Squamous variant of bladder cancer and colon adenocarcinoma with unusual presentation of hepatic metastases: a case report

==inizio objective==

Primary squamous cell carcinoma of urinary bladder is a rare disease variant, accounting for less than 5% of all primary bladder cancers [1]. The diagnosis of bscc is based on criteria established by the World Health Organization classification system [2] and it is a poorly differentiated tumor, it usually progresses rapidly and it characterizes by a worse prognosis than the most frequently represented bladder carcinoma, the urothelial carcinoma (UC) [3]. We report an unusual episode of a patient with squamous cell carcinoma of urinary bladder and contemporary adenocarcinoma of the descending colon asymptomatic, discovered in stages of staging and subsequently of hepatic metastases from colon adenocarcinoma. the patient underwent radical surgical therapy, ureterocutaneostomy and later chemiotherapy for metastases

==fine objective==

==inizio methodsresults==

The case report we are talking about concerns a 74-year-old patient, woman, who came to our attention for recurrent hematuria episodes, for several months (maybe eighteen), which have been treated with empirical antibiotic therapy (by general practitioner) without, however, investigate further with at least a radiological examination. After first stadiative investigations, the patient was diagnosed with a primary squamous bladder and a metacronous colon adenocarcinoma too, completely asymptomatic, so considered as an incidentaloma in the radiological diagnosis of staging.
The complete diagnosis was obtained by ultrasound, cystoscopy, trans urethral bladder resection, colonoscopy with biopsy and PET / CT (by usingfluoro-deoxyglucoseas radiopharmaceutical).
In 2017 the patient underwent transurethral resection of bladder cancer (TURBT) at our institution; the histological diagnosis elaborated was “Solid urothelial carcinoma (G3), with marked squamous differentiation infiltrating also the muscular tunic present”.
Subsequently the patient was subjected to a stadiative PET/CT, which showed presence of a descending colon circular neoformation. The patient was then subjected to a colonoscopy [Image 1], which confirmed the PET/CT (F-18 + FDG) suspected diagnosis, finding a circular lumen stenosing and ulcerated lesion, 40 cm away from the anal margin, and the lesion did not allow flexible endoscope further transit. Moreover, thanks to sub optimal intestinal cleansing (Boston Score = 3, as the other two traits score were not assigned), it was possible to appreciate the presence of a pedunculated polyp (size 8mm), 10 cm away from the anal margin, despite the numerous and persistent diffuse intestinal musculature’s spasms. During endoscopy, several biopsy samples were taken by the descending colon stenosing lesion, and the histological examination (in GB staining) revealed as outcome adenocarcinoma tissue.
In January 2018 the patient underwent radical cystectomy with ureterocutaneostomy, partial colon resection with termino-terminal anastomosis, left lymphandenectomy and enlarged hysterectomy with partial vaginectomy.
The histological report of the surgical specimen confirmed transurethral resection (TURBT) previous report: “solid urothelial carcinoma (G3) with marked squamous differentiation with muscular tunic infiltration”.
Colon resection showed the presence of adenocarcinoma, the surgical resection margin was negative.
No infiltration of tumor cells was found in the uterus, in the excised appendages, in the anterior wall of the vagina and no involvement of the nearby nodes was detected.
The patient performed both PET / CT (F-18 + FDG) and abdomen ultrasound six-month follow-ups.
In February 2019, PET / CT (F-18 + FDG) detected, in the liver, altered glucose metabolism in some areas as VII (SUV max 5.31), VIII (SUV max 11.5 vs 3.91 previous PET control on 07/05/2018), III segment (SUV max 11.6) and in VI segment (SUV max 6.92) [Image 2 – 3].
The remaining examined body areas were negative, within the methodic’s limits.
In March 2019, the patient underwent liver lesions’ biopsy, shown by the PET/CT (F-18 FDG) last February, which confirmed the presence of liver metastases, of intestinal origin, with adenocarcinoma metastasis’ characters.
Since May 2019 She has undergone chemotherapy cycles, with Folfox protocol (5-fluoro-uracil, folinic acid, oxaliplatin), currently the patient is still receiving therapy (with poor performance status and poor compliance) and she is monitored with general follow-ups.

