Cent European J Urol 2015; 68: 17 doi: 10.5173/ceju.2015.01.r95 Although bladder tumors can be considered as a common disease by any experienced urologist, their management remains a challenge for anyone trying to take into account every new study or additional data which continually brings significant changes. Our study was focused on evaluating the delay between the last TURBT and radical cystectomy (RC) in several countries, even though some of the causes of this sometime long delay were not entirely analyzed [1]. It is, however, obvious that there is no standardized approach to the surgical treatment of bladder cancer, probably due to many conflicting data on different therapies. Our original paper was born from the idea that a shorter time between endoscopy and radical surgery is beneficial for the patient and so we decided to get real life data on how this aspect was managed in our countries. There seems to be a consensus that a 3 months interval remains safe for performing a cystectomy, but even this parameter is challenged by some authors [2]. There are many reasons leading to this delay, some of them being beyond the borders of medical science, and so we will not comment on those. But considering some medical reasons that might induce a delay, two major situations appear to be more frequent. The first aspect is the neoadjuvant chemotherapy, recommended by the guidelines as an option, regardless of the stage or other features of the tumor. There are many ongoing studies trying to revolutionize the treatment of bladder cancer by imposing a neoadjuvant chemotherapy as a mandatory step before radical surgery [3], but such evidence needs a long period of time to maCristian Persu1, Sławomir Poletajew2
{"title":"AUTHOR'S REPLY","authors":"S. Poletajew, C. Torz, P. Radziszewski","doi":"10.5173/ceju.2016.944","DOIUrl":"https://doi.org/10.5173/ceju.2016.944","url":null,"abstract":"Cent European J Urol 2015; 68: 17 doi: 10.5173/ceju.2015.01.r95 Although bladder tumors can be considered as a common disease by any experienced urologist, their management remains a challenge for anyone trying to take into account every new study or additional data which continually brings significant changes. Our study was focused on evaluating the delay between the last TURBT and radical cystectomy (RC) in several countries, even though some of the causes of this sometime long delay were not entirely analyzed [1]. It is, however, obvious that there is no standardized approach to the surgical treatment of bladder cancer, probably due to many conflicting data on different therapies. Our original paper was born from the idea that a shorter time between endoscopy and radical surgery is beneficial for the patient and so we decided to get real life data on how this aspect was managed in our countries. There seems to be a consensus that a 3 months interval remains safe for performing a cystectomy, but even this parameter is challenged by some authors [2]. There are many reasons leading to this delay, some of them being beyond the borders of medical science, and so we will not comment on those. But considering some medical reasons that might induce a delay, two major situations appear to be more frequent. The first aspect is the neoadjuvant chemotherapy, recommended by the guidelines as an option, regardless of the stage or other features of the tumor. There are many ongoing studies trying to revolutionize the treatment of bladder cancer by imposing a neoadjuvant chemotherapy as a mandatory step before radical surgery [3], but such evidence needs a long period of time to maCristian Persu1, Sławomir Poletajew2","PeriodicalId":86295,"journal":{"name":"Urologia polska","volume":"36 1","pages":"397 - 397"},"PeriodicalIF":0.0,"publicationDate":"2016-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70778132","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
W. Krajewski, R. Zdrojowy, K. Tupikowski, B. Małkiewicz, A. Kołodziej
Introduction Lowering morbidity and mortality after RC is subject of considerable interest. Lately, many evidence-based data on improvements in operative technique, anesthetic management, and patient care have been published. In this article, we present a review of literature on how to lower postoperative complications after RC. Material and methods The Medline, and Web of Science databases were searched without a time limit on February 2016 using the terms ‘cystectomy’ in conjunction with ‘radical’, ‘bladder cancer’, ‘complications’ or ‘management’. Boolean operators (NOT, AND, OR) were also used in succession to narrow and broaden the search. The search was limited to the English, Polish and Spanish literature. Results Many complications may be avoided by appropriate patient selection and meticulous introduction of care protocols. Conclusions RC as treatment free of complications, even in the hands of an experienced urologist, does not exist. A large number of complications are acceptable in the name of good long-term results. Optimum results are possible with proper surgical technique, good patients and urinary diversion selection and proper patient management in the pre-, peri, and postoperative period.
