The overall excellent and comprehensive article (1) needs discussion:
Bladder carcinoma is typically chemically induced. Besides the errors in DNA mismatch repair mentioned in the article, defects in the known detoxification genes play a causative role (2).
Urine cytology is dependent on the examiner and its great importance for G3 urothelial carcinoma with a sensitivity of >90 % has been recognized for decades. This is explained by the high quality of training. A sensitivity of 20% to 50% in the detection of G3 carcinoma, as stated in the review article (1), would represent a fatal loss of quality in cytological diagnosis.
The authors (1) mention the ileal conduit procedure as the method of choice for incontinent urinary diversion after cystectomy. However, uretero-ureterocutaneostomy without interposition of bowl segments is an alternative and safe procedure for elderly and comorbid patients. In our own patient population (n = 417), operative time (incision-closure time: median 82 min; range 63–121 min) and mortality (2.1%) were low, despite significant negative selection of comorbid elderly patients (mean age of 79 years). A potential disadvantage compared to an ileal conduit is the obligatory placement of a ureteral stent.
Complete (100%) preservation of erectile function after robot-assisted radical cystoprostatovesiculectomy is unrealistic and has been disproved by studies, regardless of the surgical technique used (3).
The rare, usually fatal cancer immunotherapy-related hyperprogression in patients with metastatic disease should be mentioned. Currently, chronic infections associated with antibiotic treatment are being discussed as the cause of fatal courses of the disease (4).
Prof. Dr. med. Thomas Otto,
Dr. med. Dimitri Barski, PhD,
Dr. med. Roman T. Karig
Klinik für Urologie, Rheinland Klinikum Neuss GmbH, Neuss, Germany
Conflict of interest statement
Prof. Otto received fees for continuing medical education events related to the topic by Pfizer, Roche, BMS, Bayer, and Amgen. He received study support (third-party funding) from BMS.
Dr. Karig received consultancy fees from Ipsen, Apogepha and BMS. He received reimbursement of congress fees and travel as well as lecture fees from Ipsen and BMS. He received lecture fees from BMS.
Dr. Dr. Barski received reimbursement of congress and travel fees from Astellas and BMS.
|1.||de Wit M, Retz MM, Rödel C, Gschwend JE: The diagnosis and treatment of patients with bladder carcinoma. Dtsch Arztebl Int 2021; 118: 169–76 VOLLTEXT|
|2.||Selinski S, Blaszkewicz M, Ickstadt K, et al.: Identification and replication of the interplay of four genetic high risk variants for urinary bladder cancer. Carcinogenesis 2017; 38: 1167–79 CrossRef MEDLINE PubMed Central|
|3.||Venkatramani V, Reis IM, Castle EP, et al.: Predictors of recurrence, and progression-free and overall survival following open versus robotic radical cystectomy: analysis from the RAZOR trial with a 3-year followup. J Urol 2020; 203: 522–9 CrossRef MEDLINE|
|4.||Pinato DJ, Howlett S, Ottaviani D, et al.: Association of prior antibiotic treatment with survival and response to immune checkpoint inhibitor therapy in patients with cancer. JAMA Oncol 2019; 5: 1774–8 CrossRef MEDLINE PubMed Central|