Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “Cystectomy”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 235 records · Page 13Linked to original sources
PubMed2005

Correlation between annual volume of cystectomy, professional staffing, and outcomes: a statewide, population-based study.

BACKGROUND: The association between high procedure volume and lower perioperative mortality is well established among cancer patients who undergo cystectomy. However, to the authors' knowledge, the association between volume and perioperative complications has not been studied to date and hospital characteristics contributing to the volume-outcome correlation are unknown. In the current study, the authors studied these associations, emphasizing hospital factors that contribute to the volume-outcome correlation. METHODS: Multiple-variable models of inpatient mortality and complications were developed among all 1302 bladder carcinoma patients who underwent cystectomy between January 1, 1999 and December 31, 2001 in all Texas hospitals. General estimating equations were used to adjust for clustering within the 133 hospitals. Data were obtained from hospital claims, the 2000 U.S. Census, and databases from the Center for Medicare and Medicaid Services and the American Hospital Association. RESULTS: Complications were reported to occur in 12% of patients, 2.2% of whom died. Mortality was higher in low-volume hospitals compared with high-volume hospitals (3.1% vs. 0.7%; P < 0.001); mortality in moderate-volume hospitals was reported to be intermediate (2.9%). After adjustment for advanced age and comorbid conditions, treatment in high-volume hospitals was associated with lower risks of mortality (odds ratio [OR] = 0.35; P = 0.02) and complications (OR = 0.53; P = 0.01). Hospitals with a high registered nurse-to-patient ratio also had a lower mortality risk (OR = 0.43; P = 0.04). CONCLUSIONS: Mortality after cystectomy was found to be significantly lower in high-volume hospitals, regardless of patient age. Referral to a hospital performing greater than 10 cystectomies annually is indicated for all patients. However, patients with poor access to a high-volume hospital may derive similar benefit from treatment at a hospital with a high-registered nurse-to-patient ratio. This finding requires further confirmation.

Adult↗
PubMed1995

Partial cystectomy for invasive bladder cancer.

Thirty two patients--23 males and 9 females with a mean age of 52.5 years--underwent planned partial cystectomy for histologically proved muscle invasive bladder cancer. Twenty patients had transitional cell carcinoma and 12 had adenocarcinoma of the bladder. One patient had well-differentiated, 18 had moderately differentiated, and 13 had poorly differentiated tumours. The tumour size was < 2 cm in 7 patients, 2-4 cm in 19 patients, and > 4 cm in 6 patients. Patients with single primary muscle invasive tumours situated in the upper half of the bladder were considered eligible for partial cystectomy. The presence of multicentric urothelial disease, of dysplasia, or carcinoma-in-situ in bladder mucosa away from the tumour on multiple random punch biopsies was considered contraindications to partial cystectomy. All patients underwent partial cystectomy with bilateral pelvic lymphadenectomy. The tumour-free margins of resection were confirmed by intraoperative frozen section examination. The bladder was closed primarily in all patients, although three patients required re-implantation of the ureter. No patient received adjuvant radiation or chemotherapy. Five patients had pathological stage B1 (T2), 18 had B2 (T3A), and 9 had C (T3B) disease. No patient had metastatic pelvic lymph nodes. There was one postoperative death due to unrelated medical cause. Five patients had minor complications that resolved with conservative measures. All patients had adequate bladder capacity of > 250 cc at 6 months after surgery, and none had symptoms attributable to reduced bladder capacity. The overall actuarial survival was 80.1% at 5 years.(ABSTRACT TRUNCATED AT 250 WORDS)

Adenocarcinoma↗
PubMed1993

Urethral function after cystectomy: a canine in vivo experiment.

