Search

Partial cystectomy (PC) remains a viable alternative to radical cystectomy (RC) for management of invasive bladder cancer in approximately 5% of patients. We used a population-based database to examine practice patterns and recurrence after partial cystectomy. We obtained billing records of all partial and radical cystectomies performed for bladder cancer in Quebec from 1983 until 2005. Analysis included age, gender, year of surgery, surgeon’s age, hospital type, preoperative and postoperative visits with accompanying diagnoses and dates of recurrences salvage RC, and death. A total of 714 (30.4%) patients with invasive bladder cancer underwent PC. Majority of PC (65%) were performed in non-academic institutions. Pelvic lymphadenectomy was performed in only 163 patients (23%) and concomitant ureteral reimplantation was performed in 89 patients (13%). Of 714 patients, 52 (23.7%) required a salvage RC. Median time from PC to salvage RC was 17.6 months (range 1–240 months), respectively. Patients who underwent PC had similar 5-year overall survival compared with patients who underwent upfront RC (49.8% vs. 51%, p = 0.21). Rate of PC for invasive bladder cancer is significantly higher than expected. Pelvic lymphadenectomy is underutilized in bladder cancer patients treated with PC. Whether prevalent use of PC is due to less stringent selection criteria remains unknown. Since late recurrence is not uncommon, lifelong follow-up is recommended.

Many studies have suggested that nutritional factors may affect prostate cancer development. The aim of our study was to evaluate the relationship between dietary habits and prostate cancer detection.We studied 917 patients who planned to have transrectal ultrasonography-guided prostatic biopsy based on an elevated serum prostate-specific antigen (PSA) level, a rising serum PSA level or an abnormal digital rectal examination. Before receiving the results of their biopsy, all patients answered a self-administered food frequency questionnaire. In combination with pathology data we performed univariable and multivariable logistic regression analyses for the predictors of cancer and its aggressiveness.Prostate cancer was found in 42% (386/917) of patients. The mean patient age was 64.5 (standard deviation [SD] 8.3) years and the mean serum PSA level for prostate cancer and benign cases, respectively, was 13.4 (SD 28.2) mug/L and 7.3 (SD 4.9) mug/L. Multivariable analysis revealed that a meat diet (e.g., red meat, ham, sausages) was associated with an increased risk of prostate cancer (odds ratio [OR] 2.91, 95% confidence interval [CI] 1.55-4.87, p = 0.027) and a fish diet was associated with less prostate cancer (OR 0.54, 95% CI 0.32-0.89, p = 0.017). Aggressive tumours were defined by Gleason score (/= 7), serum PSA level (/= 10 mug/L) and the number of positive cancer cores (/= 3). None of the tested dietary components were found to be associated with prostate cancer aggressivity.Fish diets appear to be associated with less risk of prostate cancer detection, and meat diets appear to be associated with a 3-fold increased risk of prostate cancer. These observations add to the growing body of evidence suggesting a relationship between diet and prostate cancer risk.

To analyze some of the factors that may be associated with a higher incidence of complications during management of ureteral stones by rigid ureteroscopy.We reviewed all ureteroscopic interventions aimed at stone extraction and/or fragmentation in our institution from 2001 through 2005. A total of 442 interventions were eligible for inclusion. Our focus was concentrated on (1) patient characteristics (age, gender, duration of symptoms, history of urinary schistosomiasis, and history of surgery involving the affected ureter), (2) stone characteristics (number, length, width, and level of the ureter affected), (3) the affected reno-ureteral unit (which side was affected, the kidney's ability to excrete contrast medium, and the status of the ureter proximal and distal to the stone), and finally (4) experience level of the surgeon in charge (junior v senior). The occurrence of intraoperative adverse events was considered a dependent variable and was statistically related to each of the above factors as independent variables.Intraoperative adverse events were encountered in 121 interventions including stone migration in 54, minor mucosal injuries in 24, ureteral perforation in 12, ureteral avulsion in 2, and aborted procedure due to bleeding or edema in 29. Symptomatology present for more than 3 months, a negative history of schistosomiasis, a positive history of ureteral surgery, stones above the ischial spines, stones5 mm in width, a dilated proximal ureter, kidneys that failed to excrete contrast medium, and involvement of a more junior urologist were factors that were associated with a statistically significantly higher incidence of intraoperative complications.Rigid ureteroscopic stone manipulation remains a procedure that should be handled cautiously. Existence of any of the above risk factors should alert urologists, particularly at training centers, to adopt all possible precautionary measures.

