BackgroundThe two commonly used methods for uretero-ileal anastomosis (UIA) during radical cystectomy for muscleinvasive bladder cancer (MIBC) are the Bricker and Wallace 1 techniques. Published data on the incidence of strictures at anastomotic sites is limited. This study compares both anastomotic techniques in terms of uretero-ileal stricture (UIS) rates and the factors that govern it in the patient group.
Introduction Radical cystectomy (RC) is the current standard of care for treating muscle-invasive bladder cancer (MIBC), however bladder preservation by offering radical radiotherapy (RT) is gaining interest for improving the quality of life while maintaining a reasonable oncological outcome. In this study, we have compared outcomes of the two treatment options. Materials and methods This is a 10-year retrospective cohort study that included all patients who were treated for histologically proven muscle-invasive bladder cancer in the department of uro-oncology at Shaukat Khanum Memorial Cancer Hospital and Research Centre from January 2005 to January 2015. Data was analysed using Statistical Product and Service Solutions (SPSS), version 21 (IBM Corp., Armonk, NY). The primary end point of our study was to calculate the three-and five-year disease-free survival (DFS) and overall survival (OS). Results A total of 230 patients were included in the study with male gender predominating (88%). The mean and standard deviation for age was 58.32+11.128. Radical cystectomy was performed in 119 patients while 111 received RT. Clinically, 34% had stage 2 disease, while 66 % had stage 3 cancer. The median follow-up duration was 41 months (range: 2-155). During follow-up 57.4% of patients showed no recurrence. Local recurrence was found in 9.6% patients and distant metastasis in 32.2%. The three-year DFS of RC was 63% and that of RT was 57% while the five-year DFS for RC and RT were 60% and 49%, respectively (p=0.196). The three-year OS of RC was 64% and that for RT was 58%. On further analysis the five-year OS of RC was 53% and that for RT was 50% (p=0.98). Upon stage-based comparisons, we found no statistically significant difference between the three-and five-year DFS and OS of stage 2 and stage 3 when treated with either modality. Conclusion Most studies favor RC and consider it as the gold standard treatment for muscle-invasive bladder tumor treatment. The current study reveals that bladder preservation approach by chemo radiotherapy is a viable treatment option, having comparable oncological outcomes with patients receiving radical cystectomy, and can be offered to patients having muscle-invasive urothelial bladder cancer.
Introduction Nephron-sparing surgery in the form of partial nephrectomy (PN) is currently considered the standard treatment for relatively small localized renal cell tumors. Objectives This study aimed to determine outcomes of PN regarding complications, recurrence, and survival rates at Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan. Methods We assessed the data of patients older than 18 years undergoing PN from January 2010 to June 2017 who met our inclusion criteria. Data were analyzed using IBM SPSS Statistics for Windows, Version 20.0 (IBM Corp., Armonk, NY). Results A total of 35 patients were studied, with a male to female ratio of 2.5:1 with median age of 50 years. The median hospital stay was four days (range: 3-7), and the median RENAL (radius, exophytic/endophytic properties, nearness of tumor to the collecting system or sinus in millimeters, anterior/posterior location relative to polar lines) Score was five (range: 4-10). The most common pathological tumor stage was T1 (94%), and the median size was 3.5 cm. On histopathology, clear-cell carcinoma was the most common tumor (incidence, 71%). The median Fuhrman’s grade was two. On final histopathology, four patients had positive margins. Among them, two patients showed a progressive deterioration in renal functions and were found to have residual disease six months later. Only one patient developed metastasis in the lung. Wound infection was observed in one patient while another had wound dehiscence. Urine leakage was noted in two patients. The median follow-up duration was 18 months (range: 3-84). Mean cancer-free survival was 78.6 months, and overall survival was 79.2 months. The projected three-year and five-year disease-free and overall survival was 96% and 94%, respectively. Conclusion PN is a viable option with excellent outcomes regarding the complication profile, recurrence-free, and overall survival in patients with relatively small localized renal tumors.
BACKGROUND: The overall probability that an individual will form stones varies in different regionsof the world. The risk of having urinary tract stones in the developed country populations is between 10-15%. The prevalence of urinary tract stone disease is 13% for adult males and 7% among the females.Most of the patients with ureteric stones present with colicky pain, however some may be asymptomaticand are identified on routine assessment. Large stones typically require active treatment. Stones that donot pass can be removed by different treatment modalities such as Extracorporeal shock wave lithotripsy(ESWL), Ureteroscopic lithotripsy (URSL) and open or laparoscopic ureterolithotomy.OBJECTIVE: To compare the efficacy of Ureteroscopic lithotripsy versus extracorporeal shockwavelithotripsy in the treatment of proximal ureteric stones of size between 10mm to 15mm.MATERIALS AND METHODS: This was a randomized control trial of 138 human subjects,conducted at Department of Urology, Institute of Kidney Diseases, Hayatabad Medical Complex,Peshawar. Total sample size was based on the previously reported stone clearance rates for proximalureteric stones (88% URSL12 and 67.5% for ESWL11), 95% confidence interval and power of 90%.RESULTS: In this study mean age was 47.36 years SD +15.4. Fifty nine percent patients were male and41% patients were female. Eighteen percent patients had stone size 10mm, 19.6% patients had stone size11mm, 19.6% patients had stone size 12mm, 16.7% patients had stone size 13mm, 13.6 patients hadstone size 14mm, 11.6% patients had stone size 15mm. ESWL was effective in 65.2% and was notsuccessful in 34.8%, while in the URSL group 84.1% were treated successfully and in 15.9% patientswith proximal ureteric stones the stone clearance efficacy was not effective.CONCLUSION: Both URSL & ESWL are well accepted minimally invasive modalities of treatmentfor proximal ureteric stones. We conclude that URSL has yielded superior results as compared to theESWL group in treatment of patients with proximal ureteric stones of size 1-1.5cm.KEY WORDS: Ureteroscopic lithotripsy, extracorporeal shockwave lithotripsy, proximal ureteric stones.
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.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.