We report on the accuracy, measured with three‐dimensional (3D) computed tomography (CT) postoperatively, in positioning custom 3D printed titanium components in patients with large acetabular ...defects. Twenty patients (13 females and 7 males) received custom‐made acetabular implants between 2016 and 2018; the mean age was 66 years (SD = 11.6) and their mean body mass index was 28 (SD = 6.1). The median time to follow up was 25.5 months, range: 12 to 40 months. We describe a comparison method that uses the 3D models of CT‐generated preoperative plans and the postoperative CT scans to quantify the discrepancy between planned and achieved component positions. Our primary outcome measures were the 3D‐CT‐measured difference between planned and achieved a component position in six degrees of freedom: center of rotation (CoR), component rotation, inclination (INC), and version (VER) of the cup. Our secondary outcome measures were: Oxford hip score, walking status, and complication rate. All components (100%) were positioned within 10 mm of planned CoR (in the three planes). Eighteen (95%) components were not rotated by more than 10° compared to the plan. Eleven (58%) components were positioned within 5° of planned cup angle (INC and VER). To date one complication has occurred, a periprosthetic fracture. This is the largest study in which postoperative 3D‐CT measurements and clinical outcomes of custom‐made acetabular components have been assessed. Accurate pre‐op planning and the adoption of custom 3D printed implants show promising results in complex hip revision surgery.
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BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SAZU, SBCE, SBMB, UL, UM, UPUK
Remote solution for surgical skills teaching Ike, David Ikenna; Oyebanji, Oluwatobiloba; Tee, Sabrina Zi Yi ...
Medical education,
November 2021, 2021-11-00, 20211101, Volume:
55, Issue:
11
Journal Article
Peer reviewed
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BFBNIB, DOBA, FZAB, GIS, IJS, IZUM, KILJ, NLZOH, NUK, OILJ, PILJ, PNG, SAZU, SBCE, SBMB, SIK, UILJ, UKNU, UL, UM, UPUK, VSZLJ
Abstract Background Focal therapy (FT) for prostate cancer (PCa) seems to be part of a natural evolution in the quest to improve the management of early organ-confined disease. Objective To assess ...the morbidity of the initial experience of FT in a tertiary referral center for PCa management. Design, setting, and participants From 2009 to 2011, a total of 1213 patients with clinically localized PCa were treated at our institution. Of these patients, 547 were considered to have indolent disease according to the D’Amico criteria for low-risk disease plus unilateral disease with a maximum of three positive biopsies. A total of 106 patients underwent FT using high-intensity focused ultrasonography (HIFU), brachytherapy, cryotherapy, or vascular-targeted photodynamic therapy (VTP). Outcome measurements and statistical analysis Complications were prospectively recorded and graded according to the Clavien-Dindo scale. Data were prospectively collected and retrospectively analyzed. Results and limitations This study included 106 patients, median age 66.5 yr (interquartile range IQR): 61–73), who had a prostate hemiablation; 50 patients (47%) had cryotherapy, 23 patients (22%) had VTP, 21 patients (20%) received HIFU, and 12 patients (11%) had brachytherapy. The median prostate-specific antigen (PSA) level was 6.1 ng/ml (IQR: 5–8.1), all the patients had a biopsy Gleason score of 6, and the median prostate weight was 43 g (IQR: 33–55). The median International Prostate Symptom Score was 6 (IQR: 3–10), and the median International Index of Erectile Function score was 20 (IQR: 15–23). After treatment, the median PSA at 3, 6, and 12 mo was 3.1 2.9, and 2.7 ng/ml (IQR: 2–5.1, 1.1–4.7, and 1–4.4), respectively. Thirteen percent of the patients experienced treatment-related complications. There were 11 minor medical complications (10 grade 1 complications and 1 grade 2 complication), 2 grade 3 complications, and no grade 4 or higher complications. Conclusions FT for a highly selected population with PCa is feasible and had an acceptable morbidity with <2% major complications.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK
Clear-cell renal cell carcinoma (ccRCC) is the most common type of kidney cancer. Although ccRCC is characterized by common recurrent genetic abnormalities, including inactivation of the von ...Hippel-Lindau (vhl) tumor suppressor gene resulting in stabilization of hypoxia-inducible factors (HIFs), the tumor aggressiveness and outcome of ccRCC is variable. New biomarkers are thus required to improve ccRCC diagnosis, prognosis and therapeutic options. This work aims to investigate the expression of HIF and proteins involved in metabolism and pH regulation. Their correlation to histoprognostic parameters and survival was analyzed.
ccRCC of 45 patients were analyzed. HIF-1α, HIF-2α, HAF, GLUT1, MCT1, MCT4, CAIX and CAXII expression was assessed by immunohistochemistry in a semi-quantitative and qualitative manner. The GLUT1, MCT1, MCT4, CAIX and CAXII mRNA levels were analyzed in an independent cohort of 43 patients.
