Bilateral Pelvic Node Dissection Research Articles

A New Self-expanding, Large-caliber Ureteral Stent Applied for Bilateral Long-segment Ureteral Strictures — A Case Report

Abstract Urologists are experiencing difficulties managing ureteral strictures (US). Several treatment options have been used to treat US. Here, we present two patients with US. The first case is a 49-year-old woman with a history of squamous cell carcinoma of the cervix, status postlaparoscopy-assisted vaginal hysterectomy and radical parametrectomy, and bilateral pelvic lymph node dissection with recurrence. She regularly underwent double-J catheterization for bilateral US. The second case is a 66-year-old woman with a history of serious papillary adenocarcinoma of the endometrium, poststaging laparotomy with extrafascial hysterectomy + bilateral salpingo-oophorectomy + bilateral pelvic, common iliac, and para-aortic lymph node dissection + omentectomy. She regularly underwent double-J catheterization because of bilateral US. Allium stents have been used to treat US. Hydronephrosis improved in both patients. Renal function improved in one patient. A new self-expanding, large-caliber ureteral stent is another treatment option for patients requiring internal ureteral drainage.

Use of 18F-fluoro-2-deoxy-d-glucose (18F-FDG) PET/CT for lymph node assessment before radical cystectomy in bladder cancer patients.

To assess the diagnostic performance of 18F-fluoro-2-deoxy-d-glucose (18F-FDG) positron emission tomograpy (PET)/computed tomography (CT) in nodal staging before radical cystectomy (RC) and pelvic lymph node dissection (PLND) for bladder cancer (BCa). This analysis was based on a cohort of 199 BCa patients undergoing RC and bilateral PLND between 2015 and 2022. Neoadjuvant chemotherapy (NAC) or immunotherapy (NAI) was administered after oncological evaluation. All patients received preoperative 18F-FDG PET/CT to assess extravesical disease. Point estimates for true negative, false negative, false positive, true positive, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of conventional imaging and PET/CT were calculated. Subgroup analysis in patients receiving neoadjuvant treatment was performed. At preoperative evaluation, 30 patients (15.1%) had 48 suspicious nodal spots on 18F-FDG PET/CT. At RC and bilateral PLND, a total of 4871 lymph nodes (LNs) were removed with 237 node metastases corresponding to 126 different regions. Pathological node metastases were found in 17/30 (57%) vs 39/169 patients (23%) with suspicious vs negative preoperative 18F-FDG PET/CT, respectively (sensitivity = 0.30, specificity = 0.91, PPV = 0.57, NPV = 0.77, accuracy = 0.74). On per-region analysis including 1367 nodal regions, LN involvement was found in 19/48 (39%) vs 105/1319 (8%) suspicious vs negative regions at PET/CT, respectively (sensitivity = 0.15, specificity = 0.98, PPV = 0.40, NPV = 0.92, ACC = 0.90). Similar results were observed for patients receiving NAC (n = 44, 32.1%) and NAI (n = 93, 67.9% [per-patient: sensitivity = 0.36, specificity = 0.91, PPV = 0.59, NPV = 0.80, accuracy = 0.77; per-region: sensitivity = 0.12, specificity = 0.98, PPV = 0.32, NPV = 0.93, ACC = 0.91]). Study limitations include its retrospective design and limited patient numbers. In eight out of 10 patients with negative preoperative 18F-FDG PET/CT, pN0 disease was confirmed at final pathology. No differences were found based on NAC vs NAI treatment. These findings suggest that 18F-FDG PET/CT could play a role in the preoperative evaluation of nodal metastases in BCa patients, although its cost-effectiveness is uncertain.

Total intracorporeal laparoscopic ileal ureter replacement in a single position for ureteral stricture based on membrane anatomy.

