Cystectomy Research Articles

Trends of Lymph Node Outcomes in Partial Cystectomy for Muscle-Invasive Urothelial Carcinoma of the Bladder

IntroductionLocal tumor invasion depth has been associated with lymph node metastasis in urothelial carcinoma, and, for muscle-invasive bladder cancer (MIBC), pelvic lymph node dissection (PLND) is a critical step in curative surgery. Gold standard treatment includes radical cystectomy (RC), but partial cystectomy (PC) is an important bladder-preserving modality reserved for patients with certain favorable prognostic indicators. There is poor evidence concerning the utility of PLND in PC and we seek to further define its role by comparing survival outcomes when PLND was cursory or omitted. MethodsA retrospective analysis of 13,652 cT2N0M0 patients who underwent PC or RC between 2004 and 2016 was performed using the National Cancer Database. Patients undergoing PC were stratified by the presence of PLND as well as by node yield >15. The primary outcome was overall survival, analyzed using the Kaplan-Meier Method and multivariable Cox-proportional hazards regression. Multivariable models were adjusted for confounding clinicopathologic variables. ResultsFrom 2004 to 2016, PLND in PC increased from 44% to 57% with RC remaining over 90%. Compared to RC, PC was approximately twice as likely to be performed at community centers and approached laparoscopically/robotically (P < .001). When stratifying PC PLND yield into 1 to 15 and > 15 compared to PC without PLND, the adjusted hazard ratios for overall mortality were 0.78 and 0.54, respectively (P < .05). ConclusionsPC patients had a significantly lower rate of PLND compared to RC and improved survival when performed versus PC alone. Furthermore, increased node yield was associated with a larger reduction of adjusted mortality hazard. For MIBC patients that are appropriately selected for PC, high-yield PLND should be prioritized given the significantly improved survival outcomes.

Surgical care and outcomes in older patients with cancer through implementation of a pre-surgical toolkit (OPTI-Surg): Interim results of a phase III cluster randomized trial (Alliance A231601CD).

1541 Background: Frailty is common in older adults undergoing major cancer surgery. Mounting evidence indicates multimodal interventions to optimize patient functional status by addressing vulnerabilities associated with frailty before surgery result in decreased complications and enhanced functional recovery. This study tested the effectiveness of OPTI-Surg, a surgical prehabilitation toolkit for improving surgical care and outcomes in older patients undergoing major cancer surgery. Here, we report results from the planned futility interim analysis (IA). Methods: Thoracic (T), gastrointestinal (GI), and urologic (GU) oncological surgery practices affiliated with NCI’s Community Oncology Research Program were randomized 1:1:1, stratified by practice type, to usual care (control), OPTI-Surg toolkit, or OPTI-Surg with an implementation coach. The toolkit was implemented at the practice level. It consisted of the 12-item Edmonton Frail Scale and guided recommendations for interventions directed at identified vulnerabilities. Eligible patients were adults ≥70 years old undergoing curative intent surgery for lung, gastrointestinal, or urologic cancers. Primary outcome was 8-week post-operative function (weekly caloric expenditure) derived from the validated Community Healthy Activities Model Program for Seniors (CHAMPS) questionnaire. A linear mixed model was used to compare usual care to the 2 OPTI-Surg arms combined, controlling for baseline function. Results: From July 2019 to October 2021, 225 patients, 50% of the total accrual goal, were enrolled from 29 practices, triggering the IA. Study was suspended to new patient accrual March to June 2020 due to the COVID-19 pandemic. There were no differences in demographics by arm (mean age 76.2 years; 46.4% women; 79.6% white; 20.4% lung resection, 69.8% major GI surgery, 9.8% total cystectomy). Of the 225 patients, 140 (47 Usual Care, 93 OPTI-Surg) were evaluable for the IA. There was no significant difference in post-operative function between OPTI-Surg and usual care (mean decrease of 0.59 kCal/week for OPTI-Surg patients and 0.19 kCal/week for usual care patients, p = 0.762, intraclass correlation = 0.033). Based on the futility analysis, the DSMB recommended closure of recruitment on September 16, 2022. Conclusions: Implementation of the OPTI-Surg toolkit did not significantly improve functional outcomes 8 weeks after surgery for patients aged 70 and older undergoing major cancer surgery compared to usual care. Future analysis of implementation and ethnographic data may identify reasons why significant differences between the intervention and usual care arms were not observed, potentially including disruptions due to the COVID-19 pandemic. Clinical trial information: NCT03857620 .

Preservation of Erectile and Ejaculatory Functions After Tetramodal Bladder-Sparing Therapy Incorporating Consolidative Partial Cystectomy Against Muscle Invasive Bladder Cancer.

To cross-sectionally assess erectile and ejaculatory functions after tetramodal bladder-sparing therapy consisting of transurethral resection, chemoradiotherapy, and consolidative partial cystectomy in patients with muscle invasive bladder cancer. Among 72 enrolled male patients who underwent tetramodal bladder-sparing therapy from 2006 to 2019, 42 who visited the outpatient clinic from February to October 2020 received questionnaires. Erectile function, ejaculatory function, and quality of life were assessed using the International Index of Erectile Function short form, the Male Sexual Health Questionnaire Ejaculatory Dysfunction short form, and the Functional Assessment of Cancer Therapy. Among the 42 patients, 9 were excluded because of incomplete responses and 33 were eligible for analyses. The median (range) age at survey and the time from treatment completion to responding to the questionnaires was 70 (50-87) years and 4.2 (0.4-14.0) years, respectively. The median International Index of Erectile Function short form-5 score was 11 (5-25), and 3 (9.1%) and 9 (27.3%) patients had no and mild erectile dysfunction, respectively. The Male Sexual Health Questionnaire Ejaculatory Dysfunction short form results showed that 23 (69.7%) patients responded that they could ejaculate. Patients with higher Male Sexual Health Questionnaire Ejaculatory Dysfunction short form scores had better erectile function and quality of life than those with lower Male Sexual Health Questionnaire Ejaculatory Dysfunction short form scores. Preservation of erectile and ejaculatory functions was demonstrated in muscle invasive bladder cancer patients treated with tetramodal bladder-sparing therapy. In addition to lower urinary tract function, preservation of male sexual function, especially ejaculatory function, in bladder-sparing therapy can be an advantage over radical cystectomy.

