Patients' acceptance of urinary diversion. The pouch of Sisyphus

It is important that any patient with a urinary diversion can accept the psychological impact alongside the surgical and physical aspects. However, there are currently no validated methods or instruments available to allow direct measurement of this phenomenon in these patients. Health-related quality of life (HRQoL) is often high following different types of urinary diversion - this may suggest a high acceptance level and thus may act as a secondary end point. Such an assessment is a retrospective validation of successful patient selection, allowing us to redirect the nihilistic misinterpretation that urologists should return to offering ileal conduits as a standard. In modern urinary diversion, high patient acceptance develops from comprehensive counselling providing a realistic expectation, careful patient-to-method-matching, strict adherence to surgical detail during the procedure and a meticulous lifelong follow-up. Coping strategies, disease-related social support and confidence in the success of treatment are among other factors which contribute to acceptance of urinary reconstruction as either independent or combined factors. Significant experience is required in every respect, as misjudgement and mistakes in any of these issues may be detrimental to the patients' health. It should be acknowledged that there is no 'best' urinary diversion in general terms. A reconstructive surgeon must have all techniques available and choices need to be tailored to the individual patient

Défaut d’adoption de l’instillation intravésicale postopératoire précoce de chimiothérapie après néphro-urétérectomie totale

Objectifs Des études de niveau de preuve 1 soutiennent l’administration d’une instillation intravésicale postopératoire précoce de chimiothérapie (IPOP) suite à une néphro-urétérectomie totale (NUT) pour les tumeurs des voies excrétrices urinaires supérieures, afin de diminuer le risque de récidive intravésicale. L’objectif de notre étude était d’évaluer l’utilisation en pratique quotidienne de l’IPOP parmi un panel d’urologues européens. Méthodes Une enquête en ligne a été partagée avec les membres de l’EAU par courrier électronique (Fig. 1). Les soumissions ont été acceptées d’avril à juin 2017. Les 15 questions portaient sur l’habitude de pratiquer l’IPOP après NUT, le choix de la chimiothérapie, son dosage, les doutes et les préoccupations qui y sont liées, les raisons de ne pas effectuer d’IPOP, la connaissance du niveau de preuve supportant son utilisation et les préférences chirurgicales concernant la NUT. Résultats Au total, 127 réponses ont été recueillies (11,6 %). Environ la moitié des participants (47 %) a régulièrement administré une IPOP. La chimiothérapie la plus utilisée était la mitomycine (85 %) ; 82 % des urologues interrogés ont administré une dose standard de 40 mg. Différents timings d’administrations ont été proposés : ≤ 48 heures (39 %), 7–10 jours postopératoires (35 %), > 10 jours (11 %), en peropératoire (10 %). Le bénéfice associé avec l’administration de l’IPOP est étayé par des essais cliniques prospectifs randomisés pour seulement 65 % des intervenants. Parmi les personnes interrogées qui ne pratiquaient pas l’IPOP, les raisons le plus souvent déclarées étaient les suivantes : le manque de données justificatives (55 %), crainte d’effets secondaires potentiels (18 %), et les obstacles organisationnels (15 %) Conclusion Notre étude met en évidence la diffusion limitée de l’IPOP après NUT pour les tumeurs des voies excrétrices urinaires supérieures. Une gestion hétérogène et un manque de connaissance des preuves supportant son administration sont les principales barrières identifiées

Impact of tumor size on the oncological outcome of high-grade nonmuscle invasive bladder cancer - examining the utility of classifying Ta bladder cancer based on size.

