Anterior Exenteration Research Articles

Risk factors for major complications following pelvic exenteration: A NSQIP study

ObjectivesDue to the rarity of pelvic exenteration surgery, it is challenging to predict which patients are at an increased risk for postoperative complications. We aimed to study the predictors for postoperative complications among women undergoing pelvic exenteration for gynecologic malignancy. MethodWe used the National Surgical Quality Improvement Program registry to evaluate postoperative course and complications of those patients undergoing pelvic exenteration in the period 2012–2022. The primary objective of the analysis was to estimate the major postoperative complications following pelvic exenteration. ResultsOverall, 794 pelvic exenterations were included. Of those, 56.5 % were anterior exenteration, 43.5 % were posterior exenteration, and 13.9 % were a combined exenteration. The rate of minor complications was 72.5 % (n = 576), and the rate of major complications was 31.5 % (n = 250). The most common minor complications were blood transfusion (n = 538, 67.8 %), followed by superficial surgical site infections (SSI) and urinary tract infections (9.8 % and 9.4 %, respectively). Among the major complications, the most common was organ/space SSI (11.2 %), followed by sepsis (9.2 %), reoperation (8.6 %), and wound dehiscence (5.2 %). Death within 30 days occurred in 1.5 % of patients. In multivariable regression analysis, the following factors were independently associated with major complications: higher BMI [adjusted odds ratio (aOR) 1.03 95 % confidence interval (CI) (1.01–1.05)], diabetes [aOR 1.82 95 % CI (1.13–3.22)], low serum albumin [aOR 0.73 95 % CI (0.54–0.98)], and high serum creatinine [aOR 1.70 95 % CI (1.05–2.77)]. ConclusionsMajor postoperative complications occur in approximately one third of pelvic exenterations for gynecologic malignancies. Our study highlights independent factors associated with major postoperative complications, of which some are potentially modifiable.

Advanced female urethral adenocarcinoma: A case report.

Urethral cancer in females is a rare occurrence. Although initially believed to be derived from skene glands, there is no consensus on the cell of origin. Squamous cell carcinoma is the most common, whereas adenocarcinoma is the least common. We report the case of a 58-years-old lady with a history of voiding lower urinary tract symptoms, later requiring a suprapubic cystostomy for retention. Cystoscopy and biopsy showed prostate-specific antigen (PSA) negative adenocarcinoma and postiron emission computed tomography (PETCT) showing pelvic and inguinal nodal metastasis. The patient underwent neoadjuvant chemotherapy followed by anterior exenteration with pelvic lymphadenectomy and ileal conduit. Final histology showed ypT4 yN1 adenocarcinoma, not otherwise specified.

Primary urethral carcinoma in female: An extremely rare case series at a single tertiary referral hospital and literature review

Introduction and importancePrimary urethral carcinoma (PUC) is exceedingly uncommon and accounts for 0.02 % of all female cancers and <1 % of female genitourinary tract malignancy. PUC in female usually presents late with a higher disease stage and, hence, has higher cancer-specific mortality. Due to its rarity, the current recommendation for the management of PUC is still unclear. Case presentationThis study reports two rare cases of 59-year-old and 65-year-old women with PUC, presenting with chief complaint of hematuria. Urethrocystoscopy and biopsy were performed. Pathology results revealed mucinous adenocarcinoma (AC) and urothelial carcinoma (UC) of the urethra, respectively. Radiological imaging was conducted for staging. Both were diagnosed with cT4N2M0. The first patient underwent anterior pelvic exenteration with bilateral ureterocutaneoustomy (UCS), while the second patient received cisplatin-based chemotherapy before the surgery. Radiological follow-up was planned 3 months after the surgery. Clinical discussionBoth mucinous AC and UC are considered incredibly unusual subtypes, with no defined treatment guidelines. Anterior exenteration with or without neoadjuvant chemotherapy may be opted for advanced PUC affecting the proximal urethra and adjacent organs. Following the previous studies, in this case series, both patients (locally advanced) underwent anterior exenteration. Additionally, the UC subtype received multimodal treatment with neoadjuvant chemotherapy which was shown to improve overall survival. ConclusionIn conclusion, PUC is extremely rare, and the choice of management remained various. Long-term follow-up for these patients is mandatory to improve understanding of this incredibly uncommon disease.

