Context: Our prior systematic review and meta-analysis of individual participant data (IPD) suggesting a benefit of adjuvant chemotherapy for muscle-invasive bladder cancer was limited by the number and size of included randomised trials. We have updated results to include additional trials, providing the most up-to-date and reliable evidence of the effects of this treatment. Objective: To investigate the role of adjuvant cisplatin-based chemotherapy in the treatment of muscle-invasive bladder cancer. Evidence acquisition: Published and unpublished trials were sought via searches of bibliographic databases, trials registers, conference proceedings, and hand searching. Updated IPD were centrally collected, checked, and analysed. Results from individual randomised controlled trials (RCTs) were combined using a two-stage fixed-effect model. Prespecified analyses explored any variation in effect by trial and participant characteristics. Evidence synthesis: Analyses of ten RCTs (1183 participants) demonstrated a benefit of cisplatin-based adjuvant chemotherapy on overall survival (hazard ratio [HR] = 0.82, 95% confidence interval [CI] = 0.70-0.96, p = 0.02). This represents an absolute improvement in survival of 6% at 5 yr, from 50% to 56%, and a 9% absolute benefit when adjusted for age, sex, pT stage, and pN category (HR = 0.77, 95% CI = 0.65-0.92, p = 0.004). There was no clear evidence that the effect varied by trial or participant characteristics. Adjuvant chemotherapy was also shown to improve recurrence-free survival (HR = 0.71, 95% CI = 0.60-0.83, p < 0.001), locoregional recurrence-free survival (HR = 0.68, 95% CI = 0. 55-0.85, p < 0.001), and metastasis-free survival (HR = 0.79, 95% CI = 0.65-0.95, p = 0.01), with absolute benefits of 11%, 11%, and 8%, respectively. Conclusions: This systematic review and meta-analysis demonstrates that cisplatinbased adjuvant chemotherapy is a valid option for improving outcomes for muscleinvasive bladder cancer. Patient summary: We looked at the effect of cisplatin-based chemotherapy on outcomes in participants with muscle-invasive bladder cancer. We gathered this information from eligible randomised controlled trials. We demonstrated that cisplatin-based chemother- apy is a valid option for improving outcomes of muscle-invasive bladder cancer. (c) 2021 The Authors. Published by Elsevier B.V. on behalf of European Association of Urology. This is an open access article under the CC BY license (http://creativecommons. org/licenses/by/4.0/).

Background: The crossfolded ileal reservoir combined with an afferent tubular isoperistaltic segment for heterotopic continent urinary diversion has been performed on a regular basis for over 20 years. Yet data on long-term-outcomes remain sparse. Objective: To report long-term functional and oncological outcomes, gastrointestinal and metabolic disturbances, urinary tract infections (UTIs), and quality of life. Design, setting, and participants: Long-term functional and oncological outcomes of a consecutive series of 118 patients undergoing cystectomy and construction of a continent cutaneous crossfolded ileal reservoir from 2000 to 2018 were evaluated. Intervention: Patients underwent cystectomy and construction of a continent cutaneous crossfolded ileal reservoir according to the Studer technique for bladder reconstruction. Outcome measurements and statistical analysis: Pre-and postoperative data until last follow-up appointment were entered prospectively in the departmental database. Self reported questionnaires regarding quality of life, patient satisfaction, and difficulty in catheterisation were sent to patients preoperatively; after 3, 6, 12, and 24 mo; and at last follow-up, and were then manually entered in the departmental database. Results and limitations: The median follow-up was 7.8 (interquartile range 3-12.7) yr. Patient satisfaction was high in 77.4% and moderate in 16.9%. Serum creatinine and estimated glomerular filtration rate remained stable during follow-up. Of all patients, 81% (96/118) had at least one UTI during follow-up. Recurrent UTIs occurred in 67% (79/ 118) of patients. Urolithiasis was found in 12% (14/118), with 6% (7/118) having a single and 6% a recurrent event. Of all stone formers, 79% (11/14) had recurrent UTIs. In oncological patients, 12.5% (10/79) developed a local recurrence. Cancer-specific survival and overall survival were 90% and 88%, and 68% and 56% after 1 and 10 yr, respectively. A limitations is the retrospective analysis from prospectively assessed data. Conclusions: A high satisfaction level, stability of kidney function, and low rates of urolithiasis in patients with a heterotopic continent ileal reservoir can be achieved, provided that close attention is paid to intra-and postoperative details. Regular lifelong follow-up is essential for timely detection and treatment of complications. Oncological outcome is not affected by the urinary diversion. Patient summary: In patients with a continent cutaneous ileal reservoir, good quality of life and a high satisfaction rate are possible provided that patients adhere to regular lifelong follow-up. (c) 2020 European Association of Urology. Published by Elsevier B.V. All rights reserved.

