Search

Urothelial carcinoma is a highly heterogeneous disease that can arise throughout the entire urothelial lining from the renal pelvis to the proximal urethra. Upper tract urothelial carcinoma (UTUC) is rare, and while it shares many similarities with urothelial carcinoma of bladder (UCB), there are also significant differences between UTUC and UCB regarding clinical management and outcomes. No major advances have been made recently in the development of new systemic therapies for urothelial carcinoma, partly due to the lack of understanding of underlying molecular pathogenetic mechanisms. In the past decade, the emergence of next-generation sequencing has greatly enabled genomic characterization of tumor samples. Researchers are currently exploring a personalized approach to augment traditional clinical decision-making based on genetic alterations. In the present review, we summarize current genomic advances in UTUC and discuss the potential implications of these developments for developing prognostic and predictive biomarkers. more...

Parastomal hernias (PH) represent a clinically significant problem for many patients after radical cystectomy and ileal conduit diversion. The prevalence may be as high as 60% and in some series, up to 30% of patients require surgical intervention due to the complications of pain, poor fit of an ostomy appliance, leakage, urinary obstruction, and bowel obstruction or strangulation. Due to the potential morbidity associated with PH repair, there have been efforts to prevent PH development at the time of the index surgery. Four randomized trials of prophylactic mesh placement at the time of colostomy and ileostomy stoma formation have demonstrated significant reductions in PH rates with acceptably low complication rates. In this review, we describe the clinical and radiographic definitions of PH, the clinical impact and risk factors behind its development, and the rationale behind prophylactic mesh placement for patients undergoing ileal conduit urinary diversion. Additionally, we report our experience with prophylactic mesh placed at radical cystectomy at our institution. more...

Urothelial carcinoma of the urinary bladder (UCB) is a highly heterogeneous malignancy that causes significant morbidity and mortality. Despite advances in surgical and medical treatment, there has been no change in mortality in UCB over the past decades. Standard pathological features (stage, grade, nodal status) provide only limited information regarding biological potential and clinical behavior. Molecular biomarkers may shed light on important mechanisms of pathogenesis, provide useful additional prognostic information, and serve as targets for therapy. This review summarizes recent advances and the most promising UCB tissue and blood biomarkers of the past few years. We discuss the predictive and prognostic value of biomarkers at different stages of UCB. There is no doubt that a panel of biomarkers will eventually improve our clinical decision-making with regard to treatment and follow-up. more...