Robotic-Assisted Pelvic Exenteration for Cervical Cancer: A Systematic Review and Novel Insights into Compartment-Based Imaging.

Background: Patients with persistent or recurrent cervical cancer, following primary treatment with concurrent chemoradiation, represent a subgroup eligible for pelvic exenteration. In light of the substantial morbidity associated with open pelvic exenterations, minimally invasive surgical techniques have been introduced. This systematic review aims to analyze and discuss the current literature on robotic-assisted pelvic exenterations in cervical cancer. In addition, novel aspects of compartment-based magnetic resonance imaging (MRI) are highlighted. Methods: This systematic review followed the PRISMA guidelines, and a comprehensive literature search on robotic-assisted pelvic exenterations in cervical cancer was conducted to assess, as main objectives, early and late postoperative complications as well as oncological outcomes. Inclusion and exclusion criteria were applied to select eligible studies. Results: Among the reported cases of robotic-assisted pelvic exenterations in cervical cancer, 79.4% are anterior pelvic exenterations. Intraoperative complications are minimal and early/late major complications averaged between 30-35%, which is lower compared to open pelvic exenterations. Oncological outcomes are similar between robotic and open pelvic exenterations. Sensitivity for locoregional invasion increases up to 93% for compartment-based MRI in colorectal cancer. A refined delineation of the seven pelvic compartments for cervical cancer is proposed here. Conclusions: Robotic-assisted pelvic exenterations have demonstrated feasibility and safety, with reduced rates of major complications compared to open surgery, while maintaining surgical efficiency and oncological outcomes. Compartment-based MRI holds promise for standardizing the selection and categorization of pelvic exenteration procedures.

Squamous Cell Carcinoma of the Bladder: Analysis of Treatments and Outcomes.

Squamous cell carcinoma (SCC) of the bladder is a rare disease composing 2-5% of all bladder cancers. Currently, no consensus exists regarding treatment recommendations for this rare malignancy, although established regimens include various permutations of chemotherapy, radiation, laser treatments, immunotherapies, and surgeries, ranging from pelvic exenteration to local excision. The present study aims to analyze outcomes of the aforementioned treatments to guide clinical decision-making for patients with the disease. Patients with bladder SCC diagnosed between 2000 and 2018 were reviewed utilizing data from the Surveillance, Epidemiology, and End Results Registry (SEER) program. Data was analyzed using SPSS and Python. Examined variables included presence of metastases at diagnosis, surgery, radiotherapy, and chemotherapy reception. Five-year overall survival (OS) curves were analyzed using Kaplan-Meier probability stratified by treatment modality. A total of 5,635 patients with bladder SCC were identified; the most abundantly reported demographics were white race (86%), patient age > 70 years (61%), and male sex (63%). Median survival was 13 months and was significantly decreased in patients treated with chemotherapy or radiation (median survival of nine months or 12 months, respectively). Patients treated with radiation and surgery saw a decreased 10-year survival rate of about 10% if no chemotherapy was administered; this difference narrowed to about a 4% decrease in patients treated with chemotherapy. All radical surgical procedures (to include partial and total cystectomy, and total and posterior exenteration) resulted in a statistically significant increase in survival, except for patients that underwent radical cystectomy including anterior exenteration (p = 0.101). Patients that underwent surgery saw an increased median survival of 15 months. Heatmap analysis demonstrated a significant correlation between tumor size and distant metastases (r = 0.898). Preliminary unsupervised cluster analysis identified two distinct patient subgroups characterized most strongly by race and treatment modality used. Bladder SCC carries a high mortality burden, with a median survival time of 13 months after diagnosis. Based on this study's analysis, radical surgery may be the most effective treatment for this disease. This study also sets a precedent for future research, as more advanced machine learning methods (including cluster and binary tree analysis, as was done in this analysis) can be used to identify the most explanatory variables related to improved patient outcomes.

