Cystectomy Research Articles

A retrospective study of paraganglioma of the urinary bladder and literature review.

To review and summarize the characteristics and therapy of paraganglioma of the urinary bladder (PUB). Patients who underwent the operation in Peking Union Medical College Hospital between January 2012 and December 2021 were reviewed for this retrospective study. A total of 29 patients, comprising 9 (31%) men and 20 (69%) women, were included. The main manifestations were hypertension, palpitation, and micturition syncope. Eight patients had an increased 24-h urinary catecholamine, and seven of them had increased norepinephrine. Normetanephrine in seven patients was increased. Six of 18 metaiodobenzylguanidine and 8 of 22 octreotide scans were positive. In total, 15 cases underwent laparoscopic partial cystectomy and 14 underwent transurethral resection of bladder tumor. In all patients, the immunohistochemical index of Melan-A, AE1/AE3, and α-inhibin were negative, and chromogranin A, S-100, and succinate dehydrogenase were positive. The Ki-67 of 28/29 cases was under 5%, and 1 case with a Ki-67 of 20% was diagnosed with malignant PUB. A total of 27 patients had a regular follow-up, 2 patients were lost during the follow-up, 3 patients had a recurrence, and 1 of these patients died within 1 year of surgery. The symptoms all disappeared or were relieved after the surgery. The transurethral surgery approach fits PUB tumors with a size <3 cm or that protrudes into the bladder and can significantly reduce the postoperative hospital stay. Early detection and treatment are effective, and regular review is necessary after the surgery.

A Unique Occurrence of Vesical Endometriosis 16 Years After Cesarean Section: A Case Report

&lt;strong&gt;Background:&lt;/strong&gt; The rare disorder urinary bladder endometriosis develops when endometrial tissue, which lines the uterus, grows in the bladder wall. This aberrant endometrial tissue causes hematuria, dysuria, and pelvic discomfort. Though, these symptoms are not exclusive to this illness, they make diagnosis difficult. Ultrasound, Magnetic Resonance Imaging, and cystoscopy play a crucial role in confirming the diagnosis. Treatment options range from medical management with hormonal therapies to surgical interventions like transurethral resection or partial cystectomy depending upon personal needs and endometriosis severity. &lt;strong&gt;Case Presentation:&lt;/strong&gt; We are presenting a case report highlighting this uncommon yet clinically significant presentation of urinary bladder endometriosis in a 38-year-old female, who had been experiencing cyclical dysuria for about one year. Her medical history included two previous Caesarean deliveries with last being 16 years ago. MRI revealed variable intensity lesion with internal cystic areas along left posterolateral urinary bladder wall which was inseparable from lower segment caesarean section scar, indicative of urinary bladder endometriosis. Patient received medical treatment leading to resolution of her symptoms. &lt;strong&gt;Conclusion:&lt;/strong&gt; Urinary bladder endometriosis following caesarean section is an uncommon but clinically significant condition that demands timely recognition and appropriate management. A thorough diagnostic workup, including imaging studies and cystoscopy, is crucial for accurate diagnosis. Tailored treatment plans, ranging from hormonal therapies to surgical interventions, should be considered based on disease extent, fertility desires, and overall patient health.

Inflammatory myofibroblastic tumor of the urinary bladder: A systematic review of the literature and report of a case.

Inflammatory myofibroblastic tumors (IMTs) are intermediate-grade lesions that frequently recur and rarely metastasize. There are currently no guidelines on the management of bladder IMTs. This systematic review aims to describe the clinical presentation and compare the management options for bladder IMTs. A PubMed/Medline search was conducted, according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, using the following Mesh terms: ("inflammatory myofibroblastic") AND ("tumor") OR ("tumor") AND ("bladder") AND ("case report"). A total of 75 case reports were included in the analysis. The mean age of the patients was 36 years. 65% of the cases initially presented with hematuria. 68% of the tumors stained positive for anaplastic lymphoma kinase, and 20% invaded the muscularis. Patients underwent either transurethral resection of the bladder tumor (TURBT) only (34%), TURBT followed by complementary partial cystectomy (16%), or TURBT followed by radical cystectomy (4%). 36% and 9% of the cases underwent partial and radical cystectomy after the initial diagnosis, respectively. Cystectomies were performed using an open (74%), laparoscopic (14%), robotic-assisted (10%), or unknown (2%) approach. At a mean follow-up of 14 months, the recurrence and metastasis rates were about 9% and 4%, respectively. In addition, we present the case of a 49-year-old woman with a bladder IMT who underwent TURBT followed by laparoscopic partial cystectomy. The patient remains tumor free postoperatively (follow-up period of 12 months). A complete surgical excision of the bladder IMT is crucial for the optimal management of these cases. Proper differentiation of this tumor from sarcoma or leiomyosarcoma leads to the best outcomes.

