. LESSONS: Testicular mass may be metastatic tumor during follow-up for patients who were diagnosed as BC, especially for TCC with variant histology. The reason of this could be explained of residual micrometastases after surgery and need more examination to discover local micrometastases to apply more aggressive treatment.


Assuntos
Carcinoma de Células de Transição/secundário , Cistectomia/efeitos adversos , Prostatectomia/efeitos adversos , Neoplasias da Próstata/patologia , Neoplasias Testiculares/secundário , Neoplasias da Bexiga Urinária/patologia , Idoso , Carcinoma de Células de Transição/cirurgia , Cistectomia/métodos , Humanos , Masculino , Período Pós-Operatório , Prostatectomia/métodos , Neoplasias da Próstata/cirurgia , Neoplasias da Bexiga Urinária/cirurgia , Urotélio/patologia
6.
Medicine (Baltimore) ; 98(41): e17222, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31593079

RESUMO

RATIONALE: Radical cystectomy and urinary diversion remains the definite management for muscle invasive bladder urothelial cancer. Internal herniation caused by ureteral adhesion is an extremely rare complication after the procedure. To the best of our knowledge, this is the first case report of small bowel obstruction and internal herniation occurring between bilateral ureters and urinary diversion after robot-assisted radical cystectomy (RARC). PATIENT CONCERNS: A 64-year-old woman presented with symptom of small bowel obstruction such as nausea, vomiting, and abdominal fullness after RARC and Indiana pouch. Another 61-year-old man presented with left obstructive hydronephrosis and recurrent pyelonephritis after RARC and ileal conduit. DIAGNOSIS: Both patients received computed tomography scans and the results were suggestive of small bowel herniation between bilateral ureters and urinary diversion. INTERVENTIONS: The 2 patients underwent open ureterolysis and internal hernia reduction. During the operation, bowel loop herniation between the interureteral spaces were found. OUTCOMES: Both patients recovered smoothly after second operation. LESSONS: The incidence of internal herniation may increase by the growing use of RARC. Suitable stoma position, appropriate length of ureter dissection, and retroperitonealization can help prevent this complication.


Assuntos
Cistectomia/efeitos adversos , Hérnia/etiologia , Complicações Pós-Operatórias/etiologia , Procedimentos Cirúrgicos Robóticos/efeitos adversos , Doenças Ureterais/etiologia , Derivação Urinária/efeitos adversos , Cistectomia/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Robóticos/métodos , Derivação Urinária/métodos
7.
Urology ; 134: 90-96, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31560917

RESUMO

OBJECTIVE: To describe a rare complication in 5 women who had vaginal prolapse, dehiscence, and/or evisceration after having undergone robotic-assisted radical cystectomy with creation of ileal conduit urinary diversion. Radical cystectomy is the standard of care in the extirpative treatment for muscle invasive urothelial carcinoma. Anterior exenteration in the female patient requires removal of the anterior vaginal wall, urethra, uterus, and adnexa which results in significant changes to the pelvic floor. METHODS: Retrospective identification of all women having undergone robotic-assisted radical cystectomy for urothelial carcinoma who ultimately represented with vaginal prolapse, dehiscence, and/or evisceration between January 2012 and April 2019. We identified patient characteristics detailing their presentation. A review of the available literature highlighted the lack of available information in this uncommon cohort. RESULTS: Five women with vaginal dehiscence and/or evisceration who had previously undergone robotic-assisted radical cystectomy, anterior vaginectomy with urethrectomy, pelvic lymph node dissection, and creation of ileal conduit by 4 surgeons were identified. Mean interval time to initial presentation of prolapse or dehiscence was 44.4 weeks (range 11-120). In the 2 patients that eviscerated prior to repair, this occurred at 5 and 25 weeks after initial outpatient consultation. All reconstructive efforts were approached transvaginally. Two patients underwent 2 or more repairs. Management options included expectant management, pessary, and immediate vs delayed transvaginal surgical repair. CONCLUSION: Our case series describes the unique and potentially devastating complication of vaginal dehiscence and bowel evisceration in women with history of robotic-assisted radical cystectomy.