Female Sexual Function Following Radical Cystectomy in Bladder Cancer.

A clear and well-documented gender bias exists in the evaluation of sexual outcomes for women undergoing urologic surgery. Due to the anatomic template of anterior exenteration, women are commonly left with side effects that include sexual dysfunction and the perpetuated effects of surgical menopause. To present evaluation and treatment recommendations for female sexual dysfunction treatment and evaluation, in addition to surgical templates during radical cystectomy (RC). This article reviews current literature regarding sexual function and RC with urinary diversion in female bladder cancer patients. Furthermore, this review will provide a review of techniques for organ and neurovascular preservation, along with novel vaginal reconstruction templates. Our review will further focus on emerging technology, including minimally invasive surgery and organ and nerve preservation, directed at preservation of female sexual function. Clinically, studies have demonstrated that females who have undergone genitalia-sparing and neurovascular preservation during RC regained sexual activity earlier than patients undergoing traditional RC. If organ and nerve preservation is not feasible due to involvement of trigone or bladder neck, vaginal reconstruction can mitigate the sexual dysfunction that results from a loss of the anterior vagina during a standard RC. Female sexual dysfunction is associated with high levels of patient distress and is best comanaged with a multidisciplinary treatment approach, including preoperative counseling, intraoperative nerve, and organ preservation, and postoperative interventions to mitigate sexual side effects. Davis L, Isali I, Prunty M, et al. Female Sexual Function Following Radical Cystectomy in Bladder Cancer. Sex Med Rev 2022;10:231-239.

Safety and Efficacy of Reproductive Organ-Sparing Radical Cystectomy in Women With Variant Histology and Advanced Stage

Muscle invasive bladder cancer surgical management has been historically a radical cystoprostatectomy in males and an anterior exenteration in females. Uterine, ovarian, and vaginal preservation are utilized, but raise concerns regarding risk to oncologic control, especially in variant histopathology or advanced stage. A retrospective single institutional analysis identified radical cystectomies performed in women, including those with variant histology, which were defined as reproductive organ sparing (uterine, vaginal, and ovary sparing) or nonorgan sparing. The Kaplan-Meier method was used for recurrence-free survival (RFS), cancer-specific survival (CSS), and overall survival (OS) in patients with advanced disease. From 2000 to 2020, 289 women were identified, 188 underwent reproductive organ-sparing cystectomy. No statistical differences were noted for clinical parameters or presence of variant histology for organ-sparing (ROS) and nonorgan-sparing (non-ROS). Positive margin rates did not differ for ROS and non-ROS; 4.3% vs. 7.9%, P = .19, respectively. Median RFS was not statistically significantly different for ROS vs. non-ROS (26.1 vs. 15.3 months) P=.937 hazard ratio (HR) 1.024. CSS was not statistically different for ROS vs. non-ROS (36.3 vs. 28.6 months), P=.755 HR 0.9. OS was not statistically different for ROS vs. non-ROS (25.8 vs. 23.8 months), P=.5 HR=1.178. Variant histology did not change survival (HR 1.1, P=.643). In this analysis, ROS in women with advanced disease did not increase positive margin rates or decrease RFS, CSS, or OS compared to non-ROS. Variant histology did not decrease survival odds. Based on preoperative assessment and intraoperative findings, ROS in patients with variant histology and advanced disease should be considered.

Modified procedure of anterior orbital exenteration enables eye socket reconstruction: A retrospective cohort study.

