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Bladder cancer is one of the common malignant tumors in urology. According to statistics, there were 613 791 new cases of bladder cancer in the world in 2022, and the number of new cases of bladder cancer in China was approximately 92 900, accounting for approximately 15% of new cases of bladder cancer in the world, ranking 11th in the spectrum of malignant tumors in China, among which there are approximately 73 200 new cases in males, ranking 8th in the spectrum of male malignant tumors. Bladder urothelial cancer accounts for approximately 90% of all bladder malignant tumors. It can be divided into non-muscle-invasive bladder cancer and muscle-invasive bladder cancer according to whether it invades the bladder muscle layer. Radical cystectomy is the standard treatment for muscle invasive bladder cancer patients and bacillus calmetteguerin (BCG) unresponsive high-risk non-muscle invasive bladder cancer patients. Nevertheless, due to the patient's underlying diseases and the deterioration of the quality of life caused by surgery, many patients refused or are not suitable for radical cystectomy. Therefore, it is vital to find a bladder-preserving treatment that can achieve cure other than radical cystectomy. Bladder-preserving therapy that balances tumor control and quality of life serves as an alternative and supplement to radical cystectomy. This consensus is based on contemporary evidence-based medicine, combined with native clinical practice and experiences of bladder preservation in a multidisciplinary treatment manner. To some extent, this consensus serves as a guidance for bladder preservation of bladder cancer in China. The consensus aims to discuss issues including organizational structure and workflow of multidisciplinary treatment, the selection of patients for bladder-preserving therapy, treatment options and regimens, efficacy evaluation, follow-up, as well as regimen choices of recurrence after bladder-preserving therapy [ABSTRACT FROM AUTHOR]

Purpose: This study investigated the efficacy of intravesical gemcitabine as an alternative to bacillus Calmette–Guérin (BCG) therapy. Materials and Methods: Data were retrospectively collected across seven institutions from February 1999 to May 2023. Inclusion criteria included patients with intermediate- or high-risk non-muscle invasive bladder cancer (NMIBC) who underwent transurethral resection of bladder tumors (TURBT) and received at least four sessions of intravesical gemcitabine or BCG induction therapy. Patient characteristics, complete remission (CR), occurrence, and progression rates were compared. Results: In total, 149 patients were included in this study (gemcitabine, 63; BCG, 86). No differences were apparent between the two groups in baseline characteristics, except for the follow-up period (gemcitabine, 9.2±5.9 months vs. BCG, 43.9±41.4 months, p

Bladder cancer is considered a global health concern characterized by significant morbidity and mortality rates. The complex relationship between diet and bladder cancer is examined, with a specific focus on the role of diet in risk, outcomes, and treatment efficacy. Attention is drawn to the burgeoning field of immunotherapy in bladder cancer treatment, and the possible influence of diet on its outcomes is explored. While evidence remains limited, prior studies in other cancer types have suggested a potential connection between diet and immunotherapy response. To address this knowledge gap, the ongoing BLOSSOM study is presented, which aims to investigate the link between dietary factors, lifestyle, and the effectiveness of immunotherapy in patients with non-muscle-invasive bladder cancer. Ongoing efforts to decipher the intricate relationship between diet and bladder cancer care are highlighted, emphasizing the quest to unravel the dietary puzzle for the improvement of bladder cancer management. [ABSTRACT FROM AUTHOR]

Bladder cancer (BC) is a common malignancy in Europe and North America. Among BCs, muscle-invasive BCs (MIBCs) are distinguished, as they require aggressive treatment due to their spreading potential and poor prognosis. Despite its clinical relevance, little information on MIBC in a general population setting is available. This study aims to report practice patterns and survival outcomes for MIBC patients in a general population setting. MIBCs among BC incidence in 2011 and 2012 recorded in a French population-based cancer registry (810 000 inhabitants) were included in the study. Data were extracted from the medical files. Individual, tumour-related characteristics and initial management including diagnostic tools, multidisciplinary team meeting (MDT) assessment, and treatment delivered were described. Cystectomy, chemoradiation, radiotherapy, and chemotherapy were considered as specific treatments. Matching between MDT decision and the treatment provided was detailed. Management practices were discussed according to the guideline's recommendations. Overall survival (using the Kaplan–Meier method) and net survival (using the Pohar-Perme estimator) were calculated. Among 538 incident BC cases, 147 (27.3%) were MIBCs. Diagnostic practices displayed a relevant locoregional assessment of BC. Almost all cases (n  = 136, 92.5%) were assessed during an uro-oncological MDT with a median time from diagnosis of 18 days (first quartile:12-third quartile:32). Discrepancies appeared between MDT decisions and treatments delivered: 71 out of 86 subjects received the recommended cystectomy or chemoradiation (with or without neoadjuvant chemotherapy); 6 out of 11 had the recommended radio- or chemotherapy; and 9 patients did not undergo any specific treatment despite the MDT decision. Cystectomy was the most common treatment performed; the time to surgery appeared consistent with the guideline's recommendations. Forty people only received supportive care. Still, the 5-year overall and net survival was poor, with 19% (13–26) and 22% (14–31), respectively. The 5-year net survival was 35% (23–48) for people who underwent curative-intent treatments. MIBC management remains challenging even for cases assessed during an MDT. Many people did not undergo any specific treatment. Prognosis was poor even when curative-intent therapies were delivered. Efforts to reduce exposure to risk factors such as tobacco smoking and occupational exposures must be maintained. [ABSTRACT FROM AUTHOR]

Abstract Bladder cancer is considered a global health concern characterized by significant morbidity and mortality rates. The complex relationship between diet and bladder cancer is examined, with a specific focus on the role of diet in risk, outcomes, and treatment efficacy. Attention is drawn to the burgeoning field of immunotherapy in bladder cancer treatment, and the possible influence of diet on its outcomes is explored. While evidence remains limited, prior studies in other cancer types have suggested a potential connection between diet and immunotherapy response. To address this knowledge gap, the ongoing BLOSSOM study is presented, which aims to investigate the link between dietary factors, lifestyle, and the effectiveness of immunotherapy in patients with non-muscle-invasive bladder cancer. Ongoing efforts to decipher the intricate relationship between diet and bladder cancer care are highlighted, emphasizing the quest to unravel the dietary puzzle for the improvement of bladder cancer management.

Purpose: To investigate the effects of two preparation methods on the image quality of bladder cancer magnetic resonance imaging (MRI) and the diagnostic performance of differentiation of muscular invasion of bladder cancer. Methods: 76 cases of bladder cancer patients underwent preoperative MRI. They were divided into two groups and underwent two different bladder preparation methods respectively. The image quality of the two methods on high-resolution T2WI combined with diffusion-weighted imaging (DWI) and dynamic contrast-enhanced imaging (DCE) was compared. To determine whether the MR images of the two groups of patients have any influence on the diagnostic performance of the bladder cancer lesions in muscle invasion. Results: The consistency between the two readers was good. Compared with group B (urinate 2 hours prior to bladder MRI with no drinking), group A (after 4 to 6 hours of fasting, inject about 100 ml of physiological saline into the bladder before the examination through the catheter) had a better bladder filling degree. In terms of diagnostic efficiency, the sensitivity and accuracy of group A in diagnosing muscle-invasive bladder cancer were higher than those of group B, the difference has no statistically significant. Conclusion: Injecting an appropriate volume of physiological saline into the bladder before MR examination can be used as a clinical assistant bladder preparation method which help patients with bladder cancer properly fill the bladder, improve the quality of magnetic resonance images, and help improve the diagnosis of bladder cancer with magnetic resonance.

