Abstract Introduction Cystectomy with urinary diversion (i.e. bladder removal surgery) is commonly studied using large health administrative databases. These databases often use diagnoses or procedure codes with unknown accuracy to identify cystectomy patients, thereby resulting in significant misclassification bias. The primary objective of this study is to develop a predictive model that will return an accurate probability that patients recorded in the discharge abstract database have undergone cystectomy with urinary diversion, stratified by type of urinary diversion (continent vs incontinent). Secondary objectives of this study include: 1) to internally validate our predictive model to determine its accuracy using a cohort of all adults admitted to The Ottawa Hospital (TOH) within the study period; and 2) compare the accuracy of this model to that of code-based algorithms used previously in published studies to identify cystectomy. Methods A gold standard reference cohort (GSC) of all patients who underwent cystectomy and urinary diversion at TOH between 2009 and 2019 was created by using the SIMS registry within the TOH data warehouse which captures all primary surgical procedures performed. The GSC was then confirmed by manual chart review to ensure accuracy. Through ICES, the GSC was linked to the provincial Discharge Abstract Database (DAD), physician billing records (OHIP), and Ontario Cancer Registry (OCR) and a new combined dataset containing all admissions at TOH during the study period was created. Clinical information, billing, and intervention codes within these databases were reviewed and the co-variables thought to be predictive of cystectomy were selected a priori. A multinomial logistic regression model (i.e. The Ottawa Cystectomy Identification Model or OCIM) was created using these co-variables to determine the probability of a patient undergoing cystectomy, stratified by continent vs incontinent diversion, during an admission in the DAD. Using the OCIM and bootstrap imputation methods, co-variable values and 95% confidence intervals were calculated. The values of these same co- variables were then measured using a code algorithm (the presence of either a procedure code or billing code for cystectomy with incontinent or continent diversion). Misclassification bias was then measured by comparing the values of co-variables using the OCIM or code algorithm to the true values obtained from the gold standard reference cohort. Results Five hundred patients were included in the GSC [median age 68.0 (IQR 13.0); 75.6% male; 55.6% incontinent diversion]. The prevalence of cystectomy within the DAD over the study period was 0.12% (500/428697 total admissions). Sensitivity and positive predictive values for cystectomy codes were 97.1% and 58.6% for incontinent diversions and 100.0% and 48.4% for continent diversions, respectively. The OCIM accurately predicted cystectomy with incontinent diversion (c-statistic [C] 0.999, Integrated Calibration Index [ICI] 0.000) and cystectomy with continent diversion (C:1.000, ICI 0.000) probabilities. Misclassification bias was lower when identifying cystectomy patients using the OCIM with bootstrap imputation compared to the use of the code algorithm alone. Conclusions A model using administrative data accurately returned the probability that cystectomy by diversion type occurred during a hospitalization. Using this model to impute cystectomy status minimized misclassification bias.

Primitive neuroectodermal tumor (PNET) is part of the Ewing sarcoma family of tumors. The present case reports a primitive neuroectodermal tumor (PNET) of rare location in the bladder in a newborn. It was evaluated with prenatal ultrasound and postnatal tomography that revealed a mass in the posterior wall of the bladder. The patient underwent partial cystectomy with subsequent analysis of the surgical piece removed, the histopathological study indicated a tumor of mesenchymal origin, and immunohistochemical staining confirmed the diagnosis of PNET of the bladder. Satisfactory result and short-term follow-up. / Revisión por pares

El quiste de colédoco es una patología poco común, diagnosticada generalmente después del nacimiento; pero en los últimos tiempos el diagnóstico prenatal ha tomado mayor importancia, pues permite una intervención precoz y brinda un mejor pronóstico a los pacientes. Se presenta el caso de una lactante que fue diagnosticada mediante ecografía obstétrica, a las 21 semanas de vida intrauterina; confirmándose luego el diagnóstico por medio de resonancia magnética. La paciente fue operada a los tres meses de vida, realizándosele una quistectomía, colecistectomía y derivación biliodigestiva en Y de Roux, con evolución posoperatoria favorable.

Diss. (sammanfattning) Göteborg : Göteborgs universitet, 2007. / Härtill 4 uppsatser.

