AUA 2018: Bipolar Transurethral Resection of Bladder Tumor Provides Better Tissue for Histopathology but Has No Superior Efficacy and Safety
San Francisco, CA (UroToday.com) Bipolar TURBT technology has become increasingly used, particularly for longer procedures, in the hopes of reducing TUR syndrome – long procedures using hypotonic fluids (such as glycine or water) for monopolar TUR procedures (TURP or TURBT) puts the patient at risk of developing severe hyponatremia. Bipolar technology, which utilizes saline instead, helps reduce that risk and enables longer procedures. While very useful for TURP procedures, its utility in relatively shorter TURBT procedures has been of clinical interest.
AUA 2018: Early Opioid Use in ERAS Pathway in Radical Cystectomy Correlates with Increased Length of Stay and Cost
San Francisco, CA (UroToday.com) ERAS (Early recovery after surgery) pathways have been helping to drastically change historical post-operative recovery norms. With a better understanding of pre-operative, intra-operative and post-operative factors that affect recovery times, we can make modifications to help patients recover sooner.
AUA 2018: Frequency of Low Grade T1 Bladder Cancer Has Decreased but Continues to Vary by Institution
San Francisco, CA (UroToday.com) Non-muscle invasive bladder cancer (NMIBC) encompasses approximately 70% of new bladder cancer diagnoses. The 2004 WHO classification system classifies tumors into low and high grade disease on the basis of microscopic characteristics. In contrast, the TNM staging classifies NMIBC by depth of invasion. In general, these two correlate to some degree in that most low grade (LG) disease is Ta (involving urothelium but not into lamina propria) disease and HG disease can be either Ta or T1 (into lamina propria). LG T1 disease is very uncommon, and to many urologists, is a flag for requiring pathology re-review. True LG T1 disease is quite uncommon and a management conundrum.
AUA 2018: FDG-Positron Emission Tomography for Assessing the Response to Neo-Adjuvant Chemotherapy in Bladder Cancer Patients
San Francisco, CA (UroToday.com) Neoadjuvant chemotherapy (NAC) is a standard of care for muscle-invasive bladder cancer (MIBC), though the overall survival benefit is modest. Though it is not without its adverse effects, it is still recommended for all eligible patients prior to radical cystectomy. Yet, many medical oncologists will consider imaging during NAC or at the end of NAC to assess chemotherapy response and re-stage patients. Unfortunately, there is no consensus on the utilization or modality of this repeat imaging – and the interpretation of the anatomic information provided by CT scan or MRI is challenging post NAC because any hemorrhagic inflammation and necrosis can mimic a residual tumor.
AUA 2018: Risk of Bone Fractures Following Urinary Intestinal Diversion: A Population-Based Study
San Francisco, CA (UroToday.com) Urinary diversion is an integral part of the management of muscle-invasive bladder cancer; often, the removal of the bladder is the less involved portion of the case. Urinary diversion comes in many forms, and while different segments of bowel can be used, ileum is used most often as it has been shown to have the least consequences from a post-operative metabolic standpoint. Even in patients with an incontinent ileal conduit, metabolic complications still occur – most often, metabolic acidosis. These metabolic changes can have theoretical implications for patient care, independent of cancer outcomes. One such theoretical risk is that of bone fractures due to calcium resorption, yet this has never been demonstrated – indeed, bone fractures may also occur due to disease progression instead.
AUA 2018: Clinicopathological and Survival Analysis of Stage III/IV Papillary and Chromophobe Renal Cell Carcinoma: Implications for Future Clinical Trials
San Francisco, CA (UroToday.com) While clear cell histology remains the predominant histologic subtype of renal cell carcinoma, there remains a clinically significant proportion of patients who have papillary (type 1 and 2) and chromophobe histology. These histologic subtypes can have drastically different local and distance oncologic outcomes and, unfortunately, are rarely considered in clinical trials. Management is often inferred from trials treating clear cell histology predominantly.
AUA 2018: Comparison of Robotic and Open Techniques in Patients Undergoing Radical Nephrectomy and Level II/III Inferior Vena Cava Thrombectomy
San Francisco, CA (UroToday.com) The boundaries of robotic surgery continue to be advanced. Recent reports have begun to explore the role of robotic surgery for the management of patients with renal cell carcinoma and IVC thrombus. Inderbir S. Gill, MD, from USC presented on the USC experience in the open vs. robotic surgery debate at the 2017 Winter meeting of the Society of Urologic Oncology. Similarly, the groups from NYC and Philadelphia report their experience with robotic vs. open surgery for patients with Level II/III tumor thrombus.