Transurethral Resection Of Bladder Research Articles

Comparison of thulium and holmium lasers with conventional transurethral bladder resection for non-muscle invasive bladder cancer

Introduction. The gold standard of treatment for intermediate- and high-risk non-muscle-invasive bladder cancer (NMIBC) is transurethral resection of the bladder (TURB) in combination with intravesical therapy. However, this procedure may cause serious complications. At the same time, studies of various lasers for the treatment of NMIBC have demonstrated their safety and efficacy. Despite this, the topic has not yet been fully explored and is not widely practiced in clinical oncology, making further research necessary.Objective. To compare thulium and holmium lasers with conventional TURB for management of non-muscle-invasive bladder cancer (NMIBC).Materials & methods. In our study, depending on the treatment approach, 84 NMIBC-patients were divided into three groups. Group 1 included 27 patients (34.14%), who underwent laser thulium bladder resection; group 2 included 25 patients (29.76%), who underwent laser holmium bladder resection, and group 3 included 32 patients (38.1%), who underwent standard TURB. Prior to surgery, all patients received a standard set of preoperative general clinical and instrumental examinations for bladder cancer, and the choice of surgical approach was based on informed patient consent, taking into account the benefits and risks of the three treatment options. All surgeries were performed in accordance with established protocols.Results. In the TURB group, the surgery time was the longest and totalled in 20.5 ± 7.4 min. Laser technologies reduce the surgery time to 16.3 ± 5.3 min for a holmium laser and to 14.7 ± 5.2 min for a thulium laser. Also, in groups 1 and 2, a shorter duration of postoperative bladder irrigation was noted (4.4 ± 1.8 and 4.7 ± 1.6 hours) and shorter periods of postoperative bladder catheterisation (1.5 ± 0.08 and 1.6 ± 0.08 days) compared to group 3, where these indicators were 16.4 ± 2.5 hours and 2.5 ± 0.13 days, respectively. Among patients undergoing either holmium or thulium surgery, a higher rate of disease-free survival has been noted. Independent prognostic factors that influence the prognosis of NMIBC in all groups include the type of surgery, history of bladder tumors, and pathological stage.Conclusion. The use of laser technology, such as thulium and holmium laser, in bladder wall resection for NMIBC shows promising results and provides a good clinical outcome that is comparable to (and in some cases, superior to) standard TURB.

The Effect of Lymphovascular Invasion on Short-Term Tumor Recurrence and Progression in Stage T1 Bladder Cancer.

Introduction Lymphovascular invasion (LVI) is the most important stage for tumor spread and metastasis. The role of LVI in transurethral resection is not yet clear. In this study, the progression and recurrences of patients who underwent transurethral resection bladder tumor (TUR-BT) and T1 high-grade tumor and concomitant LVI were detected in pathology results and were evaluated. Methods Our study included 58 patients, who underwent TUR-BT with the suspicion of bladder cancer and were pathologically diagnosed with T1 stage bladder cancer and who did not undergo radical surgery, in the Urology Clinic of Afyonkarahisar Health Sciences University, Turkey. The patient's age, gender, tumor size, tumor grade, presence of LVI, second resection, recurrence, and progression rates at three months and one year were compared. Results LVI was detected in the pathology specimens of nine (15.5%) of the 58 patients who were included in the study. When the one-year progression was evaluated, progression to T2 tumor was detected in six (66.7%) patients in the group with LVI and five (10.2%) patients in the group without LVI, and the progression was significantly higher in the group with LVI (p=0.001). In logistic regression analysis, the only significant predictor for one-year progression was the presence of LVI (p=0.001). Conclusion According to the results of our study, the presence of LVI in the pathology specimens of patients with T1 high grade significantly increases the progression. Suggesting radical cystectomy and neoadjuvant chemotherapy to patients with LVI in the early period seems to be a more accurate approach, considering the course of the disease.

