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Marcus L Quek

Publications and source records attributed to Marcus L Quek.

29 records · Page 2Linked to original sources
PubMed2004

Prognosis of seminal vesicle involvement by transitional cell carcinoma of the bladder.

PURPOSE: Transitional cell carcinoma (TCC) of the bladder that extends directly into contiguous organs (pT4) portends a poor prognosis. The 2002 American Joint Committee on Cancer staging system does not include seminal vesicle involvement by primary TCC of the bladder. In this analysis we evaluated the clinical outcomes and prognostic significance of seminal vesicle involvement with TCC of the bladder after radical cystectomy. MATERIALS AND METHODS: From 1971 to 2001, 1,682 patients underwent radical cystectomy and pelvic lymphadenectomy for bladder cancer. Only those tumors that involved adjacent organs through the bladder wall (pT4) were included. Overall 132 male patients with a median age of 68 years (range 36 to 98) qualified for analysis. Patients were stratified into 4 subgroups of 1) direct extravesical prostatic stromal involvement only in 37 patients (28%), 2) prostatic stroma and seminal vesicle involvement in 37 patients (28%), 3) seminal vesicle involvement only in 10 patients (8%) and 4) other contiguous pelvic organ involvement (stage pT4b) in 48 patients (36%). Overall 88 patients (67%) received some form of adjuvant therapy. At a median followup of 12.5 years (range 0 to 15.2) clinical outcomes were analyzed including overall and recurrence-free survival using Kaplan-Meier plots. RESULTS: There was no significant difference in clinical outcomes or prognosis for groups 2 and 3, thus they were combined for analysis. Five-year overall survival for any seminal vesicle involvement (10%) was significantly worse than prostatic stromal involvement only (38%) but was similar to pT4b tumors (7%, p <0.0001). The 5-year recurrence-free survival for seminal vesicle involvement (14%) was also significantly worse than prostatic stromal involvement alone (68%) but similar to that pT4b disease (25%, p = 0.01). Results were controlled for lymph node status. CONCLUSIONS: Patients with extravesical tumor extension into seminal vesicles and contiguous pelvic organs are at high risk for recurrence and progression. Involvement of the seminal vesicles by direct extension of bladder TCC portends a prognosis similar to that of pT4b disease and should, therefore, be classified as such.

Adult↗
PubMed2004

Pubovaginal slings for stress urinary incontinence following radical cystectomy and orthotopic neobladder reconstruction in women.

PURPOSE: We evaluated the clinical efficacy of pubovaginal slings for new onset stress urinary incontinence following radical cystectomy and orthotopic lower urinary tract reconstruction in women. MATERIALS AND METHODS: Between June 1990 and July 2002, 101 female patients with primary transitional cell carcinoma of the bladder were treated with radical cystectomy and orthotopic ileal neobladder reconstruction. Four patients 61 to 73 years old underwent pubovaginal slings (autologous rectus fascia in 2 and dermal graft in 2) for stress urinary incontinence persisting 9 to 20 months following reconstruction with a Studer (2) or T pouch (2) ileal neobladder. Pre-cystectomy continence was excellent in 3 patients, while 1 had mild stress incontinence. All patients had high grade, muscle invasive transitional cell carcinoma and/or carcinoma in situ with negative urethral margins and 3 of the 4 had lymph node negative disease on pathological examination. Two patients were treated with transurethral bulking material 4 to 5 months prior to the sling procedure without noticeable improvement. RESULTS: Two patients who underwent autologous pubovaginal slings had significant complications arising from dissection in the retropubic space, including 1 entero-pouch fistula and 1 enterotomy resulting in an enterocutaneous fistula, sepsis and subsequent death. These 2 patients had persistent stress incontinence despite the sling procedures and they ultimately underwent conversion to continent cutaneous urinary diversions. Two patients were treated with a dermal graft sling using infrapubic bone anchors through a transvaginal approach, obviating the need to enter the pelvis. These patients had uneventful postoperative courses and they are currently hypercontinent, performing intermittent catheterization with complete daytime continence and only occasional nighttime leakage 3 and 9 months following sling surgery. CONCLUSIONS: Pubovaginal sling procedures for incontinence following orthotopic neobladder reconstruction in women may be complicated due to extensive pelvic surgery. Dissection in the retropubic space should be avoided because potentially fatal complications may occur. Slings using infrapubic bone anchors may provide the best option in such patients in whom conservative management has failed because the pelvis need not be violated.

Aged↗
PubMed2004

Transurethral injection of bulking agents for stress urinary incontinence following orthotopic neobladder reconstruction in women.