The conventional procedure of anterior orbital exenteration is unfavorable for eye socket reconstruction, whereas a modified procedure enables socket reconstruction and prosthesis fitting. Our study aims to compare the cosmetic outcomes between these 2 surgical techniques.We retrospectively recruited patients treated with modified or conventional exenteration during January 2015 to May 2021 in our hospital. The conventional approach was performed along with dermis-fat graft transplantation. The modified approach was conducted followed by eye socket reconstruction and eyelid blepharoplasty. The clinical data were collected and analyzed, including demographics, tumor characteristics, postoperative complications, tumor-related events, and cosmetic outcomes.Forty-nine patients were consecutively recruited in this study, including 22 cases of modified exenteration and 27 cases of conventional exenteration. Forty-four subjects (89.8%) were diagnosed with ocular surface malignancies (conjunctival melanoma and squamous cell carcinoma) and 5 subjects (10.2%) were diagnosed with extraocular stage of uveal melanoma. After follow-up for 31.8 ± 17.1 months, the 1-, 2-, 5-year overall survival rate was calculated as 100%, 79.2%, and 59.2% in the Modified group, and 94.2%, 73.8%, and 51.5% in the Conventional group. Comparison of the survival curves showed no significant differences. In the Modified group, all patients received orbital implant placement and eye socket reconstruction. The implant motility was satisfactory in 12 cases (54.5%) with movements in 3 to 4 directions. The eyelid function was acceptable in 17 cases (77.3%) with no entropion, ectropion or lower lid laxity. Ocular prosthesis was delivered in 17 cases (77.3%) with successful fitting in 11 cases (64.7%). The self-rated cosmetic score was statistically (t test, P < .0001) higher in the Modified group (6.7 ± 0.9) than the Conventional group (2.2 ± 0.4).The modified approach to anterior orbital exenteration enables eye socket reconstruction and cosmetic rehabilitation while still preserves the curable chance for the treatment of advanced periocular/intraocular malignancies.

Laparoscopic Mitrofanoff Withradical Utethrectomy Withmartius FLAP Reconstructionforvaginal Tumour Infiltrating Urethra

<h3>Study Objective</h3> Laparoscopic Mitrofanoff with Radical Utethrectomy for Vaginal Tumour Infiltrating Urethra <h3>Design</h3> Laparoscopic. <h3>Setting</h3> Open and Laparoscopic. <h3>Patients or Participants</h3> One. <h3>Interventions</h3> Laparoscopic Mitrofanoff with Radical Utethrectomy with Martius Flap Reconstruction. <h3>Measurements and Main Results</h3> Tumour clearence with uterus and bladder preservation with continent pouch. <h3>Conclusion</h3> In locally advanced urethro vaginal tumours inspite of radical procedures like anterior exenteration we should consider preservation of bladder and uterus function by Laparoscopic Mitrofanoff procedure.

798 A Rare Complication and Unexpected Pathology Following an Anterior Exenteration – A Case Report

Abstract We present a case report of an unexpected pathology in addition to a rare complication in a 62-year-old female following an anterior exenteration and an abdominal wall reconstruction. Initial biopsies characterised the malignancy as a potential urachal adenocarcinoma, but the final pathology revealed a solitary endometrial adenocarcinoma metastasis from endometrial cancer 6 years previously. Due to the nature of the tumour, an abdominal wall resection was required, and reconstruction involved a pedicled thigh flap. Post-operatively the small bowel herniated under the flap and this resulted in true mechanical small bowel obstruction. The loop of herniated bowel is visible on CT imaging in the area of the proximal thigh. The patient returned to theatre for an emergency laparotomy and the abdominal wall defect was closed instead with a surgical implant derived from animal tissue. The patient made an excellent recovery, was discharged home, and continues to do well. This patient is an example of excelling in adversity.

