Bricker ileal conduit vs. Cutaneous ureterostomy after radical cystectomy for bladder cancer: a systematic review

ABSTRACT Purpose: A systematic review of the literature with available published literature to compare ileal conduit (IC) and cutaneous ureterostomy (CU) urinary diversions (UD) in terms of perioperative, functional, and oncological outcomes of high-risk elderly patients treated with radical cystectomy (RC). Protocol Registration: PROSPERO ID CRD42020168851. Materials and Methods: A systematic review, according to the PRISMA Statement, was performed. Search through the Medline, Embase, Scopus, Scielo, Lilacs, and Cochrane Database until July 2020. Results: The literature search yielded 2,883 citations and were selected eight studies, including 1096 patients. A total of 707 patients underwent IC and 389 CU. Surgical procedures and outcomes, complications, mortality, and quality of life were analyzed. Conclusions: CU seems to be a safe alternative for the elderly and more frail patients. It is associated with faster surgery, less blood loss, lower transfusion rates, a lower necessity of intensive care, and shorter hospital stay. According to most studies, complications are less frequent after CU, even though mortality rates are similar. Studies with long-term follow up are awaited.

Endoclips as novel fiducial markers in trimodality bladder-preserving therapy of muscle-invasive bladder carcinoma: feasibility and patient outcomes

ABSTRACT Hypothesis: Endoclip can be used as fiducial marker in urology. Objective: To assess the feasibility, cost effectiveness and reliability of endoclips as novel fiducial markers in precision radiotherapy, as part of a trimodality bladder-preserving treatment (TBPT) of muscle-invasive bladder carcinoma. Materials and Methods: This retrospective study was performed at Weifang People's Hospital (Weifang, China) from January 2015 to June 2018. A total of 15 patients underwent TBPT. Endoclips were applied to healthy edges of the resected bladder wall as novel fiducial markers. Radio-sensitizing chemotherapy and routine precision radiotherapy were given. The number and position of the endoclips during radiotherapy sessions were monitored. Complications and tumor recurrence were analyzed. Results: The mean age (±standard deviation) of the patients was 67±10 years (range 46-79). There were 3 females and 12 males. Forty-nine endoclips were applied in all patients (3.3±0.8). The tumor was completely visibly resected in all patients. The number of endoclips remained the same through the planned last radiotherapy session (3.3±0.8), i.e., none were lost. All endoclips were removed after the last radiotherapy session. The average number of follow-up months was 38.9±13.2 (range 11-52). There were no procedure-related complications at discharge or follow-up. At one-year, overall recurrence-free survival was 93.3%. Two patients had recurrences at 18 months and 10 months after TBPT, respectively, and salvage radical cystectomy was performed with no further recurrences. Another patient died due to metastasis 9 months after the completion of therapy. Conclusions: Endoclips are reliable, safe and cost-effective as novel fiducial markers in precision-radiotherapy post-TBPT.

Laparoscopic radical cystectomy with intracorporeal ileal conduit: one center experience and clinical outcomes

ABSTRACT Purpose: To introduce our experience with intracorporeal ileal conduit and evaluate the safety and feasibility of this endoscopic urinary diversion. Materials and Methods: Between March 2014 and July 2017, thirty-six consecutive patients underwent laparoscopic radical cystectomy with intracorporeal ileal conduit. Patients' demographic data, perioperative data, 90-days postoperative outcomes and complications were collected. This cohort were divided into two groups of 18 patients each by chronological order of the operations to facilitate comparison of clinical data. Data were evaluated using the students' T test, Mann-Whitney test and Fisher's Exact test. Results: All surgeries were completed successfully with no conversion. Median total operating time and median intracorporeal urinary diversion time were 304 and 105 minutes, respectively. Median estimated blood loss was 200 mL, and median lymph node yield was 21. Twenty-six Clavien grade < 3 complications occurred within 30-days and 9 occurred within 30-90 days. Five Clavien grade 3-5 complications occurred within 30 days. No statistically significant differences were found between the two groups except for intracorporeal urinary diversion time. At median follow-up of 17.5 (range 3-42) months, 6 patients experienced tumor recurrence/metastasis and 4 of these patients died. Conclusions: Intracorporeal ileal conduit following laparoscopic radical cystectomy is safe, feasible and reproducible. With the accumulation of experience, the operation time can be controlled at a satisfactory level.