Results of Trans-Urethral Resection of Bladder (TURB) for the Treatment of Non-Infiltrating Bladder Tumors (NMIBT) in Musk in Bouake

Results of Trans-Urethral Resection of Bladder (TURB) for the Treatment of Non-Infiltrating Bladder Tumors (NMIBT) in Musk in Bouake

Intestinale Florid Glandular Cystitis in Centre Medicochirurgical De Kinindo Bujumbura

Background: Glandular cystitis is a metaplastic lesion of the bladder urothelium primarily affecting men. There are two types: typical glandular cystitis and intestinal glandular cystitis. Therefore, the definitive diagnosis relies on histopathology. The controversial theory surrounds the malignant degeneration of these lesions. Here, we present a case of florid glandulo-cystic cystitis of intestinal origin. Clinic observation: A 20-year-old man presented to the clinic with intermittent total hematuria associated with obstructive and irritative symptoms that had been ongoing for more than a year. In Histology examen, there was an absence of malignant tumor proliferation and signs indicative of typical inflammation: Florid glandulo-cystic cystitis of intestinal type. Conclusion: Intestinal glandular cystitis is a rare condition affecting primarily men and involving the bladder mucosa. Its symptoms are nonspecific and often go undiagnosed. Transurethral bladder resection remains the treatment of choice, but other therapeutic modalities, proven effective, should not be dismissed. The issue of malignant degeneration remains a controversial topic for debate, but the course of the disease is primarily marked by recurrences, necessitating cystoscopic monitoring.

Quality of care perceived by patients during cystoscopy and affecting factors.

It is necessary and important for quality of care to ensure the comfort of patients during the procedure, as well as before and after surgery. According to literature, it is necessary to know what patients experience and how they perceive the care they receive. This study aimed to investigate the quality of care perceived by patients during cystoscopy and the factors affecting it. This descriptive study was conducted in the surgical clinic of a teaching and research hospital, with 105 patients who underwent cystoscopy in 2022. Data collection forms consisting of a Sociodemographic and Disease Characteristics Questionnaire and the Good Perioperative Nursing Care Scale (for Patients) (GPNCS) were used for data collection, with face-to-face interviews on the first day after the procedure. This study was conducted in accordance with the principles of the Declaration of Helsinki. The study included patients with urinary tract stones, transurethral prostatectomy, and transurethral bladder resection. Of the participants, 72.4% were male, and 81.9% were married. The mean age of the patients was 50.09 ± 16.79 years. The mean total score was 143.56 ± 16.62. It was higher in single patients and those who had not previously undergone surgery. It was found that the mean of the environment sub-dimension was the highest at 18.57 ± 2.51 and the mean of the support sub-dimension was the lowest at 16.01 ± 3.44. The results of this study showed that patients undergoing cystoscopy have a good perception of the quality of their peri-operative nursing care.

Management of high-grade papillary Ta or T1 bladder cancer after restaging transurethral resection: A retrospective study comparing Bacillus Calmette–Guerin therapy upfront versus a third resection

PurposePerforming restaging transurethral bladder resection (reTURB) for high-risk non-muscle invasive bladder cancer (NMIBC) reduces the risk of recurrence and tumour understaging. Management of residual high-grade papillary Ta or T1 after reTURB has changed this last 10years in international recommendations. This study aimed to compare the recurrence free survival according to the different management procedures performed. Materials and methodsPatients who underwent reTURB for initial high-risk NMIBC between 2011 and 2020 were included. Patients with residual high-grade papillary Ta or T1 tumour after reTURB were divided into two groups: BCG instillations upfront versus BCG following a third-look resection (3TURB). Patient and tumour characteristics, BCG instillations, recurrence-free survival were retrospectively analysed. ResultsA total of 162 high-risk patients were included. Sixty-one (37.7%) had residual high-grade papillary Ta or T1 at reTURB: 35 (21.6%) had BCG instillations upfront, 18 (11.2%) had a 3TURB and 8 (5%) had other management. The mean follow-up was 34.2weeks±20.2. Recurrence-free survival was significantly better in patients who underwent BCG instillations upfront (P<0.0043). Recurrence after BCG therapy following reTURB was significantly lower in patients with no residual NMIBC at 6 (92.5% vs. 72.4%, P<0.004) and 12months (85% vs. 67.3%, P<0.03). ConclusionsThe efficacy of intravesical BCG is compromised in case of residual tumour following TURB. The role of a 3TURB following a positive reTURB is not yet determined. This study has confirmed that residual tumor following reTURB is a negative predictive factor but could not demonstrate the value of a 3TURB compared to upfront BCG. Level of evidence3.

