Concomitant Bladder Research Articles

MP40-18 OFFICE-BASED FLEXIBLE URETEROSCOPY FOR ACTIVE SURVEILLANCE FOR UPPER TRACT UROTHELIAL CARCINOMA FOLLOWING NEPHRON-SPARING SURGERY

You have accessJournal of UrologyCME1 May 2022MP40-18 OFFICE-BASED FLEXIBLE URETEROSCOPY FOR ACTIVE SURVEILLANCE FOR UPPER TRACT UROTHELIAL CARCINOMA FOLLOWING NEPHRON-SPARING SURGERY Nathan Colin Wong, Sameh Naim, Jonathan Wagmeister, Ariel Schulman, Bertie Zhang, John Phillips, Muhammad Choudhury, and Majid Eshghi Nathan Colin WongNathan Colin Wong More articles by this author , Sameh NaimSameh Naim More articles by this author , Jonathan WagmeisterJonathan Wagmeister More articles by this author , Ariel SchulmanAriel Schulman More articles by this author , Bertie ZhangBertie Zhang More articles by this author , John PhillipsJohn Phillips More articles by this author , Muhammad ChoudhuryMuhammad Choudhury More articles by this author , and Majid EshghiMajid Eshghi More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002600.18AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Nephron-sparing surgery (NSS) for upper tract urothelial carcinoma (UTUC) offers select patients renal preservation but demands close surveillance including routine ureteroscopy that typically require general anesthesia. We report feasibility and our experience in utilizing ureteric orifice meatotomy to facilitate office-based flexible ureteroscopy under local anesthesia. METHODS: A retrospective chart review was conducted including consecutive patients who underwent NSS of UTUC at our tertiary center. Patients underwent ureteric orifice meatotomy followed by attempted flexible ureteroscopy in the office setting under local anesthesia with transurethral 2% lidocaine jelly. Otherwise, patients underwent routine ureteroscopic surveillance under general anesthesia and all patients underwent routine cross-sectional imaging including 3-D ‘virtual ureteroscopy’ by reconstruction of CT urography to evaluate for disease recurrence. RESULTS: A total of 16 patients (7 male; 9 female) with UTUC were treated with NSS – 9/16 (56%) were initially managed ureteroscopically and 7/16 (44%) percutaneously. Median age at diagnosis was 79 (IQR 71.5, 81.5) and median follow-up was 3 years (IQR 2, 3.5). The majority of patients had high grade disease (75%) and tumor location was typically renal pelvis (10/16; 63%) followed by distal ureter (4), mid ureter (1) and proximal ureter (1). A total of 3/16 (18%) had history of contralateral UTUC, 3/16 (18.8%) had solitary kidney and 10/16 (62%) had concomitant bladder cancer. A total of 10/16 patients (63%) who underwent ureteric orifice meatotomy tolerated flexible ureteroscopy in an office-based setting under local anesthesia, the rest required general anesthesia. Overall, 8/16 (50%) had disease recurrence, typically at the location of their initial site of disease. Of the 10 patients with renal pelvic disease, 6 (60%) recurred in the renal pelvis. Of the 6 patients with ureteral disease, 2 (33%) recurred in the ureter. Of those who recurred, 4 (50%) were successfully managed with ongoing endoscopic therapy and 4 (50%) ultimately underwent radical nephroureterectomy, 3 of which had disease upstaging on final pathology. There were 2 deaths related to comorbidities, both of who had a solitary kidney. There were no UTUC-related deaths. CONCLUSIONS: In select patients with UTUC who undergo NSS, ureteric orifice meatotomy is feasible and allows the majority of patients to tolerate office based flexible ureteroscopy under local anesthesia without compromising oncologic outcomes. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e682 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Nathan Colin Wong More articles by this author Sameh Naim More articles by this author Jonathan Wagmeister More articles by this author Ariel Schulman More articles by this author Bertie Zhang More articles by this author John Phillips More articles by this author Muhammad Choudhury More articles by this author Majid Eshghi More articles by this author Expand All Advertisement PDF DownloadLoading ...

The role of single-nucleotide polymorphisms of the 8q24 chromosome region in patients with concomitant bladder and prostate cancer

Objective To assess whether single-nucleotide polymorphisms (SNPs) of the 8q24 chromosome region are associated with recurrence-free survival (RFS) after radical cystoprostatectomy (RC) in patients with concomitant bladder (BC) and prostate cancer (PC). Materials and methods A cohort of thirty-six patients treated with RC and pelvic lymph node dissection and histologically exhibited invasive BC and incidental PC. Using Sanger sequencing, a total of seven SNPs in the androgen-responsive element of the promoter region of the following genes were assessed in tumor-free lymph nodes and correlated with oncological outcomes: PSCA (rs2294008, rs2978974, rs1045531, rs3736001), MYC (rs6983267), FXBO32 (rs7830622), and MIR151A (rs14974929). The median follow-up was 26 months (range: 4–68). Results In a dominant model, patients exhibiting rs2978974 as a minor allelic variant of the PSCA gene had worse RFS (32 vs. 75%, p = 0.015). No associations were found for the other SNPs. Conclusions These data suggest that the rs2978974 of the PSCA gene correlates with inferior BC-specific RFS after RC and should be further evaluated in larger studies.

