• MeSH
• anastomóza chirurgická škodlivé účinky   metody   MeSH
• lidé MeSH
• močový měchýř chirurgie   MeSH
• striktura uretry * chirurgie   MeSH
• uretra * chirurgie   MeSH
• urologické chirurgické výkony u mužů metody   MeSH
• ústní sliznice * transplantace   MeSH
• zákroky plastické chirurgie metody   MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• komentáře MeSH

OBJECTIVE: To present long-term experience with buccal mucosa posterior urethroplasty (BMPU) for refractory posterior urethral stenosis (PUS) or vesicourethral anastomosis stenosis (VUAS) either by perineal approach (PA) or by endourethroplasty (EUP). MATERIALS AND METHODS: A single-center retrospective study of 38 consecutive patients operated on between 1999 and 2022. BMPU consisted of the transfer of onlay or tubular buccal mucosa grafts into dilated and/or incised strictures through an open or endourological approach. If VUAS or PUS recurred with short stenosis within the first 12 months after surgery, it was transected by a cold-knife direct vision internal urethrotomy (DVIU), referred to as an "auxiliary" DVIU. The primary outcome was 3-year stricture recurrence-free survival (SRFS). RESULTS: BMPU by perineal approach and EUP were performed in 27 (71%) and 11 (29%) patients, respectively. The 3-year SRFS was 65% for the whole cohort, with rates of 63% for the perineal approach and 73% for endourological approach. With permitted auxiliary DVIU, 3-year SRFS for the whole cohort was 81%. De novo incontinence occurred in 2 out of 18 preoperatively continent patients. Limitations include the retrospective nature of the single-center study and a small, heterogenous cohort of patients. CONCLUSION: We present 2 techniques of substitution urethroplasty with BMG in the management of PUS and VUAS with a low rate of recurrence or de novo incontinence. A novel endourological approach (EUP) is a promising minimally invasive alternative to the perineal approach.

• MeSH
• anastomóza chirurgická * metody   škodlivé účinky   MeSH
• časové faktory MeSH
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladiství MeSH
• mladý dospělý MeSH
• močový měchýř chirurgie   MeSH
• perineum chirurgie   MeSH
• retrospektivní studie MeSH
• senioři MeSH
• striktura uretry * chirurgie   MeSH
• uretra * chirurgie   MeSH
• urologické chirurgické výkony u mužů * metody   škodlivé účinky   MeSH
• ústní sliznice * transplantace   MeSH
• výsledek terapie MeSH
• zákroky plastické chirurgie metody   škodlivé účinky   MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladiství MeSH
• mladý dospělý MeSH
• mužské pohlaví MeSH
• senioři MeSH
• Publikační typ
• časopisecké články MeSH

Neoadjuvant chemotherapy (NAC) with radical cystectomy (RC) is the recommended treatment for muscle invasive bladder tumors (MIBC). However, more than half of patients are unable to undergo NAC due to contraindications. The aim of the study is to evaluate the long­‐term oncological results from one tertiary center and thus demonstrate the effectiveness of neoadjuvant chemotherapy in muscle­‐invasive bladder tumors. Methods: In the years 2010-2021, 100 patients with MIBC underwent neoadjuvant (for cN0) / induction (for cN+) chemotherapy - most often as a combination of cisplatin and gemcitabine. Patients with cT3-4 or cN+ were indicated for NAC; in the subgroup of cT2N0, the patients were selected according to risk factors. Out of a of 100 patients, 49 were without lymphadenopathy (cN0) and 51 with enlarged nodes (cN1-3). Progression occurred in 8 patients during NAC (2× in cN0, 6× in cN+), two patients refused surgical treatment after NAC. Subsequent radical cystectomy was performed in 47/49 cN0 and 43/51 cN1-3 patients. The study evaluated the intention­‐to­‐treat population, even the patients who did not undergo surgical treatment were included. We assessed five­‐year cancer­‐specific survival (CSS) using Kaplan­‐Meier curves and compared survival within subgroups using the log­‐rank test. Response to chemotherapy was defined as complete (pCR - ypT0N0), partial (pPR ≤ ypT1N0) or no response (non­‐R; ≥ypT2N0-3). The influence of clinical and histopathological parameters on progression­‐free survival (PFS) was evaluated using the Cox regression model. Median follow­‐up was 43 months (IQR 16-87). Results: The average age of the patients was 64 years, men and women comprised 76% and 24% of the cohort, respectively. The extent of the primary tumor was cT2 in 39 and cT3-4 in 61 cases. The median number of lymph nodes removed during procedure was 24 (IQR 19;29). Five­‐year CSS reached 84% in cT2-4N0 and 52% in cT2-4N1-3. Five­‐year CSS was not different for cN1 versus cN2-3 (53% and 50%, respectively). We recorded a response to chemotherapy (cCR+pCR) in 34/49 (69%) patients with cN0 and in 24/51 (47%) cN1-3. Achieving response to chemotherapy improved 5-year CSS in both subgroups, in cN0 patients 93% versus 60% (p=0.001), in cN1-3 85% versus 27% (p<0.001). In the entire group, the 30-day and 90-day mortality reached 0% and 3%, respectively. In multivariate analysis, significant predictors of progression­‐free survival were initial nodal involvement (HR 2.92; p=0.007) and failure to respond to NAC (HR 6.56; p≤0.001) Conclusion: In patients with invasive bladder cancer who are treated with neoadjuvant chemotherapy followed by radical cystectomy, excellent oncological results can be achieved in clinically localized disease. Even in the case of clinical lymphadenopathy, up to half of patients survive five years. Achieving a response to chemotherapy and the absence of lymphadenopathy at the time of diagnosis reduce the risk of recurrence.

