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Muscle-invasive bladder cancer is an aggressive disease, for which neoadjuvant chemotherapy followed by radical cystectomy remains the gold standard treatment. Although great efforts have been invested in developing and advancing urinary diversion methods, none has yet to approach those of a fully functional native bladder. Currently, the only bladder-sparing approach recommended for optimal candidates is concurrent chemoradiation (trimodal therapy). In the future, a risk-adapted approach, which includes transurethral resection of bladder tumor followed by systemic neoadjuvant treatment and stringent surveillance, could be offered to patients. Optimal patient selection remains the cornerstone of these approaches. Novel biomarkers, such as circulating tumor DNA, and the integration of multiparametric MRI with a standardized scoring system, may aid in better assessing clinical complete response, reducing misclassifications, and leading to improved oncological outcomes. The pursuit of surgeons and oncologists in fulfilling the inherent desire of patients to retain their urinary bladder despite having muscle-invasive bladder cancer (MIBC) has sparked years of research and multiple debates, given its aggressive nature and the high risk of fatal metastatic recurrence. Historically, several approaches to bladder-sparing treatment have been explored, ranging from radical transurethral resection to concurrent chemoradiation. A less well-established approach involves a risk-adapted approach with local therapy deferred based on the clinical response to transurethral resection followed by systemic therapy. Each approach is associated with potential risks, benefits, and trade-offs. In this review, we aim to understand, navigate, and suggest future perspectives on bladder-sparing approaches in patients with MIBC. [ABSTRACT FROM AUTHOR]

This study explored prognostic differences between radical cystectomy (RC), tri-modality treatment (TURBt combined with radiotherapy and chemotherapy, TMT), electrocautery (EC) and partial cystectomy (PC) for T2N0M0 MIBC. Using SEER data (2004-2015, 2018-2020), we identified T2N0M0 MIBC patients treated with RC, TMT, EC, or PC. Propensity score matching (PSM, 1:1, caliper=0.1) minimized confounding. Kaplan-Meier analysis and Cox regression identified independent prognostic factors, stratified by tumor size and age. This study included 6526 patients with T2N0M0 MIBC. Among them, 348(5.33%) underwent PC, 309(4.73%)underwent EC, 1833(28.09%)received TMT, and 4036(61.84%) RC. After 1:1 propensity score matching, RC showed improved CSS (HR=0.67, 95%CI 0.47-0.95 , and PC also benefited (HR=0.97, 95%CI 0.69-1.36) compared to EC. While TMT showed a worse end (HR=1.41, 95%Cl 1.03-1.92) compared to EC. Cox analysis was used to stratify tumor size and age for subgroup analysis. Results for tumor size subgroups were aligned with PSM findings. In the age-stratified subgroups, patients aged <67 years, both RC (HR=0.54, P=0.107) and TMT(HR=0.91, P=0.785) showed better prognoses compared to EC treatment, while PC treatment showed worse prognoses compared to EC treatment (HR=1.23, P=0.542).; for 68-77 years, RC(0.64, P=0.1436) and PC(HR=0.46, P=0.0283)had advantages, and PC is more recommended. For >78 years, RC had superior CSS over EC and PC, whereas TMT had the poorest prognosis. In clinical T2N0M0 MIBC, overall, RC outperformed focal-tumor therapy and PC, irrespective of tumor size. However, considering age, we recommend PC treatment for patients aged 68-77 and EC for those aged >78 years. This study compared radical cystectomy (RC), focal-tumor therapy combined with radiotherapy and chemotherapy (TMT and EC), and partial cystectomy (PC) for nonmetastatic muscle-invasive bladder cancer. Using SEER data and a series of statistical analyses, overall, RC outperformed focal-tumor therapy and PC, irrespective of tumor size. However, considering age, we recommend PC treatment for patients aged 68-77 and EC for those aged > 78 years. In contrast, for patients younger than 67 years of age, we recommend RC for those who can tolerate surgical treatment and TMT for those who can't. [ABSTRACT FROM AUTHOR]