Treatment and Outcome of Choledochal Cyst, our Experience in Sheikh Russel National Gastroliver Institute and Hospital, Mohakhali Dhaka, Bangladesh

Objectives: The aim of the study was to evaluate the demographic information, clinical features, surgical methods, postoperative complications, and outcomes at 6 months for patients with choledochal cysts who were treated at the Sheikh Russel National Gastroliver Institute and Hospital. The goal was to assess the outcomes of radical cystectomy versus partial hepatectomy in the treatment of choledochal cysts. Methods: This was a retrospective analysis of 36 patients who had choledochal cysts and were treated with either a total cystectomy (n=30) or partial hepatectomy (n=6). Results: The groups that underwent radical cystectomy and partial hepatectomy had similar age ranges, sex distributions, and types of cysts. The majority of the cysts were type I (83.3% of the total cystectomy group) and type V (100% of the partial hepatectomy group). Other associations included: gallstones (26.7% vs. 83.3%) and Abnormal pancreatic biliary duct junction (APBDJ) (36.7% vs. 16.7%). An increased frequency of post-operative pain, jaundice, upper abdominal swelling, and fever was noted in the group that had a radical cystectomy. Minimal post-operative complications were seen in both groups. At 6 months, the rates of complications were similar, with hypertrophic scars being the most common (30.7% for radical cystectomy and 25% for partial hepatectomy). Conclusion: The groups that had radical cystectomy and partial hepatectomy were of similar demographics, cyst types, abnormalities, clinical traits, and complication rates post surgery and at 6 months. Both procedures are still good ways to treat choledochal cysts, and this small group doesn't clearly show which is better. To get a better idea of differences in long-term results, bigger studies are needed.

Total Cystectomy in the Management of Primary Retroperitoneal Echinococcal Cysts: Current Evidence and Future Directions.

Echinococcal cysts (ECs) are a significant public health concern globally, particularly in endemic regions. Among these, primary retroperitoneal echinococcal cysts (PRECs) present unique challenges due to their location and complex presentations. Total cystectomy, involving complete removal of the EC and surrounding tissue, is a surgical option for managing PRECs. However, evidence regarding its efficacy and safety is limited. We conducted a systematic review following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines to evaluate the role of total cystectomy in managing PRECs. A comprehensive search of databases yielded four relevant studies. These studies reported favorable outcomes following total cystectomy, including low recurrence rates and minimal postoperative complications. However, challenges such as technical complexity and proximity to vital structures were noted. Future research should focus on evaluating minimally invasive approaches, exploring adjuvant therapies, identifying predictors of recurrence, and assessing cost-effectiveness. This systematic review underscores the need for further investigation to optimize the management of PRECs and improve patient outcomes.

A wireless, implantable bioelectronic system for monitoring urinary bladder function following surgical recovery

Partial cystectomy procedures for urinary bladder-related dysfunction involve long recovery periods, during which urodynamic studies (UDS) intermittently assess lower urinary tract function. However, UDS are not patient-friendly, they exhibit user-to-user variability, and they amount to snapshots in time, limiting the ability to collect continuous, longitudinal data. These procedures also pose the risk of catheter-associated urinary tract infections, which can progress to ascending pyelonephritis due to prolonged lower tract manipulation in high-risk patients. Here, we introduce a fully bladder-implantable platform that allows for continuous, real-time measurements of changes in mechanical strain associated with bladder filling and emptying via wireless telemetry, including a wireless bioresorbable strain gauge validated in a benchtop partial cystectomy model. We demonstrate that this system can reproducibly measure real-time changes in a rodent model up to 30 d postimplantation with minimal foreign body response. Studies in a nonhuman primate partial cystectomy model demonstrate concordance of pressure measurements up to 8 wk compared with traditional UDS. These results suggest that our system can be used as a suitable alternative to UDS for long-term postoperative bladder recovery monitoring.

