Is intraperitoneal bladder perforation during the transurethral resection of the bladder tumors treatable with urethral catheter alone?: Retrospective analysis over 15 years using the Clinical Data Warehouse (CDW) system (Preprint)

2020 ◽  
Author(s):  
Junghoon Lee ◽  
Jungyo Suh ◽  
Chang Wook Jeong ◽  
Cheol Kwak ◽  
Hyeon Hoe Kim ◽  
...  
Keyword(s):  
Data Warehouse ◽  
Transurethral Resection ◽  
Surgical Repair ◽  
Urethral Catheter ◽  
Bladder Tumors ◽  
Invasive Treatment ◽  
Free Survival ◽  
Non Invasive ◽  
Clinical Data Warehouse ◽  
And Control

BACKGROUND Despite the current medical trend of non-invasive treatment, open surgical repair is the gold standard for intraperitoneal perforation during the transurethral resection of the bladder tumors (TURBT). Efforts have been made to attempt non-invasive treatment, but few studies have been reported. Because intraperitoneal perforation rarely occurs, it is difficult to collect a cohort group. In this case, Clinical Data Warehouse (CDW) system is being used for data analysis for diseases management by extracting data of specific conditions from accumulated electronic health record (EHR). OBJECTIVE We investigated the clinical experience of non-invasive treatment including urethral catheter-alone treatment for bladder perforations during TURBT, especially in cases of intraperitoneal perforations (IPP). METHODS Total 4543 TURBT patients were retrospectively analyzed using the CDW system from January 2000 to December 2017. After extracting the patient with the keywords 'perforation', 'perforated', ‘fat’, 'distension', ‘extravasation’ and 'leakage' from the surgical record using CDW, extracted patients record was reviewed. After dividing the type of perforation into the extraperitoneal perforation (EPP) and the IPP, the clinicopathologic characteristics, treatment methods, clinical course, recurrence-free survival (RFS) and progression-free survival (PFS) were analyzed in the IPP patients treated with Foley alone and were compared to EPP and control TURBT groups. RESULTS IPP was observed in 16 cases (35.6%) and EPP in 29 cases (64.4%). In the IPP group, 11 (68.8%) patients were treated with Foley alone, two (12.5%) with additional percutaneous drainage, and three (18.8%) with delayed open surgery. The Foley alone in the IPP group improved without sequelae or therapeutic delay. Only one of two cases of IPP larger than the cystoscopy was accomplished with Foley alone treatment, and the other underwent delayed surgical repair. There were no differences in RFS and PFS in the Foley alone of IPP group compared to the EPP (p=0.45, p=0.69) and control TURBT groups (p=0.90, p=0.51). CONCLUSIONS It was presented that the intraperitoneal bladder perforation during the TURBT showed a low rate. In smaller intraperitoneal perforation than the cystoscopy size, urethral catheter alone treatment did not show any specific complications and the oncological outcomes were not significantly different. So, the urethral catheter alone treatment can be considered carefully when small IPP occurs.

scholarly journals Efficacy of the Treatment of Intraperitoneal Bladder Perforation during Transurethral Resection of Bladder Tumor with the Urethral Catheter Alone: Retrospective Analysis of over 15 Years Using the Clinical Data Warehouse System

2021 ◽  
pp. 1-9
Author(s):  
Junghoon Lee ◽  
Jungyo Suh ◽  
Chang Wook Jeong ◽  
Cheol Kwak ◽  
Hyeon Hoe Kim ◽  
...  
Keyword(s):  
Data Warehouse ◽  
Bladder Tumor ◽  
Matched Control ◽  
Foley Catheter ◽  
Progression Free Survival ◽  
Urethral Catheter ◽  
Recurrence Free Survival ◽  
Pelvic Radiotherapy ◽  
Free Survival ◽  
Clinical Data Warehouse

