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Purpose: To present the clinical outcomes of nephroureterectomy with bladder cuff excision (NU-BCE) or radical cystectomy (NU-RC) when distal ureteral carcinoma invaded muscle of the ureteral orifice using inverse probability of treatment weighting (IPTW). Methods: This multicenter study retrospectively studied the demographics and perioperative outcomes of 59 patients who underwent NU-BCE or NU-RC between 2003 and 2024. Relapse-free survival (RFS), cancer-specific survival (CSS), and overall survival (OS) were presented using Kaplan–Meier curves. Cox proportional hazard regression to find independent predictors. Results: Of all patients, the median follow-up time for RFS was 8 months and 18 months for CSS and OS. After IPTW, the median RFS, CSS, and OS for patients who underwent NU-BCE and NU-RC was 9 vs. 27 months (p = 0.037), 18 vs. 40 months (p = 0.027), 18 vs. 30 months (p = 0.371), respectively. The mortality due to progression and complications in NU-BCE and NU-RC patients were 56.4% vs. 20.4% and 2.2% vs. 22.9% (p = 0.016). NU-BCE reduced the median operation time, blood loss, and drainage volume. Apart from NU-RC (HR, 0.18; 95%CI: 0.08–0.44; p < 0.001) (HR, 0.28; 95%CI: 0.1–0.79; p = 0.016) and tumor volume(HR, 1.17; 95%CI: 1.06–1.29; p = 0.002) (HR, 1.21; 95%CI: 1.11–1.31; p < 0.001), which are independent prognostic factors for RFS and CSS, another independent prognostic factor for CSS is the ureteral carcinoma with renal pelvic carcinoma (HR, 4.32; 95%CI: 1.28–14.511; p = 0.018). Conclusions: Patients who underwent NU-RC had better RFS and CSS than NU-BCE, but there was little difference in OS due to the higher mortality rate of postoperative complications in the NU-RC. [ABSTRACT FROM AUTHOR]

Simple Summary: Muscle-invasive bladder cancer often requires a combination of treatments, including chemotherapy before surgery (neoadjuvant chemotherapy, NAC), to improve survival. In this study, we analyzed the use and effectiveness of NAC given before bladder removal surgery in Finland. We aimed to understand how often this treatment is used, how well it works, and which patients benefit most. We found that about one-third of patients received NAC, with usage rates staying steady over the years. Patients who received the treatment often showed reduced tumor size, and their overall survival rates were better than those who had surgery alone. Factors like older age and poor health reduced the likelihood of receiving NAC, while better kidney function and more chemotherapy cycles improved outcomes. These findings support the effective use of chemotherapy before surgery and highlight the importance of selecting the right patients for this approach. Objectives: To investigate neoadjuvant chemotherapy (NAC) eligibility, utilization, and survival outcomes for muscle-invasive bladder cancer patients undergoing radical cystectomy (RC) in a Finnish population. Materials and Methods: Data from the Finnish National Cystectomy Database (2005–2017) was combined with Finnish Cancer Registry survival data. NAC utilization rates were reported, and downstaging rates were calculated based on final pathological staging. Logistic regression analyzed NAC usage and complete response (CR) predictors. Results: Since 2011, 29% of 1157 patients received NAC. Its usage remained consistent, and the number of eligible patients not receiving NAC decreased during the study period. Among NAC patients, pathology T-category was pT0 (34%), pT1-Ta-Tis (16%), pT2 (23%), pT3 (20%), and pT4 (7%) tumors, with pN0 in 82%. In the RC + NAC group, the 5-year overall survival (OS) rates were 89% for patients with no residual disease (pT0N0), 82% for those with organ-confined residual disease (pT1, Tis, Ta, T2/N0), and 49% for patients with non-organ-confined residual disease (pT3+/N+). The corresponding cancer-specific survival (CSS) rates were 93%, 86%, and 57%, respectively. Patients with organ-confined residual disease after NAC had survival outcomes comparable to those who underwent RC alone. Higher age; odds ratio (OR) 0.93, [95% Confidence Interval (CI): 0.90–0.95] and Charlson Co-morbidity Index–score [OR 0.88 (0.79–0.98)] reduced the likelihood of receiving NAC, while a smaller center size increased the probability [OR 1.82 (1.02–3.28)]. More treatment cycles [OR 0.70, (95% CI: 0.51–0.93)] and a favorable GFR [OR 0.38 (0.16–0.88)] were associated with achieving CR. Conclusion: We report that NAC is well-utilized across Finland, with CR rates comparable to recent trials. Additionally, our survival rates are reasonable, and even with organ-confined residual disease after NAC, survival outcomes are similar to those who underwent RC alone. [ABSTRACT FROM AUTHOR]

Simple Summary: The current paper highlights the current literature on single-port surgery for genitourinary cancers. The authors aim to achieve a comprehensive review of the topic that can serve as a guide to urologic surgeons interested in learning about the advantages and disadvantages of this novel technology. Single-port technology allows for a more diverse approach to complex urologic surgery with the additional benefit of improved recovery due to decreased postoperative pain. As the field continues to advance, reviews such as this will be important catalysts for further surgical innovations that will enhance patient outcomes. Background: The da Vinci single-port (SP) platform is emerging as the latest innovation in minimally invasive surgery and its utilization in treating urologic malignancies continues to expand. Methods: A search was conducted in PubMed, MEDLINE, and ScienceDirect. The final set includes 40 academic articles. Results: Research on single-port surgery for genitourinary cancer is still an emerging topic. We divided the topic into the following categories: radical prostatectomy, radical cystectomy, nephrectomy, and nephroureterectomy. Conclusions: The single-port platform provides urologists with another tool to tackle more complex surgical cases and pathologies with the added improvements of decreased length of stay and increased pain tolerance for patients. [ABSTRACT FROM AUTHOR]

Background: Lymphatic leakage is a common complication after radical cystectomy and pelvic lymph node dissection (PLND) for muscle-invasive bladder cancer (MIBC).This study aimed to investigate the risk factors contributing to postoperative lymphatic leakage in patients with MIBC. Materials and methods: A total of 534 patients undergoing radical cystectomy and PLND were enrolled in the retrospective study at Peking University Third Hospital from January 2010 to July 2023. Patients were categorized into lymphatic leakage(n = 254)and non-leakage groups (n = 280) and compared demographic, perioperativ and pathologic factors. Multivariate logistic regression was applied to identify risk factors for lymphatic leakage. Spearman correlation was used to analyze the relationship between lymph leakage ratio and risk factors. Results: Patients with lymphatic leakage had significantly higher rates of receiving extended PLND (19.7% vs. 11.4%, p = 0.008), higher total number of dissected lymph nodes (median 11 vs. 8, p < 0.001), longer hospital stays (median 13 vs. 11 days, p < 0.001), higher postoperative hypoalbuminemia rate (56.7% vs. 36.4%, p < 0.001) and higher fever rate (14.2% vs. 8.6%, p = 0.04) compared to the non-leakage group. On multivariate analysis, higher number of dissected lymph nodes (OR 3.278, 95% CI 1.135–9.471, p = 0.028) was found to be a independent risk factor for lymphatic leakage. Additionally, a positive correlation was observed between the numbers of dissected lymph nodes and lymphatic leakage rate (R = 0.456, p = 0.013). Conclusions: The increased number of dissected lymph nodes is associated with a heightened risk of lymphatic leakage following radical cystectomy for MIBC. [ABSTRACT FROM AUTHOR]

Background: Radical cystectomy constitutes the standard therapeutic approach for high-risk urothelial carcinomas of the bladder. Contemporary guidelines advise urologists to discontinue anticoagulation therapy during the perioperative period to mitigate the risk of significant intraoperative or postoperative hemorrhage. Nevertheless, in elderly patients with a history of coronary artery disease, the cessation of anticoagulant medication elevates the risk of acute myocardial infarction, thereby posing a substantial threat to their survival. Therefore, the necessity and optimal strategy for anticoagulation therapy in patients with acute myocardial infarction following radical cystectomy remains a subject of ongoing debate. This study aims to contribute clinical insights for clinicians to manage high-risk patients with acute myocardial infarction post-major surgery. Methods and results: The 64-year-old male patient was admitted for multiple high-grade urothelial carcinomas of the bladder. The preoperative computed tomography angiography revealed intra-luminal stenosis of the coronary arteries. However, the patient declined further assessment via preoperative coronary angiography, thereby precluding the accurate prediction of postoperative myocardial infarction risk. The patient subsequently underwent laparoscopic radical cystectomy with Bricker conduit urinary diversion and the postoperative pathological examination confirmed the diagnosis of high-grade urothelial carcinoma (T1N0M0, G3). Regrettably, on the first postoperative day, the patient experienced an acute anterior wall ST-segment elevation myocardial infarction. Consequently, the patient underwent emergency percutaneous coronary intervention and was administered dual antiplatelet therapy consisting of aspirin and ticagrelor. The daily pelvic fluid drainage, routine blood and coagulation parameters remained within normal ranges. Following the second percutaneous coronary intervention and dual antiplatelet therapy, the patient was discharged after 2 days. Over a 3-year follow-up period, all hematological parameters consistently remained within normal ranges, and there were no incidents of bleeding or anastomotic leakage. Conclusion: This study demonstrates that postoperative percutaneous coronary intervention, in conjunction with continued dual antiplatelet therapy, is a safe and effective antithrombotic strategy for managing perioperative acute myocardial infarction. This finding suggests a potential paradigm shift in the management of antithrombotic therapy for high-risk surgical patients, advocating for a tailored approach rather than the routine discontinuation of such therapy. [ABSTRACT FROM AUTHOR]

