Bladder (San Francisco, Calif.)最新文献

Background: The Vesical Imaging Reporting and Data System (VI-RADS) has been introduced as a standardized tool for assessing multiparametric magnetic resonance imaging (MRI) in the pre-operative staging of bladder cancer.

Objective: The present systematic review evaluates the efficacy of VI-RADS in diagnosing muscle-invasive bladder cancer (MIBC) compared with established diagnostic techniques. A systematic review was conducted according to PRISMA guidelines using PubMed, Scopus, and Web of Science. Studies assessing VI-RADS for MIBC diagnosis were included if they reported sensitivity, specificity, area under the curve, and comparisons with conventional approaches. Study characteristics, sample size, VI-RADS cutoff, diagnostic performance, and risk of bias were evaluated. Thirteen studies (sample sizes ranging from 18 to 340) demonstrated high diagnostic performance, with sensitivity ranging from 78% to 100%, specificity from 73% to 96%, and AUC from 0.86 to 0.96. VI-RADS outperformed standard assessment in reducing transurethral resection of bladder tumor (TURBT)-related understaging. A forest plot showed variability in sensitivity, influenced by radiologist experience, magnetic resonance imaging protocols, and study design. The risk of bias was moderate-to-low.

Conclusion: VI-RADS is an effective non-invasive tool for detecting MIBC and plays an important role in pre-operative decision-making. It may reduce the need for repeat TURBT. Standardization of MRI protocols and radiologist training is vital to improve diagnostic reliability.

Background: Pneumomediastinum represents a rare but potentially serious complication of robotic-assisted radical nephrectomy, often resulting from carbon dioxide insufflation during retroperitoneal surgery.

Case presentation: Reported here is a case of a 78-year-old female who underwent an uneventful robotic-assisted radical nephrectomy for a right renal mass but presented 5 days postoperatively with shortness of breath and chest discomfort. Imaging confirmed extensive pneumomediastinum without esophageal perforation. She was managed conservatively with oxygen therapy, pain control, and a soft diet, leading to full recovery.

Conclusion: Awareness of risk factors, such as a low body mass index, prolonged operative time, and extensive retroperitoneal dissection, is essential for early recognition and management of this rare complication.

Background: Recurrence of non-muscle-invasive bladder cancer (NMIBC) still presents a significant clinical challenge, with the contributing factors yet to be fully understood.

Objective: This study explored the clinical implications of tumor location in NMIBC recurrence.

Methods: An observational cohort study was conducted, including 108 NMIBC patients who experienced a total of 344 NMIBC diagnoses (both primary and recurrent) between 1999 and 2019. Clinical information was collected for primary and recurrent tumors. Tumor locations were classified into 10 categories: bladder neck (neck), dome, posterior, anterior, trigone, right, right rear, left, multiple site(s), and others. The association between tumor location and recurrence was systematically analyzed.

Results: The median follow-up period lasted for 28 months (range: 2-88 months), the median recurrence interval was 13.5 months, and 44 patients (40.7%) progressed into muscle-invasive disease. Univariate analysis revealed that tumor location within the bladder significantly impacted recurrence-free interval, progression-free survival, and overall survival. Tumors situated in the bladder neck, dome, right posterior wall, and trigone demonstrated significantly shorter recurrence-free intervals, rendering these areas high-risk regions. The original tumor site was the most common relapse location, and the recurrence interval shortened as the number of recurrences increased. Over time, the recurrence pattern shifted, with tumors most frequently recurring in the left wall, multiple sites, right wall, and posterior wall.

Conclusion: The findings suggest that bladder cancer most commonly recurs at the original site, with high-risk locations linked to shorter recurrent intervals and greater risks for disease progression. In addition, the recurrence interval tends to decrease with successive recurrences.

Background: Muscle-invasive bladder cancer has a poor prognosis. Accurate lymph node (LN) staging is crucial, yet conventional imaging demonstrates limited sensitivity for detecting metastasis, necessitating improved pre-operative assessment.

Objectives: To evaluate the diagnostic accuracy of ¹⁸F-fluorodeoxyglucose positron emission tomography combined with computed tomography (FDG-PET/CT) compared to computed tomography (CT) for LN staging in patients with bladder cancer(BC) undergoing radical cystectomy (RC), and to assess the impact of imaging-determined nodal status on survival outcomes.

