Risk factors, follow-up, and treatment of urethral recurrence following radical cystectomy and urinary diversion for bladder cancer: a meta-analysis of 9498 patients

Abstract Introduction: This was a meta-analysis of studies on conjoined and separate anastomosis for urinary diversion after radical cystectomy due to bladder cancer. Methods: We searched databases (PubMed, Embase and the Cochrane Central Register of Controlled Trials) for studies regarding anastomosis for urinary diversion due to bladder cancer. The meta-analysis was designed to determine the difference between conjoined and separate anastomosis. Six studies including 1601 patients were considered in the meta-analysis (654 in the separate group and 947 in the conjoined group). Results: There were no significant differences with respect to age, gender or duration of follow-up. There were seven studies that compared the rate of stricture and the rate of hydronephrosis. For overall stricture, there were 186 of 1163 ureters in the separate group and 64 of 1718 ureters in the conjoined group (odds ratio, 4.53; 95% CI, 2.01-10.22; P = 0.0003). For overall hydronephrosis patients, there were 55 of 205 ureters in the separate group and 51 of 254 ureters in the conjoined group (odds ratio, 1.48; 95% CI, 0.95-2.29; P = 0.08). Conclusion: The separate anastomosis had a higher ratio of strictures than did the conjoined group. The separate anastomosis group experienced hydronephrosis more often than did the conjoined anastomosis group. The separate anastomosis is the better choice for surgery during the operation.

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Long-term renal function and mortality after radical cystectomy and ileal conduit formation.

10.21203/rs.3.rs-57335/v1 ◽

2020 ◽

Author(s):

Julio Chevarria ◽

Chaudhry A. Ebad ◽

Mairead Hamill ◽

Catalin Constandache ◽

Cliona Cowhig ◽

...

Keyword(s):

Risk Factors ◽

Bladder Cancer ◽

Renal Function ◽

Radical Cystectomy ◽

Urinary Diversion ◽

Beaumont Hospital ◽

Renal Function Decline ◽

Factors Associated ◽

Renal Function Deterioration

Abstract Background. Treatment for bladder cancer includes radical cystectomy (RC) and urinary diversion, RC is associated with long-term morbidity, renal function deterioration and mortality. Our aim was to identify risk factors associated with postoperative long-term renal function decline and mortality. Methods. Retrospective study in patients with RC and urinary diversion in Beaumont Hospital from 1996 to 2016. We include patients who had assessment for at least two years post procedure and confirmed live status. We assessed the estimated glomerular filtration rate (eGFR) preoperatively, at first and second year, renal function decline > 10 ml/min/1.73 m2, start dialysis and mortality. Logistic regression analyses were applied to assess risk factors associated, a significant p-value < 0.05 was considered. Results. We included 264 patients, with median age 68.3 years, 73,7% males, main diagnose was bladder cancer 93.3%, TNM stages were grouped in T ≥ 2 75.9%, N ≥ 1 47.6% and M1 28%. The median eGFR preoperative was 65.8 ml/min/1.73 m2 and after 2 years 58.2 ml/min/1.73 m2 (p:0.009), 5.6% required chronic dialysis and 32.8% had a decrease > 10 ml/min/1.73 m2. Risk factors associated with ESKD included age (HR:1.13, CI95% 1.05–1.22), preoperative eGFR (HR:1.04, CI95% 1.01–1.07). Overall mortality was 43.2%, 75.9% at 5 and 10 years respectively, risk factors were age (HR:1.1, CI95% 1.04–1.18), preoperative eGFR (HR:1.03, CI95% 1.01–1.06) and male gender (HR:14.8, CI95% 1.1–192). Conclusions. Patients with RC have risk of progressive renal function deterioration and high mortality and the main risk factors associated were age, sex, and preoperative eGFR. Regular monitoring of renal function will permit early diagnosis and treatment.

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Risk Factors Leading to Radical Cystectomy in Patients Who Had Undergone Nephroureterectomy

The Korean Journal of Urological Oncology ◽

10.22465/kjuo.2021.19.4.271 ◽

2021 ◽

Vol 19 (4) ◽

pp. 271-280

Author(s):

Janghui Lee ◽

Bumjin Lim ◽

Dalsan You ◽

In Gab Jeong ◽

Cheryn Song ◽

...

Keyword(s):

Risk Factors ◽

Bladder Cancer ◽

Radical Cystectomy ◽

Cox Regression ◽

Metastatic Cancer ◽

Urine Cytology ◽

Cancer History ◽

Major Predictor ◽

Bladder Recurrence

Purpose: To identify the risk factors leading to radical cystectomy in patients who had undergone nephroureterectomy (NUx).Materials and Methods: We retrospectively reviewed the medical records of patients with upper tract urothelial carcinoma who underwent NUx during 2011–2019 and excluded patients with metastatic cancer. In total 646 patients were included in this study; of these, 532 had no previous bladder cancer history. Follow-up was performed every 3 months for 2 years after NUx was administered, and recurrence was confirmed using cystoscopy, urine cytology, computed tomography, and chest radiography. Bladder recurrence was confirmed through biopsy, urine cytology, or radiologic examination. Univariate and multivariate Cox regression analyzes were performed for statistical analysis of risk factors leading to radical cystectomy in patients undergoing NUx.Results: Lymphovascular invasion (LVI) (hazard ratio [HR], 4.728; 95% confidence interval [CI], 1.463–15.570; p=0.011), previous transurethral resection of bladder tumor history (HR, 3.825; 95% CI, 1.164–12.571; p=0.027), and intravesical recurrence (IVR) within 6 months (HR, 3.733; 95% CI, 1.091–12.778; p=0.036) in patients undergoing NUx are predictors of radical cystectomy implementation. In a multivariate analysis of patients without bladder cancer history, bladder recurrence was identified as a predictor of radical cystectomy implementation, if it occurred within 6 months of NUx (HR, 8.608; 95% CI, 1.545–47.976; p=0.014).Conclusions: LVI and IVR within 6 months and previous bladder cancer history are factors that can predict the need for radical cystectomy after NUx. Even in patients without bladder cancer history, early bladder recurrence within 6 months is a major predictor of radical cystectomy.

