Retroperitoneoscopy-assisted nephroureterectomy for the management of upper urinary urothelial cancer

Summary

Traditionally, transitional cell carcinoma of the upper urinary tract needs a flank incision to remove the kidney and a lower abdominal incision to remove the ureter and bladder cuff. We report the surgical techniques and the initial clinical experience of retroperitoneoscopy-assisted nephroureterectomy for the treatment of this disease. Seven patients (6 males and 1 female; mean age 64.3 years, range 47-75 years) with the pre-operative diagnosis of upper urinary tract tumour underwent retroperitoneoscopy-assisted nephroureterectomy. The operation was performed first by retroperito-neoscopic nephrectomy, dissection of the lower third ureter and bladder cuff excision were performed with the traditional open method. The whole specimen with intact urothelium was removed through the lower abdominal incisional wound. We have successfully applied this technique for six patients with urothelial tumours. In one case, this technique had to be converted to open nephroureterectomy due to severe perirenal adhesions. Retroperitoneoscopic nephrectomy needed a mean operative time of 275 min (range 235-310), and the intraoperative blood loss was minimal. The dosage of post-operative analgesics ranged between 0 and 36 mg morphine sulphate equivalents (mean 11.6). All patients could bend their body without difficulty on the third to fifth (mean 3.7) post-operative day. The mean post-operative hospital stay was 9 d (range 6-11). There was no local recurrence or distant metastasis at the follow-up of 6 months (range 5-18). Although it needs more cases and a longer follow-up to elucidate its real clinical value, our initial experience suggests that retroperitoneoscopy-assisted nephroureterectomy is an appealing technique for the treatment of upper urinary tract tumour.     

Surgical Management of Muscle Invasive Bladder Cancer: A Review of Current Recommendations

ObjectiveTo provide a narrative overview of contemporary surgical management of muscle-invasive bladder cancer with focus on radical cystectomy and urinary tract reconstruction.Data SourcesInternational guidelines and a search for articles in PubMed, Medline, and Cochrane Database for single and collaborative studies on surgical management of muscle-invasive bladder cancer.ConclusionPatients diagnosed with muscle invasive bladder cancer often have complex treatment and care needs. For those who undergo radical cystectomy as the curative treatment, there is a considerable risk of general complications after major surgery and short- and long-term complications specific to reconstruction of the urinary tract after radical cystectomy. Contemporary care focuses on perioperative optimization to lower rates of major complications, enhanced recovery protocols, and focus on rehabilitation and cancer survivorship.Implications for Nursing PracticeNurses are integral members of the multidisciplinary team around patients undergoing surgery for muscle-invasive bladder cancer, and are in a position to coordinate pathways for these patients who often have complex care needs because of preexisting comorbidity and limited personal resources that impede recovery after major surgery and cancer survivorship.     

Intestinal intussusception caused by intestinal duplication and ectopic pancreas: A case report and review of literature

BACKGROUNDIntestinal intussusception caused by intestinal duplication and ectopic pancreas is extremely rare in the clinic and has not been reported previously.CASE SUMMARYA 29-year-old man was admitted to the hospital for chronic abdominal pain and bloating. The preoperative diagnosis was intestinal obstruction and intussusception. Then, laparotomy, partial small intestinal resection and extraintestinal decompression were performed. Postoperative pathology confirmed intestinal duplication and ectopic pancreas. After surgery, the patient recovered well with no complications. No recurrence was observed after more than 5 mo of follow-up.CONCLUSIONWe report a new case of a young male with intussusception caused by intestinal duplication and ectopic pancreas. Surgery is the main treatment for these conditions. This study aimed to raise awareness and provide information to improve the clinical management of this rare yet serious condition.     

B domain containing Tenascin-C: A new urine marker for surveillance of patients with urothelial carcinoma of the urinary bladder?

