AUA 2018: Oophorectomy at Time of Radical Cystectomy: Re-evaluating the Definition of Radical Cystectomy in Women
San Francisco, CA (UroToday.com) The classical teaching of performing a radical cystectomy for female patients is removal of the ovaries, uterus and anterior vaginal wall. This is also supported by the current American Urologic Association guidelines for muscle invasive bladder cancer (MIBC), presumably to mitigate the risk of concurrent or future ovarian cancer . Recent data on oophorectomy has suggested an increased risk of all-cause mortality, cardiovascular disease, and osteoporosis in both premenopausal and postmenopausal women, in addition to the increased risk of cognitive impairment and diminished sexual function in premenopausal women. A recently published survey of Society of Urologic Oncology members found that 75% had performed an ovarian-sparing radical cystectomy, and that 14% were aware that salpingectomy alone reduces the risk of ovarian cancer .
AUA 2018: Radical Cystectomy Provides Improved Survival Outcomes and Decreased Costs Compared with Trimodal Therapy for Patients Diagnosed with Localized Muscle-Invasive Bladder Cancer
San Francisco, CA USA (UroToday.com) Based on the inherent morbidity and legitimate risk of 90-day mortality among patients undergoing radical cystectomy, there has been a recent interest in other “non-invasive”, bladder-sparing modalities for treating muscle invasive bladder cancer (MIBC). Specifically, there have been several studies assessing outcome of trimodal therapy, with generally comparable results to patients undergoing radical cystectomy among institutional and population-level analyses.
AUA 2018: Comprehensive Characterization of Returns to the Operating Room following Radical Cystectomy
San Francisco, CA (UroToday.com) As part of the American College of Surgeons National Surgical Quality Improvement Program, several metrics are measured for improving patient safety and quality of care . One important metric for major abdominal surgery is an “unplanned return to the operating room” within 30 days of the original procedure. Certainly, radical cystectomy fits this criterion and is an inherently morbid procedure, however there is a paucity of data assessing predictors of unplanned returns to the operating room. As such, the group from the Mayo Clinic lead by Dr. Lyon presented their institutional results assessing predictors of return to the operating room following radical cystectomy at the invasive bladder cancer session at the 2018 AUA.
AUA 2018: Impact of Post-Treatment Psychiatric Illness on Survival Outcomes Following Treatment for Patients with Muscle-Invasive Bladder Cancer
San Francisco, CA (UroToday.com) For people with new cancer diagnoses, initial psychological stress can be related to several factors including medical, patient-related, societal, and cultural factors . Over 30 years ago, the Psychological Collaborative Oncology Group found that 53% of adult patients with cancer adjusted normally to the crisis of illness, however the remainder of patients met diagnostic criteria for a psychiatric disorder, most commonly adjustment disorder with depressed and/or anxious mood . More contemporary studies suggest that major depression, delirium, adjustment disorder and anxiety disorders are prevalent in 10-34% of cancer patients.
AUA 2018: Perioperative Blood Transfusion is Not an Independent Predictor of Survival After Radical Cystectomy
San Francisco, CA USA (UroToday.com) Patients with bladder cancer undergoing radical cystectomy are an inherently comorbid population. Additionally, many will suffer from preoperative anemia secondary to several factors including neoadjuvant chemotherapy, disease burden, etc. Prior studies have suggested reducing perioperative transfusion among patients undergoing radical cystectomy secondary to an association of blood transfusion and inferior survival outcomes .
AUA 2018: The Impact of Agent Orange Exposure on Bladder Cancer
San Francisco, CA (UroToday.com) Agent Orange is a mixture of herbicides that were used during the Vietnam War to clear forest coverage that concealed opposition forces. Although early studies suggested that Agent Orange increases the risk of prostate cancer , more contemporary studies suggest that a correlation between Agent Orange exposure and risk of prostate cancer is not as concrete . Less studied, is the potential impact of Agent Orange exposure and increased risk of bladder cancer.
AUA 2018: Tumor Board - Bladder Cancer: Treatment Algorithms for Localized Bladder Cancer
San Francisco, CA USA (UroToday.com) Dr. Eila Skinner hosted a panel of bladder cancer experts to discuss management of both index and complex cases that are often encountered in clinical practice. The discussion highlights our current understanding of optimal treatment algorithms. Each panelists thoughts and views are briefly summarized below for each of the presented cases.