==fine methodsresults==

==inizio results==

The patient after the surgical phase had a recovery without complications. The management of ureterocutaneostomy was home-based and all tests were negative until the appearance of asymptomatic liver metastases.

==fine results==

==inizio discussions==

==fine discussions==

==inizio conclusion==

The patient had a long disease-free duration after radical surgery. The presentation of hepatic metastases observed in our case was an event that emerged in the less-awaited follow-up compared to the possibility of local secondary or recurrence that we would have expected from the squamous cell carcinoma of urinary bladder.

==fine conclusion==

==inizio reference==

1. Sunil V.J., J Clin Diagn Res. Primary Squamous Cell Carcinoma of Urinary Bladder – A Rare Histological Variant. Epub, 2015.

2. J. N. Eble, WHO Classification of the Tumours. Pathology and Genetics of Tumours of the Urinary System and Male Genital Organs, IARC Press lon, France, 2004.

3. Tavora F, Epstein JI. Bladder cancer, pathological classification and staging. BJU International.2008.

==fine reference==

COLLINS LOOP EN BLOC RESECTION( CLEBR) FOR ACCURATE STAGING OF PRIMARY NON MUSCLE INVASIVE BLADDER CANCER: OUR EXPERIENCE

==inizio objective==

A primary aim of transurethral resection of bladder (TURB) tumors is to determine the depth of invasion or clinical stage. Transurethral resection is a stochastic procedure subject to variations in tumor type, surgical technique and pathological evaluation.
Exact pathological staging of bladder cancer is crucial for determination of further treatment. A limiting factor is the surgical ‘incise and scatter’ technique that might contribute to tumour recurrence.
We present our results with using a Collins loop (with a cutting current) en bloc resection (CLebR-ET) of bladder tumours for treatment and accurate staging of solitary transitional cell carcinoma of the bladder.

==fine objective==

==inizio methodsresults==

January 2015 – December 2019, 134 patients (96 male – 38 female) with non muscle-invasive bladder cancer (NMIBC) underwent transurethral en bloc resection using a Collins Loop. Tumor size ranged to 0.5- 45 mm and multifocality was present in 6% of cases. En bloc resection was applied on all of the tumours. On 118 of the 134 patients, a re-TURB was performed after 6 weeks. The bladder wall is incised around the lesion using a Collins loop, starting from apparently “normal” mucosa surrounding the base and then extending through the subepithelial connective tissue, muscularis mucosae and muscularis propria strata. The resected 1-piece specimen was grasped with a loop electrode and retrieved. After bladder tumor resection the resected base was observed carefully to assess perforation and bleeding. When the tumor size was greater than 3 cm, excision of the lesion could be easily achieved by mean of a resectoscope with a 5 mm working channel. After resection, the lesion is grasped with the forceps and retrieved with the resectoscope. All cases of high-risk NMIBC underwent second-look after 30-45 days.

==fine methodsresults==

==inizio results==

Pathology reported urothelial carcinoma with low grade stage Ta, T1 high –grade and T2 high-grade respectively in 76 (56,7%), 46 ( 34,3%), 12 ( 8,9%). All of the resected specimens provided detrusor muscle, No uncontrollable bleeding, perforation or other serious complications were observed. To date, with a mean follow up of 16.5 months, the recurrence rate in patients with NMIBC is 13.5%