To study the function of the pelvic floor and the isolated urethra after removal of the bladder, 5 male and 5 female mongrel dogs were used in an acute in vivo experiment. Urethral pressure changes secondary to unilateral stimulation of the pelvic and pudendal nerves were recorded. After baseline data of the intact system were documented, the following procedures were carried out: separation of the urethra from the bladder neck (prostate), nerve-sparing cystectomy (cystoprostatectomy), and cold-knife incision through the entire length of the proximal urethra. Pressure recordings were repeated after each step of surgery. Pudendal nerve stimulation resulted in rapid and large pressure rises in the distal urethra (reaction typical of striated muscle). This response remained unchanged after all three surgical steps. Pelvic nerve stimulation provoked pressure rises within the urethra of a pattern typical of smooth muscle. The findings persisted after separation of the urethra from the bladder neck (prostate) and after cystectomy, but were not observed after urethrotomy. Contractions secondary to pudendal nerve stimulation were inhibited by curare, which did not affect the reaction to pelvic nerve stimulation. Our experiments demonstrate that in the dog the continuity of bladder and urethra is not required for the function of urethral closure mechanisms. The contractile potency of the urethral smooth muscles remains intact after nerve-sparing cystectomy. We believe that problems with the baseline continence of surrogate bladders should mainly be ascribed to a lack of surgical caution in preserving the autonomic nerves of cystectomy.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1992

Superficial bladder cancer treated by total cystectomy: tumour characteristics and patient survival.

Of 113 patients with bladder cancer who underwent total cystectomy from January 1980 to December 1990, 30 (27%) had superficial tumours (pTa, pTis, and pT1). Nineteen of these 30 patients (63%) were primarily treated by total cystectomy and the remaining 11 (37%) had a past history of treatment for bladder cancer. Major reasons for choice of total cystectomy were multifocal tumours, frequent recurrence, and diffuse carcinoma in situ. Histologically stage pT1, grade 3 tumours were frequently accompanied by carcinoma in situ and often by lymphatic invasion. None of the 24 patients undergoing pelvic lymphadenectomy had lymph node metastasis. Of 25 male patients 15 (60%) underwent simultaneous prophylactic urethrectomy. Two of the remaining 10 males (20%) not undergoing this additional operation died of subsequent urethral recurrence. The 5-year actuarial survival rate was 80% for the 30 patients when all causes of death were considered. It was concluded that patients with superficial bladder cancer who undergo total cystectomy without prophylactic urethrectomy require close follow-up with urethral washings for cytology to detect early urethral recurrence, an important determinant for survival.

Adult↗
PubMed2003

Cystectomy and orthotopic ileal neobladder in a male patient 12 years after kidney transplantation; good preservation of the renal function.

In case of cystectomy, some forms of urinary diversion can impair the graft function of renal transplant patients. Here we present the case of a 70-year-old male with carcinoma of the bladder 12 years after renal transplantation. Immunosuppression was achieved with Cyclosporin A (200 mg/day) and Prednisone (5 mg/day). The patient's serum creatinine level was 1.4 mg/dl. Following cystectomy, an orthotopic ileal neobladder was constructed by means of Studer technique, and the afferent ileal loop was anastomosed to the graft ureter. Pathology revealed pT1 G3 N+ transitional cell carcinoma. Ten months later, periaortic nodal recurrences necessitated four cycles of chemotherapy with Epidoxorubicyn and Gemcytabine. To date, 20 months after cystectomy, the patient is stable, with day and night-time urinary continence. His serum creatinine level is 1.3 mg/dl, and there is no evidence of hydronephrosis or acidosis. We conclude that the orthotopic ileal neobladder is an effective form of urinary diversion in renal transplant patients requiring cystectomy, allowing good preservation of the renal function.

Aged↗
PubMed2005

Sexual function after partial cystectomy and urothelial stripping in a 32-year-old woman with radiation cystitis.

We report a case of a 32-year-old woman who underwent a partial cystectomy to preserve sexual function. After radiotherapy for stage IB1 cervical cancer, cystectomy was indicated because of severe radiation cystitis. During this procedure we resected the upper part of the bladder followed by stripping off urothelium of the remaining bladder to spare the neurovascular bundle. Follow-up after 3 months indicated intact sexual function including orgasm. In our opinion the cystectomy procedure described in this case report is a good, novel option in women who are candidates for cystectomy because of a crippled bladder, after radiotherapy, and want to retain sexual function.

Adult↗
PubMed2005

Prostatic capsule- and nerve-sparing cystectomy in organ-confined bladder cancer: preliminary results.