The aim of this study was to present our initial experience and prove the feasibility of total intracorporeal laparoscopic ileal ureter replacement (TILIUR) in a single position for ureteral stricture based on membrane anatomy. Between January 2021 and April 2023, six patients underwent TILIUR in a single position for ureteral strictures based on membrane anatomy. All patients with a past medical history underwent radical hysterectomy with bilateral pelvic lymph node dissection as well as extensive ureteral stricture due to radiotherapy. The procedure is performed completely laparoscopically. Dissection of the digestive system as well as ureteral stricture or renal pelvis is based on membrane anatomy. The surgery is performed in a single position. TILIUR in a single position for ureteral stricture based on membrane anatomy was successfully performed without open conversion in all patients. Among the 6 patients, 3 patients underwent combined ileal ureter replacement (IUR) and abdominal wall ostomy, 2 underwent unilateral IUR, and 1 underwent bilateral IUR. The mean length of the ileal substitution was 22.83cm (range: 15-28). The average operative time was 458 ± 72.77min (range 385-575min), and the average intraoperative blood loss was 158 mL (range 50-400 mL). The median postoperative hospital stay was 15.1 d (range: 8-32). The median duration of postoperative follow-up was 15 months (range: 3-29 months). The success rate was 100%. TILIUR in a single position may be a promising option for ureteral stricture based on membrane anatomy in selected patients. Moreover, it has a positive effect on patients with renal insufficiency and urinary incontinence. Although IUR is difficult and risky, proficient surgeons can perform the procedure safely and effectively.

The Predictive Value of Preoperative Inflammatory Markers / Lymphocyte Ratios for Endometrial Cancer; What does the eosinophil to lymphocyte ratio means for survival?

Aim: 
 In various solid tumors, cancer-associated inflammation is associated with adverse long-term outcomes. The purpose of this study was to examine the influence of the preoperative neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR) and other systemic inflammatory markers on lymph node metastasis and 5-year survival in endometrial cancer.
 Materials and Method: 
 A total of 379 female patients at the Gynecology and Obstetrics Clinic of the University Hospital with a final postoperative pathology of endometrial cancer were included in the 5-year survival study. The preoperative total neutrophil, monocyte, eosinophil, and platelet counts were divided by the lymphocyte count to obtain the NLR, monocyte-to-lymphocyte ratio (MLR), eosinophil-to-lymphocyte ratio (ELR), and PLR values. All patients underwent bilateral pelvic paraaortic lymph node dissection and omentectomy in addition to total abdominal hysterectomy and bilateral salpingo-oophorectomy (TAH + BSO). The pathology lab at our university evaluated all cytology and postoperative specimens. The staging system used was the FIGO 2009 surgical staging system.
 Results: 
 The results of our study showed significant correlations between lymph node metastasis and NLR, eosinophil-to-lymphocyte ratio (ELR), and PLR. Only a significant correlation between ELR and survival was discovered when the relationship with 5-year survival was examined. Aditionally significant correlations existed between NLR and cervical stromal involvement, cytology positivity, and stage.
 Conclusion: 
 The prognostic factors for lymph node metastasis are NLR, PLR, and ELR. Only ELR is predictive of 5-year survival, but more prospective studies on ELR survival prediction are needed.

A comparison study of 68gallium-prostate-specific membrane antigen positron emission tomography-computed tomography and multiparametric magnetic resonance imaging for locoregional staging of prostate cancer.

Prostate cancer (PCa) is the most common malignancy in men aged 50 years and older and the second cause of cancer death among men. Accurate staging of PCa preoperatively is of high importance for treatment decisions and patient management. Conventional imaging modalities (ultrasound, computed tomography [CT], and magnetic resonance imaging) are inaccurate for the staging of PCa. Newer modality multiparametric magnetic resonance imaging (mpMRI) and prostate-specific membrane antigen (PSMA) positron emission tomography (PET) scan show promising results for the staging of PCa. Only fewer studies are available for comparison of these modalities with histopathology as reference. The objective of our study is to evaluate the diagnostic accuracy of independent 68gallium PSMA (68Ga-PSMA) PET-CT compared with mpMRI for preoperative staging of PCa, using histopathology as the reference standard. From August 2021 to December 2022, 30 patients of biopsy-proven PCa were prospectively enrolled as per eligibility criteria. Preoperatively, 68Ga-PSMA PET scan and mpMRI were done in all the patients. Extracapsular extension (ECE), seminal vesicle invasion (SVI), and lymph node metastasis (LNM) were investigated separately. Subsequently, the patients underwent robotic-assisted radical prostatectomy with bilateral pelvic lymph node dissection. mpMRI prostate was more sensitive (66.66%) but less specific than PSMA PET-CT (55.55%) for ECE. mpMRI and PSMA PET-CT both had similar sensitivity (83.3%) and specificity (87.5%) for SVI. PSMA PET-CT was more sensitive (85.71%) and specific (95.6%) than mpMRI prostate (62.5% and 91.30%, respectively) for LNM. PSMA PET-CT is more specific for the detection of ECE and more sensitive and specific for the detection of LNM than mpMRI, and similar for the detection of SVI. mpMRI provides only local staging, while PSMA PET-CT provides information about local, regional, and distal staging. Overall, PSMA PET-CT is superior to mpMRI for locoregional staging of PCa.