Gastric neobladders: surgical outcomes of 91 cases using different techniques

ABSTRACT Introduction: We report on the surgical results of a series of 91 patients who received gastric neobladders as urinary diversion after radical cystectomies performed for the treatment of muscle-invasive bladder cancers. Materials and Methods: We report on a retrospective case series of 91 patients who received gastric neobladders as urinary diversion after radical cystectomies performed for the treatment of muscle-invasive bladder cancers. Different techniques of gastric neobladders were employed from 1988 to 2013 at a university hospital in the South of Brazil. Results: Initial outcomes utilizing Leong (Antral) and Nguyen-Mitchell (Wedge) technique were unsatisfactory, yielding high pressure, low capacity reservoirs. Further developments of these techniques, with the detubularized gastric neobladder and the "spherical" gastric neobladders resulted in low pressure, high capacity reservoirs, with better surgical and urodynamic outcomes. Complication and perioperative mortality rates of our series of gastric neobladders were significantly higher than historical results of techniques using ileum or colon. Conclusions: Stomach is an exceptional option for the creation of neobladders after radical cystectomies, but due to the increased complication rates it should be reserved for specific situations (e.g., renal insufficiency, previous pelvic/abdominal radiotherapy, short bowel syndromes).

Vaginal cuff recurrence after radical cystectomy: an under - studied site of bladder cancer relapse

ABSTRACT Introduction: Vaginal cuff recurrence of tumor following radical cystectomy is a rare site of disease recurrence, however it has never been specifically studied. The aim of the study is to evaluate incidence, risk factors, and long-term oncologic outcomes of vaginal cuff recur- rence in a cohort of female patients treated with radical cystectomy for invasive urothelial carcinoma of the bladder. Materials and Methods: From 1985 to 2012, a prospectively maintained institutional blad- der cancer registry was queried for vaginal cuff recurrence post radical cystectomy. Over- all mortality and cancer-specific mortality were reported using the Kaplan-Meier method for patients with vaginal cuff recurrence, recurrence at another local or distant site, and those without evidence of recurrence. Comparisons were performed using the log-rank test. Cox proportional hazards regression model was performed to assess predictors of vaginal cuff recurrence. Results: From 469 women treated with radical cystectomy for bladder cancer, 34 patients (7.3%) developed vaginal cuff recurrence, 130 patients (27.7%) had recurrence involving ei- ther a local or distant site, and 305 patients (65%) had no evidence of recurrence. The 5-year overall mortality-free survival rate was 32.4% for vaginal cuff recurrence, but 25.0% for other sites of recurrence. Cancer-specific mortality-free survival rate was 32.4% for vaginal cuff recurrence, and 30.3% for the other sites of recurrence. Multivariate Cox proportional hazards regression analysis demonstrated that the presence of tumor in posterior location at radical cystectomy (Hazard Ratio [HR], 0.353 [95% CI, 0.159-0.783]) and anterior vaginec- tomy, compared to no vaginectomy (HR, 2.595 [95% CI, 1.077-6.249]) were independently associated with vaginal cuff recurrence. Conclusion: Anterior vaginectomy, despite our best attempts, is perhaps not sufficient to prevent vaginal cuff recurrence. Therefore, follow-up evaluation is essential, and further studies are necessary to address the optimal approach for initial management. Patient Summary: Although vaginal cuff recurrence is an unusual site of recurrence, careful evaluation is needed before cystectomy and during follow-up to identify patients at risk.

Ureteroileal bypass: a new technic to treat ureteroenteric strictures in urinary diversion

ABSTRACT Objective: To present our technique of ureteroileal bypass to treat uretero-enteric stric- tures in urinary diversion. Materials and Methods: One hundred and forty-one medical records were reviewed from patients submitted to radical cystectomy to treat muscle-invasive bladder cancer between 2013 and 2015. Twelve (8.5%) patients developed uretero-enteric anastomotic stricture during follow-up. Five patients were treated with endoscopic dilatation and double J placement. Four were treated surgically with standard terminal-lateral im- plantation. Three patients with uretero-enteric anastomotic stricture were treated at our institution by "ureteroileal bypass", one of them was treated with robotic surgery. Results: All patients had the diagnosis of uretero-enteric anastomotic stricture via computerized tomography and DTPA renal scan. Time between cystectomy and diag- nosis of uretero-enteric anastomotic stricture varied from five months to three years. Mean operative time was 120±17.9 minutes (98 to 142 min) and hospital stay was 3.3±0.62 days (3 to 4 days). Mean follow-up was 24±39.5 months (6 to 72 months). During follow-up, all patients were asymptomatic and presented improvement in ure-terohydronephrosis. Serum creatinine of all patients had been stable. Conclusions: Latero-lateral ureter re-implantation is feasible by open or even robotic surgery with positive results, reasonable operation time, and without complications.

