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1.
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
2.
Urologiia ; (5): 54-60, 2020 Nov.
Artigo em Russo | MEDLINE | ID: mdl-33185348

RESUMO

INTRODUCTION: Robot-assisted radical cystectomy (RARC) with intracorporeal neobladder formation is a complex surgical procedure. AIM: To describe the main stages of RARC and to analyze its short-term results. MATERIALS AND METHODS: RARC with ileocystoplasty was performed in 16 patients, most of whom were men (n=14). In 15 patients, the indication for surgery was bladder cancer (BCa), while one patient has radiation-induced sigmoid fistula with a formation of small, contracted bladder. During radical cystectomy (RC), the lower ureters were dissected, followed by posterior dissection of the bladder with mobilization from both sides to the pelvic fascia, clipping and transection of the vesical pedicles, and suturing of the dorsal venous complex with urethral dissection. After pelvic lymph node dissection, 40 cm of the ileum was resected, after that two distal segments of 15 cm were U-shaped, and a 1.5 cm incision was made in the lower part of the bowel, followed by a formation of the urethral anastomosis. Then bowel segments were detubularized, and continuous suture on the posterior and anterior walls of the neobladder was done. Ureters were implanted in the proximal tubular part of the resected colon according to the Nesbit technique. RESULTS: The mean operation time was 380 minutes. The blood loss ranged from 80 to 200 ml; however, blood transfusion was not performed. Complications during 30-days after RARC were observed in 7 (43.7%) patients, including 4 (25%) of class I-II according to Clavien - Dindo, and 3 (18.7%) of class III-IV. In patients with leakage at the uretero- intestinal anastomosis (n=2) and urethro-neobladder anastomosis (n=1), percutaneous drainage was performed, which allowed to resolve these complications. There were no cases of bowel obstruction. One patient with gastrointestinal bleeding required blood transfusion. The 90-day late complications occurred in 6 (37.5%) patients, including 2 cases of upper urinary tract infection. One patient died of acute myocardial infarction. CONCLUSION: RARC is a contemporary minimally invasive method for muscle-invasive BCa. Stepwise approach to RARC with intracorporeal neobladder formation may reduce the operation time and the rate of complications.


Assuntos
Procedimentos Cirúrgicos Robóticos , Robótica , Estruturas Criadas Cirurgicamente , Neoplasias da Bexiga Urinária , Derivação Urinária , Cistectomia/efeitos adversos , Humanos , Masculino , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/cirurgia , Procedimentos Cirúrgicos Robóticos/efeitos adversos , Resultado do Tratamento , Neoplasias da Bexiga Urinária/cirurgia , Derivação Urinária/efeitos adversos
3.
Medicine (Baltimore) ; 99(43): e22893, 2020 Oct 23.
Artigo em Inglês | MEDLINE | ID: mdl-33120837

RESUMO

Radical cystectomy is considered the standard treatment for patients with muscle-invasive bladder tumors and has high postoperative complication rates among urological surgeries. High-risk patients, defined as those ≥45 years of age with history of coronary artery disease, stroke, or peripheral artery disease or those ≥65 years of age, can have a higher incidence of cardiac complications. Therefore, we evaluated the incidence, risk factors, and outcomes of myocardial injury after non-cardiac surgery (MINS) in high-risk patients who underwent radical cystectomy.This retrospective observational study analyzed 248 high-risk patients who underwent radical cystectomy. MINS was defined as serum troponin I concentration ≥0.04 mg/L within postoperative 3 days. The risk factors for MINS were evaluated by multivariate logistic regression analysis. Postoperative outcomes were evaluated. The 1-year survival after radical cystectomy was also compared between patients who developed MINS (MINS group) and those who did not (non-MINS group) by Kaplan-Meier analysis.MINS occurred in 35 patients (14.1%). Multivariate logistic regression analysis showed that early diastolic transmitral filling velocity (E)/early diastolic septal mitral annular velocity (E') ratio (odds ratio = 1.102, 95% confidence interval [1.009-1.203], P = .031) and large volume blood transfusion (odds ratio = 2.745, 95% confidence interval [1.131-6.664], P = .026) were significantly associated with MINS in high-risk patients who underwent radical cystectomy. Major adverse cardiac events and 1-year mortality were significantly higher in the MINS group than in the non-MINS group (17.1% vs 6.1%, P = .035; 28.6% vs 12.7%, P = .021, respectively). Kaplan-Meier analysis showed significantly lower 1-year survival in the MINS group than in the non-MINS group (P = .010).MINS occurred in 14.1% of patients. High E/E' ratio and large volume blood transfusion were risk factors for MINS in high-risk patients who underwent radical cystectomy. Postoperative major adverse cardiac events and 1-year mortality were significantly higher in the MINS group than in the non-MINS group. Preoperative evaluation of risk factors for MINS may provide useful information to detect cardiovascular complications after radical cystectomy in high-risk patients.


