Readmission Due to Infection After Bladder Surgery Linked to Smoking

Current smoking is independently associated with a greater than 2-fold increased odds of hospital readmission after radical cystectomy.

Infectious complications account for almost half of the readmissions following radical cystectomy (RC), and the risk for these complications is linked to current smoking, according to a new study.

Source: Readmission Due to Infection After Bladder Surgery Linked to Smoking

This study pertains to patients undergoing a radical cystectomy for bladder cancer.  It looked at data from their institution that is collected for quality purposes.  We have seen similar trends in infections related to smoking at our facility.  We have also seen poor diabetic control as a large factor in preventing postoperative complications including infections.

Patients and their physicians should keep this in mind if they are to have a surgical procedure.  If smokers can quit prior to their procedure it will help them have a safer recovery and patients should try to have the best control of their sugars if they have diabetes.

Bladder Cancer & Treatment

The bladder is an organ that stores urine before it is eliminated.

Bladder cancer can occur in men and women. The most common sign of bladder cancer is blood in the urine. This can be blood that is seen (macroscopic) or only seen under the microscope (microscopic).

2021 U.S. Bladder Cancer Statistics

Estimated New Cases (83,730)
Estimated Deaths (17,200)

Source: National Cancer Institute (NCI)

The Stages of Bladder Cancer

The Stages of Bladder Cancer

Treatment Options

The treatment of bladder cancer varies based on the stage and grade. Most low grade and noninvasive bladder cancers can be managed without major surgery.

Most invasive bladder cancers need more aggressive therapy including surgery or radiation and chemotherapy.

Learn More:

Information on robotic bladder surgery

Is the Complication Rate of Radical Cystectomy Predictive of the Complication Rate of Other Urological Procedures?

Source: UroToday

A higher hospital radical cystectomy volume appears to lead to a lower risk of complications only after other common urological oncological procedures, namely radical prostatectomy and nephrectomy, but not after nononcological urology procedures.

This abstract found that hospitals that performed radical cystectomy (removal of the bladder and surrounding tissue for bladder cancer) had less complcations for kidney and prostate cancer surgery as well.

I have been perfoming radical cystecomies my whole career and started perfoming these robotically 3 1/2 years ago. Although I thought performing the more complex surgery helpe me in other surgeries, I didnt realize that a study would show less complications for these other procedures.

Best of AUA Orlando 2008 for Prostate Cancer

Source: Urology Times
Robotic Surgery
Presented by Ashutosh K. Tewari, MD,
Weill-Cornell Medical College, New York.

* Robot-assisted laparoscopic partial nephrectomy is associated with shorter hospital stay and less bleeding, but the warm ischemia time is still around 30 minutes.

* Studies comparing robot-assisted laparoscopic cystectomy and open radical cystectomy show similar oncologic outcomes. At a high-volume tertiary care center, the robotic technique was more cost-efficient, but that finding needs to be confirmed at other centers. Other remaining issues regarding the robotic procedure include the need to define how the reconstruction should be performed, the extent of the lymphadenectomy, and ensuring clear margins at lateral areas.

* A study of almost 4,000 patients reaffirms the safety of robotic-assisted laparoscopic prostatectomy (RALP). Rates of major surgical, major medical, and minor medical complications were all ≤0.7%, and the rate of minor surgical complications was 3.3%.

* Studies comparing open and RALP show the surgeon is the most important variable in determining outcome.

* Extended lymph node dissection should be performed in high-risk prostate cancer patients, and can be done with RALP.

* A total reconstruction procedure including anterior and posterior restoration of the vesicourethral junction is associated with early return to continence and improvement in overall continence rates.

Some of the highlights from the AUA
Of interest is the growing application of robotic surgery for smaller kidney cancers (partial nephrectomy) and bladder cancer, which I have been performing since 2005 myself.

The other very important adaption is the posterior and anterior reconstruction of the urinary tract during robotic prostatectomy, which I have performing for over a year after attending Dr Tewari’s conference.