Assuntos
Carcinoma/cirurgia , Doenças do Colo , Cistectomia , Herniorrafia/métodos , Distúrbios do Assoalho Pélvico , Complicações Pós-Operatórias/cirurgia , Deiscência da Ferida Operatória , Neoplasias da Bexiga Urinária/cirurgia , Prolapso Uterino , Idoso , Carcinoma/patologia , Doenças do Colo/etiologia , Doenças do Colo/cirurgia , Cistectomia/efeitos adversos , Cistectomia/métodos , Feminino , Humanos , Pessoa de Meia-Idade , Invasividade Neoplásica , Distúrbios do Assoalho Pélvico/diagnóstico , Distúrbios do Assoalho Pélvico/etiologia , Distúrbios do Assoalho Pélvico/cirurgia , Reoperação/métodos , Procedimentos Cirúrgicos Robóticos/efeitos adversos , Procedimentos Cirúrgicos Robóticos/métodos , Deiscência da Ferida Operatória/etiologia , Deiscência da Ferida Operatória/cirurgia , Resultado do Tratamento , Neoplasias da Bexiga Urinária/patologia , Derivação Urinária/efeitos adversos , Derivação Urinária/métodos , Prolapso Uterino/etiologia , Prolapso Uterino/cirurgia
8.
Medicine (Baltimore) ; 98(36): e16873, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31490371

RESUMO

At present, intravesical Bacillus Calmette-Guerin (BCG) immunotherapy is recommended for prophylaxis purposes after transurethral resection of bladder tumor, but has chances of recurrence. Radical cystectomy reduces the risk of recurrence in bladder cancer patients, but may have chances of postoperative complications. The objective of the study was to test the hypothesis that radical cystectomy has overtreatment and definitive BCG immunotherapy has undertreatment in intermediate or high-risk nonmuscle invasive bladder cancer patients. Data regarding biopsies, ultrasound, the computed tomography scan, adopted treatment strategy, treatment-emergent adverse effect, and a follow-up period of 312 patients with confirmed nonmuscle invasive bladder cancer (pTa, pTis, or pT1 stage; intermediate or high-risk cancer) were reviewed. Patients who had received definitive intravesical BCG immunotherapy were included in BCG group (n = 210) and those who underwent radical cystectomy were included in RXC group (n = 87). Clinical decision-making for treatment strategies was evaluated for both groups. Cystitis was frequently observed in all patients who received BCG immunotherapy. In RXC group, ileus was frequently observed in all patients in early days after the operation. During 2 years of the follow-up period, biopsies, ultrasound, and the computed tomography scan reported that BCG group had fewer numbers of negative cancer patients after treatment than the RXC group after surgery (P < .0001). Total expenditure for BCG immunotherapy was higher than radical cystectomy (22,945 ±â€Š945 ¥/patient vs 17,985 ±â€Š545 ¥/patient; P < .0001). Definitive BCG immunotherapy had undertreatment and radical cystectomy had overtreatment for intermediate or high-risk invasive bladder cancer patients (level of evidence III).


Assuntos
Vacina BCG/uso terapêutico , Cistectomia/estatística & dados numéricos , Imunoterapia/métodos , Neoplasias da Bexiga Urinária/terapia , Administração Intravesical , Adolescente , Adulto , Idoso , Vacina BCG/efeitos adversos , Vacina BCG/economia , Análise Custo-Benefício , Cistectomia/efeitos adversos , Cistectomia/economia , Feminino , Comportamentos Relacionados com a Saúde , Humanos , Imunoterapia/economia , Masculino , Pessoa de Meia-Idade , Invasividade Neoplásica , Recidiva Local de Neoplasia , Estadiamento de Neoplasias , Complicações Pós-Operatórias/epidemiologia , Estudos Retrospectivos , Fatores Socioeconômicos , Neoplasias da Bexiga Urinária/patologia , Adulto Jovem
10.
J Clin Pathol ; 72(8): 550-553, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31164444