The demographic features, clinical outcomes, prognosis and treatment options for patients with sarcomatoid carcinoma of the urinary bladder: a single centre experience

ABSTRACT Introduction Carcinosarcoma of the bladder is a very rare neoplasm. The pathogenesis of carcinosarcomas is not clearly understood and remains a subject of debate. Whilst there is some research conceptualizing the histopathological findings of bladder carcinosarcomas, the demographic features, clinical outcomes, prognosis and treatment options remain unclear. Materials and Methods We analyzed 12 consecutive cases of patients with sarcoma-toid bladder cancer who were treated surgically at a single Urology Department be-tween 1999 and 2015. Radiology, pathology and surgical reports were reviewed to determine the pathological staging at the time of cystectomy. These were directly compared with 230 patients having cystectomies for urothelial cell carcinoma. The sarcomatoid patients, were compared to patients with urothelial cell cancers. The other histological sub types, squamous cell (17), neuroendocrine (9), metastatic (7), mixed (4), adenocarcinoma (3), were not included. Results and conclusion Carcinosarcoma of the urinary bladder is often described in the literature as a highly malignant neoplasm that is rapidly lethal. We found that the sarcoma does not offer a worse prognosis than conventional high-grade urothelial car-cinoma. There is no significant difference in grade, stage, positive surgical margin rate, nodal involvement, associated prostate cancer or incidence rates of progression, all cause or disease specific mortality. There was a barely significant difference in carcinoma in-situ. However, carcinosarcomas are three times the volume of urothelial cell tumors which may contribute to its reputation as an aggressive tumour (44cc v 14cc). Sarcomatous elements do not appear, from our small study, to bestow a worse prognosis.

Resultados oncológicos en pacientes con cáncer de vejiga pT0 posterior a cistectomía radical / Oncological outcomes of Patients with pT0 Bladder Cancer after Radical Cystectomy

Introducción: El estadío pT0 del cáncer de vejiga implica la ausencia de enfermedad en la pieza de cistectomía radical (CR). El objetivo de este estudio es describir los resultados oncológicos de los pacientes con estadío pT0 posterior a CR por carcinoma urotelial de vejiga. Materiales y métodos: Estudio retrospectivo de pacientes sometidos a CR por cáncer de vejiga, en una sola institución, sin neoadyuvancia, entre junio de 2005 y julio de 2013. Se incluyeron aquellos pacientes con diagnóstico histológico de estadío pT0 pN0. Se estimó la sobrevida global, sobrevida cáncer-específica y sobrevida libre de recidiva con el método de Kaplan-Meier. Resultados: De 254 pacientes cistectomizados, 17 presentaron estadío pT0 pN0 (6,7%). La mediana de edad fue 67 años (rango 49-85), 15 pacientes fueron hombres (88%). Los resultados patológicos posterior a resección transuretral de vejiga (RTUv) fueron 17% pT1 (n=3) y 83% pT2 (n=14). La mediana de tiempo entre RTUv y CR fue 60 días (rango 30- 95). Al 41% se le realizó derivación urinaria tipo Bricker y al 59%, una neovejiga. La mediana de estadía hospitalaria fue 8 días (rango 6-44). Se evidenció adenocarcinoma de próstata en 4 pacientes. La mediana de ganglios resecados fue 6 (rango 2-17). Ningún paciente recibió adyuvancia. La mediana de seguimiento fue 69 meses (rango 5-120). Un paciente presentó recidiva uretral a los 72 meses de la CR. La sobrevida cáncer-específica fue 100%, la sobrevida libre de recaída a 5 años fue 83,3% (intervalo de confianza [IC] de 95%: 53,5-100) y la sobrevida global a 5 años fue 82,4% (IC 95%: 64,7-100). Conclusión: El estadío pT0 del cáncer de vejiga presenta resultados oncológicos más favorables que los estadíos más avanzados. Sin embargo, la posibilidad de recurrencia existe, por lo que no se debe discontinuar el seguimiento de estos pacientes (AU)

Introduction: There are cases in which there is no evidence of disease in the radical cystectomy (RC) specimen (pT0 stage). The purpose of this study is to evaluate oncological outcomes of patients with pT0 bladder cancer after RC, in a single institution, without neo-adjuvant therapy. Materials and methods: Patients who underwent radical cystectomy from June 2005 to July 2013 were reviewed retrospectively. All patients had history of bladder urothelial carcinoma, treated with transurethral resection of the bladder (TURB) and confirmed with pathological analysis. Study variables included TURB pathology, time to RC, and pathologic features. Overall survival (OS), cancer-specific survival (CSS) and recurrence-free survival (RFS) were estimated. Results: RC was performed on 254 patients; 17 patients (6.7%) had pT0N0 stage. Median age was 67 years (range 49-85 years); 15 patients were male (88%). TURB pathology specimens were 17% pT1 (n=3), and 83% pT2 (n=14). Median time between TURB and RC was 60 days (range 30-95). Seven patients (41%) received an ileal conduit, and ten patients (59%) received a neobladder. Median hospital stay was eight days (range 6-44). Prostate adenocarcinoma was found in four (23%) patients. Median resected lymph nodes were six (range 2-17). No patients received adjuvant chemotherapy. Median follow-up was 69 months (range 5-120 months). One patient had a urethral relapse 72 months after RC. There was no cancer-specific mortality. RFS at 5 years was 83.3% (confidence interval [CI] 95%: 53.5-100); OS at 5 years was 82.4% (CI 95%: 64.7-100). Conclusion: pT0 stage after radical cystectomy shows more favorable oncologic outcomes than higher stages. However, cancer recurrence was found in a low number of patients, thus, patient follow-up should be maintained (AU)

