1
|
Qiao Z, Wang S, Wang H, He B, Shi Z, Zhou H, Yang Q, Chen X, You Z, Zhao J, Wang H. Diagnostic capability of 18F-PSMA PET-MRI and pelvic MRI plus bone scan in treatment-naive prostate cancer: a single-center paired validating confirmatory study. Int J Surg 2024; 110:87-94. [PMID: 37738021 PMCID: PMC10793767 DOI: 10.1097/js9.0000000000000787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 09/10/2023] [Indexed: 09/23/2023]
Abstract
BACKGROUND Radical prostatectomy with pelvic lymph node dissection for the treatment of high-risk localized prostate cancer (PCa) results in long-term benefits in selected patients. But insufficient sensitivity of conventional examinations which are pelvic MRI and bone scan, limits the diagnosis of bone and lymph node metastasis of PCa. This affects the surgical management strategy of a large number of patients. The purpose of this study was to investigate whether 18F-prostate-specific membrane antigen (PSMA) PET-MRI could improve the clinical detection of PCa metastases compared with the conventional pelvic MRI plus bone scan. MATERIALS AND METHODS From April 2020 to April 2023, we prospectively enroled 472 patients with histologically proven PCa in our centre, and 120 patients underwent 18F-PSMA PET-MRI, multiparametric MRI, and bone scan before laparoscopic radical prostatectomy plus lymph node dissection. The accuracy of imaging results in detecting lymph node and bone metastatic lesions was compared between PSMA PET-MRI and MRI plus bone scan. RESULTS In diagnosing lymph node metastasis, PSMA PET-MRI had an area under the curve (AUC) of 0.844 (95% CI: 0.738-0.949, P < 0.001), sensitivity and specificity of 75% and 96%, which performed apparently better than MRI [AUC=0.615 (95% CI: 0.480-0.750, P =0.073)]. PSMA PET-MRI showed excellent expression in the diagnosis of bone metastases, with an AUC of 0.910 (95% CI: 0.840-0.981, P <0.001) compared to 0.700 (95% CI: 0.577-0.823, P =0.001) in bone scanning. PSMA PET-MRI also had higher sensitivity than bone scanning (90% vs. 43%), while lower specificity (92% vs. 97%). CONCLUSION PSMA PET-MRI is superior to conventional imaging at diagnosing metastases in lymph nodes and bones in PCa and can provide a more accurate stagement.
Collapse
Affiliation(s)
| | | | - Haiyan Wang
- Nuclear Medicine, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | | | | | | | | | - Xing Chen
- Nuclear Medicine, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Zhiwen You
- Nuclear Medicine, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Jun Zhao
- Nuclear Medicine, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | | |
Collapse
|
2
|
Furrer MA, Sathianathen N, Gahl B, Corcoran NM, Soliman C, Rodriguez Calero JA, Ineichen GB, Gahl M, Kiss B, Thalmann GN. Oncological outcomes after attempted nerve-sparing radical prostatectomy (NSRP) in patients with high-risk prostate cancer are comparable to standard non-NSRP: a longitudinal long-term propensity-matched single-centre study. BJU Int 2024; 133:53-62. [PMID: 37548822 DOI: 10.1111/bju.16126] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/08/2023]
Abstract
OBJECTIVE To assess the long-term safety of nerve-sparing radical prostatectomy (NSRP) in men with high-risk prostate cancer (PCa) by comparing survival outcomes, disease recurrence, the need for additional therapy, and perioperative outcomes of patients undergoing NSRP to those having non-NSRP. PATIENTS AND METHODS We included consecutive patients at a single, academic centre who underwent open RP for high-risk PCa, defined as preoperative prostate-specific antigen level of > 20 ng/mL and/or postoperative International Society of Urological Pathology Grade Group 4 or 5 (i.e., Gleason score ≥ 8) and/or ≥pT3 and/or pN1 assessing the RP and lymph node specimen. We calculated a propensity score and used inverse probability of treatment weighting to match baseline characteristics of patients with high-risk PCa who underwent NSRP vs non-NSRP. We analysed oncological outcome as time-to-event and calculated hazard ratios (HRs). RESULTS A total of 726 patients were included in this analysis of which 84% (n = 609) underwent NSRP. There was no evidence for the positive surgical margin rate being different between the NSRP and non-NSRP groups (47% vs 49%, P = 0.64). Likewise, there was no evidence for the need for postoperative radiotherapy being different in men who underwent NSRP from those who underwent non-NSRP (HR 0.78, 95% confidence interval [CI] 0.53-1.15). NSRP did not impact the risk of any recurrence (HR 0.99, 95% CI 0.73-1.34, P = 0.09) and there was no evidence for survival being different in men who underwent NSRP to those who underwent non-NSRP (HR 0.65, 95% CI 0.39-1.08). There was also no evidence for the cancer-specific survival (HR 0.56, 95% CI 0.29-1.11) or progression-free survival (HR 0.99, 95% CI 0.73-1.34) being different between the groups. CONCLUSION In patients with high-risk PCa, NSRP can be attempted without compromising long-term oncological outcomes provided a comprehensive assessment of objective (e.g., T Stage) and subjective (e.g., intraoperative appraisal of tissue planes) criteria are conducted.
