Risk factors of urethral recurrence in men after radical cystectomy with orthotopic urinary diversion for urothelial carcinoma

2019 ◽  
Vol 18 (1) ◽  
pp. e802-e803
Author(s):  
W. Song ◽  
J.Y. Jeong ◽  
T.H. Kim ◽  
H.S. Yoon ◽  
K.H. Kim ◽  
...  
Keyword(s):  
Risk Factors ◽  
Urothelial Carcinoma ◽  
Radical Cystectomy ◽  
Urinary Diversion ◽  
Orthotopic Urinary Diversion ◽  
Urethral Recurrence

scholarly journals Treatment and outcomes of urethral recurrence after orthotopic neobladder replacement in patients with bladder cancer — practice in a single centre

2018 ◽  
Vol 46 (9) ◽  
pp. 3928-3937 ◽  
Author(s):  
Xiaozhou Zhou ◽  
Huixiang Ji ◽  
Heng Zhang ◽  
Tailin Xiong ◽  
Jinhong Pan ◽  
...  
Keyword(s):  
Radical Cystectomy ◽  
Urinary Diversion ◽  
Clinical Information ◽  
Tumour Resection ◽  
En Bloc ◽  
Cancer Specific Survival ◽  
Time To Recurrence ◽  
Orthotopic Urinary Diversion ◽  
Urethral Recurrence

Objectives To report on the treatment of urethral recurrence after orthotopic urinary diversion at our institution. Methods We retrospectively reviewed clinical information of urethral recurrence in patients who underwent radical cystectomy and orthotopic urinary diversion between January 1998 and January 2013. Results Of 341 patients, 282 presented for follow-up (median follow-up: 56 months; range: 1–174 months). Eight patients developed local recurrence of urothelial cancer after radical cystectomy. The rate of urethral recurrence (1.4%) in female patients who underwent orthotopic urinary diversion was lower than in male patients (3.3%). The median (range) time to recurrence was 33 (6–120) months after radical cystectomy and orthotopic urinary diversion. Recurrences were treated by transurethral resection of tumour, urethrectomy, neobladder resection, revision of urinary diversion, adjuvant chemotherapy, or radiation therapy, based on individual circumstances. Survival analysis showed that 5-year cancer-specific survival was significantly higher in patients with urethral recurrence alone (83.3%), compared with patients with other recurrences, including pelvic/abdomen recurrence and distant metastasis (26.8%). Conclusions En bloc urethrectomy and revision of urinary diversion remain the principle surgical choices. Selection of transurethral tumour resection was based on tumour stage and was used in carefully chosen patients. Cancer-specific survival might depend on multidisciplinary therapy.

MP29-16 INCIDENCE AND RISK FACTORS OF URETEROENTERIC ANASTOMOTIC STRICTURE FOLLOWING RADICAL CYSTECTOMY WITH URINARY DIVERSION

2015 ◽  
Vol 193 (4S) ◽  
Author(s):  
Boyd Viers ◽  
Amy Krambeck ◽  
Marcelino Rivera ◽  
R. Jeffrey Karnes ◽  
Robert Tarrell ◽  
...  
Keyword(s):  
Risk Factors ◽  
Radical Cystectomy ◽  
Urinary Diversion ◽  
Anastomotic Stricture

1617 RISK FACTORS OF HOSPITAL READMISSIONS FOLLOWING OPEN RADICAL CYSTECTOMY AND URINARY DIVERSION: ANALYSIS OF 1000 CONSECUTIVE PATIENTS

2013 ◽  
Vol 189 (4S) ◽  
Author(s):  
Samer El-Halwagy ◽  
Ahmed Haraz ◽  
Yasser Osman ◽  
Mahmoud Laymon ◽  
Ahmed Mosbah ◽  
...  
Keyword(s):  
Risk Factors ◽  
Radical Cystectomy ◽  
Urinary Diversion ◽  
Hospital Readmissions ◽  
Open Radical Cystectomy

Cancer-specific survival in patients with urothelial carcinoma of the bladder with recurrence after radical cystectomy: External validation of the prognostic risk stratification model.

