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Nonmuscle invasive bladder cancer (NMIBC) is mainly composed of three different types of tumors: papillary urothelial carcinoma is limited to the mucosal layer (Ta), high-grade carcinoma in situ is limited to the epithelial layer (CIS) and tumors invading the submucosa or lamina propria (T1). The standard treatment for NMIBC is complete transurethral resection of bladder tumors (TURBT) with or without intravesical instillation therapies. However, some high-risk patients are at risk of tumor progression and therefore require more aggressive treatment. Studies have reported that delayed cystectomy can lead to a significant reduction in survival benefits. Therefore, for these NMIBC patients who are at high risk of disease progression, when to abandon conservative treatment and choose cystectomy is one of the biggest challenges. This article reviews the current application status and future directions of radical cystectomy as the initial treatment on NMIBC patients.
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Objective:To explore the latent classes in developmental trajectory of post traumatic growth(PTG) and influencing factors in patients with bladder cancer.Methods:Convenience sampling method was used to recruit 215 patients with bladder cancer underwent transurethral resection or radical cystectomy in the Urological Department of Hubei Cancer Hospital. The patients were followed up for 5 times, and the latent growth mixture model and multinomial Logistic regression model were used to analyze the data.Results:The patients were identified four latent classes: high PTG group(29 cases), low PTG group(33 cases), increasing PTG group(69 cases), decreasing PTG group(84 cases). Compared with the low PTG group, elderly, patients with non-muscle invasive bladder cancer were more likely to enter the high PTG group. Patients with non-muscle invasive bladder cancer, male and employee were more likely to enter the increasing PTG group. Patients living in rural areas were more likely to enter the decreasing PTG group.Conclusions:Clinical staff should make individualized intervention according to the developmental trajectory of PTG in patients with bladder cancer.
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Objective To investigate treatment option of inguinal lymph node metastasis after inguinal lymph node dissection in patients with penile cancer.Methods To retrospectively analyze the efficacy and prognostic factors of cisplatin combined with fluorouracil in the concurrent chemoradiotherapy of inguinal lymph node metastasis after penile cancer surgery.Twenty-three patients with inguinal lymph node metastasis after inguinal lymph node dissection for penile squamous cell carcinoma from February 2009 to December 2015 were included.Inguinal lymph node metastasis with squamous cell carcinoma were confirmed by pathology or cytology.Metastatic lymph nodes of each patient were fixed,not less than 2,and greater than 4 cm in diameter.All patients received concurrent chemoradiotherapy with cisplatin and 5-fluorouracil.The response rate was evaluated after radiotherapy.The local control rate,survival time and the prognostic factors were also analyzed.Results The median time of postoperative inguinal lymph node metastasis was 6.1 months,and the recurrence rate of the patients within 16 months after the operation was 95％.The response rate was 65.2％ (15/23).After treatment,the local pain was significantly relieved and 7 cases of local hemorrhage was relieved.The 1-,2-year survival rates were 21.3％ and 5.5％,respectively,with a median survival of 6.3 months (95％ CI:3.4-8.1).And local tumor response rate correlated with radiation dose.Cox multivariate analysis showed that N staging and histological grade were independent prognostic factors for survival after treatment.Conclusions Concurrent chemoradiotherapy is effective for postoperative inguinal lymph node metastasis,especially for the local recurrence with symptoms and for patients who are not suitable for surgical salvage regarding the local tumor control,pain relief and tumor hemorrhage.However,the overall survival rate of the patients who received treatment was still low.Lower extremity edema is the main complication of concurrent chemoradiotherapy.N staging and poor differentiation of the tissue are unfavorable prognostic factors.
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Objective@#To investigate treatment option of inguinal lymph node metastasis after inguinal lymph node dissection in patients with penile cancer.@*Methods@#To retrospectively analyze the efficacy and prognostic factors of cisplatin combined with fluorouracil in the concurrent chemoradiotherapy of inguinal lymph node metastasis after penile cancer surgery. Twenty-three patients with inguinal lymph node metastasis after inguinal lymph node dissection for penile squamous cell carcinoma from February 2009 to December 2015 were included.Inguinal lymph node metastasis with squamous cell carcinoma were confirmed by pathology or cytology. Metastatic lymph nodes of each patient were fixed, not less than 2, and greater than 4 cm in diameter. All patients received concurrent chemoradiotherapy with cisplatin and 5-fluorouracil.The response rate was evaluated after radiotherapy. The local control rate, survival time and the prognostic factors were also analyzed.@*Results@#The median time of postoperative inguinal lymph node metastasis was 6.1 months, and the recurrence rate of the patients within 16 months after the operation was 95%.The response rate was 65.2% (15/23). After treatment, the local pain was significantly relieved and 7 cases of local hemorrhage was relieved. The 1-, 2-year survival rates were 21.3% and 5.5%, respectively, with a median survival of 6.3 months(95% CI: 3.4-8.1). And local tumor response rate correlated with radiation dose. Cox multivariate analysis showed that N staging and histological grade were independent prognostic factors for survival after treatment.@*Conclusions@#Concurrent chemoradiotherapy is effective for postoperative inguinal lymph node metastasis, especially for the local recurrence with symptoms and for patients who are not suitable for surgical salvage regarding the local tumor control, pain relief and tumor hemorrhage. However, the overall survival rate of the patients who received treatment was still low. Lower extremity edema is the main complication of concurrent chemoradiotherapy. N staging and poor differentiation of the tissue are unfavorable prognostic factors.
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<p><b>OBJECTIVE</b>To investigate the restoration of erectile function by reconstructing cavernous nerves with sural nerve grafts.</p><p><b>METHODS</b>Forty-eight male Sprague-Dawley rats(3-4 m old and 300-400 g) were randomly divided into three groups: the sham-operated group (n = 16) underwent pelvic exploration without transection of the cavernous nerve; the nerve ablation group (n = 16) had a 5 mm segment of the cavernous nerve excised bilaterally; the graft group (n = 16) had a 5 mm segment of the cavernous nerve excised bilaterally, followed by immediate microsurgical reconstruction with an interposition graft of the sural nerve. The cavernous nerves of each group were electrostimulated to determine their potency after 2 and 4 months. And fluorescent retrograde-transported material Fluoro-Gold(FG) was injected into the penis. FG-labeled neuron cells in whole mounts of major pelvic ganglions were observed five days after injection.</p><p><b>RESULTS</b>Electrical stimulation produced no erection in either the nerve ablation or the graft group, but 100% erection in the sham-operated group after 2 months. The numbers of FG-labeled neurons significantly differed between the nerve ablation group and the graft group. After 4 months erection examination showed statistical significance in the difference between the graft group and the nerve ablation group(P < 0.05). The FG-labeled neurons in the graft group significantly differed from those in the ablation (P < 0.05), and almost reached the level of the sham-operated(P < 0.05).</p><p><b>CONCLUSION</b>Cavernous nerve grafting can successfully restore erectile dysfunction in rats after surgical injury.</p>