Urinary Diversion for Severe Urinary Adverse Events of Prostate Radiation: Results from a Multi-Institutional Study

Bassett, Mitchell; Santiago‐Lastra, Yahir; Stoffel, John T.; Goldfarb, Robert; Elliott, Sean P.; Pate, Scott C.; Broghammer, Joshua A.; Gaither, Thomas W.; Breyer, Benjamin N.; Vanni, Alex J.; Voelzke, Bryan B.; Erickson, Beth; McClung, Christopher; Presson, Angela P.; Tward, Jonathan D.; Myers, Jeremy B.

doi:10.1016/j.juro.2016.10.091

Cited by 23 publications

(23 citation statements)

References 17 publications

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“…Severe complications are seen in onethird of the patients undergoing cystectomy, and the 90-day mortality rate is between 4.5-16%. 150,151 1.5 HYPERBARIC OXYGEN…”

Section: Treatment Optionsmentioning

confidence: 99%

Radiation-induced cystitis treated with hyperbaric oxygen therapy (RICH-ART): a randomised, controlled, phase 2–3 trial

Oscarsson

Müller

Rosén

et al. 2019

The Lancet Oncology

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Introduction Cancer is affecting a growing number of persons. Still, the treatment and survival of cancer is improving. Radiation therapy is used in the treatment of cancer. Late radiation-induced injuries afflict 5-15% of irradiated patients. The urinary bladder and bowel may be affected after irradiation of cancer in the pelvic region. Symptoms can be severe, with impaired health related quality of life (HRQoL). Hyperbaric oxygen therapy (HBOT) involves breathing oxygen at high ambient pressure. HBOT can reverse radiation-induced injuries, alleviate patient-perceived symptoms, and improve HRQoL. We aimed to clarify the effects of HBOT on late radiation-induced injuries in the urinary bladder and bowel, and to clarify some of the underlying mechanisms through which HBOT exerts its effects. Methods A prospective cohort study assessed effects of HBOT on patient-perceived symptoms (Paper I). A rat study assessed reversal of radiation-induced stress with HBOT (Paper II). A methodological experiment assessed reversal of HBOT on cellular death induced by radiation (Paper III). A multi-center, randomized, controlled trial assessed patient-perceived symptoms, HRQoL, and objective clinical outcomes (Paper IV). Result HBOT can alleviate patient-perceived symptoms, reduce objective findings, and improve HRQoL in patients affected by late radiation-induced injuries (Paper I, IV). Oxidative stress and downstream effects, induced by the irradiation, can be reversed by HBOT (Paper II). Paper III outlines a method for studies on urothelial cells exposed to radiation and HBOT. Conclusion HBOT can reduce radiation-induced oxidative stress and inflammatory response. HBOT can reverse injuries induced by radiation therapy to the pelvic region, alleviate patient-perceived symptoms and lead to improved HRQoL.

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“…Severe complications are seen in onethird of the patients undergoing cystectomy, and the 90-day mortality rate is between 4.5-16%. 150,151 1.5 HYPERBARIC OXYGEN…”

Section: Treatment Optionsmentioning

confidence: 99%

Radiation-induced cystitis treated with hyperbaric oxygen therapy (RICH-ART): a randomised, controlled, phase 2–3 trial

Oscarsson

Müller

Rosén

et al. 2019

The Lancet Oncology

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“…Moreover, there could be more comorbidities among patients who received chemotherapy [33]/radiation, which also affects the quality of life significantly such as impacting bowel and rectal domain, which may last for long even after ending radiation [34] as well as causing greater obstructive urinary symptoms [35]. Moreover, when radiotherapy is followed by urinary fistulae, a significant morbidity was reported due to rerouting the normal flow of urine out of body [36]. Indeed, radiotherapy does not only affect the targeted organ but also has a systemic effect on the whole body [37].…”