2014 ◽  
Vol 32 (4_suppl) ◽  
pp. 325-325 ◽  
Author(s):  
Tohru Nakagawa ◽  
Haruki Kume ◽  
Atsushi Kanatani ◽  
Masaomi Ikeda ◽  
Akihiko Matsumoto ◽  
...  
Keyword(s):  
Risk Factors ◽  
Urothelial Carcinoma ◽  
Radical Cystectomy ◽  
Median Survival ◽  
Prognostic Value ◽  
Risk Group ◽  
Cancer Specific Survival ◽  
Poor Risk ◽  
Carcinoma Of The Bladder ◽  
Metastatic Sites

325 Background: Prognosis of the patients with urothelial carcinoma of the bladder (UCB) who developed recurrence after radical cystectomy (RC) is generally poor, but can be variable. We previously showed that shorter time to recurrence (TTR) after RC, presence of symptoms on recurrence, more than one metastatic sites (organs), high serum C-reactive protein (CRP) level were associated with decreased survival in those patients, and proposed a model to stratify patients into 3 separate risk groups (Nakagawa et al. J Urol. 2013; 189:1275). The aim of this study was to evaluate the prognostic value of this model in a multi-institutional cohort of patients. Methods: We identified 267 patients who experienced disease recurrence after RC for UCB from 9 academic and community hospitals. Patients were categorized into three groups based on the presence of four risk factors, TTR of <1 year, presence of symptoms on recurrence, more than one metastatic sites (organs), and CRP level of ≥0.5 mg/dl: the favourable risk group included patients with none or one of these risk factors; the intermediate risk group with 2 risk factors; and those with 3 or 4 risk factors were assigned to the poor risk group. Results: Overall, median survival time (MST) of the entire cohort was 8.3 months (95%CI, 6.4-9.1). Two hundred and nineteen patients died of their disease with a median survival of 5.9 months. In a multivariate analysis, all of the 4 risk factors were statistically significant for the cancer-specific survival. Sixty-five (27.4%), 84 (35.4%), and 88 (37.1%) patients were in the favorable, intermediate and poor risk group, respectively. Thirty patients were excluded because CRP value was not obtained. MSTs of the patients in the favorable, intermediate and poor risk group were 22.2 (95% CI 16.1-28.3), 7.6 (95% CI 6.3-9.5), and 3.6 (95% CI 2.6-4.4) months, respectively, and the difference was statistically significant (p<0.001, log-rank test). Conclusions: We confirmed the prognostic value of our previous criteria based on the four variables in patients with recurrence after RC for UCB. This criteria would help in patient counseling and clinical trial design.

Risk group stratification in patients with micropapillary bladder cancer treated with radical cystectomy and/or neoadjuvant chemotherapy.

2015 ◽  
Vol 33 (7_suppl) ◽  
pp. 302-302
Author(s):  
Stephen Bentley Williams ◽  
Mario Fernandez ◽  
Daniel Levi Willis ◽  
Rebecca Slack ◽  
Arlene O. Siefker-Radtke ◽  
...  
Keyword(s):  
Risk Factors ◽  
Bladder Cancer ◽  
Neoadjuvant Chemotherapy ◽  
Urothelial Carcinoma ◽  
Radical Cystectomy ◽  
Clinical Stage ◽  
Recursive Partitioning ◽  
Risk Groups ◽  
Preoperative Risk Factors ◽  
Traditional Risk Factors

302 Background: Micropapillary bladder cancer (MPBC) is an aggressive variant of urothelial carcinoma. We have previously published clinical risk stratification groups for patients with conventional urothelial carcinoma and sought to identify if these were valid in patients with this variant histology. Methods: An IRB approved review of 1910 patients in our radical cystectomy database revealed 106 patients with preoperative diagnosis of ≤cT4aN0M0 MPBC between December 1992 and January 2012 who underwent upfront radical cystectomy (RC, n = 74) or neoadjuvant chemotherapy (NAC) followed by RC (n = 32). To determine whether patients with MPBC can be risk stratified using traditional risk factors, a recursive partitioning analysis (RPA) was performed. Results: In multivariate analyses, hydronephrosis (HR=3.1; p=0.01), and extent of MPBC at transurethral resection (TUR) (HR=1.9; p=0.04) were associated with shortened OS. In the reduced model, clinical stage also achieved significance (HR=2.8; p=0.03). Results were similar for DSS: hydronephrosis (HR=2.4, p=0.03), extent of MPBC (HR=2.1, p=0.03) and clinical stage (HR=4.7, p=0.02). Using the RPA analysis, following risk groups were identified according to OS or DSS: 1) cT1 disease with no hydronephrosis; 2) cT2 or higher with no hydronephrosis; or 3) hydronephrosis (with any cT stage). These groups corresponded to a low, intermediate and high-risk groups with 5-year OS and DSS rates of 85% and 91%, 50% and 57% and 16% and 17%, (p<0.001), respectively. We found these risk groups to hold true in those treated with NAC or upfront RC; those who received NAC trended towards better outcomes. Conclusions: In patients with MPBC, preoperative risk factors can help stratify patients into different risk groups similar to what is seen in patients with conventional UC. Presence of hydronephrosis is an especially ominous sign.

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