Simple Summary: Bladder cancer is among the most common malignancies worldwide, often requiring radical cystectomy (RC) for muscle-invasive and high-risk non-muscle-invasive cases. While effective, this procedure frequently leads to significant functional impairments, including urinary incontinence and sexual dysfunction, adversely affecting quality of life. In response, sexual-sparing techniques in robot-assisted radical cystectomy (RARC) have emerged as a promising approach to improve functional outcomes without compromising oncological control. This review examines the latest evidence on sexual-sparing RARC, highlighting its potential to preserve sexual and urinary function in both male and female patients. Techniques such as nerve-sparing, capsule-sparing, and pelvic organ-preserving approaches show encouraging functional outcomes. In select patients, oncological outcomes align closely with those of standard RC. Careful patient selection remains crucial, favoring those with organ-confined disease and good baseline function. While early data is promising, further prospective studies and standardized protocols are needed to validate these findings and facilitate broader clinical adoption. Sexual-sparing RARC represents a step forward in balancing cancer control with improved postoperative quality of life. Background/Objectives: Radical cystectomy (RC) is the standard treatment for muscle-invasive and high-risk non-muscle-invasive bladder cancer, but it often results in significant functional impairments, including sexual and urinary dysfunction, adversely affecting quality of life (QoL). Sexual-sparing robotic-assisted radical cystectomy (RARC) has been introduced to mitigate these effects. This review evaluates the oncological and functional outcomes of sexual-sparing RARC in male and female patients. Methods: A systematic literature search identified 15 studies including 793 patients who underwent sexual-sparing RARC using techniques such as nerve-sparing, capsule-sparing, and pelvic organ-preserving approaches. Data on oncological and functional outcomes were analyzed. Results: Sexual-sparing RARC achieves oncological outcomes comparable to open RC, with negative surgical margin (NSM) rates exceeding 95% in most studies. RFS and CSS rates were robust, often surpassing 85% at intermediate follow-ups. Functional outcomes were also favorable, with continence rates exceeding 90% and erectile function recovery surpassing 70% in well-selected male patients. Female patients undergoing pelvic organ-preserving techniques demonstrated improved continence, preserved sexual function, and enhanced QoL. Patient selection emerged as critical, favoring those with organ-confined disease and good baseline function. Conclusions: Sexual-sparing RARC offers a promising balance between oncological control and functional preservation, making it an effective option for selected patients. Further research is needed to refine techniques and establish standardized protocols for broader adoption. [ABSTRACT FROM AUTHOR]

Simple Summary: Intravenous fluid management plays a key role in perioperative care, particularly in patients undergoing radical cystectomy (RC) within enhanced recovery after surgery (ERAS) protocols. This study analyzed 288 patients who underwent laparoscopic RC with urinary diversion to evaluate the impact of fluid administration on postoperative complications assessed 30 days after surgery. Patients were categorized based on the type of urinary diversion (ureterocutaneostomy or ileal conduit) and the volume of intraoperative fluids administered (less than or more than 1000 mL). The results showed that administering more than 1000 mL of fluids was initially associated with an increased risk of complications, but this association lost statistical significance after adjusting for surgery duration and BMI. Indices such as the absolute Vascular Bed Filling Index (aVBFI) and the adjusted Vascular Bed Filling Index (adjVFBI) revealed differences in complication severity 30 days after surgery depending on the type of urinary diversion and fluid management strategy. Introduction: Intravenous fluid management is integral to perioperative care, particularly under enhanced recovery after surgery (ERAS) protocols. In radical cystectomy (RC), which carries high risks of complications and mortality, optimizing fluid management poses a significant challenge due to the absence of definitive guidelines. Aim: the purpose of this study was to investigate the effects of intravenous fluid administration on postoperative complications in patients undergoing RC. Material and methods: This study involved 288 patients who underwent laparoscopic RC and urinary diversion from 2018 to 2022. ERAS protocols were implemented for all patients. Participants were divided into four groups based on the type of urinary diversion (ureterocutaneostomy vs. ileal conduit) and the intraoperative fluid volume input (less than 1000 mL vs. more than 1000 mL). Postoperative complications were evaluated at 30 and 90 days post-surgery using the Clavien-Dindo scale. The fluid management effectiveness was measured using the absolute Vascular Bed Filling Index (aVBFI) and the adjusted Vascular Bed Filling Index (adjVFBI). Results: The UCS is associated with a lower risk of increased severity of postoperative complications. The administration of more than 1000 mL of fluids was associated with a higher risk of complications (p = 0.035). However, after adjusting for the duration of the surgery and BMI, this association did not hold statistical significance, indicating that fluid volume alone is not a direct predictor of postoperative complications. At aVBFI values between zero and eight, urinary diversion using the UCS method is associated with a lower risk of complications compared to the IC. When aVBFI equals eight, the differences in the severity of complications between the UCS and the IC are minimal. However, when aVBFI exceeds eight, the IC is associated with fewer complications during the 30 days post-operation compared to the UCS. The correlation between the adjVFBI (B = −0.27; 95% CI: −0.45 to −0.08; p = 0.005) and the severity of complications up to 30 days postoperatively is similar to that seen with the aVBFI. Similarly, the correlation of the adjVFBI with the method of urinary diversion (B = 0.24; 95% CI: 0.06 to 0.43; p = 0.011) resembles that of the aVBFI. The volume of fluids administered and the indices aVBFI and adjVFBI did not influence the occurrence of complications 90 days postoperatively. Conclusions: The volume of fluids administered is not a factor directly affecting the occurrence of complications following RC when the ERAS protocol is used. The amount of intraoperative fluid administration should be adjusted according to the intraoperative blood loss. Our findings endorse the utility of aVBFI and adjVFBI as valuable tools in guiding fluid therapy within the framework of ERAS protocols. However, further multicenter randomized trials are needed to definitively determine the best fluid therapy regimen for patients undergoing RC. [ABSTRACT FROM AUTHOR]

Abstract Background Radical cystectomy (RC) and urinary diversion are treatment modalities for muscle invasive bladder cancer (MIBC). However, in Cameroon, there is little information on orthotopic neo-bladder (ONB) reconstruction in the literature. Objective We aimed to share our indications for ONB reconstruction, evaluate the functional outcomes, and enumerate the surgical complications. By sharing our experience with ONB reconstruction, we hope to broaden the understanding of this procedure and aid in anticipating its various outcomes. Methods A retrospective assessment of medical records was conducted for all patients who underwent ONB reconstruction after RC for bladder cancer from January 2020 to April 2023 at Nkwen Baptist Hospital. Data collected included socio-demographic details, clinical and pathological data, indications for surgery, voiding, and metabolic outcomes at 6 and 12 months postoperatively. Data analysis was performed using IBM-SPSS version 26.0. Results Eighteen patients (66.7% male) with a mean age of 60.50 (± 6.90) years were included. Indications for ONB were 56% for pT2b, 23% for pT2a, and 23% for multifocal T1 disease without ureteral, urethral, or bladder neck extension. At 12 months, 77.8% had acceptable diurnal continence, and 72.2% had acceptable nocturnal continence. Peak urinary flow rates and post-void residual volumes were acceptable in 77.8% and 83.3% of patients, respectively. Additionally, 88.9% had normal sodium levels, 94.4% had normal potassium levels, and 94.4% had normal chloride levels at 12 months post-ONB creation. Conclusions ONB reconstruction provides satisfactory continence and minimal rates of electrolyte derangement, contributing valuable insights into the functional outcomes of this procedure.

Background and objective: Radical cystectomy (RC) is the gold-standard treatment for muscle-invasive bladder cancer (MIBC). Approximately 25% of MIBC patients are women. In women, RC includes removal of the ovaries, uterus, and the anterior vaginal wall, during which nerve damage can occur, potentially impacting sexual function. Studies on sexual function among females following RC are sparse. Our aim was to investigate the impact of RC on female sexual function. Methods: A cross-sectional registry study and a questionnaire survey were used. The Danish Cancer Registry was used to identify all female patients diagnosed with MIBC between 2015 and 2020 who were treated with RC and an ileal conduit. Comorbidity and complications data were obtained from the Danish National Patient Registry. The survey included European Organization for Research and Treatment of Cancer questionnaires on quality of life (EORTC-QLQ-C30) and sexual health (EORTC-SHQ-C22) and eight questions covering female sexual function. Key findings and limitations: A total of 151 women completed the questionnaires, of whom 30 (21%) reported worries about resuming sexual activity after RC and 51 (34%) about resuming intercourse specifically. An altered perception of vaginal size was reported by 85 (56%) respondents. Prolonged time to experiencing orgasm was reported by 43 (51%) and anorgasmia by 23 (26%) of the sexually active women. Pain during and after penetration in ≥50% of attempts was reported by 29 (54%) and 23 (43%) respondents, respectively. There was moderate correlation between pain and sexual satisfaction (p

The aim of this study was to conduct a systematic review and meta-analysis of the literature to evaluate the impact of different antibiotic prophylaxis (АР) strategies on the incidence of infectious complications within 30 days after radical cystectomy (RC).Material and Methods. The meta-analysis protocol was registered in the International Prospective Register of Systematic Reviews (PROSPERO): ID-CRD42023480525. A systematic search for studies published in the last 10 years (November 2013 – November 2023) was conducted in the PubMed and Cochrane Library databases by two independent researchers. A total of 7 full-text articles were included in the final statistical analysis (data from 90,935 patients). The analysis focused on three aspects: comparison of the effectiveness of different durations of antibiotic prophylaxis (24 hours or more), the impact of the type of antibacterial agent used, and the application of Enhanced Recovery after Surgery (ERAS) protocols on the overall incidence of infectious complications, the development of soft tissue infections, and upper urinary tract infections (UTIs). Meta-analysis was performed using R 4.3.2 (R Foundation for Statistical Computing, Vienna, Austria) and the metafor 4.2-0 package.Results. The median overall incidence of infectious complications was 31.78 % (23.8–58.8 %), surgical site infections – 16.46 % (6.25–35.41 %), and UTIs – 25.11 % (3.86–35.7 %), including cases leading to urosepsis. The meta-analysis did not reveal a statistically signifшcant effect of the duration of AP (24 hours or more) on the risk of infectious complications: for overall infectious complications, the risk was OR 1.11 (95 % CI 0.92–1.33; p=0.27), for surgical site infection OR 1.00 (95 % CI 0.87–1.15; p=0.97), and for UTIs OR 0.96 (95 % CI 0.84–1.10; p=0.59). However, the overall incidence of infectious complications was significantly higher in the standard perioperative management group, without ERAS protocols (OR=3.02 [95 % CI 2.07; 4.39], p ˂ 0.001, I2 =93.1 %).Conclusion. The results of this study indicate that existing AP strategies may be ineffective in reducing postoperative infectious complications in patients undergoing cystectomy with urinary diversion. Extending AP beyond 24 hours, as well as the standard regimen, did not demonstrate a reduction in infection risk, highlighting the need for a revision of clinical guidelines in this area. The principles of the ERAS program may play a crucial role in reducing infectious complications, showing promising results and requiring further research and implementation in clinical practice.