降低术后的发病率和死亡率是一个非常重要的课题。最近，许多关于手术技术、麻醉管理和患者护理改进的循证数据已经发表。在这篇文章中，我们回顾了关于如何降低RC术后并发症的文献。2016年2月，我们在Medline和Web of Science数据库中搜索了“膀胱切除术”和“根治性”、“膀胱癌”、“并发症”或“管理”等术语，没有时间限制。布尔运算符(NOT、AND、OR)也相继用于缩小和扩大搜索范围。搜索仅限于英语、波兰语和西班牙语文学。结果适当的患者选择和细致的护理方案可以避免许多并发症。结论RC作为无并发症的治疗方法，即使在经验丰富的泌尿科医生手中，也不存在。为了获得良好的长期效果，大量的并发症是可以接受的。在术前、围手术期和术后，通过适当的手术技术、良好的患者和尿分流选择以及适当的患者管理，可以获得最佳结果。
{"title":"How to lower postoperative complications after radical cystectomy – a review","authors":"W. Krajewski, R. Zdrojowy, K. Tupikowski, B. Małkiewicz, A. Kołodziej","doi":"10.5173/ceju.2016.880","DOIUrl":"https://doi.org/10.5173/ceju.2016.880","url":null,"abstract":"Introduction Lowering morbidity and mortality after RC is subject of considerable interest. Lately, many evidence-based data on improvements in operative technique, anesthetic management, and patient care have been published. In this article, we present a review of literature on how to lower postoperative complications after RC. Material and methods The Medline, and Web of Science databases were searched without a time limit on February 2016 using the terms ‘cystectomy’ in conjunction with ‘radical’, ‘bladder cancer’, ‘complications’ or ‘management’. Boolean operators (NOT, AND, OR) were also used in succession to narrow and broaden the search. The search was limited to the English, Polish and Spanish literature. Results Many complications may be avoided by appropriate patient selection and meticulous introduction of care protocols. Conclusions RC as treatment free of complications, even in the hands of an experienced urologist, does not exist. A large number of complications are acceptable in the name of good long-term results. Optimum results are possible with proper surgical technique, good patients and urinary diversion selection and proper patient management in the pre-, peri, and postoperative period.","PeriodicalId":86295,"journal":{"name":"Urologia polska","volume":"69 1","pages":"370 - 376"},"PeriodicalIF":0.0,"publicationDate":"2016-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70777010","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
V. G. Gupta, Santosh Kumar, S. Singh, A. Lal, N. Kakkar
Introduction To evaluate contrast enhanced ultrasound (CEUS) as a modality to predict T stage of cancer of urinary bladder (CAUB) and to predict the grade of the tumor preoperatively. Material and methods 110 patients with CAUB presenting to the Department of Urology at our institution between July 2014 and December 2015 underwent CEUS prior to endoscopic resection and the CEUS findings were compared with histopathology results. Results CEUS had a sensitivity of 75, 65 and 90% and specificity of 95, 85 and 92% in detecting Ta, T1 and muscle invasion respectively. CEUS had a sensitivity of 78% and specificity of 85% in detecting the grade of the lesion. Conclusions CEUS is a good alternative for T staging and grading of CAUB preoperatively. It is uniquely advantageous in detecting clots or necrosis and in patients with low eGFR where other imaging modalities are contraindicated.
