Aims
We aimed to assess the oncological impact of micrometric extent of invasion in patients with pT1 bladder cancer (BCa) who underwent en‐bloc resection for bladder tumour (ERBT).
Methods and ...results
We retrospectively analysed the records and specimens of 106 pT1 high‐grade BCa patients who underwent ERBT. The extent of invasion, such as depth from basal membrane, number of invasive foci, maximum width of invasive focus, muscularis mucosae invasion and infiltration pattern (pattern A: solid sheet‐like, nodular or nested growth, pattern B: trabecular, small cluster or single‐cell pattern) were evaluated by a single genitourinary pathologist. The end‐points were recurrence‐free (RFS) and progression‐free survival (PFS). Within a median follow‐up of 23 months, overall, 36 patients experienced recurrence and 13 patients experienced disease progression. The 2‐year PFS differed significantly depending on depth from basal membrane (< 1.3 mm: 94.8% versus ≧ 1.3 mm: 65.2%, P = 0.005), maximum width of invasive focus (< 4 mm: 91.7% versus ≧ 4 mm: 62.3%, P < 0.001), muscularis mucosae (MM) invasion (above MM = 96.1% versus into or beyond MM = 64.8%, P = 0.002) and infiltration pattern (pattern A: 100% versus pattern B: 83.3%, P = 0.037). In a multivariable analysis, MM invasion hazard ratio (HR) = 4.54, 95% confidence interval (CI) = 1.25–16.5 and maximum width of invasive focus ≧ 4 mm (HR = 4.79, 95% CI = 1.25–16.5) were independent prognostic factors of progression.
Conclusions
En‐bloc resection facilitates the evaluation of pathologic variables that might be useful in predicting disease recurrence and progression. In particular, not only the MM invasion but also the maximum width of invasion focus, reflecting the invasive volume, appear to be reliable prognosticators for disease progression.
Objectives
To determine if a re‐transurethral resection (TUR), in the presence or absence of muscle at the first TUR in patients with T1‐high grade (HG)/Grade 3 (G3) bladder cancer, makes a ...difference in recurrence, progression, cancer specific (CSS) and overall survival (OS).
Patients and methods
In a large retrospective multicentre cohort of 2451 patients with T1‐HG/G3 initially treated with bacille Calmette–Guérin, 935 (38%) had a re‐TUR. According to the presence or absence of muscle in the specimen of the primary TUR, patients were divided in four groups: group 1 (no muscle, no re‐TUR), group 2 (no muscle, re‐TUR), group 3 (muscle, no re‐TUR) and group 4 (muscle, re‐TUR). Clinical outcomes were compared across the four groups.
Results
Re‐TUR had a positive impact on recurrence, progression, CSS and OS only if muscle was not present in the primary TUR specimen. Adjusting for the most important prognostic factors, re‐TUR in the absence of muscle had a borderline significant effect on time to recurrence hazard ratio (HR) 0.67, P = 0.08, progression (HR 0.46, P = 0.06), CSS (HR 0.31, P = 0.07) and OS (HR 0.48, P = 0.05). Re‐TUR in the presence of muscle in the primary TUR specimen did not improve the outcome for any of the endpoints.
Conclusions
Our retrospective analysis suggests that re‐TUR may not be necessary in patients with T1‐HG/G3, if muscle is present in the specimen of the primary TUR.
The European Association of Urology (EAU) has released an updated version of the guidelines on non–muscle-invasive bladder cancer (NMIBC).
To present the 2021 EAU guidelines on NMIBC.
A broad and ...comprehensive scoping exercise covering all areas of the NMIBC guidelines since the 2020 version was performed. Databases covered by the search included Medline, EMBASE, and the Cochrane Libraries. Previous guidelines were updated, and the level of evidence and grade of recommendation were assigned.