BackgroundECM remodelling during tumorigenesis entails the re-occurrence of different Tn-C_L splicing variants. In patients with urothelial carcinoma of the urinary bladder (UBC), B and C domain containing Tenascin-C (B⁺ and C⁺ Tn-C) urine levels were shown to be increased in case of muscle invasiveness. Thus, the present study was aimed at examining the ability of B⁺ and C⁺ Tn-C as potential urinary surveillance markers of UBC patients.MethodsUrine levels of B⁺ and C⁺ Tn-C were determined by ELISA in 35 UBC patients during a 2 year follow-up period after therapy and related to clinical diagnosis and histological stage in 4 defined groups representing typical courses of disease.ResultsB⁺ Tn-C levels showed significant differences between cases of tumour progression or regression. The urine levels of B⁺ Tn-C could be used to discriminate between cases without tumour recurrence and such with tumour existence (cut-off value: 0.8 ng/ml) or between non-muscle invasive and muscle invasive tumour growth (cut-off value: 3.5 ng/ml).ConclusionsProgression of UBC with time is accompanied by significant changes in urinary levels of B⁺ Tn-C. Urinary B⁺ Tn-C can therefore be suggested as a valuable urine surveillance marker in UBC follow-up care.     

膀胱平滑肌肉瘤3例报告并文献复习

目的探讨膀胱平滑肌肉瘤的临床病理和诊治方法。方法患者3例,肉眼血尿,膀胱镜检见肿瘤分别发生于膀胱左侧壁、左前壁和右后壁,直径2.0～3.5cm,以菜花样和乳头样为主,基底较宽,瘤体表面光滑。结果 3例均行全膀胱切除术,病理表现为上皮下间质富于黏液,黏液中可见散在或束状分布的细长梭形瘤细胞,其胞质淡染,核呈长梭形,有轻度异型,核分裂象易见。免疫组化SMA（＋）3例、MSA（＋）3例、Des（＋）2例、S-100（-）2例、CD34（-）3例,均诊断为膀胱低级别平滑肌肉瘤。随访6个月～8年,1例术后2.5年死亡,2例存活。结论膀胱平滑肌肉瘤临床罕见,确诊依赖病理及免疫组化检查,应与平滑肌瘤、横纹肌肉瘤、癌肉瘤、炎性肌纤维母细胞瘤等鉴别,治疗以手术为主,需根据肿瘤分级、分期决定手术方案及术后是否需行辅助治疗。     

Successful treatment of solitary bladder plasmacytoma: A case report

BACKGROUNDPlasmacytoma is a rare neoplastic disorder that arises from B-lymphocytes. Solitary bladder plasmacytoma, a type of solitary extramedullary plasmacytoma, is even rarer. Treatments for solitary extramedullary plasmacytoma include surgery, chemotherapy, and radiation. However, there are no clinical trials or guidelines specifying which treatment might represent the gold standard.CASE SUMMARYWe herein report a case of a 51-year-old woman with solitary bladder plasmacytoma (SBP). There remains no consensus regarding the optimal treatment for SBP. However, we successfully treated her with transurethral resection of bladder tumor followed by postoperative radiotherapy (50 Gy/25 F). The patient remained free of tumor recurrence at a 7-mo follow-up.CONCLUSIONRadiation is the potential main treatment for SBP. However, surgery is also necessary.     

Mucinous cystic neoplasm of the liver: A case report

BACKGROUNDMucinous cystic neoplasm of the liver (MCN-L) is a cyst-forming epithelial neoplasm. The most distinguishing feature is the ovarian-type subepithelial stroma on pathological examination. CASE SUMMARYAn abdominal ultrasound incidentally revealed a liver tumor in a 32-year-old woman. Physical and laboratory examination results did not reveal any abnormalities. Enhanced abdominal computed tomography (CT) revealed a cystic space measuring 7.2 cm × 5.4 cm in the liver. Subsequent CT showed an increase in tumor size. Thus, we performed surgical resection of the tumor and gallbladder. Postoperative histopathological examination confirmed the diagnosis of MCN-L. At the 6-mo of follow-up, no recurrence was observed on ultrasound or CT.CONCLUSIONSince preoperative diagnosis of MCN-L is difficult, active surgery is recommended and helpful for the diagnosis and treatment of MCN-L.     

