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1.
Int. braz. j. urol ; 47(3): 584-593, May-June 2021. tab, graf
Article in English | LILACS | ID: biblio-1154495

ABSTRACT

ABSTRACT Introduction: The aim of the present prospective-randomized study was to compare perioperative outcomes and complications of bipolar and monopolar TURBT for lateral wall-located non-muscle invasive bladder cancers (NMIBC) under obturator nerve block (ONB). Patients and Methods: 80 patients who underwent TURBT for lateral wall-located primary bladder tumors under ONB from March, 2016 to November, 2019 were included in the present study. The patients were randomized equally into two groups; monopolar TUR (M-TURBT) and bipolar TUR (B-TURBT). The primary and secondary outcomes were safety (obturator jerk and bladder perforation) and efficacy (complete tumor resection and sampling of the deep muscle tissue). Results: Obturator jerk was detected in 2 patients (5%) in M-TURBT while obturator jerk was not observed during B-TURBT (p=0.494). Bladder perforation was not observed in both groups. All of the patients underwent complete tumor resection. There was no significant difference in muscle tissue sampling (67.5% vs. 72.5%, p=0.626) and thermal tissue damage rates (12.5% vs. 25%, p=0.201). The majority of complications were low-grade and the differences in Clavien grade 1-3 complications between groups were not statistically significant. Conclusion: In the treatment of lateral-wall located NMIBCs, either M-TURBT or B-TURBT can be safely and effectively performed by combining spinal anesthesia with ONB. Even so, it should be taken into consideration that low-grade postoperative hemorrhagic complications may occur in patients who undergo M-TURBT.


Subject(s)
Humans , Urinary Bladder Neoplasms/surgery , Urologic Surgical Procedures , Cystectomy , Prospective Studies , Obturator Nerve
2.
Int. braz. j. urol ; 47(2): 426-435, Mar.-Apr. 2021. tab, graf
Article in English | LILACS | ID: biblio-1154471

ABSTRACT

ABSTRACT Objective: To assess the functional outcomes and complications of modified Hautmann neobladder with Wallace ureteroileal anastomosis on a 6-8 cm long isoperistaltic chimney, following radical cystectomy. Materials and Methods: Between January 2015 and October 2019, 22 patients (18 men and 4 women) underwent radical cystectomy and Hautmann neobladder reconstruction with chimney modification and Wallace I ureteroileal anastomosis. The mean age of patients was 61 years (45-74 years). All procedures were performed by the same surgeon and the mean follow-up was 29.4 months. Complications were registered as early (occurring within 3 months) or late (occurring after 3 months), with particular attention addressed to the ureteroileal anastomotic stricture and anastomotic leakage rate. Patient evaluation also included symptom analysis for daytime continence and voiding frequency. Results: Ureteroileal anastomotic stricture was not detected as a cause of hydronephrosis. Hovewer, the anastomotic leakage occurred in one patient during the early postoperative period. Early complications occurred in 9 patients and the most common was bilateral hydronephrosis, detected in 5 examinees. Late complications occurred in 4 patients. Complete daytime and nighttime continence achieved in 18 and 16 patients respectively, with two patients (9%) still required intermittent catheterization three months after surgery. Conclusions: The functional results with modified Hautmann neobladder, incorporating short afferent limb in Wallace I uretero-enteric anastomosis, were efficient. This technique is an effective way to minimize potential uretero-enteric stricture, anastomotic leakage and incidence of vesicoureteral reflux.


Subject(s)
Humans , Male , Female , Urinary Diversion/adverse effects , Urinary Bladder Neoplasms/surgery , Postoperative Complications , Anastomosis, Surgical/adverse effects , Cystectomy/adverse effects , Follow-Up Studies , Ileum/surgery , Middle Aged
3.
Rev. medica electron ; 43(1): 2903-2916, tab
Article in Spanish | LILACS, CUMED | ID: biblio-1156783