Abstract Background Plasmacytoid urothelial carcinoma (PUC) is a rare and aggressive subtype that often presents at advanced stages with poor prognosis. This study investigated tumor invasion to better understand tumor behavior and potentially to improve management strategies by comparing the clinicopathologic characteristics of PUC with positive ureter resection margin (+ URM) with PUC with negative URMs (-URM). Methods This retrospective analysis used pathology reports from 2017 to 2023 for cases diagnosed with PUC during radical cystectomy (RC). All applicable H&E slides of RC specimens were reviewed. Cases with a plasmacytoid component greater than 25% in the RC specimens were analyzed. Frozen section analyses (FSAs) and permanent section analyses (PSAs) of ureter resection margins were performed. Results Fifteen patients with a plasmacytoid component greater than 25% in their RC specimens were identified. Compared with -URM PUC cases, +URM PUC cases were located more frequently at the trigone or bladder neck, and all + URM cases exhibited ureter orifice involvement. Among 6 PSA-positive cases, three (50%) cases showed discrepancies with FSA. Three + URM cases exhibited PUC tumor cells along the submucosa and muscularis propria layer, and the 3 remaining cases showed PUC tumor cells along the adventitia. We observed a consistent adventitia invasion in all the discordant cases, with sectioning errors and misinterpretation identified as the primary causal factors. Conclusion To the best of our knowledge, this is the first study to demonstrate two separate patterns of tumor infiltration along the ureter and to discuss the significance of comparing FSA with PSA in PUC. The significance of comprehensive management strategies for PUC patients, including a thorough evaluation of ureteral margins and accurate interpretation of periureteral fat tissue, is highlighted. Large, well-designed studies are needed to strengthen the evidence and to establish optimal management strategies for patients with PUC.

Abstract Introduction Enhanced recovery after surgery (ERAS) is a patient‐centerd, evidence‐based approach to improve postoperative outcomes. The protocol involves multidisciplinary collaboration and standardisation of perioperative interventions. ERAS has shown positive results in reducing hospitalisation and complications. Methods The study conducted in the Department of Urology was a retro‐prospective study. It included an ERAS cohort group of 47 patients, studied prospectively from May 2021 to May 2023. These patients were compared to a historical cohort of 47 consecutive patients who underwent radical cystectomy with traditional care before the ERAS pathway was implemented. The primary outcome was hospital length of stay (LOS). Secondary outcomes included perioperative management, time to recovery milestones and complications. Results Implementation of ERAS pathway for radical cystectomy was associated with reduced hospital LOS (mean LOS 16.19 ± 2.53 days vs. 10.26 ± 3.33 days 7 days; p

Objective: The aim of this study was to explore the factors affecting the major complications and the impacts of preoperative renal function on the incidence of complications in radical cystectomy procedures. Methods: A retrospective review of 705 patients who received radical cystectomy between 2006 and 2021 was conducted. The 90-day complications of patients after a radical cystectomy were reported and the Clavien–Dindo classification (CDC) was used for grading complications. The clinical characteristics and preoperative outcomes were compared among patients with different preoperative renal functions. A logistic regression analysis of all patients was used to identify the risk factors associated with the major complications. Spearman's correlation analysis was used to examine the relationship between the classification of renal insufficiency and the CDC. In order to reduce the selection bias, one-to-one propensity score matching was performed, and the comparison of complications after matching was carried out for the sensitivity analysis. Results: Within 90 days post-surgery, 71% of patients experienced complications, with 4.8% of them being major. Patients with preoperative renal insufficiency had a higher CDC and had a higher rate of major complications (16.7% vs 3.7%, p < 0.001). There was a linear relationship between preoperative serum creatinine and complications. Spearman's correlation analysis showed a slightly positive correlation between the classification of renal insufficiency and the CDC (r=0.094, p = 0.013). Preoperative renal insufficiency was a risk factor for major complications (OR = 6.805 [95%CI: 2.706-17.112]; p < 0.001). After matching, the patients in the preoperative renal insufficiency group had a higher CDC and a higher incidence of major complications (16.9% vs 1.7%, p = 0.004). Conclusions: In our cohort, patients with preoperative renal insufficiency exhibited a higher incidence of complications following a radical cystectomy, and renal insufficiency was a significant risk factor for major complications. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed to compare and analyze the feasibility and long-term efficacy of prostatic capsule-sparing (PCS) and nerve-sparing (NS) radical cystectomy in the treatment of bladder cancer. Methods: From June 2004 to December 2021, our institution treated and followed 145 patients who underwent radical cystectomy with neobladder reconstruction for over a year. These patients were divided into 2 groups: PCS (n=74) and NS (n=71). To minimize potential biases, 1:1 propensity score matching was utilized to compare oncological outcomes, functional outcomes, and complications between the groups. Additionally, Kaplan-Meier analysis and the log-rank test were used to evaluate survival differences between the PCS and NS groups. Results: The median follow-up durations for PCS and NS were 155 and 122 months, respectively. After adjusting for propensity scores, a total of 96 patients (48 in each group) were included for further analysis. Kaplan-Meier curves showed no statistically significant differences in metastasis-free probability (P=0.206), cancer-specific survival (P=0.091), and overall survival (P=0.208). The daytime urinary control (UC) rate at 3, 6, and 12 months postoperatively was 72.9%, 91.7%, and 97.9% in the PCS group and 47.9%, 79.2%, and 91.7% in the NS group, respectively (P=0.012, P=0.083, and P=0.362). The nocturnal UC rate was 54.2%, 85.4%, and 95.8% in the PCS group, and 31.3%, 60.4%, and 83.3% in the NS group, respectively (P=0.023, P=0.006, and P=0.091). Regarding erectile function recovery, 62.5% of patients in the PCS group and 22.9% in the NS group returned to preoperative levels (P<0.001). Conclusions: PCS outperformed NS in restoring UC and sexual function and did not affect oncological outcomes. However, PCS was associated with a higher risk of complications linked to bladder-neck obstruction. [ABSTRACT FROM AUTHOR]

Objective: To predict the incidence of postoperative ileus in bladder cancer patients after radical cystectomy. Methods: We retrospectively analyzed the perioperative data of 452 bladder cancer patients who underwent radical cystectomy with urinary diversion at the Second Hospital of Tianjin Medical University between 2016 and 2021. Univariate and multivariate logistic regression were used to identify the risk factors for postoperative ileus. Finally, a nomogram model was established and verified based on the independent risk factors. Results: Our study revealed that 96 patients (21.2%) developed postoperative ileus. Using multivariate logistic regression analysis, we found that the independent risk factors for postoperative ileus after radical cystectomy included age > 65.0 years, high or low body mass index, constipation, hypoalbuminemia, and operative time. We established a nomogram prediction model based on these independent risk factors. Validation by calibration curves, concordance index, and decision curve analysis showed a strong correlation between predicted and actual probabilities of occurrence. Conclusion: Our nomogram prediction model provides surgeons with a simple tool to predict the incidence of postoperative ileus in bladder cancer patients undergoing radical cystectomy. [ABSTRACT FROM AUTHOR]

Background: The incidence of urinary tract infections (UTIs) after radical cystectomy (RC) with urinary diversion (UD), the typical pathogens, and associated patient risk factors have not been well documented. In this study, we examined the incidence of post-op UTIs after RC to identify associated risk factors. Methods: Single-center, retrospective case series of 386 patients with bladder cancer who underwent RC with UD between 2012 and 2024. The primary objective was UTI incidence, defined by the frequency of patients with urine culture with >105 colony-forming units per high-powered field, spanning from post-op day 0 (POD0) to 90 days after discharge. Isolated pathogens were reported. Risk factors for UTIs were assessed. Results: The average age was 69 years old at surgery, and patients were predominantly male (80%). The cumulative incidence of post-op UTIs was 14%, among which 12 patients had more than one UTI. The UTI incidence was 2%, 8%, and 7% during the immediate post-op period, within 30 days, and within 31–90 days, respectively. Isolated pathogens included Escherichia coli (26%), Enterococcus faecalis (24%), Klebsiella pneumoniae (21%), and Pseudomonas species (21%). In the immediate post-op period, female sex was the only significant risk factor. At 31 to 90 days, cutaneous ureterostomy UD was the predominant risk factor for UTIs. For ileal conduit patients, those with a Wallace ureteral anastomosis were associated with UTI 31–90 days from discharge for RC. Conclusions: Our retrospective data suggests the incidence of UTIs and their causative pathogens after RC differ based on post-operative time points and vary according to different patient risk factors. [ABSTRACT FROM AUTHOR]