==fine results==

==inizio discussions==

TURBT is a procedure with a varied outcome in terms of adequacy of resection, recurrence and progression. There is no clinical yardstick to judge the completeness of resection. There are
a few surrogate markers to assess adequate resection such as presence of detrusor muscle in the specimen and the rate of subsequent recurrence. Successful management of
bladder tumors (particularly non-muscle-invasive tumors), relies on adequate initial resection and accurate histological diagnosis.
An ideal TURBT would mean complete resection of the visible tumor, resection of the surrounding healthy looking mucosa for up to 1 cm and then the removal of detrusor muscle. Herr and
Donat described three ways to measure the quality of a good TURBT, i.e., complete resection, presence of deep muscle in the specimen and the rate of recurrence at the site of previous
TURBT. [1] They also suggested classifying tumor resection as R0; microscopic negative margin, R1 with microscopic positive margin and R2 that is macroscopic positive margin. This kind
of assessment is not practical in CT, but could be possible in en-bloc resection, where we can have a piece of tumor tissue, which has all three layers, i.e., urothelium, lamina propria and
detrusor muscle in contiguity. The outer-most surface of the detrusor muscle in the resected specimen could then be inked to assess margin status and thereby discerning a true perspective of level of resection, i.e., R0-R1.
Inadequacy of CT is not only judged by absence of detrusor muscle in an initial specimen, but also by the rate of recurrence. Recurrence is seen in 50-70% of non-muscle invasive bladder
cancer, mostly during the 1 st year. These may be due to incomplete resection, cell implantation or the tumor biology itself. [2] Incomplete resection seems to be the most important reason for the recurrence. In a review of seven randomized controlled trials, after controlling established factors for recurrence such as tumor size, multiplicity, stage and grade, it was concluded that a wide range of recurrence rate, i.e., 0-46%, was due to the difference in quality of resection. [3] Inadequate resection leading to higher rate of recurrence at the samesite is supported by another study where 81% of recurred tumor occurred at the site of previous resection. [4]
Various techniques using different kinds of loops and laser have been described to improve the quality of TURBT. En-bloc resection technique is one of the ways to provide better pathological evaluation for Ta and T1 tumors. In a study on ET, a flat loop electrode was used to resect tumors of less than 2.5 cm. [1] Although the authors did not describe presence or absence of detrusor muscle in the resected specimen, they concluded that invasion of lamina was better delineated with en-bloc resection. A limitation of this technique was the inability to use a flat loop for tumors located at the anterior and upper posterior wall. Another limitation was that tumor of more than 2.5 cm was considered a contraindication.
Regarding the learning curve, CLebR-ET is rather more controlled technique of resection than CT as it gives better hemostasis and thereby a good vision, which is crucial to avoid complications.
Depth of the resection could also be modified with ET and it does not take more than three cases to get a knack of this technique if it is started with a relatively small tumor.

==fine discussions==

==inizio conclusion==

CLebR has been proven safe and effective for both, treatment and pathological staging of NMIBC; therefore could be an appropriate tool for accurate staging with possibly lower scattering potential for the assessment and treatment of patients with NMIBC.
The objective advantage of accurate pathological examination (identification of microfocal invasion of lamina propria or of muscular wall, surgical margins assessment) is associated with a substantial safe technique. Long term data and larger dataset of cases are necessary to demonstrate an advantage in terms of recurrence or progression.

==fine conclusion==

==inizio reference==

1. Herr HW, Donat SM. A re-staging transurethral resection predicts early progression of superficial bladder cancer. BJU Int 2006;97:1194-8.
2. Maruniak NA, Takezawa K, Murphy WM. Accurate pathological staging of urothelial neoplasms requires better cystoscopic sampling. J Urol 2002;167:2404-7.
3. Brausi M, Collette L, Kurth K, van der Meijden AP, Oosterlinck W, Witjes JA, et al. Variability in the recurrence rate at first follow-up cystoscopy after TUR in stage Ta T1 transitional
cell carcinoma of the bladder: A combined analysis of seven EORTC studies. Eur Urol 2002;41:523-31.
4. Mariappan P, Smith G, Lamb AD, Grigor KM, Tolley DA. Pattern of recurrence changes in noninvasive bladder tumors observed during 2 decades. J Urol 2007;177:867-75.

==fine reference==

Elevated Neutrophil-to-Lymphocyte Ratio (NLR) predicts poor response to hyperthermic intravesical chemotherapy (HIVECTM) with mitomycin-C (MMC) in high-risk non muscle invasive bladder cancer: a single-institution analysis

==inizio objective==

Bladder cancer is the 9th most commonly diagnosed cancer worldwide and the 13th most frequent cause of cancer death worldwide (1). The aim of this study was to evaluate the neutrophil-to-lymphocyte ratio (NLR) as a prognostic factor for response of high risk non muscle invasive bladder cancer (HR-NMIBC) treated with HIVEC™ (hyperthermic intravesical chemotherapy) therapy (2).