PURPOSE: The clinical efficacy of transurethral bulking agents for the treatment of new onset urinary incontinence following radical cystectomy and orthotopic lower urinary tract reconstruction in women was evaluated. MATERIALS AND METHODS: Between 1990 and 2002, 101 female patients with primary transitional cell carcinoma of the bladder were treated with radical cystectomy and orthotopic ileal neobladder reconstruction. Of the 101 patients 12 (12%) underwent treatment for new onset urinary incontinence following exenterative surgery with transurethral injection of bulking agents, including collagen in 11 and nonabsorbable pyrolytic carbon coated beads in 1. RESULTS: A total of 25 injections were administered to 12 female patients with a mean age of 75.4 years following orthotopic neobladder reconstruction. Mean followup was 22.5 months (range 2 to 51). Two of the 12 patients (16.7%) reported complete continence and were considered cured, although subjective complaints of urinary frequency persisted. Four patients (33%) had decreased objective average daily pad use (6.75 to 2.25) and 6 (50%) showed no subjective or objective improvement in symptomatology. CONCLUSIONS: Although injection of urethral bulking agents is a minimally invasive treatment for stress urinary incontinence following orthotopic neobladder reconstruction, long-term results in patients with severe disease show a less than optimal durable response.

Aged↗
PubMed2004

Prognosis of patients with lymph node positive prostate cancer following radical prostatectomy: long-term results.

PURPOSE: We determined the prognostic factors that affect recurrence and survival in patients with lymph node positive prostate cancer. MATERIALS AND METHODS: Between 1972 and 1999, 1,936 patients underwent radical retropubic prostatectomy and pelvic lymph node dissection for clinically organ confined prostate cancer. A total of 235 patients (12.1%) were found to have disease metastatic to the lymph nodes (stage D1). Of the patients 69% received no adjuvant treatment. We reviewed the tumor stage (TNM), Gleason score, number and percent of involved lymph nodes (lymph node density), preoperative prostate specific antigen when available and adjuvant treatment. Overall survival and recurrence-free survival were estimated using Kaplan-Meier plots. RESULTS: Followup was 1 to 24 years (median 11.4). Overall median survival was 15 years. Overall clinical recurrence-free survival at 5, 10 and 15 years was 80%, 65% and 58%, respectively. Patients who had 1 or 2 positive lymph nodes had a clinical recurrence-free survival of 70% and 73% at 10 years, respectively, vs 49% in those who had 5 or more involved lymph nodes (p = 0.0031). When stratified by lymph node density, patients with a lymph node density of 20% or greater were at higher risk for clinical recurrence compared to those with a density of less than 20% (relative risk = 2.32, p <0.0001). On stratified log rank test only prostate cancer T stage, and the number and percent of positive lymph nodes correlated with recurrence-free and overall survival. CONCLUSIONS: Local tumor bulk and the number/percent of involved lymph nodes significantly affect disease progression and the survival rate. Radical prostatectomy may offer long-term survival in patients who have limited tumor bulk and nodal involvement.

Aged↗
PubMed2004

The importance of an extended lymphadenectomy in the management of high-grade invasive bladder cancer.

The role of a regional lymphadenectomy in the surgical management of high-grade invasive bladder cancer has evolved over the last several decades. A growing body of evidence suggests that an extended lymph node dissection may provide, not only improved prognostic information, but also a clinically significant therapeutic benefit for both lymph node-positive and -negative patients undergoing radical cystectomy. The extent of the primary bladder tumor, number of lymph nodes removed and the lymph node tumor burden are important prognostic variables in patients undergoing cystectomy. In addition, the concept of lymph node density may further improve stratification of lymph node-positive patients. The historical development and contemporary rationale for an extended pelvic lymphadenectomy in patients undergoing radical cystectomy are reviewed.

Cystectomy↗
PubMed2003

Natural history of surgically treated bladder carcinoma with extravesical tumor extension.

BACKGROUND: The current TNM classification for bladder carcinoma stratifies extravesical extension into microscopic (pT3a) and macroscopic (pT3b) tumor involvement. The authors evaluated the outcomes of patients with pT3a and pT3b disease after radical cystectomy. METHODS: Patients (n = 129) with transitional cell carcinoma of the bladder treated with radical cystectomy alone demonstrated pathologic extravesical tumor extension: 37 (29%) had pT3a disease and 92 (71%) had pT3b disease. No patient received any adjuvant therapy. With a median follow-up of 13.6 years, the presence of lymph node involvement, margin positivity, local (pelvic) and distant disease recurrence, and clinical outcomes were determined. RESULTS: Of the 129 patients, 43 (33%) had lymph node tumor involvement: 13 of 37 patients with pT3a disease (35%) and 30 of 92 patients with pT3b disease (33%). The 10-year recurrence-free and overall survival for the entire group was 54% and 20%, respectively. No statistical difference between pT3a and pT3b disease was observed with regard to recurrence-free (P = 0.54) and overall (P = 0.66) survival. Lymph node involvement was predictive of a significantly worse 10-year recurrence-free survival (32%) compared with lymph node-negative disease (60%; P = 0.003). Local disease recurrence was reported to occur in 12 patients (9%), whereas 37 patients (29%) were reported to develop distant metastases. Among those who had disease recurrence, the type of disease recurrence (local or distant) was not found to be associated with tumor stage (pT3a vs, pT3b, P = 0.47). CONCLUSIONS: This cohort of surgically managed patients provided insight into the long-term natural history of pathologically confirmed extravesical bladder carcinoma after radical cystectomy. There was no important difference in the incidence of lymph node involvement, survival rates, and disease recurrence rates between patients with microscopic and macroscopic extravesical extension. Adjuvant protocols should be undertaken for these high-risk patients to further improve on these clinical outcomes.

