Bladder replacement following radical cystectomy is widely practiced and in some centers has become the standard method of urinary diversion when possible, rather than the traditional ileal conduit. To minimize the impact of cystectomy and bladder replacement on quality of life and to obtain optimal functional results, postoperative care must be comprehensive and multidisciplinary. Critical team members include the surgeon, urologic nurses, WOC nurses, and allied health care providers such as physiotherapists. This article highlights postoperative considerations for patients undergoing radical cystectomy with orthotopic neobladder construction. The common issues and complications that arise are discussed with a focus on strategies to optimize outcomes.

Bladder substitution following radical cystectomy for urothelial cancer (transitional cell carcinoma) has become increasingly common and in many centers has evolved to become the standard method of urinary diversion. In determining the best type of urinary diversion for a specific patient, consideration must be given to both the morbidity associated with surgery and the potential positive impact on the patient's quality of life. Decision-making and perioperative care is ideally multidisciplinary, involving physicians and nurse specialists in urology, continence, and ostomy therapy. Physiotherapists may also be involved for pelvic floor muscle retraining. This article highlights preoperative considerations for patients undergoing radical cystectomy with a focus on issues specific to orthotopic bladder substitution as the method of urinary diversion. The second article in this 2-part series will outline postoperative strategies to manage these patients.

Prostate cancer (PCa) is one of the leading causes of cancer death in men. CD151 is a member of the tetraspanin family and is associated with regulation of migration of normal and tumour cells via cell surface microdomain formation. Previous studies from our laboratory revealed that expression of CD151 differs across histological grades of PCa and high levels of expression are linked to shorter survival, independent of Gleason score1. In vitro motility assays of human PCa cell lines suggest CD151 is a motility promoter2. We have sought to develop a number of CD151 inhibitors and examine their ability to modulate prostate cancer motility and metastasis. The human PCa cell line, LNCaP (low endogenous level of CD151), transfected with CD151 shows increased motility and invasion compared to control LNCaP, whilst CD151 siRNA knock-down (KD) of PC-3 cells (high endogenous level of CD151), reduces motility compared to control PC-3. We have conducted in silico screening with compounds predicted to bind a model of the large extracellular domain (EC2) of CD151 and found that a number of these small molecules possess bioactivity in vitro and in vivo in inhibiting prostate cancer motility and progression. LNCaP growth and migration was confirmed by stimulating with 1 and 10 nM DHT at 24 hrs in charcoal stripped FBS. It was found that cell proliferation and motility of LNCaP cells was significantly increased after stimulation by 10 nM DHT at 24 hrs (p<0.01) and 48hrs (p<0.01), whilst DHT had minimal effect on control PC-3 and DU-145 cells. We have also analyzed a set of whole genome microarray expression data from PCa cell lines PC-3 and CD151 KD PC-3, and identified differentially expressed genes linked to CD151. Significant changes were seen in 172 genes after CD151 KD in PC-3 cells. We examined the protein interaction networks of our differentially expressed genes using Cytoscape3. Functional network analysis revealed high level of connectivity surrounding genes involved in transcriptional regulation, microtubule-based movement and protein folding and complex formation. CD151 is an important promoter of cell migration and metastatic disease in PCa and may serve as a target for a novel class of anti-metastatic therapeutic agents. A systems biology approach allows for improved mechanistic interpretation of biological data and may facilitate identification of other therapeutic targets. 1 Ang J et al. Cancer Epidemiol Biomarkers & Prevention (2004) 13: 1717-21 2 Ang J et al. Oncology Reports (2010) 24(6): 1593-1597 3 Shannon P et al. Genome research (2003) 13: 2498-2504 Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 103rd Annual Meeting of the American Association for Cancer Research; 2012 Mar 31-Apr 4; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2012;72(8 Suppl):Abstract nr 469. doi:1538-7445.AM2012-469

Penile squamous cell carcinoma (SCC) is an uncommon condition in Western countries. Inguinal lymph nodes dissection can be curative in 20%–60% of node positive patients. However, there is a high complication rates from the dissection, thus accurate diagnosis of inguinal lymph nodes metastasis is required. Current non invasive methods to detect lymph nodes metastasis are unreliable. Dynamic Sentinel Node Biopsy (DNSB), ultrasonography (US), and fine needle aspiration (FNA) cytology were proposed to in an attempt to detect sentinel lymph node (SLN). Despite the initial high rate of false negative results, recent DSNB showed improved survival compared to wait and see policy as well as reduced mortality compared to prophylactic inguinal lymphadenectomy. In addition, the US guided FNA shown 100% of specificity in detecting clinically occult lymph nodes metastasis. We proposed an algorithm for management of lymph nodes in penile cancer and suggest that FNA with US guidance should be performed in all high risk patients and that therapeutic dissection should be performed if findings are positive.

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