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Pathological Profile, Early Complications, Functional and Oncological Outcome after Radical Cystectomy - Ileal Conduit for Bladder Cancer Patients in Sanglah General Hospital between January 2013 and December 2016

Open Access Macedonian Journal of Medical Sciences ◽

10.3889/oamjms.2018.384 ◽

2018 ◽

Vol 6 (9) ◽

pp. 1647-1651 ◽

Cited By ~ 1

Author(s):

Yudiana Wayan ◽

Pratiwi Dinar Ayu ◽

Oka A. A. Gde ◽

Niryana Wayan ◽

I Putu Eka Widyadharma

Keyword(s):

Bladder Cancer ◽

Cancer Patients ◽

Radical Cystectomy ◽

Urinary Diversion ◽

Ileal Conduit ◽

Wound Dehiscence ◽

Oncological Outcome ◽

Pathological Result ◽

Muscle Invasive

BACKGROUND: Radical cystectomy is the standard treatment for nonmetastatic bladder cancer (muscle-invasive and selective superficial bladder cancer). There are many types of urinary diversion after this procedure; the ileal conduit is the most and simplest one. AIM: To asses clinical, pathological profile, early complication, functional and oncological outcome after radical cystectomy and ileal conduit for muscle-invasive bladder cancer patients. METHOD: Between January 2013 and December 2016, there were 68 patients diagnosed with bladder cancer. From those patients, 24 (35.29%) patients had been performed radical cystectomy with ileal conduit type for urinary diversion (100%). Patients demographic, clinical and pathological profile, early postoperative complication, functional and oncological outcome were collected from the medical record. RESULT: Among the 24 patients who underwent radical cystectomy, 20 patients were male (83.3%) with the mean age was 57.3 y.o (33–77 y.o). Twelve patients (50%) showed pT4 and pT2 respectively. Based on pathological result 20 patient (83.34%) had the urothelial carcinoma, three patients (12.5%) had squamous cell carcinoma, and one patient (4.1%) had adenocarcinoma. Two patients (8.3%) got neoadjuvant chemotherapy, and nine patient (37.5%) of patients followed adjuvant chemotherapy after surgery. Wound dehiscence, fistula enterocutan, prolong ileus, leakage anastomosis and sepsis were kind of complication after surgery. One year's survival rate is 84%, mortality rate 20.8% and a recurrence rate of 20.8% in 4 years follow up. CONCLUSION: Radical cystectomy and ileal conduit type of urinary diversion still become the preferable procedure for nonmetastatic bladder cancer with good functional and oncological outcome.

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Long-term kidney function and mortality after radical cystectomy and ileal conduit formation.

10.21203/rs.3.rs-57335/v2 ◽

2020 ◽

Author(s):

Julio Chevarria ◽

Chaudhry A. Ebad ◽

Mairead Hamill ◽

Catalin Constandache ◽

Cliona Cowhig ◽

...

Keyword(s):

Risk Factors ◽

Bladder Cancer ◽

Radical Cystectomy ◽

Kidney Function ◽

Urinary Diversion ◽

Factors Associated ◽

Post Procedure ◽

Common Diagnosis ◽

Kidney Function Decline

Abstract Background: Treatment for bladder cancer includes radical cystectomy (RC) and urinary diversion, RC is associated with long-term morbidity, kidney function deterioration and mortality. Our aim was to identify risk factors associated with postoperative long-term kidney function decline and mortality. Methods: Retrospective study of patients with RC and urinary diversion in Beaumont Hospital from 1996 to 2016. We included patients who had follow up data of at least two years post procedure. We assessed the following outcomes: estimated glomerular filtration rate (eGFR) preoperatively, at first and second year post-procedure, kidney function decline >10 ml/min/1.73m 2 , dialysis commencement and mortality. Logistic regression analyses were applied to assess risk factors associated, a p-value <0.05 was considered significant. Results: We included 264 patients, with median age 68.3 years, 73,7% males. The most common diagnosis was bladder cancer 93.3%, TNM stages were grouped in T≥2 75.9%, N≥1 47.6% and M1 28%. The median eGFR preoperative was 65.8 ml/min/1.73m 2 and after 2 years 58.2 ml/min/1.73m 2 (p:0.009), 5.6% required chronic dialysis and 32.8% had a decrease >10 ml/min/1.73m 2 . Risk factors associated with ESKD included; age (HR:1.13, CI95% 1.05-1.22), and pre-operative eGFR (HR:1.04, CI95% 1.01-1.07). Overall mortality was 43.2% and 75.9% at 5 and 10 years respectively, risk factors for which were age (HR:1.1, CI95% 1.04-1.18), preoperative eGFR (HR:1.03, CI95% 1.01-1.06) and male gender (HR:14.8, CI95% 1.1-192). Conclusions: Patients with RC are at risk of progressive kidney function deterioration and elevated mortality and the main risk factors associated were age, sex, and preoperative eGFR. Regular monitoring of kidney function will permit early diagnosis and treatment.

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

Journal of International Medical Research ◽

10.1177/0300060518782015 ◽

2018 ◽

Vol 46 (9) ◽

pp. 3928-3937 ◽

Cited By ~ 1

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.

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