Quality of life and functional outcomes after radical cystectomy with ileal orthotopic neobladder replacement for bladder cancer: a multicentre observational study.

PURPOSE: Ileal orthotopic neobladder (IONB) reconstruction is the preferred urinary diversion among selected patients who have undergone radical cystectomy (RC) for bladder cancer (BCa). There is insufficient data regarding patients' quality of life (QoL), sexual and urinary outcomes. Our objectives were to assess QoL in a multicentre cohort study, and to identify related clinical, oncological and functional factors. METHODS: Patients who underwent RC with IONB reconstruction for BCa from 2010 to 2017 at one of the three French hospitals completed the following self-reported questionnaires: European Organization for Research and Treatment of Cancer (EORTC) generic (QLQ-C30) and bladder cancer specific instruments (QLQ-BLM30). To assess urinary symptoms, patients completed the Urinary Symptom Profile questionnaire (USP) and a three-day voiding diary. Univariate and multivariate analyses were computed to identify clinical, pathological, and functional predictors of global QoL score. RESULTS: Seventy-three patients completed questionnaires. The median age was 64 years and 86.3% were men. The median interval between surgery and responses to questionnaires was 36 months (range 12-96). Fifty-five percent of patients presented a high global QoL (EORTC-QLQC30, median score 75). A pre-RC American Society of Anesthesiologists score > 2, active neoplasia, sexual inactivity, and stress urinary incontinence were associated with a worse QoL. After a multivariate analysis, sexual inactivity was the only independent factor related to an altered QoL. CONCLUSION: Patients with IONB reconstruction after RC have a high global QoL. Sexual activity could independently impact the global QoL, and it should be assessed pre- and post-operatively by urologists.

[Orthotopic neobladder reconstruction for bladder cancer: robotic-assisted versus open-radical cystectomy for perioperative outcomes, functional results and quality of life]. / Morbidité, résultat fonctionnel, et qualité de vie des néovessies après cystectomie pour cancer : comparaison de la voie ouverte vs robotique.

INTRODUCTION: Open radical cystectomy (ORC) is the gold standard technique for carcinologic cystectomies. Robotic-assisted radical cystectomy (RARC) was introduced in 2003 and its development is booming. OBJECTIVE: To compare ORC and RARC with totally intracorporal (IC) orthotopic neobladder (ONB) reconstruction, in terms of perioperative outcomes, morbidity, functional results and quality of life (Qol). PATIENTS AND METHODS: From February 2010 to February 2017, a French multicentric, prospective study on patients who had a RC and ONB reconstruction for bladder cancer was performed. All patients completed the following questionnaires: the European Organization for Research and Treatment of Cancer (EORTC) generic (QLQ-C30) and the bladder cancer specific instruments (QLQ-BLM30). To assess urinary symptoms, patients also completed the Urinary Symptom Profile questionnaire (USP) and a three-day voiding diary. Patients were divided in two groups: ORC and RARC. RESULTS: We included 72 patients: 55 in the ORC group (76,4%) and 17 (33,6%) in the RARC group. Operative time was longer in RARC group (median 360 vs 300min; P<0.001) but length of stay was 5 days shorter (median 12 vs 17 days; P<0,05). Patients in RARC group had less blood transfusion (0 vs 23.6%; P<0.05), but a higher rate of uretero-ileal anastomosis stenosis and eventration at long term (respectively 25.5 vs 3.6% et 23 vs 2%; P<0.05). No statistical differences were found concerning quality of life items and functional results between the groups. CONCLUSION: RARC with totally IC ONB reconstruction lead to less perioperative morbidity with a reduced rate of blood transfusion and a reduced hospital length of stay. At long term, RARC could provide higher rates of uretero-ileal stenosis and eventration. RARC and ORC do not have any differences in terms of functional outcomes and Qol at long term after ONB reconstruction. LEVEL OF EVIDENCE: 3.

[Is the ureteral length associated with the patient's size?] / La longueur de l'uretère est-elle liée à la taille du patient ?