Simultaneous hysterectomy, partial vaginectomy, and segmental resection of rectosigmoid and bladder for deep infiltrating endometriosis

Describe an interdisciplinary approach to preoperative planning to optimize complete surgical resection of multi-compartment deep infiltrating endometriosis. In this video we present a case of deep infiltrating endometriosis (DIE) involving the anterior, middle, and posterior compartments. We review the preoperative evaluation including MRI using a DIE-specific protocol and colonoscopy to identify DIE lesions at multiple pelvic and abdominal sites. A collaborative surgical approach was taken with gynecologic, colorectal, and urologic surgeons to perform a robotically assisted total laparoscopic hysterectomy, ovarian cystectomy and unilateral salpingoophorectomy with concurrent excision of a transmural bladder nodule, segmental resection of rectosigmoid, and nerve sparing excision of extensive fibrosis and nodules throughout the abdomen and pelvis. To the best of our knowledge, there are no case reports of concomitant bladder and rectosigmoid resections at time of hysterectomy and endometriosis excision, thus outcomes and complications of such procedures are not known. Thorough preoperative evaluation including MRI and colonoscopy and an interdisciplinary approach to surgical planning involving radiology, gynecology, colorectal surgery, and urology allowed for complete simultaneous resection of bladder, rectosigmoid, and pelvic DIE in a single procedure without complications.

EDITORIAL COMMENT

The authors present a large retrospective cohort of patients with pelvic fracture urethral injury (UR), who underwent posterior urethroplasty with an expert surgeon (and a wonderful guy by all reports). The authors report outstanding results, with >95% of patients being free from postoperative stricture. These results are similar to other recent retrospective outcome studies.1 Some important injury characteristics included a 13% rate of concomitant bladder injury and a 6% utilization of pelvic angioembolization.

Prevention of Kidney and Bladder Failure Following Concomitant Valves Ablation and Bladder Neck Incision in Posterior Urethral Valves: The Bladder Valve Complex Hypothesis

Prevention of Kidney and Bladder Failure Following Concomitant Valves Ablation and Bladder Neck Incision in Posterior Urethral Valves: The Bladder Valve Complex Hypothesis

Risk factor analysis of intravesical recurrence after retroperitoneoscopic nephroureterectomy for upper tract urothelial carcinoma

BackgroundOne of the major concerns of patients with upper tract urothelial carcinoma (UTUC) treated with nephroureterectomy is intravesical recurrence (IVR). The purpose of the present study was to investigate the predictive risk factors for IVR after retroperitoneoscopic nephroureterectomy (RNU) for UTUC.MethodsClinicopathological and surgical information were collected from the medical records of 73 patients treated with RNU for non-metastatic UTUC, without a history of or concomitant bladder cancer. The association between IVR after RNU and clinicopathological and surgery-related factors, including preoperative urine cytology and pneumoretroperitoneum time, was analyzed using the Fisher exact test.ResultsDuring the median follow-up time of 39.1 months, 18 (24.7%) patients had subsequent IVR after RNU. The 1- and 3-year IVR-free survival rates were 85.9% and 76.5%, respectively. The Fisher exact test revealed that prolonged pneumoretroperitoneum time of ≥ 210 min was a risk factor for IVR in 1 year after RNU (p = 0.0358) and positive urine cytology was a risk factor for IVR in 3 years after RNU (p = 0.0352).ConclusionsIn UTUC, the occurrences of IVR in 1 and 3 years after RNU are highly probable when the pneumoretroperitoneum time is prolonged (≥ 210 min) and in patients with positive urine cytology, respectively. Strict follow-up after RNU is more probable recommended for these patients.