PURPOSE To examine survival rates and to calculate the risk of disease recurrence, progression, overall, and cancer-specific mortality in patients diagnosed with high-risk NMIBC using a multi-institutional dataset to evaluate differences between the guidelines of the European Association of Urology and the guidelines of the National Comprehensive Cancer Network (NCCN) with regard to tumor size in risk stratification. METHODS AND MATERIAL In total 1,116 individuals diagnosed with high-risk NMIBC between 2001 and 2013 were included in the analysis. Patients were stratified to NCCN guideline recommendations (high-grade T1, high-grade Ta ≤ 3 cm, and high-grade Ta > 3 cm). Recurrence and progression rates were calculated. Kaplan-Meier curves were fitted to examine differences in recurrence-free (RFS) and progression-free survival (PFS). Multivariable Cox proportional hazards regression models were employed to calculate differences in the RFS, PFS, overall, and cancer-specific survival (CSS). RESULTS The majority of patients were diagnosed with high-grade T1 disease (N = 576, 51.6%), while 34.2% and 14.2% of patients were diagnosed with high-grade Ta ≤ 3 cm and Ta > 3 cm NMIBC, respectively. The 1- and 5-year RFS (1-year: 80.5% vs. 64.9%; 5-year: 58.6% vs. 48.3%, P = 0.048) and PFS (1-year: 99.1% vs. 98.6%; 5-year: 97.7% vs. 92.4%, P = 0.054) rates were higher in patients with Ta ≤ 3 cm. Patients diagnosed with high-grade Ta > 3 cm experienced unfavorable progression-free, and cancer-specific survival compared to high-grade Ta ≤ 3 cm, respectively (PFS: 2.41, 95% confidence interval [CI] 1.05-5.56, P = 0.038; CSS: hazard ratios [HR] 2.22, 95% CI 1.02-4.89, P = 0.048). CONCLUSION Patients diagnosed with high-grade Ta NMIBC ≤3 cm demonstrated a favorable progression-free, and cancer-specific survival compared to patients diagnosed with high-grade Ta > 3 cm and high-grade T1 NMIBC

Postoperative Chemotherapy Bladder Instillation After Radical Nephroureterectomy: Results of a European Survey from the Young Academic Urologist Urothelial Cancer Group

Our research highlights the limited use of postoperative intravesical chemotherapy following radical nephroureterectomy for upper tract urothelial carcinoma, raising the question of how the compliance with level 1 evidence in the urological community may be promoted

Postoperative Chemotherapy Bladder Instillation After Radical Nephroureterectomy: Results of a European Survey from the Young Academic Urologist Urothelial Cancer Group

Background: Level 1 evidence supports the administration of single postoperative intravesical chemotherapy (pIVC) following radical nephroureterectomy (RNU) for upper tract urothelial carcinoma (UTUC), in order to decrease intravesical recurrence risk. Objective: The Young Academic Urologist Urothelial Cancer Group aimed to investigate the use of pIVC in daily practice among European colleagues. Design, setting, and participants: An online survey was shared with European Association of Urology Section of Oncological Urology (ESOU) 2017 participants via e-mail. Submissions were accepted from April to June 2017. The topics for 15 questions of this survey included the habit of delivering pIVC, the choice of drug, its dosage, related doubts or concerns, reasons not to perform pIVC, knowledge of the evidence, and surgical preferences for RNU. Outcome measurements and statistical analysis: Survey software was used for analyses. Logistic regression analyses were used to investigate the association between surgeons’ experience and caseloads with pIVC utilization. Results and limitations: Overall, 127 responses were collected (11.6%). About half of the participants (47%) regularly administered pIVC following RNU. The drug most commonly utilized was mitomycin (85%); 82% adhered to the standard dosage of 40 mg. Different administration protocols were adopted: ≤48 h (39%), 7–10 postoperative days (35%), >10 d (11%), and intraoperatively (10%). The evidence was supported by prospective randomized clinical trials for only 65% of responders. Among interviewees who did not deliver pIVC, the most commonly reported reasons were lack of supporting data (55%), fear of potential side effects (18%), and organizational hurdles (15%). Conclusions: Our research highlights the limited use of pIVC following RNU for UTUC, raising the question of how the compliance with level 1 evidence in the urological community may be promoted. Patient summary: Level 1 evidence supports the administration of single postoperative intravesical chemotherapy (pIVC) following radical nephroureterectomy (RNU) for upper tract urothelial carcinoma (UTUC), in order to decrease intravesical recurrence risk. The Young Academic Urologist Urothelial Cancer Group aimed to investigate the use of pIVC in daily practice among European colleagues. Our research highlights the limited use of pIVC (47%) following RNU for UTUC, raising the question of how the compliance with level 1 evidence in the urological community may be promoted.SCOPUS: ar.jinfo:eu-repo/semantics/publishe