Fluorescence confocal microscopy (FCM) represents a novel diagnostic technique able to provide real-time histological images from non-fixed specimens. As a consequence of its recent developments, FCM is gaining growing popularity in urological practice. Nevertheless, evidence is still sparse, and, at the moment, its applications are heterogeneous. We performed a narrative review of the current literature on this topic. Papers were selected from the Pubmed, Embase, and Medline archives. We focused on FCM applications in prostate cancer (PCa), urothelial carcinoma (UC), and renal cell carcinoma (RCC). Articles investigating both office and intraoperative settings were included. The review of the literature showed that FCM displays promising accuracy as compared to conventional histopathology. These results represent significant steps along the path of FCM's formal validation as an innovative ready-to-use diagnostic support in urological practice. Instant access to a reliable histological evaluation may indeed significantly influence physicians' decision-making process. In this regard, FCM addresses this still unmet clinical need and introduces intriguing perspectives into future diagnostic pathways. Further studies are required to thoroughly assess the whole potential of this technique. [ABSTRACT FROM AUTHOR]

Objective: Whether ileal conduit diversion (ICD) or orthotopic neobladder (ONB) urinary diversion provides better quality of life (QoL) is still under debate. The Bladder Cancer Index (BCI) is a specific tool for bladder cancer (BCa) patients, providing reliable results in previous studies. A validated Farsi version of the BCI concerning cultural aspects could help Farsi-speaking clinicians gain more reliable feedback on QoL following urinary diversion. Materials and methods: Based on WHO suggestions, we translated the BCI questionnaire into the Persian language. Then, we performed a cross-sectional study on BCa patients who underwent ICD or ONB urinary diversion. We compared their QoL via BCI and WHO questionnaires. Chi-square and independent t-tests were used where appropriate. Results: The content validity ratio and the content validity indexes were 1 and 0.8-1.0, respectively. Of 57 participants, six patients (10.5%) were women. The ICD was performed for 38 (66.7%) and ONB diversion for 19 (33.3) participants. The mean age of ICD and ONB was 68.71 ± 7.40 and 64.28 ± 8.34 years, respectively (p-value: 0.055). In all sub-domains of BCI, except bowel habits, the mean scores were higher in the ICD group. A significant difference between ICD and ONB groups was found regarding urinary function (p-value<0.001). There was no significant difference between ICD and ONB groups in none of the domains of the WHO questionnaire. Conclusion: The QoL of ICD and ONB patients did not differ significantly. Even ICD may be superior in ritual purification, while the psychological status of ONB patients was better. [ABSTRACT FROM AUTHOR]

Malignant neoplasms of the bladder rank below common cancers such as breast, colon, cervix, liver, non-Hodgkin lymphoma and constitute less than 5% of all malignant tumours in most centres in Nigeria. The study analyzed all diagnosed malignant urinary bladder neoplasms in the departmental registry and clinical biodata were added. Consultants reviewed previously diagnosed cases, retrieved broken or faded tissue blocks, and stained them with Haematoxylin and Eosin. Tumours were classified according to the 2016 WHO classification of urinary bladder neoplasms. A total of 308 malignant urinary bladder neoplasms were found in 775 urinary bladder biopsies, with an annual prevalence of 39.7%. The most prevalent malignancies were infiltrative urothelial carcinoma and squamous cell carcinoma, which together accounted for 169 (54.9%) cases and 37.7% of all cases, respectively. The least frequent types of tumours were mesenchymal and glandular, accounting for 4.2% of cases. Males between the ages of 40 and 59 had the highest incidence. This study confirms that urinary bladder malignancies are uncommon as it was recorded in other centres in the country. It also shows that infiltrative urothelial carcinomas and squamous cell carcinomas are slightly equal in percentage with 46.4% and 45.6% respectively. [ABSTRACT FROM AUTHOR]

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PurposeThe RAZOR (Randomized Open versus Robotic Cystectomy) trial revealed noninferior 2-year progression-free survival for robotic radical cystectomy. This update was performed with extended followup for 3 years to determine potential differences between the approaches. We also report 3-year overall survival and sought to identify factors predicting recurrence, and progression-free and overall survival.Materials and methodsWe analyzed the per protocol population of 302 patients from the RAZOR study. Cumulative recurrence was estimated using nonbladder cancer death as the competing risk event and the Gray test was applied to assess significance in differences. Progression-free survival and overall survival were estimated by the Kaplan-Meier method and compared with the log rank test. Predictors of outcomes were determined by Cox proportional hazard analysis.ResultsEstimated progression-free survival at 36 months was 68.4% (95% CI 60.1-75.3) and 65.4% (95% CI 56.8-72.7) in the robotic and open groups, respectively (p=0.600). At 36 months overall survival was 73.9% (95% CI 65.5-80.5) and 68.5% (95% CI 59.8-75.7) in the robotic and open groups, respectively (p=0.334). There was no significant difference in the cumulative incidence rates of recurrence (p=0.802). Patient age greater than 70 years, poor performance status and major complications were significant predictors of 36-month progression-free survival. Stage and positive margins were significant predictors of recurrence, and progression-free and overall survival. Surgical approach was not a significant predictor of any outcome.ConclusionsThis analysis showed no difference in recurrence, 3-year progression-free survival or 3-year overall survival for robotic vs open radical cystectomy. It provides important prospective data on the oncologic efficacy of robotic radical cystectomy and high level data for patient counseling.

Objective: Whether ileal conduit diversion (ICD) or orthotopic neobladder (ONB) urinary diversion provides better quality of life (QoL) is still under debate. The Bladder Cancer Index (BCI) is a specific tool for bladder cancer (BCa) patients, providing reliable results in previous studies. A validated Farsi version of the BCI concerning cultural aspects could help Farsi-speaking clinicians gain more reliable feedback on QoL following urinary diversion. Materials and methods: Based on WHO suggestions, we translated the BCI questionnaire into the Persian language. Then, we performed a cross-sectional study on BCa patients who underwent ICD or ONB urinary diversion. We compared their QoL via BCI and WHO questionnaires. Chi-square and independent t-tests were used where appropriate. Results: The content validity ratio and the content validity indexes were 1 and 0.8-1.0, respectively. Of 57 participants, six patients (10.5%) were women. The ICD was performed for 38 (66.7%) and ONB diversion for 19 (33.3) participants. The mean age of ICD and ONB was 68.71 ± 7.40 and 64.28 ± 8.34 years, respectively (p-value: 0.055). In all sub-domains of BCI, except bowel habits, the mean scores were higher in the ICD group. A significant difference between ICD and ONB groups was found regarding urinary function (p-value

Urothelial bladder neoplasms (UBN) are uncommon in children and are poorly understood. Their management is contentious, and there are currently no pediatric guidelines available, making it difficult to envision a surgical approach that can be defined as the gold standard for the treatment of these diseases. Pneumovesicoscopy, which has already been used to treat other urological diseases, could be a promising treatment option for selected cases of this group of pathologies. We present our experience with three pediatric UBN cases in which pneumovesicoscopy was used for complete excision of a perimeatal papilloma in two cases and biopsy of a botryoid rhabdomyosarcoma in one. The pneumovesicoscopic approach, in our experience, provided a viable alternative technique for the management of selected cases of UBN.