Tropical spastic paraparesis - anesthetic approach / Paraparesia espástica tropical - abordagem anestésica

Abstract Introduction HTLV-1 infection is endemic in Japan, Caribbean, Africa, and South America. It is transmitted from mother to child, sexual contact, blood transfusions, or sharing needles. Tropical spastic paraparesis (TSP) is a chronic degenerative neurological disease associated with this infection. It results from a spinal cord symmetrical degeneration at the thoracic level and is characterized by progressive motor weakness in the lower limbs, hyperreflexia, sensitivity changes, urinary incontinence, and bladder dysfunction. Clinical case Female, 53 years old, HTLV-1 infection and TSP. She had decreased strength in the lower limbs and hyperreflexia, paretic gait, spasticity, and neurogenic bladder symptoms, with recurrent urinary infections. She was scheduled for cystectomy. The patient was monitored according to standard ASA. Due to severe coagulopathy and the possibility of neurological worsening, epidural catheter was not placed. The induction of general anesthesia was performed with midazolam and fentanyl, followed by etomidate and cisatracurium. She was intubated with a tube size seven and maintained with desflurane and oxygen. Anesthesia was uneventful; the surgery lasted 1 hour and 50 min. There were no complications in the immediate postoperative period, during hospitalization, nor deterioration of the neurological examination. The patient was discharged 20 days later. Discussion/Conclusion There are reports of decreased electromyographic response and neurological deterioration associated with propofol in these patients, etomidate was used. The hepatic metabolism of rocuronium posed a risk, we chose to use cistracurium. It was concluded that the anesthesia chosen did not affect the course of the disease.

Resumo Introdução A infecção por HTLV- 1 é endêmica no Japão, nas Caraíbas, na África e na América do Sul. A transmissão ocorre de mãe para filho, por contatos sexuais, transfusões de sangue ou partilha de agulhas. A essa infeção está associada uma doença neurológica degenerativa crônica, a paraparesia espástica tropical (TSP). Essa resulta de uma degeneração simétrica da espinal medula em nível torácico. Caracteriza-se por diminuição progressiva da força nos membros inferiores, hiperreflexia, alterações de sensibilidade, incontinência urinária e disfunção vesical. Caso clínico Mulher de 53 anos, infecção por HTLV-1 e TSP. Apresentava diminuição da força nos membros inferiores e hiperreflexia, tinha uma marcha parética, espasticidade e sintomas de bexiga neurogênica com infecções urinárias de repetição. Foi proposta para cistectomia. Foi monitorada de acordo com o padrão da ASA. Devido à coagulopatia grave e à possibilidade de agravamento neurológico, não se colocou cateter epidural. A indução da anestesia geral foi feita com midazolam e fentanil seguidos de etomidato e cisatracúrio. Foi entubada com um tubo sete e mantida com desflurano e oxigênio. A anestesia decorreu sem intercorrências, a cirurgia terminou em uma hora e 50 minutos. Não houve quaisquer complicações no pós-operatório imediato, durante a internação, nem deterioração do exame neurológico. A doente teve alta 20 dias depois. Discussão/Conclusão Há relatos de diminuição da resposta eletromiográfica e deterioração neurológica associadas ao propofol nesses doentes, razão para uso de etomidato. A metabolização hepática do rocurônio representava um risco e se optou pelo cisatracúrio. Conclui-se que o plano anestésico escolhido não teve qualquer interferência no curso da doença.

Hyberbaric oxygen as sole treatment for severe radiation - induced haemorrhagic cystitis

ABSTRACT Purpose To examine the safety and efficacy of hyperbaric oxygen as the primary and sole treatment for severe radiation-induced haemorrhagic cystitis. Materials and methods Hyperbaric oxygen was prospectively applied as primary treatment in 38 patients with severe radiation cystitis. Our primary endpoint was the incidence of complete and partial response to treatment, while the secondary endpoints included the duration of response, the correlation of treatment success-rate to the interval between the onset of haematuria and initiation of therapy, blood transfusion need and total radiation dose, the number of sessions to success, the avoidance of surgery and the overall survival. Results All patients completed therapy without complications with a mean follow-up of 29.33 months. Median number of sessions needed was 33. Complete and partial response rate was 86.8% and 13.2%, respectively. All 33 patients with complete response received therapy within 6 months of the haematuria onset. One patient needed cystectomy, while 33 patients were alive at the end of follow-up. Conclusions Our study suggests the early primary use of hyperbaric oxygen for radiation-induced severe cystitis as an effective and safe treatment option.

