Intermediate-term survival of robot-assisted versus open radical cystectomy for muscle-invasive and high-risk non-muscle invasive bladder cancer in The Netherlands

BACKGROUND

Radical cystectomy with pelvic lymph node dissection is the recommended treatment in non-metastatic muscle-invasive bladder cancer (MIBC). In randomised trials, robot-assisted radical cystectomy (RARC) showed non-inferior short-term oncological outcomes compared with open radical cystectomy (ORC). Data on intermediate and long-term oncological outcomes of RARC are limited.

OBJECTIVE

To assess the intermediate-term overall survival (OS) and recurrence-free survival (RFS) of patients with MIBC and high-risk non-MIBC (NMIBC) who underwent ORC versus RARC in clinical practice.

METHODS AND MATERIALS

A nationwide retrospective study in 19 Dutch hospitals including patients with MIBC and high-risk NMIBC treated by ORC (n = 1086) or RARC (n = 386) between January 1, 2012 and December 31, 2015. Primary and secondary outcome measures were median OS and RFS, respectively. Survival outcomes were estimated using Kaplan-Meier curves. A multivariable Cox regression model was developed to adjust for possible confounders and to assess prognostic factors for survival including clinical variables, clinical and pathological disease stage, neoadjuvant therapy and surgical margin status.

RESULTS

The median follow-up was 5.1 years (95% confidence interval ([95%CI] 5.0-5.2). The median OS after ORC was 5.0 years (95%CI 4.3-5.6) versus 5.8 years after RARC (95%CI 5.1-6.5). The median RFS was 3.8 years (95%CI 3.1-4.5) after ORC versus 5.0 years after RARC (95%CI 3.9-6.0). After multivariable adjustment, the hazard ratio for OS was 1.00 (95%CI 0.84-1.20) and for RFS 1.08 (95%CI 0.91-1.27) of ORC versus RARC. Patients who underwent ORC were older, had higher preoperative serum creatinine levels and more advanced clinical and pathological disease stage.

CONCLUSION

ORC and RARC resulted in similar intermediate-term OS and RFS in a cohort of almost 1500 MIBC and high-risk NMIBC.

Low Risk of Severe Complications After a Single, Post-Operative Instillation of Intravesical Chemotherapy in Patients with TaG1G2 Urothelial Bladder Carcinoma

BACKGROUND: EAU guidelines recommend a single instillation (SI) of intravesical chemotherapy (e.g. Mitomycin C) within 24 hours after transurethral resection of a bladder tumour (TURBT) in patients with low- to intermediate risk non-muscle invasive bladder cancer without (suspected) bladder perforation or bleeding requiring bladder irrigation. However, remarkable variation exists in the use of SI. The risk of severe complications is likely to contribute to this variation, but evidence is limited. OBJECTIVE: To investigate the absolute severe complication and mortality risk after SI in low- and intermediate risk bladder cancer. METHODS: In this observational, historic cohort study, data on 25,567 patients diagnosed with TaG1G2 urothelial bladder carcinoma (UBC) between 2009 and 2018 who underwent TURBT were collected from the Netherlands Cancer Registry. Data were supplemented with information on cause of death and severe complications after cancer treatment by re-examining the electronic health records and the 14-day complication risk and the 30-day mortality risk were evaluated. RESULTS: On average, 55% of patients had a SI after TURBT, varying from 0–>80% between hospitals. The 30-day mortality risk was 0.02% and the 14-day risk of severe complications was 1.6%. CONCLUSIONS: As the absolute risk of mortality and severe complications is very low, SI after TURBT can be considered a safe treatment in patients with low- to intermediate UBC without contraindications for SI. These results imply that a part of eligible patients is denied effective treatment.

Peyronie's disease and congenital penile curvature: long-term results of operative treatment with the plication procedure

OBJECTIVE

To evaluate the results of plication of the tunica albuginea in patients with a curved penis.

PATIENTS AND METHODS

Twenty-two men with congenital penile curvatures and 33 men with acquired penile curvatures were treated by the plication technique. Their files were studied and all patients underwent a follow-up interview and were physically examined. The mean age of the patients with congenital penile curvatures was 25.7 (range 17-58) and that of the men with acquired penile curvatures was 54.4 (range 28-67). The mean length of follow-up was 42 months.

RESULTS

The mean angle of deviation in relation to the longitudinal axis was 48.2 degrees in the congenital curvatures and 63.3 degrees in the acquired curvatures. All congenital curvatures were corrected successfully, i.e. the penis was straight and satisfactory intercourse was possible. Slight shortening of the penile shaft was noticed by eight patients, but none was concerned about this finding. Pre-operatively, 12 of 33 patients with acquired curvature were unable to have intercourse because of the combination of decreased rigidity and abnormal curvature. Of these patients, three were able to have satisfactory intercourse post-operatively. Most of the nine patients with a poor result were known pre-operatively to have adverse factors affecting erectile function. Of the 21 patients who were only able to have intercourse with difficulty preoperatively, intercourse was easier and more satisfactory in 18 and more difficult in three post-operatively. Pre-operative pain with erection improved in all patients. Complications were mild. Shortening concerned only two patients with recurrent Peyronie's disease after re-operation.

CONCLUSION

Plication of the curved penis is a relatively simple, save and effective procedure.