We present a novel radical cystectomy technique that allows bladder cancer control while maintaining urinary continence and reducing the risk of erectile dysfunction by sparing the prostatic capsule and the neurovascular bundles. Between September 1997 and December 2002, 85 men were candidates for cystectomy; 32 were selected for a prostatic capsule- and seminal-sparing cystectomy with orthotopic urinary diversion. All patients had clinical organ-confined bladder cancer (cT1 to cT3a). One patient died of unrelated causes. Of the remaining 31 patients, two with pT4, N+ disease underwent three cycles of adjuvant chemotherapy and are free of disease at 10 and 12 months postoperatively. Twenty-nine patients with organ-confined bladder cancer are free of disease after a mean follow-up of 32 months. At 24 months, 98% of the patients are completely continent during the day and 83% during the nighttime hours. In addition, 80% of the patients are able to complete sexual intercourse without auxiliary measures at a mean of 24 months postoperatively. Prostatic capsule- and nerve-sparing cystectomy permits en bloc removal of the bladder, of the adenomatous prostatic tissue, and of the seminal vesicles, thereby achieving local cancer control and preserving erectile function and urinary continence.

Aged↗
PubMed2006

Clinicopathological features of recurrence after radical cystectomy for patients with transitional cell carcinoma of the bladder.

BACKGROUND: The objective of this study was to investigate the clinicopathological features of recurrent transitional cell carcinoma (TCC) of the bladder in patients who had previously undergone radical cystectomy. MATERIALS AND METHODS: This study included 124 patients who underwent radical cystectomy for transitional cell carcinoma (TCC) of the bladder in our institution. Several clinicopathological factors were analyzed to characterize differences between patients with and without disease recurrence, and determined predictive factors for disease recurrence using multivariate analysis. We further analyzed prognostic parameters that affect survival after disease recurrence was diagnosed. RESULTS: Of the 124 patients, 24 (19.5%) developed recurrence, and the median time to recurrence was 9.5 months (range, 1-44 months). The 5-year recurrence-free survival in these 124 patients was 75.6%. The incidence of disease recurrence was significantly associated with gender, pathological stage, lymph node metastasis, lymphatic invasion and blood vessel invasion. Multivariate analysis identified gender, pathological stage and lymph node metastasis as independent predictors of disease recurrence following radical cystectomy. After disease recurrence, the 1-year cancer-specific survival of the 24 patients was 16.7%; that is, 23 of the 24 patients had died of progressive recurrent diseases, while the remaining 1 who survived had developed recurrence in the upper urinary tract. CONCLUSIONS: These findings suggest that careful follow-up should be performed after radical cystectomy for TCC of the bladder considering gender, pathological stage and nodal involvement; however, once recurrent disease develops, the prognosis of such patients is extremely poor. Therefore, it would be potentially important to establish a multimodal therapeutic approach targeting recurrent TCC of the bladder.

Aged↗
PubMed2005

Laparoscopic radical cystectomy with ileal conduit diversion.

Remaining the gold standard treatment of muscle-invasive bladder cancer and high-risk superficial tumors, the radical cystectomy has been translated into a fully laparoscopic protocol, actually gaining more and more acceptance worldwide. In this article, a transperitoneal antegrade laparoscopic protocol is described for radical cystectomy performed in both genders. After removal of the specimen, generally through a mini-laparotomy, most of the teams perform the maneuvers for urinary diversion through an ileal conduit as an open procedure, although a completely laparoscopic procedure has been successfully achieved. Laparoscopic cystectomy will face the proof of time if oncologic rules about surgical management of transitional cell carcinoma are carefully respected to avoid any cell spillage. When obvious laparoscopic advantages for the patients are encountered with laparoscopic cystectomy, it seems unlikely that a full laparoscopic protocol, including the diversion, may gain wide acceptance; in that case, the true laparoscopic benefits would be wasted by unjustified lengthening of operative time and by compromising the quality of uretero-ileal anastomoses.

Carcinoma, Transitional Cell↗
PubMed2005

Laparoscopic radical cystectomy.