A qualitative interview study on successful pregnancies in women with spina bifida

Improvements in antenatal medicine and surgical management for conditions associated with spina bifida such as hydrocephalus have extended the lifespan for individuals with spina bifida (SB) into adulthood. Decisions and education regarding reproductive care and pregnancies for patients with spina bifida are increasingly important. Pregnancy in these patients can be particularly challenging due to physical limitations, previous abdominal surgery for urinary or bowel management and presence of a ventriculoperitoneal shunt. To date, little research has examined the unique challenges that women with spina bifida face during pregnancy. The purpose of this descriptive study is to characterize the successful pregnancy histories of SB women and describe how pregnancy affected their mobility as well as bladder and bowel management. We conducted semi-structured interviews with women followed in our adult multidisciplinary SB clinic who previously had successful pregnancies. Questions regarding perinatal issues, obstetrical complications, urinary tract infections (UTI) and neurological changes were asked. Baseline mobility, bladder and bowel management were compared with changes during and after pregnancy. 121 women of childbearing age were followed per year by our adult multidisciplinary spina bifida clinic between 2009 and 2016. We identified 6 women who successfully carried 8 pregnancies to term. There were no miscarriages. Four women had ventriculoperitoneal (VP) shunts. No children were born with neural tube defects. Mean age at first pregnancy was 23.5 years. Average gestational age at delivery was 37 weeks. 50% of the women had a spontaneous vaginal delivery. Five of six women intended to get pregnant; only one patient consumed folic acid regularly prior to pregnancy. Two of six women had bladder augmentation surgery, one of whom had urologic changes during pregnancy that persisted after childbirth. The other patient had a concomitant bladder neck sling procedure and did not have urologic issues during pregnancy. 50% of the patients experienced bladder-bowel dysfunction during their pregnancy. While 67% patients had full baseline ambulatory function, 4 patients had decreased mobility and required additional assistance during pregnancy. All returned to their baseline functionality afterwards. Six of our patients had eight successful pregnancies, with no children born with neural tube defects. New changes to mobility, bladder and bowel management were experienced by over half of the women during their pregnancies. Future studies should focus on the role of multidisciplinary teams in reproductive health education and perinatal management of changes to activities of daily living during pregnancy in this population.

Conditional Intravesical Recurrence-Free Survival Rate After Radical Nephroureterectomy With Bladder Cuff Excision for Upper Tract Urothelial Carcinoma.

BackgroundTo evaluate the conditional intravesical recurrence (IVR)–free (IVRF) survival rate in patients with upper tract urothelial carcinoma (UTUC) who had no history of bladder cancer and no concomitant bladder cancer. Hence, we aimed to analyze a relatively large number of patients with UTUC who underwent radical nephroureterectomy with bladder cuff excision (RNUx).MethodsWe retrospectively analyzed the data of 1,095 patients with UTUC who underwent RNUx. Their baseline characteristics, bladder tumor history, and UTUC features were analyzed to evaluate oncological outcomes. To determine the factors affecting IVR, surgical modality, use of preoperative ureteroscopy, TNM stage, and pathological outcomes were evaluated. Multivariable Cox regression analyses were performed to evaluate the factors affecting IVR. Conditional IVRF survival rate was analyzed using Kaplan–Meier curves.ResultsAmong the 1,095 patients, 462 patients developed IVR, and the mean time to the development of IVR was 13.08 ± 0.84 months after RNUx. A total of 30.74% of patients with IVR and 15.32% of those without IVR had a history of bladder cancer (p < 0.001). Multivariable analysis showed that a history of bladder cancer, multifocal tumors, use of preoperative ureteroscopy, extravesical bladder cuffing method, lymph node involvement, positive surgical margins, and use of adjuvant chemotherapy were determined to be risk factors for IVR. The conditional IVRF rate was 74.0% at 12 months after RNUx, 87.1% at 24 months after RNUx, 93.6% at 36 months after RNUx, and 97.3% at 60 months after RNUx. The median IVRF survival period was 133.00 months for all patients. In patients with IVRF at 24 months after RNUx, only ureteroscopy was an independent risk factor for IVR [hazard ratio (HR) 1.945, p = 0.040]. In patients with IVRF at ≥36 months, there was no significant factor affecting IVR.ConclusionsActive IVR assessment is required until 36 months after RNUx. In addition, patient education and regular screening tests, such as urine analysis and cytology, are required for patients with IVRF for ≥36 months.

Modern physiotherapy technologies in medical rehabilitation of children with megaureter with concomitant neurogenic bladder dysfunction

This article discusses the issues of medical rehabilitation of children with megaureter with concomitant neurogenic bladder dysfunction. Objective of the study: scientific substantiation of the use of selective chromotherapy in medical rehabilitation of children with megaureter with concomitant neurogenic bladder dysfunction. Materials and research methods: clinical observations and special studies were carried out in dynamics in 40 children, aged 1 to 7, with megaureter after ureteral surgery. Of these, 20 children made up the main group (received selective chromotherapy, blue spectrum); 20 children — the control group (without physiotherapy). Based on the studies carried out, a beneficial effect of medical rehabilitation with the inclusion of selective chromotherapy in children with megaureter and concomitant neurogenic bladder dysfunction was revealed. The inclusion of selective chromotherapy in the program of medical rehabilitation of children with megaureter contributed to a decrease in the activity of inflammation in the renal parenchyma (decrease in proteinuria, leukocyturia). Selective chromotherapy had a positive effect on the urodynamics of the lower urinary tract (reduction in the number of urgent urges and episodes of urinary incontinence, decreased frequency of urination, improved uroflowmetry indicators). The effectiveness of medical rehabilitation with the inclusion of selective chromotherapy was 80.0 %, while in the control group — 40.0 %.

