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 Risk assessment is essential, but the available tools are outdated.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.     

Three‐Dimensional Echocardiography‐Based Prediction of Posterior Leaflet Resection

Clinical long‐term outcomes have shown that partial leaflet resection followed by ring annuloplasty is a reliable and reproducible surgical repair technique for treatment of mitral valve (MV) leaflet prolapse. We report a 61‐year‐old male for three‐dimensional transesophageal echocardiography (3DTEE)‐based virtual posterior leaflet resection and ring annuloplasty. Severe mitral regurgitation was found and computational evaluation demonstrated substantial leaflet malcoaptation and high stress concentration. Following virtual resection and ring annuloplasty, posterior leaflet prolapse markedly decreased, sufficient leaflet coaptation was restored, and high stress concentration disappeared. Virtual MV repair strategies using 3DTEE have the potential to help optimize MV repair.     

Decision-making in ileocecal Crohn’s disease management: surgery versus pharmacotherapy

Ileocecal Crohn’s disease (CD) can be treated medically as well as surgically. Both treatment modalities have been improved markedly in the last two decades, making CD more manageable. However, multidisciplinary research, addressing issues such as timing of surgery or medical treatment versus surgery, is scarce. Particularly in limited ileocecal CD, ileocolic resection might be a good alternative to long-term medical therapy. This review discusses the evidence on medical and surgical treatment options for ileocecal CD. It provides an aid in decision-making by discussing a treatment algorithm that can be used until further evidence on treatment is available.     

TURP术后膀胱颈瘢痕狭窄28例的诊疗分析

目的探讨膀胱颈瘢痕狭窄的治疗方法。方法回顾性分析我院泌尿外科2007年7月—2010年6月收治的TURP术后膀胱颈瘢痕狭窄患者28例。3例患者行尿道镜下冷刀内切开＋电切镜下膀胱颈瘢痕电切术,25例患者行电切镜下膀胱颈瘢痕电切术。结果 27例随访6个月未见复发,1例患者术后4个月再次出现梗阻症状。结论联合使用尿道镜下冷刀内切开及电切镜下瘢痕电切是治疗TURP术后膀胱颈瘢痕狭窄的有效方法。     

腹腔镜下直肠癌根治术的近期临床疗效观察

目的探讨腹腔镜下直肠癌根治术的近期临床疗效。方法回顾性分析2015年11月-2016年11月该院行直肠癌根治性手术的患者50例。其中,行腹腔镜下直肠癌根治术的患者27例,行开腹直肠癌根治术的患者23例,观察两组患者手术时间、肿瘤直径、标本切除长度、术中清扫淋巴结数目、开始下床活动时间、术后肛门排气时间、术后的排便时间、术后开始进食时间和术后并发症等指标。结果腹腔镜组患者的肿瘤直径、标本切除长度和淋巴结清扫数目为(3.8±1.4)cm、(18.5±2.1)cm和(7.2±3.1)枚,而开腹组患者相应检查项目分别为(3.9±1.4)cm、(18.6±2.3)cm和(7.7±3.4)枚,组间比较差异不具统计学意义(P0.05)。腹腔镜组患者在术中出血量、手术时间、术后下床活动时间、术后肛门排气时间、术后排便时间、术后进食流质食物时间和术后住院时间分别为(105.3±23.8)ml、(140.2±22.3)min、(4.0±1.2)d、(6.0±1.5)d、(3.0±1.0)d、(3.5±0.5)d和(4.0±1.0)d,开腹组相应数值为(210.4±21.3)ml、(118.9±20.7)min、(4.5±1.1)d、(7.8±1.2)d、(7.0±1.6)d、(8.1±2.0)d和(10.0±3.2)d,两组患者的比较差异有统计学意义(P0.05)。结论腹腔镜下直肠癌根治性手术安全有效,可以对肿瘤做到根治性切除,且术中出血少,术后康复快,住院时间短。     

Coronary revascularisation with Genous stent helps reduce the waiting time for lung resection

Patients suitable for lung resection for primary lung cancer and with myocardial ischaemia due to significant coronary artery stenosis, despite optimal medical therapy, are considered for either percutaneous or surgical revascularisation prior to thoracic surgery. Percutaneous coronary intervention (PCI) with bare metal stent (BMS) requires patients to initially receive dual anti-platelet therapy of clopidogrel and aspirin for at least 6 weeks, which delays the waiting time for curative lung resection. We report the successful use of the Genous endothelial progenitor cell (EPC) capture stent in two patients requiring PCI for significant coronary artery disease prior to lung resection. Following PCI with Genous stent implantation, both patients received dual anti-platelet therapy for 1 week. Clopidogrel was then discontinued and a week later both safely underwent curative lung resection receiving aspirin alone. At 6 months’ follow-up, neither patient had symptoms or electrocardiograph changes suggestive of angina. Our report suggests that in patients requiring PCI prior to lung resection the Genous EPC capture stent is suitable and reduces their waiting time for surgical resection to 2 weeks instead of 6.