Clinical application and efficacy analysis of partial cystectomy combined with intravesical chemotherapy in muscle-invasive bladder cancer

ObjectivesComparing the long-term tumor control results of partial cystectomy(PC)and radical cystectomy(RC)in the treatment of muscle-invasive bladder cancer, and to explore the feasible method of bladder preservation therapy (BPT)in patients with MIBC.MethodsWe retrospectively analyzed the clinical data of 102 patients with muscle-invasive bladder cancer in our hospital between January 2012 and December 2018, of whom 32 cases in the partial cystectomy group and 70 cases in the radical cystectomy group. We performed a comparative analysis of patient general information, perioperative-related indicators and postoperative follow-up data, comparing OS, PFS, and DSS at 1, 2, 3, 4, and 5 years in both groups, and comparing tumour recurrence and metastasis in postoperative patients.ResultsAll the 102 cases in this study were successfully completed. Partial cystectomy group and Radical cystectomy group median operating time (169.50(130.00 ~ 225.25) min and 420.00(343.75 ~ 483.75) min, p < 0.001), median intraoperative blood loss was (100(50 ~ 100)ml and 400(200 ~ 1000)ml, p < 0.001), median perioperative blood transfusion volume (0(0 ~ 0)ml and 600(150.00 ~ 906.25)ml, p < 0.001), median total hospital stay (18(14.25 ~ 20.00) and 24.5(20.00 ~ 34.25) days, p < 0.001), median preoperative preparation time (7(4.25 ~ 8.00) and 10(8.00 ~ 13.00) days, p < 0.001), median postoperative hospital stay (9(8.00 ~ 13.50) and 14(11.00 ~ 21.25) days, p < 0.001), the incidence of perioperative blood transfusion was (15.6% and 75.7%, p < 0.001), the incidence of surgical complications was(28.1%(9/32) and 50.0%(35/70), p = 0.033), average hospitalization cost ((26435.76 ± 9877.82) yuan and (58464.36 ± 19753.13) yuan, p < 0.001), the differences were statistically significant (p < 0.05). Perioperative mortality (0 vs. 2.9%(2/70), p = 1), and OS at 1, 2, 3, 4, and 5 years after surgery were (80.0%, 59.8%, 56.1%, 51.0%, 44.6% vs. 76.5%, 67.4%, 64.9%, 57.9%, 52.6%, p = 0.524), PFS (68.2%, 64.6%, 60.3%, 54.8%, 54.8% vs. 82.7%, 78.3%, 75.4%, 67.3%, 62.1%, p = 0.259). DSS (89.9%, 72.4%, 68.6%, 68.6%, 62.4% vs. 87.3%, 83.4%, 80.9%, 73.6%, 68.0%, p = 0.424), and the incidence of tumor recurrence or metastasis was (40.0%(12/30) vs. 25.4%(16/63), p = 0.151), the differences were not statistically significant (p > 0.05).ConclusionIn patients with limited solitary T2N0M0 and T3N0M0 muscle-invasive bladder cancer, partial cystectomy plus bladder instillations treatment can achieve comparable tumour control to radical cystectomy. However, patients in the PC group have significant advantages in terms of operative time, intraoperative bleeding, intraoperative and postoperative blood transfusion, preoperative preparation time, total hospital stay, postoperative recovery time, operative costs and operative complications. This option may be considered for such patients with a need for bladder preservation.

Infected Urachal Cyst in Adult

Infected urachal cyst is one of urachal spectrum abnormalities. It usually presents in children because obliteration normally happened at early infancy. Rare case occurs in adult either can be small incidence or unrecognized symptoms until adulthood. Only small numbers of literature reported. The urachus is a tube extending from the anterior roof of the vesica urinaria to the umbilicus along the midline. The urachus is a vestigial fibromuscular structure located anterior to the fascia transversalis and posterior to the peritoneum. The presence of an embryonic urachal remnant can result in a variety of clinical complications. Due to the rarity of urachal residual disorders and the possibility of vague stomach or urinary symptoms, it is difficult to make a firm preoperative diagnosis. A 32-year-old female was referred to Saiful Anwar General Hospital after suffering abdominal pain for two months; the perineum felt the pain. There was a history of dysuria and nausea since the previous month, but no history of fever or change in bowel habits. Abdominal ultrasound showed an abscess at the anterior bladder and MRI showed an infected cyst mass in the suprapubic pointing to the left umbilical. Partial cystectomy and uterus biopsy were performed. The histopathologic result showed chronic inflammation tissue, and no malignancy was found. Misdiagnosis may lead to many complications such as progressive infection until malignancy therefore early detection of this case is important.

Integrative multi-omics analysis depicts the methylome and hydroxymethylome in recurrent bladder cancers and identifies biomarkers for predicting PD-L1 expression

BackgroundUrinary bladder cancer (UBC) is a common malignancy of the urinary tract; however, the mechanism underlying its high recurrence and responses to immunotherapy remains unclear, making clinical outcome predictions difficult. Epigenetic alterations, especially DNA methylation, play important roles in bladder cancer development and are increasingly being investigated as biomarkers for diagnostic or prognostic predictions. However, little is known about hydroxymethylation since previous studies based on bisulfite-sequencing approaches could not differentiate between 5mC and 5hmC signals, resulting in entangled methylation results.MethodsTissue samples of bladder cancer patients who underwent laparoscopic radical cystectomy (LRC), partial cystectomy (PC), or transurethral resection of bladder tumor (TURBT) were collected. We utilized a multi-omics approach to analyze both primary and recurrent bladder cancer samples. By integrating various techniques including RNA sequencing, oxidative reduced-representation bisulfite sequencing (oxRRBS), reduced-representation bisulfite sequencing (RRBS), and whole exome sequencing, a comprehensive analysis of the genome, transcriptome, methylome, and hydroxymethylome landscape of these cancers was possible.ResultsBy whole exome sequencing, we identified driver mutations involved in the development of UBC, including those in FGFR3, KDMTA, and KDMT2C. However, few of these driver mutations were associated with the down-regulation of programmed death-ligand 1 (PD-L1) or recurrence in UBC. By integrating RRBS and oxRRBS data, we identified fatty acid oxidation-related genes significantly enriched in 5hmC-associated transcription alterations in recurrent bladder cancers. We also observed a series of 5mC hypo differentially methylated regions (DMRs) in the gene body of NFATC1, which is highly involved in T-cell immune responses in bladder cancer samples with high expression of PD-L1. Since 5mC and 5hmC alternations are globally anti-correlated, RRBS-seq-based markers that combine the 5mC and 5hmC signals, attenuate cancer-related signals, and therefore, are not optimal as clinical biomarkers.ConclusionsBy multi-omics profiling of UBC samples, we showed that epigenetic alternations are more involved compared to genetic mutations in the PD-L1 regulation and recurrence of UBC. As proof of principle, we demonstrated that the combined measurement of 5mC and 5hmC levels by the bisulfite-based method compromises the prediction accuracy of epigenetic biomarkers.

