Implications of the COVID19 pandemic on the need and timing of second transurethral bladder tumour resection in high-grade non-muscle invasive bladder cancer.

PURPOSE: Due to the COVID19 pandemic, the EAU has recommended to, if needed, postpone second transurethral resection of bladder tumour (TURBT) after BCG induction in selected patients. We aimed to evaluate the oncological outcomes of postponed TURBT and the potential to replace second TURBT by routine cystoscopy and cytology. METHODS: A single-center, retrospective analysis of patients with TaG3/high grade (HG) or T1HG urothelial bladder cancer was performed. All patients underwent a complete TURBT between 2000 and 2013 with presence of detrusor muscle, full BCG induction and routine cystoscopy and cytology, followed by a second TURBT. Results of the cystoscopy, cytology and pathology reports of the TURBT were analyzed by descriptive characteristics, sensitivity, specificity, negative and positive predictive values, as well as survival analyses. RESULTS: 112 patients were included. Residual tumour was present at second TURBT in 21.4%. Upstaging rate from pTaHG to pT1HG and pT1HG to pT2 was 0% and 2.7%, respectively. pT0 was confirmed in 79% of patients, but in 98% of patients with combined negative cytology and cystoscopy after BCG. With a median follow-up of 109 months, the 3-year OS was 85%, RFS 74% and PFS 89%. Sensitivity, specificity, negative predictive value and positive predictive value of cystoscopy and urinary cytology for the presence of residual tumour were 92%, 97%, 98% and 85%, respectively. CONCLUSION: This study underpins the recommendation of the EAU NMIBC guideline panel that, if needed and in selected patients, second TURBT may be postponed until after BCG induction treatment in pT1HG disease. Also, routine second TURBT can be omitted in pTaHG disease. Data on replacing second TURBT after BCG treatment by routine cystoscopy and cytology appear promising but require further confirmation in prospective studies.

[Gallstone ileus treated with shock-waves: ESWL as treatment for intestinal obstruction]. / Galsteenileus verholpen met schokgolven.

BACKGROUND: A gallstone ileus is a complication of cholelithiasis that is difficult to recognise. Morbidity and mortality are both high. Treatment often consists of surgical removal of the stone. There is limited literature available about less invasive therapies such as extracorporeal shock-wave lithotripsy (ESWL). CASE DESCRIPTION: A 72-year-old man with severe abdominal pain reported to the accident and emergency department. A blockage at the level of the sigmoid colon was visible on the CT scan, with concurrent diverticular stenosis. During a multidisciplinary consultation we decided upon treatment with ESWL. The treatment was successful, and the patient left the hospital in a good condition. CONCLUSION: The most common surgical operation for a gallstone ileus is extraction through an enterotomy. The minimally invasive ESWL technique, however, seems to be a good alternative. To date, there have only been case study reports of this in the literature.

Percutaneous resection of upper tract urothelial cell carcinoma: When, how, and is it safe?

INTRODUCTION: In the management of upper tract urothelial cell carcinoma (UTUC) endoscopic, nephron sparing procedures like ureterorenoscopy (URS) or percutaneous tumour resection (PCTR) still play a very limited role. This could lead to possible unnecessary radical nephroureterectomies (RNU), still being the gold standard treatment. The risk of chronic kidney disease (CKD) later in life is important. In this study we present the results of 24-year experience with PCTR in a single institution. METHODS: We identified 44 patients who underwent PCTR between 1992 and 2015. Radical resection was achieved in 40 patients who were included in this study. Demographic and clinical data, including tumour recurrence, progression to RNU, tumour grade and overall survival (OS) were retrospectively acquired. An outcome analysis was conducted. RESULTS: Median age at diagnosis was 68 years (range 42-94 years). Low grade tumours were found in 37 patients (92.5%) and high grade tumours in three patients (7.5%). Median follow-up was 53 months during which 20 patients developed upper tract recurrences (50.0%). The longest time to recurrence was 97 months. At follow-up 11 patients (27.5%) underwent an RNU and two patients died from UTUC. RNU could be avoided in 29 patients (72.5%). In this study we found that multifocality is a significant risk factor for recurrence, but not for stage progression to RNU. CONCLUSION: PCTR is a surgically and oncologically safe procedure. Renal preservation in patients with UTUC who are eligible for percutaneous resection can be achieved in the majority of patients. Selection criteria for PCTR should be further refined, leading to a wider application of PCTR in the future. Follow-up needs invasive procedures and should be long term.

Trends in the incidence of treated end-stage renal failure in The Netherlands: hope for the future?

This study shows that in The Netherlands there is a changing pattern in incidence of renal replacement therapy over time when adjusted for age and sex. There has been an almost linear increase in crude incidence rates during four decades. However, unlike the situation elsewhere in the Western world, a flattening of the curve has been observed during the last six years. The growing incidence of end-stage renal disease (ESRD) due to especially hypertensive renovascular disease and diabetes mellitus type 2 has been neutralized by a decrease in ESRD due to glomerulonephritis, urologic interstitial nephritis, and diabetes mellitus type 1. The latter observations suggest that renoprotective interventions can be successful on a population level, and thus, provide hope for the future. To battle the increase in ESRD due to atherosclerosis and diabetes mellitus type 2-related renal disease, it is important that screening programs are being developed that enable us to identify in an early phase patients at risk for development of ESRD who may benefit from preventive strategies. Population screening for albuminuria will be helpful in this respect.