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Morizane S, Honda M, Yumioka T, Iwamoto H, Hikita K, Takenaka A. Technique of en bloc resection of the membranous urethra and bladder during robot-assisted radical cystectomy in patients without simultaneous urethrectomy. Asian J Endosc Surg 2022; 15:683-687. [PMID: 35114733 DOI: 10.1111/ases.13034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Revised: 01/03/2022] [Accepted: 01/20/2022] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Prophylactic urethrectomy is often performed simultaneously with radical cystectomy (RC) in patients who are not selected for neobladder creation for urinary diversion. However, the indications for prophylactic urethrectomy are still controversial. Here, we introduce the ideal urethral dissection technique during robot-assisted radical cystectomy (RARC) in patients without simultaneous prophylactic urethrectomy. MATERIALS AND SURGICAL TECHNIQUE At our hospital, RARC is performed using a da Vinci surgical system with the operating table tilted to 20°. After lymph node dissection and bladder mobilization, periurethral dissection is commenced. A notable point of our technique is en bloc resection of the bladder and membranous urethra using a continuous intracorporeal approach. First, while applying traction on the isolated bladder in the cranial direction, we carefully and gradually dissect the urethral smooth muscle from the external urethral sphincter with electrocautery scissors. Next, we ligate the membranous urethra with suture material as far from the prostate as possible. Then, we cut the urethra as far from the prostate as possible after ligation of the urethra with a Hem-o-lok clip just beyond the apex of the prostate. Using this method, we are able to remove at least 1.0 cm of the membranous urethra en bloc with the bladder. Finally, we suture the pelvic floor, including the levator ani muscle, in two layers using 3-0 V-Loc and 2-0 V-Loc sutures. DISCUSSION We believe this technique allows separation of the residual urethra from the abdominal cavity and enables safe performance of secondary urethrectomy.
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Affiliation(s)
- Shuichi Morizane
- Division of Urology, Department of Surgery, Faculty of Medicine, Tottori University, Yonago, Japan
| | - Masashi Honda
- Division of Urology, Department of Surgery, Faculty of Medicine, Tottori University, Yonago, Japan
| | - Tetsuya Yumioka
- Division of Urology, Department of Surgery, Faculty of Medicine, Tottori University, Yonago, Japan
| | - Hideto Iwamoto
- Division of Urology, Department of Surgery, Faculty of Medicine, Tottori University, Yonago, Japan
| | - Katsuya Hikita
- Division of Urology, Department of Surgery, Faculty of Medicine, Tottori University, Yonago, Japan
| | - Atsushi Takenaka
- Division of Urology, Department of Surgery, Faculty of Medicine, Tottori University, Yonago, Japan
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Pang KH, Esperto F, Sproson C, Yeung M, Morgan SL, Downey AP, Hillary CJ, Catto JWF, Rosario DJ, Noon AP. Urethral recurrence after radical cystoprostatectomy: Experience from a high-volume tertiary referral centre. JOURNAL OF CLINICAL UROLOGY 2021. [DOI: 10.1177/2051415820920519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives: To report our urethral surveillance programme and urethral cancer recurrence rate following radical cystoprostatectomy (RC). Patients and methods: A retrospective analysis of clinical and histopathological data of men who underwent RC and urethral surveillance, between January 2011 and October 2016. Results: RC was performed for 491 men; 31 and 19 men had a synchronous (malignancy, n = 10, 32.3%) and interval (malignancy, n = 6, 31.6%) urethrectomy, respectively. The remaining 441 men underwent surveillance; 183 (41.5%) men had at least one urethroscopy, 14 (3.2%) urethrectomies were performed and 12 (2.7%) specimens confirmed urethral recurrence (UR). Within the URs, 7/12 (58.3%) men presented symptomatically and 5/12 (41.7%) were detected through surveillance. At a median (interquartile range) follow-up of 21.8 (9.7–36.7) months, the 2-year disease-specific survival in men who had synchronous urethrectomy was 71.4% (versus no urethrectomy (84.6%) interval urethrectomy (92.9%) and urethrectomy for recurrence (83.8%)). Conclusion: UR following RC is low in men without risk factors for urethral disease. Annual urethroscopy and urine cytology may not be feasible and appropriate in all men after RC, and does not appear to impact survival at 2 years. A risk-adapted approach may allow the avoidance of annual urethroscopy in asymptomatic men post RC. Level of Evidence: 3b
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Affiliation(s)
- Karl H Pang
- Academic Urology Unit, University of Sheffield, UK
| | - Francesco Esperto
- Department of Urology, Campus Biomedico, University of Rome, Rome, Italy
| | | | - Maidie Yeung
- Department of Histopathology, Royal Hallamshire Hospital, Sheffield, UK
| | - Susan L Morgan
- Department of Histopathology, Royal Hallamshire Hospital, Sheffield, UK
| | - Alison P Downey
- Department of Urology, Royal Hallamshire Hospital, Sheffield, UK
| | | | - James WF Catto
- Academic Urology Unit, University of Sheffield, UK
- Department of Urology, Royal Hallamshire Hospital, Sheffield, UK
| | - Derek J Rosario
- Academic Urology Unit, University of Sheffield, UK
- Department of Urology, Royal Hallamshire Hospital, Sheffield, UK
| | - Aidan P Noon