Leiomyoma is a rare benign bladder tumor, classified into intravesical, intramural and extravesical types according to the location. Because of the difficulty of accurate preoperative diagnosis, resection is performed in the majority of the cases. A 37-year-old Japanese man presented to the hospital with a chief complaint of abdominal swelling. Abdominal computed tomography (CT) revealed a large solid mass (20 cm in size) from the abdominal wall to bladder. The tumor was successfully removed by a combination of laparoscopic and open surgery. The histological diagnosis was compatible with leiomyoma, and the patient remained free from recurrence at 3 years after surgery. The possibility of urachal carcinoma could not be ruled out preoperatively because of the location and internal heterogeneous findings by contrast CT. Although imaging is useful in the diagnosis of leiomyoma, the need for histological examination for a conclusive diagnosis has been noted. Therefore, surgical intervention is reported as a major treatment option. In the present case, laparoscopic approach was performed in accordance with partial cystectomy. The procedure was useful for observation of the positional relationship between the tumor and adjacent intestinal organs, and antegrade resection was performed without incident. Laparoscopic approach may be a useful and safe procedure for the resection of extravesical bladder leiomyoma. • Leiomyoma of the urinary bladder is a rare benign tumor. This case focused on management of a giant extravesical leiomyoma mimicking urachal tumor • Laparoscopic approach was useful in observing the positional relationship with adjacent organs, and antegrade resection was performed without incident. • Combined laparoscopic and open surgery may be the treatment of choice in cases of large extravesical leiomyoma [ABSTRACT FROM AUTHOR]

• Patients with primary bladder adenocarcinoma associated with hydronephrosis have worse overall survival. • Patients with bladder adenocarcinoma present lymph node involvement in up to 1/3 of cases (32%). • Patients with primary bladder adenocarcinoma undergoing radical cystectomy have advanced T staging (T3/T4) (61.7%). [ABSTRACT FROM AUTHOR]

• Pheochromocytoma is a tumor developed at the expense of chromaffin tissues. • Extra-adrenal localization of pheochromocytoma is rare. • The main problem with these tumors is to affirm their benignity or malignancy. • Ectopic pheochromocytomas have a malignant development once in two. • Ectopic pheochromocytoma presents a diagnostic and therapeutic dilemma. Extra-adrenal localization of pheochromocytoma is rare. Its clinical revelation is paroxysmal but maybe in the form of permanent hypertension resistant to treatment. The main problem with these tumors is to affirm their benignity or malignancy, ectopic pheochromocytomas have a malignant development once in two. We report the observation of a 39-year-old woman hypertensive on Amlodipine. She presents for sweating, headache, and palpation. The dosage of urinary metabolites revealed a marked increase in metanephrine and normetanephrine. Imagery had shown, at the expense of the left lateral wall of the bladder, a budding tissue formation with irregular contours which was significantly enhanced after injection of PDC. The diagnosis of an ectopic pheochromocytoma was accepted. The patient underwent a partial cystectomy, the postoperative consequences of which were unremarkable. Threatening secretory syndromes are rare medical situations that require urgent management. Pheochromocytoma can be seen at any age from childhood to old age. The treatment of pheochromocytoma is surgical, once the stages of positive and topographic diagnosis have been carried out, the patient must be immediately entrusted to a team of trained surgeons and anesthetists. The prognosis remains unpredictable, hence the interest in prolonged monitoring. Pheochromocytoma is a tumor developed at the expense of chromaffin tissues, extra-adrenal localizations exist, but remain rare. It is a pathology that presents a diagnostic and therapeutic dilemma in which patients require regular and prolonged postoperative monitoring to detect a possible metastasis or recurrence. [ABSTRACT FROM AUTHOR]

