Effect of variant histology presence and squamous differentiation on oncological results and patient’s survival after radical cystectomy

Objective: To evaluate the effect of variant histology on pathological and survival findings in patients undergoing radical cystectomy due to muscle invasive bladder cancer. Materials and methods: Data from 146 patients with radical cystectomy performed due to muscle-invasive urothelial carcinoma between January 2006 to November 2016 at our clinic were investigated. The preoperative and postoperative data of patients with variant histology were compared with nonvariant urothelial carcinoma patients. Then of patients with variant histology only those with squamous differentiation (SqD) were compared with nonvariant urothelial carcinoma patients in terms of preoperative, postoperative and survival data. Results: Of the 146 patients, 23 had carcinoma with variant histology. Of these, 17 had SqD, 4 had glandular differentiation, 1 patient had plasmocytoid variant and 1 patient had sarcomatoid variant. In patients with variant histology, postoperative T stage and upstaging was higher, with no difference observed in terms of overall and cancer-specific survival compared with nonvariant urothelial cancer patients. SqD patients were observed to have higher postoperative T stage compared to nonvariant urothelial cancer patients, with no significant difference observed in terms of survival. Conclusions: In cystectomy pathologies, patients with variant histology (especially SqD patients) were observed to have proportionally higher T stage compared to nonvariant urothelial carcinoma; however there were no significant differences for overall survival and cancer-specific survival

Comparing the short - term outcomes and complications of monopolar and bipolar transurethral resection of bladder tumors in patients with coronary artery disese: a prospective, randomized, controlled study

ABSTRACT Introduction: To compare the perioperative outcomes and complications of monopolar and bipolar transurethral resection of bladder tumors (TURBT) in patients with coronary artery disease (CAD). Materials and Methods: A total of 90 CAD patients with newly diagnosed bladder cancer who underwent TURBT were randomized into monopolar TURBT (M-TURBT) and bipolar TURBT (B-TURBT) groups. Primary outcome was safety of the procedures including obturator jerk, bladder perforation, clot retention, febrile urinary tract infection and TUR syndrome. The secondary outcome was the efficacy of TURBT procedures, including complete tumor resection, sampling of the deep muscle tissue and sampling of the qualified tissues without any thermal damage. Results: Mean ages of the patients in M-TURBT and B-TURBT groups were 71.36±7.49 and 73.71±8.15 years, respectively (p=0.157). No significant differences were found between M-TURBT and B-TURBT groups regarding complete tumor resection (76.2% vs. 87.5%, p=0.162) and muscle tissue sampling rates (71.4% vs. 64.6%,p=0.252). Obturator jerk was detected in 16.7% of the patients in M-TURBT group and 2.1% in B-TURBT group (p=0.007). No statistically significant differences were found between the groups regarding intraoperative and postoperative complications. Conclusions: Both monopolar and bipolar systems can be used safely and effectively during TURBT procedure in CAD patients. Due to the more frequently seen obturator jerk in M-TURBT than B-TURBT, careful surgical approach is needed during M-TURBT

Comparison of the urethrovesical anastomoses with polyglecaprone (Monocryl®) and bidirectional barbed (V-Loc 180®) running sutures in laparoscopic radical prostatectomy

Objective: We compared polyglecaprone (Monocryl®) and bidirectional barbed (V-Loc® 180) running sutures during urethrovesial anastomosis (UVA) in laparoscopic radical prostatectomy (LRP). Materials and methods: A total of 92 consecutive patients underwent extraperitoneal LRP for prostate cancer. In the first 47 patients, the running UVA was performed using 3-0 monofilament polyglecaprone (Monocryl®) suture (Group 1). In the subsequent 45 patients, the running UVA was performed with the 3-0 barbed suture (V-Loc® 180) (Group 2). Rhabdosphincter reconstruction was performed in all the patients. Results: The mean prostatectomy time was 196 and 179 minutes in Group 1 and 2, respectively (p < 0.001). Moreover, the mean UVA time was 40 and 24 minutes in Group 1 and 2, respectively (p < 0.001). Also, catheterization time, lenght of hospital stay and the number of the patients with urine leakage were significantly lower in Group 2 than the other (p < 0.001). No patients in V-Loc® 180 suture group and 5 patients in Monocryl® suture group experienced postoperative drain leakage in the present study. Overall pad usage at 6th month was higher in group 1 than the other group. In group 1 and 2, 78.7% and 93.3% of the patients reported 0 to 1 pads daily, whereas 21.3% and 6.7% reported ≥ 2 pads daily (p = 0.002). Conclusions: We therefore consider that use of barbed suture running UVA during LRP is associated with a significantly shorter operative time maintaining a proper suturing tension compared with standard suture and it is not associated with a higher incidence of adverse events with no postoperative complications