Laparoscopic radical cystectomy is an emerging technique. It has been proposed as an alternative to open radical cystectomy, which is the gold standard treatment of muscle-invasive or high-risk superficial bladder cancer. The experience in laparoscopic radical cystectomy reported in peer-reviewed journals account for approximately 100 cases, with a median longest follow-up of 11.5 months. Safety of the technique and cancer control need to be confirmed by a larger cohort of patients; however, after an initial analysis, it seems to be equivalent to open radical cystectomy. Equivalent does not mean better. Long-term results will determine if supposed benefits of laparoscopy overweigh the true increment of cost and time.

Carcinoma, Transitional Cell↗
PubMed1990

Development of upper tract carcinoma after cystectomy for bladder carcinoma.

Two hundred twenty patients who underwent a radical cystectomy and en bloc pelvic lymph node dissection with urinary diversion were reviewed to define the incidence of upper tract carcinoma developing after cystectomy. Each patient was followed for at least five years or until death. In 5 of 220 (2.4%) upper tract lesions developed, with a disease-free interval from cystectomy of twenty-two to fifty-four months. All patients died within two to twenty-seven months of diagnosis. Common pathologic features included the presence of high-grade multifocal lesions or carcinoma in situ (CIS) in the cystectomy specimen, tumor invasion of the intramural ureter, and positive findings on urethrectomy specimens. Although the incidence of this disease process is low, heightened surveillance of the upper urinary tracts would seem appropriate in patients displaying these pathologic features.

Aged↗
PubMed1994

A classification after radical cystectomy of patients with bladder cancer associated with schistosomiasis.

The aim of this study was to classify the bilharzial bladder cancer patients after radical cystectomy into several prognostic strata with increasing risk of recurrence. 310 patients through the period 1977-1983 at the National Cancer Institute of Cairo were systematically analysed for 12 variables evaluated after radical cystectomy. Eight factors were shown to have a significant influence on the recurrence-free survival curve after radical cystectomy namely: tumour stage, size, grade and location in the bladder, lymph node involvement, metastasis, renal insufficiency and urinary diversion. Using the proportional hazard model, five factors were significantly related to a lower recurrence-free survival, one major prognostic factor, tumour grade (G2 or G3) (relative risk estimate of 5.5), and four minor prognostic factors (relative risk estimates around 2), namely tumour diameter greater than 5 cm, anterior or trigonal location of the tumour, tumour stage (T3 or T4) and presence of renal insufficiency before surgery. Four prognostic strata have been defined in relation to the presence of these prognostic factors. This classification was validated on a second sample of 122 patients by comparing for each prognostic stratum, the recurrence-free survival curve observed on this sample and the corresponding predicted curve by Cox model. No statistically significant difference could be detected. This classification of bladder cancer patients appears to be adequate for bilharzial bladder cancer patients after radical cystectomy, at least in the conditions they presented and were treated for at the NIC in Cairo.

Adult↗
PubMed2006

Laparoscopic cystectomy with extracorporeal-assisted urinary diversion: experience with 34 patients.

OBJECTIVES: Open radical cystectomy remains the gold standard for nonmetastatic muscle invasive bladder cancer. Laparoscopic cystectomy has been described as a feasible procedure and is still being evaluated. We describe our initial experience with this laparoscopic surgical approach in 34 patients. METHODS: From February 2002 to October 2004, 18 men and 16 women underwent laparoscopic cystectomy with extracorporeal-assisted urinary diversion for transitional cell carcinoma of the bladder (n=27), invasive cervical carcinoma (n=4), and atrophic bladder (n=3). We report here on specific technical details and present initial results of our series. RESULTS: The mean operating time was 244 min, the mean blood loss 325 ml, and the transfusion rate 5.9%. All procedures were completed laparascopically without conversion to open techniques. No major complications occurred during or after the operation. In case of urothelial malignancy (n=27), the histopathologic analysis of the removed specimen revealed organ-confined transitional cell carcinoma of the bladder in 66.7% (pT1:14.8%; pT2: 51.9%) and locally advanced disease in 33.3% (pT3: 25.9%; pT4: 7.4%). In two cases final histology proved positive surgical margins. Extended lymphadenectomy detected lymph node metastasis in two patients. CONCLUSIONS: We demonstrate that the combination of laparoscopic cystectomy and extracorporeal urinary diversion is possible and remains a safe, feasible, and repeatable surgical technique. To determine the oncologic outcome long-time follow-up will be necessary.