- Department of Urology, Royal Hallamshire Hospital, Sheffield, UK
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Hakozaki K, Kikuchi E, Ogihara K, Shigeta K, Abe T, Miyazaki Y, Kaneko G, Maeda T, Yoshimine S, Kanai K, Ide H, Shirotake S, Oyama M, Mizuno R, Oya M. Significance of prophylactic urethrectomy at the time of radical cystectomy for bladder cancer. Jpn J Clin Oncol 2021; 51:287-295. [PMID: 32893303 DOI: 10.1093/jjco/hyaa168] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 08/17/2020] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Prophylactic urethrectomy at the time of radical cystectomy is frequently recommended for patients with bladder cancer at a high risk of urethral recurrence without definitive evidence. The present study attempted to clarify the survival benefits of performing prophylactic urethrectomy. METHODS We identified 214 male patients who were treated by radical cystectomy with an incontinent urinary diversion in our seven institutions between 2004 and 2017. We used propensity score matching and ultimately identified 114 patients, 57 of whom underwent prophylactic urethrectomy (prophylactic urethrectomy group) and 57 who did not (non-prophylactic urethrectomy group). RESULTS No significant differences were observed in the 5-year overall survival rate between the prophylactic urethrectomy and non-prophylactic urethrectomy groups in the overall. However, the local recurrence rate was significantly lower in the prophylactic urethrectomy group than in the non-prophylactic urethrectomy group (P = 0.015). In the subgroup of 58 patients with multiple tumours and/or concomitant carcinoma in situ at the time of transurethral resection of bladder tumour, the 5-year overall survival rate was significantly higher in the prophylactic urethrectomy group than in the non-prophylactic urethrectomy group (P = 0.021). A multivariate analysis revealed that performing prophylactic urethrectomy was the only independent predictor of the overall survival rate (P = 0.016). In those patients who were treated without neoadjuvant chemotherapy (n = 38), the 5-year overall survival rate was significantly higher in the prophylactic urethrectomy group than in the non-prophylactic urethrectomy group (P = 0.007). CONCLUSIONS Prophylactic urethrectomy at the time of radical cystectomy may have a survival benefit in patients with multiple tumours and/or concomitant carcinoma in situ, particularly those who do not receive neoadjuvant chemotherapy.
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Affiliation(s)
- Kyohei Hakozaki
- Department of Urology, Keio University School of Medicine, Tokyo, Japan.,Department of Urology, National Hospital Organization Saitama National Hospital, Saitama
| | - Eiji Kikuchi
- Department of Urology, Keio University School of Medicine, Tokyo, Japan.,Department of Urology, St. Marianna University School of Medicine, Kanagawa
| | - Koichiro Ogihara
- Department of Urology, Keio University School of Medicine, Tokyo, Japan.,Department of Urology, Kawasaki Municipal Hospital, Kanagawa
| | - Keisuke Shigeta
- Department of Urology, Keio University School of Medicine, Tokyo, Japan
| | - Takayuki Abe
- Department of Clinical and Translational Research Center, Keio University School of Medicine, Tokyo.,Yokohama City University, School of Data Science, Kanagawa
| | - Yasumasa Miyazaki
- Department of Urology, Saiseikai Yokohamashi Tobu Hospital, Kanagawa
| | - Gou Kaneko
- Department of Uro-Oncology, Saitama Medical University International Medical Center, Saitama
| | - Takahiro Maeda
- Department of Urology, Kawasaki Municipal Hospital, Kanagawa
| | | | - Kunimitsu Kanai
- Department of Urology, National Hospital Organization Saitama National Hospital, Saitama
| | - Hiroki Ide
- Department of Urology, Saiseikai Central Hospital, Tokyo
| | - Suguru Shirotake
- Department of Uro-Oncology, Saitama Medical University International Medical Center, Saitama
| | - Masafumi Oyama
- Department of Uro-Oncology, Saitama Medical University International Medical Center, Saitama
| | - Ryuichi Mizuno
- Department of Urology, Keio University School of Medicine, Tokyo, Japan
| | - Mototsugu Oya
- Department of Urology, Keio University School of Medicine, Tokyo, Japan
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Patterns, risks and outcomes of urethral recurrence after radical cystectomy for urothelial cancer; over 20 year single center experience. Int J Surg 2015; 13:148-151. [DOI: 10.1016/j.ijsu.2014.12.006] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2014] [Revised: 10/27/2014] [Accepted: 12/05/2014] [Indexed: 11/23/2022]
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Abstract
Muscle-invasive bladder cancer is a deadly disease for which a number of new approaches have become available to improve prognosis. A recent review emphasized the importance of timely indication of surgery and highlighted current views regarding the adequate extent of the surgery and the importance of lymph node dissection. Furthermore, treatment using neoadjuvant and adjuvant systemic chemotherapy has become more prominent, while cystectomy and diversion should be conducted only in experienced centers. Optimal methods of urinary diversion and the use of robot-assisted laparoscopic cystectomy require further study.
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Affiliation(s)
- Hans Goethuys
- Department of Urology, Ziekenhuis Oost-Limburg, Genk, Belgium
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