ABSTRACT

RESUMEN Introducción: el cáncer de la vejiga es la segunda neoplasia urológica. En Cuba constituye la séptima causa de cáncer en el sexo masculino y entre las primeras quince, cuando se combinan ambos sexos. Objetivo: evaluar el comportamiento del cáncer de vejiga en pacientes del Hospital Universitario Comandante "Faustino Pérez Hernández". Materiales y Métodos: se realizó un estudio observacional, descriptivo y transversal en el período comprendido desde diciembre de 2014 hasta enero de 2020. Los pacientes se dividieron en tres grupos tratados con cirugía de mínimo acceso, cirugía abierta y no operados, se describieron los grupos histológicos y estadiaje tumoral y se les aplicó tratamiento según protocolo del servicio, sus complicaciones y la presencia de recidivas tumorales también fueron descritas. En el universo se incluyeron en el estudio 222 pacientes diagnosticados de cáncer de vejiga. Resultados: se comprobó que el mayor número de pacientes diagnosticados con cáncer de vejiga son del sexo masculino, el tipo histológico es el carcinoma de células uroteliales de bajo grado y el estadio T1. Las recidivas se presentaron antes de los 5 años en el 10,8% de los casos. 196 pacientes presentaron complicaciones. Conclusiones: el cáncer de vejiga es más frecuente en las edades comprendidas entre 60 a 69 años, las recidivas aparecieron mayormente entre 1 y 3 años. Se presentó complicaciones en 196 pacientes, siendo la cirugía la modalidad terapéutica que mayor por ciento tuvo con un 32.22% y las infecciones son las complicaciones más frecuentes (AU).


SUMMARY Introduction: Cancer of the bladder (CV) is the second urological neoplasm. In Cuba it constitutes the seventh cause of cancer in males and among the first fifteen, when both sexes are combined. Objective: To evaluate the behavior of bladder cancer (CV) in patients of the Faustino Pérez Hernández Hospital. Materials and methods: An observational, descriptive and cross-sectional study was carried out in the period from December 2014 to January 2020. The patients were divided into 3 groups treated with Minimum Access Surgery (CMA), Open Surgery (CA) and No Operated (NO), the histological groups and tumor staging were described and treatment was applied according to the service protocol, their complications and the presence of tumor recurrences were also described.Universe: 222 patients diagnosed with bladder cancer were included in the study. Results: It was found that the greatest number of patients diagnosed with CV are male, the histological type is low-grade urothelial cell carcinoma and stage T1. Recurrences occurred before 5 years in 10.8% of cases. 196 patients presented complications. Conclusions: The CV is more frequent in the ages between 60 to 69 years, the recurrences appeared mainly between 1 and three years. Complications occurred in 196 patients, with Surgery being the therapeutic modality with the highest percentage with 32.22% and infections being the most frequent complications (AU).


Subject(s)
Humans , Urinary Bladder Neoplasms/epidemiology , Carcinoma/epidemiology , Infections/etiology , Urinary Bladder Neoplasms/surgery , Urinary Bladder Neoplasms/complications , Urinary Bladder Neoplasms/diagnosis , Carcinoma/surgery , Carcinoma/complications , Carcinoma/diagnosis , Epidemiology, Descriptive , Cross-Sectional Studies , Observational Study
4.
Int. braz. j. urol ; 47(1): 93-99, Jan.-Feb. 2021. tab, graf
Article in English | LILACS | ID: biblio-1134320

ABSTRACT

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.


Subject(s)
Humans , Male , Female , Aged , Urinary Bladder Neoplasms/surgery , Urinary Bladder Neoplasms/radiotherapy , Carcinoma , Urinary Bladder , Cystectomy , China , Feasibility Studies , Reproducibility of Results , Retrospective Studies , Treatment Outcome , Combined Modality Therapy , Fiducial Markers , Middle Aged , Muscles , Neoplasm Invasiveness , Neoplasm Recurrence, Local
6.
Clinics ; 76: e2587, 2021. tab, graf
Article in English | LILACS | ID: biblio-1249583

