Cystectomy Research Articles

Delayed Detection and Immediate Repair of Iatrogenic Ureteral Injury in Laparoscopic Anterior Resection with Partial Cystectomy: Lessons Learned

Objective: This video intends to illustrate the pitfalls during laparoscopic anterior resection with partial cystectomy, causing ureteral injury, and why a delayed detection occurred. Material and Methods: A 72-year-old male with T4 rectosigmoid colon cancer involving the bladder underwent laparoscopic anterior resection with partial cystectomy. Postoperatively, urinary leakage raised concern for bladder leakage, prompting conservative management for 2 weeks. Persistent leakage led to further investigation. A CT scan with cystography revealed an iatrogenic left ureteral injury without bladder leakage. The patient immediately underwent repair in the third postoperative week. This video highlights the operative challenges encountered during our review.Results: The diagnosis of ureteral injury was initially obscured by the suspicion of bladder leakage following a partial cystectomy. The delayed diagnosis occurred due to the initiation of conservative management. After detecting the injury, the patient immediately underwent left ureteric re-implantation and experienced an uneventful discharge in the second postoperative week. A video review revealed challenging aspects that could provide vulnerable insights for future procedures.Conclusion: During concomitant partial cystectomy, the ureters must be identified clearly. The suspicion of bladder leakage post-cystectomy can obscure iatrogenic ureteral injury. Delayed diagnosis of ureteral injury can be promptly repaired in cases where the preceding operation utilizes a laparoscopic approach, which is associated with less intraabdominal adhesion.

A severe case of the bladder inversion treated by total cystectomy and hysterectomy with ileal conduit

IntroductionFemale pelvic organ prolapse (POP) is considered a borderline disease between urology and gynecology and is treated by reconstructive surgery, which restores the organs to their original positions.Case presentationAn 82‐year‐old woman with bladder and uterine prolapse at POP‐Q Stage IV was treated with an indwelling catheter for voiding dysfunction. Eventually, the catheter has been often spontaneously removed when pelvic organ prolapse occurs, resulting in a diagnosis of bladder inversion. Because of bladder inversion and low bladder capacity at the time of bladder retraction, the patient underwent total cystectomy, combined with total hysterectomy, colpopexy, and posterior colporraphy, and ileal conduit.ConclusionThe cases of complete bladder and uterine prolapse combined with bladder inversion, total hysterectomy, colpopexy, posterior colporraphy, and ileal conduit were performed safely. Considering urinary function, surgery without organ preservation with urinary diversion may be an option.

Differential Analysis of Surgical Treatment Modalities in T2N0M0 Bladder Cancer Patients: A Novel Propensity Score-Based Cohort Study

ObjectiveThis study explored prognostic differences between radical cystectomy (RC), tri-modality treatment (TURBt combined with radiotherapy and chemotherapy, TMT) and electrocautery (EC) and partial cystectomy (PC) for T2N0M0 MIBC. Materials and MethodsIn the SEER database (2004-2015, 2018-2020), we identified patients with T2N0M0 bladder cancer receiving RC, TMT, EC or PC treatment. To minimize confounding factors, 1:1 propensity score matching (PSM) with a 0.1 caliper was conducted. Kaplan-Meier analysis and log-rank tests were used to compare survival rates. Cox analysis identified independent prognostic factors, tumor size, and age, stratified treatment groups, and further Kaplan-Meier analysis of CSS was performed in matched cohorts. ResultThis study included 6526 patients with T2N0M0 MIBC. Among them, 348 (5.33%) were in the PC group, 309 (4.73%) were in the EC group, 1833 (28.09%) were in the TMT group, and 4036 (61.84%) were in the RC group. After 1:1 propensity score matching, RC showed improved CSS (HR=0.67, 95%CI 0.47-0.95, and PC also benefited (HR=0.97, 95%CI 0.69-1.36) compared to EC. While TMT showed a worse end (HR=1.41, 95%Cl 1.03-1.92) compared to EC. Cox analysis was used to stratify tumor size and age for subgroup analysis. Results for tumor size subgroups were aligned with PSM findings. In the age-stratified subgroups, patients aged <67 years, both RC (HR=0.54, P=0.107) and TMT(HR=0.91, P=0.785) showed better prognoses compared to EC treatment, while PC treatment showed worse prognoses compared to EC treatment (HR=1.23, P=0.542).; for 68-77 years, RC (0.64, P=0.1436) and PC (HR=0.46, P=0.0283)had advantages, and PC is more recommended. For >78 years, RC had superior CSS over EC and PC, whereas TMT had the poorest prognosis. ConclusionIn clinical T2N0M0 MIBC, overall, RC outperformed focal-tumor therapy and PC, irrespective of tumor size. However, considering age, we recommend PC treatment for patients aged 68-77 and EC for those aged >78 years. Micro-AbstractThis study compared radical cystectomy (RC), focal-tumor therapy combined with radiotherapy and chemotherapy (TMT and EC), and partial cystectomy (PC) for non-metastatic muscle-invasive bladder cancer. Using SEER data and a series of statistical analyses, overall, RC outperformed focal-tumor therapy and PC, irrespective of tumor size. However, considering age, we recommend PC treatment for patients aged 68-77 and EC for those aged >78 years. In contrast, for patients younger than 67 years of age, we recommend RC for those who can tolerate surgical treatment and TMT for those who can't.

