Fifteen-year single-centre experience with three different surgical procedures of nerve-sparing cystectomy in selected organ-confined bladder cancer patients

Colombo, Renzo; Pellucchi, Federico; Moschini, Marco; Gallina, Andrea; Bertini, Roberto; Salonia, Andrea; Rigatti, Patrìzio; Montorsi, Francesco

doi:10.1007/s00345-015-1482-y

Cited by 37 publications

(50 citation statements)

References 32 publications

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“…The long‐term impact of any attempt at NS found in the present analysis confirms our earlier results after a follow‐up <3 years, where NS was shown to positively affect both day‐ and night‐time continence, with NS resulting in a 40% higher continence rate . In further support of our findings, Colombo et al reported 89% and 57% day‐ and night‐time continence rates, respectively, at 24 months’ after NS RC compared to 78% and 55% after no‐NS RC. The large discrepancy in group size hampered statistical analyses and thus precluded definitive conclusions .…”

Section: Discussionsupporting

confidence: 92%

“…In further support of our findings, Colombo et al reported 89% and 57% day‐ and night‐time continence rates, respectively, at 24 months’ after NS RC compared to 78% and 55% after no‐NS RC. The large discrepancy in group size hampered statistical analyses and thus precluded definitive conclusions . In addition, a parallel can be drawn with patients who underwent RP.…”

Section: Discussionsupporting

confidence: 92%

“…The pelvic autonomic nerves, specifically the sympathetic fibres, are known to control urethral tonus at rest and assure urinary continence . A beneficial impact of nerve sparing (NS) on urinary continence after urinary diversion with an OBS has been reported in a few open and robot‐assisted RC series with short to mid‐term follow‐up . However, the debate is ongoing as to whether NS affects long‐term outcomes because it is unknown whether the positive impact of NS persists over time.…”

Section: Introductionmentioning

confidence: 99%

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Nerve‐sparing radical cystectomy has a beneficial impact on urinary continence after orthotopic bladder substitution, which becomes even more apparent over time

et al. 2018

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Section: Discussionsupporting

confidence: 92%

Section: Discussionsupporting

confidence: 92%

Section: Introductionmentioning

confidence: 99%

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Nerve‐sparing radical cystectomy has a beneficial impact on urinary continence after orthotopic bladder substitution, which becomes even more apparent over time

et al. 2018

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“…With the aim to improve sexual and functional outcomes, several prostate-sparing cystectomy techniques have been proposed [3][4][5][6]. However, the high incidence and potentially poor prognosis of urothelial carcinoma involvement of the prostate (UPI) makes these approaches too risky for widespread use [7][8][9][10].…”

Section: Introductionmentioning

confidence: 99%

Impact of the level of urothelial carcinoma involvement of the prostate on survival after radical cystectomy

Moschini¹,

Soria²,

Martin³

et al. 2016

European Urology Supplements

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Abstract.Objective: Urothelial prostatic involvement (UPI) at the time of radical cystoprostatectomy (RCP) was found associated with worse survival outcomes by several previous reports. Our aim is to evaluate the impact of different levels of UPI on survival outcomes using a large series of male patients treated with RCP. Methods: Whole step section specimens from 995 male BCa patients were assessed for UPI defined as: no involvement vs. prostatic urethral carcinoma in situ (CIS) vs. lamina propria involvement vs. ductal CIS vs. prostate stromal involvement. Primary end point of the study was predictors of prostatic involvement at RCP and its impact on overall survival after surgery. Results: Prostatic involvement was recorded in 307 (30.9%) patients: 28% with prostatic urethral CIS, 12% with lamina propria involvement, 13% with ductal CIS and 47% with stromal involvement. Median follow-up was 70 months. Patients with stromal involvement had a worse 5-year survival (12%) than those with prostatic urethra CIS (40%), lamina propria involvement (36%), and ductal CIS (35%). Considering predictors of prostatic involvement, multifocal tumor (Odds Ratio [OR]: 6.60, p < 0.001), lymphovascular invasion (OR: 2.61, p < 0.001), lymph node metastases (OR: 2.02, p < 0.001) and CIS (OR: 2.02, p < 0.001) were found associated. Similar predictors were found assessing stromal involvement. 162 M. Moschini et al. / Urothelial Prostatic Involvement during Radical CystectomyConclusions: Approximately one third of RCP patients harbor prostatic involvement of urothelial carcinoma. While all UPI are associated with worse overall survival, stromal involvement confers the worst outcome supporting its classification as T4 in the TNM staging.

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“…nerve sparing cysto-vesicleprostatectomy [5] , capsulesparing cystectomy [6], and intrafascial seminal vesiclessparing cysto-prostatectomy [7] . Despite their functional promises, these procedures remain underutilized as the oncological-related outcomes can be serious.…”

mentioning

confidence: 99%

Impact of Prostate Involvement on Outcomes in Patients Treated with Radical Cystoprostatectomy for Bladder Cancer

Moschini

Shariat²,

Freschi

et al. 2017

Urol Int

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Objective: The study aimed to evaluate the impact of the different types of prostate involvement at the time of radical cystoprostatectomy (RCP). Methods: Data from 893 male patients treated with RCP at a referral center for bladder cancer (BCa) were assessed. Prostatic urothelial carcinoma (PUC) was stratified as stromal vs. urethral/duct involvements. Multivariable Cox regression analyses were built to test the impact of the presence of incidental prostate cancer (PCa) and PUC on survival outcomes. Results: PCa was present in 319 (35.7%) RCP patients, of which 45 (14.1%) had significant PCa disease. PUC was identified in 181 patients (20%): 75 (41.1%) with urethral/duct involvement and 106 (58.6%) with stromal. Within a median follow-up of 72 months, stromal PUC, but not the other forms of PUC or PCa, was associated with worse survival outcomes. In multivariable analyses adjusted for the effects of standard features, stromal PUC remained associated with recurrence (hazards ratio [HR] 2.01, p = 0.03), cancer-specific mortality (HR 1.65, p = 0.01), and overall mortality (HR 1.45, p = 0.03). Conclusion: Prostatic stromal invasion with urothelial carcinoma confers a poor survival expectation to BCa patients after surgical treatment. Conversely, other type of urothelial prostatic invasions or the presence of concomitant PCa does not seem to be associated with differences in survival outcomes.

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Fifteen-year single-centre experience with three different surgical procedures of nerve-sparing cystectomy in selected organ-confined bladder cancer patients

Cited by 37 publications

References 32 publications

Nerve‐sparing radical cystectomy has a beneficial impact on urinary continence after orthotopic bladder substitution, which becomes even more apparent over time

Nerve‐sparing radical cystectomy has a beneficial impact on urinary continence after orthotopic bladder substitution, which becomes even more apparent over time

Impact of the level of urothelial carcinoma involvement of the prostate on survival after radical cystectomy

Impact of Prostate Involvement on Outcomes in Patients Treated with Radical Cystoprostatectomy for Bladder Cancer

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