Hydatid cyst is a zoonotic disease caused by a tapeworm, Echinococcus granulosus. A retroperitoneal hydatid cyst is extremely rare and its diagnosis can be challenging, particularly in the early stage as it can mimic several regional pathologies like pancreatic pseudocyst, pancreatic neoplasm, and other retroperitoneal cystic lesions. We report a rare case of 39-year-old Nepalese male with a left retroperitoneal hydatid cyst who presented with pain and feeling of mass in the left flank region for 6 months. Diagnosis was made by abdominal computed tomography and magnetic resonance imaging and management was done by partial cystectomy. Retroperitoneal hydatid cysts can present with chronic pain, mass, and symptoms resulting from the mass effect which varies according to the different retroperitoneal locations. Diagnosis of the retroperitoneal cyst can be challenging clinically and radiologically in its early stages. Even in the late stage, ultrasonography may not suffice and additional imaging techniques such as computed tomography or magnetic resonance imaging are required for the diagnosis. In endemic areas, hydatid cyst should be considered while dealing with a retroperitoneal swelling for early diagnosis and prevention of rupture. With a high level of clinical suspicion and radiological findings, retroperitoneal hydatid cyst can be diagnosed and surgery is the principal method of treatment. • Diagnosing retroperitoneal hydatid cysts, especially in their early stages • Presentation in this patient is unique because the abdominal mass was perceived subjectively • The diagnosis of retroperitoneal hydatid cyst can remain in doubt for months and can be diagnosed post-operatively in excision biopsy • Late diagnosis due to diagnostic dilemma or any other reason may result into complications like rupture of the cyst into abdominal cavity [ABSTRACT FROM AUTHOR]

• Among patients with clinically organ-confined MIBC, PC appears to afford similar survival outcomes to RC in a large national data set. • Partial cystectomy can be considered in carefully selected patients (cT2, cN0, tumor size ≤5 cm, and no concurrent carcinoma in situ (CIS). While radical cystectomy (RC) is the standard of care for muscle invasive bladder cancer (MIBC), partial cystectomy (PC) is an effective alternative in select patients. We sought to examine differences in survival for RC and PC in a hospital-based registry. We identified patients diagnosed with cT2−4 bladder cancer who underwent RC or PC from 2003 to 2015 in the National Cancer Database (NCDB). Using inverse probability treatment weighting (IPTW) to control for known confounders, we compared the primary outcome of overall survival (OS) in patients who underwent RC vs. PC. Kaplan-Meier survival analysis, univariable and multivariable Cox proportional hazards modeling were used. We performed a secondary survival analysis for a subcohort of patients with cT2, cN0, tumor size ≤5 cm, and no concurrent carcinoma in situ (CIS), who may be optimal candidates for PC. A total of 22,534 patients met inclusion criteria, of which 6.9% (1,457) underwent PC. RC had longer median OS than PC (67.8 vs. 54.1 months) and on Cox regression analysis (HR 0.88, 95% CI, 0.80–0.95, P = 0.002). However, in our subcohort, there was no difference in OS between RC and PC (HR 1.02, 95% CI, 0.9–1.2, P = 0.74). PC was associated with increased time from surgery to any systemic therapy or death in the subcohort. Among patients with clinically organ-confined MIBC, PC appears to afford similar survival outcomes to RC in a large national data set. The safety and tolerability of PC may warrant consideration in highly selected patients. [ABSTRACT FROM AUTHOR]

• The patients who received partial or radical cystectomy presented different patterns in real-world data. • Radical and partial cystectomy were similar in lymph node positive rates when >12 lymph nodes were removed. • Radical and partial cystectomy have similar survival when combined with adequate lymph node dissection. To compare the oncologic outcomes of bladder cancer (BCa) patients after partial cystectomy (PC) or radical cystectomy (RC) combined with lymph node dissection (LND). Relevant data from BCa patients who had >3 lymph nodes (LNs) removed were retrieved from the Surveillance, Epidemiology, and End Results (SEER) database. Different thresholds of LN count in LND were tested to eliminate potential selection bias, and the optimal threshold was applied to screen patients who underwent adequate LND. After propensity score matching, the oncologic outcomes after PC or RC were compared in patients who underwent adequate LND. After preliminary screening, 6,785 BCa cases diagnosed between 2004 and 2015 with removal of > 3 LNs were enrolled in the analysis, including 633 (9.3%) PC cases and 6,152 (90.7%) RC cases. The PC and RC groups presented entirely different profiles in clinical parameters such as sex, T stage, number of lymph nodes (LNs) removed, and adjuvant therapy. In particular, the LN-positive rate and count were higher in the RC group, even after adjusting for other confounding factors. After comparison using different thresholds, the LN positive rate and count were similar when the LN count in LND was restricted to > 12. In patients who had > 12 LNs removed, after propensity score matching, PC and RC presented similar oncologic outcomes. Further exploration found that the prognosis of patients was associated with age, T stage, and the number of positive LNs. PC and RC could provide equivalent oncologic outcomes in BCa when combined with adequate LND. The conclusion needs further validation in future studies. [ABSTRACT FROM AUTHOR]