==fine objective==

==inizio methodsresults==

Between March 2017 to May 2018, 53 consecutive patients with HR-NMIBC treated with HIVEC™ therapy (six weekly instillations) were retrospectively analysed. For each patient, we reported the pre-HIVEC and post-HIVEC hematologic and chemical data, including the total number of white blood cells (WBC), neutrophils (N) and lymphocytes (L). Patients underwent blood sampling the day before the first HIVEC™ instillation and the day after the last HIVEC™ instillation, in the morning, after at least 6 hours of fasting. We enrolled only patients without haematuria in order to avoid any sort of bias, especially in terms of total blood count. The NLR ratio was calculated by dividing the value of N by the value of L. All data were collected in a prospectively maintained database and analyzed. Mean values with standard deviations (±SD) were computed and reported for all items. Statistical significance was achieved if p-value was ≤0.05 (two-sides).

==fine methodsresults==

==inizio results==

The patients were divided in two groups (Group A: responder group and Group B: non responder group; bladder cancer recurrence or progression to T2). Recurrence occurred in 7 patients and progression occurred in 6 patients. The mean value of NLR in all 53 cases was 3.21 ± 0.79 (Pre-HIVEC) and 3.13 ± 0.77 (Post-HIVEC) (p=0.59). NLR was not significantly different between the two groups before the HIVEC™ treatment (3.18 ± 0.79 in Group A and 3.31 ± 0.78 in Group B; p=0.63) while NLR was significantly different after the HIVEC™ treatment (2.89±0.73 in Group A and 3.87±0.30 in Group B; p=0.011).

==fine results==

==inizio discussions==

There are few studies on the association between SIR (Systemic inflammatory response ) markers and NMIBC. Most studies have been performed on muscle invasive bladder cancer (MIBC) and radical cystectomy. These studies suggest that NLR before radical cystectomy may help predict tumor prognosis (3).
Yuk HD et al (2019), demonstrated that NLR before treatment was correlated with both oncological outcomes and survival outcome in NMIBC patients undergoing initial intravesical BCG treatment after TURB. Increased NLR reflects poor prognosis of these outcomes (4).
Thermotherapy has profound effects on the immune system resulting in increased activation of more natural killer cells (NKC) that target heat stressed cancer cells as they signal heat shock proteins on the cancer cell surface. The consequence is that the cancer cells actively participate in their own demise through the natural process of apoptosis (5). In our study, NLR measured at the end of the last HIVEC™ treatment was correlated with the response to the therapy. In particular, an higher proportion of lymphocytes was revealed in the group of patients who response to the therapy (and then achieve an immune response against the bladder tumor).
This study has several limitations. First, it was a retrospective study of a single institution. Thus, it cannot be free from selection bias. Second, a single test does not represent the entire systemic immune response state. Third, large-scale prospective studies are needed to apply NLR to clinical practice.

==fine discussions==

==inizio conclusion==

NLR value could be a useful tool to predict bladder cancer response to HIVEC™ therapy. These results could lead to the development of more studies to assess the real prognostic value of NLR in HR-NMIBC.

==fine conclusion==

==inizio reference==

1-Babjuk M, Bohle A, Burger M, Capoun O, Cohen D, Comperat EM, et al. EAU guidelines on non-muscle-invasive urothelial carcinoma of the bladder: update 2016. Eur Urol. (2017) 71:447–61.
2- Sousa A, Piñeiro I., Rodríguez S. et al. Recirculant hyperthermic IntraVEsical chemotherapy (HIVEC) in intermediate-high-risk non-muscle-invasive bladder cancer. Int J Hyperthermia 2016. PMID 26915466
3- Kim HS, Ku JH. Systemic inflammatory response based on neutrophil-to-lymphocyte ratio as a prognostic marker in bladder cancer. Dis Markers (2016) 2016:8345286. doi: 10.1155/2016/8345286
4-Hyeong Dong Yuk , Chang Wook Jeong, Cheol Kwak et al. Elevated Neutrophil to Lymphocyte Ratio Predicts Poor Prognosis in Non-muscle Invasive Bladder Cancer Patients: Initial Intravesical Bacillus Calmette-Guerin Treatment After Transurethral Resection of Bladder Tumor Setting Front Oncol 8, 642 2019 Jan 17
5-Fuse, K W Yoon, T Kato Heat-induced Apoptosis in Human Glioblastoma Cell Line A172Neurosurgery, 42 (4), 843-9 Apr 1998

