There is no criterion for determining whether female patients operated with cystectomy would benefit from hysterectomy. This study compares the oncological outcomes between female patients receiving uterus preserving cystectomy (UPC) and uterus excision cystectomy (UEC). Retrospective review of 121 female patients with urothelial carcinoma of bladder undergoing UPC (n = 63) or UEC (n = 49) at a single institute between January 2006 and April 2017. Individual postoperative follow-up plans were performed for patients through outpatient visits. Overall survival (OS) and progression-free survival (PFS) estimates were analyzed using Kaplan-Meier method and multivariable Cox regression. The median follow-up time was 36 months (interquartile range 16–69). Among patients, 5 (4.1%) had uterus invasion. OS probability (p = 0.939) and PFS probability (p = 0.565) were similar in two groups. In multivariable Cox regression analysis, hysterectomy was not found to be a predictor of OS (hazard ratio 0.908, 95%CI 0.428–1.924, p = 0.801) and PFS (hazard ratio 1.109, 95%CI 0.439–2.805, p = 0.826) after adjusting for age, preoperative clinical stage, pathological stage, pathological nodal stage, neoadjuvant/adjuvant chemotherapy, location of the tumor, and surgical margin. No significant difference of overall survival probability was observed in the patients with organ-confined bladder cancer (p = 0.675) and in patients with no organ-confined bladder cancer (p = 0.695). The results showed that the rate of uterus invasion was low in patients analyzed in this cohort. It was also found that hysterectomy was not an independent predictor of OS and PFS after radical cystectomy in patients with bladder cancer.

Objectives: The requirement of prolonged mechanical ventilation (PMV) is associated with increased medical care demand and expenses, high early and long-term mortality, and worse life quality. However, no study has assessed the prognostic factors associated with 1-year mortality among PMV patients, not less than 21 days after surgery. This study analyzed the predictors of 1-year mortality in patients requiring PMV in intensive care units (ICUs) after surgery. Methods: In this multicenter, respective cohort study, 124 patients who required PMV after surgery in the ICUs of five tertiary hospitals in Beijing between January 2007 and June 2016 were enrolled. The primary outcome was the duration of survival within 1 year. Predictors of 1-year mortality were identified with a multivariable Cox proportional hazard model. The predictive effect of the ProVent score was also validated. Results: Of the 124 patients enrolled, the cumulative 1-year mortality was 74.2% (92/124). From the multivariable Cox proportional hazard analysis, cancer diagnosis (hazard ratio [HR] 2.14, 95% confidence interval [CI] 1.37–3.35; P < 0.01), no tracheostomy (HR 2.01, 95% CI 1.22–3.30; P < 0.01), enteral nutrition intolerance (HR 1.88, 95% CI 1.19–2.97; P = 0.01), blood platelet count ≤150 × 10⁹/L (HR 1.77, 95% CI 1.14–2.75; P = 0.01), requirement of vasopressors (HR 1.78, 95% CI 1.13–2.80; P = 0.02), and renal replacement therapy (HR 1.71, 95% CI 1.01–2.91; P = 0.047) on the 21st day of mechanical ventilation (MV) were associated with shortened 1-year survival. Conclusions: For patients who required PMV after surgery, cancer diagnosis, no tracheostomy, enteral nutrition intolerance, blood platelet count ≤150 × 10⁹/L, vasopressor requirement, and renal replacement therapy on the 21st day of MV were associated with shortened 1-year survival. The prognosis in PMV patients in ICUs can facilitate the decision-making process of physicians and patients’ family members on treatment schedule.

The combined targeted and systematic biopsy (CTSBx) was the standard scheme for patients with visible suspicious lesions on MRI in recent years. 2024 European Association of Urology (EAU) guideline recommended targeted and perilesional biopsy (TPLBx) for the diagnosis of patients with MRI visible suspicious lesions. This RCT aims to comprehensively evaluate the efficacy and safety profiles of TPLBx and CTSBx schemes. A single-center non-inferiority RCT (NCT06482658) consecutively enrolled 380 biopsy-naïve patients (CTSBx: n=190, TPLBx: n=190) with a single unilateral suspicious lesion on prostate MRI from June 2024 to November 2024. The non-inferiority margin was -15%. All biopsies were undertaken transrectally through the cognitive fusion technique. The primary outcome was Grade Group (GG) ≥2 cancer (GG≥2-PCa) detection rate. The GG≥2-PCa [58% vs 58%, risk difference (RD): 0.53% (95%CI: -9.4%-11%)], and GG≥3-PCa [30% vs 30%, RD: 0.53% (95%CI: -8.7%-9.7%)] detection rates of TPLBx were non-inferior to that of CTSBx (p0.050). The complication rate of TPLBx was significantly lower than that of CTSBx group (Clavien-Dindo scale≥1: 62% vs 74%, p=0.023), especially for bleeding-related complications (rectal bleeding: 34% vs 48%, p=0.003; hematuria, 39% vs 56%, p<0.001) and rectal pain (25% vs 34%, p=0.018). TPLBx could significantly shorten the procedure time and saved the pathological cost (p<0.001). For patients with a single unilateral suspicious lesion on prostate MRI, TPLBx achieved the non-inferior diagnostic efficacy of csPCa and better safety than the CTSBx scheme.