We evaluated log odds of positive lymph nodes (LODDS) as a prognostic marker in patients who underwent radical cystectomy with lymph node dissection. We found that LODDS is an independent predictor of overall survival and is superior to other measures of lymph node burden including lymph node ratio and conventional node staging. Background: Radical cystectomy (RC) with lymph node dissection is the mainstay of treatment for patients with muscleinvasive bladder cancer (MIBC) and high r isk non-MIBC. The Amer ican Joint Committee on Cancer's (AJCC) node staging and lymph node ratio (LNR) systems are used in estimating prognosis; however, they do not directly factor in negative dissected nodes. In this study, we evaluated the log odds of positive lymph nodes (LODDS), a novel measure of nodal involvement, as a predictor of survival. Patients and methods: Eighty-three patients who underwent RC were retrospectively included and their demographic and clinical data were collected. Kaplan-Meier curve and Cox regression were used for survival analyses. Results: Median number of dissected lymph nodes was 13 (range 3-45). ROC curve analysis indicated -0.92 as the optimal LODDS cutoff. LODDS > -0.92 was associated with higher T stage, lymphovascular invasion, and significantly worse overall survival (OS) (mean OS 18.6 vs. 45.1 months, P -value < .001). Furthermore, we evaluated AJCC node staging, LNR, and LODDS in three separate multivariable Cox regression models. Among 3 different measures of nodal disease burden, only LODDS was an independent predictor of OS (HR 2.71, 95% CI 1.28-5.73, P = .009). Conclusions: Our results show that LODDS is an independent predictor of OS and outperforms AJCC node staging and LNR in forecasting prognosis among patients with urothelial bladder cancer who undergo RC. [ABSTRACT FROM AUTHOR]

In a large population-based study of patients with muscle invasive bladder cancer and no prior psychiatric history, we found that 31% of all patients with muscle-invasive bladder cancer were diagnosed with a new mental health disorder after their bladder cancer diagnosis. This was associated with worse cancer-specific and overall survival. Background: To examine differences in survival outcomes for muscle-invasive bladder cancer patients stratified by new mental health diagnosis. Methods: Using the Surveillance, Epidemiology, and End Results (SEER)-Medicare data, we identified patients diagnosed with muscle-invasive bladder cancer between 2008 and 2014. Our primary outcome was cancer-specific and overall hazards of mortality. As a secondary outcome, we reported predictors of developing a new mental health diagnosis after bladder cancer diagnosis. We used Cox proportional hazards models to determine the impact of palliative care and mental health diagnoses on survival outcomes after adjusting for grade, stage, comorbidity index, and baseline demographics. Results: Of the 3794 patients who met inclusion cr iter ia, 1193 (31%) were diagnosed with a mental health illness after their bladder cancer diagnosis during the 6 years in the study period. The most common diagnoses were depression (13%), alcohol and drug abuse (12%), and anxiety (11%). Patients with a postbladder cancer mental health diagnosis had a 57% higher hazard of overall mortality (HR 1.57, P = .048) and an 80% higher hazard of bladder cancer-specific mortality (HR 1.81, P = .037) Conclusions: New mental health diagnoses are associated with worse survival in patients with muscle invasive bladder cancer. This suggests that a multimodal approach to bladder cancer treatment should include addressing the non-oncologic needs of the patient to optimize survival outcomes. [ABSTRACT FROM AUTHOR]

Large-cell undifferentiated carcinoma of the urinary bladder is an extremely rare and aggressive neoplasm. We present a unique case of painless gross hematuria and a past surgical history of cystolithotomy. The patient underwent transurethral resection of the bladder tumor, which revealed high-grade urothelial cell carcinoma with lamina propria involvement. Subsequent radical cystoprostatectomy with orthotopic neobladder urinary diversion and pelvic lymphadenectomy was performed, and the postoperative pathologic examination indicated large-cell undifferentiated. This case report highlights the importance of accurate diagnosis and management for this rare malignancy and adds to the limited existing literature on Large-cell undifferentiated carcinoma. [ABSTRACT FROM AUTHOR]

Objective Retrospective analysis of the efficacy and influencing factors of bladder preservation integrated therapy for unresectable invasive bladder cancer confined to the pelvis was done, also including the bladder function preservation and adverse effects analysis. Methods Sixty-nine patients with unresectable locally invasive bladder cancer who received radiotherapy-based combination therapy from March 1999 to December 2021 at our hospital were selected. Among them, 42 patients received concurrent chemoradiotherapy, 32 underwent neoadjuvant chemotherapyand 43 with transurethral resection of bladder tumors (TURBT) prior to radiotherapy. The late adverse effect of radiotherapy, preservation of bladder function, replase and metastasis and survival were followed-up. Cox proportional hazards models were applied for the multifactorial analysis. Results The median age was 69 years. There were 63 cases (91.3%) of uroepithelial carcinoma, 64 of stage Ⅲ and 4 of stage Ⅳ. The median duration of follow-up was 76 months. There were 7 grade 2 late genito urinary toxicities, 2 grade 2 gastrointestinal toxicities, no grade 3 or higher adverse events occurred. All patients maintained normal bladder function, except for 8 cases who lost bladder function due to uncontrolled tumor in the bladder. Seventeen cases recurred locally. There were 11 cases in the concurrent chemoradiotherapy group with a local recurrence rate of 26.2% (11/42) and 6 cases in the non-concurrent chemoradiotherapy group with a local recurrence rate of 22.2% (6/27), and the difference in local recurrence rate between the two groups was not statistically significant (P=0.709). There were 23 cases of distant metastasis (including 2 cases of local recurrence with distant metastasis), including 10 cases in the concurrent chemoradiotherapy group with a distant metastasis rate of 23.8% (10/42) and 13 cases in the non-concurrent chemoradiotherapy group with a distant metastasis rate of 48.1% (13/27), and the distant metastasis rate in the non-concurrent chemoradiotherapy group was higher than that in the concurrent chemoradiotherapy group (P=0.036). The median 5-year overall survival (OS) time was 59 months and the OS rate was 47.8%. The 5-year progression-free survival (PFS) time was 20 months and the PFS rate was 34.4%. The 5-year OS rates of concurrent and non-concurrent chemoradiotherapy group were 62.9% and 27.6% (P<0.001), and 5-year PFS rates were 45.4% and 20.0%, respectively (P=0.022). The 5-year OS rates of with or without neoadjuvant chemotherapy were 78.4% and 30.1% (P=0.002), and the 5-year PFS rates were 49.1% and 25.1% (P=0.087), respectively. The 5-year OS rates with or without TURBT before radiotherapy were 45.5% and 51.9% (P=0.233) and the 5-year PFS rates were 30.8% and 39.9% (P=0.198), respectively. Multivariate Cox regression analysis results showed that the clinical stage (HR=0.422, 95% CI: 0.205-0.869) was independent prognostic factor for PFS of invasive bladder cancer. The multivariate analysis showed that clinical stages (HR=0.278, 95% CI: 0.114-0.678), concurrent chemoradiotherapy (HR=0.391, 95% CI: 0.165-0.930), neoadjuvant chemotherapy (HR=0.188, 95% CI: 0.058-0.611), and recurrences (HR=10.855, 95% CI: 3.655-32.638) were independent prognostic factors for OS of invasive bladder cancer. Conclusion Unresectable localized invasive bladder cancer can achieve satisfactory long-term outcomes with bladder-preserving combination therapy based on radiotherapy, most patients can retain normal bladder function with acceptable late adverse effects and improved survival particularly evident in patients with early, concurrent chemoradiotherapy and neoadjuvant chemotherapy. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this mixed methods study was to investigate patient and provider perceptions of repeat transurethral resection of bladder tumors to improve counseling as new nonsurgical treatment modalities for nonmuscle-invasive bladder cancer emerge. Materials and Methods: Quantitative data were collected via a web-based survey through the Bladder Cancer Advocacy Network of patients with nonmuscleinvasive bladder cancer who had undergone at least 1 transurethral resection of bladder tumor. Bivariable and multivariable analyses were performed to evaluate associations of patient demographics and clinical variables with treatment preference. Qualitative data were collected with 60 in-depth telephone interviews with patients (n[40) and urologists (n[20) to understand experiences with bladder cancer and transurethral resection of bladder tumor. Telephone interviews were conducted by trained qualitative experts. Transcripts were imported into Dedoose to facilitate analysis. Results: Survey data of 352 patients showed 210 respondents (60%) preferred repeat transurethral resection of bladder tumor while 142 (40%) preferred intravesical chemoablation. Patients who preferred repeat transurethral resection of bladder tumor were more likely to prioritize initial treatment effectiveness (63%), whereas those who preferred chemoablation prioritized risk of recurrence (55%). Variables associated with a preference for intravesical chemoablation included U.S. residence (OR=2; 95% CI 1.1, 3.8), or if they expressed their reason for treatment preference as priority of recurrence risk over effectiveness (OR=14.6; 95% CI 7.4, 28.5). Predominant interview themes varied across participants, with patients but not urologists emphasizing the emotional toll of the procedure along with the need for improved counseling regarding recurrence, terminology, and cancer-related signs and symptoms. Conclusions: Differences exist in the way patients and urologists perceive repeat transurethral resection of bladder tumor for bladder cancer. Understanding transurethral resection of bladder tumor perception will aid in shared decision making as novel treatments emerge for nonmuscle-invasive bladder cancer. [ABSTRACT FROM AUTHOR]