Simple Summary: This paper compares robotic and open radical cystectomy with cutaneous ureterostomy in frail bladder cancer patients. Of 145 patients, 30% underwent robotic surgery, which was associated with faster recovery, fewer bleeding events, and fewer complications compared to open surgery. Robotic surgery also showed a survival benefit. The findings suggest that robotic cystectomy is a viable option for frail patients, offering quicker recovery and reduced risks. Introduction: This article compares surgical and survival outcomes of robot-assisted and open radical cystectomy with cutaneous ureterostomy for the treatment of frail bladder cancer patients with limited life expectancy. Methods: The institutional database was searched for cystectomy cases with cutaneous ureterostomy, from 1 June 2016 to 31 August 2022. The study population was split into two groups, according to the surgical approach. The baseline characteristics and surgical outcomes were compared. Logistic regression analyses identified predictors of major bleeding events (hemoglobin loss ≥ 3.5 g/dL or blood transfusion) and re-operation within 30 days from surgery. The Kaplan–Meier method estimated the impact of the robotic approach on overall survival and Cox regression analysis assessed its predictors. Results: A total of 145 patients were included: 30% (n = 43) underwent robotic cystectomy. Patients' characteristics and tumor stages distribution were comparable in the two groups but those receiving a minimally invasive treatment showed significantly reduced times to flatus, bowel and hospital discharge (all p < 0.001). Although operation times were longer in this cohort, major bleeding events (60% vs. 89%) and postoperative severe complications (0 vs. 8%) (both p < 0.001) were less frequent compared to the open approach. A logistic regression showed that robotic surgery independently predicted major bleeding events (OR: 0.26; 95%CI 0.09–0.72; p = 0.02) but not the need for re-intervention. A Kaplan–Meier analysis showed that robotic cystectomy was associated with a significant advantage in terms of overall survival (LogRank = 0.03), and this result was confirmed by Cox regression analysis (HR: 0.39; 95%CI 0.14–0.94; p = 0.04). Conclusions: Robotic cystectomy with cutaneous ureterostomy may represent a viable option to treat frail bladder cancer patients, as the minimally invasive approach reduces the risk of bleeding and serious complications and provides a prompt restoration of bowel function and a shorter hospital stay compared to open surgery. [ABSTRACT FROM AUTHOR]

Background: Plasmacytoid urothelial carcinoma (PUC) is a rare and aggressive subtype that often presents at advanced stages with poor prognosis. This study investigated tumor invasion to better understand tumor behavior and potentially to improve management strategies by comparing the clinicopathologic characteristics of PUC with positive ureter resection margin (+ URM) with PUC with negative URMs (-URM). Methods: This retrospective analysis used pathology reports from 2017 to 2023 for cases diagnosed with PUC during radical cystectomy (RC). All applicable H&E slides of RC specimens were reviewed. Cases with a plasmacytoid component greater than 25% in the RC specimens were analyzed. Frozen section analyses (FSAs) and permanent section analyses (PSAs) of ureter resection margins were performed. Results: Fifteen patients with a plasmacytoid component greater than 25% in their RC specimens were identified. Compared with -URM PUC cases, +URM PUC cases were located more frequently at the trigone or bladder neck, and all + URM cases exhibited ureter orifice involvement. Among 6 PSA-positive cases, three (50%) cases showed discrepancies with FSA. Three + URM cases exhibited PUC tumor cells along the submucosa and muscularis propria layer, and the 3 remaining cases showed PUC tumor cells along the adventitia. We observed a consistent adventitia invasion in all the discordant cases, with sectioning errors and misinterpretation identified as the primary causal factors. Conclusion: To the best of our knowledge, this is the first study to demonstrate two separate patterns of tumor infiltration along the ureter and to discuss the significance of comparing FSA with PSA in PUC. The significance of comprehensive management strategies for PUC patients, including a thorough evaluation of ureteral margins and accurate interpretation of periureteral fat tissue, is highlighted. Large, well-designed studies are needed to strengthen the evidence and to establish optimal management strategies for patients with PUC. [ABSTRACT FROM AUTHOR]

Objectives: This study evaluated the prognostic value of the neutrophil-to-lymphocyte ratio (NLR) for survival outcomes in bladder cancer patients treated with radical cystectomy. Methods: Studies assessing NLR's prognostic significance for bladder cancer after radical cystectomy were identified from PubMed, Embase, Web of Science, and Cochrane databases until April 2024. Survival outcomes analyzed included overall survival (OS), disease-free survival (DFS), relapse-free survival (RFS), cancer-specific survival (CSS), and progression-free survival (PFS). Results: The meta-analysis comprised 15 cohort studies with 8,448 patients. Multivariate analysis showed significantly shorter OS, CSS, DFS, and RFS in the high NLR group compared to the low NLR group. However, no significant difference in PFS was observed between the groups. Conclusions: NLR serves as an independent prognostic indicator for bladder cancer patients undergoing radical cystectomy, with elevated NLR associated with poorer survival. Further large-scale, prospective studies are warranted to validate the relationship between NLR and prognosis in bladder cancer. Systematic review registration: https://www.crd.york.ac.uk/PROSPERO/ , identifier CRD42024549573. [ABSTRACT FROM AUTHOR]

Background: The clinical safety and efficacy of organ-sparing cystectomy (OSC) are subjects of ongoing debate, particularly concerning the potential increased risk of recurrence when retaining additional organs and its effectiveness in preserving sexual and urinary functions. Methods: Adhering to the PRISMA 2020 statement and AMSTAR Guidelines, we conducted a systematic literature search up to February 2024 using PubMed, Embase, and Web of Science. The comparison focused on the clinical safety and effectiveness of OSC and standard radical cystectomy (SRC) in the treatment of bladder tumors. Our assessment covered several dimensions: Surgical safety outcomes (operation time, length of stay (LOS), estimated blood loss (EBL), and complications), oncological safety outcomes (recurrence rate, positive surgical margin rate, overall survival, and cancer-specific survival), and functional efficacy outcomes (daytime and nighttime urinary incontinence at 6 and 12 months, clean intermittent catheterization (CIC) rate, and erectile function within and after 1 year). Results: The analysis included 19 eligible studies, encompassing 2,057 patients (1,189 OSC patients and 768 SRC patients). OSC demonstrated significant benefits in terms of erectile function and urinary continence without impacting CIC rates. No significant differences were observed in recurrence rate, positive surgical margin rate, overall survival, and cancer-specific survival. Furthermore, OSC and SRC were comparable in surgical safety outcomes, including operating time, LOS, EBL, and complications. Conclusions: OSC offers notable advantages in erectile function and urinary continence. Despite limited clinical practice and potential selection bias, urologists may still consider OSC more based on their experience and specific patient factors. [ABSTRACT FROM AUTHOR]

Background To examine the agreement of different calculated estimated glomerular filtration rate (eGFR) formulas and measured creatinine clearance (CrCI) at the primary diagnosis of muscle-invasive bladder cancer (MIBC). Materials and Methods We performed a multicenter analysis of patients with MIBC, treated with cisplatin-based neoadjuvant chemotherapy (NAC) and radical cystectomy (RC), or with RC alone, between 2011 and 2021. Baseline eGFR was computed using 4 calculated serum equations including Cockcroft-Gault (CG), MDRD, CKD-EPI 2009, and race-free CKD-EPI 2021. To examine the association between calculated eGFR and measured CrCI, subgroup analyses were performed among patients in whom measured 24-hour urine CrCl was determined. Cisplatin-ineligibility was defined as CrCI and/or eGFR < 60 mL/minute per 1.73 m2. Results Of 956 patients, 30.0%, 33.3%, 31.9%, and 27.7% were found to be cisplatin-ineligible by the CG, MDRD, CKD-EPI, and race-free CKD-EPI equations (P  = .052). The concordance between calculated eGFR formulas was rated substantial (Cohen's kappa (k): 0.66-0.95). Among the subgroup (n  = 245) with measured CrCl, 37 (15.1%) patients had a CrCI less than 60 mL/minute. Concordance between measured CrCl and calculated eGFR was poor (ĸ : 0.29-0.40). All calculated eGFR formulas markedly underestimated the measured CrCI. Specifically, 78%-87.5% of patients with a calculated eGFR between 40 and 59 mL/minute exhibited a measured CrCI ≥ 60 mL/minute. Conclusions Comparing calculated eGFR formulas, similar percentages of patients with MIBC were deemed cisplatin-ineligible. However, a significant number of patients could be upgraded by being cisplatin-fit based on measured CrCI, particularly when the calculated eGFR was falling within the gray range of 40-59 mL/minute. [ABSTRACT FROM AUTHOR]

Background & Objectives: Radical cystectomy (RC) is usually performed under general anesthesia, with the management of postoperative pain being a big challenge. Various approaches have been tried, including epidural analgesia, or regional nerve blocks in addition to the intravenous patient-controlled analgesia (IV-PCA). We compared the efficacy and safety of bilateral single-injection erector spinae plane block (ESPB) with IV-PCA administered morphine to manage postoperative pain following RC. Methodology: This prospective randomized controlled clinical study was performed on 60 participants ranging in age from 21 to 65 years, both sexes, BMI 20-40 kg/m², ASA physical status II-III, planned for elective RC. Participants were randomized into two equal groups. Group ESPB received ultrasound-guided single shot ESPB at T10 with 20 mL bupivacaine 0.25% bilaterally; IV morphine 3 mg bolus was used as rescue analgesia when the Numeric Rating Scale (NRS) pain score was ≥ 4. Group C (control group) received IV-PCA by morphine 3 mg IV when NRS pain score was ≥ 4 and repeated 1/2 mg if still pain score was recorded ≥ 4 for 15 min. Pain was measured on NRS at 2, 4, 8, and 12 h as well as the postoperative heart rate (HR) and mean arterial blood pressure (MAP). Complications were noted, Results: Time to first analgesic request was substantially prolonged in Group ESPB compared to Group C (P < 0.001). Total postoperative consumption of morphine in 1st 48 h and postoperative nausea and vomiting were substantially reduced in Group ESPB compared to Group C (P < 0.05). NRS pain scores, postoperative HR and MAP measurements were substantially reduced at 2, 4, 8, and 12 h in Group ESPB than Group C (P < 0.05). Bradycardia and hypotension varied insignificantly different between both groups. Respiratory depression and urinary retention did not occur in any patient in both groups. Conclusions: Compared with IV-PCA administered morphine, bilateral single-injection ESPB was associated with better hemodynamics and analgesic properties, as observed by lower pain scores, less postoperative opioid consumption, and longer time to first analgesic request with good safety profile after radical cystectomy. [ABSTRACT FROM AUTHOR]