腹腔镜根治性膀胱全切+原位回肠新膀胱术治疗浸润性膀胱癌

目的探讨腹腔镜根治性膀胱全切+原位回肠新膀胱术的手术方法和经验。方法回顾分析2011年3月-2014年10月该院14例浸润性膀胱癌患者的临床资料。结果 13例成功施行了腹腔镜根治性膀胱全切+原位回肠新膀胱术,1例因术中膀胱内肿瘤出血增加术野无法显露而中转开放手术。12例在直视下行新膀胱尿道间断吻合,2例在腹腔镜下采用单针连续缝合法行新膀胱尿道吻合。手术平均时间444 min,术中平均出血量490 ml。术后病理提示12例为膀胱尿路上皮癌,其中1例伴部分鳞状细胞癌,2例为膀胱腺癌。2例患者术后出现尿漏,经保守治疗后治愈,1例术后出现尿失禁。术后随访6~56个月,3例死于肿瘤远处转移,1例目前发生肿瘤颅内转移。其余10例目前仍无瘤生存,其中1例术后1年出现尿道内口狭窄,经行尿道狭窄内切开术后治愈。10例患者目前控尿功能恢复良好,新膀胱容量约300 ml。结论腹腔镜根治性膀胱全切+原位回肠新膀胱术治疗膀胱癌疗效确切、安全、创伤小及术后恢复快,可作为临床浸润性膀胱癌的首选治疗方法。     

Urethral recurrence following neobladder in bladder cancer patients

Risk factors of urethral recurrence after neobladder in bladder cancer patients were studied. Between 1977 and 2001, 73 patients (male 58, female 15) underwent neobladder as a treatment for bladder cancer. The observation time after cystectomy ranged from 2 to 254 months (median 60.5). Ten (17.2%) of 58 male patients had urethral recurrence and of the 10, 8 patients had multiple bladder cancers including bladder neck. Urethral recurrence was found by macrohematuria, follow-up cystourethroscopy, and inguinal lymph node swelling. Only one who complained of macrohematuria had positive urinary cytology. Of 58 male patients, 5 underwent total nephroureterectomy for renal pelvic or ureteral cancer before radical cystectomy, and 3 of the 5 had urethral recurrence. Two of 10 patients with urethral recurrence died with cancer, and they had renal pelvic or ureteral cancer. The five-year cause specific survival was 83% for patients with urethral recurrence, and 79% for those without urethral recurrence, respectively. Urethral recurrence did not have a significant effect on survival. The patients with multiple bladder cancers including bladder neck, and renal pelvic or ureteral cancer before radical cystectomy, have high risks for urethral recurrence. Urinary cytology has limited value for the detection of urethral recurrence.     

Developing biomarkers for improved diagnosis and treatment outcome monitoring of bladder cancer

Importance of the field: A non-invasive marker for the follow-up and diagnosis of bladder cancer is highly needed. Several markers have been studied with regard to sensitivity and specificity in detecting bladder cancer. Comparison of studies is complicated by limited data on tumor characteristics and treatment details. Many studies do not differentiate between primary and recurrent tumors, nor is the performance of the studied marker assessed separately in superficial and invasive or high- versus low-grade tumors.

Areas covered in this review: The field of bladder cancer biomarker research from the past 15 years.

What the reader gain: A summary of the current field of bladder biomarker research with concluding remarks on some specific challenges in developing biomarkers for improved diagnosis and monitoring the disease.

Take home message: In general, the best new markers give higher sensitivity than urinary cytology, but specificity is usually lower. By using new markers, the intervals between follow-up cystoscopies can be increased and the detection of relapse can be improved. But to date no non-invasive biomarker has proven to be sensitive and specific enough available to replace cystoscopy, neither in the diagnosis nor in the follow-up of bladder cancer. However, new marker combinations and algorithms for risk assessment hold promise for the future.     