ABSTRACT

OBJECTIVES: Whole genome expression profiles allow the stratification of bladder urothelial carcinoma into basal and luminal subtypes which differ in histological patterns and clinical behavior. Morpho-molecular studies have resulted in the discovery of immunohistochemical markers that might enable discrimination between these two major phenotypes of urothelial carcinoma. METHODS: We used two combinations of immunohistochemical markers, i.e., cytokeratin (CK) 5 with CK20 and CK5 with GATA3, to distinguish subtypes, and investigated their association with clinicopathological features, presence of histological variants, and outcomes. Upon searching for tumor heterogeneity, we compared the findings of primary tumors with their matched lymph node metastases. We collected data from 183 patients who underwent cystectomy for high-grade muscle-invasive urothelial carcinoma, and representative areas from the tumors and from 76 lymph node metastasis were organized in tissue microarrays. RESULTS: Basal immunohistochemical subtype (CK5 positive and CK20 negative, or CK5 positive and GATA3 negative) was associated with the squamous variant. The luminal immunohistochemical subtype (CK5 negative and CK20 positive, or CK5 negative and GATA3 positive) was associated with micropapillary and plasmacytoid variants. Remarkably, only moderate agreement was found between the immunohistochemical subtypes identified in bladder tumors and their lymph node metastasis. No significant difference in survival was observed when using either combination of the markers. CONCLUSION: This study demonstrates that these three routinely used immunohistochemical markers could be used to stratify urothelial carcinomas of the bladder into basal and luminal subtypes, which are associated with several differences in clinicopathological features.


Subject(s)
Humans , Urinary Bladder Neoplasms/surgery , Carcinoma, Transitional Cell , Prognosis , Urinary Bladder , Biomarkers, Tumor , Retrospective Studies
7.
Int. braz. j. urol ; 46(2): 169-184, Mar.-Apr. 2020. tab, graf
Article in English | LILACS | ID: biblio-1090578

ABSTRACT

ABSTRACT Background Standard management of muscle-invasive bladder cancer involves radical cystectomy with pelvic lymph node dissection. However, patients may be ineligible for surgery or may wish to avoid the morbidity of cystectomy due to quality of life concerns. Bladder preservation therapies have emerged as alternatives treatment options that can provide comparable oncologic outcomes while maintaining patients' quality of life. Objective To review bladder preservation therapies, patient selection criteria, and functional and oncologic outcomes for BPT in muscle-invasive bladder cancer. Materials and Methods We conducted a comprehensive literature review of bladder preservation therapies in Pubmed and Embase. Discussion The ideal patient for BPT has low-volume T2 disease, absence of CIS, absence of hydronephrosis, and a maximal TURBT with regular surveillance. Technological advancements involving cancer staging, TURBT technique, and chemotherapy and radiation therapy regimens have improved BPT outcomes, with oncologic outcomes now comparable to those of radical cystectomy. Advancements in BPT also includes a heightened focus on improving quality of life for patients undergoing bladder preservation. Preservation strategies with most evidence for use include trimodality therapy and partial cystectomy with pelvic lymph node dissection. Conclusions This review highlights the breadth of strategies that aim to preserve a patient's bladder while still optimizing local tumor control and overall survival. Future areas for innovation include the use of predictive biomarkers and implementation of immunotherapy, moving the field towards patient-tailored care.


Subject(s)
Humans , Urinary Bladder Neoplasms/surgery , Cystectomy/methods , Urinary Bladder Neoplasms/pathology , Combined Modality Therapy , Organ Sparing Treatments , Neoplasm Invasiveness , Neoplasm Staging
8.
Clinics ; 75: e1639, 2020. tab
Article in English | LILACS | ID: biblio-1101083

ABSTRACT

OBJECTIVES: The enhanced recovery after surgery (ERAS) protocol recommends prevention of intraoperative hypothermia. However, the beneficial effect of maintaining normothermia after radical cystectomy has not been evaluated. This study aimed to investigate the efficacy of fluid warming nursing in elderly patients undergoing Da Vinci robotic-assisted laparoscopic radical cystectomy. METHODS: A total of 108 patients with bladder cancer scheduled to undergo DaVinci robotic-assisted laparoscopic radical cystectomy were recruited and randomly divided into the control group (n=55), which received a warming blanket (43°C) during the intraoperative period and the warming group (n=53), in which all intraoperative fluids were administered via a fluid warmer (41°C). The surgical data, body temperature, coagulation function indexes, and postoperative complications were compared between the two groups. RESULTS: Compared to the control group, the warming group had significantly less intraoperative transfusion (p=0.028) and shorter hospitalization days (p<0.05). During the entire intraoperative period (from 1 to 6h), body temperature was significantly higher in the warming group than in the control group. There were significant differences in preoperative fibrinogen level, white blood cell count, total bilirubin level, intraoperative lactose level, postoperative thrombin time (TT), and platelet count between the control and warming groups. Multivariate linear regression analysis demonstrated that TT was the only significant factor, suggesting that the warming group had a lower TT than the control group. CONCLUSION: Fluid warming nursing can effectively reduce transfusion requirement and hospitalization days, maintain intraoperative normothermia, and promote postoperative coagulation function in elderly patients undergoing Da Vinci robotic-assisted laparoscopic radical cystectomy.