Extrahepatic and extrapulmonary hydatid cysts as primary lesions

Background: Hydatid cyst disease, caused by the larval stage of the parasite Echinococcus granulosus, commonly affects the liver and lungs but can also manifest in various extrahepatic and extrapulmonary locations. Splenic hydatid disease, despite being rare, is the third most common location. This paper presents a case series highlighting the clinical presentation, diagnostic challenges, and management strategies for patients with extrahepatic and extrapulmonary hydatid cysts. Several studies already postulated on sites of hydatid cysts which have statistically significant results. Methods: Patients who were operated on for hydatid disease or cystic lesions, which were later diagnosed as hydatid disease, between September 2022-August 2023 were retrieved retrospectively. Patients with lesions localized outside the liver and the lung as well as in liver and lung were enrolled in the study. Fifty-Two patients with extra-hepatic primary hydatid disease were treated surgically at our clinic. The cysts were located in different part of body. Results has undergone statistical methods like Z-test and Mann-Whitney U test. Any patient of any gender admitted with diagnosis of hydatid cyst in any part of body with age &gt;18 but less than 70 years irrespective of any comorbidities. Results: Surgical techniques like partial or total cystectomy with or without tube drainage are good option for management of extrahepatic and extrapulmonary primary hydatid cysts. There were no complications or mortality in the postoperative period. Hydatid cyst is considered in the differential diagnosis of cystic lesions, especially in endemic areas. Surgical technique planned according to the location of the cyst. Conclusions: Cystectomy is a surgical option in extrahepatic and extrapulmonary hydatid cyst which is evaluate better in this study.

Uterovesical Abscess as Late Cesarean Complication - a Case Report and Review of the Literature

Pelvic abscesses located in the uterovesical space usually appear postpartum after cesarean delivery. Late presentation after months or years following surgery is rarely reported, especially in immunocompetent patients. We report the case of a young patient presenting an abscess of the uterovesical pouch, infiltrated in the myometrium, posterior wall of the bladder and parametrium. The case particularities include limited identifiable predisposing risk factors, acute onset of symptoms and belated diagnosis eight years after her second cesarean. The abscess removal by laparotomy required extensive debridement, total hysterectomy, bilateral salpingectomy and partial cystectomy, with good outcome after surgical treatment. We highlight the importance of a mixt urogynecology team for individualized case management and we discuss similitudes with other late cesarean complications.

First reported human case of isolation of Vagococcus fluvialis from the urine of a former zoo clerk in Japan: a case report

BackgroundVagococcal infections are extremely rare in humans. There are limited studies on the optimal methods for identification, antimicrobial susceptibility testing, and clinical manifestations of vagococcal infections. Herein, we report a patient with a urinary tract infection who had Vagococcus fluvialis in the urine.Case presentationAn 84-year-old man presented to our urology department with a fever that had persisted for several days. He previously worked as a zoo clerk. The patient underwent a left nephroureterectomy for ureteral cancer 5 years ago, and total cystectomy and right cutaneous ureterostomy for muscle-invasive bladder cancer 1 year prior. He was empirically treated with 500 mg of levofloxacin intravenously every 24 h for the urinary tract infection. V. fluvialis was detected in his urine samples and Pseudomonas aeruginosa was detected in his urine and blood samples. Two bacterial species were identified using matrix-assisted laser desorption/ionization time-of-flight mass spectrometry. He was administered intravenous levofloxacin for approximately 1 week, followed by oral levofloxacin for another week, after which the infections were eradicated.ConclusionsTo the best of our knowledge, this is the first report of V. fluvialis detected in human urine in Japan. Vagococcus spp. is commonly isolated from fish or animals, and based on the patient’s work history, it is possible that the patient was a carrier because of transmission from animals.

A Troublesome Complication of Hydatid Cysts; Intra-Abdominal Rupture: A 10-Year Study from a High-Volume Center.