MP13-03 FEMALE ORGAN SPARING AT THE TIME OF CYSTECTOMY

You have accessJournal of UrologyBladder Cancer: Invasive I (MP13)1 Sep 2021MP13-03 FEMALE ORGAN SPARING AT THE TIME OF CYSTECTOMY Sunil Patel, Shirley Wang, Esther Lee, Natasha Gupta, Andrew Gabrielson, Meredith Metcalf, Phil Pierorazio, Armine Smith, Jeannie Hoffman-Censits, Noah Hahn, Mark Schoenberg, Max Kates, and Trinity Bivalacqua Sunil PatelSunil Patel More articles by this author , Shirley WangShirley Wang More articles by this author , Esther LeeEsther Lee More articles by this author , Natasha GuptaNatasha Gupta More articles by this author , Andrew GabrielsonAndrew Gabrielson More articles by this author , Meredith MetcalfMeredith Metcalf More articles by this author , Phil PierorazioPhil Pierorazio More articles by this author , Armine SmithArmine Smith More articles by this author , Jeannie Hoffman-CensitsJeannie Hoffman-Censits More articles by this author , Noah HahnNoah Hahn More articles by this author , Mark SchoenbergMark Schoenberg More articles by this author , Max KatesMax Kates More articles by this author , and Trinity BivalacquaTrinity Bivalacqua More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000001994.03AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Muscle invasive bladder cancer (MIBC) surgical management has been historically a radical cystoprostatectomy in males and an anterior exenteration in females. Uterine and vaginal preservation are being utilized more often, but often discouraged during cystectomy for oncologic control, especially in adverse histopathology. METHODS: A retrospective single institutional analysis was performed from 2000-2020, identifying cystectomies performed in women. Data was available on 291 women, 188 underwent organ preserving cystectomy, defined as uterine, vaginal, and ovary sparing. Women with prior hysterectomies were included in organ sparing if vaginal and/or ovary sparing was performed. 101 women underwent traditional anterior exenteration. Primary endpoints were recurrence-free (RFS) and overall (OS) survival. RESULTS: No statistically significant differences were noted between the two cohorts in terms of age, race, smoking status, grade, clinical stage, or adverse histology. Non-organ sparing cystectomy was associated with higher pathologic T4 and pathologic nodal positive disease compared to organ sparing (4.8% vs 22.8%, p<0.05) and (16.5% vs 28.7%, p=0.037), respectively. Utilization of an organ sparing approach increased from 2000-2009 to 2010-2020 (55% vs 71%, p=0.03). Positive margin rates for organ sparing vs non-organ sparing were 8/188 (4.3%) vs 8/101 (7.9%), p=0.194, respectively. Median RFS was not statistically significant for organ sparing vs non-organ sparing, 131 months vs 75 months, HR 0.82, p=0.37, respectively. Similarly, OS was not statistically different for organ sparing vs non-organ sparing with median survival being 75 months vs 55 months, HR 0.99, p=0.97, respectively. CONCLUSIONS: In this analysis, organ preservation during time of cystectomy in women for all stages and histopathologic variants, including T3 and T4 disease, did not increase positive margin rates or decrease RFS or OS compared to non-organ preserving cystectomy. In selected patients, organ sparing cystectomy appears to be a viable approach and should be considered. Source of Funding: none © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e243-e243 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Sunil Patel More articles by this author Shirley Wang More articles by this author Esther Lee More articles by this author Natasha Gupta More articles by this author Andrew Gabrielson More articles by this author Meredith Metcalf More articles by this author Phil Pierorazio More articles by this author Armine Smith More articles by this author Jeannie Hoffman-Censits More articles by this author Noah Hahn More articles by this author Mark Schoenberg More articles by this author Max Kates More articles by this author Trinity Bivalacqua More articles by this author Expand All Advertisement Loading ...

