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Purpose: Chronic kidney disease (CKD) is frequent in bladder cancer patients undergoing radical cystectomy (RC) with ileal conduit. However, the effect of CKD on adverse in-hospital outcomes after ileal conduit RC is not well known. Methods: Descriptive analyses, propensity score matching (PSM), and multivariable logistic and Poisson regression models were used to address National Inpatient Sample patients treated with ileal conduit RC between 2006 and 2019. CKD severity was stratified as mild (stage II) vs. moderate (stage III) vs. severe (stage IV/V). Results: Of 13,359 patients treated with RC with ileal conduit, 1973 (14.8%) had CKD. Of those, 956 (48.5%), 802 (40.6%), and 215 (10.9%) were classified as mild, moderate, or severe CKD, respectively. CKD rate increased from 4.1 to 21.9% (2006–2019, EAPC: +8.9%, p < 0.001). CKD RC patients exhibited higher rates of adverse in-hospital outcomes in 11 of 15 categories. The absolute differences were largest for overall complications (+ 13.2%), prolonged length of stay (+ 7.0%), blood transfusions (+ 6.0%, all p < 0.001). After detailed multivariable adjustment, CKD was an independent predictor of 11 of 15 adverse in-hospital outcomes' categories. The detrimental effect of CKD was most pronounced for dialysis (OR 7.09), overall complications (OR 1.84), and neurological complications (OR 1.61, all p < 0.001). Finally, a dose-response effect according to CKD severity on adverse in-hospital outcomes was observed in eight of 15 categories. Conclusions: CKD RC patients invariably exhibited higher rates of adverse in-hospital outcomes after RC with ileal conduit. In consequence this patient group should receive particularly strong consideration for preoperative optimization. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to compare adverse in-hospital outcomes in ileal conduit versus neobladder urinary diversion type after radical cystectomy (RC) in contemporary versus historical patients. Methods: Patients were identified within the National Inpatient Sample (NIS 2000–2019). Propensity score matching (PSM; 1:2 ratio) and multivariable logistic regression models (LRMs) were used. Results: Of 10,533 contemporary (2011–2019) patients, 943 (9.0%) underwent neobladder urinary diversion, while 9590 (91.0%) underwent ileal conduit urinary diversion. Furthermore, of 9742 historical (2010–2019) patients, 932 (9.6%) underwent neobladder urinary diversion and 8810 (90.4%) underwent ileal conduit urinary diversion. After 1:2 PSM, within the contemporary cohort, 943/943 (100%) neobladder versus 1886/9590 (19.6%) ileal conduit patients were included. Similarly, within the historical cohort, 932/932 (100%) neobladder versus 1864/8810 (21.1%) ileal conduit patients were included after PSM. In multivariable LRMs, relative to contemporary neobladder patients, contemporary ileal conduit patients exhibited higher rates of overall postoperative (49.0 vs. 43.6%; multivariable odds ratio [MOR] 1.2), wound (4.2 vs. 2.7%; MOR 1.6), and genitourinary (13.1% vs. 10.0%; MOR 1.3) complications as well as blood transfusions (19.0 vs. 15.6%; MOR 1.3). Conversely, in multivariable LRMs within the historical cohort, no differences were recorded between ileal conduit and neobladder patients. Conclusions: Unlike historical comparisons between ileal conduit and neobladder patients, where no differences in adverse in-hospital outcomes were recorded, analyses relying on a contemporary patient cohort subject to PSM and multivariable adjustment revealed higher rates of adverse in-hospital outcomes in 4/13 examined categories. This observation should be considered at informed consent. [ABSTRACT FROM AUTHOR]