Hydatid cyst is a parasitic infection, often caused by Echinococcus granulosus. Although it is classified as a benign disease, cyst ruptures in the abdomen can be fatal. Ruptures occur spontaneously or after trauma. We aimed to report data from patients who underwent emergency surgery due to spontaneous intra-abdominal hydatid cyst rupture. Upon a retrospective review of the records at Department of General Surgery, Faculty of Medicine, Harran University, Şanlıurfa, Turkey, we found that 34 cases were operated on due to hydatid cyst rupture between January 2012 and October 2022. All patients were operated on in an emergency, and partial cystectomy, intra-abdominal irrigation, and drainage were performed using laparotomy. The patients were evaluated in terms of age, sex, symptoms, radiological findings, laboratory results, intraoperative findings, and postoperative follow-ups. Twenty-two (64.7%) female and 12 (35.3%) male patients were enrolled. The mean age was 39.1 (±17.58) years. All patients experienced spontaneous rupture. The ruptured cyst was found in the liver in 32 patients (94%), the spleen in 1 patient (3%), and the pelvis in 1 patient (3%). The diagnosis was determined using ultrasonography in 12 (35.3%) patients, computed tomography in 21 (61.8%) patients, and magnetic resonance imaging in 1 (2.9%) patient. All patients exhibited acute abdomen and leukocytosis. The average length of hospital stay was 5.14 (±1.37) days. Hydatid cyst rupture should be considered in cases of acute abdomen, particularly in regions where the disease is endemic, as in our region. The ruptured hydatid cyst was primarily observed in the liver (94.11% of cases).

Effect of Bacille Calmette-Guérin for Non-Muscle-Invasive Bladder Cancer After Prostate Radiotherapy.

Little is known about the impact of prior prostate radiation therapy (RT) on the Bacille Calmette-Guerin (BCG) immunotherapy response in patients with non-muscle invasive bladder cancer (NMIBC). We hypothesized that the damaging radiation effects on the bladder could negatively influence BCG efficacy. Men with a history of high-risk NMIBC were identified within the Surveillance, Epidemiology, and End Results-Medicare database. All patients completed adequate BCG defined as at least 5 plus 2 treatments completed within 12 months. Patients were stratified into 2 groups: with prior RT for prostate cancer and without prior RT before the diagnosis of NMIBC. The primary endpoint was a 5-year composite for progression defined as disease progression requiring systemic chemotherapy, checkpoint inhibitors, radical or partial cystectomy, or cancer-specific death. We identified 3,466 patients with NMIBC, including 145 with prior RT for prostate cancer. Five-year progression occurred in 471 patients (13.6%). Patients with prior RT were older than patients without prior RT (77.0 vs 75.0 years; P < .001). The distribution of T stage was significantly different at diagnosis between the RT and non-RT groups (RT: Ta, 44.8%; Tis, 18.6%; T1, 36.6%; without RT: Ta, 40.9%; Tis, 10.8%; T1, 48.3%; P = .002). No difference in the risk of total progression was observed between patients with and without prior RT (P = .67). Similarly, no difference was observed after multivariable adjustment (hazard ratio, 0.99; 95% CI, 0.61-1.58; P = .95). For patients with NMIBC who undergo adequate BCG treatment, prior RT for prostate cancer was not associated with worse 5-year progression-free survival.

Resultados quirúrgicos en mujeres diagnosticadas de endometriosis profunda con afectación urológica

IntroductionThe prevalence of endometriosis is estimated to be about 10% among women of reproductive age. In about 5-10% of these patients, involvement of urological structures will be developed due to deep endometriosis. Urologists should be familiar with the management of these patients, who will require multidisciplinary care with medical and surgical treatment. Material and methodsRetrospective study of patients diagnosed with deep endometriosis involving urological structures who underwent surgery performed jointly with gynecology and colorectal surgery departments from June 2012 until June 2021 (60 cases). Urologic symptoms were grouped into 3 groupers for subsequent analysis (storage symptoms, voiding symptoms, and low back pain). ResultsStorage symptoms (frequency and urgency) are the most frequent urologic symptoms. Patients with storage symptoms and low back pain showed improvement after surgery. In contrast, patients with voiding symptoms did not improve with surgical treatment. ConclusionsThe prevalence of endometriosis and the likelihood of involving urologic structures require the urologic community to be aware of the pathology.Patients with storage symptoms will improve following excision of the endometriotic nodules. The need for Partial cystectomies with ureteral reimplantation can be safely performed by laparoscopic or robotic approach, even in previously operated patients, without compromising long-term function.