Orientadores: Ubirajara Ferreira, Fernandes Denardi / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas / Made available in DSpace on 2018-08-09T15:47:05Z (GMT). No. of bitstreams: 1 Matheus_WagnerEduardo_D.pdf: 1544170 bytes, checksum: b8c2ff3d48db298c2b90e9243e4fad82 (MD5) Previous issue date: 2007 / Resumo: O melhor tratamento para o carcinoma urotelial invasivo de bexiga é a cirurgia de cistectomia radical. O objetivo principal desse estudo foi de comparar a taxa de sobrevida global dos tumores músculo invasivos primários dos tumores invasivos progressivos. O objetivo secundário foi comparar a taxa de sobrevida global dos subgrupos pT3/4, acometimento linfonodal e presença de metástases, dos tumores primários e invasivos. Nesse estudo multicêntrico retrospectivo, foram avaliados 242 pacientes submetidos à cistectomia radical, no período de 1992 a 2005, para tratamento de carcinoma urotelial invasivo de bexiga. Os pacientes foram divididos em dois grupos: Grupo I ¿ 185 pacientes com tumor invasivo primário e Grupo II - 57 pacientes com carcinoma urotelial invasivo progressivo. Além disso, conforme achados histopatológicos, ambos os grupos foram divididos em subgrupos: pT2 (invasão de musculatura vesical), pT3/4 (invasão de gordura perivesical e órgãos ou tecidos adjacentes), N+ (acometimento de linfonodos) e M+ (presença de metástases). Para análise estatística foram aplicados os testes de qui-quadrado, Mann-Whitney, Kaplan-Meier e Wilcoxon (Breslow). A média e mediana de seguimento foram de 98 e 90 meses para o Grupo I, e 96 e 88 meses para o Grupo II, respectivamente, e sem diferença estatística significativa (p = 0.0734). No seguimento, foram observadas as seguintes taxas de sobrevida global: no primeiro ano, 77% para o Grupo I e 84% para o Grupo II; no terceiro ano, 59% e 74% e, no quinto ano, 52% e 58% para os grupos I e II, respectivamente, sem diferença estatística significativa. Quando analisados separadamente, os três subgrupos: tumores PT3/T4, acometimento linfonodal e presença de metástases, também não foram observadas diferenças estatísticas significativas nos grupos I e II. No presente estudo, não houve diferença significativa de sobrevida global dos pacientes portadores de tumores vesicais invasivos primários e progressivos, no seguimento de cinco anos. Também não houve diferença significativa na sobrevida global, quando analisados separadamente os subgrupos: PT3/4, com acometimento linfonodal e presença de metástases / Abstract: The best treatment for all-invasive bladder cancer is radical cystectomy. The main purpose of this study was to compare the overall survival rate of primary muscle-invasive urothelialbladder carcinoma (UC) to the progressive muscle-invasive bladder carcinoma. A secondary aim was to compare the survival rate of the subgroups pT3/4, lymph nodes involvement and the presence of metastasis in primary and invasive bladder carcinomas. A retrospective multicentric analysis was performed studying a total of 242 patients who underwent radical cystectomy for invasive TCCB from 1992 to 2005. The patients were divided into two groups. There were 185 patients in Group I with progressive invasive TCCB, while Group II had 57 patients with primary invasive TCCB. Both groups were further divided according to the pathological findings in pT2 (muscle invasion), pT3/4 (perivesical fat and/or adjacent organs/structure invasion), N+ (positive lymphaticnodes) and M+ (distant organ metastasis). Several tests were employed for the statistical analysis: qui-square, Mann-Whitney, Kaplan-Meier method and Wilcoxon (Breslow). The average and median follow-ups were, respectively, 98 and 90 months in Group I and 96 and 88 months in Group II, without a significant statistical difference (p = 0.0734). The 1-year survival rate was 77% in Group I and 84% in Group II. After 3 years of follow-up the survival rate fell to 59% in Group I and 74% in Group II. Finally, the 5-year survival rate was 52% in Group I and 58% in Group II, without a significant statistical difference. When the three subgroups were analyzed separately for tumors pT3/T4, invasivelymphatic nodes and the presence of metastasis, no significant statistical differences were found in either Group I or Group II. In the present study, patients with primary invasive and progressive invasive TCCB showed a similar 5-year global survival rate. Pathological stage (PT, N and M) and patient demography did not interfere with the results / Doutorado / Cirurgia / Doutor em Cirurgia