A modern day experience with Brunschwig's operation: advancements in pelvic exenteration

<h3>Objectives:</h3> To evaluate the perioperative outcomes and oncologic outcomes of patients undergoing pelvic exenteration, first described by Alexander Brunschwig in 1948, for non-ovarian gynecologic malignancies at a comprehensive cancer center. <h3>Methods:</h3> All patients who underwent exenteration at our institution from 1/2010-12/2019 were identified. Patients with non-ovarian gynecologic malignancies were included. Patients undergoing palliative exenteration were included for perioperative outcomes but excluded from the survival analysis. Post-operative complications were defined as early (≤30 days) and delayed (31-180 days). Complications were graded using a validated institutional secondary surgical events system. Major complications were defined as Grade 3 or above which would, at minimum, require surgical, endoscopic, or radiological intervention. Appropriate statistical analyses were performed. <h3>Results:</h3> One-hundred patients were identified. Eighty-nine (89%) received treatment for recurrent disease, 5 (5%) for primary disease, 1 (1%) for persistent disease, and 5 (5%) received palliative treatment. The most common cancer type was cervical (n=30, 30%), followed by vulvar (n=27, 27%), uterine (n=24, 24%), and vaginal (n=19, 19%). The most common histologies were squamous cell carcinoma (n=61, 61%), endometrioid carcinoma (n=18, 18%), and adenocarcinoma (n=13, 13%). Sixty-two (62%) patients had total exenteration, 30 (30%) anterior exenteration, 8 (8%) posterior exenteration. The median age at time of surgery was 61.3 years (range, 28-86 years). There were no intraoperative deaths or deaths within 30 days of surgery. Six patients expired within the delayed time frame, including 1 (16.7%) from respiratory failure and 5 (83.3%) from aggressive progression of disease. Ninety-seven (97%) patients experienced a perioperative complication: 49 (50%) early, 1 (1%) delayed, 47 (48%) both early and delayed. Fifty/100 patients (50%) had a major complication: 22/50 (44%) early, 19/50 (38%) delayed, 9/50 (18%) both early and delayed. We did not identify any variables statistically associated with the development of a complication, including exenteration type, initial malignancy type, conduit type, operative time, estimated blood loss, or tumor volume. The median follow-up time for the entire cohort was 27.6 months (range, 1.0-117.5). The median follow-up time for survivors was 38.0 months (range, 1.0-117.5). The 3-year PFS was 61.0%, and the 3-year OS was 61.6%. There are 58 total survivors (58%), of whom 16 (28%) and 4 (7%) remain alive after 5 and 10 years, respectively. <h3>Conclusions:</h3> The complication rate for pelvic exenteration remains high, although we identified no variables showing association with the development of a complication. However, the lack of perioperative mortality, and improved oncologic outcomes, exemplify the advancements of this surgical approach since its inception.

Primary pelvic exenteration: Our experience with 23 patients from a single institution.

This study was designed with an aim to share our experience of primary pelvic exenterations. The study included 23 patients with different types of pelvic cancer enrolled at a single institution between November 2011 and July 2020. The patient mean age was 55 years (range, 43-72 years) and the oncological indications included: Stage IVa cervical cancer (11 cases, 48.9%), stage IVa endometrial cancer (1 case, 4.3%), stage IVa vaginal cancer (6 cases, 26%), stage IIIb bladder cancer (3 cases, 13%), stage IIIc rectal cancer (1 case, 4.3%) and undifferentiated pelvic sarcoma (1 case, 4.3%). Total, anterior, and posterior pelvic exenterations were performed on 34.4, 56.5 and 13% of cases, respectively. Related to levator ani muscle, 13 (56.5%) pelvic exenterations were supralevatorian, 10 (43.5%) infralevatorian, and 5 (21.7%) were infralevatorian with vulvectomy. No major intraoperative complications occurred. Seven patients (30.5%) developed early complications, 4 of them (17.4%) required reoperation and 1 (4.3%) perioperative death caused by a pulmonary embolism was recorded. Only 1 patient experienced a late complication, a urostomy stenosis. Over a median follow-up period of 35 months, 8 (34.8%) patients died. The median overall survival (OS) was 33 months (range, 1-96 months). The 2-year and 5-year survival rates were 72 and 66%, respectively. Primary pelvic exenteration may be related with various postoperative complications, without high perioperative morality and with long-term survival.