Intraoperative neuromonitoring in surgery of cervical neurogenic tumors

Objective: To investigate the application value of intraoperative motor nerve monitoring in cervical neurogenic tumor surgery. Methods: The efficacy of intraoperative neuromonitoring (IONM) was analyzed retrospectively in 18 patients, including 6 males and 12 females, aged from 15 to 74 years, treated in Affiliated Drum Tower Hospital, Medical School of Nanjing University from June 2019 to September 2022 who underwent total cystectomy of cervical neurogenic tumors under intraoperative nerve monitoring. Results: All 18 patients had complete tumor removal, including 8 patients with tumors from the vagus nerve and 10 patients with tumors from the brachial plexus nerve. Postoperative nerve functions were normal in patients with tumors from brachial plexus nerve, and incomplete vocal cord paralysis occurred in 2 patients with tumors from vagus vagus nerve. The total incidence of motor nerve injury was 11.1% (2/18). All patients were followed up for 6 to 45 months, with no tumor recurrence. Conclusion: Intraoperative neuromonitoring has significant values in surgery of cervical neurogenic tumors, which is helpful to remove completely the tumors on the basis of protecting the nerve functions to the maximum extent.

Robotic Partial Cystectomy via a Transvesical Approach for Management of Bladder Cancer Within a Diverticulum

Robotic Partial Cystectomy via a Transvesical Approach for Management of Bladder Cancer Within a Diverticulum

Indications and results of total cystectomy to the Luxembourg University Teaching Hospital in Bamako

Indications and results of total cystectomy to the Luxembourg University Teaching Hospital in Bamako

Indirect inguinal herniation of the urinary bladder in a Shetland pony foal

SummaryA 6‐week‐old male Shetland pony was presented with pollakiuria and a scrotal mass. The diagnostic procedures conducted included a thorough clinical examination, external palpation, a scrotal ultrasonographic examination and urinary catheterisation. These revealed an indirect herniation of the urinary bladder into the tunica vaginalis. Subsequently, the case was managed surgically with a partial cystectomy through an inguinal approach. Bilateral castration was performed with an additional closure of the superficial inguinal ring. Five months post‐surgery, a routine telephone questionnaire highlighted no postoperative concerns. Gross examination of the inguinal region revealed no abnormalities and the foal was maturing as expected.

Comparison of urological outcomes and quality of life after pelvic exenteration: partial vs radical cystectomy.

To compare perioperative morbidity, functional and quality-of-life (QoL) outcomes in patients with partial cystectomy vs radical cystectomy as part of pelvic exenteration. Retrospective analysis of a prospectively maintained database of pelvic exenteration patients (1998-2021) was conducted in a single centre. Study outcomes included postoperative complications, quality-of-life, functional and stoma-related outcomes. The 36-item Short-Form Health Survey Physical and Mental Health Components, Functional Assessment of Cancer Therapy-Colorectal questionnaires and Distress Thermometer were available pre- and postoperatively. QoL outcomes were compared at the various time points. Stoma embarrassment and care scores were compared between patients with a colostomy, urostomy, and both. Urological complications were similar between both groups, but patients with partial cystectomy experienced less wound-related complications. Overall, 34/81 (42%) partial cystectomy patients reported one or more long-term voiding complication (i.e., incontinence [17 patients], frequency [six], retention [three], high post-voiding residuals [10], permanent suprapubic catheter/indwelling catheter [14], recurrent urinary tract infection [nine], percutaneous nephrostomy [three], progression to urostomy [three]). The QoL improved following surgery in both the partial and radical cystectomy groups, differences between cohorts were not significant. Patients with two stomas reported higher embarrassment scores than patients with one stoma, although this did not result in more difficulties in stoma care. Partial cystectomy patients have fewer postoperative wound-related complications than radical cystectomy patients, but often experience long-term voiding issues. The QoL outcomes are similar for both cohorts, with significant improvement following surgery.

Caregiver experiences of caring for family members with urostomy: a qualitative study.