{"title":"Contrast enhanced ultrasound in urothelial carcinoma of urinary bladder: An underutilized staging and grading modality","authors":"V. G. Gupta, Santosh Kumar, S. Singh, A. Lal, N. Kakkar","doi":"10.5173/ceju.2016.893","DOIUrl":"https://doi.org/10.5173/ceju.2016.893","url":null,"abstract":"Introduction To evaluate contrast enhanced ultrasound (CEUS) as a modality to predict T stage of cancer of urinary bladder (CAUB) and to predict the grade of the tumor preoperatively. Material and methods 110 patients with CAUB presenting to the Department of Urology at our institution between July 2014 and December 2015 underwent CEUS prior to endoscopic resection and the CEUS findings were compared with histopathology results. Results CEUS had a sensitivity of 75, 65 and 90% and specificity of 95, 85 and 92% in detecting Ta, T1 and muscle invasion respectively. CEUS had a sensitivity of 78% and specificity of 85% in detecting the grade of the lesion. Conclusions CEUS is a good alternative for T staging and grading of CAUB preoperatively. It is uniquely advantageous in detecting clots or necrosis and in patients with low eGFR where other imaging modalities are contraindicated.","PeriodicalId":86295,"journal":{"name":"Urologia polska","volume":"69 1","pages":"360 - 365"},"PeriodicalIF":0.0,"publicationDate":"2016-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.5173/ceju.2016.893","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70777461","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Introduction Urinary Tract Infections (UTIs) are caused by different types of microbial agents such as uropathogenic Escherichia coli (UPEC) and Candida albicans. The presence of strong physical barriers may prevent the breach of pathogens into the urinary tract. However, sometimes the pathogenic microorganisms may pass through the barriers and stimulate the innate and adaptive responses. Among a variety of innate immune responses, Toll-Like Receptors (TLRs) are one of the most unique and interesting molecules regarding UTIs. Thus, the authors have focused their attention on the role of TLRs in urinary tract defense against pathogenic microbial agents such as UPEC and C.albicans through this literature review. Material and methods Several papers regarding UTIs and TLRs including original and review articles were searched by PubMed and Google Scholar. They were studied and the most important aspects in association with the role of TLRs in UTIs were extracted. Additionally, this paper was prepared using the experience of the authors. Results The TLRs 2, 4 and 5 are the most functional molecules that contribute to urinary tract defense system and UTIs. It is incredible that TLRs are able to detect and recognize different parts of microbial components relating to the same pathogen. Besides, the flexibility of the TLR molecules may lead to identification of different types of microorganisms with different signaling pathways. Conclusions Our knowledge associated with TLRs and their activities against microbial causative agents of UTIs may help us to prevent, control and treat UTIs at a higher quality level.
{"title":"The role of toll-like receptors (TLRs) in urinary tract infections (UTIs)","authors":"E. Behzadi, P. Behzadi","doi":"10.5173/ceju.2016.871","DOIUrl":"https://doi.org/10.5173/ceju.2016.871","url":null,"abstract":"Introduction Urinary Tract Infections (UTIs) are caused by different types of microbial agents such as uropathogenic Escherichia coli (UPEC) and Candida albicans. The presence of strong physical barriers may prevent the breach of pathogens into the urinary tract. However, sometimes the pathogenic microorganisms may pass through the barriers and stimulate the innate and adaptive responses. Among a variety of innate immune responses, Toll-Like Receptors (TLRs) are one of the most unique and interesting molecules regarding UTIs. Thus, the authors have focused their attention on the role of TLRs in urinary tract defense against pathogenic microbial agents such as UPEC and C.albicans through this literature review. Material and methods Several papers regarding UTIs and TLRs including original and review articles were searched by PubMed and Google Scholar. They were studied and the most important aspects in association with the role of TLRs in UTIs were extracted. Additionally, this paper was prepared using the experience of the authors. Results The TLRs 2, 4 and 5 are the most functional molecules that contribute to urinary tract defense system and UTIs. It is incredible that TLRs are able to detect and recognize different parts of microbial components relating to the same pathogen. Besides, the flexibility of the TLR molecules may lead to identification of different types of microorganisms with different signaling pathways. Conclusions Our knowledge associated with TLRs and their activities against microbial causative agents of UTIs may help us to prevent, control and treat UTIs at a higher quality level.","PeriodicalId":86295,"journal":{"name":"Urologia polska","volume":"69 1","pages":"404 - 410"},"PeriodicalIF":0.0,"publicationDate":"2016-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70777172","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Introduction Photoselective laser vaporization of the prostate (PVP) is one of the most popular techniques of treatment of benign prostatic hyperplasia (BPH). The aim of this study was to assess the risk of thermal damage to the external urethral sphincter during PVP at distal part of prostatic urethra. Material and methods 66 men submitted to PVP with 80-W Green Light Laser were randomly assigned to receive standard PVP only (group A) or PVP in proximal part followed by transurethral resection in distal part of prostatic urethra (group B). Primary end-points of the study assessed at baseline, 24 hours and 8 weeks after the surgery were: urinary continence, urinary flow (Qmax), post void urine retention (PVR), international prostate symptom score (IPSS), quality of life (QoL). Results Per protocol analysis was eventually performed in 60 patients. Study groups did not differ in age, preoperative continence, values of Qmax, PVR, IPSS, QoL, or the rate of complete urinary retention (p >0.05). During the 8-week follow-up no patient reported urinary incontinence, while decrease in IPSS (16.3 vs. 14.9, p >0.05), QoL improvement (4.7 vs. 4.7, p >0.05), increase in Qmax (18.2 vs. 17.4, p >0.05) were similar in both study groups. Patients assigned to group B were more likely to have bleeding complications (85.2% vs. 18.2%), including patients requiring transfusion (14.8% vs. 0%). Moreover, postoperative catheterization time was shorter in group A (29.1 hrs vs. 37.2 hrs, p = 0.04). Conclusions Laser vaporization for treatment of BPH is safe and effective, with no significant effect on the risk of urinary incontinence in comparison to traditional methods.