A novel technique for a rare diagnosis: MRI-guided vaginal biopsy of Skene gland adenocarcinoma: Pictorial Essay.

FDG-PET and MRI imaging of the pelvis identified a suspicious lesion in a patient with a history of small cell neuroendocrine tumour of the vagina, and after a negative surgical biopsy, a multidisciplinary team meeting decided to proceed with MRGB (magnetic resonance-guided biopsy). The patient remains well and in remission two years after anterior exenteration, with final histology of the lesion determined to be Skene gland adenocarcinoma. MRGB is a novel and effective way to diagnose vaginal lesions.

Urothelial carcinoma of the graft kidney with molecular analyses: a rare case report

BackgroundMalignancy after transplantation is a leading cause of death among kidney transplant recipients. However, donor-derived malignancies are rare. We report a case of a high grade papillary urothelial carcinoma arising in a transplanted kidney.Case presentationA 62-year-old female who received a kidney transplantation more than 30 years ago presented with urinary tract infection, acute renal failure, and hydronephrosis of the transplant kidney. Anterograde nephrostogram showed a large filling defect in the lower pole of the transplant kidney and in the proximal 3–4 cm of the ureter. A biopsy from the renal pelvic mass showed a high grade urothelial carcinoma. She underwent an anterior exenteration, resection of both transplant and native kidneys and bilateral pelvic lymph node dissection. Pathologic examination showed a high grade papillary urothelial carcinoma which appeared to arise in the pelvis of the graft kidney, involve the graft ureter and native urinary bladder. The tumor had metastasized to one left obturator lymph node but spared the two native kidneys and ureters. Short tandem repeat (STR) analysis confirmed the tumor to be of donor origin. Next-generation sequencing identified amplification of TERT and loss of CDKN2A/CDKN2B in the primary tumor.ConclusionWhile it is known that transplant recipients have an increased risk of urothelial carcinoma compared to the general population, the lack of the well-documented risk factors, such as older age at transplantation, BK polyomavirus infection, and prolonged post-transplantation history and dissemination of the tumor in this case shed light on the de novo tumorigenesis of the graft kidney within the host microenvironment. Amplification of Telomerase reverse transcriptase (TERT) and loss of cyclin dependent kinase inhibitor 2A/2B (CDKN2A/CDKN2B) detected in the tumor by next gene sequencing suggests that they may play an important role in this case.

Female primary urethral carcinoma: A rare case report.

IntroductionPrimary tumors of the female urethra are exceedingly rare and account for <0.02% of the malignant disease occurring in women. This disease usually presents late and, hence, has a poor outcome. Early diagnosis is necessary to prevent further metastasis and prevent urinary catheter-dependant. Tumors arising from the distal urethra tend to be early stage and cure rates are high, however lack of knowledge about this disease is notorious, the transmission of knowledge is made only by case reports.Case presentationA 76-years-old woman presented with the chief complaint of lower pelvic pain. The complaintas also accompanied by a burning sensation in the urethra and stranguria, urinary retention, and hematuria. Macroscopic observation revealed the lesion was whitish with vegetative aspect at the urethral meatus, involving the entire urethra. The fragile mass was palpable in distal urethra and external meatus urethra per vaginally and easily bleedings. Laboratory examination of blood chemistry results within normal limit. Urinalysis showed pyuria and hematuria. Urethrocystoscopy findings were whitish lesion with vegetative aspect also fragile mass along the urethra, abnormal bladder neck, and bladder mucous was hyperemis. The histopathological result showed metaplasia squamous cell carcinoma, clear cell carcinoma. She is planned on getting cystouretherectomy (anterior exenteration) later.Clinical discussionThe female urethral carcinoma is a disease with low prevalence with urothelial carcinoma (transitional cell) is the most common histological type (Leão et al., 2016; Adolfsson et al., 2012). Symptoms of urethral carcinoma are varied. The carcinoma spreads initially by local invasion into the periurethral tissue, vagina, and vulva and proximally spread to the bladder neck (Leão et al., 2016; Mittal et al., 2020). Distant metastasis is uncommon (Mittal et al., 2020). The most suitable method for collecting material for biopsy is the urethrocystoscopy. MRI is commonly used for staging. For post-surgical staging, the best investigation is the excretory urography (Gourtsoyianni et al., 2011; Picozzi et al., 2012). The management in vogue are surgical such as tumor excision, radical nephro-ureterectomy or anterior pelvic exenteration with radiotherapy or chemotherapy complementary. This cancer is associated with poor outcomes. Therefore, prognostic factors are important to be known.ConclusionAlthough female urethral carcinoma is a rare disease entity, clinicians should have strong suspicion of malignancies in patients to make an exact diagnosis. Early radical surgery can achieve better outcomes, although the standard therapy remains controversial.