Successful Management of Incompletely Resected Transitional Cell Carcinoma with Sorafenib Tosylate in a Dog.

Most urinary bladder (UB) tumors are malignant, and transitional cell carcinoma (TCC) is the most common neoplasm affecting the UB in dogs. Sorafenib may be a potential therapeutic agent for canine TCC. A 12 yr old spayed female Maltese dog weighing 3.6 kg and with a history of hematuria was referred for a suspected UB tumor. Abdominal ultrasonography revealed a UB mass attached to the cranioventral wall. The remaining abdominal examinations, including that of the lymph nodes, were unremarkable. Ultrasound-guided traumatic catheterization of the UB mass was performed, and the cytological evaluation of the UB mass indicated TCC. Excision was performed by partial cystectomy, and histopathology confirmed TCC, although the tumor had infiltrated the surgical margins. A chemosensitivity assay was conducted using tissue from the excised tumor. Sorafenib tosylate, a tyrosine kinase inhibitor, showed the greatest effect in the chemosensitivity assay. Therefore, adjuvant chemotherapy with sorafenib tosylate and piroxicam was administered postoperatively. The dog lived without any clinical signs, including hematuria or tumor relapse, for more than 2 yr after the surgery. This is the first report of successful long-term management of TCC with sorafenib tosylate in a dog.

Efficiency of Anatomical Hepatectomy in the Treatment of Hepatic Cystic Echinococcosis.

Introduction: Total cystectomy and hepatectomy are the main radical surgical procedures for hepatic cystic echinococcosis (CE). When CE lesions severely invade intrahepatic biliary ducts and vessels or single or multiple lesions occupy one hepatic lobe, performing total cystectomy is not indicated. This study aimed to analyze the clinical efficiency of anatomical hepatectomy in the treatment of patients with hepatic CE. Methods: Clinical data of 74 patients with hepatic CE who received anatomical hepatectomy were retrospectively analyzed from January 2005 to January 2022. The patients were classified into the intrahepatic biliary duct invasion group (group A), the intrahepatic vessel invasion group (group B), and the hepatic lobe occupation group (group C). Results: Among these 74 patients who received anatomical hepatectomy, right hepatectomy was performed in 20 cases (27.03%), left hepatectomy in 26 cases (35.13%), right posterior lobectomy in nine cases (12.16%), and left lateral sectionectomy in 19 cases (25.68%). Short-term post-operative complications occurred in seven cases (9.50%), including abdominal abscess in one case, pleural effusion in three cases, intestinal obstruction in one case, incision infection in one case, and ascites in one case. Long-term post-operative complications occurred in four cases (5.4%), including recurrences of CE in two cases and incisional hernias in another two cases. There were no statistical differences in the concentrations of total bilirubin, alanine aminotransferase, and aspartic transaminase before and after surgery between groups (p > 0.05). However, differences in operative time, short-term post-operative complications, average hospital stay, and number of open hepatectomy cases were statistically significant between groups (p < 0.05). The differences in cases receiving hepatic portal occlusion, intra-operative blood loss, and intra-operative blood transfusion were not statistically significant between groups (p > 0.05). Conclusions: Anatomical hepatectomy is an effective and feasible surgical procedure for patients with hepatic CE with severe invasion of intrahepatic biliary ducts and vessels or patients with huge lesions occupying one hepatic lobe, which effectively avoids residual cavity-related complications.