Kasa İnvaze Olmayan Mesane Kanserinde Sistemik İmmün-İnflamasyon İndeksi ve Nötrofil-Lenfosit Oranının Hastalık Nüksü ve İlerleme Riski ile İlişkisi

Objective: Some systemic inflammatory response-based biomarkers are promising for predicting prognosis of non-muscle-invasive bladder cancer (NMIBC) patients and can contribute to the risk classification without any significant cost. We aimed to evaluate the neutrophil-lymphocyte ratio (NLR) and systemic immune-inflammation index (SII) for the prediction of recurrence and progression risk in patients with NMIBC. Material and Methods: The study included a retrospective analysis of 211 patients who underwent transurethral resection of bladder (TURB) in a tertiary referral center between 2015 and 2019. The receiver operating characteristic (ROC) curve was used to determine the cut-off value. The Kaplan-Meier curves and the log-rank test were constructed to evaluate the recurrence-free and progression-free survival rates according to different levels of inflammatory markers. The multivariate regression analysis was undertaken to estimate the independent prognostic factors. Results: The optimal cut-off value of SII was found to be 568 in the ROC analysis. According to the multivariate analysis, the SII value, number of tumors at the time of initial TURB, and European Organization for Research and Treatment of Cancer (EORTC) recurrence classification were statistically significant parameters in predicting recurrence. While tumor size, NLR, and SII achieved statistically significant levels in the univariate analysis, they didn’t have significance in the multivariate analysis. Conclusion: The SII, number of tumors, and EORTC recurrence classification are prognostic parameters that can be used in the assessment of recurrence. However, inflammatory parameters do not have the same predictive ability in the prediction of the progression rate.

Long-Term Outcomes of Prospective Clinical Trial HDR-Brachytherapy Monotherapy in Single Day in Patients with Localized Prostate Cancer

This prospective clinical trial to evaluated long-term outcomes associated with 2 fractions in a single day, one implant, high-dose-rate (HDR) brachytherapy as monotherapy for patients with localized prostate cancer. We report Genitourinary (GU) and gastrointestinal (GI) toxicity and Disease control. Between November 2010 and Feb 2016 a total of 120 patients diagnosed with low/intermediate-risk localized prostate cancer were treated. The prescribed dose was 27 Gy in 2 fractions in a day using a single implant. 34 patients (28%) were intermediate-risk cancer. 38 patients (31,7%) received hormonal therapy. We measured the incidence of no biochemical evidence of disease (bNED) based on the Phoenix definition of failure (nadir prostate-specific antigen (PSA) + 2 ng/mL). GU and GI toxicity were evaluated by CTCAE v4.0 and sexual function were prospectively documented at each follow up visit. With a median follow-up was 123 months (range 9-148) the actuarial rates of Local Control were 96%, Biochemical Control 93.4%, Distant Failure 3.3%, Disease-Free Survival 92.3 %, Metastasis-free survival 96.67% and Overall Survival was 86.7%. The cumulative incidence of acute grade (G) 1-2 GU toxicity was 20.8%, mainly frequency/urgency (10%), dysuria (10%), dribbling/hesitancy (0.8%). 3 patients required a Foley catheter during 1 week. No acute GI toxicities were recorded. Chronic G1-2 GU toxicities were 29 %, mainly dysuria (12.6%), urinary frequency/urgency (5.8%) and urinary Incontinence G2 (1.6%). 1 patient had G2 rectal bleeding and 2 patients had G3 GU toxicity requiring transurethral resection of bladder (TURB). 23.7% of patients without Hormonal therapy reported G1-2 sexual impotence after 2 years therapy. With 10 years of follow-up, our prospective data are sufficiently mature to report on efficacy and toxicity outcomes, making a single implant, 2 fractions HDR-BT an attractive option for patients with localized low/intermediate-risk prostate cancer and be able to consider it a standard of care in this setting. To the best of our knowledge, this is the first report regarding single day HDR-BRT as monotherapy with a median follow-up of 10 years.

Clinicopathologic features and prognostic significance of mixed (Low and high-grade) papillary urothelial carcinoma comparison with low and high-grade papillary urothelial carcinoma.

