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Background: CRP-based scoring systems were found to correlate with survival in patients with urooncologic diseases. Our retrospective single-centre study aimed to confirm CRP as a prognostic parameter in patients with bladder cancer (BCa) undergoing radical cystectomy (RC) and, based on the findings, to develop our own outcome score for muscle-invasive bladder cancer (MIBC) patients undergoing RC in order to identify patients with a high risk of mortality., Material and Methods: A total of 254 patients who underwent RC at Hanover Medical School between 1996 and 2007 were reviewed with a follow-up until autumn 2013. The clinicopathologic parameters assessed included age, co-morbidities, pre-/postoperative serum levels of CRP, leukocytes, haemoglobin, creatinine, urinary diversion, tumour grading, staging, lymph node status, lymph node density (LND), lymphovascular invasion (LVI), metastases, and resection margin status. The Chi-square test was used for univariate analyses. Kaplan-Meier estimates and the log-rank test were used for survival analyses. Regarding outcome, overall survival (OS) was assessed., Results: The multivariate analysis excluding lymph node (LN)-positive and metastatic patients at time of RC showed a significant association of R status (R; p < 0.001), LVI (L; p = 0.021) and preoperative CRP level > 5 mg/l (C; p = 0.008) with OS. Based on these parameters, the RLC score was developed. The median OS in the intermediate, high-risk and very high-risk groups according to the RLC score was 62, 22, and 6.5 months, respectively. The score had a high predictive accuracy of 0.752., Conclusion: The RLC score identifies BCa patients at a higher risk of overall mortality after RC. Overall, our study supports the role of CRP in prognostic score models for BCa., Competing Interests: Hupe MC: Vorträge für und Honorare/Reisekosten von Ipsen, Novartis, Sanofi, Solution Akademie.Struck JP: Vorträge für und Berater/Advisor für Bayer, BMS, Eusai, Ipsen, Janssen, Merck, MSD, Novartis, Pfizer, Roche.Merseburger AS: Vorträge und Berater/Advisor für Amgen, Apogepha, Astellas, Bayer, BMS, Clovis, Ferring, Hexal, Ipsen, Janssen, Merck, MSD, Novartis, Roche, Sanofi, Takeda, TEV., (Thieme. All rights reserved.)

Objectives: We had previously demonstrated changes in defecation after radical cystectomy (RC). Reports addressing long-term bowel disorders following RC are rare. This cross-sectional study evaluates long-term bowel issues in a large cohort., Material and Methods: A questionnaire assessing changes in bowel function (diarrhea, constipation, urge to defecate, sensation of incomplete defecation, and flatulence) and its effect on quality of life was developed based on the gastrointestinal quality of life index and distributed in collaboration with the German bladder cancer support group. There were 431 evaluable questionnaires. For the analyses, we focused on patients that had the RC>1 year ago (n = 324)., Results: Current bowel problems were reported by 42.6% of patients. The most frequent bowel problems were flatulence (48.8%), diarrhea (29.6%), and sensation of incomplete defecation (22.5%). In cases of bowel problems, 39.7% and 59.8% of the patients indicated life restriction and dissatisfaction, respectively. Prevalence of diarrhea and flatulence were significantly higher>12 (vs. ≤12) months following RC. Both symptoms significantly correlated with younger age at RC, life restriction, lower quality of life, lower health state, and lower energy level. Additionally, diarrhea significantly correlated with pouches as urinary diversion (vs. ileal conduit or ureterocutaneostomy) and higher dissatisfaction level., Conclusions: To our knowledge this is the largest cohort evaluating long-term bowel symptoms after RC. Diarrhea is a prominent symptom after RC with a high impact on daily life that leads to dissatisfaction. A better understanding of long-term bowel symptoms could be translated into optimized surgical procedures, postoperative medication/nutrition, and patient education., (Copyright © 2018 Elsevier Inc. All rights reserved.)

We report a successful pregnancy and birth subsequent to fertility-preserving cystectomy and neobladder formation in a muscle-invasive sarcomatoid urothelial carcinoma., (© 2015 S. Karger AG, Basel.)

Radical cystectomy is the gold standard for muscle-invasive bladder cancer. It is a challenging procedure comprising of two steps: removal of the bladder followed by construction of a new urinary diversion. Despite advances in surgical and postoperative management within the last decades, postoperative complication rates for this procedure are still considerably high. Many complications are avoidable in the pre-/intra-/postoperative setting by carefully selecting patients eligible for this procedure and by considering prophylactic measures. Fast-track concepts demonstrate current intentions to optimize perioperative management. This review summarizes the most recent studies and findings on how to lower postoperative complications with the help of preoperative and modifiable factors.