Collapse
Affiliation(s)
- Marc A Furrer
- Department of Urology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Department of Urology, Solothurner Spitäler AG, Kantonsspital Olten and Bürgerspital Solothurn, Biberist, Switzerland
- Department of Urology, Royal Melbourne Hospital, The University of Melbourne, Melbourne, Victoria, Australia
| | - Niranjan Sathianathen
- Department of Urology, Royal Melbourne Hospital, The University of Melbourne, Melbourne, Victoria, Australia
- Clinical Trials Unit Bern, University of Bern, Bern, Switzerland
| | - Brigitta Gahl
- Clinical Trials Unit Bern, University of Bern, Bern, Switzerland
| | - Niall M Corcoran
- Department of Urology, Royal Melbourne Hospital, The University of Melbourne, Melbourne, Victoria, Australia
- Department of Urology, Western Health, St Albans, Victoria, Australia
| | - Christopher Soliman
- Department of Urology, Royal Melbourne Hospital, The University of Melbourne, Melbourne, Victoria, Australia
- Clinical Trials Unit Bern, University of Bern, Bern, Switzerland
| | | | - Gallus B Ineichen
- Department of Urology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Miriam Gahl
- Department of Urology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Bernhard Kiss
- Department of Urology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - George N Thalmann
- Department of Urology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| |
Collapse
|
3
|
Furrer MA, Sathianathen N, Gahl B, Wuethrich PY, Giannarini G, Corcoran NM, Thalmann GN. Functional Impact of Neuro-Vascular Bundle Preservation in High Risk Prostate Cancer without Compromising Oncological Outcomes: A Propensity-Modelled Analysis. Cancers (Basel) 2023; 15:5839. [PMID: 38136384 PMCID: PMC10741934 DOI: 10.3390/cancers15245839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Revised: 11/30/2023] [Accepted: 12/12/2023] [Indexed: 12/24/2023] Open
Abstract
Nerve sparing (NS) is a surgical technique to optimize functional outcomes of radical prostatectomy (RP). However, it is not recommended in high risk (HR) cases because of the risk of a positive surgical margin that may increase the risk of cancer recurrence. In the last two decades there has been a change of perspective to the effect that in well-selected cases NS could be an oncologically safe option with better functional outcomes. Therefore, we aim to compare the functional outcomes and oncological safety of NS during RP in men with HR disease. A total of 1340 patients were included in this analysis, of which 12% (n = 158) underwent non-NSRP and 39% (n = 516) and 50% (n = 666) uni- and bilateral NSRP, respectively. We calculated a propensity score and used inverse probability of treatment weighting (IPTW) to balance the baseline characteristics of Pca patients undergoing non-NSRP and those having uni- and bilateral NSRP, respectively. NS improved functional outcomes; after IPTW, only 3% of patients having non-NSRP reached complete erectile function recovery (without erectile aid) at 24 months, whereas 22% reached erectile function recovery (with erectile aid), while 87% were continent. Unilateral NS increased the probability of functional recovery in all outcomes (OR 1.1 or 1.2, respectively), bilateral NS slightly more so (OR 1.1 to 1.4). NSRP did not impact the risk of any recurrence (HR 0.99, 95%CI 0.73-1.34, p = 0.09), and there was no difference in survival for men who underwent NSRP (HR 0.65, 95%CI 0.39-1.08). There was no difference in cancer-specific survival (0.56, 95%CI 0.29-1.11). Our study found that NSRP significantly improved functional outcomes and can be safely performed in carefully selected patients with HR-PCa without compromising long term oncological outcomes.