Tumours staged as Ta, T1 and carcinoma in situ (CIS) are grouped under the heading of NMIBC. Diagnosis depends on cystoscopy and histological evaluation of tissue obtained via transurethral resection of the bladder (TURB) for papillary tumours or via multiple bladder biopsies for CIS. For papillary lesions, a complete TURB is essential for the patient’s prognosis and correct diagnosis. In cases for which the initial resection is incomplete, there is no muscle in the specimen, or a T1 tumour is detected, a second TURB should be performed within 2–6 wk. The risk of progression may be estimated for individual patients using the 2021 EAU scoring model. On the basis of their individual risk of progression, patients are stratified as having low, intermediate, high, or very high risk, which is pivotal to recommending adjuvant treatment. For patients with tumours presumed to be at low risk and for small papillary recurrences detected more than 1 yr after a previous TURB, one immediate chemotherapy instillation is recommended. Patients with an intermediate-risk tumour should receive 1 yr of full-dose intravesical bacillus Calmette-Guérin (BCG) immunotherapy or instillations of chemotherapy for a maximum of 1 yr. For patients with high-risk tumours, full-dose intravesical BCG for 1–3 yr is indicated. For patients at very high risk of tumour progression, immediate radical cystectomy should be considered. Cystectomy is also recommended for BCG-unresponsive tumours. The extended version of the guidelines is available on the EAU website at https://uroweb.org/guideline/non-muscle-invasive-bladder-cancer/.
These abridged EAU guidelines present updated information on the diagnosis and treatment of NMIBC for incorporation into clinical practice.
The European Association of Urology has released updated guidelines on the classification, risk factors, diagnosis, prognostic factors, and treatment of non–muscle-invasive bladder cancer. The recommendations are based on the literature up to 2020, with emphasis on the highest level of evidence. Classification of patients as having low, intermediate, or and high risk is essential in deciding on suitable treatment. Surgical removal of the bladder should be considered for tumours that do not respond to bacillus Calmette-Guérin (BCG) treatment and tumours with the highest risk of progression.
The European Association of Urology guidelines on non–muscle-invasive bladder cancer present updated information on the diagnosis and treatment of this disease. Recent findings are provided for their routine application in clinical practice.
Abstract Context The European Association of Urology (EAU) panel on Non–muscle-invasive Bladder Cancer (NMIBC) released an updated version of the guidelines on Non–muscle-invasive Bladder Cancer. ...Objective To present the 2016 EAU guidelines on NMIBC. Evidence acquisition A broad and comprehensive scoping exercise covering all areas of the NMIBC guidelines published between April 1, 2014, and May 31, 2015, was performed. Databases covered by the search included Medline, Embase, and the Cochrane Libraries. Previous guidelines were updated, and levels of evidence and grades of recommendation were assigned. Evidence synthesis Tumours staged as TaT1 or carcinoma in situ (CIS) are grouped as NMIBC. Diagnosis depends on cystoscopy and histologic evaluation of the tissue obtained by transurethral resection of the bladder (TURB) in papillary tumours or by multiple bladder biopsies in CIS. In papillary lesions, a complete TURB is essential for the patient's prognosis. If the initial resection is incomplete, there is no muscle in the specimen, or a high-grade or T1 tumour is detected, a second TURB should be performed within 2–6 wk. The risks of both recurrence and progression may be estimated for individual patients using the European Organisation for Research and Treatment of Cancer (EORTC) scoring system and risk tables. The stratification of patients into low-, intermediate-, and high-risk groups is pivotal to recommending adjuvant treatment. For patients with a low-risk tumour and intermediate-risk patients at a lower risk of recurrence, one immediate instillation of chemotherapy is recommended. Patients with an intermediate-risk tumour should receive 1 yr of full-dose bacillus Calmette-Guérin (BCG) intravesical immunotherapy or instillations of chemotherapy for a maximum of 1 yr. In patients with high-risk tumours, full-dose intravesical BCG for 1–3 yr is indicated. In patients at highest risk of tumour progression, immediate radical cystectomy (RC) should be considered. RC is recommended in BCG-refractory tumours. The long version of the guidelines is available at the EAU Web site ( www.uroweb.org/guidelines ). Conclusions These abridged EAU guidelines present updated information on the diagnosis and treatment of NMIBC for incorporation into clinical practice. Patient summary The European Association of Urology has released updated guidelines on Non–muscle-invasive Bladder Cancer (NMIBC). Stratification of patients into low-, intermediate-, and high-risk groups is essential for decisions about adjuvant intravesical instillations. Risk tables can be used to estimate risks of recurrence and progression. Radical cystectomy should be considered only in case of failure of instillations or in NMIBC with the highest risk of progression.
OUTCOMES OF BLADDER CANCER IN NONAGENARIANS Matsumura, Soichi; Yoshida, Takahiro; Imanaka, Takahiro ...