Objective To compare the clinical efficacy of intracorporeal urinary diversion (ICUD) and extracorporeal urinary diversion (ECUD) with robot-assisted laparoscopic radical cystectomy (RARC). Methods A retrospective analysis was carried out on the patients who were diagnosed with muscle invasive bladder cancer (MIBC) and received RARC in our hospital from January 2019 to June 2020. According to the different urinary diversion adopted during the operation, they were divided into complete internal urinary diversion (ICUD group, n=18) and external urinary diversion (ECUD group, n=36). The operation time, blood loss amount, number of dissected lymph nodes, time of postoperative intestinal function recovery, length of postoperative hospital stay, time of removing plasma drainage tube, incidence of postoperative complications and rate of postoperative urinary control were compared between the 2 groups. Results RARC surgery successfully performed in all the 54 cases, and none of them were transferred to open surgery. The operation time of ICUD group was 270 (240~320) min, which was significantly shorter than that of ECUD group [330 (295~380) min, P < 0.05]. There were no obvious differences in the intraoperative volume of blood loss and number of dissected lymph nodes, or in the time of intestinal function recovery, length of hospital stay, time of removing plasma drainage tube, or rate of postoperative urinary control between the 2 groups (P>0.05). Postoperative urethral cystography showed that the new bladders located in normal position, with closely to normal capacity and no obvious ureteral reflux in the 2 groups. There were 2 cases of acute intestinal obstruction and intestinal ischemic necrosis after operation, 1 case of incomplete intestinal obstruction and 1 cases of pulmonary infection in ECUD group, and 1 case of incomplete intestinal obstruction and 2 cases of urinary tract infection in ICUD group. All of these were relieved after corresponding treatment. Conclusion Whether complete ICUD or ECUD can obtain good clinical outcome for RARC, and the former has shorter operation time and shows better advantages of robot-assisted technology.

Pheochromocytomas are neuroendocrine tumors that produce catecholamines and can be difficult to diagnose. Bladder involvement is uncommon with pheochromocytoma. Hypertension (sometimes with hypertensive crisis coinciding with micturition), headache, hematuria and syncope, which are commonly associated with voiding, are the most prevalent symptoms. While transurethral resection may be performed in roughly 20% of patients, 70% require partial cystectomy and 10% require radical cystectomy. We present a case of pheochromocytoma with hypertension and syncope that was often associated with voiding, satisfactorily treated by partial cystectomy.

Abstract Background Information about survival by stage in bladder cancer is scarce, as well as about survival of non-invasive bladder cancer. The aims of this study are: 1) to find out the distribution of bladder cancer by stage; 2) to determine cancer-specific survival by stage of bladder cancer; 3) to identify factors that explain and predict the likelihood of survival and the risk of dying from these cancers. Methods Incident bladder cancer cases diagnosed between 2006 and 2011 were identified through the Mallorca Cancer Registry. Inclusion criteria: cases with code C67 according to the ICD-O 3rd edition with any behaviour and any histology, except lymphomas and small cell carcinomas. Cases identified exclusively through the death certificate were excluded. We collected the following data: sex; age; date and method of diagnosis; histology according to the ICD-O 3rd edition; T, N, M and stage at the time of diagnosis; and date of follow-up or death. End point of follow-up was 31 December 2015. Multiple imputation (MI) was performed to estimate cases with unknown stage. Cases with benign or indeterminate behaviour were excluded for the survival analysis. Actuarial and Kaplan-Meier methods and Cox regression models were used for survival analysis. Results One thousand nine hundred fourteen cases were identified. 14% were women and 65.4% were 65 years or older. 3.9% had no stage (benign or undetermined behaviour) and 11.5% had unknown stage. After MI, 37.5% were in stage Ta (non-invasive papillary carcinoma), 3.2% in stage Tis (carcinoma in situ), 34.3% in stage I, 11.7% in Stage II, 4.3% in stage III, and 9.0% in stage IV. Survival was 76% at 5 years. Survival by stage: 98% at stage Ta, 90% at stage Tis, 85% at stage I, 45% at stage II, 35% at stage III, and 7% at stage IV. The Cox model showed that age, histology, and stage, but not sex, were associated with survival. Conclusion Bladder cancer survival vary greatly with stage, among both non-invasive and invasive cases. The percentage of non-invasive cancers is high. Stage, age, and histology are associated to survival.

Background Urothelial carcinoma (UC) accounts for roughly 90% of bladder cancer, and has a high propensity for diverse differentiation. Recently, certain histologic variants of UC have been recognized to be associated with unfavorable clinical outcomes. Several UC studies have also suggested that tumor budding is a poor prognostic marker. Distant metastasis of UC after radical cystectomy is not uncommon. However, these metastatic lesions are not routinely confirmed with histology. Methods We investigated the histopathologic features of 13 cases of UC with biopsy-proven distant metastases, with a special emphasis on histologic variants and tumor budding. Results Lymph nodes (6/13, 46%) were the most common metastatic sites, followed by the lung (4/13, 31%), liver (4/13, 31%), and the adrenal gland (2/13, 15%). The histologic variants including squamous (n = 1), micropapillary (n = 4), and plasmacytoid (n = 1) variants in five cases of UC. Most histologic variants (4/5, 80%) of primary UCs appeared in the metastatic lesions. In contrast, high-grade tumor budding was detected in six cases (46%), including one case of non-muscle invasive UC. Our study demonstrates that histologic variants are not uncommonly detected in distant metastatic UCs. Most histologic variants seen in primary UCs persist in the distant metastatic lesions. In addition, high-grade tumor budding, which occurs frequently in primary tumors, may contribute to the development of distant metastasis. Conclusions Therefore, assessing the presence or absence of histologic variants and tumor budding in UCs of the urinary bladder, even in non-muscle invasive UCs, may be useful to predict distant metastasis.

Objective To explore the effect and mechanism of Casticin (CAS) on the proliferation, migration mid invasion of bladder cancer T24 cells. Methods T24 cells were cultured in vitro and divided into control group, 5, 10, 20 μmol/L CAS groups, si-NC group, si-TM7SF4 group, CAS+pcDNA group mid CAS+pcDNA-TM7SF4 group. Cell counting kit-8 (CCK-8) was used to detect cell proliferation; Transwell was used to detect cell migration and invasion; western blot was used to detect the protein expressions of cyclin D1, p21, MMP-2, MMP-9 mid TM7SF4, and real-time quantitative reverse transcription polymerase chain reaction (RT-qPCR) was used to detect the expression of TM7SF4 mRNA. Results The inhibition rates of T24 cells in the 5, 1 0, 20 μmoVL CAS groups were (17. 68 ± 1 . 41)%, ( 33.54±3.16) % andd ( 61.44±5.50) %, respectively, higher than ( 0.00±0.00) % of the control group ( P< 0.001), but the numbers of migration and invasion were 72.83±5.66, 59.13±4.27, 41.25±3.22 and 55.83± 5.15, 42.19±3.06, 31.13±3.22, respectively, lower than 86.11 ±5.16 and 68.82±5.29 of the control group ( P<0.001). The protein expression levels of cyclin D1, MMP-2, MMP-9, TM7SF4 and the expression levels of TM7SF 4 mRNA in the 5, 10, and 20 μmoVL CAS groups were lower than the control group (P<0.001). However, the protein expression levels of p21 were 0.37±0.03, 0.51 ±0.04, and 0.66±0.06, respectively, higher than 0.25±0.03 in the control group (P<0.001). The inhibition rate of T24 cells in the si-TM7SF4 group was ( 50.35±4.67) %, higher than ( 6.31 ±0.58) % in the si-NC group ( P<0.001 ), but the numbers of migration and invasion were 53.51±4.18