Background: In patients who do not qualify for an orthotopic urinary diversion, for example, the urethra cannot be spared or is functionally impaired, a heterotopic continent cutaneous cross-folded ileal reservoir offers a good alternative. Objective: To describe the indication, surgical technique, and postoperative management, and to report the reservoir-related outcomes and complications associated with the serosa-lined tunnel. Design, setting, and participants: Perioperative outcomes of 118 consecutive patients after cystectomy and a heterotopic ileal reservoir adapted from the Studer bladder substitute technique, operated between 2000 and 2018, were evaluated. The catheterisable serosa-lined tunnel was constructed from the appendix (Mitrofanoff, n = 63), an ileal segment (Yang-Monti, n = 48), or a fallopian tube (n = 7). Outcome measurements and statistical analysis: Pre-and postoperative data until last follow-up appointment were entered prospectively in the departmental database. The chi-square test was used to compare proportions. Results and limitations: Median follow-up was 94 (interquartile range 36-152) mo. No peri-or postoperative mortality was observed within 90 d of surgery. Patient satisfaction was high in 77.5% and moderate in 16.9%. Overall, complications associated with the serosa-lined tunnel occurred in 52% (61/118) of patients. Stenosis of the continent outlet developed in 38% (45/118) of patients: 33/45 (75%) were simply dilated/incised at the outpatient clinic, of those 24% (8/33) required additional endoscopic dilatation. Of patients with stenosis of the continent outlet, 27% (12/45) needed open revision surgery. During follow-up, 8% (nine/118) of patients required revision of the serosa-lined tunnel due to incontinence. Twelve months postoperatively, 95% (92/97) patients were continent. A limitation is the retrospective analysis from prospectively assessed data. This could limit the generalisability of these findings, as selection bias cannot be excluded. Conclusions: The heterotopic continent cutaneous cross-folded ileal reservoir achieves good functional results. Complications associated with the serosa-lined tunnel occur in about half of the patients but generally are easy to manage. As a result, patient satisfaction is high. Patient summary: In patients who do not qualify for an orthotopic bladder substitute, a heterotopic continent cutaneous cross-folded ileal reservoir offers a viable alternative with good postoperative functional results and high patient satisfaction. (c) 2020 Published by Elsevier B.V. on behalf of European Association of Urology.

nasogastric tube, neostigmine, early ambulation, and early oral feeding) [4,11].Finally, as suggested by the authors in their conclusions, randomized clinical trials and wellpowered studies are already available.

OBJECTIVE:To analyse urinary continence in long-term survivors after radical cystectomy (RC) and orthotopic bladder substitution (OBS) according to attempted nerve-sparing (NS) status.PATIENTS AND METHODS:We analysed 180 consecutive patients treated at our department between 1985 and 2007, who underwent RC with OBS, and survived ≥10 years after RC. We stratified patients by attempted NS status and evaluated continence outcomes using descriptive statistics and Cox proportional hazards regression models. A secondary analysis evaluated erectile function as a quality control for attempted NS.RESULTS:The median (interquartile range [IQR]) age at RC was 62 (57-71) years. Of 180 patients, attempted NS status was none in 24 (13%), unilateral in 100 (56%), and bilateral in 56 (31%). After a median (IQR) follow-up of 169 (147-210) months, 160 (89%) patients were continent during daytime and 124 (69%) during night-time. In multivariable analysis, any degree of attempted NS was significantly associated with daytime continence (odds ratio [OR] 2.08, 95% confidence interval [CI] 1.05-4.11; P = 0.04). Correspondingly, any attempted NS was significantly associated with night-time continence (OR 2.51, 95% CI 1.08-5.85; P = 0.03). Recovery of erectile function at 5 years was also significantly associated with attempted NS (P < 0.001).CONCLUSION:Nerve-sparing during RC and OBS was associated with better long-term continence outcomes. This becomes more apparent as the patients age with their OBS. We advocate a NS RC whenever an OBS is considered.