Collapse
Affiliation(s)
- Marc A. Furrer
- Department of Urology, Inselspital, Bern University Hospital, University of Bern, 3012 Bern, Switzerland;
- Department of Urology, Solothurner Spitäler AG, Kantonsspital Olten, 4600 Olten, Switzerland
- Bürgerspital Solothurn, 4500 Solothurn, Switzerland
- Department of Urology, The University of Melbourne, Royal Melbourne Hospital, Parkville, VIC 3050, Australia; (N.S.); (N.M.C.)
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland;
| | - Niranjan Sathianathen
- Department of Urology, The University of Melbourne, Royal Melbourne Hospital, Parkville, VIC 3050, Australia; (N.S.); (N.M.C.)
| | - Brigitta Gahl
- Clinical Trials Unit Bern, University of Bern, 3010 Bern, Switzerland;
| | - Patrick Y. Wuethrich
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland;
| | - Gianluca Giannarini
- Urology Unit, Santa Maria della Misericordia University Hospital, 33100 Udine, Italy;
| | - Niall M. Corcoran
- Department of Urology, The University of Melbourne, Royal Melbourne Hospital, Parkville, VIC 3050, Australia; (N.S.); (N.M.C.)
- Department of Urology, Western Health, St. Albans, VIC 3021, Australia
| | - George N. Thalmann
- Department of Urology, Inselspital, Bern University Hospital, University of Bern, 3012 Bern, Switzerland;
| |
Collapse
|
4
|
Beilstein CM, Krutkyte G, Vetsch T, Eser P, Wilhelm M, Stanga Z, Bally L, Verra M, Huber M, Wuethrich PY, Engel D. Multimodal prehabilitation for major surgery in elderly patients to lower complications: protocol of a randomised, prospective, multicentre, multidisciplinary trial (PREHABIL Trial). BMJ Open 2023; 13:e070253. [PMID: 36596634 PMCID: PMC9815025 DOI: 10.1136/bmjopen-2022-070253] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
INTRODUCTION The global volume of surgery is growing and the population ageing, and economic pressure is rising. Major surgery is associated with relevant morbidity and mortality. Postoperative reduction in physiological and functional capacity is especially marked in the elderly, multimorbid patient with low fitness level, sarcopenia and malnutrition. Interventions aiming to optimise the patient prior to surgery (prehabilitation) may reduce postoperative complications and consequently reduce health costs. METHODS AND ANALYSIS This is a multicentre, multidisciplinary, prospective, 2-arm parallel-group, randomised, controlled trial with blinded outcome assessment. Primary outcome is the Comprehensive Complications Index at 30 days. Within 3 years, we aim to include 2×233 patients with a proven fitness deficit undergoing major surgery to be randomised using a computer-generated random numbers and a minimisation technique. The study intervention consists of a structured, multimodal, multidisciplinary prehabilitation programme over 2-4 weeks addressing deficits in physical fitness and nutrition, diabetes control, correction of anaemia and smoking cessation versus standard of care. ETHICS AND DISSEMINATION The PREHABIL trial has been approved by the responsible ethics committee (Kantonale Ethikkomission Bern, project ID 2020-01690). All participants provide written informed consent prior to participation. Participant recruitment began in February 2022 (10 and 8 patients analysed at time of submission), with anticipated completion in 2025. Publication of the results in peer-reviewed scientific journals are expected in late 2025. TRIAL REGISTRATION NUMBER NCT04461301.
