E45 320
Letter to the Editor
Re: J. Alfred Witjes, Thierry Lebret, Eva M. Compe´ rat,
et al. Updated 2016 EAU Guidelines on Muscle-invasive
and Metastatic Bladder Cancer. Eur Urol 2017;71:462–75
We have been following with great interest the evolution
of the European Association of Urology (EAU) guidelines
for the treatment of muscle-invasive carcinoma of the
urinary bladder. Since our department performs more
than 100 cystectomies per year, of which
>
50% involve
orthotopic neobladders, we find the indications and
contraindications for orthotopic urinary diversion of
particular interest. The 2015 EAU guidelines made an
important step forwards. They point to the fact that an
orthotopic neobladder could be considered in patients
with N1 involvement but not in those with N2 or N3
involvement.
The recently published 2016 guidelines (Section 10.4
Diversion) state that an orthotopic neobladder can also be
considered in patients with positive lymph nodes
[1]. Obvi-
ously, the limits have shifted, so N2 and N3 tumours are no
longer contraindications for orthotopic diversion. A com-
mon factor arising from all the papers in favour of such a
development is resectable disease. A similar situation
occurs with local extent of disease (T stage). A growing
number of authors consider that a locally advanced stage
(stages T3–T4a) but for resectable disease is not a
contraindication for an orthotopic neobladder. The preva-
lent opinion is that even a local recurrence, observed in
10–12% of patients, rarely affects the normal neobladder
function for the rest of the patient’s life
[2–4].
In line with those findings, the authors of the Interna-
tional Consultation on Urological Diseases (ICUD)–EAU
international consultation on bladder cancer
[5]concluded
that locally advanced disease has little impact on decisions
on the suitability of orthotopic diversion.
Taking into account all the above, we are of the opinion
that the new EAU Guidelines for the treatment of muscle-
invasive and metastatic bladder cancer should include the
information that in selected patients, locally advanced
disease (T3–T4a) is not a contraindication for orthotopic
urinary diversion.
Conflicts of interest:
The authors have nothing to disclose.
References
[1]
Witjes AJ, Lebret T, Compe´rat EM, et al. Updated 2016 EAU guidelines on muscle-invasive and metastatic bladder cancer. Eur Urol 2017; 71:462–75.
[2]
Ward AM, Olencki T, Peerboom D, Klein EA. Should continent diversion be performed in patients with locally advanced bladder cancer? Urology 1998;51:232–6.
[3]
Hautmann RE, Simon J. Ileal neobladder and local recurrence of bladder cancer: patterns of failure and impact on function in men. J Urol 1999;162:1963–6.
[4]
Oberneder R, Staudte S, Waidelich R, Schmeller N, Hofstetter A. Local recurrence in patients after radical cystectomy and orthotopic ileal neobladder: impact on function. Int Urol Nephrol 2003;35:175–9.
[5]
Hautmann RE, Abol-Enein H, Davidsson T, et al. ICUD-EAU Interna- tional Consultation on Bladder Cancer 2012: urinary diversion. Eur Urol 2013;63:67–80.
Pero Bokarica*
Adelina Hrkac
Ivan Gilja
Department of Urology, Clinical Hospital Sveti Duh, Zagreb, Croatia
*Corresponding author. Department of Urology, Clinical Hospital Sveti
Duh, Sveti Duh 64, 10000 Zagreb, Croatia. Tel. +385 1 3712147;
Fax: +385 1 3712027.
E-mail address:
pbokaric@gmail.com(P. Bokarica).
February 22, 2017
E U R O P E A N U R O L O G Y 7 2 ( 2 0 1 7 ) e 4 5ava ilable at
www.sciencedirect.comjournal homepage:
www.eu ropeanurology.comDOI of original article:
http://dx.doi.org/10.1016/j.eururo.2016.06.020.
http://dx.doi.org/10.1016/j.eururo.2017.02.0310302-2838/
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2017 European Association of Urology. Published by Elsevier B.V. All rights reserved.