Kidney Transplantation After Multiple Urinary Tract Conversion with an Ileal Conduit: A Case Report

Kidney transplantation (KTx) after urinary tract conversion surgery is extremely difficult due to several complications. In our case, KTx was performed after multiple operative procedures, including diversion urethrostomy. The patient was a 46-year-old woman with a right atrophic kidney, an ectopic opening of the left ureter, and urethral dysplasia since birth. The patient underwent a right nephrectomy, left ureteral sigmoidostomy, Stamey surgery, augmentation ileocystoplasty, and left ureteroileostomy. Thereafter, she underwent nephrostomy, ileal conduit diversion, open sigmoid colectomy, and total cystectomy because of persistent urinary incontinence, sigmoid colon cancer, and recurrent cystitis. Her renal function gradually deteriorated, and hemodialysis was initiated. Before the KTx, she underwent laparoscopic left nephrectomy, an intraperitoneal adhesion debridement, and left ileal conduit resection. We dissected the left ileal conduit in the abdominal cavity and penetrated the anorectal side of the free ileal conduit into the wall of the right side of the abdomen. Thereafter, a kidney from a living donor was transplanted into the right iliac fossa through the existing right ileal conduit when the patient was 46 years old. The allograft function was stable without rejection for 2 years. We report the case of a patient who underwent multiple urethral modifications followed by ileal conduit transfer and living donor KTx, which progressed without major postoperative complications.

Use of Barbed Suture During Minimally Invasive Resection of the Choledochal Cyst

Introduction: Choledochal cysts are rare congenital anomalies of the bile ducts, characterized by dilations of the intrahepatic and extrahepatic biliary ducts. Approximately 80% are diagnosed in childhood, with a higher incidence in Asian countries.1 Imaging studies are essential for the diagnosis, including magnetic resonance cholangiopancreatography as the method of choice.2 Patients with types I, II, or IV cysts usually undergo surgical resection of the cysts because of the significant risk of malignancy. The treatment of choice of type I bile duct cysts in adults is total cystectomy and hepaticojejunostomy in a Roux-en-Y manner.2 The advantages of this procedure include a reduced incidence of anastomotic strictures, stone formation, cholangitis, and intracystic malignancy.2 This video shows the surgical steps, tips, and tricks of minimally invasive resection of the choledochal cyst and continuity with a bilioenteric anastomosis. Materials and Methods: A 48-year-old woman with previous laparoscopic cholecystectomy presented with a history of right subcostal pain and jaundice. After magnetic resonance cholangiopancreatography, a type I Todani choledochal cyst was diagnosed with a width of the proximal bile duct of 12 mm. She underwent minimally invasive resection of the bile duct and a terminolateral hepaticojejunostomy in a Roux-en-Y manner. Operatively, an 11 mm trocar was placed at the umbilicus. Three 5 mm trocars were placed in the epigastrium, right hypochondrium, and right flank. An 11 mm trocar was placed in the left flank. A type I choledochal cyst was confirmed with cystic duct dilation. The right hepatic artery, proximal bile duct, and portal vein were identified. The main bile duct was completely dissected, and two clips were placed in the intrapancreatic portion. The distal part of the bile duct was sectioned above the clips. The proximal bile duct was divided 1 cm from the hilar plate and the specimen was completely removed. The jejunal loop was identified and a terminolateral hepaticojejunal anastomosis was performed using barbed suture (V-locTM 4/0, Covidien). Then, a laterolateral jejunojejunal anastomosis was performed using a stapler. The common loop between the two anastomosis was sectioned with another stapler that completed the Roux-en-Y. Finally, a subhepatic suction drain was left. Results: The drain was removed 72 hours after the procedure and the patient was discharged on postoperative day 6 without complications. The pathology report confirmed a choledochal cyst without malignancy. A follow-up was done at 1 and 6 months. The patient was asymptomatic and blood workup and cholangiography were normal. Conclusions: Different publications with high level of evidence document that minimally invasive surgical treatment on Todani I choledochal cysts reduces hospital stay and postoperative pain compared with an open approach.3 It is a demanding technique with a long learning curve that decreases with the use of barbed sutures without increasing complications. No competing financial interests exist. Runtime of video: 10 mins 0 secs

RUPTURED HEMORRHAGIC OVARIAN CYST IN A PATIENT WITH WILLEBRAND DISEASE: A CASE REPORT AND REVIEW OF LITTERATURE

Willebrand Disease (WD) is a familial haemorrhagic disease described in 1926 by Erik von Willebrand, a Finnish physician (1), and is related to a deficiency of Willebrand Factor (VWF) leading to a disorder of primary haemostasis and secondary coagulation. The clinical and biological expression of WD varies according to the form. The common feature is the existence of a constitutional quantitative and/or qualitative VWF deficiency. A classification of the different forms of the disease exists to guide the diagnosis, treatment and genetic information of patients. While isolated biological abnormalities are relatively common with a prevalence of nearly 1%, symptomatic forms of WD are more rare. The prevalence of WM type 3, the most severe form (autosomal recessive), has been estimated at 1 per million population. While autosomal genetic inheritance predicts that both sexes are affected in the same proportion, symptomatic forms are more common in women because of the haemostatic challenge of menstruation, pregnancy and childbirth. Ovarian cysts are fluid-filled sacs that lie on the surface of or within the ovary(2). Roughly 20% of women develop at least one pelvic mass in their lifetime. Therapeutic management is based on surgical haemostasis by total cystectomy and medical haemostasis by exogenous supply of Willebrand factor and finally resuscitation of any state of haemorrhagic shock starting with vascular filling with crystalloids, the introduction of vasoactive amines and finally massive transfusion.We report here the case of a 24 year old female patient, treated for Willebrands disease since birth and who presented to the emergency department with haemorrhagic shock due to a ruptured haemorrhagic ovarian cyst with internal bleeding.