{"title":"A prospective, randomized trial comparing the use of KTP (GreenLight) laser versus electroresection-supplemented laser in the treatment of benign prostatic hyperplasia","authors":"C. Torz, S. Poletajew, P. Radziszewski","doi":"10.5173/ceju.2016.859","DOIUrl":"https://doi.org/10.5173/ceju.2016.859","url":null,"abstract":"Introduction Photoselective laser vaporization of the prostate (PVP) is one of the most popular techniques of treatment of benign prostatic hyperplasia (BPH). The aim of this study was to assess the risk of thermal damage to the external urethral sphincter during PVP at distal part of prostatic urethra. Material and methods 66 men submitted to PVP with 80-W Green Light Laser were randomly assigned to receive standard PVP only (group A) or PVP in proximal part followed by transurethral resection in distal part of prostatic urethra (group B). Primary end-points of the study assessed at baseline, 24 hours and 8 weeks after the surgery were: urinary continence, urinary flow (Qmax), post void urine retention (PVR), international prostate symptom score (IPSS), quality of life (QoL). Results Per protocol analysis was eventually performed in 60 patients. Study groups did not differ in age, preoperative continence, values of Qmax, PVR, IPSS, QoL, or the rate of complete urinary retention (p >0.05). During the 8-week follow-up no patient reported urinary incontinence, while decrease in IPSS (16.3 vs. 14.9, p >0.05), QoL improvement (4.7 vs. 4.7, p >0.05), increase in Qmax (18.2 vs. 17.4, p >0.05) were similar in both study groups. Patients assigned to group B were more likely to have bleeding complications (85.2% vs. 18.2%), including patients requiring transfusion (14.8% vs. 0%). Moreover, postoperative catheterization time was shorter in group A (29.1 hrs vs. 37.2 hrs, p = 0.04). Conclusions Laser vaporization for treatment of BPH is safe and effective, with no significant effect on the risk of urinary incontinence in comparison to traditional methods.","PeriodicalId":86295,"journal":{"name":"Urologia polska","volume":"69 1","pages":"391 - 395"},"PeriodicalIF":0.0,"publicationDate":"2016-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70777091","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The idea behind this paper [1] is novel and daring. Firstly, there are no previous papers looking into the actual necessity of pathological examination after removing a part of the urinary tract. And secondly, there are many possible implications after changing something that is widely considered as elementary and routine. The conclusion that might be drawn from this paper is that if you are only looking for cancer, this might not be the best approach. But, since this type of surgery is done to relieve bladder outlet obstruction, you will most likely get a good clinical result regardless of the nature of the resected tissue. This would make a good argument for modern procedures like laser or plasma vaporization, when a biopsy would increase the total cost not only because of the pathological examination but also because of the extra time and the extra loop which is needed. But even in this field there are many voices saying that a preoperative biopsy might save a lot of trouble in the long run and, by that, be more than recommended. This will probably remain a hot topic for a while, with many good arguments from both sides [2]. The macroscopic aspect of the tissue in the area of interest might also provide a clue as to whether there is something suspect or just plain fibrosis. But the subjective opinion of the urologist might not be enough in the case of his decision being challenged at a later time and no hard evidence is available [3]. The most important argument of the authors for not doing a biopsy is the cost of the pathological examination. In their study, they had only two patients confirmed with prostate cancer out of a total of 340 patients. More than this, those two patients were known to have prostate cancer before the resection. For the rest of the group, the pathological examination diagnosed BPH or inflammation of the prostate or the bladder. The authors consider that the cost of diagnosing two cases of cancer is equivaHistopathological evaluation is still useful after bladder neck resection
{"title":"Histopathological evaluation is still useful after bladder neck resection","authors":"C. Persu","doi":"10.5173/ceju.2016.942","DOIUrl":"https://doi.org/10.5173/ceju.2016.942","url":null,"abstract":"The idea behind this paper [1] is novel and daring. Firstly, there are no previous papers looking into the actual necessity of pathological examination after removing a part of the urinary tract. And secondly, there are many possible implications after changing something that is widely considered as elementary and routine. The conclusion that might be drawn from this paper is that if you are only looking for cancer, this might not be the best approach. But, since this type of surgery is done to relieve bladder outlet obstruction, you will most likely get a good clinical result regardless of the nature of the