Introduction: To evaluate the predictors of prostate cancer in follow-up of patientsdiagnosed on initial biopsy with high-grade prostatic intraepithelial neoplasia(HGPIN) or atypical small acinar proliferation (ASAP).Methods: We studied 201 patients with HGPIN and 22 patients with ASAPon initial prostatic biopsy who had subsequent prostatic biopsies. The meantime of follow-up was 17.3 months (range 1–62). The mean number of biopsy sessions was 2.5 (range 2–6), and the median number of biopsy cores was10 (range 6–14).Results: On subsequent biopsies, the rate of prostate cancer was 21.9% (44/201)in HGPIN patients. Of these, 32/201 patients (15.9%), 9/66 patients (13.6%)and 3/18 patients (16.6%) were found to have cancer on the first, second and third follow-up biopsy sessions, respectively. In ASAP patients, the cancer detectionrate was 13/22 (59.1%), all of whom were found on the first follow-upbiopsy. There was a statistically significant difference between the cancer detectionrate in ASAP and HGPIN patients (p < 0.001). Multivariate analysis showedthat the independent predictors of cancer were the number of cores in theinitial biopsy, the number of cores (> 10) in the follow-up biopsy and a prostate specific antigen (PSA) density of ≥ 0.15 (odds ratio 0.77, 3.46 and 2.7,8 respectively;p < 0.04). Conversely, in ASAP patients none of these variables werefound to be associated with cancer diagnosis.Conclusion: ASAP is a strong predictive factor associated with cancer when comparedwith HGPIN. The factors predictive of cancer on follow-up biopsy ofHGPIN are number of cores on initial biopsy, more than 10 cores in rebiopsyand elevated PSA density. As the cancer detection rate on repeated biopsy of HGPIN patients is the same as that of patients without HGPIN, perhaps the standard of repeat biopsy in all patients with HGPIN should be revisited.

Obstruction of the urinary tract activates apoptotic pathways in collecting duct cells and leads to loss of renal parenchyma before surgical intervention. It has been suggested that developmental pathways may be reactivated to offset acute organ damage. One such molecule, PAX2, is expressed throughout the fetal collecting duct and was recently shown to suppress apoptosis during kidney development. We hypothesized that acute unilateral urinary tract obstruction (UUO) reactivates PAX2 expression in the mature kidney and partially suppresses apoptosis. If so, animals with PAX2 mutations should have increased susceptibility to parenchymal damage. Wild-type and heterozygous Pax2 mutant (C3H/ Pax21Neu) mice underwent unilateral ureteric ligation or sham operation at 6 wk of age; kidneys were examined after 5, 10, and 15 days. Whereas PAX2 protein levels fell to low levels in the first weeks of life, it was sharply reactivated by day 10 in collecting duct cells of wild-type but not in Pax21Neumutant mice with UUO. Wild-type mice with UUO had marked TUNEL and cleaved spectrin staining in tubular cells and reduced kidney weight after 10–15 days. Mutant mice had exaggerated increases in markers of apoptosis and exaggerated loss of renal parenchymal loss in the obstructed kidney. These observations suggest that PAX2 is rapidly reactivated in UUO and that mice with genetically limited PAX2 expression have heightened susceptibility to apoptosis.