Aim of the study: To investigate the time points at which different major complications occur and their temporal distribution over the postoperative intervals. Patients and methods: Patients who underwent RC between January 2003 and March 2024 at the university hospital Essen and had complete records regarding postoperative complications and their timing were included. All major complications with Clavian-Dindo (CD) grading III-V were identified and recorded according to a predefined morbidity catalog. The time to occurrence of complications, readmission and mortality, was plotted against the postoperative day over a 90-day period to illustrate the distribution of events in the postoperative period. For each complication group, the median timing and the interquartile range (IQR) as well as the incidence during the postoperative weeks were calculated. Results: Out of 757 patients, 282 (37.2%) suffered at least one major complication (CDC grade III-IV) with a total of 452 major complications. Most common complications were gastrointestinal, genitourinary and wound complications. Median (IQR) time to first major complication was 7 (4–17) days. Hospital readmission due to major complications was required in 68 (9%) patients at a median of 47 days. Most of cardiac, pulmonary, bleeding and gastrointestinal complications occurred very early in the first week, at a median of 3, 4, 4 and 5 days, respectively. Wound complications were more likely to occur within the second and third week, with a median time of 13 days. Thromboembolism developed at similar rates throughout the first 3 weeks. The other groups of complications including infectious, genitourinary and miscellaneous (mostly lymphocele) complications showed no specific pattern and occurred in a wide range over the 90 days and were considered intermediate and late events. Further analysis of the time to all complications (first major and secondary), showed an increase in median time to occurance for all complications except genitouranry and lymphocele, which occurred earlier. Deaths related to major complications were observed in 50 (6.6%) patients at a median time of 17 days. Conclusion: The current study shows the temporal patterns of the major complications within the RC morbidity catalog. Physicians should be aware of these patterns to facilitate anticipation and prevent fatal outcomes. [ABSTRACT FROM AUTHOR]

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

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

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

Purpose: We aimed to use a validated artificial intelligence (AI) algorithm to extract muscle and adipose areas from CT images before radical cystectomy (RCx) and then correlate these measures with 90-day post-RCx complications. Materials and Methods: A tertiary referral center's cystectomy registry was queried for patients who underwent RCx between 2009 and 2017 for bladder cancer. Eight hundred forty-three RCx patients with CT imaging within 90 days of preceding surgery were included, to allow for extraction of body composition parameters by AI. We assessed complications within 90 days of surgery including wound, infectious, and major complications; readmission; and death. Multivariable logistic regressions associated pre-RCx measures with post-RCx complications. Results: Increasing subcutaneous adipose tissue was associated with more wound complications, while patients with increasing visceral adipose tissue had greater odds of infectious-related complications. After adjusting for patient characteristics, every 10 cm2 increases in fat mass index were associated with more infectious (odds ratio [OR], 1.04; P =.002) and wound (OR, 1.06; P <.001) complications. On multivariable analysis, a higher preoperative skeletal muscle index was associated with lower odds of major complications (OR, 0.75 for every 10 cm2; P =.008), while higher intramuscular adipose was associated with higher odds of major complications (OR, 1.93; P =.008). Conclusions: Automated AI body composition measurements preoperatively are associated with post-RCx complications. These measurements, in addition to patient (Eastern Cooperative Oncology Group performance status and smoking status) and surgical (robotic approach and continent diversion) characteristics, can then be used to individualize patient counseling and facilitate triage of nutritional and rehabilitation efforts. [ABSTRACT FROM AUTHOR]

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

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

Introduction: Open ureteroenteric reimplantation (OUER) of ureteroenteric strictures (UESs) is related to important morbidity. Robot-assisted ureteroenteric reimplantation (RUER) has been proposed to provide similar outcomes with lower morbidity. We aimed to compare perioperative and functional outcomes between RUER and OUER. Methods: A retrospective multicenter study of 80 patients, who underwent 82 ureteroenteric reimplantations (17 OUER vs 65 RUER) at 8 institutions between 2009–2021 for benign UESs after radical cystectomy. All the open procedures were performed by the same center in order to compare the robotic approach with a standardized technique. Data were reviewed for demographics, stricture characteristics, and perioperative outcomes. Complication and stricture recurrence rates were compared between both groups. Results: Among 82 reimplantations, 44 were left sided (54%) and 12 bilateral (14%). Median time from cystectomy to diagnosis of stricture was 6 months (range 3–18). Baseline characteristics (gender, age, BMI, side, type of urinary diversion and previous abdominal radiotherapy) were comparable between RUER and OUER groups, except for ASA score and rates of prior robotic cystectomy. The 30-day overall postoperative complication rate was 37% in RUER compared to 70.6% in OUER (p = 0.026). Patients who underwent a RUER had statistically significant lower rate of intraoperative blood transfusion (0% vs 12%, p = 0.041), urinary tract infection (12% vs 53%, p < 0.001), bowel injury (0% vs 12%, p = 0.041) and high-grade complications (Clavien III-IV) (4.6% vs 23.5%, p = 0.031). RUER patients had shorter median length of hospital stay (3 days IQR[1–6] vs 6 IQR[3–9], p = 0.018) and lower readmission rate (4.6% vs 29.4%, p = 0.008). After a median follow-up of 23.5 months (8.7–43), 80% of RUER cases were stricture free compared to 90% of OUER (p = 0.42). Conclusions: RUER achieved a success rate comparable to that of open revisions and may provide some advantages in terms of perioperative outcomes. Prospective and larger studies are warranted to prove its superiority compared to the standard open technique. [ABSTRACT FROM AUTHOR]