The Japanese Journal of Urology,
2021/04/20, Volume:
112, Issue:
2
Journal Article
Open access
(Objectives) We evaluated the chronological change in the number and proportion of elderly patients with bladder cancer. We also retrospectively investigated the clinical outcomes of bladder cancer ...in patients of ≥90 years of age. (Patients and methods) We evaluated the chronological change in the number and proportion of patients of ≥90 years of age who were clinically diagnosed with bladder cancer and who underwent transurethral resection of a bladder tumor (TUR-BT) at our hospital between 2008 and 2018. We also assessed the clinicopathological factors, perioperative outcomes, and clinical outcomes in bladder cancer patients of ≥90 years of age. (Results) The number and proportion of bladder cancer patients of ≥90 years of age increased with time. A total of 39 patients of ≥90 years of age underwent TUR-BT at our hospital, among whom 22 were diagnosed with primary bladder cancer. The median age was 91 years. No grade ≥III complications were observed after TUR-BT. Two out of 6 with pT1 disease underwent second TUR-BT. Two out of 7 with pT1 disease or carcinoma in situ received intravesical BCG therapy. Six deaths were observed during the study period, 2 of which were due to bladder cancer. At 1 and 3 years after TUR-BT, the overall survival rates of the 22 patients were 80.4% and 68.9%, respectively. (Conclusions) The number and proportion of elderly patients with bladder cancer increased with time. The current standard of care including second TUR-BT and intravesical BCG therapy for high-risk non-muscle invasive bladder cancer was underutilized in nonagenarians.
Abstract Context Our aim was to present a summary of the Second International Consultation on Bladder Cancer recommendations on the diagnosis and treatment options for non–muscle-invasive urothelial ...cancer of the bladder (NMIBC) using an evidence-based approach. Objective To critically review the recent data on the management of NMIBC to arrive at a general consensus. Evidence acquisition A detailed Medline analysis was performed for original articles addressing the treatment of NMIBC with regard to diagnosis, surgery, intravesical chemotherapy, and follow-up. Proceedings from the last 5 yr of major conferences were also searched. Evidence synthesis The major findings are presented in an evidence-based fashion. We analyzed large retrospective and prospective studies. Conclusions Urothelial cancer of the bladder staged Ta, T1, and carcinoma in situ (CIS), also indicated as NMIBC, poses greatly varying but uniformly demanding challenges to urologic care. On the one hand, the high recurrence rate and low progression rate with Ta low-grade demand risk-adapted treatment and surveillance to provide thorough care while minimizing treatment-related burden. On the other hand, the propensity of Ta high-grade, T1, and CIS to progress demands intense care and timely consideration of radical cystectomy.
Purpose
Transurethral endoscopic procedures using bipolar current, or laser energy are nowadays widely accepted and have replaced the traditional monopolar resection. A major advantage of these ...techniques is the utilization of isotonic saline as irrigation solution, which minimizes side effects such as symptoms associated to classical transurethral resection syndrome (TUR-syndrome). Nonetheless, clinically significant IFA also occurs with saline and is determined by pressure gradients, systemic resistance and by the amount of irrigation fluid. We aimed to investigate the extend of IFA and symptoms due to volume overload during bipolar transurethral resection (bTUR) and laser procedures of the prostate.
Methods
We performed a systematic literature search using PubMed, restricted to original English-written articles, including animal, artificial model, and human studies. Search terms were TUR, transurethral, laser, HoLEP, ThuLEP, greenlight, enucleation, fluid absorption, fluid uptake, and TUR-syndrome.
Results
Mean and maximum IFA during bTURP ranges between 133 and 915 ml and 1019 ml and 2166 ml, respectively. Absorption during laser procedures can be significant with maximum values up to 4579 ml and mainly occurs during prostate vaporization techniques. Incidence of moderate to severe symptoms from iso-osmolar volume overload reaches 9%.
Conclusions
Irrigation fluid absorption during bTUR and laser surgery of the prostate is not negligible. Iso-osmolar overhydration with development of non-classical TUR-syndrome should be identified peri- and postoperatively and surgical teams should be aware of complications. Breath ethanol, venous pH, serum chloride, and bicarbonate could be markers for detecting dangerous events of IFA with saline.
Aim and Objectives
The aim of this was to examine the effect of bladder training on bladder functions.
Background
Urinary catheterization is frequently performed in order to evaluate the outcomes of ...the surgical procedures and to monitor the urine output after urology operations.