Résumé Objectifs Comparer la laparoscopie robot assistée (LR) et la cœlioscopie conventionnelle (CC) dans la chirurgie de l’endométriose vésicale. Méthode Étude rétrospective entre janvier 2007 et décembre 2013 incluant les patientes atteintes d’endométriose vésicale bénéficiant d’au moins une cystectomie partielle par LR ou CC. Le critère de jugement principal était la présence d’une récidive radiologique au niveau vésical. Résultats Nous avons inclus 15 patientes dans le groupe LR et 22 dans le groupe CC. L’âge médian était de 29 ± 7 ans. La symptomatologie était semblable dans les 2 groupes. La cartographie des lésions a été réalisée par l’IRM en préopératoire. Soixante pour cent dans le groupe LR versus 91 % des patientes le groupe CC présentaient d’autres lésions d’endométrioses associées, p = 0,04. La taille médiane de la lésion vésicale était de 30 ± 8 mm dans le groupe LR contre 23 ± 7 mm dans le groupe CC, p = 0,03. La médiane de la durée opératoire était de 210 min versus 225 min, p = 0,8. On ne retrouve pas de différence significative en termes de complications peropératoires et postopératoires précoces et tardives entre les 2 groupes. La durée médiane d’hospitalisation était de 5 vs 6 jours. La proportion de récidive était de 20 vs 23 %, p > 0,05. L’amélioration clinique était semblable entre les groupes 93 vs 86 %, p = 0,6 et le taux de grossesse était de 93 vs 86 %, p = 0,6. Conclusion Le traitement par laparoscopie robot assistée dans le traitement chirurgical de lésions d’endométriose vésicale semble similaire sur le risque de récidive par rapport à la cœlioscopie traditionnelle ainsi que sur les risques de complications per- et postopératoires. Objectives To compare robot-assisted laparoscopy (RL) and conventional laparoscopy (CL) in surgery for bladder endometriosis. Methods A retrospective study was conducted between January 2007 and December 2013, including patients with bladder endometriosis receiving at least a partial cystectomy by RL or CL. The primary endpoint was the presence of a radiological recurrence at bladder level. Results We included 15 patients in the RL group and 22 in the CL group. The median age was 29 years ± 7 years. The symptoms were similar in the 2 groups. Pre-surgical mapping of the lesions was carried out with MRI. Sixty percent of patients in the RL group vs 91% in the CL group had other associated endometriosis lesions, P = 0.04. The median size of the bladder lesion was 30 ± 8 mm in the RL group vs 23 ± 7 mm in the CL group, P = 0.03. The median operative time was 210 vs 225 min, P = 0.8. We did not find any significant difference in intraoperative and early and late postoperative complications between the 2 groups. The median length of stay was 5 days vs 6 days. The proportion of relapse was 20 vs 23%, P > 0.05. Clinical improvement was similar between the groups, i.e. 93 vs 86%, P = 0.6 and the pregnancy rate was 93 vs 86%, P = 0.6. Conclusions Robot-assisted laparoscopy in the surgical treatment of bladder endometriosis as compared to traditional laparoscopy does not seem to have an adverse effect neither on the risk of recurrence nor on the occurrence of intra- and postoperative complications. [ABSTRACT FROM AUTHOR]