Collapse
Affiliation(s)
- Christian M Beilstein
- Department of Anaesthesiology and Pain Medicine, Inselspital University Hospital, University of Bern, Bern, Switzerland
| | - Gabija Krutkyte
- Department of Anaesthesiology and Pain Medicine, Inselspital University Hospital, University of Bern, Bern, Switzerland
- Division of Diabetes, Endocrinology, Nutritional Medicine and Metabolism, Inselspital University Hospital Bern, University of Bern, Bern, Switzerland
| | - Thomas Vetsch
- Department of Anaesthesiology and Pain Medicine, Inselspital University Hospital, University of Bern, Bern, Switzerland
- Medical Division Rehabilitation & Sports Medicine, Inselspital University Hospital, University of Bern, Bern, Switzerland
| | - Prisca Eser
- Medical Division Rehabilitation & Sports Medicine, Inselspital University Hospital, University of Bern, Bern, Switzerland
| | - Matthias Wilhelm
- Medical Division Rehabilitation & Sports Medicine, Inselspital University Hospital, University of Bern, Bern, Switzerland
| | - Zeno Stanga
- Division of Diabetes, Endocrinology, Nutritional Medicine and Metabolism, Inselspital University Hospital Bern, University of Bern, Bern, Switzerland
| | - Lia Bally
- Department of Diabetes, Endocrinology, Clinical Nutrition and Metabolism, Inselspital University Hospital, Bern, Switzerland
| | - Martin Verra
- Institute of Physiotherapy, Inselspital University Hospital, University of Bern, Bern, Switzerland
| | - Markus Huber
- Department of Anaesthesiology and Pain Medicine, Inselspital University Hospital, University of Bern, Bern, Switzerland
| | - Patrick Y Wuethrich
- Department of Anaesthesiology and Pain Medicine, Inselspital University Hospital, University of Bern, Bern, Switzerland
| | - Dominique Engel
- Department of Anaesthesiology and Pain Medicine, Inselspital University Hospital, University of Bern, Bern, Switzerland
| |
Collapse
|
5
|
Protocol for CAMUS Delphi Study: A Consensus on Comprehensive Reporting and Grading of Complications After Urological Surgery. Eur Urol Focus 2022; 8:1493-1511. [PMID: 35221259 DOI: 10.1016/j.euf.2022.01.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 01/09/2022] [Accepted: 01/28/2022] [Indexed: 12/16/2022]
Abstract
BACKGROUND Reproducible assessment of postoperative complications is essential for reliable evaluation of quality of care to enable comparison between healthcare centres and ensure transparent patient counselling. Currently, significant discrepancies exist in complication reporting and grading due to heterogeneous definitions and methodologies. OBJECTIVE To develop a standardised and reproducible assessment of perioperative complications and overall associated morbidity, to allow for the construction of a uniform language for complication reporting and grading. DESIGN, SETTING, AND PARTICIPANTS The 12-part REDCap-based Delphi survey was developed in conjunction with methodologist review and experienced urologist opinion. International urologists, anaesthetists, and intensive care unit specialists will be included. A minimum sample size of 750 participants (500 urologists and 250 critical care specialities) is targeted. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS The survey assesses participant demographics, opinion on complication reporting and the proposed Complications After Major & Minor Urological Surgery (CAMUS) reporting recommendations, grading of intervention events using the existing Clavien-Dindo classification and the proposed CAMUS classification, and rating of various clinical scenarios. Consensus will be defined as ≥75% majority agreement. If consensus is not reached, then subsequent Delphi rounds will be performed under steering committee guidance. RESULTS AND LIMITATIONS Twenty-one participants completed the draft survey. The median survey completion time was 128 min (interquartile range 88-135). The survey revealed that 90% of participants believe that the current complication classification systems are useful but inaccurate, while 100% of participants believe that there is a universal demand for reporting consensus. Several amendments were made following feedback. Limitations include complexity of the proposed supplemental grades and time to completion of the survey. CONCLUSIONS To ensure comprehensive and comparable complication reporting and grading across centres worldwide, a conclusive uniform language for complication reporting must be created. We intend to address shortcomings of the current complication reporting and classification systems with a new CAMUS classification system developed through multidisciplinary expert consensus obtained through a Delphi survey. Ultimately, standardisation of urological complication reporting and grading may improve patient counselling and quality of care. PATIENT SUMMARY The reporting and grading of operative complications that occur during or after an operation and associated costs provide a means to stratify quality of patient care. Current complication reporting and classification systems are not standardised and somewhat inaccurate, and thus significantly underestimate patient morbidity and surgical risk. This Delphi survey will provide the basis for the creation of a uniform complication reporting and grading system. Our new system may allow improved reporting and grading between centres, and ultimately improve patient counselling and care.