Methods: This retrospective study analyzed 138 patients who underwent RC and pelvic LN dissection (PLND) at a multisite tertiary institution from 2008 to 2021. All patients received either pre-operative CT or FDG-PET/CT within 8 weeks before RC and PLND. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value for detecting LN metastasis (LNM) were calculated using pathological analysis as the reference standard. Kaplan-Meier survival analysis and Cox regression were employed to assess overall survival (OS).

Results: FDG-PET/CT exhibited higher sensitivity (70% vs. 23.3%) and PPV (70% vs. 38.46%) compared to CT, but lower specificity (78.57% vs. 85.7%). Survival outcomes showed statistically significant differences in OS between node-positive and node-negative groups in the FDG-PET/CT cohort, but not in the CT cohort.

Conclusion: FDG-PET/CT provides superior sensitivity and PPV compared to CT for LN staging in BC, facilitating more accurate pre-operative evaluation. The improved prognostic stratification associated with FDG-PET/CT may guide individualized treatment strategies.

Background: The Clinical and Laboratory Standards Institute (CLSI) recommends the development of enhanced antibiograms specifically for elderly patients (≥65 years) to address the needs of long-term care facilities and to account for the anatomical sites from which specimens are collected, thereby facilitating antimicrobial stewardship. Similarly, the Canadian Pediatric Society advocates developing local, age-specific antibiograms to guide antimicrobial selection for targeted infections.

Objective: This study aimed to develop antibiograms based on uropathogens identified at LifeLabs in British Columbia (BC), Canada.

Methods: Urinary specimens from pediatric (<18 years) and geriatric (≥65 years) patients were collected and processed at LifeLabs, a community laboratory network comprising 129 collection centers across BC, between October 1, 2023, and September 30, 2024. Urinary antibiograms for both groups were developed in accordance with CLSI guidelines.

Results: Among the 13,870 pediatric specimens, the most common uropathogen was Escherichia coli (13.7%), followed by Enterococcus faecalis (2.0%), Proteus mirabilis (1.1%), Streptococcus agalactiae (0.9%), Staphylococcus saprophyticus (0.9%), and Klebsiella pneumoniae (0.5%). Among the 148,480 geriatric specimens, the most common uropathogen was E. coli (17.1%), followed by E. faecalis (3.6%), K. pneumoniae (3.4%), S. agalactiae (2.0%), P. mirabilis (1.3%), and Pseudomonas aeruginosa (0.8%). Among the routine antimicrobials tested, ciprofloxacin consistently demonstrated significantly different susceptibility rates (p<0.05) between the pediatric and geriatric groups: E. faecalis (96.3% vs. 81.4%), E. coli (73.7% vs. 67.3%), and P. mirabilis (92.6% vs. 84.8%).

Conclusion: The distribution of common uropathogens and their susceptibilities differed between pediatric and geriatric groups, supporting the need for age-specific antibiograms in community settings. Ciprofloxacin demonstrated lower susceptibility to the predominant uropathogens in elderly patients. Community antimicrobial stewardship teams should acknowledge these differences to better prioritize interventions tailored to each age group.

Background: Local antibiograms are a highly useful tool to guide empiric antibiotic therapy for a variety of infections.

Objectives: This study compares nitrofurantoin (NF) susceptibility in outpatient urine isolates using antibiogram data from two United States academic medical centers.

Methods: In this brief report, we compare antibiograms of urinary isolates from two distinct academic institutions-the University of Texas Southwestern (UTSW) in Dallas, Texas, and the University of Kansas Medical Center (KU) in Kansas City, Kansas-focusing on the most common uropathogens susceptible to NF to evaluate whether NF remains an appropriate first-line agent for uncomplicated cystitis.

Results: For the 2022 antibiogram, KU tested 5,524 urinary isolates and UTSW tested 2,530 urinary isolates. The susceptibility data were consistent across the two institutions, suggesting that NF can continue to be considered a first-line therapy for uncomplicated urinary tract infections in women.

Conclusion: This report highlights the importance of clinicians consulting their local antibiograms to inform empiric antibiotic therapy.

Background: Ureteral tumors are rare and present unique diagnostic and therapeutic challenges.

Objective: This study aimed to evaluate the efficacy and safety of transurethral resection (TUR) in treating ureteral tumors located in the intramural segment of the bladder wall.

Methods: This retrospective study analyzed the clinical data of 24 patients who underwent TUR for intramural ureteral tumors at Changhai Hospital, Shanghai, China, from May 2020 to September 2023. All patients were treated using an "outer wedge, inner rotation" technique, with ureteral stent placed during the procedure.