The World Health Organization/International Society of Urological Pathology (2022 WHO/ISUP) classification categorizes noninvasive carcinomas based on the highest grade observed in a pathology sample. According to this classification, a lesion is classified as mixed-grade (MG) if the highest-grade component comprises less than 5% high-grade (HG) carcinoma [14]. This study included 160 cases of low-grade papillary urothelial carcinoma (LGUC) and 160 cases of HG papillary urothelial carcinoma (HGUC), selected randomly. In addition, 160 consecutive and unselected cases of MG papillary urothelial carcinoma (MGUC) were obtained from all bladder transurethral resection specimens diagnosed with papillary urothelial carcinoma between January 2007 and January 2021. The results of the multivariate analysis showed that histologic grade, invasion of the lamina propria, and the presence of carcinoma in situ at presentation were independent prognostic parameters regarding recurrence-free survival (p = 0.002; hazard ratio (HR) = 1.44, 95% confidence interval (CI) = 1.059-1.956, p = 0.02; and HR = 1.76, 95% CI = 1.159-2.684, p = 0.008, respectively). Histologic grade was the only independent prognostic parameter of disease-specific survival (DSS) (p < 0.001). Comparisons between non-muscle invasive (NMI) MGUC and NMI LGUC, as well as between NMI MGUC and NMI HGUC, revealed statistically significant differences in terms of DSS (HR = 0.07, 95% CI = 0.024-0.252,p< 0.001 and HR = 1.59, 95% CI = 1.023-2.460, p = 0.039, respectively). Our study findings demonstrate statistically significant differences regarding DSS between NMI MGUC and NMI HGUC, as well as between NMI MGUC and NMI LGUC. Therefore, we suggested that considering the presence of less than 5% MGUC as a separate category may be appropriate. However, it is important to validate our results in larger cohorts with longer follow-up periods to establish the clinical significance of MGUC and provide guidance for patient management.

Immunohistochemical Expression of Clustered Differentiation 10 (CD10) Across Various Grade &amp; Stage of Urinary BladderCarcinoma

Objective: To assess the Clustered Differentiation 10 (CD10) expression in Urothelial carcinoma and to ascertain how its expression relates to grade and stage. Method: Descriptive cross sectional research was carried out over a period of six months in Pathology Department on eighty five cases of bladder carcinoma from transurethral resection of bladder (TURBT) specimens diagnosed on Hematoxylin-eosin (H &amp; E) stained sections irrespective of patient's age and gender were included in the study. These were stained for CD10 by Immunohistochemical technique. Results: Sixty seven (78.8%) urothelial carcinomas showed positive CD10 staining while 18 cases (21.17%) demonstrated negative expression. In 67 positive cases, 42 high grade tumors had 2+ expression while 13 grade had 1+ staining .All low-grade tumors(12) displayed 1+ score. Sixteen tumorsin pT1, 21 tumorsin pT2 and 3 tumors in pT3 stage displayed 2+ score. Nineteen tumors in pT1 while 4 tumors in pT2 had 1+ score. Conclusion: Our findings indicate that CD10 expression is greater in high grade and invasive urothelial carcinomas and is associated with progression of bladder carcinomas.

Use of artificial intelligence in diagnostic cystoscopy of bladder cancer

Background. At the current stage of science and technology development, artificial intelligence (AI) is being actively developed and gradually introduced into the healthcare system.Aim. To perform a literature review to assess the diagnostic value of AI in the detection of bladder cancer at the cystoscopy stage.Materials and methods. We carried out a bibliographic search of articles in Medline and Embase databases using the keywords “artificial intelligence”, “cystoscopy”, “TURBT”.Results. Automated image processing based on AI can improve the accuracy of cancer diagnosis during cystoscopy. According to the studies presented in the review, the sensitivity of AI system for the detection of bladder cancer via cystoscopy can reach 89.7–95.4 %, while its specificity is 87.8–98.6 %, which exceeds the diagnostic capabilities of standard cystoscopy in white light, the sensitivity and specificity of which, according to recent investigations, are approximately 60 and 70 %, respectively. Despite the promising results of these studies, modern science is currently at the stage of developing and evaluating the performance of various AI methods used to analyze cystoscopy images. To date, it would be premature to introduce and widely use these technologies in healthcare, since there are no prospective clinical studies to assess the effectiveness of AI systems in diagnostic cystoscopy and transurethral resection of bladder cancer.Conclusion. Few studies show that AI-based cystoscopy is a promising approach to improvement of the quality of medical care for bladder cancer. Further research is needed to improve the diagnostic capabilities of AI and introduce the obtained technological data into clinical practice.

