Comparing Oncological and Perioperative Outcomes of Open versus Laparoscopic versus Robotic Radical Nephroureterectomy for the Treatment of Upper Tract Urothelial Carcinoma: A Multicenter, Multinational, Propensity Score-Matched Analysis

OBJECTIVES To identify correlates of survival and perioperative outcomes of upper tract urothelial carcinoma (UTUC) patients undergoing open (ORNU), laparoscopic (LRNU), and robotic (RRNU) radical nephroureterectomy (RNU). METHODS We conducted a retrospective, multicenter study that included non-metastatic UTUC patients who underwent RNU between 1990-2020. Multiple imputation by chained equations was used to impute missing data. Patients were divided into three groups based on their surgical treatment and were adjusted by 1:1:1 propensity score matching (PSM). Survival outcomes per group were estimated for recurrence-free survival (RFS), bladder recurrence-free survival (BRFS), cancer-specific survival (CSS), and overall survival (OS). Perioperative outcomes: Intraoperative blood loss, hospital length of stay (LOS), and overall (OPC) and major postoperative complications (MPCs; defined as Clavien-Dindo > 3) were assessed between groups. RESULTS Of the 2434 patients included, 756 remained after PSM with 252 in each group. The three groups had similar baseline clinicopathological characteristics. The median follow-up was 32 months. Kaplan-Meier and log-rank tests demonstrated similar RFS, CSS, and OS between groups. BRFS was found to be superior with ORNU. Using multivariable regression analyses, LRNU and RRNU were independently associated with worse BRFS (HR 1.66, 95% CI 1.22-2.28, p = 0.001 and HR 1.73, 95%CI 1.22-2.47, p = 0.002, respectively). LRNU and RRNU were associated with a significantly shorter LOS (beta -1.1, 95% CI -2.2-0.02, p = 0.047 and beta -6.1, 95% CI -7.2-5.0, p < 0.001, respectively) and fewer MPCs (OR 0.5, 95% CI 0.31-0.79, p = 0.003 and OR 0.27, 95% CI 0.16-0.46, p < 0.001, respectively). CONCLUSIONS In this large international cohort, we demonstrated similar RFS, CSS, and OS among ORNU, LRNU, and RRNU. However, LRNU and RRNU were associated with significantly worse BRFS, but a shorter LOS and fewer MPCs

Compared Efficacy of Adjuvant Intravesical BCG-TICE vs. BCG-RIVM for High-Risk Non-Muscle Invasive Bladder Cancer (NMIBC): A Propensity Score Matched Analysis

Background: Intravesical immunotherapy with bacillus Calmette-Guerin (BCG) is the standard therapy for high-risk non-muscle invasive bladder cancer (NMIBC). The superiority of any BCG strain over another could not be demonstrated yet. Methods: Patients with NMIBCs underwent adjuvant induction ± maintenance schedule of intravesical immunotherapy with either BCG TICE or RIVM at two high-volume tertiary institutions. Only BCG-naïve patients and those treated with the same strain over the course of follow-up were included. One-to-one (1:1) propensity score matching (PSM) between the two cohorts was utilized to adjust for baseline demographic and tumor characteristics imbalances. Kaplan-Meier estimates and multivariable Cox regression models according to high-risk NMIBC prognostic factors were implemented to address survival differences between the strains. Sub-group analysis modeling of the influence of routine secondary resection (re-TUR) in the setting of the sole maintenance adjuvant schedule for the two strains was further performed. Results: 852 Ta-T1 NMIBCs (n = 719, 84.4% on TICE; n = 133, 15.6% on RIVM) with a median of 53 (24-77) months of follow-up were reviewed. After PSM, no differences at 5-years RFS, PFS, and CSS at both Kaplan-Meier and Cox regression analyses were detected for the whole cohort. In the sub-group setting of full adherence to European/American Urology Guidelines (EAU/NCCN), BCG TICE demonstrated longer 5-years RFS compared to RIVM (68% vs. 43%, p = 0.008; HR: 0.45 95% CI 0.25-0.81). Conclusion: When routinely performing re-TUR followed by a maintenance BCG schedule, TICE was superior to RIVM for RFS outcomes. However, no significant differences were detected for PFS and CSS, respectively