V13-01 EXTENDED URETERAL MEATOTOMY FOR OUTPATIENT CHEMOTHERAPY ADMINISTRATION AND URETEROSCOPY IN PATIENTS WITH UPPER TRACT UROTHELIAL CARCINOMA

You have accessJournal of UrologyBladder & Upper Tract Urothelial Oncology (V13)1 Sep 2021V13-01 EXTENDED URETERAL MEATOTOMY FOR OUTPATIENT CHEMOTHERAPY ADMINISTRATION AND URETEROSCOPY IN PATIENTS WITH UPPER TRACT UROTHELIAL CARCINOMA Nikhil Gopal, Sameh Naim, Bertie Zhang, John Phillips, and Majid Eshghi Nikhil GopalNikhil Gopal More articles by this author , Sameh NaimSameh Naim More articles by this author , Bertie ZhangBertie Zhang More articles by this author , John PhillipsJohn Phillips More articles by this author , and Majid EshghiMajid Eshghi More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002100.01AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Patients with ureteral tumors managed endoscopically often benefit from adjuvant immuno-chemotherapy and require interval upper tract surveillance with ureteroscopy. However, both often require general anesthesia, which can be problematic for a predominantly elderly population with multiple co-morbidities. Here we describe an endoscopic technique of ureteral meatotomy to not only predictably allow for reflux of intravesical agents through the ureter, but also to allow upper tract endoscopy to be performed in the office setting. METHODS: From 2015-2021, we performed ureteral meatotomy on 10 patients. All patients who underwent this procedure had upper tract urothelial tumors deemed suitable for primary endoscopic management, based on patient’s clinical characteristics; tumor number; size; location; and/or biopsy grade.Under general anesthesia, a 10 F dual lumen ureteral catheter or 6-12 F Nottingham dilator was inserted into the distal ureter in order to allow for alignment of the ureter towards the bladder neck and to ensure the orifice is incised in the correct direction. Using either a Holmium laser or Collin’s knife, a full-thickness 2 cm incision was made on the distal intramural ureter at the 12 o’clock position, until the anterior portion of the catheter was visualized. Intraoperative cystogram was used to confirm ureteral reflux. A double J stent was then left in place for 3 weeks for mucosal healing and reshaping of the distal ureteral segment. Postoperatively, patients underwent 6 cycles of mitomycin, either via indwelling Foley catheter or nephrostomy tube. Lower and upper urinary tract surveillance was performed using flexible cystoscope and/or ureteroscope in the office every 3-6 months for the first two years and annually thereafter. RESULTS: 10 patients with average age of 77 years, 40% of whom were male, underwent ureteral meatotomy between 2015 and 2021. 90% of tumors were either in the distal ureter or UPJ/renal pelvis. Average tumor size was 1.6 cm. 70% of tumors were low grade on biopsy. 3 patients had concomitant bladder cancer. There were no complications associated with chemotherapy instillation. Of the patients who had only upper tract disease, none developed a new recurrence in the bladder. CONCLUSIONS: We describe a novel anterior intramural ureteral incision technique in patients with ureteral tumors managed endoscopically that reliably allows for both chemotherapy administration and upper tract surveillance in an office setting. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e1078-e1078 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Nikhil Gopal More articles by this author Sameh Naim More articles by this author Bertie Zhang More articles by this author John Phillips More articles by this author Majid Eshghi More articles by this author Expand All Advertisement Loading ...