Current intravesical therapy for non-muscle invasive bladder cancer

Introduction: Transurethral resection of the bladder tumour (TURBT) is still the standard initial treatment for non-muscle invasive bladder cancer (NMIBC). However, even after a radical resection, recurrence (30 – 80%) and progression (1 – 45%) are commonly seen. Intravesical therapy provides direct contact of the agent with the bladder mucosa and clearly has improved the outcome, especially in high-risk disease.

Areas covered: The role of a good initial TURBT is emphasized. Risk assessment tools are discussed. Different intravesical therapies are enumerated according to the latest literature, with the emphasis on Bacillus Calmette–Guérin (BCG), including the discussion on the optimal dose and schedule. New developments are mentioned.

Expert opinion: A radical TURBT is essential for good prognosis. For optimal visualisation of tumours, fluorescence techniques should be used with low threshold, especially in case of suspicion of carcinoma in situ (CIS). Increased completeness of the resection will lead to less persisting disease and less need for adjuvant treatment. A re-TURBT should be done when in doubt of radical resection (judged by the pathologist or the surgeon). Risk assessment is essential, but the available tools are outdated. A single post-operative instillation (SPI) with chemotherapy is only indicated in low-risk disease. BCG is the treatment of choice for high-grade disease. BCG should be given as maintenance. Awareness of deterioration of the prognosis after progression is of great importance. In BCG failures, cystectomy should be strongly advised. Chemotherapy in combination with hyperthermia seems to be a new promising treatment.     

女性全膀胱切除原位回肠新膀胱术20例报告

目的探讨女性全膀胱切除原位回肠新膀胱术的技术改进及临床应用价值。方法 2004年1月至2009年1月,对20例女性膀胱肿瘤患者行全膀胱切除原位回肠新膀胱术,其间进行了系列改良探索,包括保留子宫、卵巢及附件的膀胱全切;保留完整尿道、阴道及自主神经的膀胱全切;腹膜外顺行切除膀胱;手助拔针邻边全层连续褥式缝合制作＂W＂回肠新膀胱;用直线切割吻合器恢复肠道连续性;用自制引导探子引导新膀胱与尿道吻合等。随访观察肿瘤控制、并发症及排尿控尿功能。结果手术时间平均330min,术中平均出血560ml。术后2～4周拔除尿管,患者排尿通畅。18例获得随访,平均随访时间38个月,术后12个月内恢复昼夜尿控分别为94.4%和88.9%,新膀胱容量平均330ml,蹲式手辅腹压排尿下,最大尿流率平均24.6ml/s,残余尿量0～25ml。无肿瘤复发及种植转移。结论经初步观察,女性膀胱肿瘤患者行膀胱全切,可尝试保留子宫、卵巢、附件和完整的尿道、阴道;全膀胱切除原位回肠新膀胱术较适于女性患者;所行系列改良可降低手术难度,减少并发症,在肿瘤根治的同时利于控尿恢复。     

藏区高原肺包虫病胸腔镜和开胸内囊穿刺摘除术疗效对比

目的:对比藏区高原肺包虫病胸腔镜和开胸内囊穿刺摘除术的效果。方法:将2015年7月至2018年8月日喀则市人民医院收治的行胸腔镜内囊穿刺摘除术治疗的36例肺包虫病患者纳入研究组,匹配同期行开胸手术36例患者为对照组,比较2种方式的手术时间、术中出血量、术后引流量、术后住院时间、并发症,通过术后影像学和复发率评价预后情况。结果:胸腔镜组和开胸组在手术时间、出血量、引流量、术后住院时间差异有统计学意义(P<0.05),胸腔镜组皆优于开胸组。2组术后并发症、影像学不良转归、复发率差异无统计学意义。结论:采用胸腔镜内囊穿刺摘除术治疗藏区高原肺包虫病具有一定优势。     

Primary mucosal-associated lymphoid tissue extranodal marginal zone lymphoma of the bladder from an imaging perspective: A case report