Objective Bladder cancer is one of the most common malignant tumors in urology. Urothelial carcinoma accounts for about 90% of all bladder malignancies. According to whether the tumor invades the bladder muscle, it can be divided into non-muscle invasive bladder cancer and muscle invasive bladder cancer. Radical cystectomy is the standard treatment for muscle invasive bladder cancer patients and high-risk non-muscle invasive bladder cancer patients who have failed Bacillus Calmette-Guerin treatment. Due to the comorbidity of bladder cancer and the potential deterioration of the quality of life after surgery. many patients were not suitable or refused for radical cystectomy. Therefore, it is vital to find a bladder preserving treatment that can achieve cure other than radical cystectomy. Bladder-preserving therapy that balances tumor control and quality of life serves as an alternative and supplement to radical cystectomy. This consensus is based on contemporary evidence-based medicine, combined with the native clinical practice of bladder preservation in a multidisciplinary treatment manner. To some extent, this consensus serves as a guidance for bladder-preservation therapy of bladder cancer in China. Several issues are extensively discussed here, including organizational structure and workflow of multidisciplinary treatment, the selection of patients for bladder-preserving therapy, treatment options and regimens, follow-up, as well as regimen choices of recurrence after bladder-preserving therapy. [ABSTRACT FROM AUTHOR]

Bladder cancer (BCa) is among the ten most frequent cancers globally. It is the tumor with the highest lifetime treatment‐associated costs, and among the tumors with the heaviest impacts on postoperative quality of life. The purpose of this article is to review the current applications and future perspectives of the Vesical Imaging Reporting and Data System (VI‐RADS). VI‐RADS is a newly developed scoring system aimed at standardization of MRI acquisition, interpretation, and reporting for BCa. An insight will be given on the BCa natural history, current MRI applications for local BCa staging with assessment of muscle invasiveness, and clinical implications of the score for disease management. Future applications include risk stratification of nonmuscle invasive BCa, surveillance, and prediction and monitoring of therapy response. Level of Evidence: 3 Technical Efficacy Stage: 2 [ABSTRACT FROM AUTHOR]

Objective To improve the cognition of penile metastatic tumor by summarizing clinical data of 5 patients with penile metastatic tumor and reviewing the related literatures. Methods Clinical data of 5 patients with penile metastatic tumor treated in the Department of Urology of Shanghai Changzheng Hospital since 2013 were reviewed. Their clinical features, pathogenesis, treatment and prognosis were discussed combined with the relevant literature. Results The average age of 5 patients with penile metastatic tumor was 73.4 years. Among these 5 patients, 2 cases of primary tumor originated from bladder cancer, 1 case from sigmoid colon cancer, 1 case from malignant lymphoma and 1 case from malignant melanoma. Three patients presented with painful nodule of penis, one patient with painless mass and one patient with enlarged penis and thinner urinary line. The patient with malignant lymphoma had penile metastasis at the time of diagnosis. The time interval between diagnosis of primary tumor and penile metastatic tumor in the other four patients was 39, 58, 3 and 8 months. Two patients underwent partial penile resection, and three patients underwent total penile resection to clear diagnosis and relieve clinical symptoms. One patient was lost to follow-up, and the survival time after surgery of the other four patients was 9, 6, 27 and 7 months, respectively. Conclusion Penile metastatic tumors are common in primary pelvic tumors with retrograde metastasis through vein or lymphatic system, and the main clinical symptoms are solitary or multiple penile nodules, painful or painless nodules. The treatment of metastatic penile cancer mainly depends on the condition of the primary tumor and the general condition of the patient. Partial or total penile resection is beneficial to relieve pain or urinary tract obstruction, but it has no effect on poor prognosis. [ABSTRACT FROM AUTHOR]

Bladder cancer is one of the common malignant tumors in China, with 75% of bladder cancer being non-muscle invasion with a high recurrence rate after surgery. Intravesical therapy is an useful methods to either directly kill tumor cells by infusing cytotoxic drugs into the bladder or directly or indirectly induce local immune responses of the body through infusing immune agents, such as bacillus calmette guerin, and thus reduce the risk of tumor recurrence and progression. In 2019, the Urological Chinese Oncology Group issued the "Expert consensus on intravesical therapy on non-muscle invasive bladder cancer". Recently, great progress in the clinical diagnosis and treatment of non-muscle invasive bladder cancer has been achieved domestically and abroad, including the risk assessment of non-muscle invasive bladder cancer, the therapeutic choice of intravesical drugs, the adverse reactions and treatment experience of intravesical therapy, and clinical research on new types of intravesical drugs. This consensus is made according to domestic and overseas evidence-based medicine in combination with current clinical practice and experience of intravesical therapy for non-muscle invasive bladder cancer in China. It is an update of the 2019 expert consensus, with the wish to provide a guidance for domestic clinical standardized intravesical therapy for non-muscle invasive bladder cancer. [ABSTRACT FROM AUTHOR]

Introduction Extramammary Paget's disease of the vulva secondary to urothelial carcinoma is rare. It is important to determine whether extramammary Paget's disease is primary or secondary, because the appropriate treatment strategies differ. We report a case of penile extramammary Paget's disease secondary to urothelial carcinoma recurrence. Case presentation A 75‐year‐old man who was diagnosed with bladder carcinoma and received urethra‐sparing radical cystectomy 5 years ago presented with erythema and red spots in the glans penis. Immunostaining (cytokeratin 7 and cytokeratin 20) of skin biopsy specimens suggested a secondary extramammary Paget's disease that originated from the urothelial carcinoma. Under urethroscopy, urethral recurrence was also suspected. A total penectomy was performed, and a final diagnosis of urothelial carcinoma recurrence and secondary extramammary Paget's disease of the glans penis were established. Conclusion Using immunostaining, the differential diagnosis between primary and secondary extramammary Paget's disease is more accurate. Secondary extramammary Paget's disease should be considered when a skin lesion is present on the penis of patients with urothelial carcinoma.

IntroductionBladder cancer is the most common urinary tract malignancy, and 90% of bladder tumors are urothelial cell carcinomas. Ferroptosis is a new form of cell death discovered in recent years, which is an iron-dependent form of cell death characterized by the lethal intracellular accumulation of lipid-based reactive oxygen species. Ferroptosis is considered to be a double-edged sword for cancer and cancer therapy.Materials and MethodsIn the current study, expression profiles of bladder cancer (BLCA) specimens were obtained from The Cancer Genome Atlas (TCGA) RNA-Seq database. Ferroptosis-related genes were downloaded from the FerrDb website. The ferroptosis-related differentially expressed genes (DEGs) which were related to overall survival (OS) were first identified. The least absolute shrinkage and selection operator (LASSO) and multivariate Cox regression methods were utilized to develop a ferroptosis-related prognostic model (FRPM). In addition, a nomogram model based on FRPM and clinicopathological features was successfully constructed and validated. In addition, gene ontology (GO), Kyoto Encyclopedia of Genes and Genomes (KEGG), and single-sample gene set enrichment analysis (ssGSEA) methods were utilized in this study in order to compare the DEGs between the high-risk and low-risk groups. This study also adopted RT-qPCR, CCK-8 assay, and scratch assay methods to perform experimental verification processes.Results and DiscussionA 7-gene FRPM was constructed in this research investigation in order to stratify the patients into two groups according to their risk scores. The results of this study’s survival analysis and time-dependent receiver operating characteristic (ROC) analysis demonstrated that the model had achieved a stable performance level. This multivariate Cox regression results revealed that the FRPM was an independent prognostic predictor for the OS of BLCA patients and the results were displayed using a nomogram. In addition, the ROC analysis, concordance index (C-index), calibration plots, and decision curve analysis (DCA) curves further indicated that this study’s nomogram method enabled valuable prediction results. The functional enrichment analysis results suggested that the DEGs between the high- and low-risk groups played vital roles in the progression of the ferroptosis. Also, the ssGSEA indicated that the immune status was different between the two groups. This study found that the RT-qPCR results had confirmed the differential expressions of DEGs in the tissue samples, and the CCK-8 assay and scratch assay results confirmed the promoting effects of SCD on the proliferation and migration of tumor cells.ConclusionsThis study defined a novel prognostic model of seven ferroptosis-related genes, which proved to be independently associated with the OS of BLCA. A nomogram method was developed for the purpose of providing further insight into the accurate predictions of BLCA prognoses.