Assuntos
Cistectomia/efeitos adversos , Isquemia Miocárdica/etiologia , Troponina I/sangue , Neoplasias da Bexiga Urinária/cirurgia , Idoso , Idoso de 80 Anos ou mais , Transfusão de Sangue/estatística & dados numéricos , Estudos de Casos e Controles , Cistectomia/mortalidade , Feminino , Humanos , Incidência , Estimativa de Kaplan-Meier , Masculino , Isquemia Miocárdica/epidemiologia , Isquemia Miocárdica/metabolismo , Estadiamento de Neoplasias/métodos , Complicações Pós-Operatórias/epidemiologia , República da Coreia/epidemiologia , Estudos Retrospectivos , Fatores de Risco , Neoplasias da Bexiga Urinária/complicações , Neoplasias da Bexiga Urinária/patologia
6.
Urologe A ; 59(10): 1265-1274, 2020 Oct.
Artigo em Alemão | MEDLINE | ID: mdl-32936335

RESUMO

Upper urinary tract urothelial cell carcinoma (UTUC) is a rare entity. The incidence in Germany is approximately 2/100,000 with a ratio between women and men of 1:2.5. Most clinical signs are nonspecific, which is why early diagnosis is rarely successful. Computed tomography urography in combination with diagnostic ureterorenoscopy is currently the gold standard in the diagnostics of UTUC. Regarding surgical treatment, radical nephroureterectomy (RNU) with resection of a bladder cuff remains the method of choice, although the radical approach is developing towards laparoscopic/robotic or endourological procedures with preservation of kidney tissue. Due to the high recurrence rate (22-47%) of urothelial carcinoma inside the bladder, close follow-up after RNU is mandatory.


Assuntos
Carcinoma de Células de Transição , Neoplasias Ureterais , Neoplasias da Bexiga Urinária , Carcinoma de Células de Transição/diagnóstico por imagem , Carcinoma de Células de Transição/cirurgia , Feminino , Alemanha , Humanos , Masculino , Nefrectomia , Nefroureterectomia , Estudos Retrospectivos , Neoplasias Ureterais/diagnóstico por imagem , Neoplasias Ureterais/cirurgia , Neoplasias da Bexiga Urinária/diagnóstico por imagem , Neoplasias da Bexiga Urinária/cirurgia
7.
Arch Esp Urol ; 73(7): 600-610, 2020 Sep.
Artigo em Espanhol | MEDLINE | ID: mdl-32886075

RESUMO

The ERAS (Enhanced Recovery After Surgery) protocol, originated in the 1990s when two groups of researchers presented different proposals to improve the postoperative evolution of patients undergoing elective surgery. In 2001, the ERAS group was organized, consisting of different surgery units from northern Europe (Scotland, Sweden, Denmark, Norway, and the Netherlands). This group made a consensus that they called the ERAS project, characterized by a multimodal rehabilitation program for surgically operated patients on ascheduled basis. The protocol includes a combination of preoperative, intraoperative, and postoperative strategies based on scientific evidence. That improves the recovery and functionality of patients after the surgical event minimizes the response to surgical stress. Besides, this action on factors involved in the biological response to aggression impacts postoperative complications and decreases hospital stay and hospitalization costs. The professionals in charge of the patient are responsible for three key elements that affect the outcome after surgery: the first is the control of stress reactions to surgery, the second is fluid therapy, and the third is analgesia. The trimodal approach leads to improving the results in urological surgery, such as radical cystectomy.