<b><i>Introduction:</i></b> We investigated the efficacy of a urethral catheter alone for intraperitoneal perforation during transurethral resection of bladder tumor (TURBT). <b><i>Patients and Methods:</i></b> We retrospectively evaluated the medical records of 4,543 patients who underwent TURBT from January 2000 to December 2017 using the Clinical Data Warehouse system. The clinicopathologic characteristics, recurrence-free survival, and progression-free survival were compared between the patient groups with intraperitoneal perforation treated with the Foley catheter alone, extraperitoneal perforation, and matched control TURBT. <b><i>Results:</i></b> Intraperitoneal perforation and extraperitoneal perforation were observed in 16 (35.6%) and 29 (64.4%) patients, respectively. In the intraperitoneal perforation group, 11 (68.8%), 2 (12.5%), and 3 (18.8%) patients were treated with the Foley catheter alone, additional percutaneous drainage, and delayed open surgery, respectively. The use of the Foley catheter alone in patients with intraperitoneal perforation of smaller size than the cystoscope or no pelvic radiotherapy history showed improved efficacy without sequelae or therapeutic delay. One of the 2 patients with the size of the intraperitoneal perforation larger than the cystoscope was successfully treated with the Foley catheter alone, whereas the other patient underwent delayed surgical repair. There was no difference in recurrence-free survival and progression-free survival of the intraperitoneal perforation treated with the Foley catheter alone compared to those of the matched control TURBT (<i>p</i> = 0.909, <i>p</i> = 0.518) and the extraperitoneal perforation (<i>p</i> = 0.458, <i>p</i> = 0.699). <b><i>Conclusions:</i></b> Intraperitoneal perforation rarely occurred during TURBT. In the case of intraperitoneal perforation of size smaller than cystoscopy or without pelvic radiotherapy history, treatment with the Foley alone showed successful improvement and safe oncological results. Therefore, treatment with the urethral catheter alone can be carefully considered when an intraperitoneal perforation smaller than the cystoscope size or without pelvic radiotherapy history occurs.

scholarly journals Real-World Data from a Refractory Triple-Negative Breast Cancer Cohort Selected Using a Clinical Data Warehouse Approach

Cancers ◽  
2021 ◽  
Vol 13 (22) ◽  
pp. 5835
Author(s):  
Hana Kim ◽  
Hyo-Jung Kim ◽  
Hongsik Kim ◽  
Hye-Ryeon Kim ◽  
Hyunji Jo ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Overall Survival ◽  
Data Warehouse ◽  
Adjuvant Treatment ◽  
Triple Negative ◽  
Stage Iv ◽  
Free Survival ◽  
Clinical Data Warehouse ◽  
One Year ◽  
Breast Cancer Registry

Purpose: Triple-negative breast cancer (TNBC) is well known for its aggressive course and poor prognosis. In this study, we sought to investigate clinical, demographic, and pathologic characteristics and treatment outcomes of patients with refractory, metastatic TNBC selected by a clinical data warehouse (CDW) approach. Patients and methods: Data were extracted from the real-time breast cancer registry integrated into the Data Analytics and Research Window for Integrated Knowledge C (DARWIN-C), the CDW of Samsung Medical Center. Between January 1997 and December 2019, a TNBC cohort was searched for in the breast cancer registry, which includes records from more than 40,000 patients. Among them, cases of pathologically confirmed metastatic TNBC (mTNBC) were selected as the cohort group (n = 451). The extracted data from the registry via the CDW platform included clinical, pathological, laboratory, and chemotherapy information. Refractory TNBC was defined as confirmed distant metastasis within one year after adjuvant treatment. Results: This study comprised a total of 451 patients with mTNBC, including 69 patients with de novo mTNBC, 131 patients in the nonrefractory TNBC group with confirmed stage IV disease after one year of adjuvant treatment, and 251 patients with refractory mTNBC, whose disease recurred as stage IV within one year after completing adjuvant treatment. The refractory mTNBC cohort was composed of patients with disease that recurred at stage IV after surgery (refractory mTNBC after surgery) (n = 207) and patients in whom metastasis was confirmed during neoadjuvant chemotherapy (unresectable TNBC due to progression during neoadjuvant chemotherapy) (n = 44). Patients in the refractory mTNBC group were younger than those in the nonrefractory group (median age 46 vs. 51 years; p < 0.001). Considering the pathological findings, the refractory group had a greater proportion of cases with Ki-67 ≥ 3+ than did the nonrefractory group (71% vs. 47%; p = 0.004). During a median 8.4 years of follow-up, the overall survival was 24.8 months in the nonrefractory mTNBC group and 14.3 months in the refractory mTNBC group (p < 0.001), and the median progression-free survival periods were 6.2 months and 4.2 months, respectively (p < 0.001). The median disease-free survival period was 30.1 months in the nonrefractory mTNBC group and only 7.6 months in the refractory mTNBC group. Factors related to metastatic sites affecting overall survival were liver metastasis at diagnosis (p < 0.001) and leptomeningeal involvement (p = 0.001). Conclusions: We revealed that patients with refractory mTNBC had a much poorer prognosis among all mTNBC cases and described the characteristics of this patient group.