The article published in BJU International explores the outcomes of patients with residual cancer at radical cystectomy (RC) with or without neoadjuvant chemotherapy (NAC) for muscle-invasive bladder cancer. The study, based on National Cancer Database (NCDB) data, found that NAC followed by RC was associated with improved overall survival in certain pathological stages, but worse outcomes in others. The research highlights the need for better selection criteria for NAC and the exploration of novel systemic therapies for high-risk patients with locally advanced disease. Limitations include the retrospective nature of the study and the lack of detailed information on chemotherapy regimens. [Extracted from the article]

Objective: To examine the impact of increased compliance to contemporary perioperative care measures, as outlined by enhanced recover after surgery (ERAS) guidelines, among patients undergoing radical cystectomy (RC). Patients and Methods: From the National Surgical Quality Improvement Program database we captured patients undergoing RC between 2019 and 2021. We identified five perioperative care measures: regional anaesthesia block, thromboembolism prophylaxis, ≤24 h perioperative antibiotic administration, absence of bowel preparation, and early oral diet. We stratified patients by the number of measures utilised (one to five). Statistical endpoints included 30‐day complications, hospital length of stay (LOS), readmissions, and optimal RC outcome. Optimal RC outcome was defined as absence of any postoperative complication, re‐operation, prolonged LOS (75th percentile, 8 days) with no readmission. Multivariable regressions with Bonferroni correction were performed to assess the association between use of contemporary perioperative care measures and outcomes. Results: Of the 3702 patients who underwent RC, 73 (2%), 417 (11%), 1010 (27%), 1454 (39%), and 748 (20%) received one, two, three, four, and five interventions, respectively. On multivariable analysis, increased perioperative care measures were associated with lower odds of any complication (odds ratio [OR] 0.66, 99% confidence interval [CI] 0.6–0.73), and shorter LOS (β −0.82, 99% CI −0.99 to −0.65). Furthermore, patients with increased compliance to contemporary care measures had increased odds of an optimal outcome (OR 1.38, 99% CI 1.26–1.51). Conclusions: Among the measures we assessed, greater adherence yielded improved postoperative outcomes among patients undergoing RC. Our work supports the efficacy of ERAS protocols in reducing the morbidity associated with RC. [ABSTRACT FROM AUTHOR]

• Stented radical cystectomies had higher major complications (P = 0.04); • Stentless radical cystectomy was noninferior in UIAS rate; • Stentless radical cystectomy was noninferior in UIAL rate; • Stentless radical cystectomy was noninferior in UTI rate. To systematically compare the evidence about surgical outcomes, postoperative complications, and sequelae of Radical cystectomy with urinary diversion with or without stent placement. A literature search was performed through PubMed, Scopus®, and Web of Science up to December 2023 in accordance with the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) statement. The study protocol was registered in PROSPERO (CRD 42023492384), and the research question was formulated according to the PICOs model. Three comparative studies were identified, 2 randomized and 1 prospective coming from a randomized cohort. The stent group showed higher odds of postoperative major complications (OR 3.00 – 95%CI 1.06; 8.52; P = 0.04) than the stentless group. There was no statistically significant difference between the 2 groups regarding 30-day readmission (P = 0.06), postoperative uretero-ileal anastomotis stricture (UIAS) (P = 0.09), postoperative uretero-ileal anastomotis leak (UIAL) (P = 0.20), postoperative urinary tract infections (UTIs) (P = 0.08), and postoperative ureteral obstruction (P = 0.35). No statistically significant difference between the 2 groups was found regarding UIAS management in terms of ureteral reimplantation (P = 0.28) or dilatation (P = 0.36). Our pooled data analysis shows no statistically significant difference between stentless and stented urinary diversion after radical cystectomy. Stentless could be a reasonable choice when performing diversion during radical cystectomy. [ABSTRACT FROM AUTHOR]