<p>The two purposes of this thesis were to evaluate new diagnostic techniques of lymphnode staging in invasive bladder cancer and to evaluate the results of neoadjuvant chemotherapy in invasive bladder cancer.</p><p>Sentinel node detection was performed in 13 patients in preparation for radical cystectomy. The method showed to be feasible, and the results displayed the occurrence of metastatic nodes outside the traditional area of diagnostic dissection in a majority of patients. Four patients were metastasized, each one with one metastatic node detected with the help of the sentinel node procedure.</p><p>Four randomly selected sentinel nodes from four different unmetastasized patients were compared to the four metastatic sentinel nodes from the first series. After microdissection, p53 genomic structure, immunohistochemical expression and MVD (microvessel density) were assessed in the primary tumors and corresponding sentinel nodes. The results suggested that invasive bladder cancer mainly involved monoclonal proliferation with predominantly homogenous biomarker profile, but there were also signs of clonal evolution.</p><p>The Nordic Cystectomy Trial 2 (NCT2), is a randomized prospective trial investigating the possible benefit of neoadjuvant chemotherapy versus cystectomy only, in 311 eligible patients with urinary bladder cancer T2-T4aNXM0.Evaluation of overall survival did not show any statistically significant benefit in the experimental arm. This probably due to lack of statistical power.</p><p>To increase the statistical power we performed a combined analysis of randomized patients from both the Nordic Cystectomy Trial 1 (NCT1) and NCT2, n = 620. Eligible patients from NCT1 had T1G3, T2-T4a NXM0 urinary bladder cancer. Standard meta-analysis methods were used. The only end-point analysed was overall survival. Neoadjuvant platinum based combination therapy was associated with a 20 % reduction in the relative hazard in probability of death.</p>

The two purposes of this thesis were to evaluate new diagnostic techniques of lymphnode staging in invasive bladder cancer and to evaluate the results of neoadjuvant chemotherapy in invasive bladder cancer. Sentinel node detection was performed in 13 patients in preparation for radical cystectomy. The method showed to be feasible, and the results displayed the occurrence of metastatic nodes outside the traditional area of diagnostic dissection in a majority of patients. Four patients were metastasized, each one with one metastatic node detected with the help of the sentinel node procedure. Four randomly selected sentinel nodes from four different unmetastasized patients were compared to the four metastatic sentinel nodes from the first series. After microdissection, p53 genomic structure, immunohistochemical expression and MVD (microvessel density) were assessed in the primary tumors and corresponding sentinel nodes. The results suggested that invasive bladder cancer mainly involved monoclonal proliferation with predominantly homogenous biomarker profile, but there were also signs of clonal evolution. The Nordic Cystectomy Trial 2 (NCT2), is a randomized prospective trial investigating the possible benefit of neoadjuvant chemotherapy versus cystectomy only, in 311 eligible patients with urinary bladder cancer T2-T4aNXM0.Evaluation of overall survival did not show any statistically significant benefit in the experimental arm. This probably due to lack of statistical power. To increase the statistical power we performed a combined analysis of randomized patients from both the Nordic Cystectomy Trial 1 (NCT1) and NCT2, n = 620. Eligible patients from NCT1 had T1G3, T2-T4a NXM0 urinary bladder cancer. Standard meta-analysis methods were used. The only end-point analysed was overall survival. Neoadjuvant platinum based combination therapy was associated with a 20 % reduction in the relative hazard in probability of death.

