Transurethral balloon dilation (BD) is a minimally invasive treatment for urethral stricture disease (USD) performed primarily or as a recurrence salvage maneuver. With the introduction of drug-coated balloons, we sought to characterize patient outcomes using non-medicated balloons. A retrospective review identified patients who underwent BD from 2007 to 2021. Patient and stricture characteristics were collected. All dilations employed the 24Fr UroMaxTM system. Clinical failure was defined by patient-reported lower urinary tract symptom recurrence or need for further stricture management. Ninety-one patients underwent BD with follow-up median (IQR) 12 (3–40) months. Most (75/91, 82%) had prior treatment for USD (endoscopic 50/91 (55%), 51/91 (56%) urethroplasty) before BD. Recurrence rates did not significantly differ between treatment-naïve and salvage patients (44% vs. 52% (p = 0.55)). Median (IQR) time to failure was 6 (3–13) months. The most common complications were urinary tract infection (8%) and post-operative urinary retention requiring catheterization (3%). Radiation history was noted in 33/91 (36%) with 45% recurrence. Patients without previous radiation had a similar recurrence rate of 52% (p = 0.88). Balloon dilation had minimal complications and overall, 50% recurrence rate, consistent regardless of stricture characteristics, radiation history, or prior treatments. These results represent an important clinical benchmark for comparing outcomes using drug-coated balloons.
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Introduction: Radical cystectomy (RC) and radical nephroureterectomy (RNU) are commonly performed in urological oncology. Concurrent disease in the upper tract and bladder is rare, so performing both procedures in the same setting is uncommon. Here, we report the perioperative and oncological outcomes of a single-institution series of concurrent RC+RNU. Methods: We retrospectively reviewed the charts of patients who underwent concurrent RC+RNU for bladder and/or upper tract urothelial carcinoma between 2006 and 2020. Patient demographic and clinical factors, perioperative parameters, and oncological outcomes were obtained. Results: Twenty-seven patients underwent RC+RNU during the study period; 22 (81%) were male. Median (interquartile range) patient age was 71 (67–75) years. All had a diagnosis of bladder cancer. Concurrent upper tract urothelial carcinoma (UTUC) was the indication for RNU in 12 cases (44%) and non-functional renal unit in the remainder. Two patients (7%) experienced early postoperative mortality. Eight patients (30%) experienced major complications (Clavien-Dindo >3). Complications did not vary significantly between those rendered anephric (5/16, 31%) and those who were not (3/11, 27%) (p=0.82, Chi-squared test). Median (95% confidence interval) and five-year overall survival were 47 (41–52) months and 42%, respectively. Six of 22 male patients (27%) experienced a urethral recurrence and three of 14 patients (21%) with non-functional kidneys had occult UTUC discovered on final pathology. Conclusions: Combined RC+RNU carries an elevated perioperative risk, primarily in highly comorbid patients. Striking rates of occult UTUC in non-functional kidneys and of urethral recurrence after cystectomy were noted. RC+RNU is an appropriate option in select patients.
BACKGROUND: Limited data are available on the outcomes of patients with non-muscle invasive bladder cancer (NMIBC) unresponsive to intravesical bacillus Calmette-Guérin (BCG), as defined by the United States Food and Drug Administration. OBJECTIVE: To define the outcomes of patients with BCG-unresponsive NMIBC. METHODS: This was a retrospective, single-institution observational cohort study. Records of patients managed at our institution for BCG-unresponsive NMIBC between 2005 and 2020 were reviewed and clinical outcomes evaluated. RESULTS: The study included 149 patients. Management was with initial radical cystectomy in 60 patients (40%) and initial bladder-sparing therapy (BST) in 89 patients (60% ). Overall survival was greater among patients undergoing RC than BST (HR 1.83, 95% CI 1.04–3.22, p = 0.036), potentially due to patient selection, as no significant difference was noted for metastasis-free or cancer-specific survival. Patients opting for initial BST had high rates of treatment failure, with estimated 5-year cystectomy-free survival of only 42% . Patients who received additional lines of BST after a subsequent failure were at increased risk of having ≥pT3 or pN+ disease at cystectomy (42% for ≥2 lines BST, versus 18% for 1 line BST and 15% for initial cystectomy, p = 0.038). CONCLUSION: Among patients who underwent initial BST for BCG-unresponsive NMIBC, rates of treatment failure were very high. Patients who underwent delayed cystectomy after ≥2 lines of BST had elevated rates of extravesical disease. Our observations emphasize the importance of recent and ongoing clinical trials in this clinical space.
Elsewhere in JAMA Network Open, Bree and colleagues 1 present a novel analysis of 13 054 patients in the Surveillance, Epidemiology, and End Results-linked Medicare database, in which they identify an apparent pattern of increasing intensity in cancer surveillance for low-grade non-muscleinvasive bladder cancer (NMIBC) between 2004 and 2013. They specifically examine the rates of cystoscopy, upper tract imaging, and urine cytologic testing during this period and highlight the discordance with current American Urologic Association/Society of Urologic Oncology guidelines 2 recommending deescalation of surveillance. In addition, the study sheds light on specific covariates significantly associated with both escalation and deescalation of surveillance. As a secondary + Related articleAuthor affiliations and article information are listed at the end of this article.
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