resected tissue. This would make a good argument for modern procedures like laser or plasma vaporization, when a biopsy would increase the total cost not only because of the pathological examination but also because of the extra time and the extra loop which is needed. But even in this field there are many voices saying that a preoperative biopsy might save a lot of trouble in the long run and, by that, be more than recommended. This will probably remain a hot topic for a while, with many good arguments from both sides [2]. The macroscopic aspect of the tissue in the area of interest might also provide a clue as to whether there is something suspect or just plain fibrosis. But the subjective opinion of the urologist might not be enough in the case of his decision being challenged at a later time and no hard evidence is available [3]. The most important argument of the authors for not doing a biopsy is the cost of the pathological examination. In their study, they had only two patients confirmed with prostate cancer out of a total of 340 patients. More than this, those two patients were known to have prostate cancer before the resection. For the rest of the group, the pathological examination diagnosed BPH or inflammation of the prostate or the bladder. The authors consider that the cost of diagnosing two cases of cancer is equivaHistopathological evaluation is still useful after bladder neck resection","PeriodicalId":86295,"journal":{"name":"Urologia polska","volume":"69 1","pages":"358 - 359"},"PeriodicalIF":0.0,"publicationDate":"2016-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70778089","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A. Kołodziej, W. Krajewski, K. Tupikowski, B. Małkiewicz, J. Dembowski, M. Zimmer, T. Szydełko, R. Zdrojowy
Pregnancies in patients after cystectomy with urinary diversion, especially after the construction of a continent urinary reservoir, are rare. Experience in this field is limited and mainly concerns patients with congenital disorders, neurogenic diseases or trauma. In this paper, we report the outcome of pregnancy, delivery and the postpartum period in a 27-year old woman with a Studer ileal orthotopic neobladder after radical cystectomy, performed after the diagnosis of a malignant tumor at the age of 14.
{"title":"Pregnancy and delivery in a patient with a Studer orthotopic ileal neobladder","authors":"A. Kołodziej, W. Krajewski, K. Tupikowski, B. Małkiewicz, J. Dembowski, M. Zimmer, T. Szydełko, R. Zdrojowy","doi":"10.5173/ceju.2016.877","DOIUrl":"https://doi.org/10.5173/ceju.2016.877","url":null,"abstract":"Pregnancies in patients after cystectomy with urinary diversion, especially after the construction of a continent urinary reservoir, are rare. Experience in this field is limited and mainly concerns patients with congenital disorders, neurogenic diseases or trauma. In this paper, we report the outcome of pregnancy, delivery and the postpartum period in a 27-year old woman with a Studer ileal orthotopic neobladder after radical cystectomy, performed after the diagnosis of a malignant tumor at the age of 14.","PeriodicalId":86295,"journal":{"name":"Urologia polska","volume":"10 1","pages":"431 - 433"},"PeriodicalIF":0.0,"publicationDate":"2016-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70776931","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
S. Talreja, S. Yadav, V. Tomar, N. Agarwal, U. Jaipal, S. Priyadarshi
Introduction Spongiofibrosis assessment is critically important in the evaluation of anterior urethral strictures as its severity is directly proportional to stricture recurrence and thus affects management. Retrograde urethrography (RGU) is ineffective in the evaluation of spongiofibrosis. Sonourethrography (SUG) delineates it but does not accurately estimate its depth. Real-time elastography (RTE), a newer technique that not only attempts a qualitative but also quantitative estimation of spongiofibrosis (tissue stiffness) which results due to underlying pathological processes. Material and methods In the present study, various elastographic patterns and strain ratios in anterior urethral stricture patients were studied and compared to operative and histopathological findings. Sixty-three RGU diagnosed anterior urethral stricture cases were taken and re-evaluated by SUG and SE by another radiologist who was blinded to the findings of the RGU. Strain patterns and ratios of spongiofibrotic segments were documented and compared with operative findings as gold standard. Results Blue pattern on RTE showed 100% concordance with severe fibrosis as evaluated against histopathological findings whereas green pattern showed 87.5% concordance with moderate degree of fibrosis. Severe degree of fibrosis cases, confirmed on histopathology had a significantly higher mean strain ratio (10.51 ±2.297) as compared to moderate degree (6.33 ±2.353) (p <0.001 S). Conclusions Real time sonoelastography in the evaluation of spongiofibrosis not only assesses it qualitatively but also quantifies it. Strain ratios are statistically better indicators for estimating spongiofibrosis.