Background: Information about survival by stage in bladder cancer is scarce, as well as about survival of non-invasive bladder cancer. The aims of this study are: 1) to find out the distribution of bladder cancer by stage; 2) to determine cancer-specific survival by stage of bladder cancer; 3) to identify factors that explain and predict the likelihood of survival and the risk of dying from these cancers. Methods: Incident bladder cancer cases diagnosed between 2006 and 2011 were identified through the Mallorca Cancer Registry. Inclusion criteria: cases with code C67 according to the ICD-O 3rd edition with any behaviour and any histology, except lymphomas and small cell carcinomas. Cases identified exclusively through the death certificate were excluded. We collected the following data: sex; age; date and method of diagnosis; histology according to the ICD-O 3rd edition; T, N, M and stage at the time of diagnosis; and date of follow-up or death. End point of follow-up was 31 December 2015. Multiple imputation (MI) was performed to estimate cases with unknown stage. Cases with benign or indeterminate behaviour were excluded for the survival analysis. Actuarial and Kaplan-Meier methods and Cox regression models were used for survival analysis. Results: One thousand nine hundred fourteen cases were identified. 14% were women and 65.4% were 65 years or older. 3.9% had no stage (benign or undetermined behaviour) and 11.5% had unknown stage. After MI, 37.5% were in stage Ta (non-invasive papillary carcinoma), 3.2% in stage Tis (carcinoma in situ), 34.3% in stage I, 11.7% in Stage II, 4.3% in stage III, and 9.0% in stage IV. Survival was 76% at 5 years. Survival by stage: 98% at stage Ta, 90% at stage Tis, 85% at stage I, 45% at stage II, 35% at stage III, and 7% at stage IV. The Cox model showed that age, histology, and stage, but not sex, were associated with survival. Conclusion: Bladder cancer survival vary greatly with stage, among both non-invasive and invasive cases. The percentage of non-invasive cancers is high. Stage, age, and histology are associated to survival. [ABSTRACT FROM AUTHOR]

Objectives: To compare the occurrence of emptying dysfunction between surgical techniques for orthotopic neobladder suspended with round ligament (rONB) and the standard procedure (sONB). Patients and Methods: A prospective randomised controlled trial was performed in a single centre of female patients undergoing creation of an ONB using rONB or sONB. Patients were followed for ≥24 months after ONB. The primary endpoints were significant post‐void residual urine volume (sPVR) and need for clean intermittent catheterisation (CIC) at 24 months postoperatively. The secondary endpoints included early and late complications, urodynamic profile, and ONB continence. Results: Between January 2011 and October 2017, the trial enrolled 85 patients, of whom 82 were randomised. A total of 41 patients had a rONB and 41 a sONB. At 24 months, 17 of the 37 patients with a sONB and nine of the 39 patients with a rONB had a sPVR. The cumulative risk of a sPVR was significantly lower in the rONB group (23.1%) vs the sONB group (45.9%) (hazard ratio [HR] 0.43, 95% confidence interval [CI], 0.19–0.96; P = 0.040). In all, 15 of the 37 patients with a sONB and four of the 39 patients with a rONB needed CIC. The cumulative risk of requiring CIC was significantly lower in the rONB group (10.3%) vs the sONB group (40.5%) (HR 0.22, 95% CI 0.07–0.67; P = 0.008) at 24 months. Multivariable Cox regression analysis also showed that the rONB type was an independently protective factor for sPVR and CIC. The rates of early (0–90 days) and late complication (>90 days) were 54.1% and 13.5% in the sONB group, and 64.1% and 10.3% in the rONB group, respectively. There were no significant differences in complications, urodynamic profile or ONB continence. A major limitation is the small sample size at a single centre. Conclusion: Posterior support with round ligament for an ONB significantly improved the emptying of the ONB and resulted in a reduced need for CIC. The surgical modification is a feasible and safe technique without additional complication‐related surgeries. [ABSTRACT FROM AUTHOR]

Introduction: Bladder cancer is the most common urinary tract malignancy, and 90% of bladder tumors are urothelial cell carcinomas. Ferroptosis is a new form of cell death discovered in recent years, which is an iron-dependent form of cell death characterized by the lethal intracellular accumulation of lipid-based reactive oxygen species. Ferroptosis is considered to be a double-edged sword for cancer and cancer therapy. Materials and Methods: In the current study, expression profiles of bladder cancer (BLCA) specimens were obtained from The Cancer Genome Atlas (TCGA) RNA-Seq database. Ferroptosis-related genes were downloaded from the FerrDb website. The ferroptosis-related differentially expressed genes (DEGs) which were related to overall survival (OS) were first identified. The least absolute shrinkage and selection operator (LASSO) and multivariate Cox regression methods were utilized to develop a ferroptosis-related prognostic model (FRPM). In addition, a nomogram model based on FRPM and clinicopathological features was successfully constructed and validated. In addition, gene ontology (GO), Kyoto Encyclopedia of Genes and Genomes (KEGG), and single-sample gene set enrichment analysis (ssGSEA) methods were utilized in this study in order to compare the DEGs between the high-risk and low-risk groups. This study also adopted RT-qPCR, CCK-8 assay, and scratch assay methods to perform experimental verification processes. Results and Discussion: A 7-gene FRPM was constructed in this research investigation in order to stratify the patients into two groups according to their risk scores. The results of this study's survival analysis and time-dependent receiver operating characteristic (ROC) analysis demonstrated that the model had achieved a stable performance level. This multivariate Cox regression results revealed that the FRPM was an independent prognostic predictor for the OS of BLCA patients and the results were displayed using a nomogram. In addition, the ROC analysis, concordance index (C-index), calibration plots, and decision curve analysis (DCA) curves further indicated that this study's nomogram method enabled valuable prediction results. The functional enrichment analysis results suggested that the DEGs between the high- and low-risk groups played vital roles in the progression of the ferroptosis. Also, the ssGSEA indicated that the immune status was different between the two groups. This study found that the RT-qPCR results had confirmed the differential expressions of DEGs in the tissue samples, and the CCK-8 assay and scratch assay results confirmed the promoting effects of SCD on the proliferation and migration of tumor cells. Conclusions: This study defined a novel prognostic model of seven ferroptosis-related genes, which proved to be independently associated with the OS of BLCA. A nomogram method was developed for the purpose of providing further insight into the accurate predictions of BLCA prognoses. [ABSTRACT FROM AUTHOR]

Background: To summarize the current evidence on robot-assisted radical cystectomy (RARC) with intracorporeal urinary diversion (ICUD) and compare perioperative outcomes and postoperative complications of patients undergoing RARC with extracorporeal urinary diversion (ECUD) and ICUD. Patients and Methods: Through a systematical search of multiple scientific databases in March 2020, we performed a systematic review and cumulative meta-analysis of the primary outcomes of interest. Also, we assessed the quality of the relevant evidence according to the framework in the Cochrane Handbook for Systematic Reviews of Interventions. Results: Thirteen studies with 4696 participants were included in this review. No significant differences were found between the ECUD and ICUD in operation time (OT) (mean difference [MD]: −6.45, 95% confidence interval [CI]: −35.20 to 22.30), length of stay (MD: 0.36, 95% CI: −0.81 to 1.54), 30-day overall complications (odds ratio [OR]: 0.92, 95% CI: 0.60–1.41), 30-day minor complications (OR: 1.36, 95% CI: 0.85–2.19), 30-day major complications (OR: 0.70, 95% CI: 0.34–1.43), 90-day overall complications (OR: 1.34, 95% CI: 0.83–2.18), and major complications (OR: 1.03, 95% CI: 0.68–1.57). However, less estimate blood loss (MD: 99.28 mL, 95% CI: 62.59–135.98), lower intraoperative blood transfusion (OR: 1.80, 95% CI: 1.09–2.95), shorter oral intake time (MD: 0.78, 95% CI: 0.43–1.14), and 90-day minor complications (OR: 1.72, 95% CI: 1.08–2.73) were associated with ICUD. The subgroup analysis showed less estimated blood loss (MD: 149.73, 95% CI: 21.33–278.13) and less OT (MD: 32.45, 95% CI: 14.37–50.53) were found in ICUD. Conclusions: The ICUD is a safe and feasible alternative to ECUD, which decreases the need for blood transfusion and reduces 90-day complications. However, further quality studies are needed to evaluate effectiveness of ICUD and its oncologic outcomes, functional outcomes, cost, and the quality of life. [ABSTRACT FROM AUTHOR]