Assuntos
Cistectomia , Neoplasias da Bexiga Urinária/cirurgia , Recuperação Pós-Cirúrgica Melhorada , Europa (Continente) , Humanos , Tempo de Internação , Complicações Pós-Operatórias/epidemiologia
8.
Hinyokika Kiyo ; 66(9): 313-317, 2020 Sep.
Artigo em Japonês | MEDLINE | ID: mdl-32988169

RESUMO

A 74-year-old man presented with further treatment for muscle invasive small cell carcinoma of the bladder. After three courses of neoadjuvant chemotherapy with cisplatine + etoposide (EP), total cystectomy was performed. The pathological findings revealed small cell carcinoma of the bladder (ypT2N0M0). Eleven months after the operation, thoracoabdominal computed tomography (CT) showed right pelvic lymph node metastasis. He underwent 9 courses of EP chemotherapy, and everolimus, finally, Amrubicin was administered. Amrubicin might be useful for small cell carcinoma of the bladder.


Assuntos
Carcinoma de Células Pequenas/diagnóstico por imagem , Carcinoma de Células Pequenas/tratamento farmacológico , Neoplasias da Bexiga Urinária/diagnóstico por imagem , Neoplasias da Bexiga Urinária/tratamento farmacológico , Neoplasias da Bexiga Urinária/cirurgia , Idoso , Cistectomia , Etoposídeo , Humanos , Masculino
9.
Anticancer Res ; 40(10): 5861-5868, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32988916

RESUMO

AIM: To evaluate our experience with radical radiotherapy and chemotherapy in patients with muscle-invasive bladder cancer. PATIENTS AND METHODS: The study consisted of 27 patients treated with cisplatin-based chemoradiation (CCRT), 48 treated with radiation alone (RT), and 42 with locally advanced disease treated with neoadjuvant chemotherapy and radiation (neoCRT). RESULTS: The incidence of acute grade 3 or more genitourinary (GU) toxicity in the RT, CCRT and neoCRT groups was: 25%, 11% and 19%, respectively (p=0.029). The 3-year freedom from grade 2 or more GU toxicity was: 81%, 89%, 54%, respectively (p=0.36). The long-term outcomes of 3-year local control, overall survival, and disease-free survival were as follows: RT group: 74%, 61% and 55%; CCRT group: 76%, 76% and 56%; neoCRT group: 31%, 43% and 18%, respectively. CONCLUSION: The preferable bladder-conserving approach is CRT, however RT alone might also be an option for appropriately selected patients. NeoCRT for those with locally advanced tumors remain unsatisfactory; adequate selection of patients for radical treatment is of importance.


Assuntos
Cisplatino/uso terapêutico , Músculo Esquelético/patologia , Neoplasias da Bexiga Urinária/tratamento farmacológico , Neoplasias da Bexiga Urinária/radioterapia , Idoso , Idoso de 80 Anos ou mais , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Quimiorradioterapia/efeitos adversos , Terapia Combinada , Intervalo Livre de Doença , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Terapia Neoadjuvante/métodos , Invasividade Neoplásica/patologia , Neoplasias da Bexiga Urinária/patologia , Neoplasias da Bexiga Urinária/cirurgia
10.
Surgery ; 168(5): 786-792, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32771298

RESUMO

BACKGROUND: Bladder invasion by colon cancer is rare; however, its management is still controversial. Our objective was to report outcomes and identify risk factors for local recurrence in colon cancer with clinically suspected bladder invasion. METHODS: We conducted a retrospective study in 23 centers in France. All patients who underwent colon surgery with bladder resection (2010-2017) were included. Metastatic and recurrent colon cancers were excluded. RESULTS: One hundred and seventeen patients (men = 73) were included. Partial cystectomy occurred in 108 patients (92.3%), with a total cystectomy occurring in 9 patients (7.7%). Neoadjuvant treatment was given to 31 patients (26.5%). Major morbidity was 20.5%. R0 resection rates were 87.2%. Histologically confirmed bladder invasion was present in 47%. Thirty-four patients were pN+, while 60 patients (51.3%) received adjuvant chemotherapy. Mean follow-up was 33.8 months. Three-year overall survival and disease-free survival were 82.9% and 59.5%. Rates of local recurrence and distant recurrence were 14.5% and 18.8%, respectively; the local recurrences (11/17; 65%) were in the bladder, while 4 of these patients had a bladder recurrence despite not having histologically confirmed bladder invasion at the index surgery. The rate of bladder recurrence after histologic bladder invasion was 13% (7/55), while the rate of bladder recurrence without primary bladder invasion was 7% (4/62) (P = .343). Neoadjuvant therapy, type of cystectomy, and adjuvant therapy did not influence local recurrence (P > .445 each). R1 bladder resections, when compared with a R0 bladder resections, were associated with an increased rate of local recurrence (63% vs 10%; P < .0001). CONCLUSION: Clinically suspected bladder invasion increases local recurrence even in the absence of histologically confirmed bladder invasion. Only complete resections with R0 margins decrease local recurrence. Careful, detailed postoperative surveillance is required, even without pathologic bladder invasion.


