Search

OBJECTIVES: To describe a bladder cuff excision method modified with ureteral catheterization to better visualize the ureteral orifice during robot-assisted nephroureterectomy (RANU). METHODS: We retrospectively analyzed 66 patients with upper urinary tract urothelial carcinoma of the renal pelvis and/or upper-mid ureter treated between January 2020 and January 2023. Among them, 32 patients (group A) underwent RANU supported by ureteral catheterization, and the remaining patients (group B) received routine transperitoneal RANU. Postoperative cystoscopy was performed routinely to compare the rates of residual ureteral orifice between the two groups. RESULTS: Surgeries were completed uneventfully in all 66 patients, without blood transfusion or conversion to open procedures. The operative time, estimated blood loss, and postoperative length of hospital stay were similar between both groups. However, the mean time required for BCE in group A was shorter than that in group B (9.5 min vs. 16.0 min, p = 0.006). Cystoscopy at postoperative three months showed no ipsilateral ureteral orifice in group A, but residual ureteral orifice was found in 23.5% of patients in group B. During a short follow-up period of 16 months, no patients in group A experienced bladder tumor recurrence. However, two patients (5.9%) in group B developed bladder tumor recurrence, with one experiencing local tumor recurrence at the level of the ureteral stump. CONCLUSIONS: Our novel technique enables complete ureteral retrieval, accurate and rapid bladder cuff excision, which makes the procedure less invasive and safely reproducible during robot-assisted nephroureterectomy.

Background: Vesical Imaging-Reporting and Data System (VI-RADS) based on multiparametric magnetic resonance imaging (mp-MRI) performed well in diagnosing muscle-invasive bladder cancer (MIBC). However, certain cases may present challenges in determining the final VI-RADS score using only T2-weighted imaging (T2WI) and diffusion-weighted imaging (DWI) sequences, especially in the absence of dynamic contrast-enhanced (DCE) imaging. This study aims to evaluates whether biparametric MRI (bp-MRI) achieve comparable diagnostic performance to mp-MRI for predicting MIBC and seeks to identify the most suitable bp-MRI criterion by establishing four specific conditions based on T2WI and DWI. Methods: A retrospective analysis was conducted on 447 patients who underwent preoperative mp-MRI. Images were evaluated according to the VI-RADS protocol by three independent readers. In the bp-DWI and bp-DWI Plus criteria, DWI was the primary sequence used for lesion assessment, while T2WI was the primary sequence for bp-T2WI and bp-T2WI Plus criteria. The Plus criteria (bp-DWI Plus and bp-T2WI Plus) assigned a final VI-RADS score of 4 when both T2WI and DWI scores were 3. The gold standard for diagnosis was histopathological evaluation after surgery. Diagnostic performance was evaluated by comparing the area under the curve (AUC), sensitivity, specificity, and inter-reader agreement using Cohen's kappa analysis. Results: Among 447 patients, 304 confirmed as NMIBC and 143 as MIBC. The kappa values were 0.876, 0.873, 0.873, 0.642, and 0.642 for mp-MRI, bp-DWI, bp-DWI Plus, bp-T2WI, and bp-T2WI Plus, respectively, when VI-RADS cutoff > 2. Similarly, when cutoff > 3, the kappa values were 0.848, 0.811, 0.873, 0.811, and 0.873. No significant differences were observed between mp-MRI and bp-DWI (AUC: 0.916 vs. 0.912, p = 0.498), but mp-MRI and bp-DWI had higher AUCs compared to bp-DWI Plus, bp-T2WI, and bp-T2WI Plus. Conclusions: Both mp-MRI and bp-DWI demonstrate excellent performance in predicting MIBC, with bp-DWI being an alternative to mp-MRI. Trial registration: retrospectively. [ABSTRACT FROM AUTHOR]

