J. Hadzi-Djokic

Comparison of Open Nephroureterectomy and Open Conservative Management of Upper Urinary Tract Transitional Cell Carcinoma

Introduction: The treatment preserving the kidney for upper urinary tract (UUT) transitional cell carcinoma (TCC) is still controversial. We aimed to elucidate the results of open conservative surgery and compare them with the results of radical nephroureterectomy (RNU). Patients and Methods: The study included 107 patients with UUT TCC treated by open conservative surgery (21 patients) or nephroureterectomy (86 patients). Epidemiological, clinical and pathological characteristics of patients as well as 5-year survival rates were compared between groups. Results: Patients treated by conservative surgery had a significantly higher rate of bilateral tumors (38% vs. 3%, p = 0.0001) and smaller tumor size than those treated by radical operations (2.60 ± 1.24 vs. 3.99 ± 3.94 cm, p = 0.060). Five-year survival rates for patients treated by conservative and radical surgery were 59 and 55%, respectively. Within the group of patients treated by conservative surgery, 5-year overall survival rates of patients operated due to imperative and elective indications were 41 and 75%, respectively. In univariate analysis, RNU was a statistically significant predictor of poorer outcome of the disease in comparison with conservative surgery (HR = 2.2, 95% CI 1.1–4.6, p = 0.030). Conclusions: The mode of operation affects the outcome of UUT TCC patients, in addition to factors such as tumor grade, stage and size.

Prognostic significance of tumor location in high-grade non-muscle-invasive bladder cancer

The management of high-grade (HG) non-muscle-invasive bladder cancer (NMIBC) continues to be a serious clinical problem. The role of many factors related to efficacy of Bacillus Calmette-Guérin (BCG), which is the most useful intravesical agent for these tumors, is still unknown. This study investigated the prognostic value of tumor location in high-grade non-muscle-invasive bladder cancer. Seventy-four patients with HG non-muscle-invasive bladder cancer, without carcinoma in situ (CIS), were treated by transurethral resection of bladder tumor (TURBT). Twenty-eight patients received adjuvant BCG therapy after TURBT. The relation between tumor location and the recurrence capacity was estimated using a Cox regression model. Our results suggest that tumor location is an important prognostic factor for BCG-therapy response in patients with high-grade non-muscle-invasive bladder cancer. Tumors in the bladder neck might have a higher risk of recurrence after intravesical immunotherapy. In addition, tumors in the lateral and posterior bladder walls might be at higher risk of recurrence when treated by TURBT alone.

Diagnostic Value of the Nuclear Matrix Protein 22 Test and Urine Cytology in Upper Tract Urothelial Tumors

Objective: To investigate the diagnostic value of the nuclear matrix protein 22 (NMP22) test in comparison to urine cytology for the detection of upper tract urothelial carcinoma. Patients and Methods: Patients with transitional cell carcinoma of the upper urinary tract (n = 34) and patients with renal calculosis (n = 25) were included in this study. Voided urine samples and separated catheter urine specimens were assayed for NMP22 and cytological examination. Results: The sensitivity of the NMP22 test in separated and voided urine was 73.2 and 70.5%, respectively, compared to 64.7 and 58.8% of urine cytology. The specificity of the NMP22 test in separated and voided urine was 88 and 92%, respectively, compared to 96 and 96% of urine cytology. The combination of separated and voided urine is the best method because the sensitivity is 79.41% and specificity 88%. There is a high agreement of the NMP22 test in voided and separated urine (kappa = 0.795, p < 0.01), indicating that the voided urine is adequate for diagnosis. Conclusions: The NMP22 test has higher sensitivity but lower specificity than cytology. The combination of these two tests could be a very useful diagnostic method for detection of upper urothelial tumors.

Buccal mucosal graft interposition in the treatment of recurrent vesicovaginal fistula: A report on two cases

OBJECTIVE To present the use of autologous buccal mucosa graft (BMG) in the treatment of recurrent vesicovaginal fistula (VVF). CASE REPORTS In 2011, two women, aged 45 years and 56 years, were admitted due to recurrent VVF. Both women had previously undergone abdominal hysterectomies for benign conditions and, subsequently, vaginal VVF repair due to vaginal urine leakage. On admission, the younger woman had a round fistula, with a diameter of 1.5 cm, located on the left side, supratrigonally; the other woman had an ellipsoidal fistula measuring 2.5 cm × 1.5 cm, located medially and supratrigonally. Both women underwent suturing of the VVF with the interposition of BMG. After the last treatment, both women were cured. CONCLUSION Treatment of recurrent VVF with the interposition of BMG is a good alternative to the use of other tissue grafts. Larger series are needed to confirm the advantages of this method.

Vesicovaginal fistulas: transperitoneal surgical repair using omentum or peritoneal tissue interposition, a summary of 35 years of experience

SummaryObjectiveTo report the result of primary vesicovaginal fistula (VVF) repair using the transabdominal approach with omental or peritoneal flap interposition.MethodsThe study evaluated 38 patients who were treated with transabdominal approach with omental or peritoneal flap. The omental flap was used as the first choice if it was of sufficient length; otherwise, a peritoneal flap was created. Patients were followed postoperatively for 1 year and by telephone survey thereafter.ResultsThe age of patients ranged from 29 to 68 years, with a median of 52 years. The main causes of VVF in this study cohort were hysterectomy for benign conditions (60.5 %), hysterectomy for malignant conditions (34.2 %), and radiation therapy (5.3 %). Peritoneal flap interposition was used in 6 patients and omental flap was used in 32 patients. All patients were continent following catheter removal. Overall, 89.5 % (34 out of 38) of fistulae were successfully repaired at first attempt. The success with omental flap interposition was 100 %. Recurrence of the fistula was reported in four patients (all with primary peritoneal flap interposition). Two of them were successfully cured by peritoneal flap re-interposition. While in two patients, with a history of radiation therapy, sigma rectum pouch was performed.ConclusionTransperitoneal surgical repair using omentum or peritoneal tissue interposition should be considered in the first attempt of repair of supratrigonal VVFs. However, successful repair depends on the experience of the surgeon.