Surgical repair of ruptured omphalocele in a high genetic merit neonatal Holstein bull calf

AbstractA neonatal Holstein bull calf presented emergently for abdominal evisceration. Calving was unassisted. Ninety minutes postpartum, farm staff noted the defect and brought the patient to the hospital. On presentation, the calf was recumbent, dull, and in hypovolemic shock with uncompensated hyperlactatemic metabolic acidosis. Multiple organs were identified through a 4–5 cm defect in the caudoventral midline. Differentials included a ruptured omphalocele, gastroschisis, trauma and schistosomus reflexus. This presentation was consistent with a ruptured omphalocele. Following triage and haemodynamic stabilisation, the eviscerated abdominal contents were lavaged, surgically replaced and an umbilical resection with partial cystectomy performed to remove a patent urachus. Postoperatively, the patient was hospitalised with aggressive nursing care. Pharmacotherapy included prophylactic antibiotics, gastroprotectants and anti‐inflammatory medication. The calf developed mild postoperative pneumonia, but was discharged after 6 days. This report details management of omphalocele evisceration in a calf and the pathology of congenital midline anomalies in neonatal ruminants.

Echinococcosis of the detrusor: report of the first pediatric case

BackgroundThe parasitic disease known as the cystic echinococcosis (CE) is brought on by cysts made up of the larval forms (metacestodes) of Echinococcus tapeworms. In North Africa, it is greater in rural regions. This is unusual for a primary supravesical position.Case presentationWe report a case of a 6-year-old boy who had a palpable abdominal mass with hypogastric abdominal pain.A pelvic ultrasound examination demonstrated a voluminous intra-abdominal supravesical cystic formation with clear limits and regular contours of heterogeneous anechogenic echostructure and the presence of multiple hyperechoic septa separating the cubicles (daughter vesicles) in a honeycomb pattern. Computed tomography confirmed a cystic echinococcosis stage III of the pelvis.After a laparotomy surgery with total cystectomy, the patient was discharged with prescribed albendazole 10 mg/kg/day. Cystic echinococcosis was established by histological analysis.The aim is to demonstrate that from a literature search, we think this is the first case of cystic echinococcosis of the detrusor in children.ConclusionPrimary pelvic cystic echinococcosis is uncommon and even less common among children. Cystic echinococcosis must be taken into account in the differential diagnosis when there is an abdominal mass, particularly in locations where it is prevalent.

Changes in Urologic Cancer Surgical Volume and Length of Stay During the COVID-19 Pandemic in Pennsylvania

Disruptions in cancer surgery during the COVID-19 pandemic led to widespread deferrals and cancellations, creating a surgical backlog that presents a challenge for health care institutions moving into the recovery phase of the pandemic. To describe patterns in surgical volume and postoperative length of stay for major urologic cancer surgery during the COVID-19 pandemic. This cohort study identified 24 001 patients 18 years or older from the Pennsylvania Health Care Cost Containment Council database with kidney cancer, prostate cancer, or bladder cancer who received a radical nephrectomy, partial nephrectomy, radical prostatectomy, or radical cystectomy between the first quarter (Q1) of 2016 and Q2 of 2021. Postoperative length of stay and adjusted surgical volumes were compared before and during the COVID-19 pandemic. The primary outcome was adjusted surgical volume for radical and partial nephrectomy, radical prostatectomy, and radical cystectomy during the COVID-19 pandemic. The secondary outcome was postoperative length of stay. A total of 24 001 patients (mean [SD] age, 63.1 [9.4] years; 3522 women [15%], 19 845 White patients [83%], 17 896 living in urban areas [75%]) received major urologic cancer surgery between Q1 of 2016 and Q2 of 2021. Of these, 4896 radical nephrectomy, 3508 partial nephrectomy, 13 327 radical prostatectomy, and 2270 radical cystectomy surgical procedures were performed. There were no statistically significant differences in patient age, sex, race, ethnicity, insurance status, urban or rural status, or Elixhauser Comorbidity Index scores between patients who received surgery before and patients who received surgery during the pandemic. For partial nephrectomy, a baseline of 168 surgeries per quarter decreased to 137 surgeries per quarter in Q2 and Q3 of 2020. For radical prostatectomy, a baseline of 644 surgeries per quarter decreased to 527 surgeries per quarter in Q2 and Q3 of 2020. However, the likelihood of receiving radical nephrectomy (odds ratio [OR], 1.00; 95% CI, 0.78-1.28), partial nephrectomy (OR, 0.99; 95% CI, 0.77-1.27), radical prostatectomy (OR, 0.85; 95% CI, 0.22-3.22), or radical cystectomy (OR, 0.69; 95% CI, 0.31-1.53) was unchanged. Length of stay for partial nephrectomy decreased from baseline by a mean of 0.7 days (95% CI, -1.2 to -0.2 days) during the pandemic. This cohort study suggests that partial nephrectomy and radical prostatectomy surgical volume decreased during the peak waves of COVID-19, as did postoperative length of stay for partial nephrectomy.

Modified Hautmann Enterocystoplasty after Total Cystectomy for Bladder Tumor: Evolution Curve and Morbi-Mortality

Introduction: Bladder cancer is the 2nd most common urological cancer after prostate cancer. Radical cystectomy (RC) with lymph node dissection and urinary diversion (UD) is considered the standard treatment for invasive localized bladder cancer. There are many variations of bladder replacement, the most common of which is the Hautmann bladder. Patients and Methods: The global objective of our study is to report the results of a retrospective analysis concerning 46 patients who benefited from a modified Hautmann type bladder replacement post cystectomy over a period of 8 years, from January 2014 to December 2021. This evaluation focuses on the evolution of Hautmann type enterocystoplasties as well as the factors favoring. Results: The evolution of the number of patients who received Hautmann bladder replacement has varied over the years with a peak in 2016 estimated at (26%), followed by the year 2015 (21%). The average age of the patients was 54 years. The preoperative general condition of the patients was evaluated using the ASA score. ASA 1 was predominant in the age group 50-59 years (100%). Short-term postoperative mortality: 1 death (2%) was objectified. 22 patients presented short-term complications, corresponding to a morbidity rate calculated at 47%. 2 deaths (4%) occurred late. Late morbidities were looked for and diagnosed during the follow-up consultations, with a rate of (17%). Discussion: The comparative study of the evolution curve of the number of patients who received a Hautmann type bladder replacement and those who received a non-continuous Bricker type urinary diversion showed variations with a peak in 2016 for the Hautmann type bladder replacement (26%) and a peak in 2021 for the Bricker type diversion (25.03%).