Adult↗
PubMed2003

Endoscopic management of upper urinary tract transitional cell carcinoma: long-term experience.

BACKGROUND: The efficacy and long-term results of endoscopic management of upper tract transitional cell carcinoma (TCC) were examined. The authors evaluated the accuracy of endoscopic biopsy in determining tumor grade in the subset of patients who underwent open surgical excision. METHODS: Between 1987 and 2001, 50 patients (17 with a solitary kidney) underwent ureteroscopy and biopsy of upper tract TCC. Eleven patients underwent ureterectomy or nephroureterectomy shortly after endoscopic biopsy. There was no follow-up for nine patients. Thirty patients underwent endoscopic ablation of their primary tumor with laser or electrofulguration at the time of the initial biopsy and were followed with close endoscopic surveillance at 3-4-month intervals. RESULTS: For the 30 patients who underwent endoscopic ablation, mean follow-up was 38 months (range, 4-106 months). There was an average of 3.4 recurrences, with an average time to first recurrence of 7 months. Ten of the 30 patients underwent open resection during follow-up. Six patients exhibited tumor progression at follow-up. During the follow-up period, one patient died of recurrent disease, and six died of other causes. Endoscopic biopsy accurately predicted the tumor grade for 8 of the 9 patients who had open tumor resection within 2 months of their last biopsy and for 10 of the 11 patients who had open resection shortly after their initial endoscopic biopsy (overall accuracy, 18 of 20 [90%]). CONCLUSIONS: Endoscopic treatment of focal low-grade TCC of the upper urinary tract is feasible and safe, provided that vigilant follow-up and endoscopic surveillance are performed. Endoscopic biopsy provides accurate information regarding tumor grade.

Adult↗
PubMed2003

Long-term urodynamics followup of bladder augmentation for neurogenic bladder.

PURPOSE: Augmentation enterocystoplasty is well tolerated by patients with neurogenic bladder in whom conservative therapy has failed. However, few studies exist on long-term urodynamic evaluation of these patients. We assessed the clinical and urodynamic outcomes of patients with neurogenic bladder treated with augmentation enterocystoplasty with at least 4 years of followup. MATERIALS AND METHODS: A total of 26 patients with neurogenic voiding dysfunction underwent augmentation enterocystoplasty alone or in conjunction with various continence or antireflux techniques. Clinical outcomes regarding incontinence, medications, catheterization schedule, subsequent interventions, bowel function and patient satisfaction were addressed. Urodynamic evaluation was performed to assess the long-term durability of bladder augmentation. RESULTS: Mean followup was 8.0 years (range 4 to 13). All but 1 patient (96%) in our series had near or complete resolution of urinary incontinence. Mean total bladder capacity +/- SD increased from 201 +/- 106 to 615 +/- 204 ml. (p <0.001) and mean maximum detrusor pressure decreased from 81 +/- 43 to 20 +/- 12 cm. H O (p <0.01). Mean interval between catheterizations was 5 hours, with volumes ranging from 314 to 743 ml. Only 2 patients (8%) needed a low dose of oxybutynin postoperatively to maintain continence consistently. Of the 26 patients 23 (88%) reported no significant change in bowel function and nearly all patients expressed extreme satisfaction with urological management. A subsequent urological procedure was required in 12 patients (46%) at a mean of 4.4 years after initial surgery.(2) CONCLUSIONS: Bladder augmentation provides durable clinical and urodynamic improvement for patients with neurogenic bladder dysfunction refractory to conservative therapy. Furthermore, there is a high level of patient satisfaction with bladder augmentation.

Adolescent↗
PubMedDate not supplied

Quality of life in patients with localized prostate cancer.

To date, there are no studies conclusively documenting that one treatment for localized prostate cancer is superior to another in terms of overall survival. Therefore, patients must consider other outcomes when choosing primary therapy for localized disease. One of the most important factors patients consider when choosing their treatment is the effect of therapy on their quality of life (QOL). Over the past decade, there have been an increasing number of studies assessing health related QOL (HRQOL) outcomes in localized prostate cancer. The goal of this article is to review our current understanding of HRQOL in this disease. We will begin by examining the established HRQOL instruments for use in localized prostate cancer. We will then discuss the effect of various treatments on QOL and review the literature comparing HRQOL outcomes between therapies.

Erectile Dysfunction↗