RESUMO

AIMS: To describe a large tertiary care academic centre's experience with patients who achieve a complete pathological response (ie, ypT0N0) following neoadjuvant chemotherapy (NAC) and radical cystectomy (RC) with emphasis on morphological features present in the RC and clinical outcome. METHODS: 41 patients with ypT0N0 disease following transurethral resection of bladder tumour (TURBT), NAC and RC with available clinical follow-up information were analysed. Slides from all RCs were reviewed to confirm pathological stage and assess for morphological parameters (eg, foreign body giant cell reaction, dystrophic calcification, scar and fat necrosis). RESULTS: With median follow-up of 32.8 months, the recurrence-free survival at 1 and 5 years was 97.4% and 93.5%, while the overall survival at 3 and 5 years was 94.2% and 88.6%, respectively. No patients died of urothelial carcinoma. Stage assigned at TURBT was 1 pTa (2%), 1 pT1 (2%), 38 pT2 (93%) and 1 pT3a (2%). 17 TURBTs demonstrated variant histology, with the majority of these being squamous (65%). The most common morphological features present at RC were scar (100%), foreign body giant cell reaction (80%), chronic inflammation within lamina propria (68%) and dystrophic calcifications (39%). Other morphological features were less common or absent. CONCLUSION: ypT0N0 disease at RC portends an excellent prognosis, regardless of stage or variant histology in the TURBT; scar, foreign body giant cell reaction, chronic inflammation and dystrophic calcifications are often present.


Assuntos
Carcinoma/terapia , Cistectomia , Terapia Neoadjuvante , Neoplasias da Bexiga Urinária/terapia , Urotélio/patologia , Idoso , Carcinoma/mortalidade , Carcinoma/secundário , Quimioterapia Adjuvante , Cistectomia/efeitos adversos , Cistectomia/mortalidade , Bases de Dados Factuais , Progressão da Doença , Feminino , Humanos , Metástase Linfática , Masculino , Pessoa de Meia-Idade , Terapia Neoadjuvante/efeitos adversos , Terapia Neoadjuvante/mortalidade , Recidiva Local de Neoplasia , Estadiamento de Neoplasias , Intervalo Livre de Progressão , Fatores de Risco , Fatores de Tempo , Neoplasias da Bexiga Urinária/mortalidade , Neoplasias da Bexiga Urinária/patologia
11.
Future Oncol ; 15(19): 2267-2275, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31237444

RESUMO

Aim: To assess mortality from bladder cancer following a diagnosis of nonmuscle-invasive bladder cancer. Materials & methods: This is a SEER registry-based study. The risk of death from bladder cancer was compared with that of the general population. Cox proportional model was performed to calculate the hazard ratio (HR) for death according to baseline characteristics. Results: The bladder cancer-specific mortality at 20 years was 11%; and it was higher for black patients compared with white patients (adjusted HR: 1.711 [95% CI: 1.564-1.872]; p < 0.0001); additionally, it was higher for patients older than 70 years old compared with younger patients (adjusted HR: 2.005 [95% CI: 1.916-2.099]; p < 0 .0001). The risk of bladder cancer mortality increased after diagnosis of a recurrent bladder cancer (both nonmuscle-invasive and muscle-invasive; adjusted HR: 6.97 [95% CI: 6.56-7.40]; p < 0 .0001). Conclusion: Important predictors for death from bladder cancer following a diagnosis of nonmuscle-invasive bladder cancer include older age at diagnosis and black race.


Assuntos
Carcinoma de Células de Transição/mortalidade , Recidiva Local de Neoplasia/mortalidade , Neoplasias da Bexiga Urinária/mortalidade , Adulto , Idoso , Carcinoma de Células de Transição/diagnóstico , Carcinoma de Células de Transição/patologia , Carcinoma de Células de Transição/cirurgia , Cistectomia/efeitos adversos , Progressão da Doença , Feminino , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Invasividade Neoplásica/patologia , Recidiva Local de Neoplasia/diagnóstico , Recidiva Local de Neoplasia/patologia , Recidiva Local de Neoplasia/cirurgia , Modelos de Riscos Proporcionais , Programa de SEER , Neoplasias da Bexiga Urinária/diagnóstico , Neoplasias da Bexiga Urinária/patologia , Neoplasias da Bexiga Urinária/cirurgia
12.
J Urol ; 202(5): 913-919, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31219762