Laparoscopic radical cystectomy with novel orthotopic neobladder with bilateral isoperistaltic afferent limbs: initial experience

ABSTRACT Purpose To introduce a new method of constructing an orthotopic ileal neobladder with bilateral isoperistaltic afferent limbs, and to describe its clinical outcomes. Materials and Methods From January 2012 to December 2013, 16 patients underwent a new method of orthotopic ileal neobladder after laparoscopic radical cystectomy for bladder cancer. To construct the neobladder, an ileal segment 60cm long was isolated approximately 25cm proximally to the ileocecum. The proximal 20cm of the ileal segment was divided into two parts for bilateral isoperistaltic afferent limbs. The proximal 10cm of the ileal segment was moved to the distal end of the ileal segment for the right isoperistaltic afferent limb, and the remaining proximal 10cm ileal segment was reserved for the left isoperistaltic afferent limb. The remaining length of the 40cm ileal segment was detubularized along its antimesenteric border to form a reservoir. The neobladder was sutured to achieve a spherical configuration. Results All procedures were carried out successfully. The mean operative time was 330 min, mean blood loss was 328mL, and mean hospital stay was 12.5 days. The mean neobladder capacity 6 and 12 months after surgery was 300mL and 401mL, respectively. With a mean follow-up of 22.8 months, all patients achieved daytime continence and 15 achieved nighttime continence. The mean peak urinary flow rate was 11.9mL/s and 12.8mL/s at 6 and 12 months postoperatively, respectively. Conclusions This novel procedure is feasible, safe, simple to perform, and provides encouraging functional outcomes. However, comparative studies with long-term follow-up are required to prove its superiority.

Laparoscopic Radical Cystectomy in the Elderly - Results of a Single Center LRC only Series

ABSTRACT Objective: To compare outcome of laparoscopic radical cystectomy (LRC) with ileal conduit in 22 elderly ( (≥75 years) versus 51 younger (<75 years) patients. patients. Materials and Methods: Analysis of prospectively gathered data of a single institution LRC only series was performed. Selection bias for LRC versus non-surgical treatments was assessed with data retrieved from the Netherlands Cancer Registry. Results: Median age difference between LRC groups was 9.0 years. (77.0 versus 68.0 years). Both groups had similar surgical indications, body mass index and gender distribution. Charlson Comorbidity Index score was 3 versus 4 in ≥50% of younger and elderly patients. Median operative time (340 versus 341 min) and estimated blood loss (<500 versus >500mL) did not differ between groups. Median total hospital stay was 12.0 versus 14.0 days for younger and elderly patients. Grade I-II 90-d complication rate was higher for elderly patients (68 versus 43%, p=0.05). Grade III-V 90-d complication rate was equal for both groups (23 versus 29%, p=0.557). 90-d mortality rate was higher for elderly patients (14 versus 4%, p=0.157). Median follow-up was 40.0 months for younger and 57.0 months for elderly patients. Estimated overall and cancer-specific survival at 5years. was 46% versus 35% and 64% versus 64% for younger and elderly patients respectively. Conclusions: Our results suggest that LRC is feasible in elderly patients, where a non-surgical treatment is usually favoured.

Prognostic features for quality of life after radical cystectomy and orthotopic neobladder

ABSTRACT Purpose: To analyse prognostic features on quality of life (QoL) following radical cystectomy and urinary diversion via orthotopic neobladder in a single-centre patient cohort. Materials and Methods: Postoperative QoL of 152 patients was assessed retrospectively using the validated QLQ-C30 questionnaire. Potential associations of patient's quality of life including pre-and intraoperative characteristics, surgeon experience, postoperative time course, adjuvant therapies, and functional outcome were defined a priori and evaluated. Mann-Whitney-U-, Kruskal-Wallis-, Spearman correlation and post hoc-testing were used. A multivariate analysis using a multiple logistic regression model was performed. A p value <0.05 was considered to be statistically significant. Results: Median follow-up was 48 months. Univariate analysis of prognostic features for health-related QoL revealed a significant impact of gender (p=0.019), performance status (p<0.001), experience of surgeon (>100 previous cystectomies, p=0.007), and nerve-sparing surgery (p=0.001). Patients who underwent secondary chemotherapy or radiotherapy had significant lower QLQ-C30 scores (p=0.04, p=0.02 respectively). Patients who were asymptomatic had a significantly higher quality of life (p<0.001). A significant impact of severity of incontinence based on ICIQ-SF score (p<0.001) and daily pad usage (p<0.001), existence of daytime incontinence (p<0.001), existence of urgency symptoms (p=0.007), and IIEF-5 score (p<0.001) could be observed. In multivariate analysis, independent prognostic relevance could be confirmed for preoperative ECOG performance status of 0 (p=0.020 vs. ECOG 1, p=0.047 vs. ECOG 2), experience of the respective surgeon (≥100 vs. <100 previous cystectomies, p=0.021), and daytime continence (p=0.032). Conclusion: In the present study, we report health-related QoL outcomes in a contemporary patient cohort and confirm preoperative ECOG status, surgeon experience and daytime incontinence as independent prognostic features for a good postoperative QoL.