Rational use of Ga-68 PSMA PET-CT according to nomograms and risk groups for the detection of lymph node metastasis in prostate cancer

ObjectivesThe aim was to ensure efficient utilization of PSMA PET-CT by examining the correlation of pathological lymph node metastasis with nomogram scores and risk classifications. Methods and materialsRobot-assisted radical prostatectomy and bilateral pelvic lymph node dissections for pelvic lymph nodes were performed using the same template. Bilaterally pelvic lymph nodes were removed within the boundaries of genitofemoral nerves, psoas muscle and lateral pelvic wall laterally, ureteric crossing of the iliac vessels superiorly, lateral bladder wall medially, Cooper ligaments distally, and endopelvic fascia, neurovascular bundles and internal iliac arteries posteriorly. Clinical nomograms were used to calculate the probability of lymph node metastasis preoperatively. Using receiver operating characteristics analysis, discriminatory cut-offs were calculated. The diagnostic performance of PSMA PET-CT was determined for detecting lymph node metastasis. ResultsFor 81 patients, the median age was 64 years. The median PSA was 6.8 ng/ml. Most patients were in the D'Amico intermediate (56.8%) and high (37%) risk groups. Median Briganti 2017, MSKCC, and Partin scores were 35 (4–99), 37 (8–90), and 12 (2–38), respectively, in pN1 patients. The area under the curve for Briganti 2017, MSKCC, Partin nomograms and PSMA PET-CT scans were 0.852, 0.871, 0.862, and 0.588. Sensitivity, specificity, positive predictive value and negative predictive value for Ga-68 PSMA PET-CT for lymph node metastasis detection were 21.4%, 94%, 42.9%, and 85.1%, respectively, for the whole group. By using higher threshold values for clinical nomograms (Briganti 2017 >32, MSKCC >12, Partin >5), PSMA PET-CT had higher sensitivity (42.9, 30, 27.2) in detecting lymph node metastasis. ConclusionsPatients in the D'Amico high-risk group and those with high nomogram scores are the best candidates who will benefit from preoperative PSMA PET-CT staging to estimate lymph node metastasis.

RARE PRIMARY CLEAR CELL CARCINOMA OF BLADDER OF MULLERIAN ORIGIN: MORPHO- IMMUNOHISTOCHEMICAL PROFILING

Abstract Introduction/Objective Primary clear cell carcinoma of urinary bladder (PCCCUB) is a rare and aggressive cancer variant with uncertain and debatable histogenesis. The hypotheses include origins from the urothelium, pre-existing Müllerian precursors, or mesonephric remnants. Definitive diagnosis is achieved through histology and immunohistochemistry (IHC). We present an unusual case of PCCCUB in a sexagenarian woman. Methods/Case Report Patient with history of diabetes, hypertension, and smoking presented with gross hematuria. Computed tomography urogram revealed a 2.3 x 1.2 cm enhancing mass at the base of the urinary bladder. Patient underwent transurethral resection of the bladder tumor (TURBT). Histopathology revealed features of tubulo-papillary, solid, glandular structures with hyalinized stroma. Cytologic features varied from flat, hobnail, to polygonal with abundant clear to eosinophilic cytoplasm and prominent nucleoli. Immunohistochemistry revealed strong reactivity for PAX8, CK7, ER, and racemase; focal reactivity for vimentin, napsin A, p53, CA125; and non-reactivity for PAX2, WT1, PR, GATA3, pCEA, CK20, p63, p40, CD10, RCC, BRST-2, and mammaglobin. P53 showed a wild type staining pattern and Ki-67 was 10%. Combined morphologic and IHC features confirmed PCCCUB, and in the absence of muscularis mucosal invasion, tumor was staged pT1N0. PAX8 positivity and urothelial marker negativity excluded clear cell pattern of urothelial carcinoma. IHC also excluded nephrogenic adenoma, and metastasis. The female gender, and CK 7 (+)/CK 20 (−) profile supported Müllerian origin. Restaging TURBT showed consistent results. Subsequently, anterior pelvic exenteration and bilateral pelvic lymph nodes dissection was performed revealing muscularis propria invasion upstaging to mpT2 N0. Results (if a Case Study enter NA) NA Conclusion Poor prognosis, aggressive behavior, and advanced stage at the time of diagnosis warrants accurate diagnose of PCCCUB. Ambiguous origin, limited literature, and lack of clear management guidelines merit reporting in order to enhance knowledge of this rare and intriguing entity.