Colon Cancer With Bladder Invasion: A Single Center Experience.

The aim of our study was to investigate the outcome of colon cancer with bladder invasion after surgical intervention. Between 2011 and 2022, a total of 41 patients diagnosed with colon cancer and bladder invasion underwent surgical procedures at Taichung Veterans General Hospital. The impact of various risk factors on overall survival (OS) was assessed using Kaplan-Meier analyses and Cox proportional hazards models. Among the enrolled patients, 21 underwent radical cystectomy, while 20 underwent partial cystectomy. Twelve had tumors located in the rectum, 19 in the sigmoid colon, and 10 in both the rectum and sigmoid colon. The median OS was 71.8 months in stage 2, 50.8 months in stage 3, and 11.2 months in stage 4 (p=0.061). Median OS was 71.8 months in patients with negative surgical margins and 10.5 months in those with positive surgical margins (p=0.003). In multivariate regression analysis, positive surgical margins [hazard ratio (HR)=3.64, 95% confidence interval (CI)=1.28-10.34, p=0.015] and emergency operations (HR=4.57, 95%CI=1.34-15.55, p=0.015) significantly impacted OS. Complete resection of colon cancer with bladder invasion can yield excellent oncologic outcomes. The decision between partial and radical cystectomy should balance surgical margin clearance and the preservation of quality of life. Both surgical margin involvement and emergency operations are independent risk factors for OS.

Treatment and survival of non-metastatic small cell carcinoma of the bladder from multiple centers in China

Small cell carcinoma of the bladder (SCCB) is a rare, highly malignant neuroendocrine tumor. This study attempted to analyze tumor characteristics, treatments and clinical outcomes in China. We conducted a retrospective analysis of patients diagnosed with non-metastatic SCCB at multi-institutions between January 2007 and January 2022. The Kaplan-Meier method was used to calculate survival. A total of 20 patients were included. 10 had localized disease (T1-2N0), and 10 had locally advanced disease (≥ T3 or N+). 13 received local treatment (partial cystectomy or transurethral resection of the bladder tumor) and 7 received radical treatment (radical cystectomy or radiotherapy). A total of 18 patients (90%) received chemotherapy (CT), either neoadjuvant CT (n = 5) or adjuvant CT (n = 13). The median OS for the receiving local treatment was 65.3 months (95% CI 0 to 138 months) and the corresponding 1-year, 2-year, and 3-year OS was 77%, 54%, and 54%, respectively. The median OS for the receiving radical treatment was not reached and the corresponding 1-year, 2-year, and 3-year OS was 100%, 100%, and 75%, respectively. The median PFS for receiving local treatment was 13.8 months (95% CI 9.3 to 18.3 months) and the corresponding 1-year, 2-year, and 3-year PFS was 46%, 31%, and 31%, respectively. The median PFS for the receiving radical treatment was not reached and the corresponding 1-year, 2-year, and 3-year PFS was 83%, 56%, and 56%, respectively. This study reported the largest cohort of non-metastatic SCCB among Chinese population. Given its metastatic potential, CT remained an essential part of the treatment. The survival outcomes of radical cystectomy and RT in non-metastatic SCCB were encouraging.

Factors Influencing Postoperative Recurrence and Live Birth Achievement after Laparoscopic Surgery for Ovarian Endometrioma: A Retrospective Study in a Regional Core Hospital