MP08-06 OUTCOMES FOR HIGH-RISK BLADDER CANCER AFTER BCG THERAPY IN PATIENTS WITH PRIOR PROSTATE RADIOTHERAPY: A SEER-BASED STUDY

You have accessJournal of UrologyCME1 Apr 2023MP08-06 OUTCOMES FOR HIGH-RISK BLADDER CANCER AFTER BCG THERAPY IN PATIENTS WITH PRIOR PROSTATE RADIOTHERAPY: A SEER-BASED STUDY Adri Durant, Yeonsoo Lee, Lanyu Mi, Faraj Kassem, and Mark Tyson Adri DurantAdri Durant More articles by this author , Yeonsoo LeeYeonsoo Lee More articles by this author , Lanyu MiLanyu Mi More articles by this author , Faraj KassemFaraj Kassem More articles by this author , and Mark TysonMark Tyson More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003223.06AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: There is evidence that patients with bladder cancer who have previously received radiation therapy (RT) are at increased risk for poorer oncological compared to non-radiated counterparts. Little is known about the impact of prior RT on the efficacy of Bacillus Calmette-Guerin (BCG) in patients with non-muscle invasive bladder cancer (NMIBC). In this context, we investigated the impact of previous prostate RT on 5-year disease progression for NMIBC patients after BCG. METHODS: Male patients with a history of high-risk NMIBC, classified as Ta, T1 and CIS disease with completion of adequate BCG (at least 5 plus 2 treatments), were identified in the Surveillance, Epidemiology, and End Results (SEER) – Medicare database. Patients were stratified into two cohorts based on their history of prior radiation use: RT for prostate cancer prior to bladder cancer diagnosis (NMIBC RT) and no history of prostate cancer radiation (NMIBC without prior RT). The primary endpoint was 5-year total progression defined as progression to systemic chemotherapy, checkpoint inhibitors, radical or partial cystectomy, metastasis or cancer-specific death. Results: In a total of 3442 patients with NMIBC, 3306 had no history of prior RT while 136 had a history of prior RT for prostate cancer. The NMIBC RT cohort varied significantly by age (77.5 v 75.0, p=0.0002) and stage (Ta 43.4%, Tis 19.1%, T1 37.5% v Ta 41.0%, Tis 10.8%, T1 48.2%, p=0.0033) at initial tumor diagnosis. There was no significant difference in risk of progression to chemotherapy (p=0.6469), checkpoint inhibitors (p=0.1096), radical cystectomy (p=0.2023), partial cystectomy (p=0.5613), cancer-specific death (p=0.0667) and 5-year total progression between the two cohorts. On multivariate analysis NMIBC RT patients did not have a significantly higher risk of 5-year total progression (HR 1.37, p=0.08). CONCLUSIONS: In patients with NMIBC who undergo adequate BCG treatment, prior history of pelvic radiation for prostate cancer is not associated with worse progression-free survival. Source of Funding: This study was supported by Grant Number P30 CA015083 from the National Cancer Institute (NCI) and from the Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery (M.D.T.), the Christian Haub Family Career Development Award for Cancer Research Honoring Dr. Richard Emslander (M.D.T.), and the Eric and Gail Blodgett Foundation (M.D.T.). Its contents are solely the authors' responsibility and do not necessarily represent the official view of the NIH. © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e95 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Adri Durant More articles by this author Yeonsoo Lee More articles by this author Lanyu Mi More articles by this author Faraj Kassem More articles by this author Mark Tyson More articles by this author Expand All Advertisement PDF downloadLoading ...

MP68-12 OUR EARLY CLINICAL EXPERIENCE WITH MANTRA TM MULTI ARM SURGICAL ROBOTIC SYSTEM (SS INNOVATIONS GROUP COMPANY) IN MAJOR URO-ONCOLOGICAL SURGERIES

You have accessJournal of UrologyCME1 Apr 2023MP68-12 OUR EARLY CLINICAL EXPERIENCE WITH MANTRATM MULTI ARM SURGICAL ROBOTIC SYSTEM (SS INNOVATIONS GROUP COMPANY) IN MAJOR URO-ONCOLOGICAL SURGERIES Amitabh Singh, Ashish Khanna, Sarbartha Kumar Pratihar, Vivek Vasudev, Nikhil Saurabh, and Sudhir Rawal Amitabh SinghAmitabh Singh More articles by this author , Ashish KhannaAshish Khanna More articles by this author , Sarbartha Kumar PratiharSarbartha Kumar Pratihar More articles by this author , Vivek VasudevVivek Vasudev More articles by this author , Nikhil SaurabhNikhil Saurabh More articles by this author , and Sudhir RawalSudhir Rawal More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003331.12AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: SSI MantraTM is a new addition to the arsenal of robotics systems in India for clinical usage. Here, we provide the initial outcomes of patients undergoing different types of major uro-oncological procedures. METHODS: A total of 32 patients affected by various urological conditions like prostate cancer, renal cancer, bladder cancer, and vesicovaginal fistula underwent treatment with SSI MantraTM system. Study was approved by institutional board (IRB No- 765/SO/SKR-35). Clinical use of MantraTM was registered with national clinical trial registry (CTRI/2020/11/029053). This system has four independent Arms which are docked. Demography of patient and clinical outcome like docking time, console time, total operative time, complications like bleeding, bowel injury, urinary incontinence, conversion to open, total hospital stay and perioperative outcomes were reported. RESULTS: A total of thirty–two patients were included in this study. This includes radical prostatectomy (n=15), radical cystectomy with ileal conduit (n=6), radical cystectomy with neo-bladder(n=4), radical nephrectomy (n=3), partial nephrectomy (n=2), partial cystectomy (n=1) and vesico-vaginal fistula repair (n=1). Mean age, BMI, ASA, draping time, patients positioning time, arm cart positioning, docking time, surgeon console time, total surgery time, undock time of radical prostatectomy and radical cystectomy patient was 66.1 vs 57.3 yrs , 26.1 vs 22.3, 3.3 vs 2.66, 19.3 vs 13.4 mins, 3.2 vs 5.66 mins, 13.8 vs 12.7 mins 7.2 vs 5.8 mins, 3hrs 12 min vs 5 hrs 20 mins, 5 hrs 6 mins vs 6 hrs 10 min, 10.9 vs 10.2 min respectively. There were total three conversions to open (radical prostatectomy (n=1), radical nephrectomy (n=1) and radical cystectomy with ileal conduit (n=1). CONCLUSIONS: Our experience with SSI MANTRA platform confirms that it is a robust, safe and efficient platform for all major urooncological procedures and it would expand the reach of robotic platform. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e957 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Amitabh Singh More articles by this author Ashish Khanna More articles by this author Sarbartha Kumar Pratihar More articles by this author Vivek Vasudev More articles by this author Nikhil Saurabh More articles by this author Sudhir Rawal More articles by this author Expand All Advertisement PDF downloadLoading ...