Subject(s)
Humans , Male , Female , Aged , Body Temperature/physiology , Cystectomy/methods , Laparoscopy , Robotic Surgical Procedures/methods , Intraoperative Care/methods , Intraoperative Complications/prevention & control , Postoperative Complications/prevention & control , Shivering/physiology , Urinary Bladder Neoplasms/surgery , Urinary Bladder Neoplasms/pathology , Intraoperative Period
10.
Int. braz. j. urol ; 46(4): 566-574, 2020. tab, graf
Article in English | LILACS | ID: biblio-1134185

ABSTRACT

ABSTRACT Purpose To evaluate the influence of preoperative renal function on survival outcomes in patients who underwent radical cystectomy (RC) with non-continent urinary diversion (UD). Materials and Methods A total of 132 patients with bladder cancer who underwent RC with non-continent UD due to urothelial carcinoma from January 2006 toMarch 2017 at our tertiary referral center were retrospectively evaluated. Patients were divided into 2 groups as those with estimated glomerular filtration rate (eGFR) <60mL/min/1.73 m2 and ≥60mL/min/1.73 m2 according to preoperative eGFR levels. Patients' characteristics, preoperative clinical data, operative data, pathologic data, oncologic data and complications were compared between the groups. Results The mean age was 64.5±8.7 (range: 32 - 83) years and the median follow-up was 30.9±31.7 (range: 1-113) months. There were 46 patients in Group 1 and 86 patients in Group 2. There was no difference in cancer-specific mortality (45.6% for group 1 and 30.2% for group 2, p=0.078) and survival (56.8±8.3 months for group 1 and 70.5±5.9 months for group 2, p=0.087) between the groups. Overall mortality was higher (63% for group 1 and 40.7% for group 2, p=0.014) and overall survival (43.6±6.9 months for group 1 and 62.2±5.8 months for group 2, p=0.03) was lower in Group 1 compared to Group 2. Conclusions Overall mortality was higher and overall survival was lower in patients with preoperative eGFR <60mL/s. More patients had preoperative hydronephrosis with eGFR< 60mL/s.


Subject(s)
Humans , Male , Female , Adult , Aged , Aged, 80 and over , Glomerular Filtration Rate , Urinary Diversion , Urinary Bladder Neoplasms/surgery , Cystectomy , Retrospective Studies , Preoperative Period , Middle Aged
11.
Einstein (Säo Paulo) ; 18: eAO5628, 2020. tab, graf
Article in English | LILACS | ID: biblio-1142877

ABSTRACT

ABSTRACT Objective: To analyze mortality rates and hospitalization data after radical cystectomy in each public healthcare center in São Paulo in the last decade, considering the number of surgeries performed at each center. Methods: This study included patients from the Departamento de Informática do Sistema Único de Saúde from the state of São Paulo, who underwent radical cystectomy between 2008 and 2018. Data analyzed included organization name, number of procedures/year, in-hospital death rates and hospital length of stay. Results: A total of 1,377 radical cystectomies were registered in the public health system in São Paulo, between 2008-2018. A total of 91 institutions performed at least one radical cystectomy in the decade analyzed. The number of radical cystectomies performed per organization during the years analyzed ranged from one to 161. Only 45.6% of patients were operated in organizations that performed more than five radical cystectomies yearly. A total of 684 patients were operated in organizations with higher surgical volume. There were 117 in-hospital deaths, representing an 8.5% mortality rate for the state of São Paulo during the last decade. Whereas highest volume organizations (>6 radical cystectomies/year) had a mortality rate of 6.1%, the lowest volume (<1 radical cystectomy /year) had a 17.5% in-hospital mortality rate. Conclusion: There was a strong relation between organization volume of radical cystectomy and in-hospital mortality rate after radical cystectomy in São Paulo from 2008-2018. Unfortunately, we could not observe a trend toward centralization of such complex procedures, as it has occurred in developed countries during the last decades.