Is Robotic Radical Cystectomy an Appropriate Treatment for Bladder Cancer? Short-Term Oncologic and Clinical Follow-Up in 50 Consecutive Patients

Source: UroToday

Robotic cystectomy was performed in 40 men and 10 women at a mean age of 63.6 years. Of the 50 patients, 66% had Stage pT2 or less, 14% had pT3 disease, and 20% Stage N+ disease. No patient had positive surgical margins.

This abstract is from one of the leading centers for robotic cystectomy. They show relatively low morbidity for a major surgery. I have done about 20 cystectomies robotically and have switched almost all of my major bladder cancer surgery to this approach. I think I am performing the same oncological operation as open, but have seen less blood less and quicker recoveries.

Colorectal and Urological Cancers May be Markers for Each Other – in Hematology/Oncology, Colon Cancer

MedPage Today

Dr. Rubin and colleagues calculated standard incidence ratios (SIRs) of observed to expected cases of invasive colorectal cancer for each urologic cancer site and vice versa.
The analysis showed:
* Patients with previous ureteral cancer had an 80% increase in the risk of subsequent colorectal cancer, with an incidence ratio of 1.80 and a 95% confidence interval from 1.46 to 2.20.
* Those with renal pelvis cancer had a 44% increase in the risk of colorectal disease, with an incidence ratio of 1.44 and a 95% confidence interval from 1.20 to 1.72.
* Patients with bladder or renal parenchymal cancer had small but statistically significant increases in the risk of subsequent colorectal cancer, but the researchers concluded the increases were probably not clinically significant.
* The risk for any urologic cancer was increased after a diagnosis of colorectal cancer, with an incidence ratio of 1.24 and a 95% confidence interval from 1.20 to 1.28.

This study showed an increase risk of colon cancer after urinary tract cancers.

Clinical Outcomes after Sexuality Preserving Cystectomy and Neobladder (Prostate Sparing Cystectomy) in 44 Patients

From Urotoday

Functional results with regard to erectile function and urinary continence after prostate sparing cystectomy are good. Oncological results have been promising, but need to be confirmed after longer followup and in larger trials.

For men in need of a bladder removal for bladder cancer, my practice has always consisted of removing the entire prostate as well. This is what I learned at Indiana and have continued to do in NJ. As far as I know, urologic oncologists in the USA all agree on this.

In Europe I have read several studies that have left the prostate capsule or most of the prostate in place. I think you will see a higher rate of pelvic recurrences and bladder cancer recurrence in the prostate, as well as new prostate cancers this way. I do agree that men will have less side effects in regards to erections and continence potentially.
I have been performing robotic cystectomies for about 3 years now and feel that I can perform a more careful operation around the erection nerves and urinary muscles. I hope to improve on our past results while still removing the entire prostate with the bladder.

Robotic radical cystectectomy for bladder cancer

UroToday – Robotic vs Open Radical Cystectomy: Prospective Comparison of Perioperative Outcomes and Pathological Measures of Early Oncological Efficacy – Abstract

Robotic-assisted RC appears to offer some operative and perioperative benefits compared with the open approach without compromising pathological measures of early oncological efficacy, such as lymph node yield and margin status. Larger, randomized studies with long-term follow-up are required to confirm these findings and establish oncological equivalence

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The biggest operation on the oldest patient

Note: Our patient has given permission to use his story and name in our article and we are preparing a press release to give more details of this incredible story.
At 94 years old, the diagnosis of invasive bladder cancer is devastating. The treatment of choice for invasive bladder cancer is a radical cystoprostatectomy- the surgical removal of the bladder and prostate.
At 94 most urologists would tell the patient they are too old for surgery, but with Dr. Lefkon’s help I had performed this operation in a 90 year old woman and 94 year old man before and with Dr. Katz’s help had performed the operation in a 92 year old woman and a 96 year old woman.

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