OBJECTIVE: To assess the relation between the ureteral length and the patients' size. PATIENTS AND METHOD: Prospective study made between September 2012 and May 2014, on 87 patients with 42 men and 45 women, in whom the ureteral measure was performed during the various procedures that require the use of a pigtail stent. The average age of the population was 53 years old (±15.9) with an average height of 168.3cm (±8.4). This has been achieved through ureteral catheter combining fluoroscopy and endoscopy. RESULTS: The ureteral average length was 23.5cm (±2.33). The ureteral average length was 23.8cm (±2.18) for man and 23.2cm (±2.44) for women. In this population, there were a positive correlation between the size of the patients and the length of the ureters (r=0.75; P=0.01). However, this correlation was not found in all subgroups, particularly among women (r=0.16; P=0.30) and on the right side of men (r=0.34; P=0.12). This correlation was still true for the left side in the men's group (r=0.50; P=0.02). CONCLUSION: In this study, there is a positive correlation between the patients' size and the ureteral length. But this correlation is not found in some subgroups. It is better to perform in vivo the ureteral measurement to have the precise length in order to set up a pigtail stent adapted to the patient. LEVEL OF EVIDENCE: 3.

[Epidemiology of emergency consultations for acute urine retention]. / Épidémiologie des consultations aux urgences pour une retention aiguë d'urine.

INTRODUCTION: Acute urinary retention (AUR) is a common reason for emergency consultation. It may be spontaneous or precipitated and affects both men and women. The purpose of this study was to determine the profile of men visiting emergency departments for an AUR. MATERIEL AND METHODS: A retrospective monocentric study including all men who consulted the emergency department between January 2014 and December 2016 for AUR was conducted. RESULTS: In 3 years, 731 patients were admitted for AUR (611 men and 120 women). The mean age was 71.6±14 years with a mean retention volume of 948±668mL drained for 96% of patients (n=584) through a bladder catheter and 4% (n=27) with a suprapubic catheter. Most patients had an urological (66%, n=104) or neurologic (40%, n=242) history and 23% (n=136) already had an episode of AUR. In 28% of cases (n=173), the globe was not painful. A majority of AUR were spontaneous, 53% (n=326) versus 46% (n=279) who were precipitated, secondary to a recent surgical procedure (<1 month) (15%, n=89), hematuria (9%, n=54), or male urinary tract infections (7%, n=42). Patients were treated externally in 71% (n=436), 25% (n=153) were hospitalized with significantly more comorbidities. CONCLUSION: Men consulting emergency for AUR are 72 years old, with a globe volume of 942mL. Thirty-three percent have a history of BPH, with a prostate treatment like alpha-blockers type. Almost all patients were treated with a bladder catheter and the majority was treated externally. LEVEL OF EVIDENCE: 4.

[Laparoscopic robot-assisted partial nephrectomy with total ureterectomy in a symptomatic complete duplicated system: advantages of transperitoneal approach]. / Néphrectomie polaire supérieure gauche robot assistée avec urétérectomie associée, dans le cadre d'un système urinaire double complet symptomatique.

We report the case of a laparoscopic robot assisted left upper polar partial nephrectomy with total ureterectomy performed in a teenager. A 14 year-old girl was referred to our institution for stress urinary incontinence. The morphological assessment (ultrasound scan and uro-MRI) showed a double collecting system with a complete ureteral duplication complicated by a dysplasia of the upper moiety of the duplex left kidney and a mega ureter. The surgery started on a lateral decubitus position by the upper polar partial nephrectomy and the ureter section behind superior polar renal vessels. The patient was placed in a supine position and the mega ureter was released and sectioned at the level of the distal adynamic segment in the left uterine parameter. The transperitoneal route was chosen as it provides a large workspace and allows the dissection of the ureters into their pelvic portion by a simple repositioning of the robot ports without additional incision and without any modification of the operative field. No intraoperative and postoperative complication was noticed. Laparoscopic robotic assisted surgery in pediatric urology is increasing, and to our knowledge, we reported this technique and surgery for the first time in France and in children. In the reported case, we showed that the robotic minimally invasive surgery in children is an innovative and safe technique for the treatment of symptomatic upper urinary tract malformations.