Assuntos
Neoplasias do Colo/patologia , Bexiga Urinária/patologia , Idoso , Idoso de 80 Anos ou mais , Neoplasias do Colo/mortalidade , Neoplasias do Colo/cirurgia , Cistectomia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Invasividade Neoplásica , Recidiva Local de Neoplasia , Prognóstico , Estudos Retrospectivos , Neoplasias da Bexiga Urinária/mortalidade , Neoplasias da Bexiga Urinária/cirurgia
13.
Beijing Da Xue Xue Bao Yi Xue Ban ; 52(4): 632-636, 2020 Aug 18.
Artigo em Chinês | MEDLINE | ID: mdl-32773791

RESUMO

OBJECTIVE: To explore the clinical application value of using needle electrode in transurethral plasmakinetic resection of bladder tumor around ureteral orifice. METHODS: Retrospective analysis was performed on the clinical data of 16 cases who had bladder tumors around ureteral orifice and underwent transurethral resection using plasmakinetic needle electrode in Department of Urology, Peking University International Hospital from June 2015 to December 2019. There were nine cases with the tumor of one to two centimeters from the ureteral orifice. The rest of the seven cases had tumor that was within one centimeter from the ureteral orifice, including two cases whose ureteral orifice was invaded by the tumor. All the patients studied were diagnosed before surgery and contraindications were excluded. The plasmakinetic needle electrode was used to treat the tumor with en bloc resection, and all the excised tissue was sent for pathological examination. Intravesical chemotherapy and postoperative follow-ups were performed. Statistical analysis was performed on the operation time, the incidence of obturator nerve reflex, the peri-operative bleeding, the parameters of indwelling ureteral catheter or double-J stent, the incidence of postoperative hydronephrosis, the clinical stage of tumor, and the recurrence rate. RESULTS: The operation was successfully completed for all the sixteen cases. The operation time was 16 to 57 minutes, with an average of (32.6±11.8) minutes. No obvious obturator nerve reflex and perioperative bleeding occurred in all the patients. Ureteral catheters were indwelled prior to the operation of tumor resection in seven cases. Four of the seven cases had the ureteral catheters remained while the rest three were replaced by double-J stent after surgery. Postoperative pathological analysis showed that all the tumors were urothelial carcinoma, including 9 cases of low grade and 7 cases of high grade. Pathological staging: 10 cases were in Ta stage, 5 cases in T1 stage, and 1 case in T2a stage. All tumor bases and lateral margins were negative. All the patients received 3-56 months, with an average of (26.0±18.1) months of follow-up. There was no case of upper urinary tract hydronephrosis or tumor recurrence. CONCLUSION: The transurethral plasmakinetic resection of bladder tumor using needle electrode can realize en bloc tumor resection without obturator nerve reflex and reduce the risk of ureteral orifice injury. It is a safe and effective surgical method for treating bladder tumors around the ureteral orifice.


Assuntos
Neoplasias da Bexiga Urinária , Carcinoma de Células de Transição , Eletrodos , Humanos , Recidiva Local de Neoplasia , Estudos Retrospectivos , Neoplasias da Bexiga Urinária/cirurgia
14.
Beijing Da Xue Xue Bao Yi Xue Ban ; 52(4): 697-700, 2020 Aug 18.
Artigo em Chinês | MEDLINE | ID: mdl-32773804

