Purpose: We postulate that the number of lymph nodes examined in cystectomy specimens can have an impact on the outcome of patients with bladder cancer. Materials and Methods: We analyzed data on 322 patients with muscle invasive bladder cancer who underwent radical cystectomy and bilateral pelvic lymphadenectomy. We evaluated the associations of the number of lymph nodes identified by the pathologist in the surgical specimen with the local recurrence rate and survival outcome. Results: Patients were divided into groups by lymph node status and the distribution of the number of lymph nodes examined. In stages pN 0 and pN + cases improved survival was associated with a greater number of lymph nodes examined. We determined that at least nine lymph nodes should be studied to define lymph node status accurately. Conclusions: These results indicate that surgical resection and pathological assessment of an adequate number of lymph nodes in cystectomy specimens increases the likelihood of proper staging and impacts patient outcome. Such information is important not only for the therapy and prognosis of individuals, but also for identifying those who may benefit from adjuvant chemotherapy.

Impact of the number of lymph nodes retrieved on outcome in patients with muscle invasive bladder cancer.

https://www.europeanurology.com/article/S0302-2838(14)01263-9/pdf/systematic-review-and-cumulative-analysis-of-oncologic-and-functional-outcomes-after-robot-assisted-radical-cystectomy

Systematic Review and Cumulative Analysis of Oncologic and Functional Outcomes After Robot-assisted Radical Cystectomy

https://www.europeanurology.com/article/S0302-2838(10)00756-6/pdf/influence-of-modified-posterior-reconstruction-of-the-rhabdosphincter-on-early-recovery-of-continence-and-anastomotic-leakage-rates-after-robot-assisted-radical-prostatectomy

Influence of Modified Posterior Reconstruction of the Rhabdosphincter on Early Recovery of Continence and Anastomotic Leakage Rates after Robot-Assisted Radical Prostatectomy

Following curative treatment for localised renal cell carcinoma (RCC), up to 30% of patients develop tumour recurrence. Prognostic scores are essential to guide individualised surveillance protocols, patient counselling and potentially in the future to guide adjuvant therapy. In metastatic RCC, prognostic scores are routinely used for treatment selection in clinical practice as well as in all major trials. We performed a literature review on the current evidence based on prognostic factors and models for localised and metastatic RCC. A number of prognostic factors have been identified, of which tumour node metastasis classification remains the most important. Multiple prognostic models and nomograms have been developed for localised disease, based on a combination of tumour stage, grade, subtype, clinical features, and performance status. However, there is poor level of evidence for their routine use. Prognostic scores for patients with metastatic RCC receiving targeted treatments are used routinely, but have limited accuracy. Molecular markers can improve the accuracy of established prognostic models, but frequently lack external, independent validation. Several factors and models predict prognosis of localised and metastatic RCC. They represent valuable tools to provide estimates of clinically important endpoints, but their accuracy should be improved further. Validation of molecular markers is a future research priority.

Prognostic factors and prognostic models for renal cell carcinoma: a literature review.

This review summarizes all studies that compare the effect of a MBSR program to a control group intervention, in which the participants had been randomly allocated to be in either the MBSR group or a control group. The review summarizes the results in two categories. First, where the effect of the MBSR program was compared to an inactive group (either a wait list group or one receiving ordinary care also received by the MBSR group). Second, where MBSR was compared with an alternative active group intervention.

Based on this review it is reasonable to consider MBSR a moderately well-documented method for helping adults improve their health and cope better with the challenges and stress that life brings. New research should improve the way the trials are conducted addressing the pitfalls in research on mind-body interventions.

https://onlinelibrary.wiley.com/doi/pdf/10.4073/csr.2017.11

Mindfulness‐based stress reduction (MBSR) for improving health, quality of life and social functioning in adults: a systematic review and meta‐analysis

Mp43-06 24 hour urinary parameters in overweight and obese pediatric patients - a single institution cohort

Mixed epithelial and stromal tumour (MEST) is a renal neoplasm with a mixture of solid and cystic components and microscopic findings of epithelial and stromal cells within the tumour.1 MESTs are most often seen in adult females, commonly during perimenopausal ages (40–50 years).1 Some believe MEST and cystic nephroma (CN) represent a spectrum of the same tumour process, and the term “renal and epithelial stromal tumour” was first proposed by Turbiner et al in 2007 to better encapsulate both MEST and CN.1,2 More recently, the 2016 World Health Organization classification of tumours combined adult CN and MEST under the term “mixed epithelial and stromal tumour family.”3 Although CN/MEST is recognized as one diagnosis in adults, recent studies describe pathologial and genetic differences between adult CN/MEST and pediatric CN.3,4 Since similar relationships between pediatric MEST and CN have not been defined, it is important to recognize MEST as a distinct potential diagnosis in a pediatric patient with a renal neoplasm.

/pdf/case-mixed-epithelial-and-stromal-tumours-a-rare-pediatric-3cul5pttqq.pdf

Case - Mixed epithelial and stromal tumours: A rare pediatric renal tumour.

Relationship of lymph node count and accuracy of nodal stage at radical cystectomy

Post-operative analgesic management is challenging in infants and opioids have been the standard of care. However, they are associated with adverse effects which may negatively impact infants. In this retrospective cohort study, we sought to explore the postoperative analgesic efficacy of quadratus lumborum (QL) block in the infant population undergoing dorsal lumbotomy pyeloplasty. Chart review of 34 infants (≤12 months) who underwent dorsal lumbotomy pyeloplasty between 2016–2020 was performed. Post-operative pain was assessed using externally validated pain scales (CRIES & FLACC) and monitored hemodynamics (pulse and blood pressure). Opioid doses were standardized by using morphine milligram equivalency (MME). The Prescription Database Monitoring Program (PDMP) was utilized to determine if discharge opioid prescriptions were filled. Of 34 patients, 13 received the QL block. Mean age at the time of surgery was 6.2 months ± 3.2 months. The QL group received 0.8 MME postoperatively, whereas the non-QL group received 0.9 MME (p = 0.82). The QL group (20%) filled their discharge opioid prescription less frequently compared to non-QL group (100%) (p = 0.002). There were no observed differences between pain scale or hemodynamic variables. Further studies are warranted to explore QL block’s efficacy for post-operative infant pain management.

Analgesic Efficacy of Quadratus Lumborum Block in Infants Undergoing Pyeloplasty

Application of minimally invasive surgery with robotic technology has been well accepted for certain pediatric urologic procedures. The benefits of 3-D view with magnification, motion scaling, and tremor filtering have been advantageous for some upper and lower tract reconstructive procedures.

Pankaj P. Dangle

Papers

Mp43-06 24 hour urinary parameters in overweight and obese pediatric patients - a single institution cohort

Case - Mixed epithelial and stromal tumours: A rare pediatric renal tumour.

Relationship of lymph node count and accuracy of nodal stage at radical cystectomy

Analgesic Efficacy of Quadratus Lumborum Block in Infants Undergoing Pyeloplasty

Robotic-Assisted Laparoscopic Ileocystoplasty and Mitrofanoff Appendicovesicostomy: Technique and Updated Experience