Interobserver agreement and the role of smoothelin immunostain in the evaluation of Muscularis Propria (MP) invasion of Bladder Urothelial Carcinoma (BUC)

Link of Video Abstract: https://youtu.be/KymxBUAr9eIBackground: Bladder Urothelial Carcinoma (BUC) is common cancer in the genitourinary organs. One important determinant for its therapy modality is the presence of tumor invasion into Muscularis Propria (MP). Assessing MP invasion in routine Hematoxylin-Eosin (HE) slides of Transurethral Resection of Bladder (TUR-B) specimens is not always easy due to tissue fragmentation and morphological similarities of MP to muscularis mucosa (MM) and myofibroblasts. This study was done to determine the interobserver agreement in evaluating MP invasion and to find alternatives to overcome this diagnostic problem. Methods: This cross-sectional observational analytic study was conducted in the Pathology Laboratory of the Faculty of Medicine, Universitas Udayana/Prof. Dr. I.G.N.G. Ngoerah Hospital, Bali, in 2022. As many as 72 HE slides of TUR-B specimens of BUC patients were examined separately by five experienced pathologists. Smoothelin immunostaining, a marker to identify MP, was also examined as a comparison. Data were processed and statistically tested using the SPSS version 20.0 program for Windows. Results: The interobserver agreement of those five pathologists was found to be low to moderate, with an average = 0.48, ranging between 0.18-0.69. One pathologist had a low agreement with four others (&lt;0.4) and indicated diagnostic uncertainty in 41% of the samples examined. Among four other pathologists, the agreements were moderate, with = 0.40-0.69. The proportion of concordant examination results was only 45.8%. When the outcome of each HE slide was concluded by consensus, it was found that there was no statistically significant difference with smoothelin immunostaining results. Conclusion: Evaluation of MP invasion of BUC in TUR-B specimens had low to moderate interobserver agreement, which indicated that this examination was subjective. However, the consensus of several pathologists seems to lead to better accuracy, close to the result of smoothelin immunostaining.

3-year experience of hyperthermic intravesical chemotherapy use in patients with high risk non-muscular-invasive bladder cancer

Cur rently, the search for additional organ-sparing methods of intravesical therapy for non-muscular-invasive bladder cancer (NMIBC) is actively continuing, which could become an effective alternative to standard treatment using the Bacillus Calmette-Guérin (BCG) vaccine. The aim of this work was to analyze the safety profile and long-term results of treatment of patients with the high-risk non-muscular-invasive bladder cancer who received adjuvant intravesical chemotherapy using the Combat BRS HIVEC® device for local hyperthermia (HIVEC® therapy group; n=53) in comparison with patients who received adjuvant therapy after transurethral resection of bladder performed with the Bacillus Calmette-Guérin vaccine (BCG therapy group; n=54). As a result, the median follow-up was 30 months (range 7-36). According to Common Terminology Criteria for Adverse Events (CTCAE) v 5.0, the most relevant side effects in HIVEC®/BCG therapy groups were adverse events grade 1-2: fever – 1%/8%; dysuria – 9%/13%; bladder spasms – 7%/12%; hematuria – 3%/4% and urinary tract infection – 3%/10%. Tumor recurrence was reported in 23 patients receiving intravesical BCG therapy and in 10 patients receiving intravesical hyperthermic chemotherapy (42.6% versus 18.9%, p=0.008). Tumor progression was recorded in 11 patients receiving intravesical BCG therapy and in 4 patients receiving intravesical hyperthermic chemotherapy (20.4% versus 7.5%, p=0.046). The study allows us to conclude that the method of hyperthermic intravesical chemotherapy has a better safety profile compared to intravesical Bacillus Calmette–Guérin vaccine therapy, while such indicators of oncological efficacy as 3-year recurrence-free survival and the incidence of progression were better in the HIVEC® therapy group.