Bakgrund: Vid muskelinvasiv urinblåsecancer är cystektomi den vanligaste behandlingen. Cystektomi innebär en stor livsomställning där bland annat individens sexuella liv förändras. På grund av bristande kunskap hos vårdpersonal förblir påverkan på sexuellt välbefinnande ofta obemärkt. Trots att patienter frågar om potentiella förändringar i sitt sexuella liv efter cystektomi, tas dessa konsekvenser sällan upp av vårdpersonal. För att kunna utföra en god omvårdnad behöver sjuksköterskor ha god kunskap om cystektomins inverkan på individers upplevelser av sin sexualitet. Syfte: Syftet med litteraturstudien var att belysa individers upplevelser av sin sexualitet efter cystektomi. Metod: En litteraturstudie baserades på åtta kvalitativa studier. Databassökning utfördes i Cinahl, PubMed och Scopus. Analysen genomfördes med inspiration från guiden för dataanalyser av litteraturöversikter av Popenoe et al. Resultat: Analysen resulterade i nio subkategorier och fyra kategorier. De fyra kategorierna var: “nedsatt sexuell funktion”, “förändrad självbild”, “förändrad intimitet med sin partner”, “bristfälligt stöd och information från vårdpersonal”. Konklusion: Cystektomi kan leda till utmaningar i individens sexualitet vilka innefattar fysiska, emotionella och sociala aspekter. För att minska individens stress och oro kring sitt sexuella liv behövs adekvat information och stöd från en sjuksköterska med god kompetens inom ämnet. Det behövs ytterligare forskning för att få en bättre inblick i hur sjuksköterskor kan förbättra sitt stöd till individer både före och efter cystektomi. / Background: The standard treatment of muscle-invasive bladder cancer is cystectomy. For many, cystectomy represents a significant life change, including changes in their sexual lives. However, due to a lack of knowledge among healthcare professionals, the impact on sexual well-being often goes unnoticed. While patients often ask about potential changes to their sexual life after cystectomy, these concerns are rarely addressed within healthcare settings. To provide effective nursing care, nurses must have a thorough understanding of how cystectomy affects individuals’ experiences of sexuality.  Aim: The aim was to illuminate individuals’ experiences of their sexuality following cystectomy.  Methods: A qualitative literature review was based on eight qualitative studies. Database searches were performed in Cinahl, PubMed and Scopus. The data analysis was conducted with inspiration from the guide for data analysis in literature reviews by Popenoe et al.  Results: The analysis resulted in nine subcategories and four categories: “diminished sexual function”, “changed self-image”, “changed intimacy with their partner” and “insufficient support and information from healthcare providers”.  Conclusion: Cystectomy can lead to challenges in the individual’s sexuality including physical, emotional and social aspects. To reduce the individual’s stress and concerns surrounding their sexual life, adequate information and support from nurses with good competence in this area are crucial. Further research is needed to gain deeper insights into how nurses can enhance their support for individuals both before and after cystectomy.

Objetivo: Identificar os principais fatores prognósticos patológicos do carcinoma urotelial tratado com cistectomia radical e linfadenectomia pélvica, analisar o impacto desses na sobrevida livre de doença (RFS), câncer específico (CSS), geral (OS) e propor um conjunto de fatores que possa prever a evolução. Métodos: Realizamos levantamento dos casos de cistectomia radical e linfadenectomia no período de 2006 a 2009 no Hospital das Clinicas da FMUSP. Correlacionamos fatores prognósticos patológicos estádio (pT), grau tumoral, presença de metástase linfática (pN), invasão linfovascular (LVI), perineural (PNI) e presença de CIS com RFS, CSS e OS. Consideramos significante quando p > 0,05. Resultados: Avaliamos 128 casos que obedeceram aos critérios sendo 20 (15,6%) femininos e 108 (84,4%) masculinos, idades variando de 41 a 84 anos e média de 67 anos. Constatamos associação de recidiva com estádio >pT2 (p=0,032) e pN+ (p=0,003). Os fatores estádio >pT2 (p=0,001), pN+ (p=0,034) LVI+ (p=0,038), e PNI+ (p=0,024) tiveram associação com óbito pela doença e a morte geral com estádio >pT2 (p=0,001), pN+ (p=0,038) e PNI+ (p=0,01). A análise multivariada demonstrou que apenas estádio >pT2 e pN+ são os fatores prognósticos independentes na RFS, CSS e OS. Conclusão: A análise dos fatores patológicos após cistectomia radical e linfadenectomia demonstrou que estádio >pT2 e pN+ são os fatores prognósticos mais importantes no CaB / Objective: To identify the most important pathologic prognostic factors for urothelial bladder cancer treated by cystectomy and pelvic lymphadenectomy, analyze the impact of these on recurrence and mortality and suggest a group of factors that can predict the outcome after surgery. Method: We review all radical cystectomy and lymphadenectomy cases at the Clinical Hospital of São Paulo Medical School from 2006 to 2009. We correlate the following pathologic prognostic factors tumor stage (pT), tumor grade, lymphonodal metastasis (pN), lymphovascular invasion (LVI), perineural invasion (PNI), presence of CIS with RFS, CSS and OS. We considered a significant association p<0.05. Results: We selected 128 cases for this study. There were 20 (15.6%) females and 108 (84.4%) males, ages ranging from 41 years to 84 years and an average 67 years old. The tumor recurrence was associated with stage >pT2 (0,032) and pN+ (p=0.003). Stage >pT2 (p=0.001), pN+ (p=0.034), LVI+ (p=0.038) and PNI+ (p=0.024) was associated with death by cancer and overall death with stage >pT2 (p=0.001), N+ (p=0.038) and PNI (p=0.01). The multivariate analysis found that only stage >pT2 and pN+ were independent prognostic variable for RFS, CSS and OS. Conclusion: The analysis of pathologic prognostic factors after radical cystectomy and pelvic lymphadenectomy show that stage >pT2 and pN+ has strong association with RFS, CSS and OS