{"title":"‘Real-time sonoelastography’ in anterior urethral strictures: A novel technique for assessment of spongiofibrosis","authors":"S. Talreja, S. Yadav, V. Tomar, N. Agarwal, U. Jaipal, S. Priyadarshi","doi":"10.5173/ceju.2016.808","DOIUrl":"https://doi.org/10.5173/ceju.2016.808","url":null,"abstract":"Introduction Spongiofibrosis assessment is critically important in the evaluation of anterior urethral strictures as its severity is directly proportional to stricture recurrence and thus affects management. Retrograde urethrography (RGU) is ineffective in the evaluation of spongiofibrosis. Sonourethrography (SUG) delineates it but does not accurately estimate its depth. Real-time elastography (RTE), a newer technique that not only attempts a qualitative but also quantitative estimation of spongiofibrosis (tissue stiffness) which results due to underlying pathological processes. Material and methods In the present study, various elastographic patterns and strain ratios in anterior urethral stricture patients were studied and compared to operative and histopathological findings. Sixty-three RGU diagnosed anterior urethral stricture cases were taken and re-evaluated by SUG and SE by another radiologist who was blinded to the findings of the RGU. Strain patterns and ratios of spongiofibrotic segments were documented and compared with operative findings as gold standard. Results Blue pattern on RTE showed 100% concordance with severe fibrosis as evaluated against histopathological findings whereas green pattern showed 87.5% concordance with moderate degree of fibrosis. Severe degree of fibrosis cases, confirmed on histopathology had a significantly higher mean strain ratio (10.51 ±2.297) as compared to moderate degree (6.33 ±2.353) (p <0.001 S). Conclusions Real time sonoelastography in the evaluation of spongiofibrosis not only assesses it qualitatively but also quantifies it. Strain ratios are statistically better indicators for estimating spongiofibrosis.","PeriodicalId":86295,"journal":{"name":"Urologia polska","volume":"69 1","pages":"417 - 424"},"PeriodicalIF":0.0,"publicationDate":"2016-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.5173/ceju.2016.808","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70775771","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
M. Álvarez-Maestro, J. Rivas, S. Gregorio, C. D. C. Guerin, Á. T. Gómez, J. C. Ledo
Introduction Lymphadenectomy (LND) has recently attracted considerable interest from urological surgeons, as extended lymphadenectomy might have a role in accurate staging or improving patient survival in those patients with urological malignancies. Upper tract urothelial carcinoma (UTUC) is a relatively rare neoplasm, accounting for about 5% of all urothelial cancers. Up to 30% of patients with muscle-invasive UTUC have metastasis in the regional lymph nodes (LNs), which represents a well-established poor prognostic factor. Material and methods A medline search was conducted to identify original articles and review articles addressing the role of lymphadenectomy LND in UTUC. Keywords included lymphadenectomy, lymph node excision, nephroureterectomy, and upper tract urothelial carcinoma. Results LND instead of lymphadenectomy has recently attracted considerable interest from urological surgeons and might have a potential role in improving the oncological outcome in patients with urothelial carcinoma. LND ideally improves disease staging; thereby, we need to find the way to identify the patients who could really benefit from adjuvant systemic theraphy. Template-based LND with Radical Nephroureterectomy (RNU) for high risk disease is gaining support based on accumulating retrospective data and supports its utility as a potentially therapeutic maneuver. RNU is still the gold standard treatment for UTUC, but minimal invasive procedures such as laparoscopic RNU and Robot Assisted Nephroureterectomy (RANU) are becoming more employed in recent years and should be used by expert hands. Conclusions Therapeutic benefits of LND and nodal status on disease free survival (DFS) and Cancer Free Survival (CSS) remains controversial. Although most of the data comes from retrospective studies, we encourage performing well designed, prospective, and multicentre studies to clarify this in the coming years.