PD43-04 A URINE-BASED DNA METHYLATION MARKER TEST TO DETECT UPPER TRACT UROTHELIAL CARCINOMA: A PILOT STUDY

You have accessJournal of UrologyBladder Cancer: Upper Tract Transitional Cell Carcinoma I (PD43)1 Sep 2021PD43-04 A URINE-BASED DNA METHYLATION MARKER TEST TO DETECT UPPER TRACT UROTHELIAL CARCINOMA: A PILOT STUDY Alireza Ghoreifi, Sanam Ladi-Seyedian, Paolo Piatti, Benjamin Jara, Taikun Yamada, Lucy Sanossian, Sina Sobhani, Andrew Hung, Sumeet Bhanvadia, Rene Sotelo, Monish Aron, Mihir Desai, Inderbir Gill, Siamak Daneshmand, Gangning Liang, and Hooman Djaladat Alireza GhoreifiAlireza Ghoreifi More articles by this author , Sanam Ladi-SeyedianSanam Ladi-Seyedian More articles by this author , Paolo PiattiPaolo Piatti More articles by this author , Benjamin JaraBenjamin Jara More articles by this author , Taikun YamadaTaikun Yamada More articles by this author , Lucy SanossianLucy Sanossian More articles by this author , Sina SobhaniSina Sobhani More articles by this author , Andrew HungAndrew Hung More articles by this author , Sumeet BhanvadiaSumeet Bhanvadia More articles by this author , Rene SoteloRene Sotelo More articles by this author , Monish AronMonish Aron More articles by this author , Mihir DesaiMihir Desai More articles by this author , Inderbir GillInderbir Gill More articles by this author , Siamak DaneshmandSiamak Daneshmand More articles by this author , Gangning LiangGangning Liang More articles by this author , and Hooman DjaladatHooman Djaladat More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002057.04AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Upper tract urothelial carcinoma (UTUC) is an uncommon, yet lethal tumor of the urinary tract. Diagnosis and preoperative risk stratification of these patients present distinct challenges given the limitations of current available diagnostic tools, including endoscopic biopsy and imaging. Herein, we explore the feasibility of a urine-based epigenetic assay to detect UTUC. METHODS: Under an IRB approved protocol, urine samples were collected from UTUC patients before radical nephroureterectomy between December 2019 and December 2020. Patients with concomitant bladder cancer (n=4) and those who did not pass the quality control due to low DNA concentration (n=5) were excluded. Samples were analyzed with Bladder CARE™, a urine-based assay that measures methylation levels of 3 cancer biomarkers (TRNA-Cys, SIM2, and NKX1-1) and two internal control loci using methylation-sensitive restriction enzymes coupled with qPCR. Results are reported as Bladder CARE Index (BCI) score and categorized as positive (BCI>5), high-risk (BCI 2.5-5), or negative (BCI<2.5), which correlate to the concentration of cancer DNA in the sample. The findings were compared to 54 sex/age matched healthy (cancer-free) individuals. RESULTS: A total of 19 patients with a median age of 73 (14 male and 5 female) were included in the final analysis. Separate samples were sent from bladder and nephrostomy tube in 2 patients (total urine sample n=21). Final pathology revealed stage Ta (n=11), T1 (n=2), T2 (n=2), and T3 (n=4) UTUC. Among all samples, 20 showed positive and 1 high-risk BCI results. Urine cytology was available in 9 patients, in whom 3 had positive BCI results despite negative cytology. UTUC patients had a significantly higher BCI values compared to the control cases (average BCI value of 227.3 vs. 1.7, respectively; p < 0.0001) (Figure 1-A). The Receiver Operating Characteristic (ROC) curve demonstrating the sensitivity, specificity, positive predictive values, and negative predictive value of 100%, 87.1%, 75%, and 100%, respectively (AUC=0.996, Fig. 1B). CONCLUSIONS: In this pilot study, the proposed urine-based epigenetic assay showed high sensitivity and negative predictive value in the diagnosis of patients with UTUC. A larger sample size study to validate the accuracy of this test is the next step. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e731-e732 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Alireza Ghoreifi More articles by this author Sanam Ladi-Seyedian More articles by this author Paolo Piatti More articles by this author Benjamin Jara More articles by this author Taikun Yamada More articles by this author Lucy Sanossian More articles by this author Sina Sobhani More articles by this author Andrew Hung More articles by this author Sumeet Bhanvadia More articles by this author Rene Sotelo More articles by this author Monish Aron More articles by this author Mihir Desai More articles by this author Inderbir Gill More articles by this author Siamak Daneshmand More articles by this author Gangning Liang More articles by this author Hooman Djaladat More articles by this author Expand All Advertisement Loading ...

High Frequency of Concomitant Bladder, Bowel, and Sexual Symptoms in Huntington's Disease: A Self-Reported Questionnaire Study.

Huntington’s disease (HD) can be associated with pathologic involvement beyond the striatum including the autonomic nervous system. Bladder, bowel, and sexual dysfunction have been reported independently in HD, but little is known about their concomitant occurrence. To document this concomitant phenomena, forty-eight subjects (54% male, ages 28–74 years, CAG repeat 38–61) with manifest/symptomatic HD completed detailed questionnaires regarding bladder, bowel, and sexual function. In total, 45 subjects (93.8%) reported symptoms in at least one organ system (bladder, bowel, or sexual), 13 (27.1%) reported symptoms in two systems, and 19 (39.6%) reported concomitant symptoms in all three systems. Urinary problems were most frequent in 42 subjects (87.5%) followed by lower bowel (60.4%) and sexual dysfunction (56.2%). Participants reporting concomitant symptoms were more likely to have longer duration of disease and lower Total Functional Capacity (TFC) scores. This study documents the high frequency of bladder, bowel, and sexual dysfunction in HD and the common occurrence of concomitance of these pelvic organ problems.