Early radical cystectomy with negative margins in a 57-year-old female with myxoid/round cell liposarcoma of the bladder suggests prolonged overall survival

BackgroundBladder cancer is the 17th most common cancer in the female population. Most bladder cancers are of urothelial origin. Sarcomas of the bladder are very uncommon.Case presentationThis case concerns a 57-year-old female from a rural town in the Eastern Cape who was diagnosed with myxoid/round cell liposarcoma of the bladder. After the initial transurethral resection of the bladder tumour, she underwent an anterior exenteration with Bricker’s diversion (ileal conduit) and negative margins were achieved.ConclusionsSarcomas of the bladder are known to have a poor prognosis. Our patient is alive with good stoma function more than 24 months since her radical surgery. We are of the opinion that her favourable overall survival is attributable to early radical surgical intervention with negative margins.

A Rare Complication and Unexpected Pathology Following an Anterior Exenteration - A Case Report

A Rare Complication and Unexpected Pathology Following an Anterior Exenteration - A Case Report

Prolapse repair after anterior exenteration.

This report presents our experience in performing prolapse repair after anterior exenteration. The patient had a history of invasive bladder cancer and underwent a robotically assisted laparoscopic anterior exenteration with extended bilateral pelvic lymph node dissection and creation of an Indiana pouch continent diversion. Her pelvic organ prolapse progressed over time despite multiple pessary fittings. She eventually decided to proceed with pelvic reconstructive surgery 6 years after her cancer surgery. She underwent a successful vaginal native tissue reconstruction with uterosacral ligament suspension, posterior repair and reconstruction of the anterior compartment. The patient has been followed for 16months without recurrent prolapse. Vaginal native tissue pelvic reconstruction is feasible in a patient with a history of pelvic exenteration.

Aggressive course of a rare type of urethral cancer in women

The article provides a clinical case of urethral cancer in women. Primary urethral carcinomas are rare, less than 1% of all malignant tumors. According to the Rarecare Cancer Surveillance Agency for Europe (RARECARE), urethral cancer in women is 0.6 and 1.6 in men per 1 million people per year. A 56-year-old patient with histologically verified clear cell adenocarcinoma of the proximal urethra was monitored for 18 months. An aggressive course of the tumor process has been shown, which led to the need to perform anterior exenteration of the pelvic organs. The histogenesis of primary clear cell urethral adenocarcinoma has not been definitively determined. The atypical external localization in the described case suggests the periurethral origin of this cancerous tumor from the Skenes glands. The demonstration of a rare form of urethral cancer, clear cell adenocarcinoma, contributes to the accumulation of knowledge about its histopathology and clinical course, as well as increasing cancer alertness in the treatment of urethral diseases in doctors of any specialty.