{"title":"Current role of lymphadenectomy in the upper tract urothelial carcinoma","authors":"M. Álvarez-Maestro, J. Rivas, S. Gregorio, C. D. C. Guerin, Á. T. Gómez, J. C. Ledo","doi":"10.5173/ceju.2016.834","DOIUrl":"https://doi.org/10.5173/ceju.2016.834","url":null,"abstract":"Introduction Lymphadenectomy (LND) has recently attracted considerable interest from urological surgeons, as extended lymphadenectomy might have a role in accurate staging or improving patient survival in those patients with urological malignancies. Upper tract urothelial carcinoma (UTUC) is a relatively rare neoplasm, accounting for about 5% of all urothelial cancers. Up to 30% of patients with muscle-invasive UTUC have metastasis in the regional lymph nodes (LNs), which represents a well-established poor prognostic factor. Material and methods A medline search was conducted to identify original articles and review articles addressing the role of lymphadenectomy LND in UTUC. Keywords included lymphadenectomy, lymph node excision, nephroureterectomy, and upper tract urothelial carcinoma. Results LND instead of lymphadenectomy has recently attracted considerable interest from urological surgeons and might have a potential role in improving the oncological outcome in patients with urothelial carcinoma. LND ideally improves disease staging; thereby, we need to find the way to identify the patients who could really benefit from adjuvant systemic theraphy. Template-based LND with Radical Nephroureterectomy (RNU) for high risk disease is gaining support based on accumulating retrospective data and supports its utility as a potentially therapeutic maneuver. RNU is still the gold standard treatment for UTUC, but minimal invasive procedures such as laparoscopic RNU and Robot Assisted Nephroureterectomy (RANU) are becoming more employed in recent years and should be used by expert hands. Conclusions Therapeutic benefits of LND and nodal status on disease free survival (DFS) and Cancer Free Survival (CSS) remains controversial. Although most of the data comes from retrospective studies, we encourage performing well designed, prospective, and multicentre studies to clarify this in the coming years.","PeriodicalId":86295,"journal":{"name":"Urologia polska","volume":"69 1","pages":"384 - 390"},"PeriodicalIF":0.0,"publicationDate":"2016-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70777071","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
P. Adamczyk, K. Juszczak, T. Drewa, M. Hora, P. Nyirády, M. Sosnowski
Introduction In recent years, the laparoscopic approach in oncologic urology seems more attractable to the surgeons. It is considered to have the same oncologic quality as open surgery, but is less invasive in patients. It is used widely in all of Europe, but with various frequency. The aim of the study was to present a various amount of oncourological procedures from three neighbouring countries – Poland, Czech Republic and Hungary. Prostatectomy, cystectomy, nephrectomy and tumorectomy (Nephron Sparing Procedures – NSS) were presented as a list of procedures prepared from the national registry. Material and methods The total amount of procedures was presented, as well as the LO (Lap to Open procedures) index, P/P (procedures/population) index, ratio of cystectomy/population, and cystectomy/TURBT. Results In the Czech Republic, the most complex procedures are performed (laparoscopic/robotic prostatectomy, NSS LAP, LAP nephrectomy) in the majority when analysing the country's population. In Hungary and Czech Republic, there are more laparoscopic/robotic radical prostatectomies performed, than open ones. In Poland the largest number of cystectomies is performed when analysing the country's population, but it is difficult to explain the much higher ratio of 6.57 TUR/one cystectomy. In the Czech Republic this procedure is performed in almost one quarter of the patients (23.36%). Interestingly, in Hungary the cystectomy with pouch creation is performed in about 67.65% cases. The highest reimbursement for surgical procedure is present in the Czech Republic with approximately 20–40% more than when compared to Poland or Hungary. Conclusions The definitive leader in Central Europe (based on the national registry) is the Czech Republic, where the most complex procedures are performed (laparoscopic/robotic prostatectomy, NSS LAP, LAP nephrectomy) in biggest amounts when analysing the country's population. Explanation of such circumstances, can be the higher reimbursement rate for surgical procedure in this country.