RESUMO

PURPOSE: To our knowledge the reliability of administrative claims codes to report postoperative radical cystectomy complications has not been examined. We compared complications identified by claims data to those abstracted from clinical chart review following radical cystectomy. METHODS: We manually reviewed the charts of 268 patients treated with radical cystectomy between 2014 and 2016 for 30-day complications and queried administrative complication coding using 805 ICD-9/10 codes. Complications were categorized. Using Cohen κ statistics we assessed agreement between the 2 methods of complication reporting for 1 or more postoperative complications overall, categorical complications and complications stratified by the top quartile length of hospital stay and patients who were readmitted. RESULTS: At least 1 or more complications were recorded in 122 patients (45.5%) through manual chart review and 80 (29.9%) were recorded via claim coding data with a concordance rate of κ=0.16, indicating weak agreement. Concordance was generally weak for categorical complication rates (range 0.05 to 0.36). However, when examining only the top length of stay quartile, 1 or more complications were reported in 32 patients (65%) by the manual chart review and in 12 (25%) via coding data with a concordance rate of κ=-0.2. Agreement was weak, similar to the total cohort. CONCLUSIONS: Manual chart review and claim code identification of complications are not highly concordant even when stratified by patients with an extended length of stay, who are known to have more frequent complications. Researchers and administrators should be aware of these differences and exercise caution when interpreting complication reports.


Assuntos
Cistectomia/efeitos adversos , Complicações Pós-Operatórias/diagnóstico , Procedimentos Cirúrgicos Robóticos/efeitos adversos , Neoplasias da Bexiga Urinária/cirurgia , Idoso , Feminino , Seguimentos , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Curva ROC , Estudos Retrospectivos , Fatores de Risco , Taxa de Sobrevida/tendências , Estados Unidos/epidemiologia , Neoplasias da Bexiga Urinária/diagnóstico
13.
Dis Markers ; 2019: 7593560, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31089397

RESUMO

Introduction: A growing number of studies have explored the association between the pretreatment lymphocyte-to-monocyte ratio (LMR) and survival outcomes in various cancers. However, its prognostic significance on bladder cancer remains inconsistent. The aim of this meta-analysis was to evaluate the prognostic value of pretreatment LMR in bladder cancer. Methods: The MEDLINE, EMBASE, Cochrane Library, and CNKI databases were comprehensively searched for relevant studies. A meta-analysis of overall survival (OS), recurrence-free survival (RFS), or cancer-specific survival (CSS) clinicopathological features was conducted. Results: Nine studies containing 5,638 cancer patients were analyzed in this meta-analysis. Patients with high LMR tended to have favourable OS (HR: 0.63, 95% CI: 0.50-0.80, P < 0.001), RFS (HR: 0.59, 95% CI: 0.38-0.91, P = 0.017), and CSS (HR: 0.76, 95% CI: 0.70-0.83, P < 0.001). Moreover, low LMR was highly correlated with age (≥60), differentiation (low), T stage (III-IV), lymph node metastasis (yes), and concomitant Cis (yes). Conclusion: Pretreatment LMR might be a useful predictor of survival outcomes in patients with bladder cancer.


Assuntos
Biomarcadores Tumorais/sangue , Cistectomia/efeitos adversos , Linfócitos/patologia , Monócitos/patologia , Recidiva Local de Neoplasia/epidemiologia , Complicações Pós-Operatórias/epidemiologia , Neoplasias da Bexiga Urinária/sangue , Idoso , Feminino , Humanos , Contagem de Leucócitos , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/sangue , Complicações Pós-Operatórias/sangue , Análise de Sobrevida , Neoplasias da Bexiga Urinária/patologia , Neoplasias da Bexiga Urinária/cirurgia
14.
Afr J Reprod Health ; 23(1): 139-149, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31034181

RESUMO

Enterocutaneous fistula is an abnormal communication between the intestine and the skin, while enterovesical fistula is an abnormal communication between the intestine and the bladder. Both are not usual complications of ovarian cystectomy. We present a patient with enterovesical fistula coexisting with enterocutaneous fistula following ovarian cystectomy. She is a 24- year-old lady with background immunosupression who presented to the National Obstetric Fistula Centre, Abakaliki South-East Nigeria with a history fecaluria, pneumaturia and passage of feculent fluid through the skin following ovarian cystectomy. Fistulogram was in keeping with rectovesical fistula. She was repaired in a single stage and made an uneventful recovery. Enterovesical fistula and enterocutaneus fistula are uncommon but possible complications of ovarian cystectomy.