RESUMO

OBJECTIVE: To investigate the effect of NBI assisted white light transurethral resection of bladder tumor (TURBT) in the treatment of bladder urothelial carcinoma and to summarize the experience of narrow band imaging (NBI) operation. METHODS: Patients with bladder urothelial carcinoma were selected, and TURBT was performed after anesthesia. First of all, the bladder tumor was found and resected under white light. Then we replaced with NBI, looked for suspicious lesions and resected them, The specimens excised under white light and NBI were collected separately. The number, location and pathological results of the lesions under white light were recorded, and the residual lesions under NBI were also recorded. To evaluate the effect of NBI, the ratio of residual bladder tumor was calculated. The cases were divided into three groups according to the time sequence. The clinical data of each group were collected and the learning curve of TURBT under NBI assisted white light was observed. RESULTS: A prospective study of 45 patients with bladder tumor from April 2018 to January 2020, including 32 males and 13 females, aged from 23 to 89 years, with an average age of 65.2 years. All the operations were successfully completed, without obvious complications after operation. Nine cases were single and 36 cases were multiple. The maximum diameter of the tumors was 0.5 to 4.0 cm, with an average of 2.2 cm. The histopathology of the resected tissue under white light was urothelial carcinoma, and 19 cases (42.2%) were pathologically positive by NBI resection. The 45 cases were divided into three groups according to the time sequence, 15 cases in each group. The true positive rate of NBI was 33.3%, 46.7% and 46.7%, respectively, and the false positive rate was 60.0%, 46.7% and 26.7%, respectively in the three groups. CONCLUSION: TURBT is an effective way to treat bladder urothelial cancer, NBI is an effective supplement of white light, which can increase the detection rate of bladder cancer and reduce post-operative recurrence. The NBI light source has a certain learning curve. With the increase of cases, the false-positive rate of NBI is gradually reduced. After the NBI operator has rich experience, the recognition degree of flat tumor is gradually improved under white light, and the residual rate of NBI is reduced after the removal under white light.


Assuntos
Autocontrole , Neoplasias da Bexiga Urinária , Adulto , Idoso , Idoso de 80 Anos ou mais , Cistoscopia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Imagem de Banda Estreita , Recidiva Local de Neoplasia , Estudos Prospectivos , Neoplasias da Bexiga Urinária/diagnóstico por imagem , Neoplasias da Bexiga Urinária/cirurgia , Adulto Jovem
15.
Medicine (Baltimore) ; 99(34): e21768, 2020 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-32846804

RESUMO

BACKGROUND: To compare the efficacy and safety of bipolar and monopolar transurethral resection of bladder tumors (TURBT) in non-muscle invasive bladder cancer (NMIBC) treatment. METHODS: This protocol established in this study has been reported following the preferred reporting items for systematic review and meta-analysis protocols. Web of Science, PubMed, EMBASE, and the Cochrane Library were searched for all randomized controlled trials comparing bipolar TURBT and monopolar TURBT in NMIBC treatment until 31st of June 2020. We will use a combination of Medical Subject Heading and free-text terms with various synonyms to search based on the eligibility criteria. Two investigators independently reviewed the included studies and extracted relevant data. The odds ratio and 95% confidence intervals of were used as effect estimate. I-square (I) test, substantial heterogeneity, sensitivity analysis, and publication bias assessment will be performed accordingly. Stata 15.0 and Review Manger 5.3 are used for meta-analysis and systematic review. RESULTS: The results will be published in a peer-reviewed journal. CONCLUSION: The results of this review will be widely disseminated through peer-reviewed publications and conference presentations. This evidence may also provide helpful evidence of the efficacy and safety of bipolar and monopolar transurethral resection of TURBT in NMIBC treatment. PROSPERO REGISTRATION NUMBER: CRD42020151997.


Assuntos
Neoplasias da Bexiga Urinária/cirurgia , Procedimentos Cirúrgicos Urológicos/métodos , Humanos , Razão de Chances , Ensaios Clínicos Controlados Aleatórios como Assunto , Projetos de Pesquisa , Neoplasias da Bexiga Urinária/patologia , Procedimentos Cirúrgicos Urológicos/efeitos adversos
16.
Adv Clin Exp Med ; 29(7): 857-863, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32725972

