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Adnexal/Ovarian Torsion
Published in Botros Rizk, A. Mostafa Borahay, Abdel Maguid Ramzy, Clinical Diagnosis and Management of Gynecologic Emergencies, 2020
Hajra Takala, Mona Omar, Ayman Al-Hendy
Specific ovarian lesions should be excised. Cystectomy in an ischemic, edematous ovary, however, may technically be difficult due to the friable nature of the tissues, but early elective cystectomy has been described after an interval of 2 to 3 weeks to allow time for the edema and congestion to resolve. Some authors recommend delaying cystectomy until 6 to 8 weeks after primary intervention [126].
Bladder Cancer
Published in Pat Price, Karol Sikora, Treatment of Cancer, 2020
Radical cystectomy remains the treatment associated with highest local cure, with pelvic recurrence rates of less than 10% in node-negative tumors and 10–20% in patients with resected pelvic nodal metastases.53 A review comparing outcomes of surgery in National Cancer Institute (NCI) cancer centers (n = 2,977) with those in other American hospitals (n = 2,566) included patients over 65 years of age on the Medicare database treated for cancer by cystectomy in cancer centers between 1994 and 1999.54 As illustrated in Figure 13.5a, there was no significant difference between the two hospital groups, with 5-year survival of approximately 38%. In the past, cystectomy was associated with significant morbidity and high mortality, but improvements in operative technique have seen the perioperative complication rate fall from approximately 35% prior to 1970 to less than 10% reported currently. In the UK, combined with centralization surgery this has resulted in a fall in operative mortality from nearly 20% to 3% and improvement in 5-year survivals (Figure 13.5b).54,55
Bladder cancer
Published in Anju Sahdev, Sarah J. Vinnicombe, Husband & Reznek's Imaging in Oncology, 2020
With advances in surgical techniques, it is now generally considered that surgery offers a good treatment option for muscle-invasive tumours and may also be considered as first-line treatment in cases of superficial tumours with severe anaplasia. It involves en bloc excision of the bladder, prostate, and seminal vesicles with pelvic nodal dissection. Because the bladder is completely removed at radical cystectomy, urinary diversion is an essential part of the procedure. Long term, there is frequently concern about upper tract dilatation due to reflux disease and recurrent urinary infections and accompanying loss of renal function. Other complications include prolapse of the stoma, parastomal herniation, stomal stenosis, and parastomal dermatitis.
Swedish National Guidelines on Urothelial Carcinoma: 2021 update on non-muscle invasive bladder cancer and upper tract urothelial carcinoma
Published in Scandinavian Journal of Urology, 2022
Fredrik Liedberg, Sofia Kjellström, Anna-Karin Lind, Amir Sherif, Karin Söderkvist, Karin Falkman, Helena Thulin, Firas Aljabery, Dimitrious Papantonio, Viveka Ströck, Elisabeth Öfverholm, Tomas Jerlström, Johan Sandzen, Ingrida Verbiene, Anders Ullén
Patients with high risk of progression are recommended a re-resection of the tumor base in stage T1 disease (but not in TaG3 if the primary TURB was macroscopically radical and with detrusor muscle in the resected specimen) and subsequently adjuvant BCG-instillations with six induction courses and maintenance with an additional three courses at 3, 6 and 12 months. This strategy is applied provided no other risk factors for progression that not are included in the EAU 2021 risk group stratification are present, such as residual T1-disease at re-resection, lymphovascular invasion, deep lamina propria invasion (T1e), T1-disease in a diverticulum, variant histology or concomitant CIS in the prostatic urethra. Under these circumstances primary cystectomy is another and more valid treatment option. Patients with very high risk of progression according to the EAU 2021 risk group stratification are recommended primary cystectomy upfront, without performing a re-resection.
Mucoid-producing lesion following hip arthroplasty
Published in Baylor University Medical Center Proceedings, 2022
Rachel Vopni, Katherine E. Dowd, Erin T. Bird
A 54-year-old woman 4 years after right THA presented for urological consultation following 1 year of intermittent gross hematuria, tissue and sediment in the urine, and associated irritative voiding symptoms of dysuria and frequency. Computed tomography (CT) with contrast prior to the visit was negative for an abdominopelvic abnormality and made no note of hardware displacement. Cystoscopy revealed a right lateral bladder lesion with mucoid production. The patient experienced persistent symptoms despite undergoing transurethral resection of bladder tumor (TURBT), with the pathologic analysis showing acute and chronic cystitis with polypoid architecture negative for dysplasia or neoplasia. Repeat CT after TURBT with contrast demonstrated a fistulous tract extending from the right perirectal fascia to the right ischiorectal fossa. Robot-assisted laparoscopic partial cystectomy was performed; the specimen had similar findings with no apparent malignancy identified. Reassessment after recurrence of symptoms included negative fluorescence in situ hybridization cytology and colonoscopy. Repeat cystoscopy demonstrated recurrence of a right lateral bladder lesion with mucoid production at the site of resection. A CT cystogram showed an ill-defined 5 × 4 cm fluid collection in the right pelvis adjacent to the bladder concerning for recurrent or persistent ischiorectal abscess fistulation of unknown etiology to bladder.
Patient perspectives of vigorous intensity aerobic interval exercise prehabilitation prior to radical cystectomy: a qualitative focus group study
Published in Disability and Rehabilitation, 2021
Srijit Banerjee, Kelly Semper, Katy Skarparis, Jenni Naisby, Liane Lewis, Gabriel Cucato, Robert Mills, Mark Rochester, John Saxton
Bladder cancer is the tenth most common cancer in the UK and the eighth most common cancer in men [1]. It is usually slow to develop and is most common in older people over 60 years [2]. Bladder cancer is a heterogeneous disease, with 70% of patients presenting with nonmuscle invasive tumors confined to the bladder, and 30% presenting with muscle invasive bladder cancer, in which the cancer has spread beyond the inner lining of the bladder to the muscle wall, and this is associated with a high risk of death from distant metastases [3]. The initial treatment for high risk nonmuscle invasive bladder cancer is typically a course of intravesical immunotherapy with Bacillus Calmette-Guerin or primary cystectomy if disease is extensive. Those who do not respond to this, or progress on treatment are offered radical cystectomy. A radical cystectomy is complete removal of the bladder, and in men may involve removal of the prostate and seminal vesicles and in women the fallopian tubes and womb are often removed. The standard treatment for muscle invasive bladder cancer is radical cystectomy. Radical cystectomy is associated with high rates of morbidity (19–64%) and mortality (0.8–8.3%) [4–7].