Assuntos
Cistectomia/efeitos adversos , Fístula Intestinal/cirurgia , Fístula Retal/cirurgia , Fístula da Bexiga Urinária/cirurgia , Bexiga Urinária/cirurgia , Feminino , Humanos , Fístula Intestinal/etiologia , Nigéria , Complicações Pós-Operatórias , Fístula Retal/etiologia , Resultado do Tratamento , Fístula da Bexiga Urinária/etiologia , Adulto Jovem
15.
Int J Clin Oncol ; 24(9): 1081-1088, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30972505

RESUMO

BACKGROUNDS: This study aimed to describe the morbidity and mortality in older patients undergoing laparoscopic radical cystectomy (LRC) and compare the outcomes of LRC between octogenarians and younger patients (< 80 years) in a Japanese multicenter cohort. METHODS: We identified 433 patients (80 octogenarians) who underwent LRC in a retrospective multicenter database from 10 institutions. The perioperative outcomes and the 90-day and late (> 90-day) complications according to the Clavien-Dindo classification were compared between the octogenarians and younger patients. Recurrence-free survival (RFS), overall survival (OS), and cancer-specific survival (CSS) were measured by the Kaplan-Meier method. RESULTS: Compared with the younger group, the octogenarian group included a significantly higher proportion of women, patients with a lower body mass index, patients with a lower preoperative albumin level, and patients with a history of abdominal surgery. The 90-day rates of all complications and major complications (grades III-V) were 50.0% and 20.0% among octogenarians and 54.7% and 16.4% among younger patients. The 90-day mortality rate among octogenarians was 3.8%. The 2-year RFS, CSS, and OS rates for octogenarians stratified by pathological stage was 95.2, 100, and 100% for ≤ pT1; 50.7, 76.6, and 56.1% for pT2; 33.6, 82.5, and 72.6% for ≥ pT3; and 23.1, 42.2, and 37.5% for pN + or distant metastasis, respectively. There was significant difference between octogenarians and younger patients only in 2-year OS for pT2 (56.1% vs 87.7%, p = 0.03). CONCLUSIONS: This study revealed that LRC can be performed for selected octogenarians with a complication rate similar to that of younger patients. Appropriate risk evaluation and modification of surgical procedures are necessary for octogenarians.


Assuntos
Cistectomia/métodos , Neoplasias da Bexiga Urinária/mortalidade , Neoplasias da Bexiga Urinária/cirurgia , Idoso de 80 Anos ou mais , Estudos de Coortes , Cistectomia/efeitos adversos , Feminino , Humanos , Japão/epidemiologia , Laparoscopia/efeitos adversos , Laparoscopia/métodos , Masculino , Morbidade , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Taxa de Sobrevida , Neoplasias da Bexiga Urinária/patologia
16.
Arch Ital Urol Androl ; 91(1): 63-67, 2019 Mar 29.
Artigo em Inglês | MEDLINE | ID: mdl-30932436

RESUMO

Pubic bone osteomyelitis is a rare infectious condition which is characterized by a complex diagnostic and therapeutic workup, due to its various clinical manifestations. Among the many causes of this condition, urinary fistula is the most common in case of previous urological procedures. In order to solve this complication, it is crucial to treat both the fistula and (moreover) the infectious locus arising from it, because treating the fistula alone does not provide any control on the infectious noxa. We present the first case of pubic bone osteomyelitis arising from a urinary fistula after a robotic radical cystectomy with intra corporeal continent neobladder, which has been successfully treated through a multidisciplinary approach.


Assuntos
Cistectomia/métodos , Osteomielite/etiologia , Derivação Urinária/métodos , Fístula Urinária/complicações , Idoso , Cistectomia/efeitos adversos , Humanos , Masculino , Osteomielite/diagnóstico , Osteomielite/terapia , Complicações Pós-Operatórias/patologia , Complicações Pós-Operatórias/terapia , Osso Púbico/patologia , Procedimentos Cirúrgicos Robóticos/métodos , Neoplasias da Bexiga Urinária/cirurgia , Fístula Urinária/etiologia , Fístula Urinária/terapia
17.
Int Braz J Urol ; 45(4): 686-694, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30901172