Purpose: Bladder preservation surgical strategies for the treatment of invasive bladder cancer have been developed to provide options to those patients who are medically unfit to undergo radical extirpative surgery or prefer conservative therapy for limited disease. The purpose of this manuscript is to review the available bladder-preserving surgical techniques for treatment of muscle-invasive bladder cancer.Methods: We performed a thorough literature search to determine the available bladder-preserving treatments for muscle-invasive bladder cancer as well as their corresponding outcomes.Results: Available surgical strategies include radical transurethral resection (TUR) with or without neoadjuvant chemotherapy, partial cystectomy and multi-modal therapy. Patient selection is critical in determining which patients can safely be offered bladder preservation therapies. Disease characteristics that portend more favorable outcomes in the setting of bladder preservation include cT2 stage, unifocal tumor, the absence of carcinoma in situ and hydronephrosis, and complete TUR. Several new technologies, including fluorescence and cryoablation treatment, have been incorporated into existing treatment modalities to improve surgical precision and margins. Ongoing studies aimed at improving the accuracy of clinical staging can further refine patient selection and improve clinical outcomes.Conclusions: Surgical bladder preservation techniques for treatment of invasive bladder cancer requires careful, long-term follow-up. Prospective, randomized studies comparing bladder sparing treatment modalities with radical cystectomy are needed, but ultimately will be difficult to accrue due to a variety of factors. [ABSTRACT FROM AUTHOR]

Purpose: Urachal carcinoma (UC) is a rare genitourinary cancer with an insidious onset, high risk of recurrence, and a poor prognosis. Surgical resection alone has difficulty in controlling the tumor. We aim to explore treatment options and prognostic risk factors for UC based on a multicenter cohort and long-term follow-up database.Materials and Methods: The clinical data, treatment and follow-up results of 163 patients with UC in 6 medical centers were analyzed retrospectively. Kaplan-Meier analysis and a Cox proportional hazards model were used to assess the treatment options and prognostic risk factors for UC.Results: Kaplan-Meier analysis showed no difference in the 5-year recurrence-free survival rate (P =0.282) or overall survival rate (P =0.673) between extended partial cystectomy (EPC) and radical cystectomy (RC) for patients at stage III and below. Whether bilateral pelvic lymph nodes were dissected was also not significantly correlated with the patient's recurrence (P =0.921) or prognosis (P =0.741). Postoperative adjuvant chemotherapy significantly reduced the recurrence rate of patients with stage Ⅲb or below (P =0.005). Combined treatment of postoperative recurrence patients prolonged the survival time of patients compared with single chemotherapy or conservative treatment (34.022±5.031 vs. 12.837±2.349 or 6.192±0.875 months, P <0.001). Kaplan-Meier and univariate Cox regression analyses showed that age >55 years, Sheldon stage, carbohydrate antigen 19-9 (CA19-9) >9.935 U/mL, carbohydrate antigen 72-4 (CA724) >6.02 U/mL, and postoperative adjuvant chemotherapy were closely related to the overall survival and recurrence-free survival of patients (P <0.05). Multivariate Cox proportional hazard regression confirmed that the Sheldon stage and CA724 >6.02 U/mL were independent recurrence risk factors.Conclusions: EPC or RC provides similar oncologic results for UC, but bilateral pelvic lymph node dissection is not necessary in early-stage patients. Postoperative adjuvant chemotherapy can significantly reduce the recurrence rate, and combination therapy may provide better survival outcomes. CA724 can predict tumor recurrence or metastasis at an early stage. [ABSTRACT FROM AUTHOR]

Purpose: Partial cystectomy (PC) is a bladder sparing option to treat bladder cancer in a carefully selected group of patients. We sought to analyze outcomes of partial cystectomy (PC) in a contemporary cohort of patients at a single institution.Material and Methods: Records were reviewed for 43 patients with a primary urothelial carcinoma (UC) who had a partial cystectomy with curative intent at Columbia University Medical Center from 2004 to 2019. Endpoints of interest were noninvasive recurrence (defined as any recurrent nonmuscle invasive disease), advanced recurrence (defined as a muscle invasive recurrence or metastasis), and death. We used unadjusted Cox proportional hazards regressions and log rank tests to estimate the association between clinical characteristics and endpoints of interest.Results: Among 43 patients with bladder cancer treated with partial cystectomy, median patient age was 73 years (interquartile range 67-77.5) and 86% were male. Twenty-three percent of patients received preoperative neoadjuvant chemotherapy (NAC) and 49% of patients were given perioperative intravesical chemotherapy at the time of PC. Pathologic stage was Conclusions: In well-selected patients, partial cystectomy offers adequate local control of bladder cancer. The risk of systemic progression is similar to reported case series of RC. [ABSTRACT FROM AUTHOR]