Background: Ovarian endometrioma (OMA) is a common gynecological condition affecting women of reproductive age, often requiring laparoscopic surgery for removal. However, the management of OMA, including postoperative hormone therapy, is complex and must be tailored to the individual's conditions. Therefore, to provide meaningful insights, we aimed to analyze 10 years of accumulated data from patients who underwent laparoscopic surgery for OMA, with a primary focus mainly on postoperative OMA recurrence and live birth outcomes. Methods: We reviewed the medical records of 158 patients who underwent laparoscopic surgery for OMA, including total laparoscopic cystectomy (TLC) (79 patients), total laparoscopic adnexectomy (TLA) (62 patients), or both unilateral TLA and contralateral TLC (17 patients), between January 2014 and December 2023. Among the OMA patients, we identified 7 cases of postoperative OMA recurrence out of 158 patients, and 23 live births among 79 TLC patients. We performed a multivariate logistic regression analysis to assess the impact of each representative factor on postoperative OMA recurrence and live birth achievement. Results: The multivariate analyses of the 158 patients revealed that advance age and massive blood loss were significantly associated with an increased risk of postoperative OMA recurrence, while postoperative hormone treatment was associated with a decreased risk of recurrence. In the analysis of live birth achievement among the 79 TLC patients, advanced age, postoperative hormone treatment and cancer antigen 125 (CA125) positivity were significantly associated with a reduced likelihood of achieving live birth. Conclusions: Our data highlight the unfavorable effects of advanced age, massive blood loss and CA125 positivity on the outcomes of laparoscopic surgery for OMA. Additionally, postoperative hormone treatment was found to decrease postoperative OMA recurrence. These findings may offer more accurate information to guidance in selecting treatment options for patients with OMA.

Management of a liver hydatid cyst patient who fistulized the diaphragm and subsequently presented with thorax rupture: a case report

Hydatid cysts, caused by Echinococcus species, are zoonotic diseases frequently observed in endemic regions worldwide, including Turkey. It is most commonly localized in the liver, followed by the lungs. Anaphylaxis and peritonitis, which develop after cyst rupture, are the most significant complications observed in these patients. Early diagnosis and prompt surgical intervention are extremely important. This study presented an extremely rare case of a hepatic hydatid cyst ruptured into the thorax, which may have high morbidity and mortality. A 24-year-old male patient presented to our emergency department with cough, dyspnea, fever, and allergy symptoms. He had a history of hepatic hydatid cyst surgery 5 years ago. Physical examination revealed urticarial lesions on the skin. The body temperature was 39 °C, and the pulse rate was 120 beats/min. Laboratory tests revealed leukocytosis and elevated C-reactive protein. Contrast-enhanced thoracic and abdominal computed tomography was performed. Diagnostic tests revealed that the patient had a ruptured hepatic hydatid cyst in the right thoracic cavity; hence, he was scheduled for emergency surgery. Laparotomy was performed via a right subcostal incision, and the ruptured cyst was located. It was understood that this cyst had fistulized into the diaphragm during a chronic process and subsequently ruptured acutely into the thorax. Partial cystectomy was performed for a ruptured liver cyst. The diaphragm was repaired, and catheters were placed in the thorax and abdomen for drainage. There were no other postoperative complications. Rupture of hydatid cyst disease is frequently observed in endemic regions. The rupture of a hepatic hydatid cyst into the thorax is an extremely rare event. In patients presenting with pulmonary symptoms who have a history of hepatic hydatid cyst surgery, the abdomen should always be thoroughly evaluated, and emergency surgery should be performed if required.

Analysis of 15 children with type Ⅳ branchial cleft cyst treated with endoscopic transoral approach

Objective: To analyze the clinical characteristics and endoscopic surgical procedures of the second branchial cleft cyst type Ⅳ in children. Methods: A retrospective review was conducted on 15 pediatric cases with type Ⅳ second branchial cleft cysts treated at the Beijing Children's Hospital affiliated with Capital Medical University and Henan Children's Hospital from September 2019 to November 2023. All patients underwent excision via a two-person, three-hand endoscopic transoral approach. The cohort included 12 males and 3 females, with an age range of 10 months to 10 years and 5 months, and a median age of (59.20±32.05) months. The clinical data of initial symptoms, sides, imaging features, treatment methods, complications, length of hospital stay, prognosis and outcome were recorded and analyzed. SPSS 22.0 software was used for statistical analysis. Results: Of the 15 children, 13 cases presented with snoring as the primary symptom, 1 case with dysphagia, and 1 case was asymptomatic and was found unintentionally. The mean disease duration was (6.74±9.05) months (range, from 3 days-2 years). MRI revealed cystic lesions on the right side in 12 cases and on the left side in 3 cases, characterized by uniform long T2 signal, equal T1 or short T1 signal. The cysts appeared dumbbell-shaped in 10 cases with the pharyngeal constrictor muscle as the waist, the posterior outside of the mass was adjacent to the internal carotid artery. The remaining 5 cases showed an isolated cyst located inside the pharyngeal constrictor muscle. The intraoperative MRI findings were consistent. Partial cystectomy was performed in 10 cases near the internal carotid artery, leaving only the portion with a clear arterial pulse intact. Five cases with isolated cysts on the medial side of the pharyngeal constrictor muscle were totally removed. The average length of hospital stay was (4.53±0.52) days (4-5 days). All patients were followed up for 7-56 months [median (30±15.12) months] with no recurrence of symptoms observed. Conclusions: The second branchial cleft cyst type Ⅳ in children is characterized by prominent pharyngeal cystic mass, with snoring as a predominant initial symptom, MRI provides excellent diagnostic value. The two-person, third-hand endoscopic transoral approach for cyst excision is feasible, safe, and offers the benefits of minimal invasiveness and reduced hospitalization time.