RESUMO Objetivo: Analisar as taxas de mortalidade e os dados de hospitalização após cistectomia radical em cada unidade pública de saúde de São Paulo na última década, levando em conta o número de cirurgias realizadas por unidade. Métodos: Este estudo incluiu pacientes do Departamento de Informática do Sistema Único de Saúde de São Paulo submetidos à cistectomia radical entre 2008 e 2018. Os dados analisados incluíram o nome da instituição, o número de procedimentos/ano, taxas de mortalidade hospitalar e tempo de internação hospitalar. Resultados: Foram registrados 1.377 cistectomias radicais no sistema público de saúde de São Paulo no período. Um total de 91 instituições realizou pelo menos uma cirurgia na década analisada. O número de cistectomias realizadas por instituição durante os anos analisados variou de uma a 161. Apenas 45,6% dos pacientes foram operados em instituições com volume cirúrgico maior do que cinco cistectomias radicais/ano. Ao todo, 684 pacientes foram operados em instituições com maior volume cirúrgico. Houve 117 óbitos hospitalares, representando taxa de mortalidade de 8,5% para o estado de São Paulo na última década. Enquanto instituições com o maior volume (seis cistectomias radicais/ano) apresentaram mortalidade de 6,1%, as instituições com menor volume (<1 cistectomia radical/ano) apresentaram taxa de mortalidade de 17,5%. Conclusão: Houve forte relação entre o volume institucional de cistectomia radical e a taxa de mortalidade hospitalar após cistectomia radical em São Paulo, no período de 2008 a 2018. Infelizmente, não se observa no Brasil tendência de centralização de procedimentos complexos, como tem ocorrido em países desenvolvidos nas últimas décadas.


Subject(s)
Humans , Cystectomy , Urinary Bladder Neoplasms/surgery , Hospital Mortality , Hospitalization
13.
Int. braz. j. urol ; 45(5): 910-915, Sept.-Dec. 2019. graf
Article in English | LILACS | ID: biblio-1040086

ABSTRACT

ABSTRACT Purpose As a rare bladder tumor, paraganglioma of the urinary bladder (PUB) is frequently misdiagnosed as bladder cancer, particularly for the non-functional type. To date, transurethral resection remains a controversial treatment for non-functional PUB. This study aimed to identify the clinical features, pathological characteristics, prognosis, and safe/effective treatment of non-functional PUB using transurethral resection of the bladder tumor (TURBT). Materials and Methods The clinical records, radiological data, pathological characteristics and follow-up times were retrospectively reviewed in 10 patients with clinically and pathologically proven non-functional PUB in our hospital from January 2008 to November 2016. All patients underwent TURBT treatment. Results The incidence of non-functional PUB in patients with bladder cancer was 0.17%. The mean age at diagnosis was 44.5 ± 13.6 years (range, 29-70 years), and the patient population had a female: male ratio of 3: 2. No patients had excess catecholamine (CA) whilst four patients had painless hematuria. All neoplasms were completely resected via TURBT. The majority of samples were positive for immunohistochemical markers including chromogranin A (CgA) and Synaptophysin (Syn), but were negative for cytokeratins (CKs). Only a single recurrence was observed from the mean follow-up period of 36.4 ± 24.8 months. Conclusion Complete TURBT is a safe and efficient treatment that serves both diagnostic and therapeutic purposes. Histopathological and immunohistochemistry examinations are mandatory for diagnostic confirmation. Long-term follow-up is recommended for patients with non-functional PUB.