Recurrent early-stage squamous cell carcinoma cervical cancer presenting with isolated ovary metastasis: a rare case report

Introduction: Ovarian metastatic squamous carcinoma of the cervix is rare, accounting for about 0.4%. This study reports a single case of metastatic recurrent cervical cancer in the ovary. Case presentation: A 46-year-old patient with a history of cervical cancer T1b2N0M0 underwent a radical hysterectomy, bilateral pelvic lymph node dissection, and ovarian preservation. One year later, the patient was admitted to the hospital because of abdominal pain in the left iliac fossa; the abdominal computed tomography image showed a left ovarian tumour. The patient underwent laparoscopic left oophorectomy. Postoperative histopathology confirmed ovarian squamous cell carcinoma. From this case, we would like to review the literature on epidemiology, diagnosis, treatment, and prognosis. Clinical discussion: Ovarian preservation during surgery in patients with cervical cancer offers many benefits, but careful patient selection is required. However, it should be selected carefully and closely monitored. Conclusions: Clinicians should be aware of this situation of ovarian metastasis in patients with early cervical cancer undergoing ovarian-conserving surgery.

Uterine cancer: a nine-year review from a tertiary hospital in Tamil Nadu

Background: With increasing uterine cancer in developing nations, there is a need for timely determination of the diagnosis, prognosis, and management options to reduce morbidity and mortality. Objective: To analyze the socio-demographic, etio-pathological features and management of uterine cancer and evaluate its correlation with grading/staging in our population. Methods: This retrospective descriptive study analyzed data from 97 histologically proven uterine cancer cases. Age, parity, symptoms, co-morbidities, body mass index (BMI), ultrasound features, histopathology type, stage and grade of the tumor, type of hysterectomy done, complications and mortality were analysed. Statistical analysis was done using ANOVA and chi-square test, and a p-value<0.05 indicated statistical significance. Results: The mean age of diagnosis was 57.91 years, and the mean BMI was 29.32 Kg/m2. Majority of the patients were multiparous (42.27%), and only 10% were nulliparous. The disease was detected at an earlier age in nulliparous and obese women. Diabetes and hypertension were found in 75.25%. Most of the patients were detected with stage I cancer (80.6%). Patients diagnosed with uterine cancer on biopsy were treated with total abdominal hysterectomy with bilateral salpingo-oophorectomy andbilateral pelvic lymph node dissection (55.8%). Over 36% of patients received postop radiotherapy and/or chemotherapy. 21% patients were lost to follow-up and 12.37% died. Also, 24 cases had postoperative complications (wound infection). Conclusion: Uterine cancer is common among obese women with diabetes and hypertension. In nulliparous and the obese, the cancer was detected at an earlier age. Most of our patients had stage 1 disease, and 90% was endometroid cancer. The study highlights the importance of endometrial sampling before hysterectomy in perimenopausal women to avoid suboptimal surgery in patients diagnosed with uterine cancer after a simple hysterectomy.

The Implementation of FDG PET/CT for Staging Bladder Cancer: Changes in the Detection and Characteristics of Occult Nodal Metastases at Upfront Radical Cystectomy?