PD22-04 USEFULNESS OF DELTA-RADIOMICS APPLIED TO CONTRAST- AND NON-ENHANCED MRI FOR PREDICTING THERAPEUTIC EFFICACY IN MUSCLE-INVASIVE BLADDER CANCER

You have accessJournal of UrologyCME1 Apr 2023PD22-04 USEFULNESS OF DELTA-RADIOMICS APPLIED TO CONTRAST- AND NON-ENHANCED MRI FOR PREDICTING THERAPEUTIC EFFICACY IN MUSCLE-INVASIVE BLADDER CANCER Kohei Isemoto, Yuma Waseda, Motohiro Fujiwara, Koichiro Kimura, Daisuke Hirahara, Tatsunori Saho, Eichi Takaya, Shohei Fukuda, Hajime Tanaka, Soichiro Yoshida, Minato Yokoyama, and Yasuhisa Fujii Kohei IsemotoKohei Isemoto More articles by this author , Yuma WasedaYuma Waseda More articles by this author , Motohiro FujiwaraMotohiro Fujiwara More articles by this author , Koichiro KimuraKoichiro Kimura More articles by this author , Daisuke HiraharaDaisuke Hirahara More articles by this author , Tatsunori SahoTatsunori Saho More articles by this author , Eichi TakayaEichi Takaya More articles by this author , Shohei FukudaShohei Fukuda More articles by this author , Hajime TanakaHajime Tanaka More articles by this author , Soichiro YoshidaSoichiro Yoshida More articles by this author , Minato YokoyamaMinato Yokoyama More articles by this author , and Yasuhisa FujiiYasuhisa Fujii More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003295.04AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Radiomics is the extraction of quantitative features from radiological images. Recently, a new technique called delta-radiomics, which analyzes the feature variation at different acquisition times, has been invented. Multimodal bladder-sparing therapy consisting of transurethral resection, chemo- and radiotherapy has been recommended as an alternative treatment for muscle invasive bladder cancer (MIBC). Response to chemoradiotherapy (CRT) is key to oncological outcome. The application of delta-radiomics to contrast-enhanced (CE-) and non-enhanced (NE-) T1-weighted images (T1WI) would enable accurate blood flow assessment, and here we investigated whether feature variation was useful in predicting therapeutic efficacy to CRT. METHODS: We reviewed 43 non-metastatic MIBC patients (cT2-4N0M0) who underwent partial or total cystectomy after CRT (approval # M2000-1717). Complete response (CR) to CRT was defined as the absence of residual viable tumor cells in the cystectomy specimen. The volume of interest (VOI) was set for the index cancer on pretherapeutic CE-T1WI, then the same VOI was applied to NE-T1WI. From the radiological features of CE- and NE-T1WI, 46 delta-radiomics features were calculated, and put into various machine learning algorithms to create the best model for CR prediction. The predictive ability of a model constructed from CE-T1WI alone was also calculated. RESULTS: CR was achieved by 21 patients (49%). The best-performing model was obtained using gradient boosting classifier, with an area under the curve (AUC) of 0.80 (95% confidence interval [CI] 0.70-0.90), which employed the following 3 features; “Compactness”, indicating how spherical the tumor shape was, “Kurtosis”, showing the sharpness of the histogram of signal intensity, and “AUC of cumulative standardized uptake value-volume histogram”, indicating the heterogeneity of tumor contrast. The best AUC for the model obtained from CE-T1WI alone was 0.63 (95%CI 0.51-0.75). CONCLUSIONS: Delta-radiomics had better predictive ability than the CE-T1WI alone model. Angiogenesis and vascular architecture of bladder tumor may play a key role in the therapeutic efficacy of CRT. Delta-radiomics showed potential usefulness in predicting therapeutic efficacy for CRT in MIBC. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e665 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Kohei Isemoto More articles by this author Yuma Waseda More articles by this author Motohiro Fujiwara More articles by this author Koichiro Kimura More articles by this author Daisuke Hirahara More articles by this author Tatsunori Saho More articles by this author Eichi Takaya More articles by this author Shohei Fukuda More articles by this author Hajime Tanaka More articles by this author Soichiro Yoshida More articles by this author Minato Yokoyama More articles by this author Yasuhisa Fujii More articles by this author Expand All Advertisement PDF downloadLoading ...

PD36-07 DEFINING OPTIMAL CANDIDATES FOR BLADDER-SPARING TREATMENT IN MUSCLE-INVASIVE BLADDER CANCER: ANALYSIS USING PATHOLOGICAL REFERENCE STANDARDS AFTER CHEMORADIATION