Extraperitoneal versus transperitoneal laparoscopic radical cystectomy for selected elderly bladder cancer patients: a single center experience

ABSTRACT Objective: This study reports the initial experience of extraperitoneal laparoscopic radical cystectomy (ELRC) and compared with transperitoneal laparoscopic radical cystectomy (TLRC) in the treatment of selected elderly bladder cancer patients. Patients and Methods: A total of forty male bladder cancer patients who underwent ELRC (n=19) or TLRC (n=21) with ureterocutaneostomy were investigated. Demographic parameters, perioperative variables, oncological outcomes and follow-up data were retrospectively analyzed. Results: A significantly shorter time to exsufflation (1.5±0.7 vs 2.1±1.1 d; p=0.026) and liquid intake (1.8±0.9 vs 2.8±1.9 d; p=0.035) were observed in the ELRC group compared with the TLRC group. The incidence of postoperative ileus in the ELRC group was lower than the TLRC group (0 vs 9.5%). However, the difference had no statistical significance (p>0.05). The removed lymph node number in the ELRC group was significantly lower than the TLRC group (p<0.001). No significant differences were observed between the two groups in the overall and cancer-free survival rates (p>0.05). Conclusions: ELRC seems to be a safe and feasible surgical strategy for the selected elderly bladder cancer patients with ≤ T2 disease. The surgical and oncological efficacy of the ELRC is similar to that of the TLRC, but with faster intestinal function recovery. Further studies with a large series including different urinary diversions are needed to confirm our results and to better evaluate the benefit of ELRC in bladder cancer patients.

Error related negativity and multi-source interference task in children with attention deficit hyperactivity disorder-combined type / La negatividad relacionada al error en una tarea de interferencia multifuente en niños con trastorno por déficit de atención-hiperactividad tipo combinado

Objective To compare performance of children with attention deficit hyperactivity disorders-combined (ADHD-C) type with control children in multi-source interference task (MSIT) evaluated by means of error related negativity (ERN). Method We studied 12 children with ADHD-C type with a median age of 7 years, control children were age- and gender-matched. Children performed MSIT and simultaneous recording of ERN. Results We found no differences in MSIT parameters among groups. We found no differences in ERN variables between groups. We found a significant association of ERN amplitude with MSIT in children with ADHD-C type. Some correlation went in positive direction (frequency of hits and MSIT amplitude), and others in negative direction (frequency of errors and RT in MSIT). Conclusion Children with ADHD-C type exhibited a significant association between ERN amplitude with MSIT. These results underline participation of a cingulo-fronto-parietal network and could help in the comprehension of pathophysiological mechanisms of ADHD. .

Objetivo Comparar el rendimiento de un grupo de niños con trastorno por déficit de atención-hiperactividad de tipo combinado (TDAH-C), con niños controles, en la tarea de interferencia multi-fuente (TIMF), evaluado por la negatividad relacionada al error (NRE). Método Estudiamos 12 niños con TDAH-C con una mediana de 7 años, los controles estuvieron pareados por edad y género. Los niños realizaron la TIMF con registros simultáneos de NRE. Resultados No encontramos diferencias en los parámetros de la TIMF entre grupos. No encontramos diferencias en las variables de la NRE entre grupos. Encontramos asociaciones significativas entre la amplitud de la NRE en niños con TDAH-C. Una correlación fue en dirección positiva: (frecuencia de aciertos y amplitud de TIMF), y otras fueron en dirección negativa (frecuencia de errores y el tiempo de respuesta en la TIMF). Conclusión Los niños con TDAH-C presentan una asociación significativa entre la amplitud de la NRE con la TIMF. Los resultados sugieren la participación de la red cíngulo-fronto-parietal y pueden ayudar en la comprensión de los mecanismos fisiopatológicos del TDAH-C. .