RESUMO

PURPOSE: The present study aimed to determine whether sarcopenia after radical cystectomy (RC) could predict overall survival (OS) in patients with urothelial bladder cancer (UBC). MATERIALS AND METHODS: The lumbar skeletal muscle index (SMI) of 80 patients was measured before and 1 year after RC. The prognostic signifi cance of sarcopenia and SMI decrease after RC were evaluated using Kaplan-Meier analysis and a multivariable Cox regression model. RESULTS: Of 80 patients, 26 (32.5%) experienced sarcopenia before RC, whereas 40 (50.0%) experienced sarcopenia after RC. The median SMI change was -2.2 cm2/m2. Patients with sarcopenia after RC had a higher pathological T stage and tumor grade than patients without sarcopenia. Furthermore, the overall mortality rate was signifi - cantly higher in patients with sarcopenia than in those without sarcopenia 1 year after RC. The median follow-up time was 46.2 months, during which 22 patients died. Kaplan-Meier estimates showed a signifi cant difference in OS rates based on sarcopenia (P=0.012) and SMI decrease (P=0.025). Multivariable Cox regression analysis showed that SMI decrease (≥2.2 cm2/m2) was an independent predictor of OS (hazard ratio: 2.68, confi dence interval: 1.007-7.719, P = 0.048). CONCLUSIONS: The decrease in SMI after surgery might be a negative prognostic factor for OS in patients who underwent RC to treat UBC.


Assuntos
Carcinoma in Situ/cirurgia , Cistectomia/efeitos adversos , Sarcopenia/etiologia , Neoplasias da Bexiga Urinária/cirurgia , Idoso , Índice de Massa Corporal , Carcinoma in Situ/complicações , Carcinoma in Situ/mortalidade , Cistectomia/métodos , Cistectomia/mortalidade , Feminino , Humanos , Estimativa de Kaplan-Meier , Masculino , Análise Multivariada , Músculo Esquelético/fisiopatologia , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Sarcopenia/fisiopatologia , Fatores de Tempo , Neoplasias da Bexiga Urinária/complicações , Neoplasias da Bexiga Urinária/mortalidade , Neoplasias da Bexiga Urinária/fisiopatologia
18.
J Cancer Res Ther ; 15(Supplement): S51-S55, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30900621

RESUMO

Background/Objective: To report the initial experience and the early outcomes of a modified U-shaped ileal neobladder, which was developed to facilitate the neobladder-urethral anastomosis by minimizing the anastomotic tension. Patients and Methods: Between June 2015 and December 2016, two male and two female patients (median age: 65.5 years, range: 43-72 years) underwent the modified U-shaped ileal neobladder after robotic-assisted radical cystectomy (RARC). The most mobile and dependent ileal segment was first selected intracorporeally as the site for later neobladder-urethral anastomosis. The neobladder was formed extracorporeally, and the previously selected ileal segment formed the most dependent portion of the neobladder. The neobladder-urethral anastomosis was completed after robotic redocking. Results: The median follow-up was 8 months (3-21 months). The median operative time, console time, and extracorporeal reconstruction time were 620 min (534-674 min), 372 min (314-420 min), and 151 min (128-215 min), respectively. In all patients, the neobladder-urethral anastomosis was completed intracorporeally with minimal tension. The median hospital time after the surgery was 14.5 days (14-19 days). Postoperatively, the median peak flow rate and void volume were 10 ml/s (4-35 ml/s) and 258 ml (88-775 ml). The median postvoid residual was 20 ml (10-53 ml). At daytime, two were completely continent; the other two reported mild (1-2 pads) and moderate (>2 pads) incontinence at the postoperative 3 and 4 months, respectively. Three reported nocturnal enuresis. Conclusions: Our initial experience demonstrated that the modified U-shaped neobladder designed for minimizing the anastomotic tension is safe and feasible with its satisfactory functional outcomes.


Assuntos
Íleo/cirurgia , Ureter/cirurgia , Uretra/cirurgia , Neoplasias da Bexiga Urinária/cirurgia , Derivação Urinária/métodos , Adulto , Idoso , Anastomose Cirúrgica/efeitos adversos , Anastomose Cirúrgica/métodos , Cistectomia/efeitos adversos , Estudos de Viabilidade , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Procedimentos Cirúrgicos Robóticos/efeitos adversos , Resultado do Tratamento , Bexiga Urinária/cirurgia , Derivação Urinária/efeitos adversos , Incontinência Urinária/epidemiologia , Incontinência Urinária/etiologia , Coletores de Urina/efeitos adversos , Urodinâmica
19.
J Urol ; 202(1): 83-89, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-30835627