You have accessJournal of UrologyCME1 Apr 2023PD36-07 DEFINING OPTIMAL CANDIDATES FOR BLADDER-SPARING TREATMENT IN MUSCLE-INVASIVE BLADDER CANCER: ANALYSIS USING PATHOLOGICAL REFERENCE STANDARDS AFTER CHEMORADIATION Hajime Tanaka, Wei Chen, Kasumi Yoshitomi, Takahiko Soma, Masaki Kobayashi, Motohiro Fujiwara, Yuki Nakamura, Bo Fan, Yudai Ishikawa, Shohei Fukuda, Yuma Waseda, Kazuma Toda, Soichiro Yoshida, Minato Yokoyama, Ryoichi Yoshimura, and Yasuhisa Fujii Hajime TanakaHajime Tanaka More articles by this author , Wei ChenWei Chen More articles by this author , Kasumi YoshitomiKasumi Yoshitomi More articles by this author , Takahiko SomaTakahiko Soma More articles by this author , Masaki KobayashiMasaki Kobayashi More articles by this author , Motohiro FujiwaraMotohiro Fujiwara More articles by this author , Yuki NakamuraYuki Nakamura More articles by this author , Bo FanBo Fan More articles by this author , Yudai IshikawaYudai Ishikawa More articles by this author , Shohei FukudaShohei Fukuda More articles by this author , Yuma WasedaYuma Waseda More articles by this author , Kazuma TodaKazuma Toda More articles by this author , Soichiro YoshidaSoichiro Yoshida More articles by this author , Minato YokoyamaMinato Yokoyama More articles by this author , Ryoichi YoshimuraRyoichi Yoshimura More articles by this author , and Yasuhisa FujiiYasuhisa Fujii More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003334.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Bladder-sparing treatment based on chemoradiotherapy (CRT) has taken a large interest as an alternative to radical cystectomy (RC) for muscle-invasive bladder cancer (MIBC). However, major concerns include MIBC recurrence even after achieving clinical complete response (CR) to CRT, which may be derived from microscopic cancer remnant in the preserved bladder. We have conducted a bladder-sparing protocol that incorporates induction CRT and subsequent partial cystectomy (PC). In addition, CRT was administered as an induction therapy before RC for MIBC patients who had no indication for bladder preservation. In this study, we analyzed these patient series and investigated clinical determinants of CRT response using the pathological reference standards to define optimal candidates for bladder preservation. METHODS: We analyzed 285 patients with cT2-4N0M0 bladder cancer who underwent CRT (40 Gy to the true pelvis with concurrent cisplatin) followed by PC/RC (approval # M2019-192). CRT response was assessed using the cystectomy specimens. Risk factors related to the CRT response were identified using multivariable logistic regression model, and the accuracy of the multivariable model was assessed using the area under the curve (AUC) in the receiver operating characteristic curve (ROC) analysis. RESULTS: Clinical T stage was T2/3/4 in 169 (59%)/105 (37%)/11 (3.9%) patients, respectively. The median tumor size was 3.0 cm and 108 patients (38%) had multiple tumors. Hydronephrosis was observed in 69 patients (24%). Overall, 54 (19%), 34 (12%), and 60 (21%) patients had bladder neck involvement (BNI), concomitant carcinoma in situ, and variant histology in the transurethral resection before CRT. The cystectomy specimens revealed ypT0, defined as pathological CR (pCR), in 178 patients (63%). In the multivariable logistic regression analysis, cT3-4 (Odds ratio=0.53 [95% confidence interval: 0.30-0.92]), tumor size>3.0 cm (0.45 [0.26-0.80]), multiplicity (0.34 [0.19-0.59]), and BNI (0.40 [0.20-0.80]) were independently associated with pCR. The final model including the four factors yielded the AUC of 0.75. In the cohort, 85 (30%), 83 (29%), and 117 (41%) patients had 0, 1, and 2 or more risk factors, respectively; pCR rates after CRT in the respective groups were 87%, 65%, and 43% (p<0.001). CONCLUSIONS: Our analysis identified independent risk factors related to CRT response using the pathological reference standards, which may help decide the indication of bladder preservation in MIBC patients. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e982 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Hajime Tanaka More articles by this author Wei Chen More articles by this author Kasumi Yoshitomi More articles by this author Takahiko Soma More articles by this author Masaki Kobayashi More articles by this author Motohiro Fujiwara More articles by this author Yuki Nakamura More articles by this author Bo Fan More articles by this author Yudai Ishikawa More articles by this author Shohei Fukuda More articles by this author Yuma Waseda More articles by this author Kazuma Toda More articles by this author Soichiro Yoshida More articles by this author Minato Yokoyama More articles by this author Ryoichi Yoshimura More articles by this author Yasuhisa Fujii More articles by this author Expand All Advertisement PDF downloadLoading ...

MP48-08 30-DAY, 90-DAY, AND 1-YEAR COMPLICATIONS FOLLOWING MAJOR UROLOGIC SURGERY: AN ANALYSIS OF MORBIDITY AND MORTALITY USING A LARGE MULTI-CENTER RESEARCH NETWORK

You have accessJournal of UrologyCME1 Apr 2023MP48-08 30-DAY, 90-DAY, AND 1-YEAR COMPLICATIONS FOLLOWING MAJOR UROLOGIC SURGERY: AN ANALYSIS OF MORBIDITY AND MORTALITY USING A LARGE MULTI-CENTER RESEARCH NETWORK Tyler Garman, Andrew Gabrielson, Una Choi, Gabriella Ewachiw, and Andrew Cohen Tyler GarmanTyler Garman More articles by this author , Andrew GabrielsonAndrew Gabrielson More articles by this author , Una ChoiUna Choi More articles by this author , Gabriella EwachiwGabriella Ewachiw More articles by this author , and Andrew CohenAndrew Cohen More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003294.08AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Many studies evaluating complication rates following urologic procedures focus on a narrow subset of procedures, include the experience of select, high volume surgeons, or have variable follow-up. We systematically compare national complication rates following an array of urologic surgeries by numerous providers, which can serve as an important benchmarking tool in the pursuit of quality care. METHODS: We performed a retrospective cohort study using the TriNetX research network from 2006-2022, which includes claims data for 110 million patients. Procedure type, age at index procedure, sex, race, and complications were queried using applicable CPT and ICD10 codes. Rates of all-cause (Clavien I-V), life-threatening (Clavien IV), and mortality (Clavien V) complications were evaluated using 30-day, 90-day, and 1-year timepoints from the index operation. Clavien IV complications included: sepsis, acute renal failure requiring dialysis, PE, reintubation, myocardial infarction, cardiac arrest, and re-operation. RESULTS: A total of 484,099 urologic procedures were included. Age, sex, race, and 30-day, 90-day, and 1-year complication rates stratified by procedure are listed in Table 1. All-cause complication rates ranged from 2-37%, 10-48%, and 17-60% for 30-day, 90-day, and 1-year time points, respectively. Rates of Clavien IV complications were less than or equal to 10% at all timepoints for most procedures with notable exceptions being total nephrectomy (14-23%), cystectomy (22-36%), and RPLND (14-22%). The 1-year mortality rate for most procedures was low. Exceptions include cystectomy (12%), TURBT (8%), RPLND (6%), and total nephrectomy (5%). Procedures with the lowest rates of 30-day, 90-day, and 1-year complications included those within reconstructive urology including AUS placement, sling procedures for incontinence, colporrhaphy, IPP placement and urethroplasty. 30-day, 90-day, and 1-year mortality rates following these procedures mirrored that of the general population not undergoing surgery. CONCLUSIONS: This analysis establishes benchmark complication rates up to 1-year post-op for many urologic procedures using a national database, which can aid hospital systems in identifying deficiencies in quality care. Source of Funding: NA © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e657 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Tyler Garman More articles by this author Andrew Gabrielson More articles by this author Una Choi More articles by this author Gabriella Ewachiw More articles by this author Andrew Cohen More articles by this author Expand All Advertisement PDF downloadLoading ...