Subject(s)
Humans , Male , Female , Adolescent , Adult , Paraganglioma/surgery , Urinary Bladder Neoplasms/surgery , Paraganglioma/pathology , Urethra/surgery , Urinary Bladder Neoplasms/pathology , Immunohistochemistry , Reproducibility of Results , Retrospective Studies , Follow-Up Studies , Treatment Outcome , Synaptophysin/analysis , Cystoscopy/methods , Chromogranin A/analysis , Middle Aged
15.
Int. braz. j. urol ; 45(4): 853-853, July-Aug. 2019.
Article in English | LILACS | ID: biblio-1040056

ABSTRACT

ABSTRACT Introduction Urological surgery is estimated to be the third most common cause of iatrogenic-retained foreign bodies 1. Presentation A 76-year old man was undergoing a transurethral resection of bladder tumor with a 26-Ch continuous flow resectoscope (Karl Storz, Germany). Before starting resection, a detachment of resectoscope sheath tip was noted. The ceramic tip was free-floating in the bladder lumen, and it would not fit within the sheath, making direct extraction using the loop impossible. An attempt was made to break it with a stone punch, but it was unsuccessful due to impossibility of closing it in the branches. Therefore, we decided to fragment the tip with holmium laser (RevoLix®, LISA Laser products, Germany), using an 800-micron, front-firing fiber. Laser device was settled at with 2.5 J energy and 5 Hz frequency. Ceramic appeared very hard, but it was difficult to carry on breaking with this setting because of tip retropulsion. Then, laser setting was switched to lower energy and higher frequency (1 J and 13 Hz). This setting guaranteed the same power of 13 W, but with minimal retropulsion. Results Tip was fragmented against the posterior bladder wall in seven pieces, which were retrieved trough the outer sheath. A total 5.62 kJ were used to fragment it. At the end, superficial lesions of the posterior bladder wall were highlighted. Surgical time was 55 minutes. Patient was discharged home next day without problems. Conclusions Holmium laser fragmentation is a safe and effective approach to remove foreign bodies from the bladder.


Subject(s)
Humans , Male , Aged , Urinary Bladder/surgery , Ceramics/radiation effects , Equipment Failure , Lasers, Solid-State/therapeutic use , Foreign Bodies/surgery , Radiation Dosage , Time Factors , Urinary Bladder Neoplasms/surgery , Treatment Outcome , Operative Time
16.
Int. braz. j. urol ; 45(4): 686-694, July-Aug. 2019. tab, graf
Article in English | LILACS | ID: biblio-1019886

ABSTRACT

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


Subject(s)
Humans , Male , Female , Aged , Urinary Bladder Neoplasms/surgery , Carcinoma in Situ/surgery , Cystectomy/adverse effects , Sarcopenia/etiology , Time Factors , Urinary Bladder Neoplasms/complications , Urinary Bladder Neoplasms/physiopathology , Urinary Bladder Neoplasms/mortality , Carcinoma in Situ/complications , Carcinoma in Situ/mortality , Body Mass Index , Cystectomy/methods , Cystectomy/mortality , Proportional Hazards Models , Multivariate Analysis , Retrospective Studies , Muscle, Skeletal/physiopathology , Kaplan-Meier Estimate , Sarcopenia/physiopathology
17.
Int. braz. j. urol ; 45(3): 560-571, May-June 2019. tab, graf
Article in English | LILACS | ID: biblio-1012321

ABSTRACT

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.


Subject(s)
Humans , Male , Female , Adult , Aged , Urinary Diversion/methods , Urinary Bladder Neoplasms/surgery , Adenocarcinoma/surgery , Cystectomy/methods , Laparoscopy/methods , Postoperative Complications , Time Factors , Urinary Bladder Neoplasms/pathology , Anastomosis, Surgical , Carcinoma, Squamous Cell/surgery , Carcinoma, Squamous Cell/pathology , Adenocarcinoma/pathology , Prospective Studies , Reproducibility of Results , Treatment Outcome , Statistics, Nonparametric , Surgical Stomas , Neoplasm Grading , Operative Time , Medical Illustration , Middle Aged , Neoplasm Staging
18.
Int. braz. j. urol ; 45(2): 315-324, Mar.-Apr. 2019. tab, graf
Article in English | LILACS | ID: biblio-1002193

