European Urology Supplements RSS feed: Current Issue. Supplements to European Urology are published under the title European Urology Supplements (ISSN 1569-9056). All subscribers to European Urology automatically receive this publication. European Urology Supplements is the perfect publication vehicle for the proceedings of a scientific symposium, commissioned thematic issues, or for disseminating a selection of invited articles. What makes European Urology Supplements unique is the fact that it has impact factor of 1.711 (2008)* and sits within the widely respected European Urology family of urology publications published by Elsevier on behalf of the EAU and EBU. Publication History: Incorporating EAU-EBU Update Series. You can also visit the European Urology (ISSN 0302-2838) and EAU-EBU Update Series (ISSN 1570-9124).http://www.europeanurology-supplement.com/?rss=yesElsevier Inc.en © 2010 Published by Elsevier Inc. All rights reserved. European Urology Supplements1569-905691April 2010 © 2010 Published by Elsevier Inc. All rights reserved. healthpermissions@elsevier.comhttp://www.europeanurology-supplement.com/article/PIIS1569905610000114/abstract?rss=yesEditorial Board10.1016/S1569-9056(10)00011-4European Urology Supplements 9, 1 (2010)2010-04-01European Urology Supplements2010-04-0191S1569-9056(10)X0002-1iihttp://www.europeanurology-supplement.com/article/PIIS1569905610000047/abstract?rss=yesMuscle-invasive bladder cancer is a difficult diagnosis for the patient and a challenge for the urologist. The patient will be faced with the possibility of losing the bladder if radical surgery is recommended. For the urologic surgeon, radical cystectomy is a challenging procedure both in itself and also for the ensuing urinary diversion.Muscle-Invasive Bladder Cancer and Radical CystectomyOliver W. Hakenberg10.1016/j.eursup.2010.01.003European Urology Supplements 9, 1 (2010)2010-02-11European Urology Supplements2010-02-1191S1569-9056(10)X0002-111http://www.europeanurology-supplement.com/article/PIIS1569905610000060/abstract?rss=yesAbstract: Context: The staging of bladder cancer (BCa) is crucial for optimal management of the disease. The staging process is known to be challenging and fraught with errors.Objective: Our aim was to present current BCa grading and staging systems and to review the crucial steps of the staging process. Sources of errors and pitfalls in the staging process are also discussed.Evidence acquisition: A comprehensive literature review was performed to identify relevant original articles, review articles, and clinical guidelines in the field of BCa staging.Evidence synthesis: Staging error is extremely common with reported upstaging in up to 40% of patients. Sadly, little, if any, improvements have been reported during the past two decades. Quality of the transurethral resection of bladder tumor (TURBT) and pathologic evaluation of resected tissue by a specialized uropathologist is the cornerstone of BCa staging. In addition to primary resection, restaging transurethral resection is indicated in high-risk noninvasive cancers and also if incomplete resection is demonstrated or suspected. The accuracy of traditional imaging studies (computed tomography [CT], magnetic resonance imaging [MRI]) is of limited value both in the staging of the primary tumor and nodal status. Novel imaging studies, such as positron emission tomography–CT and USPIO (ultra–small-particle superparamagnetic iron oxide)–MRI are promising modalities and may improve the accuracy of imaging in the future. Nomograms provide some additional information, but novel variables, such as molecular markers, are needed to improve the accuracy of risk-stratification models.Conclusions: Incorrect clinical staging and especially understaging is a serious problem in BCa, and improvements in all steps of the staging process are needed to achieve more accuracy and improved care for BCa patients.Take Home Message: Staging is a crucial step in bladder cancer management. Staging errors are common, and upstaging is a serious problem. High-quality transurethral resection of bladder tumor and pathologic analysis are the cornerstones of staging. Improved imaging and markers are needed for better staging accuracy.Staging and Staging Errors in Bladder CancerPeter J. Bostrom, Bas W.G. van Rhijn, Neil Fleshner, Antonio Finelli, Michael Jewett, John Thoms, Sally Hanna, Cynthia Kuk, Alexandre R. Zlotta10.1016/j.eursup.2010.01.005European Urology Supplements 9, 1 (2010)2010-02-08European Urology Supplements2010-02-0891S1569-9056(10)X0002-129http://www.europeanurology-supplement.com/article/PIIS1569905610000059/abstract?rss=yesAbstract: Context: Radical cystectomy (RC) offers the best opportunity for ultimate cure of high-grade and high-risk invasive bladder cancer (BCa).Objective: To review the available literature on indications for and oncologic outcomes of RC for urothelial carcinoma of the bladder.Evidence acquisition: A database search of the US National Library of Medicine (PubMed) was performed for relevant medical articles using the Medical Subject Headings invasive bladder cancer and radical cystectomy with restrictions to English-language publications.Evidence synthesis: Immediate or early RC should be offered as a treatment of choice to all patients with recurrent or multifocal high-grade T1 tumours, T1 tumours at high risk of progression, failures of bacillus Calmette-Guérin treatment, and muscle-invasive bladder tumours. RC offers excellent recurrence-free survival (RFS) and disease-specific survival rates as well as local tumour control in patients with organ-confined and node-negative disease. Tumour control in non–organ-confined tumours is still satisfactory, with long-term RFS rates of about 50%. For node-positive disease, surgery may only be curative in