MP25-15 INTERNATIONAL EXPERTS CONSENSUS ON PERFORMANCE METRICS FOR A TRANSURETHRAL RESECTION OF BLADDER

MP25-15 INTERNATIONAL EXPERTS CONSENSUS ON PERFORMANCE METRICS FOR A TRANSURETHRAL RESECTION OF BLADDER

PD13-14 THE GENETIC INFORMATION OF NON-MUSCLE INVASIVE BLADDER CANCER ASSOCIATED WITH RECURRENCE

You have accessJournal of UrologyCME1 Apr 2023PD13-14 THE GENETIC INFORMATION OF NON-MUSCLE INVASIVE BLADDER CANCER ASSOCIATED WITH RECURRENCE Seong Hyeon Yu, Do Gyeong Lim, Jeong Hoon Oh, Jiwon Ryu, Ho Seok Chung, Eu Chang Hwang, Kyung Jin Oh, Sun-Ouck Kim, Seung Il Jung, Taek Won Kang, Kwangsung Park, and Dong Deuk Kwon Seong Hyeon YuSeong Hyeon Yu More articles by this author , Do Gyeong LimDo Gyeong Lim More articles by this author , Jeong Hoon OhJeong Hoon Oh More articles by this author , Jiwon RyuJiwon Ryu More articles by this author , Ho Seok ChungHo Seok Chung More articles by this author , Eu Chang HwangEu Chang Hwang More articles by this author , Kyung Jin OhKyung Jin Oh More articles by this author , Sun-Ouck KimSun-Ouck Kim More articles by this author , Seung Il JungSeung Il Jung More articles by this author , Taek Won KangTaek Won Kang More articles by this author , Kwangsung ParkKwangsung Park More articles by this author , and Dong Deuk KwonDong Deuk Kwon More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003260.14AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The next-generation sequencing (NGS) is widely used in muscle invasive bladder cancer (MIBC), but limited use in non-muscle invasive bladder cancer (NMIBC) due to significant heterogeneity and high cancer-specific survival. Therefore, we aimed to evaluate the genomic information of NMIBC and identify molecular alteration associated with tumor recurrence. METHODS: A total of 43 patients with NMIBC who underwent transurethral resection of bladder were enrolled. We performed NGS using oncomine panel on tumor specimen and blood sample corresponding to each specimen. The mutation results were analyzed by pairwise comparison according to the recurrence of bladder tumor within 1 year. RESULTS: The median incidence of genetic variation in 43 tumor samples was 53 variations per sample, and high TMB was associated with tumor recurrence. (median variation 33 vs. 64, p=0.023) The most mutated gene was ATM (79%), followed by NF1 (79%), and NOTCH1 (79%). In the results of pairwise comparison according to the recurrence of bladder tumor within 1-year, epidermal growth factor receptor (EGFR) mutation was significant factor associated with tumor recurrence (odds ratio [OR], 4.81; 95% confidence interval [CI], 1.96-32.92, p=0.045). In addition, TERT (OR, 4.10; 95% CI, 0.92-22.38, p=0.054) and MYCL (OR, 5.22; 95% CI, 0.86-57.88, p=0.068) might be the associated factor of tumor recurrence. CONCLUSIONS: Our results revealed that EGFR mutation has a prognostic value on tumor recurrence of NMIBC; therefore, EGFR might be a useful prognostic biomarker in NMIBC. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e411 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Seong Hyeon Yu More articles by this author Do Gyeong Lim More articles by this author Jeong Hoon Oh More articles by this author Jiwon Ryu More articles by this author Ho Seok Chung More articles by this author Eu Chang Hwang More articles by this author Kyung Jin Oh More articles by this author Sun-Ouck Kim More articles by this author Seung Il Jung More articles by this author Taek Won Kang More articles by this author Kwangsung Park More articles by this author Dong Deuk Kwon More articles by this author Expand All Advertisement PDF downloadLoading ...

Development of a predictive model for optimizing the selection of patients for second transurethral resection bladder