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

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

Purpose: Patients treated with radical cystectomy experience a high rate of postoperative complications and frequent hospital readmissions. We sought to explore the utility of the Care Assessment Need (CAN) score, derived from electronic health data, to estimate the risk of these adverse clinical outcomes, thereby aiding patient counseling and informed treatment decision-making. Materials and Methods: We retrospectively examined data from 982 patients with bladder cancer who underwent radical cystectomy between 2013 and 2018 within the national Veterans Health Administration system. We tested for associations between the preoperative CAN score and length of stay, discharge location, and readmission rates. Results: We observed a correlation between higher CAN scores and longer hospital stays (adjusted relative risk = 1.03 [95% CI: 1.02-1.05]). An increased CAN score was also linked to greater odds of discharge to a skilled nursing facility or death (adjusted odds ratio = 1.16 [95% CI: 1.06-1.26]). Furthermore, the score was associated with hospital readmission at both 30 and 90 days postdischarge (adjusted HR = 1.03 [95% CI: 1.00-1.07] and 1.04 [95% CI: 1.00-1.07], respectively). Conclusions: The CAN score is associated with length of hospital stay, discharge to a skilled nursing facility, and readmission within 30 and 90 days after radical cystectomy. These findings highlight the potential of health care systems leveraging electronic health records for automatically calculating multidimensional tools, such as the CAN score, to identify patients at risk of adverse clinical outcomes after radical cystectomy. [ABSTRACT FROM AUTHOR]

Purpose of Review: The purpose of this review is to highlight the health-related quality of life (HRQOL) burden of bladder cancer due to the disease itself and its treatments. Recent Findings: Large database studies have provided evidence that patients with bladder cancer have worse HRQOL than the general population. While transurethral resections and intravesical therapy are known to cause urinary symptoms, a large impact on HRQOL otherwise has not been demonstrated. Radical cystectomy (RC) has considerable morbidity, but after an initial adjustment period, there are favorable HRQOL outcomes. Evidence is insufficient to conclude that there are HRQOL advantages for continent versus ileal conduit urinary diversion, minimally invasive RC, or trimodal therapy. Summary: Bladder cancer and its treatment has a considerable HRQOL burden, but even among those requiring radical treatment, acceptable long term HRQOL is possible. Research on improved HRQOL assessment and translating this to personalized support are needed. [ABSTRACT FROM AUTHOR]

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

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

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

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

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

Objectives Methods Results Conclusion It is not known whether cancer‐specific mortality (CSM) differences distinguish radical cystectomy (RC) from trimodal therapy (TMT) in octogenarians harbouring organ‐confined (T2N0M0) urothelial cancer of the urinary bladder (UCUB).Within the Surveillance, Epidemiology, and End Results database (2004–2021), CSM and other‐cause mortality (OCM) rates were computed in octogenarian patients with organ‐confined UCUB undergoing either TMT or RC. Smoothed cumulative incidence plots depicted 5‐year CSM and OCM rates according to RC vs TMT. Competing risks regression (CRR) models were fitted, adjusting for age, gender, and race/ethnicity. Nearest‐neighbour 1:1 propensity‐score matching (PSM) for age and gender was also applied. Sensitivity analyses were additionally performed, focusing on White patients.Of 2335 octogenarian patients with T2N0M0 UCUB, 1562 (66.3%) received TMT and 793 (33.7%) received RC. Of those, 2082 (88.4%) were White. TMT rates increased from 53.5% in 2004 to 82.2% in 2021 (P < 0.001). The 5‐year CSM rate was 50.1% for TMT vs 31.1% for RC. After multivariable CRR, TMT independently predicted 1.7‐fold higher CSM (P < 0.001). After additional PSM, TMT also independently predicted 1.7‐fold higher CSM (P < 0.001). In sensitivity analyses exclusively focusing on White patients, almost identical results were recorded.Rates of TMT have nearly doubled in octogenarian patients with organ‐confined UCUB in recent years; however, CSM rates after TMT are also nearly twice as high as those observed after RC. It is crucial to communicate these observations. [ABSTRACT FROM AUTHOR]