BACKGROUNDMucosal-associated lymphoid tissue extranodal marginal zone (MALT) lymphoma is a low-grade tumor that rarely occurs in the urinary bladder. There is currently no consensus on the common imaging findings or most appropriate treatment in MALT lymphoma in the urinary bladder due to the limited number of reports.CASE SUMMARYA 48-year-old woman was admitted to the hospital with a 1-year history of macroscopic hematuria. Imaging showed a large homogeneous mass with an unclear boundary and an irregular morphology in the bladder. The mass had an abundant blood supply. For further diagnosis, transurethral cystoscopic biopsy and bone marrow biopsy was performed, and the patient was finally diagnosed with primary MALT lymphoma of the bladder. R-CHOP chemotherapy was carried out. After three cycles of chemotherapy, the mass disappeared and the bladder wall thickness was only 4 mm, which indicated excellent therapeutic response to the chemotherapy. To date, the patient remains asymptomatic and she visits our hospital regularly for the completion of the remaining chemotherapy cycles.CONCLUSIONPrimary MALT lymphoma of the bladder is rare, and there are certain characteristics in the ultrasonographic findings. Imaging findings play an important role in evaluating the therapeutic efficacy and are critical during long-term follow-up after therapy.     

Pelvic lipomatosis with cystitis glandularis managed with cyclooxygenase-2 inhibitor: A case report

BACKGROUNDPelvic lipomatosis (PL) is a rare benign condition with characteristic overgrowth of histologically benign fat and invasion and compression of pelvic organs, often leading to non-specific lower urinary tract symptoms (LUTS). Approximately 40% of patients with PL have cystitis glandularis (CG). The cause of PL combined with CG is poorly understood, and there is currently no effective treatment. Refractory CG with upper urinary tract obstruction even requires partial or radical bladder resection. CASE SUMMARYIn this case, a patient suffering from PL with CG was treated by transurethral resection of bladder tumour (TUR-BT) and oral administration of celecoxib, a selective cyclooxygenase-2 (COX-2) inhibitor. The LUTS were alleviated, and the cystoscopy results improved significantly. Immunohistochemistry showed up-regulated COX-2 expression in the epithelium of TUR-BT samples, suggesting that COX-2 may participate in the pathophysiological process of PL combined with CG. CONCLUSIONWe report for the first time that celecoxib may be an effective treatment strategy for PL combined with refractory CG.     

Carbon ion radiotherapy for bladder cancer: A case report

BACKGROUNDRadical cystectomy is considered the first choice for the treatment of muscle-invasive bladder cancer. However, for some patients who have lost the indications for surgery, external beam radiotherapy is a non-invasive and effective treatment.CASE SUMMARYA 76-year-old patient with bladder cancer who had serious comorbidities and could not tolerate surgery or chemotherapy came to the Wuwei Heavy Ion Center. He received carbon ion radiotherapy (CIRT) with a whole-bladder dose of 44 GyE and tumor boost of 20 GyE. When he finished CIRT, his bladder cancer-related hematuria completely disappeared, and computed tomography examination showed that the tumor had obviously decreased in size. At the 3-mo follow-up, the tumor disappeared, and there were no acute or late adverse events. CIRT was well tolerated in this patient.CONCLUSIONCIRT may allow for avoiding resection and was well tolerated with curative outcomes.     

Extracranial multiorgan metastasis from primary glioblastoma: A case report

BACKGROUNDGlioblastoma has a high degree of malignancy and poor prognosis. It is common to have in situ recurrence and intracranial metastasis, while extracranial metastasis is rare, and extracranial multiorgan metastasis is extremely rare. We report a case of glioblastoma with extracranial multiorgan metastasis, which will strengthen clinicians’ attention to the extracranial metastasis of glioblastoma and its treatment.CASE SUMMARYA male patient visited our hospital for treatment of dizziness and headache. Magnetic resonance imaging of the brain revealed a space-occupying lesion in the right temporoparietal occipital region. Chest computed tomography and abdominal ultrasound were normal, and no space-occupying lesions were observed in other organs of the body. The patient underwent surgery and diagnosed with glioblastoma. Postoperative concurrent radiotherapy and chemotherapy were completed. During the follow-up, the tumor was found to have metastasized to the scalp and neck, and a second tumor resection was performed. Postoperative follow-up revealed extracranial metastases to multiple extracranial organs including skull, scalp, ribs, spine, liver and lung. His family members refused further treatment, and requested only symptomatic treatment such as pain relief, and the patient died of systemic multiple organ failure. Survival time from diagnosis to death was 13 mo and from extracranial metastasis to death was 6 mo.CONCLUSIONGlioblastoma extracranial metastasis is extremely rare, clinicians should always pay attention to its existence. The mechanism of glioblastoma extracranial metastasis is still unclear, and genetic and molecular studies are required.     