OBJECTIVE In this retrospective research, it was aimed to evaluate results of radiotherapy (RT) in elderly bladder cancer patients. METHODS A total of 47 patients who receiving RT or chemoradiotherapy treatment for bladder cancer in elderly patient (>70 years) were included in the study. RESULTS In total 47 patients, 4 patients (8.5%) had Stage I, 38 patients (80.8%) had Stage II, and 5 patients (10.6%) had Stage III bladder cancer. About 76.9% of patients had invasive urothelial, 3.8% of patients had squamous and micropapillary carcinoma, and 19.2% of had other (adenocarcinoma) histopathological type. Gender, age, family cancer history, hematuria, smoking, bladder carcinoma type, Charlson CoMorbidity Index, RT dose, concurrent chemoradiotherapy, metastasis side, acute and late toxicity, and follow-up duration of patients showed insignificant differences according to stage (p>0.05). We found that overall survival and disease-free survival (DFS) were statistically significant according to the stages (p<0.05). DFS for Karnofsky Performance Status (KPS) >70 group (25.97±19.06) was higher than KPS <70 group (2.37±1.53) with statistically significant difference (p<0.05). CONCLUSION Curative RT and chemoradiotherapy can be safe regimen for older (>70 year) patients with bladder cancer. Nonetheless, KPS and geriatric assessments tools should be consideration before RT and chemoradio-therapy administration. [ABSTRACT FROM AUTHOR]

Objective: Information on bladder cancer (BC) according to the risk scoring for recurrence or progression in a general population is scarce despite its clinical relevance. The objective was to describe the characteristics of incident BC in a general population, with a focus on the initial management of high-risk non-muscle invasive BC (HR-NMIBC)., Materials: BC incident in 2011-2012 recorded in a population-based cancer registry were studied. Data was extracted from medical files. NMIBC were classified according to potential risk for recurrence/progression. Individual and tumor characteristics of incident BC were described. Incidence, initial management and survival (12/31/2021) of HR-NMIBC were assessed., Results: Among 538 BC cases, 380 were NMIBC [119 low (22.1%), 163 intermediate (30.3%), 98 high (18.2%) risk] and 147 (27.3%) were MIBC. HR-NMIBC diagnostic and therapeutic management [imaging, re-TUR, multidisciplinary team meetings (MDT) assessment, specific treatment] revealed discrepancies with guidelines recommendations. Seventy-two out of 98 cases were assessed in an MDT with a median time from diagnosis of 18days [first quartile: 12-third quartile: 32]. Globally, treatment agreed with MDT decisions. Intravesical instillation was the most common treatment (n=56) but 27 HR-NMIBC did not receive specific treatment after TUR. Five and 10years overall survival was 52% [42-63] and 41% [31-51], respectively. Five years net survival was 63% [47-75]., Conclusions: Despite National cancer plans aiming to improve care giving and despite the severity of HR-NMIBC, guideline-recommended patterns of care were underused in this region. This may deserve attention to identify obstacles to guideline adoption to try to improve BC patient care and survival., (Copyright © 2024 Elsevier Masson SAS. All rights reserved.)

PurposeAdding pelvic lymph node dissection (PLND) to cystectomy offers significant survival benefit. However, it remains unclear whether this benefit persists in all histologic types. The aim of the study was to examine the impact of PLND on overall survival (OS) after cystectomy in bladder carcinoma patients with histological variants.MethodsWithin the Surveillance, Epidemiology and End Results database, we identified 16,880 bladder carcinoma patients receiving cystectomy between 2004 and 2015. Patients were stratified according to the following histologic types: transitional cell carcinoma, squamous cell carcinoma, adenocarcinoma, small cell carcinoma, neuroendocrine carcinoma, signet ring cell carcinoma, pseudosarcomatous carcinoma, and other histology. Cox regression models were used to evaluate the effect of PLND on OS stratified by histologic type.ResultsHistologic types were significantly associated with the presence of lymph node metastasis in patients with bladder carcinoma (P < 0.001). In multivariable Cox regression analyses, PLND compared with non-PLND was associated with OS benefit in patients with transitional cell carcinoma (hazard ratio [HR], 0.595; 95% confidence interval [95% CI], 0.557–0.634 [P < 0.001]), squamous cell carcinoma (HR, 0.646; 95% CI, 0.494–0.846 [P = 0.002]), and signet ring cell carcinoma (HR, 0.233; 95% CI, 0.107–0.504 [P < 0.001]), whereas no significant differences in OS were observed in other histological subsets.DiscussionOur analyses revealed a significant OS benefit from PLND in patients with transitional cell carcinoma, squamous cell carcinoma, and signet ring cell carcinoma. However, a survival benefit of PLND in patients with other histologic types was not demonstrated.

Objective To describe the epidemiological characteristics of bladder cancer in 2015 and temporal trends in China. Methods From 501 cancer registries in China, we collected data of cancer new cases, deaths and populations in 2015. After qualified, sex-specific, area-specific, age-specific and overall incidence/mortality rates (including age-standardized rates by Chinese standard population and by world standard population) and estimated cases of bladder cancer were calculated. Annual Percent Change (APC)/Average Annual Percent Change (AAPC) fitted from Log-line model was applied to evaluate the temporal trends of bladder cancer incidence/mortality rates from 1998 to 2015. Results Bladder cancer is the 13th most common cancer in China. The crude, age-standardized by China standard population and by world standard population rates were 5.80/105, 3.60/105 and 3.57/105 for incidence, and 2.37/105, 1.31/105 and 1.32/105 for mortality, respectively. The incidence of bladder cancer ranked 7th in male. The incidence and mortality of male were 3.8 and 4.0 times as high as those of female. Bladder cancer incidence in urban area was 1.4 times as high as that in rural area. Incidence in western areas and middle areas of China were similar, which were lower than that in eastern areas. Geographical distribution characteristics of mortality was along with incidence.Both incidence and mortality remained low before 45 and 55 years old, then they increased rapidly and peaked at 80-84 and over 85 years old age group. Temporal trend analysis suggested that bladder cancer incidence in China increased in 1998-2007 (APC=2.58, P<0.001), while decreased from 2007 to 2015 (APC=-3.82, P<0.001). Bladder cancer mortality declined gradually, with APCs for 1998-2003 and 2003-2015 of 3.65% (P=0.002) and 1.42% (P<0.001). Conclusions Bladder cancer is one of the main cancers in China. Its epidemiological distributions varies among different sex, area and age group. Both incidence and mortality of bladder cancer decline. More efforts on tobacco control should be made, and awareness of early diagnosis and early treatment could be enhanced for the middle-aged and elderly. [ABSTRACT FROM AUTHOR]