State of the art on stress incontinence management after benign prostatic obstruction surgery.

Stress urinary incontinence (SUI) is mostly seen after prostate surgery (radical prostatectomy or benign prostatic obstruction [BPO] relief). As new surgical techniques (laser, endoscopic enucleation) have been dramatically expanded in the past decade, a focus on postoperative SUI is necessary to provide the best management in this iatrogenic situation. Surgery is the main option for curative management of SUI after BPO as no oral medication is recommended. Preoperative work-up is mandatory to assess concomitant bladder dysfunction. All available surgical options (peri-urethral injections, periurethral balloons, various male slings, and artificial urinary sphincter) have been studied, but the level of evidence is very low. In this setting, SUI after BPO management is widely inspired from post-PR SUI management, mainly based on clinical experience. The available literature regarding persistent SUI after BPO relief is very scarce and further studies are warranted in this specific population.

Impact of Surgical Wait Time on Survival in Patients With Upper Urinary Tract Urothelial Carcinoma With Hydronephrosis.

Background and ObjectivesDue to the inevitability of waiting time for surgery, this problem seems to have become more pronounced since the outbreak of COVID-19, and due to the high incidence of preoperative hydronephrosis in upper urinary tract urothelial carcinoma (UTUC) patients, it is particularly important to explore the impact of preoperative waiting time and hydronephrosis on upper urinary urothelial carcinoma.Methods316 patients with UTUC who underwent radical surgery at a high-volume center in China between January 2008 and December 2019 were included in this study. We retrospectively collected the clinicopathologic data from the medical records, including age, sex, smoking history, ECOG performance status (ECOG PS), body mass index (BMI), tumor location and size, number of lesions, T stage, N stage, surgical approach and occurrence of hydronephrosis, lymph node invasion, lymph node dissection, surgical margin, tumor necrosis, infiltrative tumor architecture, lymphovascular invasion and concomitant bladder cancer. Surgical wait time was defined as the interval between initial imaging diagnosis and radical surgery of UTUC. Hydronephrosis was defined as abnormal dilation of the renal pelvis and calyces due to obstruction of the urinary system. Firstly, all patients were divided into short-wait (<31 days), intermediate-wait (31-90 days) and long-wait (>90 days) groups according to the surgical wait time. The clinicopathological characteristics of each group were evaluated and the survival was compared. For patients with hydronephrosis, we subsequently divided them into two groups: short-wait (≤60 days) and long-wait (>60 days) groups according to the surgical wait time. Univariate and multivariate COX regression analysis were performed to evaluate the prognostic risk factor for patients with hydronephrosis.ResultsA total of 316 patients with UTUC were included in this study with a median surgical wait time of 22 days (IQR 11-71 days). Of the 316 patients, 173 were classified into the short-wait group (54.7%), 69 into the intermediate-wait group (21.8%) and 74 into the long-wait group (23.5%). The median follow-up time for all patients was 43 months (IQR 28-67months). The median surgical wait times of the short-wait, intermediate-wait and long-wait group were12 days (IQR 8-17days), 42days (IQR 37-65days) and 191days (IQR 129-372days), respectively. The 5-year overall survival (OS) of all patients was 54.3%. The 5-year OS of short-wait, intermediate-wait and long-wait groups were 56.4%, 59.3% and 35.1%, respectively (P=0.045). The 5-year cancer-specific survival (CSS) of short-wait, intermediate-wait and long-wait groups were 65.8%, 70.9% and 39.6%, respectively (P=0.032). In the subgroup analysis, we divided 158 UTUC patients with hydronephrosis into short-wait group (≤60 days) and long-wait group (> 60 days), 120 patients were included in the short-wait group and 38 patients in the long-wait group. The median surgical wait times of the short-wait and long-wait group were 14days (IQR 8-28days) and 174days (IQR 100-369days), respectively. The 5-year OS of long-wait group was significantly lower than the OS of short-wait group (44.2% vs. 55.1%, P =0.023). The 5-year CSS of long-wait and short-wait group were 49.1% and 61.7%, respectively (P=0.041). In multivariate Cox regression analysis of UTUC patients with hydronephrosis, surgical wait time, tumor grade, pathological T stage, and tumor size were independent risk factors for OS and CSS. Lymph node involvement was also a prognostic factor for CSS.ConclusionFor patients with UTUC, the surgical wait time should be limited to less than 3 months. For UTUC patients with hydronephrosis, the OS and CSS of patients with surgical wait time of more than 60 days were relatively shorted than those of patients with surgical wait time of less than 60 days.

Diagnostic Ureteroscopy in CT Urography-Diagnosed Upper Tract Urothelial Carcinoma: Delay in Definitive Treatment and Increased Intravesical Recurrence.

