Perioperative, oncological, and survival outcomes of robotic radical cystectomy with urinary diversion in females: A single-center retrospective observational study.

Introduction: Robot-assisted radical cystectomy (RARC) is a standrad approach for surgical management of bladder cancer. Currently, most literature on RARC is in men, possibly due to the higher incidence of bladder cancer in males. We reviewed the perioperative, oncological and survival outcomes in 41 women who underwent RARC by a single surgeon at a tertiary health-care center. Methods: Out of 225 RARC and urinary diversion procedures performed from 2012 to 2020, a retrospective analysis of 41 women was performed. Baseline demographic and perioperative details, oncological data, and survival were recorded and analyzed. Kaplan-Meir analysis was done for survival outcomes and prognostic factors were assessed by log rank test. Results: Thirty-eight patients underwent intracorporeal urinary diversion, while three underwent extracorporeal diversion. One patient underwent organ preserving cystectomy. Clavien-Dindo 30-day postoperative complications were Grade I in 8 (19.5%), Grade II in 4 (9.8%), and Grade IIIa in 3 (7.3%) patients with no mortality. During the median follow-up of 34 months (range: 6-87 months), 7 patients died of disease recurrence. Five-year survival was 74% (95% confidence interval [CI]: 59-82) and 35% (95% CI: 10-91) in transitional cell carcinoma (TCC) and non-TCC group, respectively, with P = 0.04. There was no mortality in Stages 0 and 1 disease. Five-year survival was 78% in Stage 2 and 41% in Stage 3 and 4. Conclusion: Our study demonstrates acceptable clinical, perioperative, and oncological outcomes of robotic radical cystectomy in females, thus highlighting its safety and feasibility.

Intravesical bacillus Calmette-Guerin (BCG) in treating non-muscle invasive bladder cancer-analysis of adverse effects and effectiveness of two strains of BCG (Danish 1331 and Moscow-I).

Objective: To compare the differences in adverse effects and efficacy profile between bacillus Calmette-Guerin (BCG) Danish 1331 and BCG Moscow-I strain in management of non-muscle invasive bladder cancer. Methods: Clinical data of 188 cases of non-muscle invasive bladder cancer treated with BCG between January 2008 and December 2018 in our institute were collected prospectively and analysed retrospectively, and 114 patients who completed a minimum of 12 months of follow-up were analysed. Patient and tumor characteristics, strain of BCG, adverse effects, and tumor progression were included for analysis. Intravesical BCG was instilled in intermediate- and high-risk patients. Six weeks of induction BCG, followed by three weekly maintenance BCG at 3, 6, 12, 18, and 24 months was advised in high-risk patients. Results: Overall 68 patients received BCG Danish 1331 strain and 46 patients received Moscow-I strain. Patient and tumor characteristics were well balanced between the two groups. The median follow-up period was 42.5 months and 34.5 months in Danish 1331 and Moscow-I groups, respectively. Adverse events like dropout rate, antitubercular treatment requirement, and need of cystectomy were higher in Moscow-I group (n=31, 67.4%) when compared to Danish 1331 strain (n=33, 48.5%) (p=0.046). On direct comparison between Danish 1331 and Moscow-I strain, there was similar 3-year recurrence-free survival (80.0% vs. 72.9%) and 3-year progression-free survival (96.5% vs. 97.8%). Conclusion: Study results suggest no significant differences between Danish 1331 and Moscow-I strain in recurrence-free survival and progression-free survival, but a significantly higher incidence of moderate to severe adverse events in BCG Moscow-I strain.

Safety of uro-oncology practice and robot-assisted surgery during the peak of COVID-19 pandemic: A report from India.

Aim: The pandemic by novel coronavirus disease 2019 (COVID-19) is the biggest threat to global health care. Routine care of cancer patients is affected the most. Our institute, situated in Mumbai, declared as the hotspot of COVID-19 in India, continued to cater to the needs of cancer patients. We did an observational study to review the experience of managing uro-oncology patients and who underwent either open, endoscopic, or robot-assisted surgery for urological malignancy. Materials and Methods: During the peak of COVID-19 pandemic from March 21, 2020, to June 21, 2020, all the uro-oncology cases managed in our tertiary care hospital were analyzed. Teleconsultation was started for follow-up patients. All patients requiring surgery underwent reverse transcription-polymerase chain reaction for COVID-19. Institutional protocol was formulated based on existing international guidelines for patient management. Adequate personal protection and hydroxychloroquine prophylaxis were provided to health-care professionals. Results: During the study period, 417 outpatient consultations were made. Forty-nine patients underwent surgery for different urological malignancies. Majority of the surgeries were robot-assisted surgeries (59.2%, 29 patients), followed by endoscopic procedures (28.5%, 14 patients) and few open procedures (10.2%, five patients). Most of our patients were elderly males (mean, 62.5 years). With a median follow-up of 55 days (interquartile range, 32-77), there was no report of COVID-19 infection in any patient or health-care provider. Conclusions: We can continue treating needy cancer patients with minimal risk by taking all precautions. Our initial experience of managing uro-oncology cases during this pandemic is encouraging. Robotic surgeries can be safely performed.