ПОСЛЕОПЕРАЦИОННЫЕ ОСЛОЖНЕНИЯ МАЛОИНВАЗИВНЫХ МЕТОДОВ ЛЕЧЕНИЯ РАКА ПРЕДСТАТЕЛЬНОЙ ЖЕЛЕЗЫ

Prostate cancer is the most common cancer among men. Radical prostatectomy (open, laparoscopic, or robotic) remains the main method of surgical treatment for prostate cancer. However, minimally invasive therapies for prostate cancer are becoming increasingly popular in recent years, because they have similar efficacy as open surgery. The most studied minimally invasive therapies are cryoablation, high intensity focused ultrasound (HIFU), and brachytherapy.Despite the minimization of damage to neighboring structures, minimally invasive procedures can cause a number of complications, like any other surgical interventions. Each method has specific limitations and the most typical complications. Since multiple minimally invasive methods are currently available, we can ensure an individual approach to each particular patient, thus using the advantages of the methods and avoiding possible complications. This article covers the most frequent and severe complications of minimally invasive therapies for prostate cancer, as well as the methods of their prevention and treatment.Рак предстательной железы (РПЖ) является наиболее распространенным онкологическим заболеванием среди мужчин. Радикальная простатэктомия (открытая, лапароскопическая, роботическая) считается основным хирургическим методом лечения РПЖ. Однако в последние годы все бόльшую популярность набирают малоинвазивные методы лечения РПЖ, которые не отстают по эффективности от радикальной операции (по данным последних исследований). К наиболее изученным малоинвазивным технологиям относятся криоаблация, HIFU-терапия (High Intensity Focused Ultrasound) и брахитерапия.Несмотря на минимизацию повреждения соседних структур, малоинвазивные методы лечения РПЖ, как и любые другие хирургические вмешательства, могут приводить к развитию ряда осложнений. Для каждого из методов существуют определенные ограничения, а также наиболее характерные и вероятные осложнения. Благодаря существованию на сегодняшний день целого ряда малоинвазивных методов лечения РПЖ возможен индивидуальный подход к конкретному пациенту, что позволяет избежать нежелательных осложнений и использовать сильные стороны каждого из методов. В настоящей работе рассмотрены наиболее частые и тяжелые осложнения, возникающие после малоинвазивного лечения РПЖ, а также методы их профилактики и лечения

POSTOPERATIVE COMPLICATIONS OF MINIMALLY INVASIVE THERAPIES FOR PROSTATE CANCER

Prostate cancer is the most common cancer among men. Radical prostatectomy (open, laparoscopic, or robotic) remains the main method of surgical treatment for prostate cancer. However, minimally invasive therapies for prostate cancer are becoming increasingly popular in recent years, because they have similar efficacy as open surgery. The most studied minimally invasive therapies are cryoablation, high intensity focused ultrasound (HIFU), and brachytherapy.Despite the minimization of damage to neighboring structures, minimally invasive procedures can cause a number of complications, like any other surgical interventions. Each method has specific limitations and the most typical complications. Since multiple minimally invasive methods are currently available, we can ensure an individual approach to each particular patient, thus using the advantages of the methods and avoiding possible complications. This article covers the most frequent and severe complications of minimally invasive therapies for prostate cancer, as well as the methods of their prevention and treatment

Erectile function after endoscopic surgery for prostatic hyperplasia removal

Introduction. Currently, benign prostatic hyperplasia (BPH) is diagnosed in 50 % of men aged 50 and older and in 80 % of men aged 80 and older. The most effective treatment method is surgical  removal of prostate adenoma. It allows to quickly remove  infravesical urinary tract obstruction, but at the same time it  increases the risk of erectile dysfunction, one of the most important  possible complications. The rate of this complication was significantly decreased by implementation of modern laser technology in  urological practice.The study considers the effect of different methods of endoscopic removal of BPH on erectile function (EF): mono- and bipolar transurethral resection (TUR) of the prostate, holmium (HoLEP) and  thulium (ThuLEP) laser enucleation, prostate vaporization. Evolution  of modern laser technologies and changes in approaches to  preservation of EF in treatment of prostate adenoma are presented. The study objective is to discuss possible mechanisms of  EF disorders after endoscopic surgeries for BPH removal, as well as  to identify which of the mechanisms is the most probable cause of postoperative erectile dysfunction.Conclusion. According to the available data, such methods as bipolar TUR of the prostate, HoLEP, and ThuLEP do not negatively affect erection in any significant way. Moreover, in some cases its  recovery is significantly quicker after ThuLEP; therefore, the last  method is recommended for patients interested in quick EF recovery

Erectile function after endoscopic surgery for prostatic hyperplasia removal

Introduction. Currently, benign prostatic hyperplasia (BPH) is diagnosed in 50 % of men aged 50 and older and in 80 % of men aged 80 and older. The most effective treatment method is surgical  removal of prostate adenoma. It allows to quickly remove  infravesical urinary tract obstruction, but at the same time it  increases the risk of erectile dysfunction, one of the most important  possible complications. The rate of this complication was significantly decreased by implementation of modern laser technology in  urological practice.The study considers the effect of different methods of endoscopic removal of BPH on erectile function (EF): mono- and bipolar transurethral resection (TUR) of the prostate, holmium (HoLEP) and  thulium (ThuLEP) laser enucleation, prostate vaporization. Evolution  of modern laser technologies and changes in approaches to  preservation of EF in treatment of prostate adenoma are presented. The study objective is to discuss possible mechanisms of  EF disorders after endoscopic surgeries for BPH removal, as well as  to identify which of the mechanisms is the most probable cause of postoperative erectile dysfunction.Conclusion. According to the available data, such methods as bipolar TUR of the prostate, HoLEP, and ThuLEP do not negatively affect erection in any significant way. Moreover, in some cases its  recovery is significantly quicker after ThuLEP; therefore, the last  method is recommended for patients interested in quick EF recovery