Background: The presence of postoperative bile leak is the major outcome measure for the assessment of operative success in partial cystectomy for hydatid liver disease. However, the optimal operative strategy to reduce the postoperative bile leak rate is yet to be defined.Methods: Medical records of patients who underwent partial cystectomy for hydatid liver disease between January 2013 and January 2015 were reviewed in this retrospective analysis. All patients were managed with a specific operative protocol. The primary outcome measure was the rate of persistent postoperative bile leak. The secondary outcome measures were the morbidity and mortality rate, and the length of hospital stay.Results: Twenty-eight patients were included in the study. Only one patient (3.6 %) developed persistent postoperative bile leak. The overall morbidity and mortality rate was 17.8 and 0 %, respectively. The median length of hospital stay was 5 days.Conclusion: Aggressive preventative surgical measures have led to low persistent bile leak rates with low morbidity and mortality. [ABSTRACT FROM AUTHOR]

Abstract: Purpose: To identify predictive factors underlying recurrence and survival after partial cystectomy for pelvic lymph node-negative muscle-invasive bladder cancer (MIBC) (urothelial carcinoma) and to report the results of partial cystectomy among select patients. Methods: We retrospectively reviewed 101 cases that received partial cystectomy for MIBC (pT2-3N0M0) between 2000 and 2010. The log-rank test and a Cox regression analyses were performed to identify factors that were predictive of recurrence and survival. Results: With a median follow-up of 53.0 months (range 9–120), the 5-year overall survival (OS), cancer-specific survival (CSS) and recurrence-free survival (RFS) rates were 58%, 65% and 50%, respectively. A total of 33 patients died of bladder cancer and 52 patients survived with intact bladder. Of the 101 patients included, 55 had no recurrence, 12 had non-muscle-invasive recurrence in the bladder that was treated successfully, and 34 had recurrence with advanced disease. The multivariate analysis showed that prior history of urothelial carcinoma (PH.UC) was associated with both CSS and RFS and weakly associated with OS; lymphovascular invasion (LVI) and ureteral reimplantation (UR) were associated with OS, CSS and RFS. Conclusions: Among patients with pelvic lymph node-negative MIBC, PH.UC and UR should be considered as contraindications for partial cystectomy, and LVI is predictive of poor outcomes after partial cystectomy. Highly selective partial cystectomy is a rational alternative to radical cystectomy for the treatment of MIBC with negative pelvic lymph nodes. [Copyright &y& Elsevier]

Résumé: Objectifs de l’étude: La radiothérapie prostatique est parfois responsable de séquelles vésicosphinctériennes qui peuvent nécessiter une prise en charge chirurgicale. L’objectif de cette étude était de rapporter les résultats obtenus après traitement chirurgical de l’incontinence urinaire post-radique. Patients et méthode: Les dossiers médicaux des patients traités par chirurgie pour des séquelles vésicosphinctériennes après radiothérapie prostatique entre septembre 2004 et février 2012 ont été revus rétrospectivement. Résultats: Au total, sept hommes âgés en moyenne de 70ans±4,1 ont été inclus. Le suivi moyen a été de 32,3mois±29 (3–86). Une cystectomie sustrigonale avec entérocystoplastie d’agrandissement a permis de traiter les troubles de complication urinaire post-radique dans tous les cas. Le taux de fistule vésicocutanée était de 33 %, avec un délai moyen de survenue de 18,5jours±2,1 (17–20). Les durées moyennes de sondage vésical et d’hospitalisation étaient respectivement de 16jours±8,4 (12–35) et de 18jours±7,8 (13–37). Dans cinq cas, il y a eu nécessité de recourir à l’implantation asynchrone d’un sphincter urinaire artificiel pour tarir les fuites urinaires persistantes. Le délai moyen entre la cystectomie sustrigonale avec entérocystoplastie d’agrandissement et l’implantation d’un sphincter urinaire artificiel a été de 27,6mois±26,4 (7–72). Conclusion: Le traitement chirurgical des séquelles vésicosphinctériennes post-radiques après irradiation de la prostate offre des résultats fonctionnels satisfaisants au prix d’une morbidité non négligeable qui doivent être proposés par des centres qui en ont l’expertise. [ABSTRACT FROM AUTHOR]