OBJECTIVES:To assess the effect of adding lymph nodes (LNs) located along the common iliac vessels and in the fossa of Marcille to the extended pelvic LN dissection (PLND) template at radical prostatectomy (RP).PATIENTS AND METHODS:A total of 485 patients underwent RP and PLND at a referral centre between 2000 and 2008 (historical cohort: classic extended PLND template) and a total of 268 patients between 2010 and 2015 (contemporary cohort: extended PLND template including LNs located along the common iliac vessels and in the fossa of Marcille). Descriptive analyses were used to compare baseline, pathological, complication and functional data between the two cohorts. A logistic regression model was used to assess the template's effect on the probability of detecting LN metastases.RESULTS:Of 80 patients in the historical cohort with pN+ disease, the sole location of metastasis was the external iliac/obturator fossa in 23 (29%), and the internal iliac in 18 (23%), while 39 patients (49%) had metastases in both locations. Of 72 patients in the contemporary cohort with pN+ disease, the sole location of metastasis was the external iliac/obturator fossa in 17 patients (24%), the internal iliac in 24 patients (33%), and the common iliac in one patient (1%), while 30 patients (42%) had metastases in >1 location (including fossa of Marcille in five patients). Among all 46 patients in the contemporary cohort with ≤2 metastases, three had one or both metastases in the common iliac region or the fossa of Marcille. The adjusted probability of detecting LN metastases was higher, but not significantly so, in the contemporary cohort. There were no differences between the two cohorts in complication rates and functional outcomes.CONCLUSION:A more extended template detects LN metastases in the common iliac region and the fossa of Marcille and is not associated with a higher risk of complications; however, the overall probability of detecting LN metastases was not significantly higher.

e16535 Background: Development of biochemical recurrence with a rising PSA level after radical prostatectomy causes significant anxiety for patients and treating oncologist. Management of these patients is controversial. Here, we characterize the natural course and pattern of disease progression and survival in men with biochemical recurrence (BCR) after radical prostatectomy (RP) for intermediate and high-risk prostate cancer (PCa) untreated until clinical failure (CF). Methods: Retrospective analysis of consecutive men with BCR after RP for intermediate/high risk PCa. All patients underwent RP+extended pelvic lymph node dissection. A PSA level > 0.2 ng/ml on two consecutive measures was considered BCR. None received neoadjuvant or adjuvant therapy prior to documented clinical failure by body imaging, which was performed at the time point of BCR or symptoms and at least once per year. Results: Of the 622 men with BCR included into the analysis, 267 (43%) had high risk PCa. Median follow-up after RP was 9.4 yrs. (IQR 4.8-15.1) and median time from RP to BCR was 1.4 yrs. (IQR 0.4-3.6). Of the patients 324 (52%) never experienced CF (Æfollow-up from BCR 5.8yr, IQR2.1-11.9); 88 (14%) had local recurrence only; 59 (9%) had lymph node metastasis +/-local recurrence and 151(24%) distant metastasis. The median times from BCR to CF were: 9.5 yrs. (IQR 5.6-13.5) for local failure; 4.9 yrs. (IQR 3.1-8.8) for lymph node failure and 5.6 yrs. (IQR 3-10.5) for distant failure. The 10-yrs cancer specific (CSS) and overall survival (OS) of the entire group from time point of BCR was 78% and 66%, respectively. 5- and 7-yrs conditional CSS from time of CF was strongly depended on recurrence pattern and ranged from 90% and 79% (local only) to 70% and 47% (lymph node+/-local) and 47% and 36% (distant mets), respectively. PSA-doubling time < 12 months and > 2 positive nodes were independent predictors of outcome in multivariate analysis. Conclusions: These data may be useful in informing men with intermediate/high risk PCa regarding the natural course of PSA recurrence and counseling the timing of additional therapies.