PurposeTo investigate the effect of diagnostic ureteroscopy (URS) on the delay to surgical treatment of upper tract urothelial carcinoma (UTUC) detected by imaging and the risk of intravesical recurrence.Materials and methodsWe undertook a retrospective case-note analysis of all patients who underwent radical nephroureterectomy (NUU) from November 2012 to July 2019. We identified those who underwent diagnostic ureteroscopy prior to NUU as Group 1 and those who did not undergo diagnostic URS as Group 2. Perioperative and pathological parameters were compared between both groups. Kaplan-Meier and Log-Rank analyses were used to compare delay to NUU and the intravesical recurrence (IVR) free survival. Cox regression models were employed to analyze the risk factors of intravesical recurrence.ResultsOut of 69 patients with a mean age of 71.3 years and a mean follow-up of 48.5 months, 49 (71%) underwent URS while 20 (29%) did not. The mean time between the computerized tomography urography (CTU) and surgery was 86 days with URS and 59 days in the control groups(p=0.007). Intravesical recurrence in year one postoperatively was 28.2 % in the URS group vs 5.9% in the control group (p=0.04). The Kaplan-Meier curve showed improved, yet insignificant, IVR-free survival for the control group (Log-Rank p-value=0.21). In multivariate Cox regression analysis, concomitant bladder carcinoma was an independent risk factor for IVR (HR, 15.01; 95%CI, 3.311 - 68.07; p=0.0004). Intravesical mitomycin-c was a protective factor (HR 0.154; 95%CI 0.025 - 0.922; p=0.040).ConclusionIn our retrospective single-unit study, diagnostic ureteroscopy for CTU-detected upper tract urothelial carcinoma delayed definitive surgical treatment. Furthermore, it was associated with a significantly increased risk of early intravesical recurrence. URS can provide useful information and reassurance prior to major surgery but must be used with caution in light of these findings.

P0782 - Is prior or concomitant bladder urothelium carcinoma a significant prognostic factor of survival in patients with upper tract urothelium carcinoma

P0782 - Is prior or concomitant bladder urothelium carcinoma a significant prognostic factor of survival in patients with upper tract urothelium carcinoma

From open simple to robotic-assisted simple prostatectomy (RASP) for large benign prostate hyperplasia: the time has come.

Robotic-assisted simple prostatectomy (RASP) has recently been studied as an alternative to open simple prostatectomy or endoscopic treatment options. At present, there is no defined recommendation for a robotic procedure as a standard surgical technique to treat large benign prostate hyperplasia. Several robotic techniques have been described since 2007. Contemporaneously, multiple endoscopic enucleation techniques have been proposed. Nevertheless, open simple prostatectomy still remains a mainstay of therapy. We aimed to evaluate the development of robotic-assisted prostatectomy for large benign prostatic obstruction, thus comparing the technical aspects and clinical outcomes with open and endoscopic enucleation. Robotic-assisted simple prostatectomy provides significantly less blood loss and shorter hospital stay but longer operative time compared to open simple prostatectomy. Compared to endoscopic treatments, robotic approaches have a similar perioperative outcome, but cause less urethral trauma or potential bladder neck strictures. Moreover, concomitant bladder pathologies can be treated within the same setting. Robotic-assisted simple prostatectomy is an effective and safe technique, and can hence be considered to become the preferred first-line therapy to treat patients with obstructive large prostate glands.

Clinical and\xa0genetic characteristics of concomitant Mucopolysaccharidosis type IVA and neurogenic bladder in children: two case reports and literature review

BackgroundMucopolysaccharidosis IVA (MPS IVA; Morquio A syndrome) is a rare autosomal recessive lysosomal storage disorder. Up to now, reports on the clinical characteristics of MPS IVA mainly focused on patients with progressive bone dysplasia and multiple organ damage, while the effects of this disorder on neurogenic bladder have not been reported. Therefore, the aim of the present study is to report two cases of nocturnal enuresis finally diagnosed as neurogenic bladder in MPS IVA.Case presentationBoth children were characterized by the presence of pectus carinatum, kyphoscoliosis, nocturnal enuresis, urinary incontinence, normal intelligence, and loss of strength in the legs, diagnosed as neurogenic bladder in association with MPS IVA through the analysis of the clinical characteristics, enzyme activity and genetic testing. In addition, the terminator codon mutation c.1567T > G (p.X523E) and a novel missense mutation c.575A > G (p.E192G) were found in the coding region of the GALNS gene of the 1st patient, while the missense mutation c.488C > A (p.P163H) was found in the coding region of the GALNS gene of the 2nd patient.ConclusionsNeurogenic bladder may occur in patients with MPS IVA after spinal cord injury. It is necessary to screen for the diagnosis of MPS IVA in patients with atypical enuresis and skeletal abnormalities through the analysis of the clinical characteristics, enzyme activity and genetic testing.