Background: Transurethral resection of bladder (TURB) is considered the gold standard treatment of non-muscle invasive bladder tumor (NMIBT). The urological clinical practice guidelines recommend second-TURB (re-TURB), in certain situations, to achieve a complete resection and appropriately stratify the tumor. Objective: To design a predictive model of residual tumor in re-TURB, to optimize patient selection and avoid unnecessary surgeries. Methods: Retrospective analysis of 413 NMIBT with a macroscopically complete TURB and identification of the muscle layer, with subsequent re-TURB (2-6 weeks), according to EAU Clinical Guidelines criteria, from January 2010 to December 2021. We have identified predictive variables of residual tumor through univariate and multivariate analysis using logistic regression. The evaluation of the exactitude of the predictive model has been made using AUC (area under curve-ROC curve). Results: Median age in the series was 74 (38-91) years old, and 86.7% were male. Tumors that required second-TURB were mostly primary (64.6%), stage T1 (84.5%), high grade (82.6%), multifocal (54.8%) and with a size less than 3 cm (73.1%). Residual tumor was found in 28.1% of re-TURB. The independent predictors factors of residual tumor identified were: recurrence tumor (OR 1.87; IQ 1.14-3.06, p=0.01) and multifocality tumors (OR 2.11; IQ 1.31-3.4; p=0.002). High-grade shows a trend to statistical signification as risk factor (p=0.07) and early administration of mitomycin-C behaved as an independent protector factor (OR 0.40; IQ 0.3-0.81; p=0.006). The predictive model shows an AUC=0.7 (IQ 0.62-0.73; p=0.0001). Conclusion: Our predictive model evaluates the probability of finding residual tumor in second-TURB with a 70% accuracy. This way, we could optimize the selection of patients in low risk of residual tumor, thus avoiding unnecessary surgeries.

Poorly Differentiated Neuroendocrine Tumor of the Bladder: A Case Report

Neuroendocrine tumors rarely occur in the urinary bladder, relatively less than 1% of occurrence, as the tumor is very rare, pathogenesis is uncertain some authors showed that it is from urothelial origin. It can be carcinomatous, subdivided into small cell and large cell pathology. Small cell carcinoma of the bladder is a rarity that may present at an advanced pathologic stage. No treatment regimens have been standardized for local or metastatic disease. Many publications showed that the disease is treated with combined chemotherapy or with radical cystectomy, here we are presenting a case of a 78 years old male, who underwent transurethral resection of bladder 1 month ago and the biopsy report was suggestive of neuroendocrine tumor of bladder, after that patient underwent radical cystectomy with neobladder reconstruction surgery.

BCG shortage for intravesical instillation is associated with early tumoral recurrence in patients with high-risk non-muscle invasive bladder tumours

IntroductionDuring 2019 there was a worldwide shortage of BCG strains for intravesical instillation, limiting the availability of full dose schemes for maintenance courses. The main objective was to analyze the impact on tumoral relapse secondary to BCG shortage in our center. Secondary outcomes included recurrence and progression–free survival rates and tumoral relapse specific characteristics. MethodsRetrospective cohort study including 158 subjects (64 treated during 2019 and 94 during 2017) with high-risk non-muscle invasive bladder cancer and treated with a combination of Transurethral bladder resection (TURB) followed by adjuvant intravesical instillation with BCG in a tertiary hospital in Spain.Basal characteristics of both groups were analyzed. Times to event of interest (relapse; including recurrence and/or progression) were estimated with Kaplan–Meier survival analysis. Disease-free survival rates were analyzed using a multivariable Cox regression model of proportional hazards. ResultsMedian follow-up in the 2019 sample was 24 months and 50 months in the 2017 group with a median number of instillations of 8 and 12 respectively. Median time to relapse of 285 days (145–448) during 2019 and 382 days (215–567) in 2017 were observed (logRank p = 0.025). Further multivariable analysis revealed a proportional hazard ratio (HR) for disease-free survival rate of 1.87 (95% CI: 1.04–3.37 p = 0.036). No statistically significant differences in tumoral relapse characteristics were observed. ConclusionBCG shortage and subsequent reduced-dose schemes used for intravesical instillation due to limited availability, increase early tumoral relapse rates. These findings are consistent with available evidence, showing the need for full-dose BCG courses.

International experts consensus on performance metrics for a transurethral resection of bladder (TURB)

International experts consensus on performance metrics for a transurethral resection of bladder (TURB)

Urinary Bladder Leiomyoma Causing Obstructive Uropathy: A Case Report and Literature Review

This is the first time a large endovesical leiomyoma of the urinary bladder has been reported in India. A 44-year-old woman had painless gross haematuria, increased urine frequency, an incomplete emptying feeling, and left loin discomfort. Imaging and cystoscopy revealed a 6 x 5 cm projecting endovesical tumour emerging from the bladder's base near the left vesico-ureteric junction. Transurethral bladder resection with few biopsies was performed, histopathological examination revealed a pathological diagnosis of a leiomyoma of the urinary bladder. Intravesical complete excision of the tumor was performed after ligating its pedicle. Complete surgical resection is a very effective treatment, associated with almost no recurrence. We discuss the relevant recent literature of bladder leiomyoma.