Comparison of Endoscopic Versus Percutaneous Approach (Blind) to Control the Obturator Jerk in Patients Undergoing Transurethral Resection of Bladder Tumors Under Spinal Anesthesia

2020 ◽  
Vol 21 (2) ◽  
pp. 120-126
Author(s):  
Alamgir Md ◽  
Karim Km Monwarul ◽  
Nandy SP ◽  
Md Monwar Ul Haque ◽  
Sakhawat Mahmud Khan
Keyword(s):  
Statistical Analysis ◽  
Spinal Anesthesia ◽  
Transurethral Resection ◽  
Bladder Tumor ◽  
Complete Resection ◽  
Satisfaction Level ◽  
Bladder Tumors ◽  
Percutaneous Approach ◽  
Group A ◽  
Group B

Objective: The aim of the study was to compare the endoscopic versus percutaneous approach (blind) to control the obturator jerk in patients undergoing transurethral resection of bladder tumors under spinal anesthesia. Materials and methods: A prospective observational study was performed in Department of Urology, Chittagong Medical College, Chittagong and some Private Hospitals (Ltd.) in Chittagong city during the period from January 2016 to June 2016. Total 100 patients were grouped into two, on alternate basis. Fifty(50) patients in group- A conducted with endoscopic infiltration with 20ml of injection 2% lignocaine at the bladder tumor base and another 50 patients in group-B, conducted with blind percutaneous technique with same drug and volume ( 20ml inj.2% lignocaine) to control obturator jerk. Severity of obturator jerk in both procedure, percentage of complete resection, ONB procedure related time, ONB procedure related complications and surgeon’s satisfaction level were recorded and compared between two approaches. Chi-square analysis was performed to compare the ease of approach and outcome of the two techniques. A value of P<0.05 was considered statistically significant. Results: The mean age of the patients were 59.44+7.681. In group-A, 50 patients were given inj. 2% lignocaine endoscopically at the bladder tumor base to control obturator jerk. Twenty five patients (50%) had no jerk, 20 patients(40%) developed mild jerk and 5 patients (10%) developed moderate jerk and no patients developed severe jerk. Second attempt was taken in moderate jerk patients (5 patients) and succeeded in 3(6%) patients. So, in this group, complete resection of bladder tumor was possible in 96%. In group B, complete resection of bladder tumor was possible in 84%. Statistical analysis was done and result is significant in case of endoscopic procedure to control obturator jerk(p<0.05). ONB Procedure related time was <20 mins. in 32(64%) patients in group-A and 45 (90%) patients in group- B. 20 mins. or more time was required for 18 (36%) patients in group-A and 5 (10%) patients in group-B. Statistical analysis was done and result is significant in percutaneous (blind) technique (p<0.05). ONB procedure related complications in group-A and Group –B were noted. Statistical analysis was done and result is insignificant (p>0.05). Surgeons satisfaction level were recorded on the basis of obturator jerk block and complete resection and which was statistically significant in favour of endoscopy group (p<0.05). Conclusion: It is concluded that endoscopic injection of 2% lignocaine into the bladder tumor base is better in case of jerk elimination and complete resection than blind percutaneous approach. Though, ONB procedure related time was significantly less in percutaneous group. Bangladesh Journal of Urology, Vol. 21, No. 2, July 2018 p.120-126

scholarly journals Variability of serum IgG sialylation and galactosylation degree in women with advanced endometriosis

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Katarzyna Sołkiewicz ◽  
Hubert Krotkiewski ◽  
Marcin Jędryka ◽  
Ewa M. Kratz
Keyword(s):  
Cluster Analysis ◽  
Sialic Acid ◽  
Control Group ◽  
Clinical Tool ◽  
Non Invasive ◽  
Healthy Women ◽  
Serum Igg ◽  
And Cluster Analysis ◽  
Invasive Diagnostics ◽  
And Control