==fine reference==

DEPTH OF INVASION AS A POTENTIAL PREDICTOR OF RECURRENCE IN PATIENTS TREATED WITH ENBLOC-TRANSURETHRAL RESECTION OF THE BLADDER: A FEASIBILITY STUDY

==inizio objective==

As for other tumors it is likely that depth of invasion is a prognostic factor for disease recurrence and progression in high grade pT1 urothelial bladder cancer. To date nor anatomy based neither dimensional subclassification proved reliable correlation with recurrence and progression, mainly considering the high interobserver variability in pT1 diagnosis, based by the TURB resection technique intrinsic artifact. Aim of this study is to assess the feasibility of measuring depth of invasion of urothelial carcinoma in patients undergoing EB-TURB for pT1HG disease.

==fine objective==

==inizio methodsresults==

27 patients undergoing EB-TURB with Collins knife and with pT1-HG disease were included. A second TURB was performed after 4-6 weeks from the first one. A dedicated pathologist assesses the feasibility of depth of invasion measurement

==fine methodsresults==

==inizio results==

Overall 32 patients with pT1HG disease were enrolled. EB-resection was adequately performed in 27/32 (85%) of the patients. Overall 40 lesions were identified with a median tumour size of 2 cm (1/4).
Median depth of invasion was 1.35 mm (0.48/3.5). Deepness measurement was feasible in 100% of the patients and in 100% of the lesions. As well on re TURB 8/27(29%) patients presented residual disease and in 100% of these patients it was possible to measure depth of invasion with a median value was 1.1 mm (0.43/2.3). Limitations include number of patients.

==fine results==

==inizio discussions==

.

==fine discussions==

==inizio conclusion==

In specimen obtained from EB-TURB measurement assessment proved to be easy and highly reproducible. Recruitment of patients is still ongoing to evaluate an eventual prognostic value of neoplastic invasion in recurrence and progression.

==fine conclusion==

==inizio reference==

.

==fine reference==

Narrow Band Imaging reduces persistence of cancer in patients with pT1 high grade bladder cancer

==inizio objective==

To evaluate persistence rate on repeated transurethral resection of the bladder (re-TURB) 6 weeks after the first TURB in patients with pT1HG disease undergoing resection of the margins and bed on Narrow Band Imaging.

==fine objective==

==inizio methodsresults==

A consecutive series of patients undergoing TURB and a diagnosis of pT1 high grade disease were prospectively enrolled. On initial TURB patients underwent classic white light resection of the tumour followed by narrow band image (NBI) resection of margins and bed. After 6 weeks from the initial TURB, patients underwent a re-TURB under white light. Persistence rates on re-TURB were recorded.

==fine methodsresults==

==inizio results==

Overall 797 patients underwent TURB, out of them 126 patients with pT1 high grade disease were included in the study. The total number of lesions was 226 meaning 1.79 lesions per patient. On re-TURB 24/126 (19%) of the patients presented residual disease with a total of 28/226 (12%) lesions identified. All these patients presented a pTa residual disease. Out of them 8/21 (38%) presented bladder cancer on the resection bed and 13/21 (62%) presented bladder cancer on margins.

==fine results==

==inizio discussions==

.

==fine discussions==

==inizio conclusion==

Narrow Band Imaging trans-urethral resection of the bladder is an oncological effective procedure in the treatment of pT1HG disease. The procedure has a 19% of persistence rate which is inferior when compared to the available evidence on white light TURB. Further multicenter studies are needed in order to validate our results.

==fine conclusion==

==inizio reference==

.