• MeSH
• cystektomie MeSH
• lidé středního věku MeSH
• lidé MeSH
• lymfadenopatie MeSH
• nádory močového měchýře * terapie   MeSH
• neoadjuvantní terapie * MeSH
• přežití bez známek nemoci MeSH
• protokoly protinádorové léčby MeSH
• retrospektivní studie MeSH
• senioři MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• práce podpořená grantem MeSH

• MeSH
• diverze moči klasifikace   metody   MeSH
• lidé MeSH
• nádory močového měchýře neinvadující svalovinu terapie   MeSH
• nádory močového měchýře epidemiologie   klasifikace   terapie   MeSH
• pooperační komplikace klasifikace   patologie   terapie   MeSH
• prognóza MeSH
• recidiva MeSH
• riziko MeSH
• rizikové faktory MeSH
• sekundární prevence * MeSH
• terapie klasifikace   škodlivé účinky   MeSH
• urologické chirurgické výkony škodlivé účinky   MeSH
• urologické nádory * epidemiologie   klasifikace   terapie   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• přehledy MeSH

AIMS: Isolated retroperitoneal recurrence (IRR) in renal cancer patients after radical nephrectomy (RN) is a rare event and poses a therapeutic dilemma. We evaluated oncologic outcomes in surgically treated patients with IRR and established prognostic factors associated with survival. The benefit of metastasis-directed therapy (MDT) in those with clinical progression after extirpation of IRR was assessed. METHODS: This was a retrospective single-institutional study in which 60 renal cancer patients after previous RN underwent surgery for suspicion of IRR within the period of 2004-2019; in 55 of them, RCC recurrence was histologically confirmed. No patient had distant metastatic disease at the time of IRR diagnosis. In cases of clinical progression after IRR surgery, MDT (metastasectomy, stereotactic radiotherapy) was selectively used. Kaplan-Meier curves were used to estimate survival outcomes. Univariable and multivariable Cox proportional hazards regression analyses were used to evaluate associations between clinicopathological parameters and cancer-specific survival. RESULTS: Median age at IRR diagnosis was 64 years (range 23-81). IRR was diagnosed at a median of 42 months (IQR 19-99) after RN. Surgical complications of grade 3-5 after IRR extirpation were rare (7%). Median follow-up time was 50 months (IQR 19-80). Five-year recurrence-free survival and cancer-specific survival rates were 32% and 66%, respectively. Radiographic progression was observed in 34 (62%) patients at a median of 11 months after IRR surgery, out of which 22 patients (40%) underwent MDT. When compared with 12 patients without MDT, the MDT patients had a prolonged median time to systemic treatment of 58 (vs. 16 months), and median cancer-specific survival of 88 (vs. 46 months). Upon multivariable analysis, the interval from nephrectomy ≤12 months (HR 7.77), tumour grade 3-4 (HR 13.24) and female sex (HR 7.42) were determined to be independent prognostic factors of cancer-related mortality. CONCLUSION: Aggressive surgical therapy of IRR is feasible with relatively low morbidity. More than half of the patients experience long-term survival. The interval from nephrectomy to IRR less than 12 months, tumour grade 3-4 and female sex were negative prognostic predictors. In the case of progression, metastasis-directed therapy may prolong the interval to initiation of systemic treatment.

• MeSH
• dospělí MeSH
• karcinom z renálních buněk * patologie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• lokální recidiva nádoru patologie   chirurgie   MeSH
• mladý dospělý MeSH
• nádory ledvin * patologie   MeSH
• nefrektomie MeSH
• retroperitoneální nádory * sekundární   MeSH
• retrospektivní studie MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladý dospělý MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH

• MeSH
• lidé MeSH
• močový měchýř chirurgie   patologie   MeSH
• nádory močového měchýře * dějiny   terapie   MeSH
• urologické chirurgické výkony MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• úvodníky MeSH

• Publikační typ
• abstrakt z konference MeSH

• Publikační typ
• abstrakt z konference MeSH

V případě nutnosti konverze močové derivace na ileální konduit lze s výhodou využít materiál ilea z původní derivace a jeho retubularizací získat požadovanou délku konduitu. Je možné se tak vyhnout další resekci střeva a není nutná nová střevní anastomóza ani reimplantace močovodů.

If it is necessary to convert a urinary diversion to an ileal conduit, it is advantageous to use the material of the ileum from the original diversion and retubularize it to obtain the desired length of the conduit. Further resection of the intestine can be avoided and no new intestinal anastomosis or ureter reimplantation is required.

• Klíčová slova
• ileální konduit, augmentace,
• MeSH
• diverze moči * metody   MeSH
• dospělí MeSH
• kontinentní náhrady močového měchýře MeSH
• lidé středního věku MeSH
• lidé MeSH
• výsledek terapie MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• kazuistiky MeSH

Prezentujeme kazuistiku objemného recidivujícího angiomyolipomu podkovovité ledviny u mladé pacientky s podezřením na syndrom tuberózní sklerózy. Stav byl řešen opakovanou cytoredukční operací v kombinaci se systémovou léčbou mTOR inhibitory.

We present a case report of gigantic recurrent angiomyolipoma of the horseshoe kidney in a young patient with suspected tuberous sclerosis syndrome. The condition was solved by repeated cytoreductive surgery in combination of systemic treatment with mTOR inhibitors.

• MeSH
• angiomyolipom * diagnóza   terapie   MeSH
• dospělí MeSH
• fúze ledvin * chirurgie   diagnóza   MeSH
• lidé MeSH
• mTOR inhibitory MeSH
• nádory ledvin diagnóza   terapie   MeSH
• nefrektomie metody   MeSH
• tuberózní skleróza MeSH
• výsledek terapie MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• ženské pohlaví MeSH
• Publikační typ
• kazuistiky MeSH