Results: All surgeries were successfully completed, with a median operative time of 45 min (range: 25-75 min), median intraoperative blood loss of 5 mL (range: 1-30 mL), median post-operative hospitalization of 4 days (range: 3-10 days), mean ureteral stent placement duration of 34.1 ± 10.1 days, and a mean tumor resection diameter of 1.9 ± 0.7 cm. There were no intraoperative complications, while post-operative hydronephrosis occurred in 12.5% of patients. Pathological examination revealed that all tumors were urothelial carcinoma, with five cases of Ta stage, one case of pT1 low-grade, 14 cases of pT1 high-grade, and four cases of pT2a high-grade. The median follow-up period lasted for 28 months (range: 11-38 months), with a tumor recurrence rate of 20.8%.

Conclusion: TUR of ureteral tumors in the intramural segment is a minimally invasive procedure associated with low blood loss, reduced post-operative complications, and efficacious tumor control while preserving renal function. However, the possibility of local tumor recurrence remains, necessitating close post-operative surveillance.

Background: Bladder cancer (BCa) poses a significant global health burden with mounting incidence and mortality rates. Effective treatment strategies are urgently needed to alleviate the disease burden and improve patients' quality of life (QoL).

Objective: This study aimed to evaluate the efficacy of robot-assisted radical cystectomy (RARC) plus the Bordeaux robotic intracorporeal orthotopic neobladder (riONB) technique for the treatment of BCa.

Methods: We retrospectively analyzed clinical data from seven male patients who had undergone RARC with Bordeaux riONB between June 2023 and November 2024. The median age was 68 years, and the median body mass index was 24.2 kg/m². The study assessed their demographic data, intra- and post-operative parameters, pathological characteristics, and complications.

Results: The median operation time lasted for 583 min, with a median estimated blood loss of 375 mL and a median post-operative hospital stay of 10 days. Pathological results showed that five patients (71.4%) were at stage ≥T2. According to the Clavien-Dindo classification, six patients (85.7%) had grade I - II complications. At 6 months post-surgery, the average maximum cystometric capacity measured 397 mL, the average post-void residual urine volume was 29 mL, the average urine flow rate was 5.6 mL/s, and the incontinence-QoL score was 85. Daytime urinary control was good in five patients (71.4%), and nighttime control was good in three patients (42.9%).

Conclusion: The results indicate that RARC + Bordeaux riONB is a safe and effective surgical option for BCa, accomplishing good patient recovery and significant clinical efficacy. However, the study was subject to limitations of a small sample size and a short follow-up period. Further research with larger cohorts and longer follow-up is warranted to confirm these findings.

Background: T1 high-grade (T1HG) bladder cancer (BC) carries substantial risks of recurrence and progression, deserving of heightened clinical attention.

Objective: The present study evaluated the management approaches and reported 14-year real-world outcomes in patients with T1HG BC from a single-center cohort.

Methods: Data were retrospectively collected from primary T1HG patients who had undergone transurethral resection of bladder tumors (TURBT) at our institution between 2010 and 2023. A total of 165 patients were included. Their baseline characteristics, pathological findings, adjuvant therapies, recurrence, progression, and survival outcomes were analyzed. Predictors of tumor recurrence were modeled using multivariable analyses.

Results: Tumor recurrence was significantly associated with post-operative Bacillus Calmette-Guérin (BCG) treatment (odds ratio [OR]: 0.315, p=0.001) and tumor multifocality (OR: 0.476, p=0.033). Among patients having received post-operative BCG treatment, tumor recurrence bore a significant correlation with tumor multifocality (OR: 0.328, p=0.027), and elevated body mass index (BMI) was identified as a potential accelerator of recurrence (hazard ratio: 1.098, p=0.01). The 10-year recurrence-free survival rate among all patients stood at 54.9% (95% confidence interval [CI]: 44.3-65.5%), with a median of 134 months (95% CI: 64.7-203.3 months). The rate of re-TURBT was 20%. The 10-year progression-free survival was 87.2% (95% CI: 81.0-93.5%) and the 10-year overall survival was 66.7% (95% CI: 54.0-79.4%). The 10-year cancer-specific survival and the 10-year cystectomy-free survival (CFS) rates were 93.7% (95% CI: 88.4-99.0%) and 86.3% (95% CI: 79.8-92.8%), respectively. Notably, BCG treatment significantly improved CFS (p=0.01).

Conclusion: Recurrence in T1HG disease is associated with BCG therapy and tumor multifocality, with a high BMI potentially promoting relapse.