Collapse
|
6
|
Zhou D, Gao J, Liao Y, Da L, Wang J, Wang K, Zhu J, Hu H, Wu C, Tian D. The CUSUM curve combined with comprehensive complication index for assessing short-term complications of radical cystectomy. J Clin Lab Anal 2022; 36:e24616. [PMID: 35881663 PMCID: PMC9459268 DOI: 10.1002/jcla.24616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 06/22/2022] [Accepted: 07/07/2022] [Indexed: 11/25/2022] Open
Abstract
Objective To evaluate the comprehensive complication index(CCI) and Clavien‐Dindo classification(CDC) for short‐term postoperative complications in radical cystectomy and assess cumulative surgical morbidity to compare sufficient surgical skill. Methods From September 30, 2010, to October 1, 2020, clinical data of patients with urothelial carcinoma who underwent radical cystectomy with urinary diversion were gathered, patients who had only a urinary diversion, bladder sparing surgery, additional abdominal surgeries at the same time were all excluded. The CDC and CCI were utilized to evaluate 30‐d complications after radical cystectomy and the relevance of hospital stay was compared between CCI and CDC. The cumulative sum control models (CUSUM) were used to evaluate the overall surgical morbidity of radical cystectomy in our facility and for comparisons between surgeons. Results This study enrolled a total of 635 individuals, 548 (86.3%) of whom had 1124 problems. The incidence of severe complications (CDC≥ Grade III) was 10.2%. The average CCI was 20.2 ± 14.7. Gender, urinary diversion subtype, procedure method, and surgeon were significantly correlated with the increase of CCI (p < 0.05). The CCI demonstrated a better relationship with hospital stay (R2 = 0.429) than the CDC (R2 = 0.361). The CUSUM‐CCI model demonstrated a difference and growth distribution in dynamic time between individual surgeons. Conclusions CCI can better reflect the incidence of complications for radical cystectomy than CDC, and CCI is more strongly correlated with postoperative hospital stay. The CUSUM‐CCI model can reflect the quality of surgical skill for each surgeon instantaneously.
Collapse
Affiliation(s)
- Diansheng Zhou
- Department of Urology, The Second Hospital of Tianjin Medical University, Tianjin, China
| | - Jie Gao
- Department of Urology, The Second Hospital of Tianjin Medical University, Tianjin, China
| | - Yihao Liao
- Department of Urology, The Second Hospital of Tianjin Medical University, Tianjin, China
| | - La Da
- Department of Urology, The Second Hospital of Tianjin Medical University, Tianjin, China
| | - Jian Wang
- Department of Urology, The Second Hospital of Tianjin Medical University, Tianjin, China
| | - Keke Wang
- Department of Urology, The Second Hospital of Tianjin Medical University, Tianjin, China
| | - Jianqiang Zhu
- Department of Urology, The Second Hospital of Tianjin Medical University, Tianjin, China
| | - Hailong Hu
- Department of Urology, The Second Hospital of Tianjin Medical University, Tianjin, China
| | - Changli Wu
- Department of Urology, The Second Hospital of Tianjin Medical University, Tianjin, China
| | - Dawei Tian
- Department of Urology, The Second Hospital of Tianjin Medical University, Tianjin, China
| |
Collapse
|
7
|
Soliman C, Thomas BC, Santaguida P, Lawrentschuk N, Mertens E, Giannarini G, Wuethrich PY, Wu M, Khan MS, Nair R, Thurairaja R, Challacombe B, Dasgupta P, Malde S, Corcoran NM, Spiess PE, Dundee P, Furrer MA. Active involvement of nursing staff in reporting and grading complication‐intervention events—Protocol and results of the CAMUS Pilot Nurse Delphi Study. BJUI COMPASS 2022; 3:466-483. [PMID: 36267199 PMCID: PMC9579890 DOI: 10.1002/bco2.173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Objectives The aim of this study is to gain experienced nursing perspective on current and future complication reporting and grading in Urology, establish the CAMUS CCI and quality control the use of the Clavien‐Dindo Classification (CDC) in nursing staff. Subjects and Methods The 12‐part REDCap‐based Delphi survey was developed in conjunction with expert nurse, urologist and methodologist input. Certified local and international inpatient