You have accessJournal of UrologyProstate Cancer: Staging I1 Apr 2017MP20-16 A MORE EXTENDED LYMPH NODE DISSECTION TEMPLATE AT RADICAL PROSTATECTOMY DETECTS METASTASES IN THE COMMON ILIAC REGIONS AND IN THE FOSSA OF MARCILLE Lydia Maderthaner, Marc-Alain Furrer, George N. Thalmann, Urs E. Studer, and Daniel P. Nguyen Lydia MaderthanerLydia Maderthaner More articles by this author , Marc-Alain FurrerMarc-Alain Furrer More articles by this author , George N. ThalmannGeorge N. Thalmann More articles by this author , Urs E. StuderUrs E. Studer More articles by this author , and Daniel P. NguyenDaniel P. Nguyen More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.648AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES A 2008 mapping study showed that primary lymphatic landing sites of the prostate are also found medially to the internal iliac vessels, in the fossa of Marcille and along the common iliac vessels up to the ureter crossing. We then expanded our PLND template accordingly (Graphic). We assessed the effects of the template revision on pathologic and complication outcomes. METHODS 753 pts underwent RP and extended PLND from 2000 to 2008 (485 pts [64%]; historical cohort) and from 2010 to 2015 (268 [36%]; contemporary cohort) at a referral center. Descriptive statistics and a logistic regression model were used. Subanalysis of patients with =2 metastases was performed because these patients are the ones who may most benefit from removal of LN metastases. RESULTS Median number of LN removed in the historical cohort was 25 (IQR 19-33) and in the contemporary cohort 34 (27-43; p <0.0001). Among 80 N+ pts (16%) in the historical cohort, the sole location of metastasis was external iliac/obturator region in 23/80 (29%) and internal iliac in 18/80 (23%), while 39/80 (49%) had metastases in both locations. Among 72 N+ pts (27%) in the contemporary cohort, the sole location of metastasis was external iliac/obturator region in 17 (24%) patients, internal iliac region in 24 (33%), and common iliac region in 1 (1%), while 30 (42%) had metastases in more than one location. While 5 patients had LN metastases in the fossa of Marcille, the latter was never the exclusive location. However, among pts with =2 metastases in the contemporary cohort, 3 pts had one or both metastases in the common iliac regions or in the fossa of Marcille only. The adjusted risk to harbor nodal metastases was higher in the contemporary cohort, albeit not significantly (OR 1.19, 95% CI 0.77-1.84; p=0.4). Complications such as lymphoceles, thrombosis and neuropraxia were no more frequent with a more extended template. CONCLUSIONS A more extended PLND template detects LN metastases in the common iliac regions and in the fossa of Marcille and is associated with an overall non-significant higher risk of harboring LN metastases. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e245 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Lydia Maderthaner More articles by this author Marc-Alain Furrer More articles by this author George N. Thalmann More articles by this author Urs E. Studer More articles by this author Daniel P. Nguyen More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

You have accessJournal of UrologyBladder Cancer: Invasive I1 Apr 2016MP38-17 ATTEMPTED NERVE SPARING HAS A LONG TERM IMPACT ON URINARY CONTINENCE IN PATIENTS WITH AN ORTHOTOPIC BLADDER SUBSTITUTE Marc Furrer, Daniel P. Nguyen, Tobias Gross, George N. Thalmann, and Urs E. Studer Marc FurrerMarc Furrer More articles by this author , Daniel P. NguyenDaniel P. Nguyen More articles by this author , Tobias GrossTobias Gross More articles by this author , George N. ThalmannGeorge N. Thalmann More articles by this author , and Urs E. StuderUrs E. Studer More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.121AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The value of nerve sparing (NS) in order to improve functional outcomes after diversion with an orthotopic bladder substitute (OBS) remains a matter of debate. The purpose of this study was to analyze voiding patterns of long-term survivors. METHODS 195 pts (177 men, 18 women) who underwent radical cystectomy (RC) and diversion with an OBS from April 1985 to December 2004, who had no adjuvant radiotherapy and survived ≥10 yrs were evaluated. Continence status (≤1 pad/day) during day- and nighttime at last follow-up were assessed stratified by NS status (none, unilateral, bilateral). Descriptive statistics compared outcomes between groups. RESULTS Median age at RC was 63 years (IQR 57-69). Of 195 pts, 32 (16%) had no NS, 119 (61%) unilateral attempted NS, and 44 (23%) had bilateral attempted NS. After a median follow-up of 167 months (IQR 137-206) contincene rates were 87% (169/195) during nighttime and 64% (125/195) during nighttime. In pts with no NS, uni- or bilateral attempted NS the median time to daytime continence was 6, 3 and 3 months, respectively. None of the pts has required an artificial urinary sphincter or used condom catheters during daytime whereby 2/195 pts (1%) used condom catheters during nighttime for convenience reasons. In univariate analysis (OR 2.69 [95% CI 1.05-6.86]; p=0.04) attempted NS (uni- or bilateral) was a significant predictor of continence during day- and nighttime at last follow-up. In multivariable analysis adjusted for age and gender, the predictive value remained borderline significant (OR 2.24 [95% CI 0.99-6.58; p=0.053). Attempted NS was a significant predictor of continence during nighttime at last follow-up in univariate analysis (OR 2.35 [95% CI 1.09-5.07]; p=0.03) and in multivariable analysis adjusted for age and gender (OR 2.24 [95% CI 1.03-4.89; p=0.04). Regarding continence status over time in pts with attempted NS (uni- or bilateral) compared to those without NS, the percentage of continent pts during daytime was significantly higher during the first 12 months, thereafter differences were less pronounced. Considering nighttime continence, among pts with attempted NS the proportion of continent pts compared to those without NS was significantly higher from 2 yrs on and up to 18 yrs after RC. CONCLUSIONS In long-term survivors, attempted NS is a predictor of continence status and has a long term impcat on functional outcome of patients after RC and diversion with an OBS. Even with long-term follow up, pts in whom no NS was performed at the time of RC will not reach the better continence status of pts in whom NS was attempted. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e539-e540 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Marc Furrer More articles by this author Daniel P. Nguyen More articles by this author Tobias Gross More articles by this author George N. Thalmann More articles by this author Urs E. Studer More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