Surgical use of fascia lata grafts as bladder wall substitutes after partial cystectomy in dogs

Surgical use of fascia lata grafts as bladder wall substitutes after partial cystectomy in dogs

Patent urachus with subcutaneous communication and ventral abdominal swelling in a domestic short‐hair cat

AbstractA 3‐month‐old, male, entire, domestic shorthair kitten underwent investigations for stranguria and haematuria, and was diagnosed with a urinary tract infection secondary to a suspected extramural vesicourachal diverticulum. Lower urinary tract signs resolved with a 14‐day course of amoxicillin clavulanate. Three months later, the kitten re‐presented for investigation of acute onset ventral abdominal discomfort and bruising. On presentation, clinical examination revealed omphalitis and subcutaneous bruising, with no evidence of an umbilical stoma. Ultrasonography demonstrated a patent urachus communicating with the subcutaneous tissue space, resulting in accumulation of urine at the level of the umbilicus. A ventral midline coeliotomy was performed to allow resection of the urachal remnant, including a partial cystectomy. The cat was urinating normally within 10 hours postoperatively, and the wound healed without complication. No postoperative complications or recurrent lower urinary tract signs were reported at follow‐up (312 days).

EP118 - Chronic Vesicouterine Fistula (Youssef's syndrome) Complete Opening of Anterior Uterine Wall in the Urinary Bladder: A- very rare case

Abstract Background Vesicouterine fistula is an uncommon urogenital condition typically following Caesarean sections (C/S). Youssef syndrome, characterized by haematuria, amenorrhea, and urinary incontinence, poses a diagnostic challenge and demands comprehensive assessment. Case report We present a case of a 40-year-old woman with persistent urine incontinence and haematuria for three years post her fourth C/S. Clinical evaluation revealed periodic lower abdominal pain, haematuria, amenorrhea, and urine incontinence. sonography was normally reported, while cystoscopy revealed a complete 5x2 cm opening between the anterior uterine wall and the posterior bladder wall, confirming Youssef syndrome. After a course of antibiotic therapy, surgical intervention was planned. Transabdominal total hysterectomy, partial cystectomy, and repair were performed following meticulous anatomical delineation using cystoscopy. The procedure involved dissecting the vesicouterine attachment, performing partial cystectomy, and eventually total hysterectomy. Closure of the urinary bladder defect with absorbable sutures and a negative leak test concluded the surgery. The patient showed no postoperative complications, with follow-ups at 6 and 12 months indicating complete recovery without complaints.

The prognostic impact of tumor location in nonmuscle-invasive bladder cancer patients undergoing transurethral resection: insights from a cohort study utilizing Chinese multicenter and SEER registries.