Agregação familiar da doença renal crônica secundária à hipertensão arterial ou diabetes mellitus: estudo caso-controle / Family clustering of secondary chronic kidney disease with hypertension or diabetes mellitus. A case-control study

No Brasil, a hipertensão e o diabetes mellitus tipo 2 são responsáveis por 60% dos casos de doença renal crônica terminal em terapia renal substitutiva. Estudos americanos identificaram agregação familiar da doença renal crônica, predominante em afrodescendentes. Um único estudo brasileiro observou agregação familiar entre portadores de doença renal crônica quando comparados a indivíduos internados com função renal normal. O objetivo deste artigo é avaliar se existe agregação familiar da doença renal crônica em familiares de indivíduos em terapia renal substitutiva causada por hipertensão e/ou diabetes mellitus. Estudo caso-controle tendo como casos 336 pacientes em terapia renal substitutiva portadores de diabetes mellitus ou hipertensão há pelo menos 5 anos e controles amostra pareada de indivíduos com hipertensão ou diabetes mellitus e função renal normal (n = 389). Os indivíduos em terapia renal substitutiva (casos) apresentaram razão de chance de 2,35 (IC95% 1,42-3,89; p < 0,001) versus controles de terem familiares com doença renal crônica terminal, independente da raça ou doença de base. Existe agregação familiar da doença renal crônica na amostra estudada e esta predisposição independe da raça e da doença de base (hipertensão ou diabetes mellitus).

In Brazil hypertension and type 2 diabetes mellitus are responsible for 60% of cases of end-stage renal disease in renal replacement therapy. In the United States studies have identified family clustering of chronic kidney disease, predominantly in African-Americans. A single Brazilian study observed family clustering among patients with chronic kidney disease when compared with hospitalized patients with normal renal function. This article aims to assess whether there is family clustering of chronic kidney disease in relatives of individuals in renal replacement therapy caused by hypertension and/or diabetes mellitus. A case-control study with 336 patients in renal replacement therapy with diabetes mellitus or hypertension for at least 5 years (cases) and a control matched sample group of individuals with hypertension or diabetes mellitus and normal renal function (n = 389). Individuals in renal replacement therapy (cases) had a ratio of 2.35 (95% CI 1.42-3.89, p < 0.001) versus the control group in having relatives with chronic renal disease, irrespective of race or causative illness. There is family clustering of chronic kidney disease in the sample studied, and this predisposition is irrespective of race and underlying disease (hypertension or diabetes mellitus).

Re-examination of the Natural History of High-grade T1 Bladder Cancer using a Large Contemporary Cohort

IntroductionHigh-grade T1 (HGT1) bladder cancer represents a clinical challenge in that the urologist must balance the risk of disease progression against the morbidity and potential mortality of early radical cystectomy and urinary diversion. Using two non-muscle invasive bladder cancer (NMIBC) databases, we re-examined the rate of progression of HG T1 bladder cancer in our bladder cancer populations.Materials and MethodsWe queried the NMIBC databases that have been established independently at the Atlanta Veterans Affairs Medical Center (AVAMC) and the University of Pennsylvania to identify patients initially diagnosed with HGT1 bladder cancer. Demographic, clinical, and pathologic variables were examined as well as rates of recurrence and progression.ResultsA total of 222 patients were identified; 198 (89.1%) and 199 (89.6%) of whom were male and non-African American, respectively. Mean patient age was 66.5 years. 191 (86.0%) of the patients presented with isolated HG T1 disease while 31 (14.0%) patients presented with HGT1 disease and CIS. Induction BCG was utilized in 175 (78.8%) patients. Recurrence occurred in 112 (50.5%) patients with progression occurring in only 19 (8.6%) patients. At a mean follow-up of 51 months, overall survival was 76.6%. Fifty two patients died, of whom only 13 (25%) patient deaths were bladder cancer related.ConclusionsIn our large cohort of patients, we found that the risk of progression at approximately four years was only 8.6%. While limited by its retrospective nature, this study could potentially serve as a starting point in re-examining the treatment algorithm for patients with HG T1 bladder cancer.

Second transurethral resection of bladder tumour for the treatment of muscle-invasive bladder tumours / Segunda resección transuretral del tumor de la vejiga en el tratamiento de los tumores de vejiga con invasión muscular

OBJECTIVE: This work aims to evaluate the effectiveness of a second transurethral resection for muscle-invasive bladder tumours. The clinical literature of 15 cases of patients with muscle-invasive bladder cancer treated by second transurethral resection of bladder tumours (TURBT) was analysed. METHODS: The operation was based on the principle of TURBT down to the fatty layer outside the bladder wall. A second transurethral resection was performed four to six weeks after the initial resection. All patients received intravesical chemotherapy postoperation. Fifteen cases were followed-up for three to 26 months, with a mean period of 14 months. RESULTS: After the second transurethral resection, residual tumours were found in two patients. All patients underwent computed tomography scan and biopsy. No patient had a recurrence of the tumour. Eighty per cent of the patients had normal bladder function and 20% had mild-to-moderate lower urinary tract symptoms. All patients had a high quality of life. CONCLUSIONS: A second TURBT is suitable for muscle-invasive bladder cancer when bladder preservation is planned as it prolongs the survival time and improves the patients' quality of life.