Objective: Treatment delays have been associated with adverse outcomes in patients with bladder cancer treated with radical cystectomy (RC). We sought to evaluate the impact of treatment delay on disease recurrence and survival in patients with bladder cancer treated with partial cystectomy (PC) in Quebec. Methods: We reviewed and obtained billing records for all patients who underwent PC and/or RC for bladder cancer in Quebec between 1983 and 2005. Analysis included age, sex, year of surgery, surgeon’s age, hospital type, preoperative and postoperative visits with accompanying diagnoses and dates of death. Results: A total of 714 patients underwent PC. The median patient age was 70 years. Two-hundred nineteen (30.7%) patients experienced recurrence; of these, 52 (23.7%) required salvage RC. Five-year overall and recurrence-free survival for patients who underwent PC were 49.8% and 40.3%, respectively. Patients delayed more than 12 weeks from transurethral resection of bladder tumours (TURBT) to PC were at significantly increased risk of requiring salvage RC compared with those delayed 12 weeks or less (hazard ratio [HR] 3.0, p < 0.001). Patients who underwent salvage RC had worse survival than patients who had upfront RC (HR 1.5, p = 0.006). Variables including age, sex, presence of hematuria, intravesical therapy, surgeon age, hospital PC volume, surgeon PC volume, type of hospital (academic v. nonacademic) or year of surgery were not significantly associated with PC treatment delay. Conclusion: Treatment delay in patients with bladder cancer managed with PC was associated with increased risk of salvage RC. Patients with bladder cancer who underwent salvage RC had worse outcomes than those who had upfront cystectomy. Objectif : Chez les patients atteints de cancer de la vessie traites par cystectomie radicale (CR), un delai avant l’instauration du traitement est associe a des resultats defavorables. Nous avons tente d’evaluer l’impact d’un tel delai sur la recidive de la maladie et le taux de survie des patients atteints de cancer de la vessie traites par cystectomie partielle (CP) au Quebec. Methodologie : Les dossiers de facturation ont ete obtenus pour les patients ayant subi une CP et/ou une CR pour le traitement d’un cancer de la vessie au Quebec de 1983 a 2005. L’analyse tenait compte de l’âge, du sexe, de l’annee de l’intervention chirurgicale, de l’âge du chirurgien, du type d’hopital, des visites preoperatoires et postoperatoires, des comorbidites et des dates de deces. Resultats : En tout, 714 patients dont l’âge moyen etait de 70 ans ont subi une CP. De ce nombre, 219 patients (30,7 %) ont presente une recidive, dont 52 (23,7 %) necessitant une CR de sauvetage. La survie globale apres 5 ans et la survie sans recidive chez les patients ayant subi une CP etaient respectivement de 49,8 % et de 40,3 %. Un intervalle superieur a 12 semaines entre la resection transuretrale de la tumeur et la CP a ete associe a un taux accru de CR de sauvetage en comparaison avec un intervalle de 12 semaines ou moins (risque relatif [RR] 3,0, p < 0,001]. La CR de sauvetage etait associee a un taux inferieur de survie en comparaison avec les patients traites par CR des le depart (RR 1,5, p = 0,006). Les autres variables, soit l’âge, le sexe, la presence d’une hematurie, le recours a une therapie intravesicale, l’âge du chirurgien, le nombre de CP effectuees a l’hopital, le nombre de CP effectuees par le chirurgien, le type d’hopital (universitaire ou non universitaire), et l’annee de l’intervention chirurgicale n’ont pas ete associees de facon significative au delai avant la CP. Conclusion : Le delai avant l’instauration du traitement chez les patients atteints de cancer de la vessie traites par CP a ete associe a un taux accru de CR de sauvetage. Les patients atteints de cancer de la vessie qui ont subi une CR de sauvetage presentaient une issue de la maladie moins favorable que les patients traites par cystectomie des le depart.

Background: The province of Quebec has the highest incidence of urothelialtumours in Canada. Radical cystectomy remains the standard treatment for invasivebladder cancer. We have previously observed that prolonged delays betweentransurethral resection of bladder tumour (TURBT) and radical cystectomy leadto worse survival in Quebec.Objective: The aim of our study was to characterize the various periods of delaysustained by bladder cancer patients before radical cystectomy across Quebecand to determine their relation to survival.Methods: We obtained the billing records for all patients treated with radicalcystectomies for bladder cancer across Quebec from 1990 to 2002. Collectedinformation included patient age and sex; dates of family physician (FP) andspecialist visits with accompanying diagnoses; dates of cystoscopy, TURBT andCT scanning; surgeon age; surgical volume and dates of death.Results: We analyzed a total of 25 862 visits for 1633 patients. Median diagnosticdelays from FP to specialist, then to cystoscopy, then to TURBT and finallyfrom TURBT to CT were 20, 11, 4 and 14 days, respectively, over the entirestudy period. Median overall delay from FP visit to radical cystectomy was93 days. In addition, median FP to radical cystectomy delay progressivelyincreased from 1990 to 2000 from 58 to 120 days (p < 0.01). Multivariate analysesshowed that patients with an overall delay of either < 25 or > 84 dayshad a 2.1 and 1.4 times increased risk of dying, respectively (p ≤ 0.01).Conclusion: Preoperative delays have been progressively increasing over time.Overall, delays from FP to radical cystectomy of < 25 and > 84 days may translateinto worse outcomes. Poor survival in cases with < 25 days delay maybe attributed to case selection, with more advanced cases being managed muchquicker. Poor survival in cases with delays of > 84 days may be attributed todisease progression while awaiting completion of management.