Bladder cancer (BC) has become a significantly prevalent disease in China, with an incidence rate of 5.80 per 100 000 in 2015, ranking it as the thirteenth most common type of cancer within the nation. This illness presents a serious public health concern, highlighting the imperative need to unify the standards for diagnosis and treatment to improve patient outcomes. The section of the clinical practice guideline in question is dedicated to addressing muscle-invasive bladder cancer (MIBC) and metastatic BC. The primary treatment strategies for MIBC are well-defined: preoperative (neoadjuvant) chemotherapy combined with radical cystectomy stands as the conventional treatment protocol. For patients with locally advanced MIBC, integrating systemic and local therapies is advocated to enhance treatment effectiveness. In cases of metastatic BC, the focus shifts to systemic treatment supplemented by supportive care measures. The guideline also succinctly presents the pros and cons of various urinary diversion surgeries, which are critical considerations following radical cystectomy. It provides an in-depth exploration of the treatment modalities for metastatic urothelial carcinoma of the bladder. Additionally, this part delves into the integrated approach to treatment and the use of radiotherapy in bladder preservation for localized disease. Moreover, it offers a concise overview of the classification, diagnosis, and therapeutic approaches for nonurothelial carcinoma of the bladder. Lastly, this part emphasizes the importance of recommended posttreatment follow-up for MIBC patients to ensure comprehensive and ongoing care management.
Background: As one of the most common diseases in urology, a large number of preclinical studies have been accumulated to explore the etiological mechanism and potential intervention of chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS).
Methods: In this study, we systematically evaluated the current status of preclinical research on CP/CPPS through bibliometrics analysis using VOSviewer and Citespace. Characteristics of publication such as year, country/region, institution, author, journal, citation, and keywords were analyzed. Based on the bibliometrics analysis results of keywords, we summarized the possible mechanisms and promising treatments for CP/CPPS narratively.
Results: According to the results of this study, the most common mechanisms involved in CP/CPPS were as follows: Disturbed immune and inflammation mediators, immune cell dysfunction, oxidative stress, dysregulated signaling pathways, apoptosis, gut microbiota, and testosterone metabolism. Traditional Chinese Medicine and extracorporeal shock wave therapy have important potential in the treatment of CP/CPPS.
Conclusion: Further translational studies targeting the above mechanisms and validating the objective efficacy of potential treatments indicated by preclinical studies in clinical patients are needed in the future.
Backgound: Given the overall aging of the population, erectile dysfunction (ED) has become an increasingly relevant issue. When elective surgery is offered, the patient’s age is often noted as a potential limiting factor. The aim of this study is to investigate the safety of implanting penile prostheses (PPs) in men 90 years and older, and report the potential complications associated with this population.
Methods: The database was screened between the years 2003 and 2023 to identify patients at least 90 years and older who underwent implantation of PP by a single surgeon at MD Anderson Cancer Center and Memorial Hermann Texas Medical Center. We collected demographic information, their anesthesia perioperative assessment, surgical procedure details, and postoperative pathway.
Results: Between 2003 and 2023, 2000 men underwent PP surgery. Three patients were 90 years or older at the time of PP surgeries. All surgeries were performed without intraoperative or postoperative complications. Following the surgery, patients were monitored, and the patients with implantations demonstrated the ability to use the device and reported satisfaction.
Conclusion: This case series demonstrates that implantation of PP is a safe and effective treatment for elderly men with ED. Maintaining a satisfactory sexual life in this age group is vital and achievable through inflatable PP insertion. There are several factors that must be considered prior to operating on an older patient. However, with proper patient selection and preoperative optimization, this operation can be effectively performed in these patients.
Background: Radical prostatectomy (RP) and radical cystectomy (RC) with concurrent pelvic lymph node dissection (PLND) are considered as the curative surgical treatment options for localized prostate cancer (PC) or muscle-invasive bladder cancer (BC). Regarding lymphatic leakage management after PLND, there is no standard of care, with different therapeutic approaches having been reported with varying success rates.
Methods: Seventy patients underwent pelvic lymphadenectomy during robotic RP and RC with postoperative pelvic drainage volume more than 50 mL/day before the removal of drainage tube, were retrospectively evaluated in this study between August 2015 and June 2023. If the pelvic drainage volume on postoperative Day 2 was more than 50 mL/day, a drainage fluid creatinine was routinely tested to rule out urine leakage. We removed the drainage if the patient had no significant abdominal free fluid collection, no abdominal distension or pain, no fever, and no abdominal tenderness. After 1-day observation of the vital signs and abdominal symptoms, the patient was discharged and followed-up in clinic for 2 weeks after surgery.
Results: Forty-one cases underwent the early drainage removal even if the pelvic drainage volume was more than 50mL/day. Among these forty-one cases, twenty-five drainage tubes were removed when drainage volume was more than 100 mL/day. All the forty-one cases with pelvic drainage volume greater than 50mL/day were successfully managed with the early drainage removal. No paracentesis or drainage placement was required. No readmission occured during the follow-up period.
Conclusion: It is safe to manage the high-volume pelvic lymphatic leakage by early clamping of the drainage tube, ultrasonography assessment of no significant residual fluid in the abdominal and pelvic cavity, and then the early removal of the drainage tube.