ABSTRACT

ABSTRACT Objectives: To evaluate the neutrophil-to-lymphocyte ratio (NLR) as a prognostic factor for response of high risk non muscle invasive bladder cancer (HRNMIBC) treated with BCG therapy. Materials and Methods: Between March 2010 and February 2014 in a tertiary center 100 consecutive patients with newly diagnosed HRNMIBC were retrospectively analyzed. Patients were divided according to NLR value: 46 patients with NLR value less than 3 (NLR < 3 group), and 54 patients with NLR value more than 3 (NLR ≥ 3 group). At the end of follow-up 52 patients were high grade disease free (BCG-responder group) and 48 patients underwent radical cystectomy for high grade recurrence or progression to muscle invasive disease (BCG non-responder group). The average follow-up was 60 months. Intervention: analysis and correlation of preoperative NLR value with response to BCG in terms of recurrence and progression. Results: The optimal cut-off for NLR was ≥ 3 according to the receiver operating characteristics analysis (AUC 0.760, 95% CI, 0.669-0.850). Mean NLR value was 3.65 ± 1.16 in BCG non-responder group and 2.61 ± 0.77 in BCG responder group (p = 0.01). NLR correlated with recurrence (r = 0.55, p = 0.01) and progression risk scores (r = 0.49, p = 0.01). In multivariate analysis, NLR (p = 0.02) and EORTC recurrence risk groups (p = 0.01) were associated to the primary endpoint. The log-rank test showed statistically significant difference between NLR < 3 and NLR ≥ 3 curves (p < 0.05). Conclusions: NLR value preoperatively evaluated could be a useful tool to predict BCG response of HRNMIBC. These results could lead to the development of prospective studies to assess the real prognostic value of NLR in HRNMIBC.


Subject(s)
Humans , Male , Female , Aged , Urinary Bladder Neoplasms/drug therapy , BCG Vaccine/therapeutic use , Lymphocytes/pathology , Carcinoma, Transitional Cell/drug therapy , Adjuvants, Immunologic/therapeutic use , Neutrophils/pathology , Prognosis , Urinary Bladder Neoplasms/surgery , Urinary Bladder Neoplasms/pathology , Carcinoma, Transitional Cell/surgery , Carcinoma, Transitional Cell/pathology , Biomarkers, Tumor/blood , Cystectomy , Retrospective Studies , Lymphocyte Count , Disease Progression , Neoplasm Grading , Middle Aged , Neoplasm Recurrence, Local/surgery , Neoplasm Staging
20.
Int. braz. j. urol ; 44(6): 1156-1165, Nov.-Dec. 2018. tab, graf
Article in English | LILACS | ID: biblio-975653

ABSTRACT

ABSTRACT Purpose: To describe our technique and outcomes for laparoscopic intracorporeal ileal neobladder (ICNB) reconstruction. Materials and Methods: From April 2014 to November 2016, 21 patients underwent laparoscopic ICNB at our tertiary referral centre. ICNB with bilateral isoperistaltic afferent limbs and several technique improvements were introduced. Demographics, clinical, and pathological data were collected. Perioperative, 1-year oncologic, 1-year Quality of life and 1-year functional outcomes were reported. Results: ICNB was successfully performed in all 21 patients without open conversion and transfusion. Mean operative time was 345.6±66.9 min, including 106±22 min for LRC and PLND and 204±46.4 min for ICNB, respectively. Mean established blood loss was 192±146 mL. The overall incidence of 90-d complication was 33.3%, while major complication occurred in 4.8%. One-year daytime and night-time continence rates were 85.7% and 57.1%, respectively. One patient died from myocardial infarction six months postoperatively, and two patients had lung metastasis five months and six months respectively. Conclusions: We described our experience of 3D LRC with a novel intracorporeal orthotopic ileal neobladder, and the technique improvements facilitate the procedure. However, further studies are required to evaluate long-term outcomes of the intracorporeal neobladder with bilateral isoperistaltic afferent limbs.


Subject(s)
Humans , Male , Female , Urinary Bladder Neoplasms/surgery , Urinary Reservoirs, Continent , Laparoscopy/methods , Retrospective Studies , Operative Time , Length of Stay , Middle Aged
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