OBJETIVO: Este trabajo tiene como objetivo evaluar la eficacia de una segunda resección transuretral de los tumores vesicales con invasión de la capa muscular. Se analizó la literatura clínica de 15 casos de pacientes con cáncer de la vejiga con invasión muscular, tratados con segunda resección transuretral de los tumores de la vejiga (TURBT). MÉTODOS: La operación se basó en el principio de TURBT hasta la capa de grasa fuera de la pared de la vejiga. De cuatro a seis semanas después de la resección inicial, se realizó una segunda resección transuretral. Todos los pacientes recibieron quimioterapia intravesical postoperatoria. Quince casos tuvieron seguimiento de tres a 26 meses, con un período promedio de 14 meses. RESULTADOS: Después de la segunda resección transuretral, se hallaron tumores residuales en dos pacientes. A todos los pacientes se les hizo una biopsia y una tomografía computarizada. Ningún paciente tuvo una recidiva del tumor. Ochenta por ciento de los pacientes tenían una función vesical normal, en tanto que un 20% presentaban síntomas de las vías urinarias de leves a moderadamente bajos. Todos los pacientes tenían un alto nivel de vida. CONCLUSIONES: Es conveniente una segunda TURBT para el cáncer de vejiga con invasión muscular cuando se planea la preservación vesical, ya que prolonga el tiempo de supervivencia y mejora la calidad de vida de los pacientes.

Comparison of Radical Cystectomy with Conservative Treatment in Geriatric ( 80) Patients with Muscle-Invasive Bladder Cancer

Introduction The aim of this study was to compare overall survival in elderly patients (≥ 80 years) with muscle-invasive bladder cancer (MIBC) undergoing either radical cystectomy (RC) or conservative treatment. Material and Methods We performed a retrospective, comparative analysis of overall- and cancer-specific survival in octagenarians with MIBC (≥ pT2) submitted to RC or conservative treatment. Uni- and multivariable Cox regression analysis were performed to assess predictors of overall survival. Cumulative hospital stay was also analyzed for all patients. Results The RC-group consisted of 33 patients with a mean age of 82.3 years (IQR 80.4-85.4 years) and the bladder preservation a cohort of 35 patients aged 83.8 years (IQR 81.8-88.2 years). No difference was detectable for overall survival (15.9 months versus 9.5 months; p = 0.18) and cancer-specific survival (23.5 months versus 19.5 months p = 0.71) or 90-day mortality (6.1% versus 14.3%; p = 0.43) between the two groups. Patients who received conservative treatment had a shorter cumulative length of hospital stay (p = 0.001). Age at the time of transurethral resection of the bladder (TUR-B) was an independent predictor of the overall survival (p = 0.004). Conclusions In this retrospective study, no clear survival benefit was observed for patients ≥ 80 years submitted either to radical cystectomy or conservative treatment. There was however a trend favoring radical cystectomy but this did not approach statistical significance. Octagenarians that underwent RC however spent more of their remaining lifetime in the hospital than those treated conservatively. .

Sexual Function after Non-Nerve-Sparing Radical Cystoprostatectomy: A Comparison between Ileal Conduit Urinary Diversion and Orthotopic Ileal Neobladder Substitution

Objective To compare the erectile function (EF) and sexual desire (SD) in men after radical cystoprostatectomy (RCP) who had either an ileal conduit urinary diversion or orthotropic ileal neobladder substitution. Materials and Methods Eighty one sexually active men with bladder cancer were enrolled in this prospective study. After RCP according to patients' preferences they underwent either ileal conduit urinary diversion (n = 41) or orthotropic ileal neobladder substitution (n = 40). EF and SD were assessed using International Index of Erectile Function (IIEF) questionnaire. Patients were assessed at 4-week before surgery and were followed up at 1, 6, and 12-month postoperatively using the same questionnaire. Results Postoperatively the EF and SD domains deteriorated significantly in both groups, but in a small proportion of the patients submitted to ileal neobladder they gradually improved with time (P = 0.006). At 12-month postoperative period, 4 (9.8%) and 14 (35.0%) patients in ileal conduit and ileal neobladder groups were able to achieve erections hard enough for vaginal penetration and maintained their erection to completion of intercourse, respectively (P = 0.006). Among patients in the ileal conduit and ileal neobladder groups, additional 4 (9.8%) and 7 (17.1%) patients were able to get some erection, but were unable to maintain their erection to completion of intercourse (P = 0.02). At 12-month follow up period 24.4% of the ileal conduit and 45.0% of the ileal neobladder patients rated their sexual desire very high or high (P = 0.01). Conclusion When performed properly, orthotopic ileal neobladder substitution after RCP offers better long-term results in terms of EF and SD. .