Objective To investigate the effects of isoalantolactone on proliferation and apoptosis of human bladder cancerT2 4 cells and its mechanism. Methods CDT2 4 cells in the logarithmic phase were divided into the groups 1, 2, 3, 4, 5 and 6; cells in the groups 1-5 (experimental group) were added with different concentrations of isoalantolactone (5, 10, 20, 40, and 80 μmoVL), and group 6 with normal culture medium (control group) ; after 24, 48, 72 h of culture, the cell proliferation ab山ty of each group was detected by C C K-8 method. (2) T24 cells were divided into the groups A, B, C, D, and E; cells in the group A were cultured in medium without isoalantolactone, cells in the groups B and E were pretreated with 5 nmol/L N-acetylcysteine (NAC ) for 2 h, and cells in the groups C, D and E were cultured with 10, 20 and 20 μmol/L isoalantolactone; after 24 hours of culture, the apoptosis rate of each group was measured by flow cytometry, the level of reactive oxygen species (ROS) was detected by DC FH-DA, and the mitochondrial membrane potential was detected by JC-1 mitochondrial membrane potential. @ T24 cells were divided into 4 groups with 6 compound wells in each group; cells in the three groups were added with 10, 20 and 40 μ,moVL isoalantolactone, and cells in the other group were treated with culture medium without isoalantolactone (control group) ; after 24 hours of culture, Western blotting was used to detect apoptosis-related proteins Bax, B-lymphocyticoma-2 (Bcl-2), Cytochrome C, and Caspase-3. Results (D Compared with the group 1, the inh山山on rate of cell proliferation increased in the groups 2, 3, 4 and 5 (all P < 0. 05) ; compared with the group 2, the inhibition rate of cell proliferation increased in the groups 3, 4 and 5 (all P < 0. 05) ; compared with the group 3, the inh如tion rate of cell proliferation increased in the groups 4 and 5 (all P < 0. 05). @ Compared with the group A, the apoptosis rate and ROS content increased in the groups C and D (all P < 0. 05) ; compared with the group C, the apoptosis rate and ROS content increased in the group D (all P < 0. 05) ; compared with the group D, the apoptosis rate and ROS content were reduced in the group E (all P < 0. 05). Compared with the group A, the mitochondrial membrane potential of group C decreased (P < 0. 05). Compared with the group C, the mitochondrial membrane potential of group D decreased (P < 0. 05) ; compared with the group D, the cell mitochondrial membrane potential increased in the group E (P < 0. 05). @ Compared with the control group, the relative expression levels of Bax, Cytochrome C and Caspase-3 in the drug groups increased, and the relative expression levels of Bcl-2 decreased (all P <0 . 05); with the increase of concentration, the relative expression levels of Bax, Cytochrome C and Caspase-3 in the drug group increased, and the relative expression levels of Bcl-2 decreased (all P <0. 05). Co nclusion lsoala ntolactone can inhibit cell proliferation and induce apoptosis by promoting the accumulation of reactive oxygen specie, decreasing the mitochondrial membrane potential and regulating the expression of apoptosis-related proteins [ABSTRACT FROM AUTHOR]

Purpose: Adding pelvic lymph node dissection (PLND) to cystectomy offers significant survival benefit. However, it remains unclear whether this benefit persists in all histologic types. The aim of the study was to examine the impact of PLND on overall survival (OS) after cystectomy in bladder carcinoma patients with histological variants. Methods: Within the Surveillance, Epidemiology and End Results database, we identified 16,880 bladder carcinoma patients receiving cystectomy between 2004 and 2015. Patients were stratified according to the following histologic types: transitional cell carcinoma, squamous cell carcinoma, adenocarcinoma, small cell carcinoma, neuroendocrine carcinoma, signet ring cell carcinoma, pseudosarcomatous carcinoma, and other histology. Cox regression models were used to evaluate the effect of PLND on OS stratified by histologic type. Results: Histologic types were significantly associated with the presence of lymph node metastasis in patients with bladder carcinoma (P < 0.001). In multivariable Cox regression analyses, PLND compared with non-PLND was associated with OS benefit in patients with transitional cell carcinoma (hazard ratio [HR], 0.595; 95% confidence interval [95% CI], 0.557–0.634 [ P < 0.001]), squamous cell carcinoma (HR, 0.646; 95% CI, 0.494–0.846 [ P = 0.002]), and signet ring cell carcinoma (HR, 0.233; 95% CI, 0.107–0.504 [ P < 0.001]), whereas no significant differences in OS were observed in other histological subsets. Discussion: Our analyses revealed a significant OS benefit from PLND in patients with transitional cell carcinoma, squamous cell carcinoma, and signet ring cell carcinoma. However, a survival benefit of PLND in patients with other histologic types was not demonstrated. [ABSTRACT FROM AUTHOR]

Purpose: To report clinical, histopathological, and treatment features of small cell carcinoma of (SmccB) bladder during 7 years in a referral center.Methods: The clinical, histopathological features, treatment modalities, and outcome of all patients with bladder SmccB treated between 2009 and 2016 who were managed in Hasheminejad Kidney Center (HKC) were retrospectively collected.Results: Thirteen patients were diagnosed and managed with SmccB. The average age of patients was 64.92 years. For each patient, 8 markers were used for IHC staining on average. Neuroendocrine markers such as CD 56, Neuron Specific Enolase, Synaptophysin, and Chromogranin were found in a significant percentage of patients (69%, 38%, 54%, and 31% respectively). Patients were managed with TURBT alone (N=3), chemotherapy after TURBT (N=4), chemotherapy plus radical surgery (N=4) and radical surgery alone (N=2). The best clinical result was seen in chemotherapy received patients with or without radical surgery. The mean(SE) of survival rate in patients who received only chemotherapy alone was 42.4 (10.0) months, while in those who were managed with chemotherapy plus radical surgery it was 47.7 (10.1) months.Conclusion: In our center immunohistochemistry was needed for definitive diagnosis in 17/19 samples. Misdiagnosis happened in two samples without IHC request. We think that use of immunohistochemistry should be mandatory for diagnosis of SmccB to exclude misdiagnosis. Chemotherapy is the most important part of treatment and the addition of radical surgery can slightly improve patients' survival. [ABSTRACT FROM AUTHOR]

Urachal adenocarcinoma is a rare tumor entity, an average incidence of 1 case per 5 million inhabitants is described. Clinically it manifests with hematuria (73%), abdominal pain (14%), dysuria (13%), mucosuria (10%), irritative symptoms (40%), palpable mass in the lower abdomen (17% ), bacteriuria (8%), umbilical mucosal flow (2%). We present the case of a 45-year-old patient with a diagnosis of urachal adenocarcinoma, who received multiple treatments without response, performing radical surgery with en bloc resection of the umbilicus, urachus, peritoneum, posterior fascia of the rectus abdominis muscle and partial cystectomy. by laparoscopic approach, with excellent oncological and aesthetic results, with fast recovery, and without complications. The role of chemotherapy and radiation therapy and their benefit to the patient is still unclear. With this case we want to contribute a new case to the literature, in addition to being able to show that minimally invasive management can be adequate in expert hands, with results equal to open surgery, with the already known benefit of the laparoscopic approach. [ABSTRACT FROM AUTHOR]

The surgical management of clinically localized bladder cancer is challenging, and the quality of care delivered to patients with bladder cancer is a subject of increasing interest. Multiple large studies have examined the association between surgical volume and outcomes after radical cystectomy. These studies generally find lower mortality and complication rates at high-volume centers, though interpretation of the data must be tempered by limitations of the datasets driving the studies. Benefits of regionalization of care also must be weighed against other measures proven to predict outcomes; a delay in time to cystectomy beyond 3 months, for example, is strongly associated with increased mortality. Other candidate process measures supported by existing literature include adequacy of lymphadenectomy as measured by nodal yield and availability or offering of orthotopic diversion when appropriate. Assessment and reporting of bladder cancer outcomes should be risk adjusted based on oncologic risk factors and patient comorbid illness. Perioperative morbidity and mortality, cause-specific survival, and overall survival are all key measures. Assessment of health-related quality of life after bladder cancer treatment should also be standardized for reporting. Multiple survey instruments have been developed in recent years, but none has yet been well validated or widely adopted. In particular, capturing variation in quality of life outcomes between patients undergoing bladder-sparing protocols vs. continent diversion vs. incontinent diversion is an important but difficult goal that has not yet been met. The urologic oncology community should take a strong lead in achieving consensus regarding the definition, assessment, and reporting of quality of care data for bladder cancer.