In China, bladder tumors rank first for morbidity and mortality among urological and reproductive system tumors. Total radical cystectomy plus urinary flow conversion is the gold standard for the treatment of muscle-layer invasive bladder cancer. With an increasing number of radical cystectomies each year, the number of patients living with urostomy is growing. After discharge, primary care of urostomy patients is given at home, and high demands are placed on home caregivers due to issues of privacy and the complexity of replacing the urostomy device. This research explored the challenges faced by the family caregivers of urostomy patients. We used descriptive qualitative research methods to conduct interviews with twenty-five family caregivers of patients with urostomy. Survey subjects were from five general hospitals. All interviews were recorded, transcribed, and analyzed using thematic analysis. Three critical challenges were identified-confusion, family crisis, and struggle psychology. Within these three themes, six sub-themes wereconstructed by coders. They were knowledge and skill deficiency, strong insecurities and uncertainties, role conflict, economic burden, emotional overwhelmed and calm acceptance. Family caregivers play a critical role in patient care, and especially in urostomy care. Caregiving is associated with significant challenges that hinder the family caregiver's ability to effectively care for the patient, further diminishing the caregiver's quality of life. Therefore, healthcare professionals should consider the challenges faced by family caregivers and take measures to obviate them through education, preparation, and support.

Robotic Assisted En-Bloc Removal of Kidney, Ureter and Bladder Wall for Endometriosis

To highlight a case where a nephroureterectomy and partial bladder cystectomy needed to be done due to endometriosis. A video article demonstrating a case study and the surgical management. Ureteral endometriosis is a complex form of endometriosis [1]. If left untreated, the ureter can become significantly compressed leading to hydroureter, hydronephrosis and complete loss of kidney function [2]. This is a case of a 29-year-old patient with pelvic pain and cyclical rectal bleeding. Further investigation showed significant left hydronephrosis and almost complete loss of left kidney function (8% on renogram). MRI revealed endometriosis involving the posterior bladder wall and distal left ureter, a large full-thickness sigmoid nodule and a large left endometrioma. The patient underwent a robotic-assisted left nephroureterectomy, partial cystectomy (bladder), excision of pelvic endometriosis and sigmoid resection. This procedure was performed jointly with the gynecologist, urologist, and colorectal surgeon and the SOSURE technique was employed [3]. The specimen (left kidney, whole length of ureter and bladder wall around ureteric orifice) was removed en-bloc through a small 3cm extension of the umbilical incision. As the distance between the sigmoid nodule and the anal verge was 35cm, which was above the limit of the transanal circular stapler, a limited resection was performed over a discoid excision. The patient made a good recovery postoperatively. Ureteral endometriosis is an indolent and aggressive condition which can lead to silent kidney loss. It is essential that hydronephrosis and hydroureter is ruled out in cases with deep endometriosis. Isolated hydronephrosis should also prompt a suspicion for endometriosis.

Clinical efficacy analysis of partial cystectomy and radical cystectomy in the treatment of muscle-invasive sarcomatoid carcinoma of the urinary bladder.

This study compares the clinical efficacy of partial cystectomy (PC) versus radical cystectomy (RC) in the treatment of muscle-invasive bladder urothelial carcinoma (SCUB) through a retrospective analysis. We retrospectively analyzed the clinical data of 20 patients diagnosed with muscle-invasive SCUB from July 2015 to August 2023 at Ganzhou People's Hospital. All patients underwent surgical treatment followed by chemotherapy, with 9 receiving PC and 11 undergoing RC. We compared the average survival time of deceased patients for both treatments and conducted survival and multivariate analyses using the Kaplan-Meier method and Cox proportional hazards model, respectively. All 20 patients were postoperatively diagnosed with muscle-invasive SCUB and were followed up for 4 to 60 months. The average survival time for patients undergoing PC was 11.5 months, with survival rates at 1 year, 2 years, and 5 years of 55.56%, 22.22%, and 11.11%, respectively. In contrast, patients receiving RC had an extended average survival time of 22.5 months, and their 1-year, 2-year, and 5-year survival rates increased to 63.64%, 36.36%, and 18.18%, respectively. Survival analysis revealed statistically significant differences in prognosis between PC and RC for the treatment of muscle-invasive SCUB (P<0.05). SCUB is a rare malignant tumor with unique biological characteristics often associated with poor prognosis. Upon diagnosis, RC should be considered as an early treatment approach when the patient's overall condition permits.