V03-04 FIRST HUMAN NOTES FOR BLADDER LEIOMYOMA ENUCLEATION AND CYSTORRAPHY

You have accessJournal of UrologyCME1 Apr 2023V03-04 FIRST HUMAN NOTES FOR BLADDER LEIOMYOMA ENUCLEATION AND CYSTORRAPHY Andreia Cardoso, Sara Anacleto, Catarina Laranjo Tinoco, Ricardo Matos Rodrigues, Ana Sofia Araújo, Mariana Capinha, Vera Marques, João Pimentel Torres, Carlos Oliveira, Miguel Mendes, and Emanuel Carvalho-Dias Andreia CardosoAndreia Cardoso More articles by this author , Sara AnacletoSara Anacleto More articles by this author , Catarina Laranjo TinocoCatarina Laranjo Tinoco More articles by this author , Ricardo Matos RodriguesRicardo Matos Rodrigues More articles by this author , Ana Sofia AraújoAna Sofia Araújo More articles by this author , Mariana CapinhaMariana Capinha More articles by this author , Vera MarquesVera Marques More articles by this author , João Pimentel TorresJoão Pimentel Torres More articles by this author , Carlos OliveiraCarlos Oliveira More articles by this author , Miguel MendesMiguel Mendes More articles by this author , and Emanuel Carvalho-DiasEmanuel Carvalho-Dias More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003241.04AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Bladder leiomyomas (BL) are rare benign tumors, with roughly 250 cases reported worldwide. Surgical excision is the recommended treatment, classically through open partial cystectomy. As alternatives, minimally invasive approaches, such as laparoscopic (lap), robot-assisted and transurethral (TU) resection (TUR), are arising. In parallel, TU cystorraphy has been reported for vesicovaginal fistulas or traumatic perforations. Thus, to the best of our knowledge, we report the 1st Human Natural Orifice Transluminal Endoscopic Surgery (NOTES) with a purely TU approach for BL enucleation and cystorraphy, without transvesical access, gas insufflation, neither extracorporeal knot tying. METHODS: A 68-year-old woman presented an incidental 22mm lesion on the left posterolateral bladder wall on MRI, highly suspicious for BL. After cystocopic confirmation of a submucosal lesion, TUR was proposed. We performed a pioneer NOTES with total TU BL enucleation and cystorraphy using: 30° lens, white light only, saline irrigation, 26Ch resectoscope, operative cystoscope, Collin’s knife and standard resection loop, bipolar energy, 5mm lap needle holder and 3-0 V-Loc 23cm length suture. RESULTS: BL complete enucleation was done with bipolar energy on Collin’s knife and standard resection loop. Then, V-Loc suture was completely placed inside the bladder through the operative cystoscope, and with the lap needle holder inserted through it, a total intravesical cystorraphy with single hand continuous suture was performed. Operative time was 40min. Patient was discharged on the next day, with bladder catheter for 5 days. There were no complications. CONCLUSIONS: TUR has been used for BL, but without cystorraphy, which is a limitation for bigger or more profound infiltrative lesions. Cystorraphy techniques combining TU, transperitoneal and/or transmural bladder access were reported. A purely TU cystorraphy recently reported required extracorporeal sliding knot techniques, so, it was only possible in women. Thus, our approach may be the most minimally invasive possible for the safest treatment of BL. We combined several techniques aiming to reach an ideal one. Using only regular material, a single urethral route, and no gas insufflation, we achieved a quick and safe procedure, with no need for continuous bladder irrigation and short catheterization. Yet, it requires advanced skills such as single hand lap suturing. Our technique seems also feasible in small bladder perforations, fistulas, or other lesions (e.g.: endometriosis). Additionally, with total intravesical suture, it may also be viable in men. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e247 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Andreia Cardoso More articles by this author Sara Anacleto More articles by this author Catarina Laranjo Tinoco More articles by this author Ricardo Matos Rodrigues More articles by this author Ana Sofia Araújo More articles by this author Mariana Capinha More articles by this author Vera Marques More articles by this author João Pimentel Torres More articles by this author Carlos Oliveira More articles by this author Miguel Mendes More articles by this author Emanuel Carvalho-Dias More articles by this author Expand All Advertisement PDF downloadLoading ...

Urachal Adenocarcinoma: a Case Report and Review of the Literature.

Urachal adenocarcinoma is one of the rare and aggressive neoplasms that often presents at an advanced stage and has a poor prognosis. Urachal adenocarcinoma makes up 0.17 to 0.34% of all bladder carcinomas. Patients commonly present with hematuria. Wide local excision of urachal mass with umbilicus and surrounding soft tissue en bloc combined with partial or radical cystectomy and bilateral pelvic lymphadenectomy is considered to be the primary surgical management. However, many publications in literature report that en bloc removal of tumor with umbilicus, entire urachal ligament, and bladder dome alone has long-term survival and disease-free period. Here, we present a case of a 50-year-old post-menopausal female patient with a fungating mass in the umbilical region of size approximately 10 cm in maximum diameter with mucopurulent discharge from the mass. The patient had no history of any hematuria, mucinuria, burning micturition, or any particles in urine. A laparotomy was performed, and tumor mass along with the cuff of the bladder dome was removed as en bloc along with umbilectomy. This case report highlights a rare case of urachal adenocarcinoma with a fungating mass of large size in a female patient which is otherwise more commonly seen in males. A review of published literature is also presented.