You have accessJournal of UrologyTrauma/Reconstruction/Diversion: Ureter (including Pyeloplasty) and Bladder Reconstruction (including fistula), Augmentation, Substitution, Diversion II1 Apr 2016MP56-14 FACTORS INFLUENCING POSTOPERATIVE CONTINENCE STATUS IN FEMALES AFTER ORTHOTOPIC ILEAL BLADDER SUBSTITUTION Tobias Gross, Susan D. Meierhans Ruf, Claudia Meissner, Katharina Ochsner, and Urs E. Studer Tobias GrossTobias Gross More articles by this author , Susan D. Meierhans RufSusan D. Meierhans Ruf More articles by this author , Claudia MeissnerClaudia Meissner More articles by this author , Katharina OchsnerKatharina Ochsner More articles by this author , and Urs E. StuderUrs E. Studer More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.626AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Certain risk factors for postoperative incontinence in females after radical cystectomy and orthotopic ileal bladder substitution (BS), such as higher age and advanced tumor stage, are described in the literature. There is little knowledge about other factors influencing postoperative continence status in these patients. We therefore evaluated which other factors may influence postoperative continence status in females after BS. METHODS Postoperative continence status was evaluated in 73 female patients (median age 61.7 y; range 34.7-78.5 y) after radical cystectomy and ileal BS. According to their postoperative continence status they were divided into 2 groups: continent (n=46) and incontinent (>1 pad/24h; n=42). For each patient age, tumor stage, chemotherapy (yes/no), attempted nerve sparing and uterus preservation (preserved, perioperative hysterectomy, preoperative hysterectomy) were evaluated. For multivariate analysis these possible risk factors were analysed with a logistic regression model and deleted in a backward selection if not significant at the 0.1 level. RESULTS Continent patients had a significantly higher rate of preserved uterus (51.2%) compared to incontinent patients (13.3%; p<0.01). Continent patients had a significantly higher rate of attempted nerve sparing (bilaterally 62.8%, unilaterally 34.9%) compared to incontinent patients (bilaterally 36.7%, unilaterally 53.3%; p=0.02). In multivariate analysis, perioperative hysterectomy (odds ratio 8.3, CI 2.1-34), preoperative hysterectomy (odds ratio 7.4, CI 1.5-36.9) as well as higher age (odds ratio 1.09, CI 1.01-1.2) led to a significantly higher incontinence rate while attempted nerve sparing resulted in a lower incontinence rate (odds ratio 0.39, CI 0.15-0.99). Tumor stage and chemotherapy did not influence postoperative continence status significantly in this multivariate model. CONCLUSIONS Uterus preservation, attempted nerve sparing and age are factors influencing postoperative continence status in females after radical cystectomy and orthotopic ileal bladder substitution. Uterus preservation and attempted nerve sparing have the most beneficial effect on postoperative continence and should therefore be considered if ever possible. © 2016FiguresReferencesRelatedDetails Volume 195 Issue 4S April 2016 Page: e750 Advertisement Copyright & Permissions© 2016Metrics Author Information Tobias Gross More articles by this author Susan D. Meierhans Ruf More articles by this author Claudia Meissner More articles by this author Katharina Ochsner More articles by this author Urs E. Studer More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