Design and Methods
This quasi‐experimental study was conducted in the urology clinic in Istanbul, Turkey in which 50 males were nonrandomly assigned to either a bladder training (n = 28) or a control group (n =22). In the bladder training groups, the urinary catheters of the patients were clamped at 4‐hr intervals and then were left open for 5 min on the second postoperative day. This study was created in accordance with TREND Statement Checklist.
Results
The first urgency time and the first voiding time were longer, and the prevoiding and the voiding volumes were higher following the removal of the catheter in the training group (p = 0.001). In addition, the evaluation of the patient bladder diaries in the first three days after the discharge period revealed that the daily frequencies of micturition and nocturia were lower (p = 0.04), the mean duration of intervals between the micturition was longer (p = 0.006), and the mean voided urinary volume was higher (p = 0.024) in the training group.
Conclusion
At the end of the study, it is observed that bladder training performed by clamping the catheter on postoperative day 2 after Transurethral Resection of Prostate (TUR‐P) operation is a significant positive effect on the storage symptoms of the patients.
Relevance to clinical practice
Before removing the urinary catheter, bladder training programme affects positively to patients, especially prevoiding and the voiding volumes, the daily frequencies of micturition and nocturia on postoperative periods.
Objectives: Urethral stricture is one of the complex subjects of urology in terms of high recurrence rates, patient care, treatment difficulties and follow-up. We aimed to evaluate factors associated ...with the occurrence of urethral stricture after TUR-P (Transurethral resection of the prostate) surgery.
Material and methods: In our clinic, 301 patients who underwent TUR-P surgery for benign prostatic hyperplasia (BPH) were analyzed retrospectively. The patients who developed urethral stricture after TUR-P were named Group-1, did not develop were named Group-2. In addition, the patients were compared in terms of demographic and perioperative data.
Results: Urethral stricture was observed in 21 (6.97%) of the patients and not in 280 (93.03%) of them. There was no significant difference between the two groups in terms of age (p=0.913), resectoscope size (p=0.932), energy source type (p=0.932), energy source power (p=0.838), urethral catheter type (p=0.776), urethral catheter size (p=0.973), urethral catheter duration (p=0.797) and urethral catheter traction (p=0.887). Resection time was significantly higher in patients with urethral stricture (53.1±10.8 min vs. 42.2±9.7 min, p<0.001). The preoperative urinary tract infection (UTI) rate was significantly higher in patients with urethral stricture. (76.2% vs 40.0%, p=0.001). The optimum cut-off value for resection time associated with the risk of urethral stricture after TUR-P was 38.5 minutes, with an AUC of 0.812 (95% CI 0.738–0.885).
Conclusion: Prolonged resection time and even if treated, preoperative UTI increases the risk of urethral stricture after TUR-P surgery. However, if the resection time is not long, patients are more protected from developing urethral stricture.
To describe one method of transurethral resection and drainage of a prostate abscess. Prostatitis is the most common urologic diagnosis in patients <50 years of age. Overall prevalence of prostatitis ...is ~8%. Acute bacterial prostatitis accounts for ~10% of all prostatitis cases. Prostate abscess is estimated to affect 0.2-0.5% of men. Risk factors for prostate abscess include immunocompromise (e.g. diabetes, HIV), indwelling catheter, recent lower urinary tract instrumentation, genitourinary infection, acute or chronic bacterial prostatitis, bladder outlet obstruction, recent prostate biopsy, cirrhosis, and renal failure.
42-year-old male presented to the emergency department with a four-day history of diffuse abdominal pain, severe genital pain, and urinary stream slowing eventually leading to urinary retention. He also complained of irritative voiding symptoms. Computed tomography (CT) scan showed a 6cm, central fluid collection within the prostate leading to obstructive uropathy with marked dilation of the urinary bladder as well as both ureters and proximal collecting systems. We performed transurethral resection and drainage of the prostate abscess.
The prostate abscess was drained successfully and the cystoscope was able to be advanced into the prostatic abscess cavity post-drainage. We left both a urethral catheter as well as a suprapubic catheter indwelling. The operative time was approximately 30 minutes. There were no post-operative complications and the patient was discharged on post-operative day three.
Transurethral unroofing is an effective approach to the treatment of prostate abscesses.
This technique should be considered for abscesses that are large and multi-loculated, and in those that have recurred post-needle aspiration.
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