近年来，腹腔镜入路越来越受到泌尿外科医生的青睐。它被认为与开放手术具有相同的肿瘤质量，但对患者的侵入性较小。它在整个欧洲广泛使用，但频率各不相同。这项研究的目的是介绍来自三个邻国——波兰、捷克共和国和匈牙利的不同数量的肿瘤学手术。前列腺切除术、膀胱切除术、肾切除术和肿瘤切除术(保留肾元手术- NSS)作为国家登记处准备的手术清单提出。材料与方法统计手术总数、LO (Lap to Open procedures)指数、P/P (procedures/population)指数、膀胱切除术/人群比例、膀胱切除术/TURBT。结果在捷克共和国，在分析该国人口时，最复杂的手术(腹腔镜/机器人前列腺切除术、NSS LAP、LAP肾切除术)占多数。在匈牙利和捷克共和国，腹腔镜/机器人根治性前列腺切除术比开放式手术要多。在波兰，在分析该国人口时进行的膀胱切除术数量最多，但很难解释6.57 TUR/一次膀胱切除术的高得多的比率。在捷克共和国，几乎四分之一的患者(23.36%)接受了这一手术。有趣的是，在匈牙利，67.65%的病例行膀胱切除术并造袋。捷克共和国的外科手术报销最高，比波兰或匈牙利高出约20-40%。在中欧(基于国家登记)，捷克共和国是最具决定性的领导者，在分析该国人口时，实施最复杂的手术(腹腔镜/机器人前列腺切除术，NSS LAP, LAP肾切除术)的数量最多。这种情况的解释，可以是这个国家外科手术的报销率较高。
{"title":"Urological procedures in Central Europe and the current reality based on the national registries of Czech Republic, Hungary, and Poland (2012 status)","authors":"P. Adamczyk, K. Juszczak, T. Drewa, M. Hora, P. Nyirády, M. Sosnowski","doi":"10.5173/ceju.2016.886","DOIUrl":"https://doi.org/10.5173/ceju.2016.886","url":null,"abstract":"Introduction In recent years, the laparoscopic approach in oncologic urology seems more attractable to the surgeons. It is considered to have the same oncologic quality as open surgery, but is less invasive in patients. It is used widely in all of Europe, but with various frequency. The aim of the study was to present a various amount of oncourological procedures from three neighbouring countries – Poland, Czech Republic and Hungary. Prostatectomy, cystectomy, nephrectomy and tumorectomy (Nephron Sparing Procedures – NSS) were presented as a list of procedures prepared from the national registry. Material and methods The total amount of procedures was presented, as well as the LO (Lap to Open procedures) index, P/P (procedures/population) index, ratio of cystectomy/population, and cystectomy/TURBT. Results In the Czech Republic, the most complex procedures are performed (laparoscopic/robotic prostatectomy, NSS LAP, LAP nephrectomy) in the majority when analysing the country's population. In Hungary and Czech Republic, there are more laparoscopic/robotic radical prostatectomies performed, than open ones. In Poland the largest number of cystectomies is performed when analysing the country's population, but it is difficult to explain the much higher ratio of 6.57 TUR/one cystectomy. In the Czech Republic this procedure is performed in almost one quarter of the patients (23.36%). Interestingly, in Hungary the cystectomy with pouch creation is performed in about 67.65% cases. The highest reimbursement for surgical procedure is present in the Czech Republic with approximately 20–40% more than when compared to Poland or Hungary. Conclusions The definitive leader in Central Europe (based on the national registry) is the Czech Republic, where the most complex procedures are performed (laparoscopic/robotic prostatectomy, NSS LAP, LAP nephrectomy) in biggest amounts when analysing the country's population. Explanation of such circumstances, can be the higher reimbursement rate for surgical procedure in this country.","PeriodicalId":86295,"journal":{"name":"Urologia polska","volume":"69 1","pages":"327 - 333"},"PeriodicalIF":0.0,"publicationDate":"2016-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70777764","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
京公网安备 11010802042870号
京ICP备2023020795号-1
扫码关注我们
求助内容：
应助结果提醒方式：