Background: The human epidermal growth factor receptor 2 (HER2) has recently emerged as hotspot in targeted therapy for urothelial bladder cancer (UBC). The HER2 status is mainly identified by immunohistochemistry (IHC), preoperative and noninvasive methods for determining HER2 status in UBC remain in searching. Purposes: To investigate whether radiomics features extracted from MRI using machine learning algorithms can noninvasively evaluate the HER2 status in UBC. Study Type: Retrospective. Population: One hundred ninety‐five patients (age: 68.7 ± 10.5 years) with 14.3% females from January 2019 to May 2023 were divided into training (N = 156) and validation (N = 39) cohorts, and 43 patients (age: 67.1 ± 13.1 years) with 13.9% females from June 2023 to January 2024 constituted the test cohort (N = 43). Field Strength/Sequence: 3 T, T2‐weighted imaging (turbo spin‐echo), diffusion‐weighted imaging (breathing‐free spin echo). Assessment: The HER2 status were assessed by IHC. Radiomics features were extracted from MRI images. Pearson correlation coefficient and the least absolute shrinkage and selection operator (LASSO) were applied for feature selection, and six machine learning models were established with optimal features to identify the HER2 status in UBC. Statistical Tests: Mann–Whitney U‐test, chi‐square test, LASSO algorithm, receiver operating characteristic analysis, and DeLong test. Results: Three thousand forty‐five radiomics features were extracted from each lesion, and 22 features were retained for analysis. The Support Vector Machine model demonstrated the best performance, with an AUC of 0.929 (95% CI: 0.888–0.970) and accuracy of 0.859 in the training cohort, AUC of 0.886 (95% CI: 0.780–0.993) and accuracy of 0.846 in the validation cohort, and AUC of 0.712 (95% CI: 0.535–0.889) and accuracy of 0.744 in the test cohort. Data Conclusion: MRI‐based radiomics features combining machine learning algorithm provide a promising approach to assess HER2 status in UBC noninvasively and preoperatively. Evidence Level: 2 Technical Efficacy: Stage 3 [ABSTRACT FROM AUTHOR]

Background: Vesical Imaging‐Reporting and Data System (VI‐RADS) has been developed for assessing bladder cancer from multiparametric (mp) MRI but its performance in diagnosing muscle‐invasive bladder cancer (MIBC) is suboptimal. Purpose: To investigate associations between normalized apparent diffusion coefficient (NADC) and clinicopathological characteristics and to determine whether the inclusion of NADC can improve the performance of VI‐RADS in diagnosing MIBC. Study Type: Retrospective. Population: Two hundred seventy‐five patients with pathologically confirmed bladder cancer (101 MIBC and 174 non‐MIBC [NMIBC]) underwent preoperative mpMRI (233 male, 42 female). Field Strength/Sequence: 3‐T, T2‐weighted imaging (turbo spin‐echo), diffusion‐weighted imaging (free‐breathing spin‐echo), and dynamic contrast‐enhanced imaging (gradient‐echo). Assessment: NADC was the mean ADC of tumor divided by that of the iliopsoas muscles in trans caput femoris plane. Associations between NADC and clinicopathological characteristics were evaluated. Models were established for differentiating MIBC and NMIBC: VI‐RADS model; VN model (VI‐RADS and NADC), Images model (significant variables from imaging associated with MIBC), LN model (Images model without NADC), and Full model (all significant variables associated with MIBC). Statistical Tests: Variables for model development were based on logistic regression. Models were evaluated by receiver operating characteristic (ROC) curve. Comparison of the area under the curves (AUCs) for the models used DeLong's test. A P value <0.05 was considered statistically significant. Results: NADC was significantly lower in lesions with diameter ≥ 3 cm, MIBC, histological high grade, lymph node metastasis, and lymphovascular invasion. Compared with VI‐RADS model, the AUCs for VN model (VI‐RADS score and NADC), Images model (VI‐RADS score, NADC and tumor size) and Full model (VI‐RADS score, NADC, tumor size and histological grade) were significantly higher. No significant differences were observed between the AUCs for VN model and Images model (P = 0.051). Data Conclusion: NADC reflects information about the aggressiveness of bladder cancer. Combining VI‐RADS with NADC can improve performance in diagnosing MIBC. Evidence Level: 4 Technical Efficacy: Stage 2 [ABSTRACT FROM AUTHOR]

Background: The relationship between tumor and muscle layer in the vesical imaging‐reporting and data system (VI–RADS) 3 is ambiguous, and there is a lack of preoperative and non‐invasive procedures to detect muscle invasion in VI‐RADS 3. Purpose: To develop a nomogram based on MRI features for detecting muscle invasion in VI–RADS 3. Study Type: Retrospective. Population: 235 cases (Age: 67.5 ± 11.5 years) with 11.9% females were randomly divided into a training cohort (n = 164) and a validation cohort (n = 71). Field Strength/Sequence: 3T, T2‐weighted imaging (turbo spin‐echo), diffusion‐weighted imaging (breathing‐free spin echo), and dynamic contrast‐enhanced imaging (gradient echo). Assessment: 3 features were selected from the training cohort, including tumor contact length greater than maximum tumor diameter (TCL > Dmax), flat tumor morphology, and lower standard deviation of apparent diffusion coefficient (ADCSD). Three readers assessed VI‐RADS scores and the tumor morphology. Statistical Tests: Interobserver agreement was assessed by Kappa analysis. Features for final analysis were selected by logistic regression. The performance of the nomogram was evaluated by the receiver operating characteristic curve, decision curve analysis, and calibration curve. Results: TCL > Dmax, flat morphology, and lower ADCSD were the independent risk factors for muscle invasive in VI‐RADS 3. The AUCs, accuracy, sensitivity, and specificity of the nomogram 1 composed of three features for detecting muscle invasion were 0.852 (95% CI: 0.793–0.912), 0.756, 0.917, and 0.663 in the training cohort, and 0.885 (95% CI: 0.801–0.969), 0.817, 0.900, and 0.784 in the validation cohort. The nomogram 2 without ADCSD has nearly the same performance as the nomogram 1. Data Conclusion: Nomogram can be an efficient tool for preoperative detection of muscle invasion in VI–RADS 3. Level of Evidence: 3 Technical Efficacy: Stage 2 [ABSTRACT FROM AUTHOR]

