Introduction and Objectives Poor preoperative nutritional status is a risk factor for adverse outcomes after major surgery. We evaluated the effect of preoperative nutritional deficiency (ND) on peri–operative mortality and overall survival in patients undergoing radical cystectomy (RC) for bladder cancer. Methods 538 patients underwent RC for urothelial carcinoma (UC) between January 2000 and June 2008 and had nutritional parameters documented. Patients with preoperative albumin <3.5 g/dL, BMI <18.5 or pre–surgical weight loss >5% of body weight were considered ND. Primary outcomes were 90–day mortality and overall survival. Survival was estimated using Kaplan–Meier analysis and compared using the log–rank test. Cox proportion hazards models were used for multivariate survival analysis. Results 103 of 538 patients (19%) met criteria for ND. 90–day mortality was 7.3% overall (39 deaths); 16.5% in patients with ND and 5.1% in the others, p<0.01..ND was a strong predictor of death within 90 days on multivariate analysis (HR 2.91, 95% CI [1.36, 6.23], p<0.01). Overall survival at 3 years was 44.5% (33.5, 54.9) for ND patients and 67.6% (62.4, 72.2) for nutritionally normal patients, p<0.01. On multivariate analysis, ND patients had significantly higher risk of all-cause mortality (HR 1.82, 95% CI [1.25, 2.65], p<0.01). Conclusions Nutritional deficiency, as measured by preoperative weight loss, BMI and serum albumin, is a strong predictor of 90–day mortality and poor overall survival. Prospective studies are needed to demonstrate the best indices of preoperative nutritional status and whether nutritional intervention can alter the poor prognosis for RC patients with nutritional deficiencies.

Objectives The relationship between perioperative blood transfusion (PBT) and oncologic outcomes is controversial. In patients undergoing surgery for colon cancer and several other solid malignancies, PBT has been associated with an increased risk of mortality. Yet, the urologic literature has a paucity of data addressing this topic. We sought to evaluate whether PBT affects overall survival following radical cystectomy (RC) for patients with bladder cancer. Methods The medical records of 777 consecutive patients undergoing RC for urothelial carcinoma of the bladder were reviewed. PBT was defined as transfusion of red blood cells during RC or within the postoperative hospitalization. The primary outcome was overall survival. Clinical and pathologic variables were compared using chi-squared tests, and Cox multivariate survival analyses were performed. Results A total of 323 patients (41.6%) underwent PBT. In the univariate analysis, PBT was associated with increased overall mortality (HR 1.40, 95%CI 1.11–1.78). Additionally, an independent association was demonstrated in a nontransformed logistic regression model(HR, 95%CI 1.01–1.36) but not in a model utilizing restricted cubic splines(HR 1.03, 95%CI 0.77–1.38). The c-index was 0.78 for the first model and 0.79 for the second. Conclusions In a traditional multivariate model, mirroring those that have been applied to this question in the general surgery literature, we demonstrated an association between PBT and overall mortality after RC. However, this relationship is not observed in a second statistical model. Given the complex nature of adequately controlling for confounding factors in studies of PBT, prospective study will be necessary to fully elucidate the independent risks associated with PBT.

The likelihood of biochemical recurrence was similar between groups when stratified by known risk factors of recurrence. Surgical approach was not a significant predictor of biochemical recurrence in the multivariate model. Our analysis is suggestive of comparable effectiveness for robot assisted laparoscopic prostatectomy, although longer term studies are needed.

What’s known on the subject? and What does the study add? The association between squamous cell carcinoma of the bladder and schistosomal bladder infection is well‐known to most physicians. Less recognized is the remarkable cause and effect relationship between the eradication of schistosomiasis and the subsequent radical decline in squamous cell bladder cancer. Public health initiatives in Egypt have effectively eliminated the most common cause of death in young Egyptian men, and the result is a testament to how basic science, properly applied to public policy, can dramatically improve the health of an entire country. Schistosomiasis is a parasitic disease caused by flatworms that live in snail‐infested fresh water. It is endemic to 74 countries and affects some 200 million people worldwide, causing an estimated 200 000 deaths annually [1]. Schistosomiasis can affect the gastrointestinal tract and liver (S. mansoni and S. japonicum species), resulting in diarrhoeal disease and hepatic fibrosis, or the urinary tract (S. haematobium) where it causes haematuria, strictures, obstruction, super‐infection and, ultimately, cancer. In children and vulnerable adults, systemic effects such as anaemia, malnutrition, stunted growth and impaired cognition can be profound. The association between this parasitic infestation and the development of bladder cancer literally took millennia to uncover. It is unusual for a parasitic disease to result in a fatal neoplastic process, and rarer still to have public health efforts, aimed at eradication of the parasitic menace, to result in a dramatic shift in the epidemiology of the most common cancer in a nation.

Of low risk cases 31% were upgraded at final pathology. Smaller prostate size predicts Gleason score upgrading in men with clinically low risk prostate cancer. This is important information when counseling patients on management and prognosis.

A solitary positive apical margin was associated with worse biochemical recurrence but on multivariate analysis it was not an independent predictor of recurrence. Models to predict biochemical recurrence after radical prostatectomy should account for differences in the prognostic significance of different positive margin sites.

Sociodemographic factors, preoperative performance status, and comorbidities and perioperative factors contribute to the discharge decision after radical cystectomy. Some subgroups can be predicted to have increased postoperative care needs and may be appropriate targets for disposition planning preoperatively.

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