Bowel Preparation and Peri-operative Management for Radical Cystectomy in Turkey Turkish Urooncology Association Multicenter Survey

WOS: 000291847000007PubMed ID: 21656469Purpose: To investigate the preferences and practice patterns of urooncologic surgeons in Turkey on bowel preparation and pen-operative management for radical cystectomy. Materials and Methods: This study was conducted by Turkish Urooncology Association as a multicenter survey. Participants were asked to fill in questionnaires dispensed at annual oncologic meeting or using internet access to the website of Urooncology Association. The questionnaire consisted of multiple choice or open-ended questions related to frequency of cystectomy, surgical technique and type of diversion, bowel preparation protocol, nasogastric tube applications, antibiotic prophylaxis, and deep vein thrombosis prophylaxis. Collected data from the survey were presented descriptively. Results: Forty-four questionnaires from 44 surgeons of different centers were evaluated. All participants answered that they always perform bowel preparation before cystectomy. Four participants reported that they had an experience of cystectomy without bowel preparation. Bowel preparation methods included long conservative methods, short enema protocols, and Golytely, but there were significant differences in application of each method. Of participants, 88.6% perform diversion by themselves whereas others ask help from a general surgeon. Antibiotic prophylaxis is preferred mostly by 2 agents using third-generation cephalosporins and metronidazole for a period of 5 days or more in the majority. Type, duration, and dosage of deep vein thrombosis prophylaxis differed among participants. Conclusion: There are significant individual differences in pen-operative management of radical cystectomy, which render deficient and sometimes inadequate patient care. There is a need to establish standard protocols for bowel preparation and adequate pen-operative management for radical cystectomy

Anatomy of the Dorsal Nerve of the Penis, Clinical Implications

OBJECTIVE To show the branching patterns and the anatomic variations of the dorsal nerve of the penis (DNP) along the penile shaft, particularly the relation with the tunica albuginea

Urothelial bladder cancer in young adults: Diagnosis, treatment and clinical behaviour

Introduction: The aim of the study is to reveal pathologic characteristics and clinical behaviour of patients 40 years old or younger diagnosed with and treated for urothelial bladder carcinoma

Double-sling procedure for the surgical management of stress urinary incontinence with concomitant anterior vaginal wall prolapse

To assess the safety, efficacy of double-sling procedure (DS) for the surgical management of stress urinary incontinence (SUI) with concomitant anterior wall prolapse (AVWP) and to identify if less synthetic material implantation will decrease the complication rates without decreasing the high cure rates

Do severe obese patients with stress urinary incontinence benefit from transobturator tape procedure? 3-year surgical outcome

INTRODUCTION: We evaluate the impact of severe obesity on surgical outcomes of the transobturator tape (TOT) procedure in patients with stress urinary incontinence (SUI). METHODS: In total, 32 women with severe obesity (body mass index [BMI] >35 kg/m(2)) were included in the study. All patients were preoperatively evaluated with history, pelvic examination, ultrasonography, and cough stress test. All patients completed the International Consultation on Incontinence Questionnaire-Short form (ICIQ-SF) preoperatively and at the postoperative follow-up. Cure of incontinence was defined as being completely dry after surgery. Cure was assessed subjectively and objectively. Subjective improvement defined as an International Consultation on Incontinence Questionnaire-Short form (ICIQ-SF) score ≤12 and satisfaction with surgery. Failure was defined as having no change or worsening of urinary incontinence after surgery. Postoperative patient satisfaction was assessed using a visual analog scale. RESULTS: The mean follow-up time and mean BMI were 40.9 ± 20.9 months and 38 ± 3 kg/m(2), respectively. According to preoperative ICIQ-SF questionnaire scores, 20 patients (62.5%) had severe and 12 patients (37.5 %) had very severe urinary incontinence symptoms. No patient had slight or moderate symptoms. None of the patients experienced worsening symptoms after surgery. Objective cure, subjective cure, subjective improvement and patient satisfaction rates were 81.2%, 46.8%, 37.5%, and 84.3% respectively. Our overall complication rate was 9.3%. None of the patients experienced intraoperative complications. CONCLUSION: In experienced hands, TOT is an effective and safe procedure to treat SUI, with minimal complications in severe obese women