Section: Discussionmentioning

confidence: 99%

Examined and Positive Lymph Node Counts Are Associated with Mortality in Prostate Cancer: A Population-Based Analysis

et al. 2020

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Background: Prostate cancer (PCa) is the third leading cause of death from cancer in the United States. We aimed to disclose the prognostic values of examined (dissected) lymph node (ELN), negative lymph node (NLN), and positive (metastatic) lymph node (PLN) counts and lymph node (LNs) ratio in PCa patients. Methods: We extracted data of PCa patients diagnosed between 2004 and 2015 from the Surveillance, Epidemiology, and End Results (SEER) program. We included patients with a histologically confirmed diagnosis having at least one ELN and with the PCa as the primary tumor only. Results: We have included 96,064 patients. Multivariable Cox proportional hazards regression models disclosed that patients having more ELNs were associated with better survival. However, we demonstrated that patients having more PLNs were associated with worse survival. Additionally, older age, unmarried patients, with Gleason's score of 8-10, T4 and M1 stages and those who received chemotherapy and/ or radiation but did not receive surgery were significantly associated with worse PCa survival. Conclusions: We have disclosed several independent predictors affecting PCa patients including age, marital status, Gleason's score, T and N stages, having received therapy, surgery, and ELN and PLN counts. Moreover, we demonstrated that patients with lower ELN and higher PLN counts were a high-risk group. We strongly recommend adding the ELN and/or PLN counts into consideration during patient staging/treatment.

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“…This association makes sense since pelvic radiation potentially damages the quality of the distal ureteral supply and thereby may increase the rates of ureteral complications. For instance, in men undergoing urinary diversion, after prostate cancer radiotherapy we high rate of ureteral stenosis (12%) than reported in the literature in urinary diversion . The literature on the impact of radiation therapy on urinary diversion outcome is mixed, however, and other studies, involving a high proportion of patients with preoperative radiation, have reported equivalent complications compared to other contemporary cohorts .…”

Section: Discussionmentioning

confidence: 96%

“…For instance, in men undergoing urinary diversion, after prostate cancer radiotherapy we high rate of ureteral stenosis (12%) than reported in the literature in urinary diversion. 15 The literature on the impact of radiation therapy on urinary diversion outcome is mixed, however, and other studies, involving a high proportion of patients with preoperative radiation, have reported equivalent complications compared to other contemporary cohorts. 14,16,17 It is obvious to any pelvic surgeon that the complexity of patients with radiation injury is very high.…”

Section: Discussionmentioning

confidence: 99%

Outcomes of right colon continent urinary pouch using standardized reporting methods

Myers

Martin

Cheng

et al. 2019

Neurourology and Urodynamics

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Aims Studies of right colon pouch urinary diversion estimate risk of perioperative complications, 1%‐50%, and reoperation, 1%‐69%. This wide range is due to variable outcome measurements and reporting methods; it is also unclear which factors increase the risk of complications and reoperation. We sought to characterize the impact of patient‐specific factors on risk of complications, readmission, and reoperation after right colon pouch urinary diversion. Methods Patients undergoing right colon pouch urinary diversion from January 2010 to April 2017 were analyzed. Outcomes included: high‐grade complications within 90 days (Clavien‐Dindo grade ≥3), readmission within 90 days, and reoperation at any time during follow‐up. Patient‐specific factors were analyzed to establish any associations with these outcomes. Results During the study period, 53 patients underwent the procedure and the average follow‐up was 30 (standard deviation [SD] 21.5) months; 90‐day high‐grade complications were 22% and readmission was 45%. The cumulative rate of any reoperation was 53% and major reoperation was 32%. Diabetes was associated with an increased risk of both postoperative complications and reoperation. Larger body mass index and prior abdominal surgery were associated with increased risk of readmission. Conclusions Overall the rate of postoperative complications, readmissions, and reoperation was high, but in agreement with other contemporary series. This study helps to further characterize surgical outcomes after right colon pouch urinary diversion, however, similar to other studies in the literature, the rarity of the procedure limits the power to establish a link between preoperative patient factors and outcomes.

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Urinary Diversion for Severe Urinary Adverse Events of Prostate Radiation: Results from a Multi-Institutional Study

Cited by 23 publications

References 17 publications

Radiation-induced cystitis treated with hyperbaric oxygen therapy (RICH-ART): a randomised, controlled, phase 2–3 trial

Radiation-induced cystitis treated with hyperbaric oxygen therapy (RICH-ART): a randomised, controlled, phase 2–3 trial

Examined and Positive Lymph Node Counts Are Associated with Mortality in Prostate Cancer: A Population-Based Analysis

Outcomes of right colon continent urinary pouch using standardized reporting methods

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