Most bladder cancers are nonmuscle invasive bladder cancer (NMIBC), and transurethral resection of bladder tumors (TURBT) is the standard treatment. However, postoperative recurrence remains a significant challenge, and the influence of bladder tumor location on prognosis is still unclear. This study aims to investigate how tumor location affects the prognosis of NMIBC patients undergoing TURBT and to identify the optimal surgical approach. A multicenter study was conducted, which included Chinese NMIBC data from 15 hospitals (1996-2019) and data from 17 registries of the Surveillance, Epidemiology, and End Results database (SEER) (2000-2020). Patients initially diagnosed with NMIBC and undergoing TURBT or partial cystectomy were analyzed, with cases lost to follow-up or with missing data excluded. The study investigated the overall survival (OS), disease-specific survival (DSS), and recurrence-free survival (RFS) among patients with different tumor locations. Kaplan-Meier, Cox regression, and propensity score matching methods were employed to explore the association between tumor location and prognosis. Stratified populations were analyzed to minimize bias. This study included 118477 NMIBC patients and highlighted tumor location as a crucial factor impacting post-TURBT prognosis. Both anterior wall and dome tumors independently predicted adverse outcomes in two cohorts. For anterior wall tumors, the Chinese cohort showed hazard ratios (HR) for OS of 4.35 ( P <0.0001); RFS of 2.21 ( P <0.0001); SEER cohort OS HR of 1.10 ( P =0.0001); DSS HR of 1.13 ( P =0.0183). Dome tumors displayed similar trends [Chinese NMIBC cohort OS HR of 7.91 ( P <0.0001); RFS HR of 2.12 ( P <0.0001); SEER OS HR of 1.05 ( P =0.0087); DSS HR of 1.14 ( P =0.0006)]. Partial cystectomy significantly improved the survival of dome tumor patients compared to standard TURBT treatment ( P <0.01). This study reveals the significant impact of tumor location in NMIBC patients on the outcomes of TURBT treatment, with tumors in the anterior wall and bladder dome showing poor post-TURBT prognosis. Compared to TURBT treatment, partial cystectomy improves the prognosis for bladder dome tumors. This study provides guidance for personalized treatment and prognosis management for NMIBC patients.

VJY08 Novel use of near infrared fluorescence imaging in guiding robotic partial cystectomy for bladder adenocarcinoma

VJY08 Novel use of near infrared fluorescence imaging in guiding robotic partial cystectomy for bladder adenocarcinoma

A comparative study of survival outcomes between partial and radical cystectomy in octogenarians with muscle-invasive bladder cancer.

Neoadjuvant chemotherapy with radical cystectomy (RC) is the preferred first-line treatment for localized muscle-invasive bladder cancer (MIBC). Due to the concern about morbidity associated with RC, the elderly population considers bladder preservation alternatives. Guidelines suggest partial cystectomy (PC) can be considered a viable option in carefully selected individuals. We used the National Cancer Database (NCDB) to compare the overall survival (OS) among octogenarians treated with PC and RC. Using NCDB, we retrospectively evaluated individuals aged 80 years and above diagnosed with localized MIBC (cT2-4aN0M0) with tumor size less than 5 cm and urothelial histology between 2004 and 2018. Our primary cohort was divided into the RC cohort, which included patients who underwent RC with or without chemotherapy/radiotherapy, and the PC cohort, which included those who underwent PC. After propensity-matching, we compared the OS. Of 94,104 patients with MIBC, 2,528 octogenarians met our selection criteria. Among them, 313 were treated with PC, and 2,215 were treated with RC. A total of 151 (48.2%) PC patients had pelvic lymph node dissection, while 1,967 (88.8%) RC patients had lymph node dissection (P<0.001). The OS for matched PC and RC was 33.4 and 29.9 months, respectively (P=0.68). In T2 tumors, the OS for PC and RC was 37 and 33.5 months, respectively (P=0.52); for T3 tumors, the OS was 22.3 and 24.4 months, respectively (P=0.98). Our study compared PC and RC in octogenarians with localized MIBC and observed that PC is safe and not inferior to RC in carefully selected octogenarians. The role of PC needs further exploration by comparing or integrating with strategies like concurrent chemoradiation to improve the oncological and survival outcomes.

Impact of Age, Period, Cohort, Region, Race, and Health Services on Bladder Cancer Mortality in Brazil: A 23-Year Ecological Study.