Objectives Patients and Methods Results Conclusion To assess whether the effect of sarcopenia on neoadjuvant chemotherapy (NAC) toxicity is modified by borderline renal function (estimated glomerular filtration rate [eGFR] 40–65 mL/min) and whether sarcopenia and borderline renal function are independently associated with NAC toxicity risk.All patients with muscle‐invasive bladder cancer (MIBC) who underwent radical cystectomy (RC) between 2010 and 2022, with available cross‐sectional imaging prior to NAC initiation, were included. Skeletal mass was measured from axial computed tomography images obtained at the level of the L3 vertebral body, using Aquarius Intuition software. Sarcopenia was assigned based on consensus definitions of skeletal mass index. NAC toxicity was graded according to Common Terminology Criteria for Adverse Events version 5.0. Binary logistic regression was used to identify the predictors of NAC‐associated renal toxicity.A total of 216 patients were included. Most patients had sarcopenia (83%) and received gemcitabine/cisplatin NAC (76%). In an unadjusted model, sarcopenia was associated with a significant risk of renal‐associated NAC toxicity (odds ratio [OR] 4.88, 95% confidence interval [CI] 1.65–14.44; P = 0.004). In an effect modification model evaluating the interaction between sarcopenia and renal function, the OR for renal toxicity with sarcopenia among patients with eGFR 40–65 mL/min was 8.46 (95% CI 1.06–67.72) vs 3.11 (95% CI 0.81–11.88) among patients with normal renal function (P = 0.43).Among MIBC patients who received NAC, sarcopenia was associated with higher odds of NAC‐associated renal toxicity and may increase risk of renal toxicity among patients with borderline renal function. [ABSTRACT FROM AUTHOR]

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

Objective Methods Results Conclusion To evaluate whether surgical margin status, alongside existing postoperative risk indicators, improves the identification of bladder cancer patients who may benefit from adjuvant therapy following radical cystectomy (RC).In this nationwide cohort study, patients aged ≥18 years diagnosed with muscle‐invasive bladder cancer (MIBC) without nodal or distant metastasis (cT2‐4aN0/xM0) between November 2017 and December 2020 who underwent RC were selected from the Netherlands Cancer Registry. Detailed information on surgical margin status was obtained through linkage with the Dutch central pathology database, Palga. Overall survival (OS) and progression‐free survival (PFS) were assessed using the Kaplan–Meier method. Multivariable Cox regression analysis was performed to assess the independent prognostic effect of positive surgical margins (carcinoma in situ (CIS)] only or invasive carcinoma) on PFS and OS.We identified 1445 MIBC patients treated by RC (53% open, 47% robot‐assisted), of whom 135 (9.3%) had positive surgical margins (10.7% in the open and 7.7% in the robot‐assisted cohort). In the entire cohort, OS was 79% and 60% at 12 and 48 months after RC, respectively. PFS was 70% and 61% at 12 and 24 months, respectively. Multivariable Cox regression showed worse PFS (hazard ratio (HR) 2.13, 95% confidence interval (CI) 1.67–2.72) and OS (HR 2.02, 95% CI 1.58–2.58) in patients with surgical margins with invasive carcinoma vs patients with negative margins. Patients with only CIS in the margins also appeared to have worse PFS (HR 1.60, 95% CI 1.00–2.58) but these results were not statistically significant. No difference was found for OS (HR 1.30, 95% CI 0.80–2.12).Positive margins should be considered a ‘high risk feature, as they result in increased risk of disease progression and impaired survival outcomes. These findings support further investigation of the potential efficacy of adjuvant therapy (i.e., radiotherapy and systemic therapy) among patients with positive surgical margins. [ABSTRACT FROM AUTHOR]

Objectives: This study aims to develop a prognostic model that estimates the post‐operative risk of cancer‐specific mortality in patients with bladder cancer who underwent radical cystectomy (RC). Methods: We analyzed the data from patients with bladder cancer who had undergone radical cystectomy without receiving adjuvant chemotherapy across 36 institutions in the Japan Urological Oncology Group. The data were randomly split into training (N = 1348) and validation sets (N = 674) in a 2:1 ratio. Twenty‐five variables were analyzed, and a multivariable Cox regression model predicting cancer‐specific mortality was developed and validated. Prognostic scores were categorized into good and poor prognostic groups based on the upper tertile. The performance of the model was compared against the CheckMate 274 risk classification as a reference, which is used for determining the indication of adjuvant nivolumab therapy. Results: The final model incorporated eight variables. In the validation set, it outperformed the CheckMate 274 risk classification with superior time‐dependent area under the curves (5‐year: 0.81 vs. 0.67) and was well‐calibrated. Furthermore, our model reclassified 27.8% of patients categorized as high‐risk by the CheckMate 274 risk classification into the good prognosis group. Conclusions: We developed and validated a prognostic model for patients with bladder cancer who underwent RC. This model will be beneficial in identifying patients with poor prognosis and those who are potential candidates for clinical trials of adjuvant therapy. [ABSTRACT FROM AUTHOR]