RESUMO

PURPOSE: Patient centered care aims to align treatment with patient goals, especially when treatment options have equivalent clinical outcomes. For surgeries with lasting impacts that alignment is critical. To our knowledge no psychometrically tested preference elicitation measures exist to support patients with bladder cancer treated with cystectomy, who can often choose between ileal conduit and neobladder diversions. In this study we created a scale to measure how patient goals align with each type of urinary diversion and the associated surgical outcomes. MATERIALS AND METHODS: We performed formative research through focus groups and clinician outreach to adapt a goal dissonance measure. We mailed a survey to adult Kaiser Permanente® members who underwent cystectomy for bladder cancer between January 2013 and June 2015. Eligible patients were identified through electronic health records and chart review. Surveys were mailed 5 to 7 months postoperatively. We administered our 10-item decision dissonance scale along with other decision making measures. We explored goal alignment as well as dissonance. Psychometric analysis included factor analysis, evaluation of scale scores between surgery groups and evaluation with other decision making scores. RESULTS: We identified 10 goals associated with ileal conduit or neobladder diversion. Using survey data on 215 patients our scale differentiated patient goals associated with each diversion choice. On average patients with a neobladder strongly valued neobladder aligned goals such as maintaining body integrity and volitional voiding through the urethra. Patients with an ileal conduit had neutral values on average across all goals. CONCLUSIONS: Our measure lays the foundation for a simple value elicitation approach which could facilitate shared decision making about urinary diversion choice.


Assuntos
Tomada de Decisão Clínica/métodos , Tomada de Decisões , Preferência do Paciente , Neoplasias da Bexiga Urinária/cirurgia , Derivação Urinária/psicologia , Idoso , Cistectomia/efeitos adversos , Feminino , Grupos Focais , Metas , Humanos , Masculino , Pessoa de Meia-Idade , Psicometria , Inquéritos e Questionários , Derivação Urinária/efeitos adversos , Derivação Urinária/métodos
20.
Int J Clin Pharm ; 41(2): 408-413, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30864080

RESUMO

Background After radical cystectomy, delayed return of bowel function is relatively common. Although studies investigating on the best modality for delivering nutritional support to this patient group are limited, parenteral nutrition was standard of care in those patients at the urological ward of the University Hospitals Leuven. In 2015, we published the findings from our study conducted in patients undergoing elective regular radical cystectomy at the urological ward of the University Hospitals Leuven comparing the length of hospital stay in patients with early postoperative parenteral nutrition (n = 48) versus an immediate oral nutrition protocol (n = 46). It was demonstrated that the implementation of an oral nutrition protocol was associated with a significant reduced length of hospital stay (median [IQR] of 18 [15-22] to 14 [13-18] days (p < 0.001)). The sample size was however too small to investigate the impact of the oral nutrition protocol on the incidence of catheter-related bloodstream infection, a common parenteral nutrition related complication. Objective To investigate the long term impact of an oral nutrition protocol on the incidence of catheter-related bloodstream infection, duration of catheterization and the length of hospital stay. Method Retrospectively, before (parenteral nutrition group) and after the implementation of the oral nutrition protocol (since March 10th 2010), two cohorts of 549 patients who underwent an elective regular radical cystectomy were included. The incidence of a catheter-related bloodstream infection and the length of stay were compared. A central venous catheter was present in every patient, which is standard of care. Results Catheter-related bloodstream infection was reduced from 22 (4%) to 10 (1.8%) (p = 0.031). The median duration of catheterization was 10 [7-13] days for the parenteral nutrition versus 7 [7-7] days for the oral nutrition group (p < 0.001). The median length of stay between both groups, 20 [17-25] before versus 17 [14-21] days after the implementation of the oral nutrition protocol, also differed significantly (p < 0.001). Implementing the oral nutrition protocol resulted in a parenteral nutrition associated cost saving of €470 per patient. Conclusion This large follow-up study showed that the oral nutrition protocol is associated with a reduction in catheter-related bloodstream infection. Besides, postponing parenteral nutrition in favour of oral nutrition enhances recovery.


Assuntos
Cateteres Venosos Centrais/efeitos adversos , Cateteres Venosos Centrais/tendências , Cistectomia/efeitos adversos , Nutrição Enteral/estatística & dados numéricos , Terapia Nutricional/efeitos adversos , Nutrição Parenteral/estatística & dados numéricos , Bélgica/epidemiologia , Estudos de Casos e Controles , Redução de Custos/estatística & dados numéricos , Procedimentos Cirúrgicos Eletivos/efeitos adversos , Feminino , Seguimentos , Humanos , Tempo de Internação/estatística & dados numéricos , Masculino , Nutrição Parenteral/economia , Cuidados Pós-Operatórios/métodos , Fatores de Tempo
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