Occult lymph node (LN)-metastases are frequently found after upfront radical cystectomy (uRC) for bladder cancer (BC). We evaluated whether the implementation of 18F-fluoro-2-deoxy-D-glucose positron emission tomography/computed tomography (FDG PET/CT) influenced nodal staging at uRC. All consecutive BC patients who underwent uRC with bilateral pelvic lymph node dissection (PLND) were identified and divided into two cohorts: cohort A consisted of patients staged with FDG PET/CT and contrast-enhanced CT (CE-CT) (2016-2021); cohort B consisted of patients staged with CE-CT only (2006-2011). The diagnostic performance of FDG PET/CT was assessed and compared with that of CE-CT. Thereafter, we calculated the occult LN metastases proportions for both cohorts. In total, 523 patients were identified (cohort A n = 237, and cohort B n = 286). Sensitivity, specificity, PPV and NPV of FDG PET/CT for detecting LN metastases were 23%, 92%, 42%, and 83%, respectively, versus 15%, 93%, 33%, 81%, respectively, for CE-CT. Occult LN metastases were found in 17% of cohort A (95% confidence interval (CI) 12.2-22.8) and 22% of cohort B (95% CI 16.9-27.1). The median size of LN metastases was 4 mm in cohort A versus 13 mm in cohort B. After introduction of FDG PET/CT, fewer and smaller occult LN metastases were present after uRC. Nevertheless, up to one-fifth of occult (micro-)metastases were still missed.

Diagnostic Value of the Sentinel Lymph Node Technique in Patients with Muscle-Invasive Bladder Cancer.

The optimal limits of the bilateral pelvic lymph node dissection (PLND) template in bladder cancer treatment remain controversial. This study aimed to investigate whether radio-guided sentinel node (SLN) detection is a reliable technique for the perioperative localisation of potential lymphatic metastasis during cystectomy for muscle-invasive bladder cancer (MIBC). We studied 54 patients with pT2-pT4 MIBC who underwent cystectomy with extended PLND (ePLND) augmented by the SLN technique. The identification of SLN was performed by preoperative SPECT/CT hybrid lymphoscintigraphy using peritumoral injection of nanocolloid-Tc-99m, followed by intraoperative navigation with a handheld γ-probe. All nodal specimens were collected separately and then fixed in formalin, stained with haematoxylin and eosin, and examined by an experienced uropathologist. A total of 1414 LNs were resected and examined for the presence of metastases. The mean number of harvested LNs was 26 (range: 11-50) per patient. In 51 of 54 patients, 192 SLNs were resected. In addition, 20/192 (10.4%) SLNs were located outside of the ePLND area. Overall, 72 metastatic LNs (LN+) were found in 22 of 54 patients (40.7%) and in 24/192 SLNs (12.5%). The SLN technique detected LN+ in 14 of 22 (64%) patients. The SLNs were the only sites of metastasis (SLN+ = LN+) in 6 of 22 (27.3%) LN+ patients, including two cases with foci located in the pararectal region. The diagnostic values for the sensitivity, specificity, positive predictive value, and false-negative rate for the SLN technique were 66.66%, 4.16%, 28.57%, and 33.33%, respectively. Extended lymphadenectomy and its combination with the SLN technique enabled the correct assessment in 96.3 and 100% of patients, respectively. The combination of ePLND and SLN provides a better pN assessment compared to ePLND alone. Although the SLN technique has restrictions that limit its diagnostic value, its use as an addition to lymphadenectomy allows for the visualisation of nonstandard lymph drainage pathways that may be potential metastatic routes.

Unilateral Pelvic Lymph Node Dissection in Prostate Cancer Patients Diagnosed in the Era of Magnetic Resonance Imaging-targeted Biopsy: A Study That Challenges the Dogma.

Bilateral extended pelvic lymph node dissection at the time of radical prostatectomy is the current standard of care if pelvic lymph node dissection is indicated; often, however, pelvic lymph node dissection is performed in pN0 disease. With the more accurate staging achieved with magnetic resonance imaging-targeted biopsies for prostate cancer diagnosis, the indication for bilateral extended pelvic lymph node dissection may be revised. We aimed to assess the feasibility of unilateral extended pelvic lymph node dissection in the era of modern prostate cancer imaging. We analyzed a multi-institutional data set of men with cN0 disease diagnosed by magnetic resonance imaging-targeted biopsy who underwent prostatectomy and bilateral extended pelvic lymph node dissection. The outcome of the study was lymph node invasion contralateral to the prostatic lobe with worse disease features, ie, dominant lobe. Logistic regression to predict lymph node invasion contralateral to the dominant lobe was generated and internally validated. Overall, data from 2,253 patients were considered. Lymph node invasion was documented in 302 (13%) patients; 83 (4%) patients had lymph node invasion contralateral to the dominant prostatic lobe. A model including prostate-specific antigen, maximum diameter of the index lesion, seminal vesicle invasion on magnetic resonance imaging, International Society of Urological Pathology grade in the nondominant side, and percentage of positive cores in the nondominant side achieved an area under the curve of 84% after internal validation. With a cutoff of contralateral lymph node invasion of 1%, 602 (27%) contralateral pelvic lymph node dissections would be omitted with only 1 (1.2%) lymph node invasion missed. Pelvic lymph node dissection could be omitted contralateral to the prostate lobe with worse disease features in selected patients. We propose a model that can help avoid contralateral pelvic lymph node dissection in almost one-third of cases.