Adult↗
PubMed2006

Perioperative complications of radical cystectomy in a contemporary series.

OBJECTIVES: Radical cystectomy is the preferred standard treatment for patients with muscle-invasive bladder cancer. With improvements in intra- and perioperative care lower complication rates have been reported. We retrospectively evaluated our series of patients who underwent radical cystectomy for advanced bladder cancer for perioperative complications as well as operative time, postoperative hospital stay and transfusion rates. PATIENTS AND METHODS: Between April 1993 and August 2005, 516 radical cystectomies were performed for muscle infiltrating transitional cell carcinoma and other types of neoplastic diseases of the bladder at our institution. The average age was 66.3 yr (31-89). RESULTS: The perioperative mortality rate was 0.8%. A total of 141 patients (27.3%) developed at least one perioperative complication. The most frequent medical complications were subileus in 20 (3.9%) patients, deep venous thrombosis in 24 (4.7%), and enterocolitis in 10 (1.9%). Surgical complications included pelvic lymphoceles in 42 (8.1%) patients, wound dehiscence in 46 (8.9%), pelvic hematoma in 4 (0.8%), peritonitis in 4 (0.8%) and small bowel obstruction in 4 (0.8%). The total early reoperation rate was 6.2%. Operative time, postoperative hospital stay and average number of blood units transfused decreased over the period 1993-2005. CONCLUSIONS: Radical cystectomy today is a procedure with an acceptable rate of perioperative morbidity and mortality. Improvements in surgical technique and anaesthesia as well as increased quality of perioperative care in recent years have resulted in reduced morbidity and shorter hospital stay.

Adult↗
PubMed2006

Superficial (pT2a) and deep (pT2b) muscle invasion in pathological staging of bladder cancer following radical cystectomy.

PURPOSE: We compared and evaluated clinical outcomes in patients with pathological superficial (pT2a) and deep (pT2b) invasion of bladder muscle with transitional cell carcinoma following radical cystectomy and urinary diversion. MATERIALS AND METHODS: From 1971 to 2001, 311 of 1,359 patients (23%), including 244 males (78%) and 67 females, were found to have pathological muscle invasive (pT2) bladder cancer following radical cystectomy. Of this group 147 patients (47%) had pT2a (superficial) and 164 (53%) had pT2b (deep) muscle invasive tumors. Overall 242 patients had no evidence of lymph node metastasis, including 127 with pT2a (86%) and 115 with pT2b (70%). A total of 69 patients (22%) had lymph node involvement, including 20 with pT2a (14%) and 49 with pT2b (30%). At a median followup of 14.3 years (range 0 to 30.1) clinical outcomes were determined, including recurrence-free and overall survival, and local vs distant recurrence. RESULTS: In the 311 patients with pT2 tumors 10-year recurrence-free and overall survival rates were 72% and 47%, respectively. There was a significantly higher risk of node positive disease with pT2b vs pT2a tumors (30% vs 14%, p <0.001). No significant difference was observed in 10-year recurrence-free survival in patients with pT2a node negative vs pT2b node negative tumors (84% vs 72%, p = 0.091). When comparing pT2a node positive vs pT2b node positive tumors, no significant difference was observed in 10-year recurrence-free survival (50% vs 48%, p = 0.84). Recurrence-free survival was significantly higher in patients with pT2 lymph node negative tumors than in those with pT2 lymph node positive tumors (79% vs 49%, p <0.001). Furthermore, these differences remained significant when stratified by pT2a and pT2b node negative vs positive disease. Local pelvic recurrence developed in 10 of 311 patients (3%) with pT2 disease, while 69 (22%) had distant metastatic disease. In patients with recurrence the local or distant recurrence site was not associated with tumor stage (pT2a vs pT2b p = 0.24) or lymph node status (node negative vs positive p = 0.37). CONCLUSIONS: In muscle invasive (pT2) bladder cancer treated with radical cystectomy there is a higher risk of lymph node positive disease in deep muscle (pT2b) vs superficial (pT2a) invasion. However, no apparent difference was observed in recurrence-free survival between pT2a (superficial) vs pT2b (deep) muscle invasive tumors when controlling for lymph node status. Recurrence-free survival is significantly improved in patients with pT2 lymph node negative tumors compared to survival in those with pT2 lymph node positive tumors. Patients with muscle invasive (pT2), lymph node negative tumors have excellent clinical outcomes following cystectomy, while those with muscle invasive (pT2), lymph node positive tumors have higher recurrence rates and should be considered for adjuvant treatment protocols.