approximately one-fourth of patients.Conclusions: Evidence from the literature supports early, aggressive surgical management for invasive BCa. Risk stratification of patients with BCa based on pathologic features at initial transurethral resection or at recurrence can select those patients most appropriate for RC early. In patients with organ-confined, lymph node–negative urothelial bladder carcinoma, excellent long-term survival rates can be achieved.Take Home Message: Evidence from the literature supports early, aggressive surgical management for invasive bladder cancer (BCa). Risk stratification of patients with BCa based on pathologic features at initial transurethral resection or at recurrence can select those patients most appropriate for radical cystectomy early. In patients with organ-confined, lymph node–negative urothelial bladder carcinoma, excellent long-term survival rates can be achieved.Indications and Oncologic Outcome of Radical Cystectomy for Urothelial Bladder Cancer†Juergen E. Gschwend, Margitta Retz, Hubert Kuebler, Michael Autenrieth10.1016/j.eursup.2010.01.004European Urology Supplements 9, 1 (2010)2010-02-08European Urology Supplements2010-02-0891S1569-9056(10)X0002-11018http://www.europeanurology-supplement.com/article/PIIS1569905610000072/abstract?rss=yesAbstract: Detection of lymph node metastases in patients undergoing radical cystectomy and pelvic lymph node dissection (PLND) for bladder cancer indicates poor prognosis. For pretreatment assessment of lymph node status, computed tomography and magnetic resonance imaging are generally performed, both of which show a low sensitivity of approximately 30%. Newer imaging techniques are being developed; however, it will take time until they can be used in everyday clinical practice. Therefore, PLND remains the only reliable method for lymph node staging in the pelvis. The extent of PLND remains a matter of discussion, but a recent study mapping the lymphatic drainage from the bladder suggests that the template for an appropriate PLND at cystectomy should include the external iliac, obturator, and internal iliac region (lateral and medial to the internal iliac vessels) as well as the common iliac vessels up to the uretero-iliac junctions bilaterally. Additionally, the lymph nodes of the fossa of Marcille should be removed. Questions remain about whether it is worthwhile to resect the few draining lymph nodes between the uretero-iliac junctions and the inferior mesenteric artery with regard to both the increased risk of complications and the injury to the autonomic sympathetic nerves. In addition, PLND at the time of radical cystectomy not only is associated with more accurate staging but also allows removal of undetected micrometastases in patients with bladder cancer. Evidence is growing that extended PLND in patients with bladder cancer may confer a survival benefit for node-positive and node-negative patients without increasing morbidity.Take Home Message: Growing retrospective evidence from many centres indicates that pelvic lymph node dissection (PLND) improves survival in patients with both node-negative and node-positive bladder cancer. Extended PLND is not only associated with a more accurate staging but may improve survival in patients with bladder cancer compared with a limited PLND.The Role of Lymphadenectomy in Radical CystectomyBeat Roth, Fiona C. Burkhard10.1016/j.eursup.2010.01.006European Urology Supplements 9, 1 (2010)2010-02-10European Urology Supplements2010-02-1091S1569-9056(10)X0002-11924http://www.europeanurology-supplement.com/article/PIIS1569905610000084/abstract?rss=yesAbstract: Context: Radical cystectomy (RC) is probably the most extensive urologic operation, involving simultaneous surgery on the urinary and gastrointestinal tracts and lymph node dissection. Consequently, early complications and morbidity frequently occur due to the complexity of the procedure.Objective: This review is focused on early complications related to RC but not related to urinary diversion.Evidence acquisition: Literature on RC and complications was retrieved from PubMed in November 2009.Evidence synthesis: The mortality, complications, and morbidity that occur after RC are time dependent and, hence, should be ascertained at the earliest point 90 d after surgery to get a true picture of incidence. Standardised reporting methodology is necessary for comparing data from different hospitals or from patients subjected to different surgical techniques. Today, the most common complications are gastrointestinal problems followed by infectious events.Conclusions: Extensive complications and morbidity occur after RC. All hospitals that perform RC should prospectively register and assess postoperative complications.Take Home Message: Complications after radical cystectomy (RC) occur more frequently than reported previously. Use of standardized protocols for registering complications and early morbidity at 90 d after RC is mandatory.Early Complications and Morbidity of Radical CystectomyFredrik Liedberg10.1016/j.eursup.2010.01.007European Urology Supplements 9, 1 (2010)2010-02-08European Urology Supplements2010-02-0891S1569-9056(10)X0002-12530http://www.europeanurology-supplement.com/article/PIIS1569905610000035/abstract?rss=yesCME Questions for European Urology Supplements Volume xx (2010) pp. xx[en]xx10.1016/j.eursup.2010.01.002European Urology Supplements 9, 1 (2010)2010-02-08European Urology Supplements2010-02-0891S1569-9056(10)X0002-13132http://www.europeanurology-supplement.com/article/PIIS1569905610000023/abstract?rss=yesAnswers to the CME Questions Published in European Urology Supplements Volume 8 (2009) pp. 563–56510.1016/j.eursup.2010.01.001European Urology Supplements 9, 1 (2010)2010-02-01European Urology Supplements2010-02-0191S1569-9056(10)X0002-13333