PURPOSE:Orthotopic bladder substitution has been performed on a regular basis for more than 30 years and yet data on long-term functional outcomes are still lacking.MATERIALS AND METHODS:We evaluated 181 men and 19 women who underwent radical cystectomy and urinary diversion with ileal orthotopic bladder substitution from 1985 to 2004 and who had 10 years or more of followup.RESULTS:Median age at radical cystectomy was 63 years (IQR 57-69). Median followup was 167 months (IQR 137-206). Daytime and nighttime continence rates peaked 24 months postoperatively and decreased slightly thereafter during almost 2 decades. At 10, 15 and 20 years daytime continence rates were 92%, 90% and 79%, and nighttime continence rates were 70%, 65% and 55%, respectively. During the day and at night fewer than 3% and 10% of patients, respectively, had urine loss 100 ml or greater at any time 10 years or longer after surgery. At 10 and 20 years 11 of 200 patients (6%) and 1 of 29 (3%), respectively, had to perform clean intermittent self-catheterization. After an initial postoperative decrease in the estimated glomerular filtration rate the subsequent decrease was less than 1 ml/minute/1.73 m(2) per year. A total of 81 complications were observed in 42 of the 200 patients (21%) 10 years or longer after radical cystectomy with pyelonephritis as the most frequent cause.CONCLUSIONS:Patients who survive up to 20 years after radical cystectomy and diversion with an ileal orthotopic bladder substitution may enjoy satisfactory urinary continence and retain the ability to void spontaneously while experiencing no more than a physiological decrease in renal function.

The bladder and the prostate have a multitude of primary lymphatic landing sites, making the sentinel node concept inapplicable in patients with bladder or prostate cancer. However, some imaging techniques may be helpful in guiding surgeons for the removal of suspicious nodes that would not have been resected in a standardized template. Despite the multitude of new imaging techniques available today, a meticulous histologic workup of lymph nodes retrieved by an extended pelvic lymph node dissection still has the highest accuracy for detection of lymph node metastases in bladder or prostate cancer.