Comparing adverse effects, short term outcomes, and cost implications of hyperthermic intravesical chemotherapy with Mitomycin-C and intravesical bacillus Calmette-Guerin instillation (Moscow-I strain) in the management of intermediate and high-risk nonmuscle invasive bladder cancer.

INTRODUCTION: The recommended treatment for intermediate and high-risk nonmuscle invasive bladder cancer (NMIBC) is adjuvant intravesical bacillus Calmette-Guerin (BCG) instillation. However, up to 50% experience tumor recurrences even after adjuvant BCG, and many patients develop local or systemic adverse effects. Our study compared adverse effects, short-term recurrence rates, and cost-implications of BCG therapy to Hyperthermic Intra-VEsical Chemotherapy (HIVEC) with Mitomycin-C (MMC) in these patients. MATERIALS AND METHODS: Retrospective analysis of intermediate and high-risk NMIBC patients who received either intravesical BCG or HIVEC® after transurethral resection of bladder tumor in our institute (January 2017 to March 2020) was done. Twenty-two patients who received HIVEC and 29 who received BCG were analyzed. We used SPSS Statistics v20.0 (IBM Corp., Armonk, NY, USA) software for the statistical analysis. RESULTS: Nineteen (86.4%) patients in the HIVEC group had no adverse effects. Two (9.1%) patients had Grade I lower urinary tract symptoms (LUTS) treated symptomatically. One patient developed UTI after HIVEC, and further cycles were stopped (Grade II). BCG group had a higher rate of Grade III adverse effects in six (20.7%) patients. Median follow-up was 10.5 and 22 months. The tumor recurred in one (4.5%) and six (20.7%) patients in HIVEC and BCG groups, respectively. There was no difference in recurrence-free survival at 18 months and the cost for the HIVEC therapy was more. CONCLUSIONS: HIVEC with MMC is a reasonable adjuvant treatment option in NMIBC, which is well tolerated, albeit increased cost of the treatment. Randomized trials with more follow-up are required for further conclusion.

Comparative study of perioperative and survival outcomes after video endoscopic inguinal lymphadenectomy (VEIL) and open inguinal lymph node dissection (O-ILND) in the management of inguinal lymph nodes in carcinoma of the penis.

Open inguinal lymph node dissection (O-ILND) is the gold standard in the management of lymph nodes in carcinoma penis; however, video endoscopic inguinal lymphadenectomy (VEIL) is performed in some centers. Our primary objective is to compare perioperative and survival outcomes in patients undergoing VEIL with O-ILND, as very few studies have reported long-term survival outcomes till date. We analyzed patients who underwent O-ILND and VEIL (laparoscopic or robot-assisted) from January 2009 to January 2020 in our institute for carcinoma of the penis. Patient details, perioperative complications, and survival outcomes were analyzed. Perioperative outcomes were analyzed by logistic regression and survival outcomes by log-rank and Cox regression methods. We analyzed 79 patients (32 O-ILND, 47 VEIL) with a median follow-up of 51 (IQR 25.5-75.5) and 42 months (IQR 21-62). Wound complications were common in O-ILND group (65.6%) compared to VEIL group (27.7%) (p = 0.001), predominantly skin flap necrosis in 14 groins (23.73%) after O-ILND and none after VEIL. Median overall survival was 80 and 88 months (p = 0.840) with five-year survival of 65% and 66.8% (p = 0.636) and five-year DSS of 76.6% and 73.9% (p = 0.96) in O-ILND and VEIL, respectively. Multivariate analysis showed that grade and pathological node status were significant (HR-2.650, p = 0.040; HR-3.218, p = 0.024) factors for survival. The retrospective nature of the study design is the limitation. Management of inguinal lymph nodes in carcinoma penis by VEIL is safe, associated with lesser wound-related complications, and equivalent survival outcomes compared to O-ILND. It should be considered as an alternative option for inguinal lymph node dissection.