BACKGROUND AND OBJECTIVE: There has been a recent surge in the development of agents for bacillus Calmette-Guérin-unresponsive (BCG-U) non-muscle-invasive bladder cancer (NMIBC). Critical assessment of these agents and practical recommendations for optimal selection of patients and therapies are urgently needed, especially in the absence of randomized trials on bladder-sparing treatment (BST) options. METHODS: A global committee of bladder cancer experts was assembled to develop recommendations on BST for BCG-U NMIBC. Working groups reviewed the literature and developed draft recommendations, which were then voted on by International Bladder Cancer Group (IBCG) members using a modified Delphi process. During a live meeting in August 2023, voting results and supporting evidence were presented, and recommendations were refined on the basis of meeting discussions. Final recommendations achieved >75% agreement during the meeting, and some were further refined via web conferences and e-mail discussions. KEY FINDINGS AND LIMITATIONS: There is currently no single optimal agent for patients with BCG-U disease who seek to avoid radical cystectomy (RC). BST selection should be personalized, taking into account individual patient characteristics and preferences, tumor attributes, and efficacy/toxicity data for the agents available. For patients with BCG-U carcinoma in situ (CIS), gemcitabine/docetaxel (GEM/DOCE), nadofaragene firadenovec (NFF), and nogapendekin alfa inbakicept-pmln (NAI) + BCG are recommended; because of its systemic toxicity, pembrolizumab should only be offered after other options are exhausted. For patients with BCG-U papillary-only tumors, GEM/DOCE, NFF, NAI + BCG, single-agent chemotherapy, hyperthermic mitomycin C, and pembrolizumab are recommended. Given the modest efficacy of available options, clinical trial participation is encouraged. For unapproved agents with reported data, IBCG recommendations await the final results of pivotal trials. CONCLUSIONS AND CLINICAL IMPLICATIONS: The IBCG consensus recommendations provide practical guidance on BST for BCG-U NMIBC.

• MeSH
• adjuvancia imunologická terapeutické užití   MeSH
• BCG vakcína * terapeutické užití   MeSH
• cystektomie MeSH
• invazivní růst nádoru * MeSH
• léčba šetřící orgány * MeSH
• lidé MeSH
• nádory močového měchýře neinvadující svalovinu MeSH
• nádory močového měchýře * farmakoterapie   patologie   MeSH
• výběr pacientů * MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• přehledy MeSH
• směrnice pro lékařskou praxi MeSH

PURPOSE: Conflicting evidence exists on the complication rates after cystectomy following previous radiation (pRTC) with only a few available series. We aim to assess the complication rate of pRTC for abdominal-pelvic malignancies. METHODS: Patients treated with radical cystectomy following any previous history of RT and with available information on complications for a minimum of 1 year were included. Univariable and multivariable logistic regression models were used to assess the relationship between the variable parameters and the risk of any complication. RESULTS: 682 patients underwent pRTC after a previous RT (80.5% EBRT) for prostate, bladder (BC), gynecological or other cancers in 49.1%, 27.4%, 9.8% and 12.9%, respectively. Overall, 512 (75.1%) had at least one post-surgical complication, classified as Clavien ≥ 3 in 29.6% and Clavien V in 2.9%. At least one surgical complication occurred in 350 (51.3%), including bowel leakage in 6.2% and ureteric stricture in 9.4%. A medical complication was observed in 359 (52.6%) patients, with UTI/pyelonephritis being the most common (19%), followed by renal failure (12%). The majority of patients (86%) received an incontinent urinary diversion. In multivariable analysis adjusted for age, gender and type of RT, patients treated with RT for bladder cancer had a 1.7 times increased relative risk of experiencing any complication after RC compared to those with RT for prostate cancer (p = 0.023). The type of diversion (continent vs non-continent) did not influence the risk of complications. CONCLUSION: pRTC carries a high rate of major complications that dramatically exceeds the rates reported in RT-naïve RCs.

• MeSH
• cystektomie * MeSH
• hodnocení rizik MeSH
• internacionalita MeSH
• lidé středního věku MeSH
• lidé MeSH
• močový měchýř účinky záření   MeSH
• nádory břicha radioterapie   MeSH
• nádory močového měchýře chirurgie   MeSH
• pooperační komplikace epidemiologie   MeSH
• retrospektivní studie MeSH
• senioři MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• multicentrická studie MeSH

Transurethral resection of bladder tumour is the initial, most critical step in the management of bladder cancer; as such, this is a call to arms for the urological community to it the due diligence it deserves regarding technology and training.

• MeSH
• biomedicínské technologie MeSH
• cystektomie metody   MeSH
• lidé MeSH
• nádory močového měchýře chirurgie   MeSH
• uretra MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• úvodníky MeSH

Tento článok bol napísaný v období ekonomického útlmu, ktorý sa odzrkadlil aj vo financovaní zdravotníctva. Cieľom dokumentu je vytýčiť cestu, ktorá by viedla k upevneniu pozície Európskej urologickej spoločnosti (EAU), ako garanta špičkovej zdravotnej starostlivosti v Európe, ktorá by následne mohla slúžiť ako vzor pre ostatný svet. Budúcnosť urológie závisí od zdokonaľovania výučby a školení, ktoré povedú k zlepšovaniu kvality starostlivosti o urologických pacientov s dôrazom na individuálny prístup. Individuálny prístup je v urológii čoraz dôležitejší.

• MeSH
• cystoskopie MeSH
• magnetická rezonanční tomografie MeSH
• nádorové biomarkery MeSH
• nádory močového měchýře diagnóza   epidemiologie   terapie   MeSH
• ultrasonografie MeSH
• Publikační typ
• sborníky MeSH

• Konspekt
• Patologie. Klinická medicína
• NLK Obory
• urologie
• onkologie

• MeSH
• adjuvantní chemoterapie MeSH
• aplikace intravezikální MeSH
• deoxycytidin MeSH
• lokální recidiva nádoru MeSH
• management nemoci MeSH
• nádorové biomarkery MeSH
• nádorové procesy MeSH
• nádory močového měchýře terapie   MeSH
• prognóza MeSH
• Publikační typ
• sborníky MeSH

• Konspekt
• Patologie. Klinická medicína
• NLK Obory
• onkologie
• urologie