Adult↗
PubMed2004

Robotic radical cystectomy and urinary diversion in the management of bladder cancer.

The authors have explored the versatility of the da Vinci robot for pelvic surgery to develop the technique of robotic radical cystectomy in conjunction with the Urology and Nephrology Center in Mansoura, Egypt, a world leader in conventional (open) cystectomy. This approach, which is designed to minimize the time required for surgery, is a sandwich technique in which the cystectomy and the neobladder-urethral anastomosis are performed with robotic assistance and the urinary diversion is performed extracorporeally. This article reviews the published literature and details the authors' current technique of robotic radical cystectomy and urinary diversion.

Cystectomy↗
PubMed2005

Complications after cystectomy and urinary diversion in patients previously treated for localized prostate cancer.

OBJECTIVES: To assess the morbidity associated with radical cystectomy in patients who had previously undergone definitive treatment of prostate cancer. METHODS: A retrospective review was undertaken, identifying 35 patients undergoing radical cystectomy with a previous history of radical prostatectomy and/or radiotherapy for prostate cancer. The clinical and surgical information was analyzed to assess patient outcomes. Specific attention was given to the rate, severity, and time course of the postoperative complications. In addition, outcomes after orthotopic and continent cutaneous diversion in this patient cohort were examined. RESULTS: An overall complication rate of 76% was seen in this patient cohort, with 47% of patients experiencing a complication that presented later than postoperative day 30. Radiotherapy was associated with a slightly greater complication rate compared with radical prostatectomy monotherapy (77% versus 71%). Continent urinary diversion (n = 14) was associated with increased morbidity compared with ileal conduit diversion (n = 21). However, a greater percentage of the complications occurring in patients undergoing ileal conduit diversion were major (80% versus 67%). CONCLUSIONS: Our experience has suggested that radical cystectomy in patients previously treated for prostate cancer with radiotherapy and/or radical prostatectomy may be associated with a greater level of morbidity than previously reported. This finding may be, in part, because a significant portion of complications present in a delayed fashion and, as such, have not been seen in previous reports with limited follow-up. For this reason, careful consideration of these risks is necessary when counseling this patient cohort regarding the decision to undergo radical cystectomy.

Aged↗
PubMed2006

Racial disparities in resource utilization for cystectomy.

OBJECTIVES: To examine the association of race with mortality and resource use among patients requiring cystectomy for bladder cancer, given the known racial differences with regard to bladder cancer incidence and survival. METHODS: Using the Nationwide Inpatient Sample (a nationally representative data set), 22,088 patients who underwent cystectomy for bladder cancer from 1988 to 2000 were identified using the International Classification of Disease, Ninth Revision, codes. The outcomes included in-hospital mortality, length of stay (LOS), and discharge status. Multivariable models were developed to perform risk-adjusted analyses and identify factors associated with these outcomes. RESULTS: The overall mortality rate after cystectomy was 2.9%. Unadjusted analyses revealed significant racial differences with respect to in-hospital mortality, LOS, and discharge disposition. Whites had a mortality rate of 2.8% compared with 4.2% for blacks and 3.9% for Hispanics (P = 0.006). Whites had a prolonged LOS 24.9% of the time compared with 38.2% for blacks and 24.6% for Hispanics (P < 0.001). The rate at which whites were discharged to subacute care facilities was 9.9% compared with 11.2% for black patients and 7.7% for Hispanics (P < 0.001). After adjusting for confounding factors, blacks were more likely to experience in-hospital mortality and prolonged LOS (odds ratios 1.66 and 2.10, respectively) compared with whites, although no significant differences were observed for Hispanics. No significant racial differences were noted for discharge status after risk adjustment. CONCLUSIONS: Black patients undergoing cystectomy for bladder cancer had greater mortality and greater LOS than did white patients. Additional study using detailed clinical data is necessary to identify the underlying causes of these differences.

Black or African American↗