You have accessJournal of UrologyBladder Cancer: Invasive II1 Apr 2016PD27-10 LONG-TERM SURVIVORS WITH AN ILEAL ORTHOTOPIC BLADDER SUBSTITUTE MAINTAIN GOOD CONTINENCE AND RENAL FUNCTION OUTCOMES Marc-Alain Furrer, Beat Roth, Daniel P. Nguyen, Bernhard Kiss, Silvan Boxler, Fiona C. Burkhard, George N. Thalmann, and Urs E. Studer Marc-Alain FurrerMarc-Alain Furrer More articles by this author , Beat RothBeat Roth More articles by this author , Daniel P. NguyenDaniel P. Nguyen More articles by this author , Bernhard KissBernhard Kiss More articles by this author , Silvan BoxlerSilvan Boxler More articles by this author , Fiona C. BurkhardFiona C. Burkhard More articles by this author , George N. ThalmannGeorge N. Thalmann More articles by this author , and Urs E. StuderUrs E. Studer More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.384AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Low pressure orthotopic bladder substitutes (OBS) have been performed worldwide for ≥30 yrs. Nevertheless, little is known on long-term functional outcomes. We report on our institutional series of OBS pts who were followed ≥10 yrs. METHODS 200 pts (181 men, 19 women; median age at RC 63 yrs [IQR 57-69]) who underwent radical cystectomy (RC) and urinary diversion with an OBS between 1985 and 2004 and who survived ≥10 yrs were evaluated. Functional outcomes (day- and nighttime continence, renal function) and complications had been prospectively assessed during regular follow-up according to our institutional post-cystectomy protocol. Median follow-up was 167 mts (IQR 137-206) with 61/200 pts having died during this period. RESULTS Both day- and nighttime continence rates peaked 24 mts postoperatively with 92% and 72% of pts being continent during the day and at night, respectively. Thereafter, both day- and nighttime continence rates remained almost stable over two decades; daytime continence rates were 91%, 90% and 79% and nighttime continence rates were 70%, 66% and 55% at 10, 15 and 20 yrs, respectively. Only 2%, 0% and 3% of pts had a urine loss of ≥100ml during the day at 10, 15 and 20 yrs, respectively. With timed voiding every four hours only 10%, 7% and 10% of pts had a urine loss of ≥100ml at night at 10, 15 and 20 yrs, respectively. The rate of pts who had to perform clean intermittent self-catheterization was always low (5.6%, 3.8% and 3.2% at 10, 15 and 20 yrs, respectively). After an initial decline renal function decreased age-appropriate over time; the median eGFRs were 80.1 (IQR 62.4-92.6), 74.1 (IQR 58.8-92.4), 68.5 (IQR 53.8-84.8), and 59.9 (IQR 52.1-63) ml/min per 1.73m2 before RC, at 12 mts, at 10 yrs, and after 20 yrs, respectively. Only 3/200 pts (2%) aged ≥70 yrs developed end-stage renal failure caused by long lasting arterial hypertension and/or diabetes. During the first 10 yrs of follow-up, 92/200 pts (46%) experienced 177 complications (46/177 were minor and 116/177 major complications; Clavien Dindo 2-3a and 3b-5, respectively). 89% of those were diversion-related with outlet obstruction being most frequent (65/77 [84%]) and easy to treat endourologically. A significant reduction in complications was seen from 10 yrs of follow-up onwards; only 42/200 pts (21%) experienced a total of 81 complications (p<0.001), with pyelonephritis being most frequent (26%). CONCLUSIONS In our institution, long-term survivors up to 20 yrs after RC and diversion with an OBS enjoy excellent continence and renal function outcomes and experience few complications. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e653 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Marc-Alain Furrer More articles by this author Beat Roth More articles by this author Daniel P. Nguyen More articles by this author Bernhard Kiss More articles by this author Silvan Boxler More articles by this author Fiona C. Burkhard More articles by this author George N. Thalmann More articles by this author Urs E. Studer More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

You have accessJournal of UrologyBladder Cancer: Invasive III1 Apr 2015MP65-16 ADMINISTRATION OF POSTOPERATIVE PARENTERAL NUTRITION DOES NOT AFFECT ONCOLOGICAL OUTCOMES AFTER RADICAL CYSTECTOMY (RC) IN BLADDER CANCER PATIENTS. Alvaro Vidal Faune, Bernhard Kiss, Fiona C. Burkhard, Urs E. Studer, George N. Thalmann, and Beat Roth Alvaro Vidal FauneAlvaro Vidal Faune More articles by this author , Bernhard KissBernhard Kiss More articles by this author , Fiona C. BurkhardFiona C. Burkhard More articles by this author , Urs E. StuderUrs E. Studer More articles by this author , George N. ThalmannGeorge N. Thalmann More articles by this author , and Beat RothBeat Roth More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.2306AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Conflicting and inconclusive results exist whether total parenteral nutrition (TPN) stimulates cancer growth and causes tumor progression. In a prospective randomized trial we were able to show an increase in postoperative infectious complications in patients undergoing pelvic lymphadenectomy (PLND), RC, and urinary diversion if TPN was administered postoperatively, mainly because of an impairment of the immune system. However, there seems to be a clinical benefit of TPN for malnourished patients. The aim of this study was to assess whether administration of TPN influences oncological outcomes. METHODS From September 2008 to March 2011, 157 consecutive cystectomy patients (≤cT3, cN0, cM0) were prospectively randomized to receive either postoperative TPN (group A: n = 74) or oral nutrition alone (group B: n = 83). Postoperative follow-up (including computed tomography and bone scan 6, 12, and 24 mos following surgery) was performed after 3, 6, 12, 18 and 24 mos, and annually thereafter. Two patients did not have follow-up at our institution and were excluded, thus remaining 155 patients for analysis. RESULTS Median follow up was 49 mos (range: 1-81). Forty-two (57%) patients in group A and 45 (56%) patients in group B had organ confined disease (