Extended pelvic lymph node dissection in muscle invasive bladder cancer.

Bilateral pelvic lymph node dissection (PLND) at the time of radical cystectomy (RC) provides important staging information and oncologic benefit in patients with bladder cancer. The optimal extent of the PLND remains controversial. Our aim is to highlight nodal mapping studies and the data that guides optimization of both staging and oncologic outcomes. We then review contemporary randomized trials studying the extent of PLND. A recent randomized trial (RCT) powered for a 15% improvement in recurrence-free survival (RFS) of extended (e) over limited (l)PLND was completed but failed to identify this large difference in outcome. Concerns over study design limit the ability to interpret the oncologic results. Importantly, ePLND minimally changed surgical morbidity. An ongoing, similar RCT (SWOG S1011) powered to detect a 10% difference in RFS has completed accrual, but no published outcomes are available. RC and ePLND can provide cure in 33% of LN positive bladder cancer patients. Current data support a 5% improvement in RFS if ePLND is routinely used in MIBC patients. Two randomized trials powered to identify much larger (15 and 10%) improvements in RFS are unlikely to identify such an ambitious benefit by extending the PLND.

PD27-05 IMPACT OF PERITONEAL BLADDER FLAP ON THE RISK OF SYMPTOMATIC LYMPHOCELES AFTER ROBOTIC RADICAL PROSTATECTOMY: RESULTS OF A PROSPECTIVE RANDOMISED-CONTROLLED TRIAL

You have accessJournal of UrologyCME1 Apr 2023PD27-05 IMPACT OF PERITONEAL BLADDER FLAP ON THE RISK OF SYMPTOMATIC LYMPHOCELES AFTER ROBOTIC RADICAL PROSTATECTOMY: RESULTS OF A PROSPECTIVE RANDOMISED-CONTROLLED TRIAL Randi Pose, Sophie Knipper, Lukas Hohenhorst, Burkhard Beyer, Derya Tilki, Alexander Haese, Hans Heinzer, Georg Salomon, Thomas Steuber, Lars Budäus, Hendrik Isbarn, Tobias Maurer, Pierre Tennstedt, Markus Graefen, and Uwe Michl Randi PoseRandi Pose More articles by this author , Sophie KnipperSophie Knipper More articles by this author , Lukas HohenhorstLukas Hohenhorst More articles by this author , Burkhard BeyerBurkhard Beyer More articles by this author , Derya TilkiDerya Tilki More articles by this author , Alexander HaeseAlexander Haese More articles by this author , Hans HeinzerHans Heinzer More articles by this author , Georg SalomonGeorg Salomon More articles by this author , Thomas SteuberThomas Steuber More articles by this author , Lars BudäusLars Budäus More articles by this author , Hendrik IsbarnHendrik Isbarn More articles by this author , Tobias MaurerTobias Maurer More articles by this author , Pierre TennstedtPierre Tennstedt More articles by this author , Markus GraefenMarkus Graefen More articles by this author , and Uwe MichlUwe Michl More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003305.05AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: To test the impact of fixing a peritoneal flap of the bladder to the plexus Santorini as final step of robot-assisted radical prostatectomy (RARP) to reduce the incidence of symptomatic lymphoceles and postoperative complications. METHODS: A two-armed prospective randomised, controlled, single-centre trial on 1080 patients with prostate cancer who underwent RARP with bilateral pelvic lymph node dissection was carried out. Patients in the intervention arm received fixation of the peritoneal flap of the bladder to the plexus Santorini at the end of surgery (Michl-technique, MT); in the control group, surgery was performed without this modification. The primary endpoint was the rate of lymphoceles requiring intervention. Secondary endpoints were total lymphocele rate and other complications ≥ grade IIIa according to Clavien-Dindo as well as continence rates within one year after RARP. RESULTS: Overall, between June 2017 and October 2019, 531 patients were randomised to the MT arm and 549 to the control arm. There were no differences in both arms with respect to age at surgery, PSA, BMI, prostate volume, surgical time, blood loss, and time to removal of the catheter. In median 14 lymph nodes were dissected in both groups. There was no statistically significant difference in the lymphoceles requiring intervention (7.2% in MT-group versus 8.8% in control group, p=0.4). There was no difference in continence rates and other complications between the two groups after 12 months of follow-up. CONCLUSIONS: There was no significant reduction in lymphoceles requiring intervention observed when using the Michl-technique. Lymphoceles remain a significant complication post lymph node dissection in RARP patients. Source of Funding: none © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e743 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Randi Pose More articles by this author Sophie Knipper More articles by this author Lukas Hohenhorst More articles by this author Burkhard Beyer More articles by this author Derya Tilki More articles by this author Alexander Haese More articles by this author Hans Heinzer More articles by this author Georg Salomon More articles by this author Thomas Steuber More articles by this author Lars Budäus More articles by this author Hendrik Isbarn More articles by this author Tobias Maurer More articles by this author Pierre Tennstedt More articles by this author Markus Graefen More articles by this author Uwe Michl More articles by this author Expand All Advertisement PDF downloadLoading ...