Despite the advent of robotics and the decreasing rate of complications after radical cystectomy, several factors are renowned to impair the early outcomes of this procedure. The aim of this paper is to provide a multivariate analysis (MVA) of patient and surgical procedure-related variables likely to affect postoperative course and 30-day complication rate. Fifty-five robotic-assisted radical cystectomies (RARCs) performed at a single center from July 2021 to March 2023 were enrolled. Baseline demographics, comorbidities, and intraoperative and postoperative data were collected. Uni- and multivariate analyses were performed to evaluate the relationship with Clavien ≥ II complications arising within 30 days of surgery. A postoperative Clavien ≥ II complication was evident in 15 patients (28%), whereas Clavien ≥ III occurred only in 5 (9%). At MVA, the only independent predictor of Clavien ≥ II complications was a prior neoadjuvant chemotherapy (OR 5.6; 95% CI 1.22–25.3, p = 0.026). Recognized the small sample size, patients who received a prior NAC should deserve special care within the postoperative course. [ABSTRACT FROM AUTHOR]

Background: Standard 24-h antibiotic prophylaxis (AP) is widely employed to minimize the risk of infection complications (ICs) within 30 days following a radical cystectomy (RC). However, a considerable variety of prophylaxis protocols do not prevent a high ICs rate after surgery (37–67%). Therefore, antibiotic's type and its duration are still controversial for AP.(Objective: To compare standard 24-h AP with a prolonged 120-h regimen in a multicenter randomized clinical trial. Methods: Patients were randomized in a 1:1 ratio to standard 24-h AP regimen (Group A) versus the prolonged meropenem AP 120-h (Group B). The primary endpoint was an event rate defined as the frequency of ICs within 30 days. The secondary endpoint were biomarker's analysis and antibiotic re-administration rate (ArAR). Results: A total of 92 patients were enrolled. The Clavien-Dindo complications rate did not differ between the groups (p = 0.065), however the overall complication rate was higher in Group A (63.0% vs. 34.8%, p = 0.007). The infection complication rate was 2.75 times higher in the standard antibiotic prophylaxis group: 47.8% compared to 17.4% cases in Group B (p = 0.002). The new prolonged antibiotic regimen decreased the risk of ICs (OR 0.23; 95% CI 0.08–.598; p = 0.003). The event-free survival for ICs of clinical interest in group A was 7.00 days and in group B was 9.00 days (HR = 0.447; 0.191–1.050, p = 0.065). The ArAR was higher in Group A -47.8%, while in Group B it was only in 17.4% of the cases. The incidence of bacteriuria before RC was the same between groups (p = 0.666), however, after stent removal the risk of a positive culture was lower in group B (RR = 0.64; 95% CI 0.37–1.08; p = 0.05). Conclusions: The administration AP over 120-h appears to be safe and feasible, demonstrating a reduction in the total number of complications and ArAR. Trial registration in Clinical Trials: NCT05392634. Trial registration in Clinical Trials: NCT05392634. [ABSTRACT FROM AUTHOR]

BACKGROUND: Bladder cancer poses a significant public health burden, with high recurrence and progression rates in patients with non-muscle-invasive bladder cancer (NMIBC). Current treatment options include bladder-sparing therapies (BST) and radical cystectomy, both with associated risks and benefits. However, evidence supporting optimal management decisions for patients with recurrent high-grade NMIBC remains limited, leading to uncertainty for patients and clinicians. The CISTO (Comparison of Intravesical Therapy and Surgery as Treatment Options) Study aims to address this critical knowledge gap by comparing outcomes between patients undergoing BST and radical cystectomy. METHODS: The CISTO Study is a pragmatic, prospective observational cohort trial across 36 academic and community urology practices in the US. The study will enroll 572 patients with a diagnosis of recurrent high-grade NMIBC who select management with either BST or radical cystectomy. The primary outcome is health-related quality of life (QOL) at 12 months as measured with the EORTC-QLQ-C30. Secondary outcomes include bladder cancer-specific QOL, progression-free survival, cancer-specific survival, and financial toxicity. The study will also assess patient preferences for treatment outcomes. Statistical analyses will employ targeted maximum likelihood estimation (TMLE) to address treatment selection bias and confounding by indication. DISCUSSION: The CISTO Study is powered to detect clinically important differences in QOL and cancer-specific survival between the two treatment approaches. By including a diverse patient population, the study also aims to assess outcomes across the following patient characteristics: age, gender, race, burden of comorbid health conditions, cancer severity, caregiver status, social determinants of health, and rurality. Treatment outcomes may also vary by patient preferences, health literacy, and baseline QOL. The CISTO Study will fill a crucial evidence gap in the management of recurrent high-grade NMIBC, providing evidence-based guidance for patients and clinicians in choosing between BST and radical cystectomy. The CISTO study will provide an evidence-based approach to identifying the right treatment for the right patient at the right time in the challenging clinical setting of recurrent high-grade NMIBC. TRIAL REGISTRATION: ClinicalTrials.gov, NCT03933826. Registered on May 1, 2019.

Abstract Objectives To evaluate the feasibility and safety of robotic‐assisted salvage radical cystectomy (RA‐SRC). Materials and Methods We retrospectively searched the prospectively collected surgical database of two highly experienced robotic urological surgeons for cases of RA‐SRC, defined as RARC performed post‐previous pelvic RT for palliative or oncologic treatment purposes. Collected data included demographic and clinical information and outcome measures including operative course, hospital stay and complications. Results Eighteen patients were included in the current analysis. All patients had previous RT to the pelvis with 12 patients also having prior radical pelvic surgery. Indications for salvage cystectomy were either palliation (n = 12) or oncological (MIBC or high risk NMIBC, n = 6). There were no intraoperative complications and no conversions to open surgery. Ninety day postoperative complications were recorded in 11 patients (61.1%), with major complications (Clavien–Dindo grades 3 and 4) in three patients (16.6%). After a median follow‐up of 43.5 months, one late postoperative complication was observed requiring surgical intervention. Conclusion Our data, together with the limited published data from other cohorts of RA‐SRC, suggest that in experienced hands, RA‐SRC is feasible, with intraoperative and perioperative complication rates that are lower than the published data for open SRC and are equivalent to open primary RC. These data will contribute to treatment decision making both in patients with post‐pelvic radiation symptoms requiring palliation and patients with MIBC considering or treated with trimodal treatment.

BackgroundRadical cystectomy constitutes the standard therapeutic approach for high-risk urothelial carcinomas of the bladder. Contemporary guidelines advise urologists to discontinue anticoagulation therapy during the perioperative period to mitigate the risk of significant intraoperative or postoperative hemorrhage. Nevertheless, in elderly patients with a history of coronary artery disease, the cessation of anticoagulant medication elevates the risk of acute myocardial infarction, thereby posing a substantial threat to their survival. Therefore, the necessity and optimal strategy for anticoagulation therapy in patients with acute myocardial infarction following radical cystectomy remains a subject of ongoing debate. This study aims to contribute clinical insights for clinicians to manage high-risk patients with acute myocardial infarction post-major surgery.Methods and resultsThe 64-year-old male patient was admitted for multiple high-grade urothelial carcinomas of the bladder. The preoperative computed tomography angiography revealed intra-luminal stenosis of the coronary arteries. However, the patient declined further assessment via preoperative coronary angiography, thereby precluding the accurate prediction of postoperative myocardial infarction risk. The patient subsequently underwent laparoscopic radical cystectomy with Bricker conduit urinary diversion and the postoperative pathological examination confirmed the diagnosis of high-grade urothelial carcinoma (T1N0M0, G3). Regrettably, on the first postoperative day, the patient experienced an acute anterior wall ST-segment elevation myocardial infarction. Consequently, the patient underwent emergency percutaneous coronary intervention and was administered dual antiplatelet therapy consisting of aspirin and ticagrelor. The daily pelvic fluid drainage, routine blood and coagulation parameters remained within normal ranges. Following the second percutaneous coronary intervention and dual antiplatelet therapy, the patient was discharged after 2 days. Over a 3-year follow-up period, all hematological parameters consistently remained within normal ranges, and there were no incidents of bleeding or anastomotic leakage.ConclusionThis study demonstrates that postoperative percutaneous coronary intervention, in conjunction with continued dual antiplatelet therapy, is a safe and effective antithrombotic strategy for managing perioperative acute myocardial infarction. This finding suggests a potential paradigm shift in the management of antithrombotic therapy for high-risk surgical patients, advocating for a tailored approach rather than the routine discontinuation of such therapy.

Background and purpose: The gold standard when treating muscle-invasive bladder cancer (MIBC) is radical cystectomy (RC), a procedure that holds the potential to affect the function of several pelvic organs, causing an impact on the patient’s Quality of Life (QoL). Knowledge of the late effects following bladder cancer and treatment with RC is sparse. The aim is to describe the incidence of late effects and to investigate the impact on QoL. Methods: A cross-sectional study using register data in combination with a questionnaire, measuring pelvic organ specific symptoms to treatment and QoL. MIBC patients diagnosed between 2015 and 2020 and able to receive digital mail was invited. For each MIBC patient, 6 age- and gender matched controls were invited. QoL was measured using EORTC-QLQ-C30. The MIBC specific EORTC-QLQ-BLM30 was administered to cases only. Background and purpose: The gold standard when treating muscle-invasive bladder cancer (MIBC) is radical cystectomy (RC), a procedure that holds the potential to affect the function of several pelvic organs, causing an impact on the patient’s Quality of Life (QoL). Knowledge of the late effects following bladder cancer and treatment with RC is sparse. The aim is to describe the incidence of late effects and to investigate the impact on QoL. Methods: A cross-sectional study using register data in combination with a questionnaire, measuring pelvic organ specific symptoms to treatment and QoL. MIBC patients diagnosed between 2015 and 2020 and able to receive digital mail was invited. For each MIBC patient, 6 age- and gender matched controls were invited. QoL was measured using EORTC-QLQ-C30. The MIBC specific EORTC-QLQ-BLM30 was administered to cases only. Results: A total of 628 (54.3%) MIBC patients and their 1,204 (37.3%) matched controls responded. Median age was 73. Mean time since RC was 4.9 (SD 2.1) years. Scoring of the functional items on EORTC-QLQ-C30 and overall QoL were similar for cases and controls. Regarding late effects, similar responses were seen on questionnaire data when comparing cases and controls. On registry data, a higher risk of infections and hydronephrosis were seen for cases. A strong correlation between fatigue and impaired QoL was identified. Interpretation: MIBC patients were more often diagnosed with late effects such as infections and hydronephrosis, compared to controls. In spite of this, MIBC patients overall QoL was equal to that of the controls.

