ICUD-EAU International Consultation on Bladder Cancer 2012: Urinary Diversion

Hautmann, Richard E.; Abol‐Enein, Hassan; Davidsson, Thomas; Guðjónsson, Sigurður; Hautmann, S.; Holm, Henriette Veiby; Lee, Cheryl T.; Liedberg, F.; Madersbacher, Stephan; Manoharan, Murugesan; Månsson, Wiking; Mills, Robert; Penson, David F.; Skinner, Eila C.; Stein, Raimund; Studer, Urs E.; Thueroff, Joachim W.; Turner, William H.; Volkmer, Bjoern G.; Xu, Aiming

doi:10.1016/j.eururo.2012.08.050

Cited by 248 publications

(142 citation statements)

References 118 publications

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“…In particular, cutaneous ureterostomy was the selected UD in about 25% of our patients. Although cutaneous ureterostomy is performed worldwide in about 2/10% of patients treated with RC, 23 it is still a common procedure in Italy and in a real life setting it could be indicated in patients with advanced bladder cancer and higher co-morbidities as observed in our series. In this group of patients we particularly observed, together with advanced bladder cancer, a higher incidence of hydronephrosis and co-morbidities when compared to patients receiving an ileal UD (Table 4).…”

Section: Discussionmentioning

confidence: 58%

Analysis of radical cystectomy and urinary diversion complications with the Clavien classification system in an Italian real life cohort

Nunzio

Cindolo

Leonardo

et al. 2013

European Journal of Surgical Oncology (EJSO)

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Introduction: Standardized methods of reporting complications after radical cystectomy (RC) and urinary diversions (UD) are necessary to evaluate the morbidity associated with this operation to evaluate the modified Clavien classification system (CCS) in grading perioperative complications of RC and UD in a real life cohort of patients with bladder cancer. Materials and methods: A consecutive series of patients treated with RC and UD from April 2011 to March 2012 at 19 centers in Italy was evaluated. Complications were recorded according to the modified CCS. Results were presented as complication rates per grade. Univariate and binary logistic regression analysis were used for statistical analysis. Results: Results and limitations: 467 patients were enrolled. Median age was 70 years (range 35e89). UD consisted in orthotopic neobladder in 112 patients, ileal conduit in 217 patients and cutaneous ureterostomy in 138 patients. 415 complications were observed in 302 patients and were classified as Clavien type I (109 patients) or II (220 patients); Clavien type IIIa (45 patients), IIIb (22 patients); IV (11 patients) and V (8 patients). Patients with cutaneous ureterostomy presented a lower rate (8%) of CCS type IIIa ( p ¼ 0.03). A longer operative time was an independent risk factor of CCS III (OR: 1.005; CI: 1.002e1.007 per minute; p ¼ 0.0001).

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Section: Discussionmentioning

confidence: 58%

Analysis of radical cystectomy and urinary diversion complications with the Clavien classification system in an Italian real life cohort

Nunzio

Cindolo

Leonardo

et al. 2013

European Journal of Surgical Oncology (EJSO)

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“…Second, cystectomy deteriorates the quality of life. Finally, cystectomy is a highly complicated surgery in the urological field, and almost 30%-50% of patients experience perioperative or long-term complications (37). In our experience, the most important predictive prognostic factor -in patients with pT1HG tumours -is the presence of concomitant CIS.…”

Section: Discussionmentioning

confidence: 81%

Can re-cTURBT be useful in pT1HG disease as a risk indicator of recurrence and progression? A single centre experience