Bladder cancer is one of the most economically costly types of cancer, but few studies have evaluated its mortality considering the factors that impact this outcome. This study aimed to investigate the impact of sociodemographic factors, period, cohort, and health services on bladder cancer mortality. This ecological study analyzed bladder cancer mortality data in Brazil from 2000 to 2022 and evaluated sociodemographic variables (race, region of residence), socioeconomic variables (gross domestic product per capita, Gini index of household income per capita, number of health professionals per inhabitant, expenditure on public health services, and consultations per inhabitant), and bladder cancer diagnosis and treatment procedures. These data were subjected to statistical analysis, which revealed that after the age of 50, there was a progressive increase in the risk of bladder cancer. Indigenous people had the lowest mortality rate, while white people had a significantly greater mortality rate than black and brown people. The North Region and Northeast Region presented the lowest mortality rates, whereas the South Region presented the highest mortality rates. In the South and Southeast Regions, a higher GDP was related to lower mortality. In the South, higher mortality was associated with a lower number of consultations per inhabitant per region. Fewer bladder punctures/aspirations and bladder biopsies were associated with higher mortality rates. In oncology, more procedures, such as total cystectomy, cystoenteroplasty, and total cystectomy with a single shunt, do not reduce the mortality rate. These results can serve as guidelines for adjusting public health policies.

Urachal adenocarcinoma in an adolescent boy: a case report

BackgroundUrachal carcinoma is an extremely rare malignant tumor originating from the urachus. Urachal adenocarcinoma has never been reported in patients under 20 years of age. In this case, we describe a 15-year-old patient with urachal adenocarcinoma and propose possible risk factors.Case presentationThe patient presented with hematuria for two months and dysuria for one month, and had a history of smoking and alcohol consumption for three years. Ultrasonography showed an irregular mass on the anterior wall of the bladder. Contrast-enhanced computed tomography revealed a pedicled soft tissue mass measuring 2.6×2.4 cm within the bladder, showing significant enhancement. Partial cystectomy was conducted, and a histopathological diagnosis of urachal adenocarcinoma (T2N0M0) was made. During eight months of follow-up, the patient remained asymptomatic with no evidence of recurrence.ConclusionsUrachal remnants may lead to urinary symptoms and the development of urachal carcinoma. A history of smoking and alcohol consumption could be possible risk factors for urachal adenocarcinoma in this case. It is possible that urachal remnants can undergo malignant transformation, even at ages as young as 15 years. Regular follow-up should be recommended for patients whose urachal remnants persist beyond childhood.

Recurrent symptomatic abdominopelvic cystic lesions of unknown etiology treated with image-guided sclerotherapy: A case report

This case report highlights the diagnostic approach and treatment for 30 cm bilateral multiloculated pelvic peritoneal cystic masses. The patient had a history of spina bifida with ventriculoperitoneal shunt placement and neurogenic bladder with partial cystectomy and ileal conduit diversion. The cysts were suspected to be peritoneal inclusion cysts. Due to prior failed surgical intervention, the patient was treated with image-guided sclerotherapy.

Metastasis of malignant melanoma to urinary tract: a case report

IntroductionMetastasis of malignant melanoma to urinary tract is reported to be rare. According to retrospective analysis of a single center study, improvement of overall survival was observed in patients with metastasis to the gastrointestinal tract that had undergone metastasectomy with curative intent. However, there is no significant evidence regarding resection for metastasis to urinary tract.Case presentationCase 1: an 86-year-old Japanese man was diagnosed with a small bladder tumor by computed tomography scan during post operative follow-up of malignant melanoma in the choroid of the left eye. Cystoscopy revealed black, nonpapillary tumors, suggesting metastatic malignant melanoma. Because no apparent invasive growth to muscle layer was observed by magnetic resonance imaging, transurethral resection was performed. Pathological appearance was compatible with metastatic malignant melanoma. No recurrence in urinary tract was observed; however, multiple liver metastasis was diagnosed at 3 months after surgery. Case 2: a 57-year-old Japanese man was diagnosed with right hydronephrosis due to ureteral tumor. He had a past history of subungual malignant melanoma to the left thumb 2 years prior to his visit. Right nephroureterectomy was performed, and pathological evaluation revealed metastatic malignant melanoma. He revisited 2 years later due to dysuria, and a large bladder tumor was revealed by ultrasound. Cystoscopy showed black-colored nonpapillary tumor, suggesting malignant melanoma. Total cystectomy was recommended; however, the patient withheld consent. Therefore, we performed transurethral resection. The resulting pathological finding was compatible with metastatic malignant melanoma without invasion to muscle layer. He remained free from local recurrence and metastasis for 22 years after surgery.ConclusionWe successfully performed metastasectomy for bladder and ureteral metastases without recurrence in the urinary tract. Long recurrence-free survival was observed in case 2. Complete resection for metastasis of malignant melanoma may have the potential to improve survival.