Primary clear cell adenocarcinoma (CCA) of the urinary bladder is a rare and aggressive malignancy. Few reports in the literature describe this presentation, as associated with malignant transformation of endometriosis. This case highlights the complex etiology of this variant of CCA, initially diagnosed using comprehensive imaging and genetic analysis, and subsequently confirmed through extensive surgical intervention and chemotherapy.

Objective: The endothelial glycocalyx layer (EGL) is the interface between the blood and the endothelium that regulates permeability. This study compared the effects of liberal and restrictive fluid therapies on atrial natriuretic peptide (ANP) release and EGL products in radical cystectomy surgery. We hypothesized that a liberal regimen would damage the glycocalyx layer, resulting in a higher serum EGL product concentration than restrictive therapy. Materials and Methods: Patients were randomized into two groups for restrictive (group R) or liberal (group L) regimens. Group R received 2 mL/kg/h Ringer’s lactate and 2 mcg/kg/h norepinephrine infusion, whereas group L received only Ringer’s lactate infusion at 10 mL/kg/h rate during the surgery. Preoperative and postoperative blood samples were obtained to evaluate ANP levels and glycocalyx degradation products. The stroke volume index, cardiac index, stroke volume variation, and systemic vascular resistance index parameters were recorded at 30-min intervals throughout the surgery. The length of stay in the hospital and intensive care unit and postoperative complications were recorded. Results: The study was completed with 39 patients. Postoperative ANP levels were higher in group L in both between- and within group examination (p0.05). Postoperative complications and length of stay data were similar (p>0.05). Conclusion: ANP, hyaluronan, and syndecan-1 concentrations can be used as an indirect measurement method to show EGL damage and hypervolemia in major urologic surgeries. Advanced hemodynamic monitoring was ineffective for confirming hypervolemia.

Abstract Background Since radical cystectomy is associated with relatively high perioperative morbidity and mortality, this study was conducted to evaluate the efficacy of perioperative immune nutrition in radical cystectomy patients on postoperative outcomes including wound healing, postoperative complications, either infectious or non-infectious, and length of hospital stay. Patients and methods This prospective, randomized controlled study was conducted between June 2022 and November 2023. Forty-two patients who had undergone radical cystectomy with ileal conduit were randomized into two groups: the immune nutrition group, which received perioperative immune nutrition, and the conventional group, which did not receive immune nutrition. Patients were followed up for 30 days postoperatively to assess wound healing, infectious and non-infectious complications, and the length of hospital stay. Results Patients who received immune nutrition had significantly lower postoperative infectious complications (19.0 vs 61.9%; P = 0.004), shorter hospital stay (16.57 ± 3.74 vs 20.38 ± 5.97; P = 0.01) and shorter ICU stay (2.60 ± 1.07 vs 7.09 ± 7.50; P = 0.029). The proper wound healing was significantly higher in the immune nutrition group (90.5 vs 52.4%; P = 0.006). However, there was no significant difference between both groups in the rate of non-infectious complications (28.5% vs. 57.1%, P = 0.061). Conclusion Perioperative immune nutrition is associated with improved wound healing, reduced infectious complications, and reduced length of hospital stay. Trial registration clinicaltrials.gov, NCT05822518. Registered 1 April 2023—Retrospectively registered, https://clinicaltrials.gov/study/NCT05822518 .

Abstract Background Pelvic organ-preserving radical cystectomy (POPRC) has been reported to result in a better postoperative quality of life in female with bladder cancer compared to standard radical cystectomy (SRC). However, its oncological outcomes remain a concern. Patients and methods Female patients with bladder cancer who underwent POPRC or SRC were identified from the Surveillance, Epidemiology, and End Results (SEER) database. Logistic regression was used to identify predictors of POPRC usage. To avoid the potential impact of baseline differences between groups on survival, a 1:2 propensity score matching (PSM) was implemented. After that, Kaplan-Meier curves and Log-rank tests were used to determine the significance of overall survival (OS) differences between patients in the SRC group and POPRC group. Finally, subgroup analysis based on predetermined indicators was performed. Results A total of 2193 patients were included with a median follow-up of 53 months, of whom 233 (10.6%) received POPRC and 1960 (89.4%) received SRC. No definitive predictors of POPRC were identified. Before PSM, POPRC resulted in comparable OS to SRC (HR = 1.09, p = 0.309), while after PSM, POPRC was associated with significantly worse OS (HR = 1.23, p = 0.038). In subgroup analyses, POPRC led to non-inferior OS (HR = 1.18, 95%CI 0.71–1.95, p = 0.531) in patients with non-muscle invasive bladder cancer (NMIBC) and T2 patients (HR = 1.07, p = 0.669), but significantly worse OS in T3 patients (HR = 1.41, p = 0.02). Conclusion Currently, patients undergoing POPRC have not undergone strict screening, and candidates for POPRC should have more stringent criteria in the future to achieve satisfactory oncological outcomes. However, flaws in the study make more evidence needed to support our findings.

Abstract Background Neoadjuvant chemotherapy (NAC) with radical cystectomy (RC) is the preferred first-line treatment for localized muscle-invasive bladder cancer (MIBC). In recent years, octogenarians have been undergoing RC uneventfully, but studies showed older adults receive NAC less often. We studied the utilization and effect of RC with or without NAC in octogenarians and compared survival outcomes between responders and non-responders. Methods In our retrospective study using the National Cancer Database (NCDB), we identified octogenarians with MIBC and urothelial histology who underwent RC with or without NAC between 2004 and 2018. The NAC cohort included patients who underwent RC with NAC, and the non-NAC cohort included those with or without adjuvant chemotherapy. The NAC cohort was subcategorized into responders and non-responders based on surgical pathology. Patients with comorbidity index > 1 were not included, thereby excluding patients with possible renal impairment. After propensity-matching, we compared the overall survival (OS) between NAC and non-NAC cohorts and responders and non-responders. Results 33924 patients underwent RC, and 3056 octogenarians met our selection. Among them, 396 received NAC, and 2660 did not receive NAC. Among those who received NAC, 112(28.3%) experienced downstaging, and 223(56.4%) exhibited upstaging or no change (p

Background: Lymph node involvement (N+) in bladder cancer indicates a poor prognosis. Current preoperative evaluations of N+ are often inaccurate. We aimed to develop a predictive model for N+ using basic clinical variables and assess the diagnostic accuracy of Computed Tomography (CT). Methods: A retrospective cohort study was conducted. We include 62 MIBC patients who underwent radical cystectomy (RC) from 2010 to 2019 in our center. We evaluated diagnostic concordance between CT and histopathology for extravesical extension (T3a≥) and N+. Univariate and multivariate logistic regressions were used to create a predictive model, with an ROC curve and nomogram developed. Results: We found 59% sensitivity and 69% specificity for CT for staging cT3≥ and a sensitivity of 22% and a specificity of 21% for N+. NLR > 2.60 (OR 6.03, p = 0.02) and lymphovascular invasion (LVInv) in the TURB sample (OR 9.26, p = 0.04) were correlated with N+. Both fundus lesions (OR 0.21, p = 0.04) and creatinine > 0.94 mg/dL (OR 0.17, p = 0.025) were associated with reduced risk. The ROC curve of the model showed 80.4% AUC. Conclusions: A predictive model with good diagnostic performance for N+ can be developed from basic clinical data. CT sensitivity and specificity for the detection of N+ patients are limited.

Background: Check-Mate 274 has demonstrated the disease-free survival (DFS) benefit of adjuvant nivolumab in surgically treated muscle-invasive bladder cancer (MIBC). Since immunotherapy represents an expensive treatment with potential side effects, a better understanding of patient-specific risks of disease progression might be useful for clinicians when weighing the indication for adjuvant nivolumab. Objective: To identify the criteria for risk stratification of disease progression among MIBC patients eligible for adjuvant nivolumab. Materials and methods: A single-institution, prospectively maintained database was queried to identify patients eligible for adjuvant nivolumab according to Check-Mate 274 criteria. To account for immortal bias, patients who died or were lost to follow-up within 3 months of undergoing a radical cystectomy (RC) were excluded. Kaplan–Meier and Cox regression analyses addressed DFS, defined as the time frame from diagnosis to the first documented recurrence or death from any cause, whichever occurred first. Regression tree analysis was implemented to identify criteria for risk stratification. Results: Between 2011 and 2022, 304 patients were identified, with a median follow-up of 50 (IQR 24–72) months. After multivariable adjustment, including NAC as a potential confounder, higher CCI (HR 1.56, 95%CI 1.10–2.21, p = 0.013), T stage (HR 2.06, 95%CI 1.01–4.17, p = 0.046), N stage (HR 1.73, 95%CI 1.26–2.38, p = 0.001) and presence of LVI (HR 1.52, 95%CI 1.07–2.15, p = 0.019) increased the risk of disease recurrence or death. Finally, a two-tier classification was developed. Here, five-year DFS rates were 56.1% vs. 18.1 for low vs. high risk (HR: 2.54, 95%CI 1.79–3.62, p < 0.001). Conclusions: The current risk classification, if externally validated on larger samples, may be useful when weighing the risk and benefit of adjuvant nivolumab treatment and making patients more aware about their disease and about the need for additional treatment after RC. [ABSTRACT FROM AUTHOR]