and outpatient nurses specialised in urology, perioperative nurses and urology‐specific advanced practice nurses/nurse practitioners will be included. A minimum sample size of 250 participants is targeted. The survey assesses participant demographics, nursing experience and opinion on complication reporting and the proposed CAMUS reporting recommendations; grading of intervention events using the existing CDC and the proposed CAMUS Classification; and rating various clinical scenarios. Consensus will be defined as ≥75% agreement. If consensus is not reached, subsequent Delphi rounds will be performed under Steering Committee guidance. Results Twenty participants completed the pilot survey. Median survey completion time was 58 min (IQR 40–67). The survey revealed that 85% of nursing participants believe nurses should be involved in future complication reporting and grading but currently have poor confidence and inadequate relevant background education. Overall, 100% of participants recognise the universal demand for reporting consensus and 75% hold a preference towards the CAMUS System. Limitations include variability in nursing experience, complexity of supplemental grades and survey duration. Conclusion The integration of experienced nursing opinion and participation in complication reporting and grading systems in a modern and evolving hospital infrastructure may facilitate the assimilation of otherwise overlooked safety data. Incorporation of focused teaching into routine nursing education will be essential to ensure quality control and stimulate awareness of complication‐related burden. This, in turn, has the potential to improve patient counselling and quality of care.
Collapse
Affiliation(s)
- Christopher Soliman
- Department of Urology, Royal Melbourne Hospital University of Melbourne Parkville Victoria Australia
| | - Benjamin C. Thomas
- Department of Urology, Royal Melbourne Hospital University of Melbourne Parkville Victoria Australia
| | - Pasqualina Santaguida
- Department of Health Research Methodology Evidence and Impact (HEI) McMaster University Hamilton Ontario Canada
| | - Nathan Lawrentschuk
- Department of Urology, Royal Melbourne Hospital University of Melbourne Parkville Victoria Australia
| | - Evie Mertens
- Department of Urology, Royal Melbourne Hospital University of Melbourne Parkville Victoria Australia
| | - Gianluca Giannarini
- Unit of Urology Santa Maria della Misericordia Academic Medical Centre Udine Italy
| | - Patrick Y. Wuethrich
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital University of Bern Bern Switzerland
| | - Michael Wu
- Department of Urology, Royal Melbourne Hospital University of Melbourne Parkville Victoria Australia
| | - Muhammad S. Khan
- Department of Urology Guy's and St. Thomas NHS Foundation Trust London UK
| | - Rajesh Nair
- Department of Urology Guy's and St. Thomas NHS Foundation Trust London UK
| | - Ramesh Thurairaja
- Department of Urology Guy's and St. Thomas NHS Foundation Trust London UK
| | | | - Prokar Dasgupta
- Department of Urology Guy's and St. Thomas NHS Foundation Trust London UK
| | - Sachin Malde
- Department of Urology Guy's and St. Thomas NHS Foundation Trust London UK
| | - Niall M. Corcoran
- Department of Urology, Royal Melbourne Hospital University of Melbourne Parkville Victoria Australia
- Department of Urology Western Health St Albans Victoria Australia
| | - Philippe E. Spiess
- Department of Genito‐Urinary Oncology H. Lee Moffitt Cancer Center and Research Institute Tampa Florida USA
| | - Philip Dundee
- Department of Urology, Royal Melbourne Hospital University of Melbourne Parkville Victoria Australia
| | - Marc A. Furrer
- Department of Urology, Royal Melbourne Hospital University of Melbourne Parkville Victoria Australia
- Department of Urology Guy's and St. Thomas NHS Foundation Trust London UK
- Department of Urology University of Bern Bern Switzerland
| |
Collapse
|
8
|
Grüne B, Kowalewksi KF, Waldbillig F, von Hardenberg J, Rassweiler-Seyfried MC, Kriegmair MC, Herrmann J. The Comprehensive Complication Index (CCI) for improved reporting of complications in endourological stone treatment. Urolithiasis 2021; 49:269-279. [PMID: 33388823 DOI: 10.1007/s00240-020-01234-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Accepted: 11/21/2020] [Indexed: 12/23/2022]