Abstract: Study Objective: To describe outcomes after laparoscopic excision of deep bladder endometriosis. Design: Retrospective study (Canadian Task Force classification II-3). Setting: University hospitals. Patients: Twenty-one consecutive patients with endometriotic nodule on the bladder (infiltrating detrusor muscle) from a series of 169 patients were included in the study. The primary outcome studied was resolution of bladder symptoms. Secondary outcomes included complication rates, recurrence rates, and pregnancy rates after laparoscopic surgery. Interventions: Laparoscopic excision of bladder endometriosis. Measurements and Main Results: Laparoscopy was feasible in all cases without the need for conversion. Median follow-up was 20 months. Ten patients (47.6%) underwent partial cystectomy, and the remaining patients underwent partial-thickness excision of the detrusor muscle. Sixteen patients (76%) had associated deep lesions in the pelvis. The most common associated lesions were rectovaginal nodules (38%) and ureteric lesions (14%), with signs of obstruction. Major complications developed in 3 patients (14%), primarily related to bowel resection. Six patients became pregnant (60%). No patients experienced disease recurrence. Conclusion: Laparoscopic excision is feasible in all types of bladder endometriosis but often involves multiple procedures to manage associated lesions, especially rectovaginal nodules and ureteric lesions. Previous reports have suggested that ureteric lesions are not associated with bladder endometriosis; however, this was not true in our series. Complications are primarily related to severity of the disease and associated procedures. Partial cystectomy is not required in all cases to achieve adequate clearance. Complete excision of the disease is associated with resolution of bladder symptoms and low recurrence rates. [ABSTRACT FROM AUTHOR]

Objective: This study aims to show the treatment outcome in women affected by bladder endometriosis. Patients and methods: Retrospective review of records of 24 women with deep vesical endometriosis treated between 1998 and 2007. Results: All cases had cyclic symptoms even though they were not specific. A percentage of 66% of women had concomitantly deep nodules of the rectovaginal septum and/or uterosacral ligaments. Five patients (20.8%) had previously undergone a transurethral resection (TUR) of the bladder lesion, but this therapy has failed in all cases. Partial cystectomy was carried out in 14 patients (60.8%) and an extramucosal dissection of the endometriotic lesion in nine patients (39.2%). Laparoscopy was used in 19 cases (82.6%). Recurrence of bladder endometriotic lesions was documented in two patients. This was mainly due to an incomplete initial treatment. Success rate, defined by total improvement of symptoms after the initial treatment, was estimated at 86.7% in this series. The only complication encountered was a pelvic hematoma with bladder compression that required a ureteral cannulation (JJ). Seven patients out of 11 became pregnant; four of them were infertile before the surgical treatment. Discussion and conclusion: Diagnosis of bladder endometriosis is often difficult to make because of its non-specific symptoms. The management is mainly surgical and resection should be complete. TUR is not an optimal treatment for bladder endometriosis. [Copyright &y& Elsevier]

Abstract: Pseudosarcomatous fibromyxoid tumors are uncommon lesions with uncertain pathogenesis. We present the case of a 36-year-old healthy patient who was evaluated for painless gross hematuria. Work-up revealed a bladder mass that was initially treated with transurethral resection that showed pseudosarcomatous fibromyxoid tumors. However, the mass recurred and was subsequently treated definitively with partial cystectomy with no recurrence at last follow-up. Partial cystectomy is a viable option in the treatment of recurrent symptomatic pseudosarcomatous fibromyxoid tumors of the bladder, when performed selectively. [Copyright &y& Elsevier]