Objetivo: Identificar os principais fatores prognósticos patológicos do carcinoma urotelial tratado com cistectomia radical e linfadenectomia pélvica, analisar o impacto desses na sobrevida livre de doença (RFS), câncer específico (CSS), geral (OS) e propor um conjunto de fatores que possa prever a evolução. Métodos: Realizamos levantamento dos casos de cistectomia radical e linfadenectomia no período de 2006 a 2009 no Hospital das Clinicas da FMUSP. Correlacionamos fatores prognósticos patológicos estádio (pT), grau tumoral, presença de metástase linfática (pN), invasão linfovascular (LVI), perineural (PNI) e presença de CIS com RFS, CSS e OS. Consideramos significante quando p > 0,05. Resultados: Avaliamos 128 casos que obedeceram aos critérios sendo 20 (15,6%) femininos e 108 (84,4%) masculinos, idades variando de 41 a 84 anos e média de 67 anos. Constatamos associação de recidiva com estádio >pT2 (p=0,032) e pN+ (p=0,003). Os fatores estádio >pT2 (p=0,001), pN+ (p=0,034) LVI+ (p=0,038), e PNI+ (p=0,024) tiveram associação com óbito pela doença e a morte geral com estádio >pT2 (p=0,001), pN+ (p=0,038) e PNI+ (p=0,01). A análise multivariada demonstrou que apenas estádio >pT2 e pN+ são os fatores prognósticos independentes na RFS, CSS e OS. Conclusão: A análise dos fatores patológicos após cistectomia radical e linfadenectomia demonstrou que estádio >pT2 e pN+ são os fatores prognósticos mais importantes no CaB / Objective: To identify the most important pathologic prognostic factors for urothelial bladder cancer treated by cystectomy and pelvic lymphadenectomy, analyze the impact of these on recurrence and mortality and suggest a group of factors that can predict the outcome after surgery. Method: We review all radical cystectomy and lymphadenectomy cases at the Clinical Hospital of São Paulo Medical School from 2006 to 2009. We correlate the following pathologic prognostic factors tumor stage (pT), tumor grade, lymphonodal metastasis (pN), lymphovascular invasion (LVI), perineural invasion (PNI), presence of CIS with RFS, CSS and OS. We considered a significant association p<0.05. Results: We selected 128 cases for this study. There were 20 (15.6%) females and 108 (84.4%) males, ages ranging from 41 years to 84 years and an average 67 years old. The tumor recurrence was associated with stage >pT2 (0,032) and pN+ (p=0.003). Stage >pT2 (p=0.001), pN+ (p=0.034), LVI+ (p=0.038) and PNI+ (p=0.024) was associated with death by cancer and overall death with stage >pT2 (p=0.001), N+ (p=0.038) and PNI (p=0.01). The multivariate analysis found that only stage >pT2 and pN+ were independent prognostic variable for RFS, CSS and OS. Conclusion: The analysis of pathologic prognostic factors after radical cystectomy and pelvic lymphadenectomy show that stage >pT2 and pN+ has strong association with RFS, CSS and OS