Abstract
The Clavien-Dindo Classification (CDC) lacks a combined score of multiple complications in one patient. The comprehensive complication index (CCI) circumvents this problem making it a valuable instrument to optimize quality control. We aimed to introduce and validate CCI in the treatment of urolithiasis. 60 day postoperative complications of 327 consecutive patients undergoing percutaneous nephrolitholapaxy (PNL) and ureterorenoscopy (URS) between 2017 and 2019 were retrospectively assessed and graded according to CDC. CCI was calculated for each patient. Overall morbidity scores of CCI and CDC were compared. Correlation analyses between the two scores and length of hospital stay (LOS) were performed. A multivariate analysis was performed to identify predictive factors for complications. Sample size calculation for an imaginary clinical trial was compared between CCI and CDC. A significant difference in overall morbidity between CCI and CDC was revealed for PNL (p < 0.001) and URS (p = 0.001). There was no statistically significant difference in comparing correlations between cumulative CCI and LOS versus non-cumulative CDC and LOS for both cohorts. Operating time > 90 min, maximum stone size, positive preoperative urine culture and PNL type (p < 0.001) were predictive factors for postoperative complications in PNL, while urine culture (p = 0.02) was for URS. Sample size calculation based on CCI resulted in a significant reduction of required patients for PNL (- 48%) and URS (- 84%) compared to CDC. CCI could successfully be validated in endourological stone treatment with the advantage of assessing complications in their entirety compared to CDC. CCI can significantly reduce the required sample size in future clinical trials.
Collapse
Affiliation(s)
- Britta Grüne
- Department of Urology, University Medical Center Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.
| | - Karl-Friedrich Kowalewksi
- Department of Urology, University Medical Center Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Frank Waldbillig
- Department of Urology, University Medical Center Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Jost von Hardenberg
- Department of Urology, University Medical Center Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Marie-Claire Rassweiler-Seyfried
- Department of Urology, University Medical Center Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Maximilian C Kriegmair
- Department of Urology, University Medical Center Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Jonas Herrmann
- Department of Urology, University Medical Center Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| |
Collapse
|
9
|
Furrer MA, Kiss B, Wüthrich PY, Thomas BC, Noser L, Studer UE, Burkhard FC. Long-term Outcomes of Cystectomy and Crossfolded Ileal Reservoir Combined with an Afferent Tubular Segment for Heterotopic Continent Urinary Diversion: A Longitudinal Single-centre Study. Eur Urol Focus 2020; 7:629-637. [PMID: 32654968 DOI: 10.1016/j.euf.2020.06.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 06/04/2020] [Accepted: 06/12/2020] [Indexed: 01/17/2023]
Abstract
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.
Collapse
Affiliation(s)
- Marc A Furrer
- Department of Urology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland; Department of Urology, The University of Melbourne, Royal Melbourne Hospital, Parkville, Victoria, Australia.
| | - Bernhard Kiss
- Department of Urology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Patrick Y Wüthrich
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Benjamin C Thomas
- Department of Urology, The University of Melbourne, Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Ladina Noser
- Department of Urology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Urs E Studer
- Department of Urology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Fiona C Burkhard
- Department of Urology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| |
Collapse
|