==fine reference==

CONFEZIONAMENTO DI NEOVESCICA ILEALE ORTOTOPICA SEC HAUTMAN MODIFICATA APPROCCIO TOTALMENTE LAPAROSCOPICO CON RICOSTRUZIONE MANUALE ( V- LOCK SUTURE)

==inizio abstract==

IL VIDEO MOSTRA LA TECNICA DI CONFEZIONAMENTO DI NEOVESCICA ILEALE CON APPROCCIO LAPAROSCOPICO TOTALMENTE INTRACORPOREO A DUE OPERATORI.
TERMINATA LA FASE DEMOLITIVA E LA LINFECTOMIA, ISOLATO UN TRATTO DI ILEO DI CIRCA 60 CM SI PROCEDE PRIMA AD ANASTOMOSI URETRO-ILEALE SU FOLEY 20 CH SILICONATO CON DUE EMICONTINUE DI PDS 3/0. A SEGUIRE, AVENDO UN PUNTO FISSO URETRALE, SI REALIZZA LA DETUBULARIZZAZIONE ILEALE AL VERSANTE ANTIMESENTERICO E SUCCESSIVAMENTE LA RICONFIGURAZIONE MEDIANTE SUTURE DEL TIPO V-LOCK CONVIDIEN 3/0. SI RICONFIGURA PRIMA LA PARETE POSTERIORE (3 SUTURE), POI A NEOVESCICA ANCORA “APERTA” SI PROCEDE ALLE ANASTOMOSI URETERO ILEALI. A TAL PROPOSITO LA TIPOLOGIA DI NEOVESICA LA DEFINIAMO DI HAUTMAN MODIFICATA PER LA PRESENZA DI DUE CAMINI NON DETUBULARIZZATI AI DUE CAPI DELLA W-SHAPE AL FINE DI RENDERE PIU’ AGEVOLI LE ANASTOMOSI URETERO ILEALI DIRETTE. COMPLETATE LE ANASTOMOSI URETERALI SI PROCEDE ALLA CHIUSURA DEL SERBATOIO ILEALE ORTOTPICO NELLA PARETE ANTERIORE E A LIVELLO DELLA “CUPOLA” DA CUI FUORIESCONO I TUTORI URETERALI ESETERIORIZZATI DALLA PARETE ADDOMINALE ATTRAVERSO UN PORTA DA 5 MM. LA METODICA SEPPUR INDAGINOSA E RICHIDENTE UN LIVELLO AVANZATO SULLA CURVA DI APPRENDIMENTO PUO’ ESSERE UNA ALTERNATIVA MINIVASIVA ALLO STANDARD OPEN IN PAZIENTI SELEZIONATI.

==fine abstract==

CISTECTOMIA RADICALE VIDEOLAPAROSCOPICA PROSTATE-SEMINAL SPARING CON ILEOCAPSULOANASTOMOSI

==inizio abstract==

LA CISTECTOMIA RADICALE LAPAROSCOPICA PROSTATE – SEMINAL SPARING E’ PROPONIBILE SOLO A PAZIENTI ACCURATAMENTE SELEZIONATI E CANDIDABILI AL CONFEZIONAMENTO DI NEOVESCICA ORTOTOPICA. NEL VIDEO PROPONIAMO IL CASO DI UN CINQUANTENNE, EX SPORTIVO AGONISTA, CON DIAGNOSI DI NEOPLASIA VESCICALE INFILTRANTE (T2) ALTO GRADO, DELLA PARETE VESCICALE POSTERIORE , PRIMA MANIFESTAZIONE, SINGOLA. IPSS 3 PSA 1.5, Q MAX 23 PROSTATA 25 CC, NON SOSPETTA. MOTIVATO NELLA PRESERVAZIONE DELLA FUNZIONE SESSUALE. IL VIDEO PONE IN RISALTO COME L’APPROCCIO LAPAROSCOPICO NELLA FASE DEMOLITIVA DIFFERISCE DALLO STANDARD SIA IN FASE DI DISSEZIONE POSTERIORE CHE ANTERIORE. PIU’ARTICOLATA LA PRIMA PER LA NECESSITA’ SVILUPPARE UN PIANO DI CLIVAGGIO TRA VESCICOLE SEMINALI LASCIATE IN SEDE E LA PARETE VESCICALE POSTERIORE RETRO-SOVRA TRIGONALE. CIO’ CONSENTE LA PRESERVAZIONE SIA DEI BUNDLE VASCOLO NERVOSI CHE DELLA RETE DEL PLESSO PELVICO PRESENTE A TALE LIVELLO. LA DISSEZIONE ANTERIORE E LA PREPARAZIONE DEL COLLO VESCICALE E DELLA BASE PROSTATICA DEVONO CONSENTIRE LA DELMITAZIONE DELLA CAPSULA E DELL’ URETRA PROSTATICA SOVRA COLLICOLARE. NON ESEGUITA TURP PRELIMINARE PER LE ESIGUE DIMENSIONI PROSTATICHE IN PAZIENTE GIOVANE SENZA SINTOMI DI RILIEVO. LA NEOVESCICA CONFEZIONATA CON STAPLER INTRACORPOREA E’ UNA CAMEY II. ANASTOMOSI URETERALI DIRETTE NON ANTIREFLUSSO. A DISTANZA DI 3 ANNI IL PAZIENTE E’ POTENTE CON EIACULAZIONE, CONTINENTE. NON EVIDENZA DI RECIDIVE PELVICHE E A DISTANZA.