Background: Benign uretero‐ileal anastomotic stricture (UIAS) is a potentially serious complication that can arise after radical cystectomy (RC) and subsequent urinary diversion. To preserve residual renal function and improve prognosis, it is crucial to derive insights from experience and tailor individualized treatment strategies for different patients. Patients and Methods: From October 2014 to June 2021, a total of 47 patients with benign UIAS underwent endoscopic management (n = 19) or reimplantation surgery (n = 28). The basic data, perioperative conditions, and postoperative outcomes of the two groups were compared and analyzed to evaluate efficacy. Results: Comparing preoperative and postoperative clinical efficacy within the same group, the endoscopic group showed no significant differences in creatinine and blood urea nitrogen (BUN) levels before surgery or after extubation (p > 0.05). However, significant differences were observed in glomerular filtration rate (GFR) levels on the affected side before surgery and after extubation (p < 0.05). In contrast, the laparoscopic reimplantation group did not exhibit significant differences in creatinine, BUN, or GFR levels of affected side before surgery and after extubation (p > 0.05). Postoperative clinical efficacy showed no significant difference in creatinine and BUN levels between the two groups (p > 0.05). However, GFR values of affected side in the endoscopic treatment group decreased more than those in the laparoscopic reimplantation group (p < 0.05). Additionally, the laparoscopic reimplantation group was able to remove the single‐J tube earlier than the endoscopic treatment group (p < 0.05), had a lower recurrence rate of hydronephrosis after extubation (p < 0.05), and experienced a later onset of hydronephrosis compared to the endoscopic treatment group (p < 0.05). Conclusions: Based on our experience in treating UIAS following RC combined with urinary diversion, laparoscopic reimplantation effectively addresses the issue of UIAS, allowing for the removal of the ureteral stent relatively soon after surgery. This approach maintains long‐term ureteral patency, preserves residual renal function, reduces the risk of ureteral restenosis and hydronephrosis, and has demonstrated superior therapeutic outcomes in this study. [ABSTRACT FROM AUTHOR]

Background: Lymph node involvement (N+) in bladder cancer indicates a poor prognosis. Current preoperative evaluations of N+ are often inaccurate. We aimed to develop a predictive model for N+ using basic clinical variables and assess the diagnostic accuracy of Computed Tomography (CT). Methods: A retrospective cohort study was conducted. We include 62 MIBC patients who underwent radical cystectomy (RC) from 2010 to 2019 in our center. We evaluated diagnostic concordance between CT and histopathology for extravesical extension (T3a≥) and N+. Univariate and multivariate logistic regressions were used to create a predictive model, with an ROC curve and nomogram developed. Results: We found 59% sensitivity and 69% specificity for CT for staging cT3≥ and a sensitivity of 22% and a specificity of 21% for N+. NLR > 2.60 (OR 6.03, p = 0.02) and lymphovascular invasion (LVInv) in the TURB sample (OR 9.26, p = 0.04) were correlated with N+. Both fundus lesions (OR 0.21, p = 0.04) and creatinine > 0.94 mg/dL (OR 0.17, p = 0.025) were associated with reduced risk. The ROC curve of the model showed 80.4% AUC. Conclusions: A predictive model with good diagnostic performance for N+ can be developed from basic clinical data. CT sensitivity and specificity for the detection of N+ patients are limited. [ABSTRACT FROM AUTHOR]

Objective: The endothelial glycocalyx layer (EGL) is the interface between the blood and the endothelium that regulates permeability. This study compared the effects of liberal and restrictive fluid therapies on atrial natriuretic peptide (ANP) release and EGL products in radical cystectomy surgery. We hypothesized that a liberal regimen would damage the glycocalyx layer, resulting in a higher serum EGL product concentration than restrictive therapy. Materials and Methods: Patients were randomized into two groups for restrictive (group R) or liberal (group L) regimens. Group R received 2 mL/kg/h Ringer’s lactate and 2 mcg/kg/h norepinephrine infusion, whereas group L received only Ringer’s lactate infusion at 10 mL/kg/h rate during the surgery. Preoperative and postoperative blood samples were obtained to evaluate ANP levels and glycocalyx degradation products. The stroke volume index, cardiac index, stroke volume variation, and systemic vascular resistance index parameters were recorded at 30-min intervals throughout the surgery. The length of stay in the hospital and intensive care unit and postoperative complications were recorded. Results: The study was completed with 39 patients. Postoperative ANP levels were higher in group L in both between- and within group examination (p<0.05). EGL constituents; syndecan-1 and hyaluronan concentrations, were higher in group L (p<0.05). Advanced hemodynamic parameters indicated insignificant changes between the groups (p>0.05). Postoperative complications and length of stay data were similar (p>0.05). Conclusion: ANP, hyaluronan, and syndecan-1 concentrations can be used as an indirect measurement method to show EGL damage and hypervolemia in major urologic surgeries. Advanced hemodynamic monitoring was ineffective for confirming hypervolemia. [ABSTRACT FROM AUTHOR]

Background: Pelvic organ-preserving radical cystectomy (POPRC) has been reported to result in a better postoperative quality of life in female with bladder cancer compared to standard radical cystectomy (SRC). However, its oncological outcomes remain a concern. Patients and methods: Female patients with bladder cancer who underwent POPRC or SRC were identified from the Surveillance, Epidemiology, and End Results (SEER) database. Logistic regression was used to identify predictors of POPRC usage. To avoid the potential impact of baseline differences between groups on survival, a 1:2 propensity score matching (PSM) was implemented. After that, Kaplan-Meier curves and Log-rank tests were used to determine the significance of overall survival (OS) differences between patients in the SRC group and POPRC group. Finally, subgroup analysis based on predetermined indicators was performed. Results: A total of 2193 patients were included with a median follow-up of 53 months, of whom 233 (10.6%) received POPRC and 1960 (89.4%) received SRC. No definitive predictors of POPRC were identified. Before PSM, POPRC resulted in comparable OS to SRC (HR = 1.09, p = 0.309), while after PSM, POPRC was associated with significantly worse OS (HR = 1.23, p = 0.038). In subgroup analyses, POPRC led to non-inferior OS (HR = 1.18, 95%CI 0.71–1.95, p = 0.531) in patients with non-muscle invasive bladder cancer (NMIBC) and T2 patients (HR = 1.07, p = 0.669), but significantly worse OS in T3 patients (HR = 1.41, p = 0.02). Conclusion: Currently, patients undergoing POPRC have not undergone strict screening, and candidates for POPRC should have more stringent criteria in the future to achieve satisfactory oncological outcomes. However, flaws in the study make more evidence needed to support our findings. [ABSTRACT FROM AUTHOR]

Objective: Radical cystectomy with ileal conduit is the current mainstay of treatment for muscle-invasive bladder cancer and is also a high-risk procedure. Existing studies have limited targeted assessment of the efficacy and safety of this procedure, and the patient population appropriate for this procedure is still poorly defined. We sought to longitudinally analyze differences in the efficacy and safety of radical cystectomy with ileal conduit by age subgroups to assess whether the age factor should be used as an exclusion criterion when selecting this procedure. Materials and methods: We retrospectively examined the clinicopathological data of patients with MIBC treated with RC with IC at the Cancer Hospital of Harbin Medical University between February 2014 and October 2023. Additionally, we utilized clinical and pathological data from the SEER database (2000-2020) for external validation of our findings. Patients were categorized into elderly (≥70 years at diagnosis) and non-elderly (<70 years) groups. Statistical analyses included t-tests, non-parametric tests for continuous data, chi-square tests for categorical data, and Kaplan-Meier survival analysis. Results: In this study, 152 patients were included: 119 were categorized as nonelderly and 33 as elderly. For external validation, data from 416 patients in the SEER database were analyzed, with 172 classified as non-elderly and 244 as elderly. The results indicated that elderly patients were more likely to require ICU transfer postoperatively but exhibited a lower incidence of stoma inflammation. Additionally, both the data from our center and the external validation from the SEER database showed a concordance in cancer-specific survival (CSS) between the elderly and non-elderly groups. The efficacy of RC with IC was comparable in both elderly and non-elderly patients. Conclusion: For longitudinal age subgroups, RC with IC for both elderly and non-elderly MIBC had good efficacy and safety, and good quality of life after surgery. Although there are surgical and perioperative risks in elderly patients, there is no significant difference compared with non-elderly patients. In elderly patients requiring RC for bladder cancer, IC should remain the preferred mode of urinary diversion, and old age should not be used as an absolute exclusion criterion for IC. [ABSTRACT FROM AUTHOR]

Background: Sarcopenia is the degenerative loss of skeletal muscle mass, which is known as a poor postoperative outcome in various cancer types. Radical cystectomy (RC) is often associated with high mortality rates, and sarcopenia is hypothesized to aid in risk stratification. Hence, this study assessed the role of Sarcopenia as an indicator of postoperative outcomes and survival rates in patients undergoing RC for bladder cancer. Methods: This cross-sectional research was carried out between January 2022 and January 2023 on 30 patients with bladder cancer who were candidates for RC and referred to the urology clinic of Imam Khomeini Hospital in Tehran. One week before surgery, the cross-sectional area of the psoas muscle was measured using MRI to estimate muscle volume, and the sarcopenia index was calculated. Muscle area evaluation was performed by calculating the cross-sectional area of the left and right psoas muscles on MRI. The psoas muscle area was calculated by excluding blood vessels, bony structures, and intermuscular fat regions based on fat signals. The calculated psoas muscle area was then normalized to the patient's height in square meters. To improve the quality of reporting on surgical complications, the patients were re-examined and the duration of patients' hospital stays was measured. Results: The mean sarcopenic index for the patients was 1264.6 ± 591.5 mm²/m². Seven patients (24.1%) were smokers, while 22 patients (75.9%) were non-smokers. During the 10-month follow-up period, 25 patients (83.3%) remained alive, and 5 patients (16.7%) passed away. The mean value of sarcopenic index in patients with localized cancer was higher than those with advanced cancer, but this difference was not statistically significant. Data analysis revealed a significant association between higher mortality rates and the presence of locally advanced bladder tumors (P = 0.046). Additionally, a reduced sarcopenic index in this study was significantly correlated with lymphovascular invasion. In this study, no correlation was found between perioperative complications and sarcopenic index. Conclusion: To conclude, a significant association was observed between a reduction in the sarcopenic index and lymphovascular invasion; however, no connection was identified between mortality rates and postoperative complications following RC. [ABSTRACT FROM AUTHOR]