AbstractEndometriosis is an inflammatory disease which diagnostics is difficult and often invasive, therefore non-invasive diagnostics methods and parameters are needed for endometriosis detection. The aim of our study was to analyse the glycosylation of native serum IgG and IgG isolated from sera of women classified as: with endometriosis, without endometriosis but with some benign ginecological disease, and control group of healthy women, in context of its utility for differentiation of advanced endometriosis from the group of healthy women. IgG sialylation and galactosylation/agalactosylation degree was determined using specific lectins: MAA and SNA detecting sialic acid α2,3- and α2,6-linked, respectively, RCA-I and GSL-II specific to terminal Gal and terminal GlcNAc, respectively. The results of ROC and cluster analysis showed that the serum IgG MAA-reactivity, sialylation and agalactosylation factor may be used as supplementary parameters for endometriosis diagnostics and could be taken into account as a useful clinical tool to elucidate women with high risk of endometriosis development. Additionally, we have shown that the analysis of native serum IgG glycosylation, without the prior time-consuming and expensive isolation of the protein, is sufficient to differentiation endometriosis from a group of healthy women.

scholarly journals Carbon Dioxide Laser Vulvovaginal Rejuvenation: A Systematic Review

Cosmetics ◽  
2021 ◽  
Vol 8 (3) ◽  
pp. 56
Author(s):  
Tassahil Messas ◽  
Achraf Messas ◽  
George Kroumpouzos
Keyword(s):  
Carbon Dioxide ◽  
Systematic Review ◽  
Laser Therapy ◽  
Carbon Dioxide Laser ◽  
Invasive Treatment ◽  
Erbium:Yag Laser ◽  
Non Invasive ◽  
Level I ◽  
Carbon Dioxide Co2

Genitourinary syndrome of menopause (GSM) causes significant symptomatic aggravation that affects the quality of life (QoL). Vulvovaginal atrophy (VVA), the hallmark of GSM, is managed with topical non-hormonal therapy, including moisturizers and lubricants, and topical estrogen application. Patients not responding/being unsatisfied with previous local estrogen therapies are candidates for a noninvasive modality. Carbon dioxide (CO2) laser therapy, especially the fractionated type (FrCO2), has drawn considerable attention over the past two decades as a non-invasive treatment for GSM. This systematic review describes the accumulated evidence from 40 FrCO2 laser studies (3466 participants) in GSM/VVA. MEDLINE, Scopus and Cochrane databases were searched through April 2021. We analyze the effects of FrCO2 laser therapy on symptoms, sexual function, and QoL of patients with GSM/VVA. As shown in this review, FrCO2 laser therapy for GSM shows good efficacy and safety. This modality has the potential to advance female sexual wellness. Patient satisfaction was high in the studies included in this systematic review. However, there is a lack of level I evidence, and more randomized sham-controlled trials are required. Furthermore, several clinical questions, such as the number of sessions required that determine cost-effectiveness, should be addressed. Also, whether FrCO2 laser therapy may exert a synergistic effect with systemic and/or local hormonal/non-hormonal treatments, energy-based devices, and other modalities to treat GMS requires further investigation. Lastly, studies are required to compare FrCO2 laser therapy with other energy-based devices such as erbium:YAG laser and radiofrequency.

Comparison of Thulium Laser Resection of Bladder Tumors and Conventional Transurethral Resection of Bladder Tumors for Non-Muscle-Invasive Bladder Cancer

2021 ◽  
pp. 1-6
Author(s):  
Zheng Liu ◽  
Yucong Zhang ◽  
Guoliang Sun ◽  
Wei Ouyang ◽  
Shen Wang ◽  
...  
Keyword(s):  
Bladder Cancer ◽  
Transurethral Resection ◽  
Invasive Bladder Cancer ◽  
Perioperative Outcomes ◽  
Thulium Laser ◽  
Bladder Tumors ◽  
Muscle Invasive Bladder Cancer ◽  
Laser Resection ◽  
Baseline Characteristics ◽  
Muscle Invasive

