Intravesical ichthyosis: a rare case report

Background!#!Ichthyosis is a rare skin disorder, in which the shedding of squamous cells is altered. Intravesical ichthyosis is an extremely rare condition. There is evidence for an association with intravesical condylomata accuminata, caused by urogenital infections of the human papilloma virus. These lesions are generally benign but known to be of a carcinogenic potential and therefore should be treated immediately and followed-up closely.!##!Case presentation!#!We present the case of a 39-year-old woman who presented with recurrent urinary tract infections. During cystoscopy diffuse black pigmented flat bladder tumours were visualized. After transurethral resection the pathological report diagnosed an ichthyosis vesicae.!##!Conclusion!#!We recommend a complete resection with frequent clinical and cystoscopic follow-up. Furthermore, testing for the human papilloma virus should be performed and a vaccination should be offered to the patient. As ichthyosis vesicae is a rare phenomenon, there is an evident lack of clinical data regarding therapy, prognosis and follow-up. With our report, we want to emphasize the need for further research

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

Advanced Prostate Cancer Consensus Conference 2017. Discussion of the recommendations for diagnosis and treatment of metastatic prostate cancer by a German panel of experts

In March 2017 the aEuroeAdvanced Prostate Cancer Consensus Conference' (APCCC) took place in St. Gallen (Switzerland). The APCCC-panelists are internationally well known experts. With the actual data in mind they discussed treatment options for patients with advanced prostate cancer in order to update the international APCCC-recommendations from the previous meeting in 2015. Recently these consensus recommendations have been published in European Urology. A group of German experts discussed this year APCCC-votes during the meeting and the recommendations that were concluded from the votes from the German perspective. Reasons for an additional German discussion are country-specific variations that may have influenced the APCCC-votes und recommendations. Due to the concept of the APCCC-meeting the wording of the questions could not always be as necessary. One focus of this year consensus discussion was the treatment of metastatic castration-naive prostate cancer (mCNPC). There are new data which may also influence the therapeutic situation of patients with metastatic castration-resistant prostate cancer (mCRPC). Further points of discussion were the impact of new imaging procedures in the clinical setting as well as the treatment of oligometastatic prostate cancer

Conditional analyses of recurrence and progression in patients with TaG1 non-muscle-invasive bladder cancer.

OBJECTIVE To determine conditional recurrence-free survival (RFS) and progression-free survival (PFS) and improve decision-making toward surveillance protocols and scheduling. Furthermore, evaluating the evolution of predictors for disease recurrence over time, because TaG1 non-muscle-invasive bladder cancer harbors a risk of disease recurrence and progression. MATERIAL AND METHODS The retrospective multicenter design study includes 1,245 TaG1 bladder cancer patients with median follow-up of 62.7 (interquartile range: 34.3-91.1) months. Conditional RFS and PFS estimates were calculated using the Kaplan-Meier method. Multivariable Cox regression model was calculated proportional for the prediction of recurrence and progression (covariables: age, tumor size, multiple tumors, prior recurrence, and immediate postoperative instillation of chemotherapy). RESULTS After 3 months without event, the conditional RFS and PFS (to ≥pT2) rates for 5 additional years without event were 57.5% and 93.4%, respectively. Given a 1-, 2-, 3-, and 5-year survival, the conditional RFS rates for 5 additional years without event improved by +9.8 (67.3%), +5.2 (72.5%), +6.5 (79.0%), +2.0 (81.0%), and +1.0% (82.0%), respectively. In contrast, the 5-year conditional PFS rates were more or less stable with 94.3% after 1 year to 94.1% after 5 years. Multivariable analyses showed decreasing impact of risk parameters on RFS estimates over time. Based on these findings, we suggest a risk stratification to individualize follow-up for intermediate risk TaG1. Main limitation was the retrospective design. CONCLUSIONS Conditional-survival analyses demonstrates that the patient risk profile changes over time. RFS rates rise with increasing survival whereas PFS rates were stable. The impact of prognostic features decreases over time. Our findings can be used for patient counseling and planning of personalized follow-up

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

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