Background: Neoadjuvant chemotherapy (NAC) with radical cystectomy (RC) is the preferred first-line treatment for localized muscle-invasive bladder cancer (MIBC). In recent years, octogenarians have been undergoing RC uneventfully, but studies showed older adults receive NAC less often. We studied the utilization and effect of RC with or without NAC in octogenarians and compared survival outcomes between responders and non-responders. Methods: In our retrospective study using the National Cancer Database (NCDB), we identified octogenarians with MIBC and urothelial histology who underwent RC with or without NAC between 2004 and 2018. The NAC cohort included patients who underwent RC with NAC, and the non-NAC cohort included those with or without adjuvant chemotherapy. The NAC cohort was subcategorized into responders and non-responders based on surgical pathology. Patients with comorbidity index > 1 were not included, thereby excluding patients with possible renal impairment. After propensity-matching, we compared the overall survival (OS) between NAC and non-NAC cohorts and responders and non-responders. Results: 33924 patients underwent RC, and 3056 octogenarians met our selection. Among them, 396 received NAC, and 2660 did not receive NAC. Among those who received NAC, 112(28.3%) experienced downstaging, and 223(56.4%) exhibited upstaging or no change (p < 0.001). After propensity-matching, the median OS of the NAC and non-NAC cohorts were 51.6 months and 31.3 months, respectively (p<0.001). Similarly, the median OS of responders and non-responders were 89.4 months and 26.5 months, respectively(p < 0.0001). Conclusion: In our study, we observed that NAC with RC for MIBC may help to improve OS among healthy octogenarians. Similarly, responders had better OS than non-responders. [ABSTRACT FROM AUTHOR]

Objective: To observe the effect of Pseudomonas aeruginosa mannose-sensitive hemagglutinin (PA-MSHA) on the prognosis and the incidence of lymphatic leakage in patients undergoing radical cystectomy (RC). Method: A total of 129 patients who underwent RC in Lanzhou University Second Hospital from 2013 to 2022 were enrolled in this study. They were divided into 43 patients treated with PA-MSHA and 86 patients in the control group. Inverse probability of treatment weighting (IPTW) was applied to reduce potential selection bias. Kaplan-Meier method and Cox regression analysis were used to analyze the effect of PA-MSHA on the survival of patients and the incidence of postoperative lymphatic leakage. Results: The PA-MSHA group exhibited improved overall survival (OS) and cancer-specific survival (CSS) rates compared to the control group. The 3-year and 5-year overall survival (OS) rates for the PA-MSHA group were 69.1% and 53.2%, respectively, compared to 55.6% and 45.3% for the control group (Logrank= 3.218, P=0.072). The 3-year and 5-year cancer-specific survival (CSS) rates for the PA-MSHA group were 73.3% and 56.5%, respectively, compared to 58.0% and 47.3% for the control group (Log-rank=3.218, P=0.072). Additionally, the 3-year and 5-year progression-free survival (PFS) rates for the PA-MSHA group were 74.4% and 56.8%, respectively, compared to 57.1% and 52.2% for the control group (Log-rank=2.016, P=0.156). Multivariate Cox regression analysis indicates that lymph node metastasis and distant metastasis are poor prognostic factors for patients, while the use of PA-MSHA can improve patients' OS (HR: 0.547, 95%CI: 0.304-0.983, P=0.044), PFS (HR: 0.469, 95%CI: 0.229-0.959, P=0.038) and CSS (HR: 0.484, 95%CI: 0.257-0.908, P=0.024). The same trend was observed in the cohort After IPTW adjustment. Although there was no significant difference in the incidence of postoperative lymphatic leakage [18.6% (8/35) vs. 15.1% (84.9%), P=0.613] and pelvic drainage volume [470 (440) ml vs. 462.5 (430) ml, P=0.814] between PA-MSHA group and control group, PA-MSHA could shorten the median retention time of drainage tube (7.0 d vs 9.0 d) (P=0.021). Conclusion: PA-MSHA may improve radical cystectomy in patients with OS, PFS, and CSS, shorten the pelvic drainage tube retention time. [ABSTRACT FROM AUTHOR]

Radical cystectomy (RC) remains a mainstay surgical treatment for non-metastatic muscle-invasive and BCG-unresponsive bladder cancer. Various perioperative scoring tools assess comorbidity burden, complication risks, and cancer-specific mortality (CSM) risk. We investigated the prognostic value of these scores in patients who underwent RC between 2015 and 2021. Cox proportional hazards were used in survival analyses. Risk models' accuracy was assessed with the concordance index (C-index) and area under the curve. Among 215 included RC patients, 63 (29.3%) died, including 53 (24.7%) cancer-specific deaths, with a median follow-up of 39 months. The AJCC system, COBRA score, and Charlson comorbidity index (CCI) predicted CSM with low accuracy (C-index: 0.66, 0.65; 0.59, respectively). Multivariable Cox regression identified the AJCC system and CCI > 5 as significant CSM predictors. Additional factors included the extent of lymph node dissection, histology, smoking, presence of concomitant CIS, and neutrophil-to-lymphocyte ratio, and model accuracy was high (C-index: 0.80). The internal validation of the model with bootstrap samples revealed its slight optimism of 0.06. In conclusion, the accuracy of the AJCC staging system in the prediction of CSM is low and can be improved with the inclusion of other pathological data, CCI, smoking history and inflammatory indices. [ABSTRACT FROM AUTHOR]

Objective: To compare the differential therapeutic effects of Bacillus Calmette-Gue'rin (BCG) instillation and radical cystectomy (RC) for high-risk non-muscle-invasive urothelial cancer (NMIBC) classified as high-grade T1 in initial and repeat transurethral resection of bladder tumors (TURBT) and to construct a prediction model. Methods: We retrospectively analyzed the clinical data of patients with malignant bladder tumors treated at the First Affiliated Hospital of Soochow University from January 2016 to December 2017 and compared the differences in 1-year, 2-year, 3-year, 5-year, and comprehensive overall survival (OS) and progression-free survival (PFS) between BCG instillation treatment and RC treatment. Survival curves were drawn to show differences in OS and PFS between the two groups. Concurrently, univariate and multivariate COX analyses were performed to identify risk factors affecting OS and PFS, and a nomogram was created. Results: In total, 146 patients were included in the study, of whom 97 and 49 were in the BCG and RC groups, respectively. No statistical differences were observed in the 1- and 2-year OS and PFS between the two groups, whereas significant statistical differences were found in the 3-year, 5-year, and comprehensive OS and PFS. Survival curves also confirmed the statistical differences in OS and PFS between the BCG and RC groups. Multivariate COX analysis revealed that the treatment method, concomitant satellite lesions, and albumin-to-alkaline phosphatase ratio (AAPR) were independent risk factors affecting OS and PFS. The nomogram that was further plotted showed good predictive ability for OS and PFS. Conclusion: For patients who exhibit high-level T1 pathology after both initial and repeat TURBT, especially those with low AAPR, and concomitant satellite lesions, choosing RC as a treatment method offers a better prognosis. [ABSTRACT FROM AUTHOR]

Introduction We assessed the differential performance of imaging modalities predicting pathological response to neoadjuvant chemotherapy (NAC) in urothelial bladder cancer (UBC). Material and methods Literature search was conducted using the MEDLINE, SCOPUS, and Cochrane Library in December 2023 to identify eligible studies. Results Twenty-two studies comprising 1085 patients were selected. The pooled diagnostic odds ratio (DOR), positive likelihood ratio (LR), and negative LR of FDG positron emission tomography–computed tomography (PET/CT) for predicting bladder tumor complete pathological response (CPR) were 17.33 (95% CI: 1.65–180.99), 2.80 (95% CI: 1.04–7.57), and 0.16 (95% CI: 0.02–0.90), respectively. The pooled DOR, positive LR, and negative LR of FDG- PET/CT for predicting lymph node CPR were 5.25 (95% CI: 2.77–9.93), 1.62 (95% CI: 1.20–2.19), and 0.30 (95% CI: 0.22–0.43), respectively. The pooled DOR, positive LR, and negative LR of contrast enhanced magnetic resonance imaging (CEMRI) for predicting bladder tumor CPR were 153 (95% CI: 26.29–890.1), 16.20 (95% CI: 4.19–62.54), and 0.10 (95% CI: 0.04–0.26), respectively. The pooled DOR, positive LR, and negative LR of CEMRI for predicting lymph node CPR were 13.33 (95% CI: 1.06–166.37), 5.62 (95% CI: 0.82–38.53), and 0.42 (95% CI: 0.16–1.06), respectively. Conclusions We demonstrated that CEMRI (including mpMRI) helps accurate assessment of response to NAC in UBC. While CEMRI is a useful tool to detect residual tumor in lymph nodes, contrast enhanced CT scan and FDG-PET/CT are precise staging modality to identify nodal metastasis responders to NAC. Nevertheless, this differential diagnostic performance needs to be further refined with radiomics and novel tracers to help individualized clinical decision-making. [ABSTRACT FROM AUTHOR]