The feasibility of reduced field-of-view diffusion-weighted imaging in evaluating bladder invasion of uterine cervical cancer

Objectives: Uterine cervical cancer with bladder mucosal invasion is classified as FIGO stage IVA with poor prognosis. MRI can rule out the bladder invasion and skipping cystoscopy may be possible; however, high false-positive rate may be problematic. The purpose of this study is to evaluate the diagnostic performance of reduced field-of-view (FOV) diffusion-weighted imaging (DWI) in evaluating bladder mucosal invasion of cervical cancer. Methods: 3T MRI including T2WI and reduced FOV DWI in 15 women with histologically proven cervical cancer (two stage IIIB, six stage IVA, seven stage IVB) were retrospectively evaluated compared with cystoscopic findings. Results: Cystoscopy revealed mucosal invasion in 13 of 15 cases. The border between the tumor and the bladder wall was unclear on T2WI and clear on reduced FOV DWI in all 15 cases. The diagnosis of mucosal invasion on reduced FOV DWI had a sensitivity of 100%, specificity of 50%, accuracy of 93%, PPV of 93%, and NPV of 100%. Conclusions: Addition of reduced FOV DWI may improve the staging accuracy of MRI for cervical cancer in assessing the bladder mucosal invasion. Advances in knowledge: Reduced FOV DWI may improve the staging accuracy of cervical cancer in assessing bladder mucosal invasion with high NPV and PPV, which may be helpful for avoiding unnecessary cystoscopy.

Cesarean Hysterectomy for Placenta Previa Accreta Using Retrograde Abdominal Hysterectomy Approaching from the Posterior Vaginal Wall

Hysterectomy for placenta percreta with bladder invasion is a difficult operation because of the high possibility of massive bleeding; therefore, surgery should be performed in a facility equipped with a sufficient number of trained staff. The degree of bladder invasion should be assessed correctly before the operation, and it is necessary to carefully consider how to address intraoperative complications and massive bleeding in the preoperative conference. The following should be prepared preoperatively: autologous blood and stored blood; ureteral catheter and insertion materials; materials to separate and tape the internal iliac artery and ureter; balloon for insertion into the common iliac artery or aorta and aortic clamps; and materials for compression suturing, such as B-Lynch suture. Sufficient informed patient consent is also required. During surgery, which may cause massive and sometimes life-threatening bleeding, the general rule is to begin at a safe site without adhesions and then treat the adhesion site. According to this rule, bladder dissection should be performed last in cases of placenta percreta with bladder invasion. As a surgical technique using this principle, we introduce retrograde hysterectomy approaching from the posterior vaginal wall.

Carbon ion radiotherapy for prostate cancer with bladder invasion

Background The optimal management of clinical T4 (cT4) prostate cancer (PC) is still uncertain. At our institution, carbon ion radiotherapy (CIRT) for nonmetastatic PC, including tumors invading the bladder, has been performed since 2010. Since carbon ion beams provide a sharp dose distribution with minimal penumbra and have biological advantages over photon radiotherapy, CIRT may provide a therapeutic benefit for PC with bladder invasion. Hence, we evaluated CIRT for PC with bladder invasion in terms of the safety and efficacy. Methods Between March 2010 and December 2016, a total of 1337 patients with nonmetastatic PC received CIRT at a total dose of 57.6 Gy (RBE) in 16 fractions over 4 weeks. Among them, seven patients who had locally advanced PC with bladder invasion were identified. Long-term androgen-deprivation therapy (ADT) was also administered to these patients. Adverse events were graded according to the Common Terminology Criteria for Adverse Event version 5.0. Results At the completion of our study, all the patients with cT4 PC were alive with a median follow-up period of 78 months. Grade 2 acute urinary disorders were observed in only one patient. Regarding late toxicities, only one patient developed grade 2 hematuria and urinary urgency. There was no grade 3 or worse toxicity, and gastrointestinal toxicity was not observed. Six (85.7%) patients had no recurrence or metastasis. One patient had biochemical and local failures 42 and 45 months after CIRT, respectively. However, the recurrent disease has been well controlled by salvage ADT. Conclusions Seven patients with locally advanced PC invading the bladder treated with CIRT were evaluated. Our findings seem to suggest positive safety and efficacy profiles for CIRT.

Placenta percreta with bladder invasion: managed successfully

Placenta percreta (PP) is a potentially life-threatening condition. When PP is complicated by bladder invasion, mortality rates have been estimated as high as 9.5% and 24% for mother and child, respectively. Early diagnosis allows for appropriate antenatal care and accordingly surgical planning and management. Herein, we are going to present a case report, in which a woman G3P2L2 with previous 2 caesarean section with pre-term gestation was diagnosed with placenta accreta, but intra-operatively it was placenta percreta with bladder invasion. Patient was managed successfully by doing subtotal hysterectomy. Any pregnant patient with previous history of caesarean section we should be suspicious of placenta accrete spectrum, hence should be managed in a tertiary care center with a multidisciplinary approach, and with earliest possible involvement of the urologist in decision-making.

A study of the sensitivity and specificity of the Magnetic Resonance Imaging (MRI) technique used in the diagnosis of endometriosis versus the intraoperative appearance considered the reference standard in the diagnosis of endometriosis

Endometriosis is a gynecological pathology with chronic symptoms, which negatively affects the patient’s quality of life. The prevalence of endometriosis in asymptomatic women is between 2% and 50%, depending on the populations studied and the method of diagnosis. The severity of the symptoms as well as the probability of diagnosing endometriosis increases with age9. Because endometriosis is a gynecological condition with a nonspecific clinical picture, sometimes even asymptomatic, imaging technology can be considered the first line of diagnosis for this pathology. The main objective of this study is to evaluate the sensitivity and specificity of nuclear magnetic resonance imaging (MRI) used in the diagnosis of endometriotic lesions depending on their location, and compare the results obtained with the intraoperative appearance considered a reference standard in the diagnosis of endometriosis. Our study revealed the highest specificity for MRI in the case of endometriotic bladder invasion, respectively the highest sensitivity for endometriotic rectal nodules.