RESUMO

BACKGROUND: Evaluating health-related quality of life (HR-QoL) is important in urological oncology. OBJECTIVES: To evaluate the impact of minimally invasive radical cystectomy (RC) on the patients' QoL depending on the surgical strategy (laparoscopic compared to robotic). MATERIAL AND METHODS: The study involved 110 patients divided into 2 groups: group 1 (n = 65), qualified for robotic-assisted RC (RARC), and group 2 (n = 45), qualified for laparoscopic RC (LRC). A prospective analysis of QoL was performed. In the study, we used sociodemographic data taken from the patients' medical records, and data from standardized questionnaires of QoL surveys entitled Functional Assessment of Cancer Therapy - General (FACT-G) and Functional Assessment of Cancer Therapy for Bladder Cancer (FACT-Bl). RESULTS: In the patients who had undergone LRC, a statistically significant difference in HR-QoL was noted only for the subjective well-being (SWB) domain regarding family and social life: The patients had higher SWB values before surgery than after it. In the patients who had undergone RARC, statistically significant differences in HR-QoL were noted in 3 domains: 1) SWB - family and social life, 2) FACT-Bl assessment and 3) FACT-G assessment. Both before and after surgery, no statistically significant differences were found between the 2 groups for any of the HR-QoL domains. CONCLUSIONS: The surgical technique of minimally invasive endoscopic RC used (laparoscopic or robotic) does not affect HR-QoL domains.


Assuntos
Laparoscopia , Procedimentos Cirúrgicos Robóticos , Cistectomia/efeitos adversos , Humanos , Complicações Pós-Operatórias , Estudos Prospectivos , Qualidade de Vida , Procedimentos Cirúrgicos Robóticos/efeitos adversos , Resultado do Tratamento , Neoplasias da Bexiga Urinária/cirurgia
17.
Medicine (Baltimore) ; 99(27): e20902, 2020 Jul 02.
Artigo em Inglês | MEDLINE | ID: mdl-32629682

RESUMO

BACKGROUND: Enhanced Recovery After Surgery (ERAS) protocols were introduced in clinical practice to reduce complication rates and hospital stay. We performed a randomized controlled single center study to evaluate perioperative benefits of an adapted ERAS protocol in patients with bladder cancer who underwent radical cystectomy (RC) and ileal urinary diversions (IUD). MATERIALS AND METHODS: Forty five from 90 consecutive randomized patients were enrolled in an adapted ERAS protocol. Length of stay, diet issues, return of bowel function, readmission rates and complications were examined. RESULTS: Among patients following ERAS protocol, we found a significant reduction in time to first flatus (1 vs 5 days, P < .001), time to first stool (2 vs 5 days, P < .001), time to normal diet (5 vs 6 days, P < .001) and length of stay (16 vs 18 days, P < .001). Also, postoperative ileus at less than 4 days was lower than in non-ERAS patients (15.6% vs 24.4%), but with a marginal trend toward significance (P = .05). Readmission rate was lower in the ERAS group, but the difference did not reach statistical significance. We also found a lower readmission and complication rate in patients with ERAS protocol (6.6% vs 11.1%, P = .23 and 46.6% vs 57.5%, P = .29, respectively). CONCLUSIONS: Implementation of ERAS protocol for patients undergoing RC in our center was associated with a significant reduction in the time to the first flatus, time to the first stool, time to a normal diet, length of hospital stay.


Assuntos
Protocolos Clínicos , Cistectomia/reabilitação , Recuperação Pós-Cirúrgica Melhorada , Neoplasias da Bexiga Urinária/cirurgia , Derivação Urinária/reabilitação , Feminino , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Readmissão do Paciente , Complicações Pós-Operatórias/prevenção & controle , Resultado do Tratamento
18.
Anticancer Res ; 40(8): 4299-4307, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32727757

RESUMO

BACKGROUND/AIM: The present research was performed to clarify the differences in circulating tumor cells (CTCs) counts between non-muscle-invasive (NMIBC) and muscle-invasive (MIBC) bladder cancer following transurethral resection of bladder tumor (TURBT). PATIENTS AND METHODS: The cohort in the prospective research was categorized into the NMIBC (n=13) and the MIBC (n=13) groups. The pre- and postoperative number of CTCs was counted by the FISHMAN-R® system. RESULTS: The difference of the number of preoperative CTCs between the NMIBC group (2.3±2.6) and MIBC group (4.8±4.2) did not reach statistical significance (p=0.08). However, there was a significantly greater increase in postoperative CTC count in the MIBC group (14.6±14.6) than in the NMIBC group (3.1±2.1, p=0.01). CONCLUSION: After TURBT, more carcinoma cells can be discharged from the bladder in the MIBC. Excessive deep layer resection and excessive pressure of the infusion fluid during TURBT should be avoided in patients with MIBC.