Abstract: We report the first case of cavernous hemangiolymphangioma of the urinary bladder without cutaneous hemangiomatosis. A 5-year-old boy was admitted for investigation of a 2-month episode of gross hematuria accompanied by lower abdominal pain. Radiological investigations revealed a solid enhancing mass at the dome of the bladder with associated low-flow lesion in the posterolateral wall of the bladder. Physical examination did not show any cutaneous vascular malformations. A differential diagnosis of hemangioma or rhabdomyosarcoma bladder was made, but fine-needle aspiration cytology did not reveal any malignant cells. At surgery, a red, wide-based, nodular tumor was found on the dome of the bladder and extending to the base and lateral walls. Partial cystectomy and excision of the cystic lymphangioma was performed. Histological examination of the resected specimen showed it to be a cavernous hemangiolymphangioma. The postoperative course was uneventful and no recurrence was seen after 8 months. [Copyright &y& Elsevier]

Abstract: A 40-year-old nulliparous woman with a 7-year history of progressive abdominal discomfort and lower urinary tract symptoms was diagnosed with a deeply infiltrating 4-cm bladder endometrioma. After failing conservative therapy, she was treated with simultaneous transurethral and laparoscopic partial cystectomy and robot-assisted bladder reconstruction. She remained symptom free at last follow-up. [Copyright &y& Elsevier]

Abstract: Background:: Radical cystectomy with pelvic lymph node dissection is the standard treatment for patients with invasive bladder cancer. However, many alternative techniques to spare the bladder have been investigated. Single-center, non-randomized studies have reported good patient''s acceptance and reasonably good treatment outcomes. Methods:: We review the experience reported in the literature on bladder-sparing techniques, including transurethral resection, chemotherapy, radiation, and multimodality approaches for muscle-invasive disease focussing on controlled clinical trials. Results:: Most comparative studies indicate that local recurrence and survival outcomes for bladder-sparing approaches are inferior to those from radical cystectomy to control muscle-invasive bladder cancer. Conclusions:: Although molecular biologic techniques may have the capacity to identify a subgroup of patients who may benefit from a bladder-sparing approach, cystectomy is normally required for optimal results. Nevertheless, several alternatives to radical cystectomy for muscle-invasive bladder cancer have been studied. None, however, are reliably superior to radical operative treatment. [Copyright &y& Elsevier]

The authors report a case of pheochromocytoma of the bladder revealed by an important gross hematuria with shock. The diagnosis has been established by the pathologist after a partial cystectomy. This location mimicks a bladder tumor.The diagnosis is difficult; conservative surgery is the rule. [Copyright &y& Elsevier]

Objectives: To investigate treatment patterns of partial cystectomy (PC), neoadjuvant chemotherapy (NAC), lymph node dissection (LND), and treatment delays, and the associations with overall survival (OS) among patients with muscle-invasive bladder cancer.Patients and Methods: We identified patients with cT2-4cN0cM0 urothelial carcinoma of the bladder in the National Cancer Database who underwent PC from 2007 through 2015. We performed descriptive statistics and assessed temporal trends using the Cochrane-Armitage test. Our outcomes of interest were NAC, LND, and treatment delay defined as ≥8 or ≥12 weeks for patients who underwent NAC or upfront surgery, respectively. We used logistic regression and multivariable Cox proportional hazards models to evaluate predictors and associations with OS, respectively.Results: A total of 9,199 patients met inclusion criteria. Over the study period, PC utilization decreased from 9% to 7% (P = 0.06). Compared with patients who underwent radical cystectomy, patients treated with PC less frequently received NAC (7% vs. 17%, P < 0.01) and LND (57% vs. 91%, P < 0.01), but were less likely to experience treatment delays (25% vs. 31%, P < 0.01). Only 4.1% (27/655) of patients treated with PC received the combination of NAC, LND, and no treatment delay. In a Cox model, adequacy of LND was associated with improved OS (<10 nodes: HR 0.62, 95% CI 0.48-0.81 and ≥10 nodes: HR 0.48, 95% Cl 0.32-0.72).Conclusion: PC is uncommon and associated with poorer utilization of NAC and LND, but fewer treatment delays. The adequacy of LND was associated with improved OS while NAC and treatment delay were not. [ABSTRACT FROM AUTHOR]