Benign metastasizing uterine leiomyoma with lymphatic and pulmonary metastases: a case report and literature review

BackgroundBenign metastasizing leiomyoma (BML) is a rare disease usually observed in women of reproductive or premenopausal age with a history of uterine myomectomy or hysterectomy. The most common sites of metastases are the pulmonary, and other sites include heart, bones, liver, lymph nodes, bladder, skeletal muscles, and central nervous system. Here, we report a case of a 50 year-old woman with a history of hysterectomy who was initially suspected of uterine sarcoma but was finally confirmed to have BML with lung and lymph node metastases, and discuss the treatment and prognosis of BML.Case presentationA 50 year-old woman with a history of total abdominal hysterectomy presented with mild but persistent abdominal pain for more than 3 months. She was suspected of having uterine sarcoma before surgery and laparoscopic extensive debulking surgery including bilateral oophorectomy, pelvic and para-aortic lymph node dissection to the level of the left renal vein, and transcutaneous dissection of the right inguinal lymph nodes. Pathology confirmed a benign leiomyoma, and the patient was diagnosed with BML. No medication was administered after the surgery, and the follow-up was of no significance.ConclusionBenign metastasizing leiomyoma (BML) is a rare disorder in which histologically benign smooth muscle tumors metastasize to extrauterine sites. Metastases are commonly observed in the lung, liver, lymph nodes, skin, bladder, esophagus, and skeletal muscles. BML is usually misdiagnosed as a malignant tumor before surgery until the pathology confirms its benign nature. However, this treatment remains controversial and undetermined. The prognosis is usually favorable owing to its benign nature.

Comparison between preoperative chemoradiotherapy and lateral pelvic lymph node dissection in clinical T3 low rectal cancer without enlarged lateral lymph nodes.

The standard strategy for clinical T3 rectal cancer without enlarged lateral lymph nodes is preoperative chemoradiotherapy (CRT) followed by total mesorectal excision (TME) in Western countries and TME with bilateral lateral pelvic lymph node dissection (LPLND) in Japan. This study compared surgical, pathological and oncological results of these two strategies. Patients who underwent preoperative CRT followed by TME in France (CRT + TME group) and those who underwent TME with LPLND in Japan (TME + LPLND group) for clinical T3 rectal adenocarcinoma without enlarged lateral lymph nodes from 2010 to 2016 were retrospectively analysed. In total, 439 patients were included in this study. The estimated local recurrence rate (LRR), disease-free survival and overall survival at 5 years post-surgery was 4.9%, 71% and 82% in the CRT + TME group, and 8.6%, 75% and 90% in the TME + LPLND group, respectively. Lateral LRR versus non-lateral LRR was 0.5% versus 4.2% in the CRT + TME group and 1.8% versus 6.2% in the TME + LPLND group. Obturator nerve injury and isolated pelvic abscess were shown only in the TME + LPLND group. Urinary complications were more frequent in the TME + LPLND group than in the CRT + TME group. Disease-free survival was not significantly different after TME with LPLND and after CRT followed by TME. LRR was not significantly different after both strategies; however, there was a trend for higher LRR after TME with LPLND than after CRT followed by TME. Obturator nerve injury, isolated lateral pelvic abscess and urinary complications should be noted when TME with LPLND is applied.

