SIU 2017: Upper Tract Urothelial Carcinoma
Lisbon, Portugal (UroToday.com) Dr. Catto gave an excellent talk on the etiological factor for upper tract urothelial carcinoma (UTUC). This is a pan urothelial disease, which can be multifocal and consists of 1-5% of all urothelial carcinomas. It is more common in the ureter than the renal pelvis, and smoking is the most common etiological factor. It has been shown that smoking increases risk of bladder cancer by an odds ratio (OR) of 3.22 (2.29-4.52), ureter by OR of 6.2 (2.04-18.81), and renal pelvis by OR of 5.91 (1.47-23.66).
SIU 2017: New Diagnostic Techniques in Cystoscopy
Lisbon, Portugal (UroToday.com) Dr. Paniero presented a detailed description of various diagnostic techniques in cystoscopy. He began by stating that the TURBT procedure is limited due to residual tumor that can be left, and a significant problem of under-staging in this procedure. Therefore, there is a genuine need to improve endoscopic technology in order to improve TURBT outcomes.
SIU 2017: Is It Always Necessary to Perform Restaging TUR for cT1 Urothelial Carcinoma of the Bladder?
Lisbon, Portugal (UroToday.com) In this State-of-the-Art lecture, Dr. Palou addresses the question of repeat TURBT for staging in patients with initial diagnosis of pT1 Urothelial Bladder Cancer.
The rate of incomplete resection, and therefore understaging, has always been cited as the primary reason to pursue a re-resection. Meta-analyses have identified residual disease on re-resection at rates up to 61%, though even at its best, at least 25%. The understaging resulting in missed pT2 disease is the most worrisome component, and meta-analyses have demonstrated understaging rates of approximately 15%.
SIU 2017: The Role of Lymphadenectomy in the Oligometastatic and Salvage Prostate Cancer Setting
Lisbon, Portgual (UroToday.com) In this State-of-the-Art lecture, Dr. Heidenreich provided an insightful presentation into the role of lymphadenectomy in the oligometastatic and salvage prostate cancer setting, as it evolves over time.
The Optimal Treatment of Muscle Invasive Urothelial Bladder Cancer with Neoadjuvant Chemotherapy with Cystectomy
Lisbon, Portugal (UroToday.com) Dr. Brausi moderated this SIU-SUO/ESOU debate between Dr. Black and Dr. Khochikar on the topic of neoadjuvant chemotherapy (NAC) in an elderly patient with muscle invasive bladder cancer (MIBC). This was an excellent debate with important points by both debaters – there may not be a right answer, but it was educational nonetheless. Below are the highlights and main points of the discussion.
SIU 2017: Controversies in Urology--Bladder Cancer: Old is Gold!
Lisbon, Portugal (UroToday.com) Dr. Risk presented his support for the old traditional white light cystoscopy. Dr. Risk began with stating that there is a need for randomized controlled trials (RCT) to demonstrate a true advantage and improvement in outcomes with the usage of fluorescent cystoscopy (FC), compared to white cystoscopy. So far, the level of evidence for this has been low, with heterogeneity and inconsistency very common. There has also been proof for performance bias, detection bias, and publication bias.
SIU 2017: Open vs. Robot assisted Radical Cystectomy: Robot is useless
Lisbon, Portugal (UroToday.com) Dr. Rawal began his presentation by stating that there is sufficient data on oncological adequacy of Robotic assisted Radical Cystectomy (RARC) both in randomized and non- randomized trials. Although RARC has been in use for quite some time (since 2003), no meta-analysis has been able to show the superiority of RARC over open radical cystectomy (ORC) in terms of clinical outcomes such as complications and health related quality of life. One of the reasons for this is the fact that this is a very technically difficult procedure. RARC has a learning curve of at least 30 cases for experienced pelvic robotic surgeons. Complete intra-corporeal urinary diversion has an even longer learning curve, necessitating up to 45 cases for experienced robotic surgeons.