==fine abstract==

Cistectomia laparoscopica con confezionamento di Bricker intracorporea

==inizio abstract==

L’approccio mininvasico, laparoscopico o robotico, alla cistectomia radicale offre indubbi vantaggi nel recupero clinico nel post operatorio, basti pensare alla riduzione delle perdite ematiche intraoperatorie e alla conseguente riduzione di emotrasfusioni, alla riduzione del dolore da ferita chirurgica quindi alla precoce mobilizzazione e alla precoce canalizzazione intestinale soprattutto se viene eseguita la resezione ileale per il confezionamento di una derivazione ortotopica o eterotopica. L’approccio mininvasivo associato al fast track chirurgico permette la canalizzazione fin dal POD#3. Il sondino nasogastrico viene rimosso la mattina successiva all’intervento e il pz inizia a sorseggiare acqua e mangiare del gelato mattina e sera fin dal post operatorio. Non viene somministrata nutrizione parenterale. La mobilizzazione è in prima giornata post operatoria.
Il video mostra gli steps laparoscopici più salieni. Con scopo descrittivo viene mostrata la cistectomia radicale e la linfoadenectomia iliaco otturatoria estesa. Con finalità didattica, e quindi soffermandosi sui particolari, viene mostrato l’utilizzo delle suturatrici meccaniche laparoscopiche e la gestione della anastomosi ureteroileale intracorporea.
Il condotto ileale secondo Bricker rappresenta a nostro giudizio la migliore derivazione dopo cistectomia radicale per qualità di vita nei pazienti per i quali è improponibile la neovescica ileale ortotopica. L’approccio laparoscopico permette un più rapido recupero post operatorio.

==fine abstract==

Neovescica Ileale ortotopica con approccio Robot-assistito: quale scegliere?

==inizio abstract==

Il video descrive le tre tecniche utilizzate presso il nostro Istituto per il confezionamento della neovescica ileale ortotopica intracorporea con approccio robot-assistito: la VIP (Vescica Ileale Padovana), la “Y shaped” e la FloRIN.
Nel dettaglio da gennaio 2017 ad Aprile 2019 sono stati trattati 37 pazienti (28 M e 9 F):
28 VIP
6 “Y” shaped
3 FloRIN
I dati relativi ai tempi operatori, perdite ematiche, degenza e tempi di cateterizzazione sono riportati nel video.
Nei pazienti sottoposti a VIP si sono registrati due casi di infezione complicata delle vie urinairie, un caso di osteomielite pubica, un caso di fistola urinaria esitata in stenosi dell’anastomosi neo-vescico-ureterale.
Non ci sono state complicanze, ad oggi, nei pazienti trattati con le altre due derivazioni intracorporee.
Ulteriori dati patologici e funzionali vengono riportati nelle tabelle del video.
Sulla base della nostra esperienza preliminare possiamo concludere che la neovescica più anatomica è la VIP. Nei casi in cui gli ureteri siano corti o il meso non complicante, la “Y” shaped, grazie alla sua versatilità e facilità di esecuzione è la più indicata. La giusta via di mezzo potrebbe essere la FloRIN.
La nostra esperienza supporta la fattibilità delle 3 tecniche descritte nel video e dimostra la loro somiglianza e sicurezza in termini con risultati.

==fine abstract==