Assuntos
Invasividade Neoplásica , Células Neoplásicas Circulantes , Uretra , Neoplasias da Bexiga Urinária/cirurgia , Procedimentos Cirúrgicos Urológicos/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
19.
Medicine (Baltimore) ; 99(28): e20825, 2020 Jul 10.
Artigo em Inglês | MEDLINE | ID: mdl-32664075

RESUMO

INTRODUCTION: Primary bladder mucosa-associated lymphoid tissue (MALT) lymphoma is a rare tumor. To date, the PubMed database contains only 39 English articles covering 63 cases of primary bladder MALT lymphoma. Herein, we report a case of this disease and review the current literature. PATIENT CONCERNS: A 77-year-old woman presented with frequent urination, urinary urgency, and dysuria for 3 years. In the past 3 years, the patient's symptoms recurred and progressively worsened, and she was admitted to the hospital. DIAGNOSIS: A histopathological examination revealed the bladder mass as a tumor with high proliferation of atypical B-lymphocytes. Immunohistochemistry showed positive results for CD20, PAX-5, Ki-67, BCL-2, and CD21 and negative results for CD10, MUM1, TDT, and cyclin D1. These data supported the diagnosis of primary bladder MALT lymphoma. INTERVENTIONS: A transurethral resection of bladder tumor was performed to treat the disease. OUTCOMES: The patient was alive and healthy at the 15-month follow-up. CONCLUSION: Primary bladder MALT lymphoma is a rare disease and can be easily missed or misdiagnosed before achieving a histological confirmation. Surgery may be the best choice for both diagnosis and treatment.


Assuntos
Linfoma de Zona Marginal Tipo Células B/patologia , Neoplasias da Bexiga Urinária/patologia , Transtornos Urinários/etiologia , Adolescente , Adulto , Assistência ao Convalescente , Idoso , Idoso de 80 Anos ou mais , Linfócitos B/patologia , Cistoscopia/métodos , Feminino , Humanos , Imuno-Histoquímica/métodos , Linfoma de Zona Marginal Tipo Células B/metabolismo , Linfoma de Zona Marginal Tipo Células B/cirurgia , Masculino , Margens de Excisão , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento , Neoplasias da Bexiga Urinária/diagnóstico por imagem , Neoplasias da Bexiga Urinária/cirurgia , Transtornos Urinários/fisiopatologia , Adulto Jovem
20.
Arch Esp Urol ; 73(6): 564-567, 2020 Jul.
Artigo em Espanhol | MEDLINE | ID: mdl-32633253

RESUMO

INTRODUCTION: Bladder Cancer (BC) is11th most common malignancy. In terms of pathology, the vast majority of patients suffer from transitional cell carcinoma. Apart from this common type of BC, there are many morphological subtypes with different oncological characteristics. Plasmacytoid BC is a well-recognized subtype of BC with great diagnostic importance as it usually presents in locally advanced or even metastatic stage. OBJECTIVE: The objective of this study was to evaluate our experience in diagnosing and treating patients with this rare BC subtype. METHODS: A retrospective analysis of 5 patients diagnosed with plasmacytoid BC in our department during they ears 2014-2016 was performed. Transurethral resection of the tumors was performed in all patients and pathology diagnosis of plasmacytoid variant was based on several morphologic and immunohistochemical parameters. Staging included abdominal and thoracic CT. RESULTS: 3 of 5 patients were diagnosed with metastatic disease. These patients were referred to the oncology department. 2 patients presented with non-metastatic BC after initial staging and thus a radical cystectomy was performed. Follow up of all patients was carried out and their survival was recorded. CONCLUSIONS: We concluded that despite the fact that the plasmacytoid variant of BC is rare, it is important to take into account the pathologic and clinical features of this tumor in order to manage the optimal treatment of this poor prognosis cancer.


Assuntos
Carcinoma de Células de Transição/cirurgia , Neoplasias da Bexiga Urinária/cirurgia , Cistectomia , Humanos , Estudos Retrospectivos
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