3D laparoscopic radical cystectomy in patients with urinary bladder cancer: a prospective evaluation of safety and efficacy
Bladder cancer is one of the most common urological malignancies. Bladder carcinoma is divided into non-muscle-invasive bladder cancer (NMIBC) and muscle-invasive bladder cancer (MIBC). The usual treatment of NMIBC comprises transurethral resection of the bladder tumour with or without adjuvant courses of intravesical immunotherapy or chemotherapy. MIBC is usually treated with radical cystectomy, pelvic lymph node (LN) dissection and urinary diversion with perioperative chemotherapy for patients who are fit. Although the open approach to radical cystectomy with pelvic LN dissection is still considered to be the gold standard procedure, laparoscopic and robotic approaches are replacing open approach in the majority of high-volume tertiary care centres worldwide.
Bladder cancer in Senegal: what’s new?
Bladder cancer is the tenth most common cancer in the world. Differences in incidence worldwide can be explained in part by differences in exposure to bladder cancer risk factors. The most common histological type in Africa, in the past, was squamous cell carcinoma, while urothelial carcinoma is the predominant histological type in northern countries.
Does percutaneous drainage of malignant obstructive uropathy improve renal function? A retrospective record review.
Advanced or locally advanced malignant conditions of the pelvis and/or abdomen can cause ureteric obstruction and associated impaired renal function. This obstruction can be managed by performing percutaneous nephrostomy (PCN) tube insertion with or without antegrade double J stent insertion. Having PCN tubes in situ is associated with prolonged hospital stay which affects quality of life.
How seriously should we take haematuria?
Asymptomatic ‘dipstick-positive haematuria’ is a common reason for urological referrals with prevalence rates that range from 13% to 20%.6 Given the low pick-up rate for NVH and the attendant economic burden, some authors have tried to risk-stratify patients. Tan et al. have developed and validated a novel haematuria cancer risk calculator. Unsurprisingly, age > 65 years, VH, smoking and male gender were most predictive. They showed that adopting a risk score approach identified significantly more cancers (11.4%), which would have been missed if NICE guidance was applied. They also reduced the number of patients (149 of 3 539) subjected to investigations.
Assessment of the rate of practice of endoscopic urological surgery in three selected healthcare facilities in Douala, Cameroon
Endoscopy is a minimally invasive medical procedure, which permits the visual exploration of an inner (“endon” in Greek) cavity of the human body that is inaccessible with the naked eye. The procedure is performed via natural orifices when possible but, in certain situations, via incisions. Over several years, surgeons have sought to develop techniques to decrease morbidity. An extensive array of minimally invasive procedures now exists in the urologist’s armamentarium for both diagnostic and therapeutic indications. This has promoted the trend of endoscopic surgery in both gastrointestinal and non-gastrointestinal operations. There has been significant progress in the development of the field of endourology over the last two decades.
Circumcision practice among trained circumcisers in Ghana
Male circumcision is the surgical removal of all or part of the foreskin of the penis and is performed for cultural, religious, social or medical reasons. An estimated one in three males worldwide are circumcised, with almost universal coverage in some places and very low prevalence in others. Approximately 90% of infant males are circumcised in West Africa and 95% in Ghana. Circumcision in Ghana is performed by formal health service providers such as nurses, midwives and doctors in health facilities and also by informal providers such as traditional circumcisers.
Selective and super-selective angioembolisation for intractable haematuria of prostatic origin
Significant haematuria of prostatic origin can occur because of a number of causes such as benign prostatic hyperplasia, carcinoma of the prostate (primary or after radiation) and following transurethral resection of the prostate. Often, the bleeding can be managed by passing a wide bore 3-ways Foley catheter with balloon inflated and traction applied at the bladder neck or prostatic fossa and continuous bladder irrigation. If this fails, cystoscopy and evacuation of bladder clot and electro-fulguration of the bleeding points is employed. If bleeding continues despite these measures, a life-threatening situation may arise and will require open surgical exploration to pack the prostatic fossa and peri-prostatic space. In patients with pre-existing comorbidities and risk factors, these repeated surgical procedures may carry a higher rate of morbidity and mortality. Selective or super-selective angioembolisation of the bleeding vessels is minimally invasive and has been employed in such cases with good short and long-term control of the haematuria. We present our own institutional experience with the procedure in 10 patients.
The dawn of minimal invasive surgical therapies for benign prostate hyperplasia in South Africa: water vapour energy ablation with Rezum
The challenges in managing the ever-increasing burden of patients with benign prostatic hyperplasia (BPH) in South Africa are as diverse as everything else in this beautiful country. The longstanding three-tier approach of watchful waiting, medical therapies and surgical management is well ingrained into our collective BPH management plan. Transurethral resection of the prostate (TURP) and retropubic simple prostatectomy for larger prostates has been the gold standard treatment for the better part of the past century. With the advent of different laser technologies and techniques, came better safety profiles for patients. In the South African private sector, a variety of medical therapies have alleviated some of the surgical burden, but many patients’ dissatisfaction with both medical therapy as well as current available surgical options provides a challenge that, in many instances, leads to equal frustration on the side of the patient and urologist. The sexual side effects (erectile, libido and ejaculatory) and the burden of taking lifelong medication discourages some patients from commencing or persevering with medical management. Recent studies have additionally identified potential psychiatric side effects, e.g. depression and anxiety, associated with finasteride usage in younger patients. Similar sexual side effects, together with the need for anaesthesia, in-hospital stay and potential complications such as urinary incontinence, make current surgical options, for other patients, a bridge too far.
A renal mas(s)querader
Initial ultrasonographic imaging and an elevated beta-human chorionic gonadotropin (B-hCG) of 1 744 IU/L suggested ovarian cancer and a staging laparotomy (there was no preoperative cross-sectional imaging done) revealed two normal ovaries and a uterus with a large retroperitoneal mass. A postoperative computed tomography (CT) scan demonstrated a large cystic-solid right renal mass with complete distortion of normal renal anatomy (Figure 1) and a normal left kidney, which prompted referral to our department. Clinically, she had a firm mass extending from the right upper quadrant to the pelvis, which crossed the midline. Her urine dipstix was normal and microscopy, culture and sensitivity revealed no leukocytes or erythrocytes with a mixed growth. Urine cytology was negative for high-grade urothelial carcinoma. She had a normal serum creatinine and HIV and hydatid serology were negative. She had a normal Papanicolau smear.
Small cell neuroendocrine tumour of the bladder: a case report
The staging computed tomography (CT) scan showed posterolateral bladder wall thickening, with no signs of distant metastasis. A repeat cystoscopy was performed after six weeks which found residual bladder tumour and a resection was performed. The repeat histology reported an invasive neuroendocrine carcinoma with small cell morphology and no deep muscle involvement. The tumour stained positive for CK7, chromogranin, TTF1 and negative for CK20, which is in keeping with a small cell neuroendocrine carcinoma.
Voiding lower urinary tract symptoms in a young female due to a large cecoureterocele – a rare presentation
Ureterocele refers to the cystic dilation of the distal lower ureter that is located within the bladder or spans the bladder and the urethra. Cecoureteroceles have the orifice of the affected ureter in the bladder but the cavity of the ureterocele extends submucosally beyond the bladder neck into the urethra. Due to the rarity of this condition, there is sparse data in the literature regarding its management. In this article we present the case of a 22-year-old female with voiding lower urinary tract symptoms (LUTS) due to a large cecoureterocele, and we discuss its management options.