Giulianelli¹,

Gentile²,

Mirabile³

et al. 2017

Arch Ital Urol Androl

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Introduction: Understaging after initial transurethral resection is common in patients with high-risk non muscle infiltrating bladder cancer (NMIBC) and can delay accurate diagnosis and definitive treatment. The rate of upstaging from T1 to T2 disease after repeated transurethral resection ranges from 0 to 28%, although the rate of upstaging may be even higher up to 49% when muscularis propria is absent in the first specimen. A restaging classic transurethral resection of bladder tumour (re-cTURBT) is the better predictor of early stage progression. According to some reports, the rate of positivity for tumor in re-cTURBT performed within eight weeks after initial cTURBT was as high as 18-77%, and in about 40% of the patients a change in tumor stage was reported. We aimed to investigate, in high risk group, the presence of residual tumor following white light classical transurethral resection of bladder tumor (WLre-cTURBT) and the different recurrence and progression rate between patients with persistent or negative (pT0) oncological disease after WLre-cTURBT. Materials and methods: A cohort of 285 patients presenting with primitive bladder cancer underwent to WLcTURBT from January 2011 to December 2015; out of them 92 (32.28%) were T1HG. In according to EAU guidelines 2011, after 4-6 weeks all HG bladder cancer patients underwent a WL recTURBT . All patients were submitted to a subsequent followup including cystoscopy every 3 months with multiple biopsies, randomly and in the previous zone of resection; urinary citology on 3 specimens and kidney/bladder ultrasound every 6 months. The average follow-up was 48 months. Results: Following WLre-cTURBT we observed a persistent disease in 18 (15.2%) patients: 14 (77.7%) with a HG-NMIBC and 4 (22.2%) with a high grade (HG) muscle invasive bladder cancer (pT2HG). After follow up of all 92 patients according to the guidelines EAU, we observed recurrence in 36/92 (39.1%) and progression in 14/92 (15.2%). Of 14 NMIBC with persistent disease, 10 patients (71.4%) showed recurrence: 4 patients (40%) were pT1HG with concomitant carcinoma in situ (CIS), 3 patients (30%) multifocal pTaHG, 2 (20%) patients CIS and one patient (10%) a muscle invasive neoplasm (pT2HG). Instead of the group of 48 patients pT0 following WL recTURBT, we observed recurrence in 26 patients (54.1%) and in two patients (4.1%) progressions, who presented after 3 months in association with CIS. The remaining 22 patients (45.9%) with initial pT1HG are still progression free. Multivariate analysis showed that the most important variable of early progression were persistent neoplasm and histopathological findings at WLre-cTURBt (p = 0.01), followed by the Summary No conflict of interest declared. INTRODUCTION Bladder cancer is a common genito-urinary malignancy, with transitional cell carcinoma comprising nearly 90% of all primary bladder tumours. At the first diagnosis 70% to 80% of urothelial tumours are confined to the epithelium, the remainder is characterized by muscle invasion. A significant number of patients with high risk non-muscle invasive bladder tumours (HG-NMIBT) treated with white light classic transurethral resection of bladder tumours (WLcTURBT) and intravesical BCG will progress to invasive disease (1-3). Progression to muscle invasion (pT2) mandates immediate radical cystectomy (4). WLcTURBT is the standard initial therapy for NMIBT, but the high percentage of recurrence after surgery is still an unresolved problem (5). High grade pT1 bladder neoplasm (pT1HG) really represents a therapeutic challenge due to the high risk of progression (about 15-30%) to muscle-invasive disease, usually within 5 years (6). However, no consensus exists regarding the treatment of patients with recurrent bladder tumours that invade the lamina propria (pT1) (7-9). Recent studies suggested that the first cTURBT may be incomplete in a significant number of cases (10). Understaging at the time of the initial transurethral resection is common for patients with high-risk NMIBC and can delay accurate diagnosis and definitive treatment. It is therefore recommended for patients with high-risk disease and in those with large or multiple tumors or when the initial transurethral resection is incomplete, to repeat WLre-cTURBT within 2-6 DOI: 10.4081/aiua.2017.4.272 result of the first cystoscopy (p = 0.002) and presence of CIS (p = 0.02). Discussion: Following WLre-cTURBt in HG-NMIBC patients we identified in 15% of cases a persistent disease with a 4.3% of MIBC. In the high risk persistent bladder neoplasms group we observed recurrent and progression rate higher than in T0 bladder tumours group (Δ = + 17.3% and = Δ + 62.5%, p < 0.05

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“…While absolute contraindications are well established, many relative indications include patients in the "gray zone" and therefore the decision for UD should be individually tailored to each patient. Commonly, females, elderly, patients with significant comorbidities, prior radiation therapy or locally advanced disease patients are less likely to receive CUD [1,9]. However, the past decade has witnessed a significant change in the paradigm for the acceptable criteria for CUD which proved to be feasible among patients with the aforementioned factors.…”

Section: Discussionmentioning

confidence: 99%

Does Robot-Assisted Approach to Radical Cystectomy Influence Surgeon Choice for Urinary Diversion?

Guru¹

2016

JURNOA

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ICUD-EAU International Consultation on Bladder Cancer 2012: Urinary Diversion

Cited by 248 publications

References 118 publications

Analysis of radical cystectomy and urinary diversion complications with the Clavien classification system in an Italian real life cohort

Analysis of radical cystectomy and urinary diversion complications with the Clavien classification system in an Italian real life cohort

Can re-cTURBT be useful in pT1HG disease as a risk indicator of recurrence and progression? A single centre experience

Does Robot-Assisted Approach to Radical Cystectomy Influence Surgeon Choice for Urinary Diversion?

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