Local hyperthermia combined with chemotherapy for the treatment of multiple recurrences of undifferentiated pleomorphic sarcoma: A case report

BACKGROUND Undifferentiated pleomorphic sarcoma (UPS) is a type of soft tissue sarcoma, the histologic origin and differentiation direction of which are still unclear. There are few treatment options for UPS other than surgery. Herein we describe a patient who had multiple recurrences of UPS postoperatively, but R0 resection was achieved by local hyperthermia combined with chemotherapy, thus providing a new treatment approach for similar situations. CASE SUMMARYA 65-year-old man sought evaluation from a physician for a mass on his right back. After surgery, the pathologic diagnosis was fibrosarcoma. During the follow-up evaluations until 2021, the patient had four relapses of varying degrees. Postoperative pathology confirmed the recurrence of UPS on the right back. In March 2021, he underwent local hyperthermia combined with two cycles of chemotherapy for recurring lesions. After magnetic resonance imaging re-examination and preoperative examination, the patient chose surgery again. During the operation, the tumors were easy to excise, the amount of bleeding decreased significantly, and the pathologic evaluation confirmed that one of the specimens was an R0 excision.CONCLUSIONLocal hyperthermia combined with chemotherapy enables R0 resection to be achieved in patients with advanced UPS recurrence.     

Severe hematuria due to vesical varices in a patient with portal hypertension: A case report

BACKGROUNDHematuria is one of the most common clinical symptoms for urologists and is typically observed in urinary system tumors, prostate hyperplasia, and urinary stone disease. Hematuria due to vesical varices is very rare, and only a few cases have been reported since 1989. We report the first case of vesical varices due to portal hypertension with aberrant development and functioning of the genitourinary system along with the complete diagnosis and treatment process.CASE SUMMARYThis patient was a 53-year-old man with a history of aberrant development of the genitourinary system and hepatitis B-associated cirrhosis. He was admitted to the emergency department with severe hematuria and bladder clot tamponade. Many abnormally dilated blood vessels were found surrounding the bladder in the pelvis by color Doppler ultrasound, contrast-enhanced computed tomography, and three-dimensional visualization technology. It was difficult to perform transurethral cystoscopy and hemostasis in this patient, so we performed open surgical bladder exploration for hemostasis and surgical devascularization around the bladder.CONCLUSIONUrologists should improve the understanding of the pathophysiology, clinical manifestations, diagnosis, and treatment of vesical varices. This case may be presented as a reference for the diagnosis and management of severe hematuria due to vesical varices.     

脐尿管癌临床病理学特点及手术效果分析

目的 探讨脐尿管癌的临床病理学特点和手术方式,提高其诊治水平.方法 回顾性分析9例脐尿管癌的临床特点、病理特征、诊断、手术方式及手术效果.结果 9例中病理诊断结果为脐黏液腺癌7例,未特殊分类腺癌、小细胞型内分泌癌各1例.Sheldon分期ⅢA期8例,ⅢC期1例.行扩大性膀胱部分切除术8例,膀胱部分切除术1例.术后3个月死于骨转移1例,术后11个月因膀胱前壁局部复发行二次手术1例,分别于术后15个月和24个月出现膀胱颈部及尿道复发行肿瘤电切术1例,余6例随访6～42个月,均无肿瘤复发.结论 脐尿管癌临床少见,预后较差.熟悉本病的临床病理学特点对于提高诊断水平非常重要.早期行扩大性膀胱部分切除术可达到长期无瘤生存的效果.