Objectives: To investigate the lymph node invasion (LNI) rate in patients exhibiting complete pathological response (CR) to neoadjuvant chemotherapy (NAC) and to test the association of CR status with lower LNI and better survival outcomes. Materials and Methods: We included patients with bladder cancer (BCa; cT2‐4a; cN0; cM0) treated with NAC and radical cystectomy (RC) + pelvic lymph node dissection (PLND) at our institution between 2012 and 2022 (N = 157). CR (ypT0) and LNI (ypN+) were defined at final pathology. Univariable and multivariable logistic regression analysis was performed to test the association between CR and LNI after adjusting for number of lymph nodes removed (NLR). Kaplan–Meier and Cox regression analyses were used to assess overall survival (OS), metastasis‐free survival (MFS) and disease free‐survival (DFS) according to CR status. Results: Overall CR and LNI rates were 40.1% and 19%, respectively. The median (interquartile range [IQR]) NLR was 26 (19–36). The LNI rate was lower in patients with CR vs those without CR (2 [3.2%] vs 61 [29.8%]; P < 0.001). After adjusting for NLR, CR reduced the LNI risk by 93% (odds ratio 0.07, 95% confidence interval [CI] 0.01–0.25; P < 0.001). Kaplan–Meier plots depicted better 5‐year OS (69.7 vs 52.2%), MFS (68.3 vs 45.5%) and DFS (66.6 vs 43.5%) in patients with CR vs those without CR. After multivariable adjustments, CR independently reduced the risk of death (hazard ratio [HR] 0.44, 95% CI 0.24–0.81; P = 0.008), metastatic progression (HR 0.41, 95% CI 0.23–0.71; P = 0.002) and disease progression (HR 0.41, 95% CI 0.24–0.70; P = 0.001). Conclusion: Based on these findings, we postulate that PLND could potentially be omitted in patients exhibiting CR after NAC, due to negligible risk of LNI. Prospective Phase II trials are needed to explore this challenging hypothesis. [ABSTRACT FROM AUTHOR]

This overview of the 2024 European Association of Urology guidelines offers valuable insights into risk factors, diagnosis, classification, prognostic factors, treatment, and follow-up of non–muscle-invasive bladder cancer patients. These guidelines are designed for effective integration into clinical practice. This publication represents a summary of the updated 2024 European Association of Urology (EAU) guidelines for non–muscle-invasive bladder cancer (NMIBC), TaT1, and carcinoma in situ. The information presented herein is limited to urothelial carcinoma, unless specified otherwise. The aim is to provide practical recommendations on the clinical management of NMIBC with a focus on clinical presentation. For the 2024 guidelines on NMIBC, new and relevant evidence was identified, collated, and appraised via a structured assessment of the literature. Databases searched included Medline, EMBASE, and the Cochrane Libraries. Recommendations within the guidelines were developed by the panel to prioritise clinically important care decisions. The strength of each recommendation was determined according to a balance between desirable and undesirable consequences of alternative management strategies, the quality of the evidence (including the certainty of estimates), and the nature and variability of patient values and preferences. Key recommendations emphasise the importance of thorough diagnosis, treatment, and follow-up for patients with NMIBC. The guidelines stress the importance of defining patients' risk stratification and treating them appropriately. This overview of the 2024 EAU guidelines offers valuable insights into risk factors, diagnosis, classification, prognostic factors, treatment, and follow-up of NMIBC. These guidelines are designed for effective integration into clinical practice. [ABSTRACT FROM AUTHOR]