Background: Vesical Imaging–Reporting and Data System (VI‐RADS) is widely used to assess the muscle‐invasive status of bladder cancer. However, the current classification efficacy of VI‐RASD 2 tumors of stalk is unsatisfactory. Purpose: To develop a nomogram to assess muscle‐invasive bladder cancer (MIBC) in VI‐RADS 2 tumors with stalk. Study Type: Retrospective. Population: A total of 186 patients (age: 67.8 ± 12.7 years) with 15.1% females, divided randomly into a training cohort (N = 130) and validation cohort (N = 56). Field Strength/Sequence: 3‐T, T2‐weighted imaging (turbo spin‐echo), diffusion‐weighted imaging (breathing‐free spin‐echo), and dynamic contrast‐enhanced imaging (gradient‐echo). Assessment: Twenty‐one MRI features of tumors and stalks were developed from training cohort. The mean apparent diffusion coefficient (ADC) values of the tumor, stalk, and psoas muscles were calculated from the three circular regions of interest. The normalized T value=meanADCtumormeanADCmuscle. The normalized ST value=meanADCstalkmeanADCtumor. Three readers assessed the morphology of tumors and stalks. Statistical Tests: The final features of nomogram were selected by univariable logistic and the least absolute shrinkage and selection operator (LASSO) regression. The performance of the nomogram was assessed by the receiver operating characteristic (ROC) curve, calibration, and decision curve analysis. Results: In VI‐RADS 2 tumors with stalk, tumor size over 3 cm, increased stalk width, stalk morphology, decreased normalized T value, and increased normalized ST value were selected as the risk factors for MIBC. The AUC, accuracy, sensitivity, and specificity of the nomogram to assess MIBC were 0.969 (95% CI: 0.941–0.997), 92.3%, 94.1%, and 92.0% in training cohort and 0.940 (95% CI: 0.859–1.000), 89.3%, 75.0%, and 91.7% in validation cohort. Data Conclusion: This study constructed a nomogram for preoperative assessment of MIBC and modifying the current VI‐RADS. Level of Evidence: 3 Technical Efficacy: Stage 2 [ABSTRACT FROM AUTHOR]

Introduction: The treatment of renal artery aneurysms (RAAs) includes surgical repair and endovascular techniques. Surgical repair is divided into open surgery repair and laparoscopic surgery repair. Laparoscopic RAA has fewer postoperative complications than open surgery. Some experiences with robotic RAA repair via transperitoneal access have been recently reported. However, no report could be found on the treatment of retroperitoneal RAA with the da Vinci robot-assisted surgery thus far. Case Presentation: Here, the surgical management of an 8.6-mm right-sided RAA via robot-assisted laparoscopic retroperitoneal approach in a 58-year-old man who presented with flank discomfort is reported. The aneurysm was resected, and the renal artery was reconstructed. The total operative time was 2 h with a warm ischemia time of 25 min, and the estimated surgical blood loss was 50 mL. The patient resumed a regular diet on postoperative day 2, and the hospital stay lasted 5 days. No intraoperative nor postoperative morbidity was reported. Follow-up imaging and functional analysis demonstrated resolution of the aneurysm and preservation of renal function after 2.5 months. Conclusions: Robot-assisted laparoscopic retroperitoneal RAA repair is flexible and safe. The greatest advantage of retroperitoneal surgery is direct access to the renal artery. Furthermore, it could reduce the injury in the abdominal organs and avoid abdominal adhesion. This approach may also allow for improved postoperative recovery, reduce the morbidity correlated with transperitoneal RAA, and thus may be considered as an alternative to transperitoneal surgery for RAAs in the future. [ABSTRACT FROM AUTHOR]

