<p>Orthotopic Neobladder Reconstruction: Patient Selection And Perspectives</p>

Abstract

Orthotopic neobladder (ONB) reconstruction is a continent urinary diversion procedure that may be performed in a patient with bladder cancer following a radical cystectomy. The selection of a patient for an ONB reconstruction is strict as not everyone may be suitable to undergo this complex surgery. Patients must be not only mentally competent but also physically dexterous enough to allow for appropriate neobladder training post-procedure, to achieve best urinary function. However, even with a carefully chosen patient population, various complications specific to ONB reconstruction may result. Metabolic acidosis may result from electrolyte shifts, resulting in secondary complications such as bone demineralization and urinary calculi. In addition, nutritional deficiencies may result from the use of a transposed intestinal segment for the fashioning of the reservoir. A widely used outcome measure when assessing for ONB reconstruction is continence. With a strict neobladder training regimen, daytime continence may be achieved in roughly 70% of patients post-ONB procedure. This number may increase over the course of several years, although may decrease in up to 20 years of follow-up. Similarly, quality of life (QoL) measures have been widely studied, and current literature suggests slightly better QoL achieved with ONB compared to other urinary diversion procedures. Of note, the tools used to assess continence and QoL vary between studies, limiting the interpretability of the summarized data. Nevertheless, ONB reconstruction is a procedure that is still evolving, with ongoing modifications that can reduce complications and improve patient urinary function.

Relationship of frailty with treatment modality selection in patients with muscle-invasive bladder cancer (FRART-BC study)

“…With the increased interest on frailty, majority of the studies focused on the association of frailty with postoperative complications after RC. However, there are few evidences on the use of different frailty assessment tools for a treatment selection in patients with MIBC (5,16). This is the first study evaluating the difference of frailty between the RC and TMT in patients with MIBC using three different frailty assessment tools.…”

“…Radical cystectomy (RC) with urinary diversion is the standard treatment for nonmetastatic, muscle-invasive bladder cancer (MIBC) (1)(2)(3)(4)(5). However, not all patients are eligible for RC because patients with MIBC have the highest age among all cancers (6).…”

The contemporary status of robotic intracorporeal neobladder

“…Patient selection is crucial to a successful operative outcome and will be influenced by surgeon experience, clinical factors affecting the decision to undertake a robotic procedure, and specific patient factors related to the choice of neobladder itself. Generally, the ideal patient for Robot-Assisted Radical Cystectomy (RARC) will be under 75 years of age, slim with a BMI of less than 30, have a T2 tumor without locally advanced disease, have good performance status with minimal co-morbidities, and no history of prior abdominal radiation or surgery [3] . As surgeons gain experience, these guidelines will be flexed, but whatever the surgeon experience is, patients with BMI > 35, complex cardio-respiratory co-morbidities and prior abdominal or vascular surgery, pelvic trauma or radiotherapy, and locally advanced disease will prove challenging.…”

Development and Verification of a Prostate Cancer Prognostic Signature Based on an Immunogenomic Landscape Analysis

“…According to the latest available data, prostate cancer (PCa) is the most common cancer diagnosed among men and the second leading cause of male cancer deaths in the United States ( 1 , 2 ). The PCa incidence has recently risen and can be explained by the widespread use of prostate-specific antigen (PSA) tests ( 3 ).…”