Tumor Location Based Segmentation in Upper-Tract Urothelial Carcinoma Impacts on the Urothelial Recurrence-Free Survival: A Multi-Institutional Database Study

Introduction and Objectives: The predictive impact of primary tumor location for patients with upper-tract urothelial carcinoma (UTUC) in the presence of concomitant urothelial bladder cancer, along with urothelial recurrence after the curative treatment is still contentious. We evaluated the association between precise tumor location and concomitant presence of urothelial bladder cancer and urothelial recurrence-free survival in patients with UTUC treated by radical nephroureterectomy with a bladder cuff. Methods: A total of 1,349 patients with localized UTUC (Ta-4N0M0) from a retrospective multi-institutional cohort were studied. We queried four UTUC databases. This retrospective clinical series was of patients with localized UTUC managed by nephroureter-ectomy with a bladder cuff, for whom data were from the Nishinihon Uro-Oncology Collaborative Group registries. Patients with a history of chemotherapy or radiotherapy were excluded from the study. Associations between the location of the tumor and subsequent outcome following nephroureterectomy were assessed using COX multivariate analysis. The location of the tumor was verified by pathological samples. Urothelial recurrence was defined as tumor relapse in any local urothelium, and coded apart from distant metastasis. The median follow-up was 34 months. Results: A total of 887 patients had an evaluation of the tumor location in which 475 patients had pelvic tumors (53.6%), 96 had ureteral tumors in the U1 segment (10.8%), 87 in the U2 segment (9.8%), and 176 in the U3 segment (19.8%). There were 52 patients who had multifocal tumors (5.9%) as follows: 8 (0.9%) in the pelvis and ureter, 11 (1.2%) in U1 + U2, 1 (0.1%) in U1 + U3, 27 (3.0 %) in U2 + U3, and 6 (0.7%) in U1 + U2 + U3. In all, 145 (16.3%) had concomitant bladder tumors. Logistic regression analysis of gender, age, hydronephrosis, cytology, performance status, grade, lymphovascular invasion, pT, pN, and tumor focality showed that tumor location was associated with the presence of concomitant bladder cancer (p = 0.004, HR = 1.265). When the tumor location was stratified into 8 segments, including multifocal tumors, only the U3 segment remained as a predictor for the presence of concomitant bladder cancer (p = 0.002, HR = 2.872). Kaplan-Meier analysis for unifocal disease showed that lower ureter tumors (a combination of U2 and U3) had a worse prognosis for urothelial recurrence than pelvic tumors or upper ureteral tumors (U1) (p < 0.001 for lower ureteral tumors versus pelvic tumors, p = 0.322 for upper ureteral tumor versus pelvic tumor by log rank). Multivariate analysis showed that lower ureter remained as a prognostic factor for urothelial recurrence after adjusting for gender, age, hydronephrosis, urine cytology, lymphovascular invasion, pT, and pN (p < 0.001, HR = 1.469), and a similar tendency was found when the analysis was run for patients without concomitant bladder tumors (p = 0.003, HR = 1.446). Patients with lower ureteral tumors had a higher prevalence of deaths (HR = 2.227) compared to patients with upper ureter tumors. Conclusions: This multi-institutional study showed that the primary tumor locations were independently associated with the presence of concomitant bladder tumors and subsequent urothelial recurrence.

The Evidence For and Against Prostate-Reducing Procedures for Men with Neurogenic Bladder

The evaluation of anatomic bladder outlet obstruction due to benign prostatic hyperplasia in patients with neurogenic bladder dysfunction can be a challenging and complex process for urologists. Lower urinary tract symptoms are non-specific, and the attribution of symptoms to underlying neurologic disease may result in withholding potentially beneficial therapies and procedures from patients with benign prostatic hyperplasia. Conversely, the underlying neurologic disorder may have profound effects on lower urinary tract symptoms and quality of life and must be considered in patient management decisions. Thorough evaluation is necessary to evaluate male patients with concomitant benign prostatic hyperplasia and neurogenic bladder with careful attention to the underlying neurologic disease. While surgical management of anatomic bladder outlet obstruction has a clear role in carefully selected and thoroughly evaluated patients with neurogenic bladder, treatment strategies must be individualized for each patient. This review seeks to explore the role of prostate-reducing surgeries in management of patients with neurogenic bladder and to compile evidence for and against these procedures in this population. Only a few studies have been published exploring prostate-reducing surgery in the management of patients with neurogenic bladder, with no recent trials. These existing studies are poorly controlled and are characterized by small, heterogeneous study populations, retrospective design, and high risk of bias. While some studies suggest positive outcomes from prostate-reducing surgery for management of patients with neurogenic bladder, more high-quality trials are needed.