Background: Retroperitoneal approach and segmental renal artery clamping in partial nephrectomy are techniques that facilitate postoperative recovery and renal function preservation. This study aimed to compare the renal function preservation and perioperative outcomes of robot-assisted partial nephrectomy (RAPN) and laparoscopic partial nephrectomy (LPN) with these techniques. Materials and Methods: Clinical parameters of 43 patients who had undergone retroperitoneal RAPN from March 2017 to December 2019 were retrospectively collected and compared with those of 52 patients who had undergone retroperitoneal LPN at the same period in our institution. Differences in operating time, warm ischemia time, estimated blood loss, complications, postoperative hospital stay, as well as renal function loss were compared between the two groups. Results: Background characteristics between RAPN and LPN groups such as age, gender, BMI, and tumor characteristics were comparable. All RAPNs and LPNs were successfully completed without conversion to open surgery or nephrectomy. No significant difference in operating time, estimated blood loss, complications, and postoperative hospital stay was observed between RAPN and LPN groups. The warm ischemia time in RAPN group was slightly shorter than that of LPN groups (P = .054). Compared with the LPN group, the RAPN group was significantly associated with less glomerular filtration rate reduction and renal volume loss rate (P = .042 and P = .013, respectively). Conclusions: The perioperative outcomes were comparable between the two groups. However, compared with LPN, RAPN had superiority in preserving renal function in our series. [ABSTRACT FROM AUTHOR]

The objective of this study is to systematically evaluate the diagnostic performance of the Vesical Imaging–Reporting and Data System for predicting muscle‐invasive bladder cancer. Embase, PubMed and Web of Science were systematically searched from 1 September 2018 to 30 July 2021 to include proper studies. We included studies that included data on Vesical Imaging–Reporting and Data System and their associated pathological findings, and we assessed their quality using the Quality Assessment of Diagnostic Accuracy Studies‐2 tool. The pooled sensitivity and specificity were calculated and plotted using hierarchical summary receiver operating characterisijutic modeling. Meta‐regression analysis was carried out to detect heterogeneity. A total of 20 studies with 2725 patients were included. When the cut‐off point was 3, the pooled sensitivity and specificity were 0.92 (0.89–0.94) and 0.85 (0.78–0.90), respectively, and 0.82 (0.75–0.88) and 0.95 (0.91–0.97), respectively, when the cut‐off point was 4. The area under the curve was 0.95 and 0.95, respectively. Heterogeneity was substantially considerable in sensitivity and specificity. All subgroup variables, including patient number, study design, magnetic resonance imaging field strength, number of radiologists, surgery pattern, diffusion‐weighted imaging, and dynamic contrast‐enhanced magnetic resonance imaging, contributed to sensitivity heterogeneity when the cut‐off point was 3 and specificity heterogeneity when the cut‐off point was 4. Multiple image acquisition plane of diffusion‐weighted imaging achieved a higher sensitivity than single image acquisition plane of diffusion‐weighted imaging in both the Vesical Imaging–Reporting and Data System 3 and 4 groups, and higher specificity in the Vesical Imaging–Reporting and Data System 4 group. Another significant source of heterogeneity was the cut‐off point. The diagnostic performance of the Vesical Imaging–Reporting and Data System for predicting muscle‐invasive bladder cancer was excellent in both cut‐off points of the Vesical Imaging–Reporting and Data System 3 and 4. Multiple image acquisition planes of diffusion‐weighted imaging should be given more attention in the Vesical Imaging–Reporting and Data System. [ABSTRACT FROM AUTHOR]

Objectives: Accurate preoperative differentiation between non-muscle-invasive bladder cancer (NMIBC) and muscle-invasive bladder cancer (MIBC) is crucial for surgical decision-making in bladder cancer (BCa) patients. MIBC diagnosis relies on the Vesical Imaging-Reporting and Data System (VI-RADS) in clinical using multi-parametric MRI (mp-MRI). Given the absence of some sequences in practice, this study aims to optimize the existing T2-weighted imaging (T2WI) sequence to assess MIBC accurately., Methods: We analyzed T2WI images from 615 BCa patients and developed a multi-view fusion self-distillation (MVSD) model that integrates transverse and sagittal views to classify MIBC and NMIBC. This 3D image classification method leverages z-axis information from 3D MRI volume, combining information from adjacent slices for comprehensive features extraction. Multi-view fusion enhances global information by mutually complementing and constraining information from the transverse and sagittal planes. Self-distillation allows shallow classifiers to learn valuable knowledge from deep layers, boosting feature extraction capability of the backbone and achieving better classification performance., Results: Compared to the performance of MVSD with classical deep learning methods and the state-of-the-art MRI-based BCa classification approaches, the proposed MVSD model achieves the highest area under the curve (AUC) 0.927 and accuracy (Acc) 0.880, respectively. DeLong's test shows that the AUC of the MVSD has statistically significant differences with the VGG16, Densenet, ResNet50, and 3D residual network. Furthermore, the Acc of the MVSD model is higher than that of the two urologists., Conclusions: Our proposed MVSD model performs satisfactorily distinguishing between MIBC and NMIBC, indicating significant potential in facilitating preoperative BCa diagnosis for urologists., (© 2024 Walter de Gruyter GmbH, Berlin/Boston.)