Objective: To summarise the currently available literature and analyse available results of the outcome of intraoperative frozen-section analysis (FSA) on upper urinary tract recurrence (UUTR) after radical cystectomy (RC). Materials and methods: A systematic review of the literature was performed according to the Cochrane Reviews guidelines and in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist. Articles discussing ureteric FSA with RC were identified. Results: The literature search yielded 21 studies, on which the present analysis was done. The studies were published between 1997 and 2019. There were 10 010 patients with an age range between 51 and 95 years. Involvement of the ureteric margins was noted in 2-9% at RC. The sensitivity and specificity of FSA were~75% and 99%, respectively. Adverse pathology on FSA and on permanent section, prostatic urothelial carcinoma involving the stroma but not prostatic duct, and ureteric involvement on permanent section were all more likely to develop UUTR. Neither evidence of ureteric involvement nor ureteric margin status on permanent section were significant predictors of overall survival. Conclusion: Routine FSA is mandatory for a tumour-free uretero-enteric anastomosis and is predictive of UUTR. To lower the UUTR, FSA is not necessary if the ureters are resected at the level where they cross the common iliac vessels. FSA is indicated whenever the surgeon encounters findings suspicious of malignancy, e.g. ureteric obstruction, periureteric fibrosis, diffuse carcinoma in situ, induration or frank tumour infiltration of the distal ureter is discovered unexpectedly during surgery, and prostatic urethral involvement.
Background
Renal arterial embolization (RAE) is considered to be a safe and effective method for treating a variety of renal lesions and pathology. It is the optimal method not only to stop bleeding, but to preserve renal parenchyma and renal function. Patients who are scheduled to RAE who showed negative catheter angiography with the procedure subsequently denied have a special concern because they are subjected to unnecessary procedure with its complications and didn’t get its benefits. This circumstance is infrequently reported in the literature, and that compelled us to identify the predictors of negative renal angiography findings that would result in a failure to undertake RAE.
Results
The study included 180 patients (126 males; 70%) with a mean ± SD age of 44 ± 14 years. Iatrogenic causes were the most common indication for RAE (108 of 180; 60%), while spontaneous unknown reasons constituted (17 of 180 patients; 9%). Angiography showed various lesions in 148 patients: pseudoaneurysm (80 of 148; 54%), tumours (28 of 148; 19%), arteriovenous (AV) fistulas (22 of 148; 15%)
and both pseudoaneurysm and AV fistulas (18 of 148; 12%). However, in the remaining 32 of 180 patients (18%) no lesions were identified on renal angiography and RAE procedures were not undertaken. On bivariate analysis, neither gender, side of the lesions, haematuria prior to RAE, or renal artery anatomy were predictors for negative angiography. However, the indication for RAE (spontaneous unknown reasons) of renal haemorrhage was the only predictor for negative angiography (9/17 (53%), P = 0.001).
Conclusion
Patients scheduled for RAE may show negative findings with no lesions on renal angiography. Among the different indications for RAE, patients with spontaneous (unknown) have the highest probability (53%) of being associated with negative renal angiography findings, however, those with renal tumours and post-traumatic causes have a low probability. In those patients with spontaneous (unknown), conservative management should be the initial treatment of choice in order to avoid unnecessary RAE and its associated complications.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.