Regina Stredele

Prediction of cancer-specific survival after radical cystectomy in pT4a urothelial carcinoma of the bladder: development of a tool for clinical decision-making

To externally validate the pT4a‐specific risk model for cancer‐specific survival (CSS) proposed by May et al. (Urol Oncol 2013; 31: 1141–1147) and to develop a new pT4a‐specific nomogram predicting CSS in an international multicentre cohort of patients undergoing radical cystectomy (RC) for urothelial carcinoma of the bladder (UCB)

Comparative analysis of the effect of prostatic invasion patterns on cancer-specific mortality after radical cystectomy in pT4a urothelial carcinoma of the bladder

PURPOSE To evaluate the prognostic relevance of different prostatic invasion patterns in pT4a urothelial carcinoma of the bladder (UCB) after radical cystectomy. MATERIALS AND METHODS Our study comprised a total of 358 men with pT4a UCB. Patients were divided in 2 groups-group A with stromal infiltration of the prostate via the prostatic urethra with additional muscle-invasive UCB (n = 121, 33.8%) and group B with continuous infiltration of the prostate through the entire bladder wall (n = 237, 66.2%). The effect of age, tumor grade, carcinoma in situ, lymphovascular invasion, soft tissue surgical margin, lymph node metastases, administration of adjuvant chemotherapy, and prostatic invasion patterns on cancer-specific mortality (CSM) was evaluated using competing-risk regression analysis. Decision curve analysis was used to evaluate the net benefit of including the variable invasion pattern within our model. RESULTS The estimated 5-year CSM-rates for group A and B were 50.1% and 66.0%, respectively. In multivariable competing-risk analysis, lymph node metastases (hazard ratio [HR] = 1.73, P<0.001), lymphovascular invasion (HR = 1.62, P = 0.0023), soft tissue surgical margin (HR = 1.49, P = 0.026), absence of adjuvant chemotherapy (HR = 2.11, P<0.001), and tumor infiltration of the prostate by continuous infiltration of the entire bladder wall (HR = 1.37, P = 0.044) were significantly associated with a higher risk for CSM. Decision curve analysis showed a net benefit of our model including the variable invasion pattern. CONCLUSIONS Continuous infiltration of the prostate through the entire bladder wall showed an adverse effect on CSM. Besides including these patients into clinical trials for an adjuvant therapy, we recommend including prostatic invasion patterns in predictive models in pT4a UCB in men.

The complex interplay of physician, patient, and spouse in preoperative counseling for radical prostatectomy: a comparative mixed-method analysis of 30 videotaped consultations.

Spouses of cancer patients play a crucial role in deciding on therapeutic choices. The aim of our study was to assess their role in counseling for radical prostatectomy.

PD12-02 SPECIFIC PREDISPOSING RISK FACTORS FOR THE DEVELOPMENT OF URETEROENTERIC STRICTURES AFTER OPEN RADICAL CYSTECTOMY AND ILEAL NEOBLADDER DIVERSION

INTRODUCTION AND OBJECTIVES: Stricture of the ureteroenteric anastomosis is a complication after cystectomy with urinary diversion. Relatively little has been reported on the perioperative course during surgical repair of a ureteroenteric anastomosis. Adhesions can increase the risk of bowel injury and necessitate concomitant bowel repair. We hypothesized that the need for concomitant bowel surgery during revision of a ureteroenteric anastomosis is associated with adverse perioperative outcomes. METHODS: The National Inpatient Sample (2002-2012) was used to identify patients requiring revision of ureteroenteric anastomosis, excluding patients 0.2). Overall complication rate was 50%, with 19% UTI, 17% bleeding and 3% venous thromboembolism. Of these, only overall complications (65% vs 41%, p 0.1). Undergoing concomitant bowel surgery (OR 2.8 [1.2-6.2], p1⁄40.02) was the only independent risk factor for complications during ureteral reimplantation after controlling for demographics, clinical and hospital characteristics. CONCLUSIONS: Reimplantation of a ureteroenteric anastomosis was associated with a 50% complication rate. There were no demographic or clinical factors associated with need for concomitant bowel surgery, which was necessary in 35% of patients. Undergoing a concomitant bowel procedure was an independent predictor for perioperative complications.

INLAY-ONLAY URETHROPLASTY IN SEVERE HYPOSPADIAS

INTRODUCTION AND OBJECTIVES: Scrotal Agenesis is an extremely rare anomaly with only a handful of case reports in the literature. METHODS: We present a patient with an UPJ obstruction, absence of the scrotum and undescended testicles that was noted during extensive workup for Genitopatellar syndrome. Genitopatellar syndrome encompasses a multitude of abnormalities, including: absent patella, imperforate anus, agenesis of the corpus callosum, hydronephrosis, and scrotal hypoplasia. RESULTS: The patient was followed until 6 months of age when adequate penile skin was available for repair. He was then taken back to the operating room for a complex scrotoplasty. After degloving the penis, a ventral penile U-shaped flap and a dorsal buttonhole pedicle were used for a neo scrotum. We elected to stage the procedure, with the 2nd stage entailing bilateral orchiopexy. CONCLUSIONS: We believe this video provides a unique learning opportunity to better understand the important steps in this very rare anomaly.