Laparoscopic radical hysterectomy and total vaginectomy for vaginal malignant melanoma with cervical metastasis

The presented case is a 63-years-old multiparous woman admitted with the complaint of postmenopausal bleeding. On gynecologic examination multifocal lesions were detected, including 1 cm on lateral vaginal wall, 4 cm on posterior vaginal wall and 0.5 cm on the left lateral part of the cervix. Histopathology examination gave a diagnosis of epithelioid malignant melanoma. Consequently, laparoscopic radical hysterectomy and total vaginectomy with bilateral pelvic and inguinofemoral lymph node dissection were planned. On both sides, pararectal and paravesical spaces were created and the ureter was identified. Then, the vesicouterine and vesicovaginal spaces were developed. Uterine artery and superior vesical artery were coagulated, cut and the lateral parametrium was prepared. The left ureter was dissected and the ureteral tunnel was unroofed up to the bladder entrance. Subsequently, the anterolateral parametrium was transected. Then, the infundibulopelvic and sacrouterine ligaments were sealed and transected. At this time, the rectovaginal space was developed. Bilateral paracolpos were transected. The endopelvic fascia with the levator muscles were sealed and cut circumferentially. Anteriorly, the pubovesicocervical fascia was transected and the bladder was mobilized up to the uretrovesical junction. Thereafter, through a vaginal approach, the cervix and vagina were inverted by grasping the cervix with a tenaculum. An incision on the posterior vaginal wall at the introitus was made and the urogenital diaphragm was dissected to connect with the pelvic cavity. The vaginal entrance was cut circumferentially and the surgical specimen was extracted. In conclusion, laparoscopy can be considered as a feasible approach for radical hysterectomy and total vaginectomy in selected patients.

URINARY BLADDER LEIOMYOSARCOMA --- A RARE CAUSE OF HEMATURIA

Cases of bladder leiomyosarcoma represent 0.1% of all nonurothelial tumours. Nonurothelial neoplasms of the bladder account for <5% of all bladder tumours. Urinary bladder leiomyosarcoma is a very rare entity with few cases reported in the literature. Given its scarcity, little is known about its etiology and consensus lacking on therapeutic management. Here we present the case of a 36year old female patient diagnosed with bladder leiomyosarcoma and then treated with partial cystectomy of the bladder and bladder reconstruction with bilateral pelvic lymph node dissection..

Diagnostic performance of PET-CT compared to conventional CT for lymph node staging in bladder cancer patients undergoing radical cystectomy and bilateral pelvic lymph node dissection

Diagnostic performance of PET-CT compared to conventional CT for lymph node staging in bladder cancer patients undergoing radical cystectomy and bilateral pelvic lymph node dissection

Lateral pelvic lymph node metastasis in T2 low rectal cancer: is TME alone sufficient for cure?

Some patients with even T2 low rectal cancer are known to develop lateral pelvic lymph node metastasis. This study aimed to investigate real-world evidence regarding lateral nodal metastasis on T2 low rectal cancer treatment. Consecutive patients with pathological T2 low rectal adenocarcinoma who underwent curative-intent surgery between January 2007 and December 2015 at two Japanese cancer centres dedicated to lateral pelvic lymph node dissection were identified and included in the analysis. Lateral pelvic lymph node metastasis was defined as pathologically confirmed metastatic lateral pelvic lymph node or lateral-local recurrence after primary surgery. A total of 215 consecutive patients, including 101 and 114 patients who did and did not undergo bilateral lateral pelvic lymph node dissection, were included in the analysis. Overall, 19 (8.8%) patients had lateral pelvic lymph node metastasis, including 13 with pathologically confirmed metastatic lateral pelvic lymph node and six with lateral-local recurrence. A total of 10 (4.7%) patients had local recurrence, including six with lateral-local recurrence, two with central-local recurrence and two with anastomotic recurrence. Five/7-year cumulative risks of lateral-local recurrence in patients with and without lateral pelvic lymph node dissection were 1.1/1.1% and 3.9/5.2%, respectively. The problem of the relatively high rate of lateral local recurrence remains in treating T2 low rectal cancer with only total mesorectal excision. The selection of high-risk patients of lateral pelvic lymph node metastasis and the indication of additional treatment in T2 low rectal cancer should be discussed further.