Background: Radical cystectomy in women generally includes the removal of the uterus, ovaries, and anterior vaginal wall, but the criteria for reproductive organ sparing are not clear. Methods: A total of 2674 patients with bladder cancer were retrospectively reviewed, having undergone cystectomy at this nationwide multicenter from January 2013 to December 2019. We evaluated the incidence of malignancy in reproductive organs in a cohort of 417 women and analyzed the clinicopathological features of reproductive organ involvement. Recurrence-free survival and overall survival were reported using Kaplan–Meier survival curves. Results: Median follow-up was 36.9 months. Of the 417 patients with urothelial carcinoma of the bladder, 325 underwent hysterectomy, and 92 had a spared uterus and anterior wall of the vagina. Twenty-nine (8.9%) patients exhibited reproductive organ involvement; this consisted of 22 (6.8%) uteri, 16 (4.9%) vaginas, and two (0.6%) ovaries. Incidental primary reproductive malignancies were found in only two (0.6%) patients. Recurrence-free survival and overall survival were significantly shorter in patients with reproductive organ involvement than in those without. Patients with reproductive organ involvement were more likely to have tumors with ≥ cT3 or sub-localization at the posterior/trigone/bladder neck. Conclusions: The risk of reproductive organ involvement cannot be ignored in women undergoing radical cystectomy for urothelial carcinoma of the bladder, therefore, the eligibility criteria for reproductive organ preservation should be considered carefully. [ABSTRACT FROM AUTHOR]

Objectives Patients and Methods Results Conclusions To investigate changes in quality of life (QoL) up to 8 years after radical cystectomy (RC) and compare QoL after RC with a gender‐ and age‐matched Dutch normative population. Furthermore, we aimed to identify patient characteristics associated with QoL and QoL trajectories after RC.Patients with bladder cancer were invited to complete QoL questionnaires at 3‐month intervals in the first year and yearly thereafter. Follow‐up data were available for a maximum of 8 years. We used linear mixed‐effect models to investigate changes in QoL subscales (physical functioning [PF], emotional functioning [EF], and QoL summary score [QoL‐sum]) over time, and to identify potential demographic and clinical correlates of QoL and QoL trajectories (i.e., interaction with time).Data from 278 patients was included. Post‐RC EF scores increased from 83.7 (95% confidence interval [CI] 81.7–85.6) to levels comparable to the normative population (90.1) 8 years after RC. PF (post‐RC: 82.4, 95% CI 78.5–86.3) and QoL‐sum (post‐RC: 88.2, 95% CI 85.2–91.2) remained lower compared to the normative population (88.9 and 91.4, respectively) 8 years after RC. Compared to patients with an American Society of Anesthesiologists (ASA) score of 1 at diagnosis, those with ASA score 2 or ASA score 3 had significant lower post‐RC PF (mean difference (MD) = −8 and −22, respectively; P < 0.001), EF (MD = −1 and −11; P = 0.5 and P < 0.01) and QoL‐sum (MD = −2 and −9; P = 0.2 and P < 0.01). In addition, patients with a higher ASA score had a worse QoL‐sum trajectory (Pinteraction = 0.01). Older patients had a worse PF trajectory (Pinteraction < 0.01) but higher post‐RC EF (P < 0.01).Directly after RC, patients have lower PF, EF and QoL‐sum, compared to a normative population. Notably, EF recovers to normative levels over a period of 8 years after RC. Clinicians are encouraged to administer supportive care interventions to enhance the QoL for patients undergoing RC, especially targeting older patients and those with higher ASA scores. [ABSTRACT FROM AUTHOR]

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

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

Background: To develop a prognostic model to manage patients with muscle-invasive bladder cancer (MIBC) undergoing radical cystectomy (RC) and chemotherapy. Patients and Methods: Clinicopathologic characteristics and survival data were collated from a North American database to develop a model. Genomic and clinicopathologic data were also obtained from European and Asian databases to externally validate the model. Patients were classified as either "primary" or "progressive" MIBC according to non-muscle invasive stage history. Optimized cancer-specific survival (CSS) models, based on MIBC types, were constructed using Cox's proportional hazard regression. Differences of biological function and tumor immunity, between two risk-based groups stratified according to the prognostic model, were estimated. Results: There were 2631 participants in the American cohort, 291 in the European cohort and 142 in the Asian cohort. Under Cox's regression analysis, tumor stage, lymph node stage, age, ethnicity, and MIBC types were independent CSS predictors (all p < 0.05). The constructed nomogram, which integrated these variables, improved the predictive power. This model had good discrimination and calibration. Patients were categorized into high- or low-risk groups according to the total points calculated. Kaplan–Meier curves revealed that patients in the high-risk group had poorer survival (p < 0.001). This was confirmed with two external validation cohorts (both with p < 0.001). Higher stromal scores and increased M0 and M2 macrophage numbers were observed in samples from the high-risk group, whereas regulatory T cells had lower infiltration in these populations (all with p < 0.05). Conclusions: This MIBC type-based nomogram provides accurate CSS predictions, which could help improve patient management and clinical decision-making. [ABSTRACT FROM AUTHOR]