<b><i>Introduction:</i></b> The thulium laser resection of bladder tumors (TmLRBT) was increasingly used in the treatment of non-muscle-invasive bladder cancer (NMIBC) recently, and here we report the relevant outcomes of our institution to evaluate its efficacy and safety. <b><i>Methods:</i></b> We retrospectively collected the data of NMIBC patients who underwent either TmLRBT or transurethral resection of bladder tumor (TURBT). The baseline characteristics and perioperative outcomes were compared in these 2 groups. <b><i>Results:</i></b> The TmLRBT had a higher rate of detrusor identification than TURBT (97.4 vs. 87.6%, <i>p</i> = 0.001). After screening, 134 patients who underwent TmLRBT and 152 patients who received TURBT were enrolled in the analysis, and their baseline characteristics were similar. During the TURBT, 24 (15.8%) obturator nerve reflexes and 9 (5.9%) bladder perforations occurred, while none happened during the TmLRBT. After surgery, TmLRBT patients had fewer postoperative gross hematuria (38.1 vs. 96.7%, <i>p</i> &#x3c; 0.001) and postoperative irrigation (27.6 vs. 92.7%, <i>p</i> &#x3c; 0.001), and its irrigation duration was significantly shorter (2.3 vs. 3.3 day, <i>p</i> &#x3c; 0.001). During the follow-up, no significant difference in the recurrence rate was detected (<i>p</i> = 0.315). <b><i>Conclusions:</i></b> TmLRBT is a safer technique than conventional TURBT in the treatment of NMIBC, and it could offer better specimens for pathologic assessment while the cancer control was not compromised.

scholarly journals The effect of short-term use of finasteride versus cyproterone acetate on perioperative blood loss with monopolar transurethral resection of prostate

2021 ◽  
Vol 27 (1) ◽  
Author(s):  
Shabieb A. Abdelbaki ◽  
Adel Al-Falah ◽  
Mohamed Alhefnawy ◽  
Ahmed Abozeid ◽  
Abdallah Fathi
Keyword(s):  
Blood Loss ◽  
Transurethral Resection ◽  
Cyproterone Acetate ◽  
Histopathological Examination ◽  
Microvascular Density ◽  
Controlled Study ◽  
Control Group ◽  
Transurethral Resection Of Prostate ◽  
Perioperative Bleeding ◽  
And Control

Abstract Background Perioperative bleeding is the most common complication related to transurethral resection of prostate; the aim of the study was to compare the effect of pre-operative use of finasteride versus cyproterone acetate (CPA) on blood loss with monopolar TURP. Methods This prospective randomized controlled study was conducted on (60) patients with BPH underwent monopolar TURP between July 2019 and July 2020. Patients were distributed into three equal groups; CPA group: 20 patients received cyproterone acetate 50 mg tab BID for two weeks before TURP, finasteride group: 20 patients received single daily dose of finasteride 5 mg for two weeks before TURP, control group: 20 patients received no treatment before TURP, all patients underwent monopolar TURP, and then histopathological examination of the resected tissues was done with assessment of the microvascular density of the prostate. Results Our study showed that there was significant decrease in intraoperative blood loss and operative time in CPA and finasteride groups in comparison with control group (p = 0.0012) (p < 0.0001), respectively, significant decrease in post-operative Hb and HCT value in finasteride and control groups in comparison with CPA group (p < 0.01), significant increase in specimen weight in CPA group compared to other groups (p < 0.01), and there was also significant decrease in microvascular density in CPA group in comparison with other groups (p < 0.01). Conclusion Cyproterone acetate is more effective than finasteride in decreasing perioperative bleeding with TURP by decreasing microvascular density of the prostate.

scholarly journals The impact of completeness of last transurethral resection of bladder tumors on the outcomes of radical cystectomy

2019 ◽  
Vol 37 (12) ◽  
pp. 2707-2714
Author(s):  
Stefania Zamboni ◽  
Marco Moschini ◽  
Andrea Gallina ◽  
Renzo Colombo ◽  
Francesco Montorsi ◽  
...  
Keyword(s):  
Radical Cystectomy ◽  
Transurethral Resection ◽  
Bladder Tumors ◽  
The Impact
Sign in / Sign up

Export Citation Format

Share Document