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

Suprapubic catheters are used routinely for bladder drainage; however, complications are commonly reported. These complications could be attributed to surgical technique or the catheter itself. Complications related to surgical technique can be controlled and reduced, but catheter-related complications are unavoidable and unpredictable. We report a rare catheter-related complication leading to obstruction of the ureter in a solitary kidney in a patient with neurogenic bladder and voiding dysfunction managed with suprapubic catheter drainage.

/pdf/suprapubic-cystostomy-a-bizarre-complication-of-catheter-51i6r1zdhu.pdf

Suprapubic cystostomy: a bizarre complication of catheter migration causing ureteric obstruction

Objectives To assess the optimal length of follow-up for patients undergoing both open and minimally invasive pyeloplasties to ensure prompt detection of a recurrent obstruction There are no standard guidelines on ideal follow-up and imaging post-pediatric pyeloplasty currently Methods A retrospective chart review identified 264 patients (<18 years old) who underwent pyeloplasty for ureteropelvic junction obstruction between April 2002 and December 2014 Ultrasound was obtained every 3-4 months for the first year following pyeloplasty and thereafter at discretion of treating physician Patient characteristics including symptoms and imaging were reviewed Results Of the 264 patients, 72% were male with mean age of 51 months and follow-up of 268 months Approximately 73% followed-up to three years Fourteen patients (53%) had a recurrent obstruction Among the failures, 85% were diagnosed and underwent successful redo-pyeloplasty within three years The six infants with recurrence (43% of all unsuccessful surgeries) were diagnosed within three years of the initial surgery Patients undergoing a minimally invasive procedure were less likely to be followed for more than three years compared to an open procedure (p<0001) Patients with severe hydronephrosis preoperatively were followed longer (p=0031) Age at surgery and type of surgical approach (p<001) were significant predictors of length of follow-up in a negative binomial regression Conclusions Based on the results, a minimum of three years of follow-up is necessary to detect the majority of recurrent obstructions Amongst those who require a secondary pyeloplasty, younger patients with severe hydronephrosis are at an increased risk of recurrence

/pdf/optimal-length-of-follow-up-for-the-detection-of-3c4a993xw2.pdf

Optimal Length of Follow-up for the Detection of Unsuccessful Pediatric Pyeloplasty: A Single-Center Experience

Our aim was to examine the current status of minimally invasive approaches to ureteropelvic junction (UPJ) obstruction and compare it to the gold standard of open pyeloplasty. A review of the literature was conducted using PubMed and Medline databases for UPJ obstruction. Open pyeloplasty achieves good results, in the range of 90–100%. Laparoscopic pyeloplasty results are as good as those of open surgery. However, the goal of laparoscopic pyeloplasty as a means of providing minimally invasive surgery to a larger number of patients has not been achieved. The reason for this is the difficulty faced by most urologists in acquiring the technical skills to perform a laparoscopic pyeloplasty. In reports of robot-assisted pyeloplasty, results in the range of 88–97% appear to be achieved. Robotic technology has the potential to make minimally invasive pyeloplasty an easier skill to acquire for a larger number of urologists. Long-term data are still required to determine its efficacy.

/pdf/robot-assisted-laparoscopic-pyeloplasty-a-review-of-1b0xkgr1uv.pdf

Robot-assisted laparoscopic pyeloplasty: a review of minimally invasive treatment options for ureteropelvic junction obstruction.

Clinical and Radiological Risk Factors Predicting Open Surgical Repair in Pediatric Patients With Dilating Vesicoureteral Reflux

We describe a case of early postoperative aortoureteric fistula following exenterative surgery treated with wet ostomy with bilateral ureterosigmoidostomies and ureteric stent placement. A high index of clinical suspicion is required, as diagnosis is often difficult.

/pdf/ureteral-stent-related-aortoureteric-fistula-case-report-and-nz2agj45b6.pdf

Pankaj P. Dangle

Papers

Suprapubic cystostomy: a bizarre complication of catheter migration causing ureteric obstruction

Optimal Length of Follow-up for the Detection of Unsuccessful Pediatric Pyeloplasty: A Single-Center Experience

Robot-assisted laparoscopic pyeloplasty: a review of minimally invasive treatment options for ureteropelvic junction obstruction.

Clinical and Radiological Risk Factors Predicting Open Surgical Repair in Pediatric Patients With Dilating Vesicoureteral Reflux

Ureteral stent-related aortoureteric fistula: case report and literature review.