A significant correlation was observed between increased GLUT1, MCT1, CAXII protein expression and a high Fuhrman grade in ccRCC patients. Moreover, while HIF-1α, HIF-2α and HAF expression was heterogenous within tumors, we observed and confirmed that HIF-2α co-localized with HAF. We confirmed, in an independent cohort, that GLUT1, MCT1 and CAXII mRNA levels correlated with the Fuhrman grade. Moreover, we demonstrated that the high mRNA level of both MCT1 and GLUT1 correlated with poor prognosis.
This study demonstrates for the first time a link between the aggressiveness of high- Fuhrman grade ccRCC and metabolic reprogramming. It also confirms the role of HIF-2α and HAF in tumor invasiveness. Finally, these results demonstrate that MCT1 and GLUT1 are strong prognostic markers and promising therapeutic targets.
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DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Abdominal aortic aneurysm (AAA) represents a major health concern and the curative treatment relies on surgical approaches including open and endovascular aortic repair (EVAR). While epidemiological ...studies have addressed the major outcomes including mortality and life threatening complications, the impact of surgical intervention on sexual function has been less well described. The aim of this review was to summarise current knowledge on the occurrence of sexual dysfunction in the context of AAA surgical repair and to explore whether surgical techniques could have differential impact.
The MEDLINE database was searched in May 2017 and all studies related to sexual dysfunction assessment following AAA surgical repair were included. Given the heterogeneity of the definitions of sexual dysfunction and its assessment, a comprehensive literature review was performed rather than a meta-analysis.
The published literature search identified 29 studies including prospective, retrospective, and single centre and multicentre trials. The post-operative erectile dysfunction prevalence varied from 7.4% to 79% following open repair and from 4.7% to 82% following EVAR. The incidence of de novo erectile dysfunction was estimated, respectively, at 20%, 26.6%, and 83% after open repair and at 11% and 14.3% after EVAR. Erectile dysfunction rates varied from 5.3% to 8.2% in patients who had EVAR with unilateral hypogastric artery exclusion and from 5.1% to 46.6% in patients who had bilateral hypogastric artery exclusion. The rates of retrograde ejaculation after surgery varied from 3.3% to 9% after open repair and from 6% to 6.6% after laparoscopic repair.
Clinical studies demonstrated heterogeneous results, which could be attributed mainly to methodology including study design and criteria used to evaluate sexual dysfunction. Given the potential consequences of sexual dysfunction on quality of life, this review highlights the real need to inform patients and to better assess this potential side effect to improve its management in patients undergoing AAA surgical repair.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
What's known on the subject? and What does the study add?
During radical prostatectomy, urological surgeons have tried to identify the “cord‐like NVB” at the lateral aspect of the prostate. However, ...little histological or physiological investigation was conducted to verify that the NVB identified at surgery really included the cavernous nerve. Recently, there have been observations that refute the dogma that the cavernous nerve is always within the NVB.
In this study, we have described a hammock‐like distribution of the nerves on which the prostate rests, demonstrating that the NVB is more a network of multiple fine dispersed nerves than a distinct structure. We presented a novel nerve‐sparing approach to complete hammock preservation. This risk‐stratified approach for determining the degree of nerve sparing based on the patient's likelihood of ipsilateral EPE seeks to categorize patients for optimal balance between oncological outcomes and functional outcomes.
OBJECTIVES
•
To report the potency and oncological outcomes of patients undergoing robot‐assisted radical prostatectomy (RARP) using a risk‐stratified approach based on layers of periprostatic fascial dissection.
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We also describe the surgical technique of complete hammock preservation or nerve sparing grade 1.
PATIENTS AND METHODS
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This is a retrospective study of 2317 patients who had robotic prostatectomy by a single surgeon at a single institution between January 2005 and June 2010.
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Included patients were those with ≥1 year of follow‐up and who were potent preoperatively, defined as having a sexual health inventory for men (SHIM) questionnaire score of >21; thus, the final number of patients in the study cohort was 1263.
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Patients were categorized pre‐operatively by a risk‐stratified approach into risk grades 1–4, where risk grade 1 patients received nerve‐sparing grade 1 or complete hammock preservation and so on for risk grades 2–4, as long as intraoperative findings permitted the planned nerve sparing.
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We considered return to sexual function post‐operatively by two criteria: i) ability to have successful intercourse (score of ≥4 on question 2 of the SHIM) and ii) SHIM >21 or return to baseline sexual function.
RESULTS
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There was a significant difference across different NS grades in terms of the percentages of patients who had intercourse and returned to baseline sexual function (P < 0.001), with those that underwent NS grade 1 having the highest rates (90.9% and 81.7%) as compared to NS grades 2 (81.4% and74.3%), 3 (73.5% and 66.1%), and 4 (62% and 54.5%).
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The overall positive surgical margin (PSM) rates for patients with NS grades 1, 2, 3, and 4 were 9.9%, 8.1%, 7.2%, and 8.7%, respectively (P = 0.636).
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The extraprostatic extension rates were 11.6%, 14.3%, 29.3%, and 36.2%, respectively (P < 0.001).
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Similarly, in patients younger than 60, intercourse and return to baseline sexual function rates were 94.9% and 84.3% for NS grade 1 as compared to 85.5% and 77.2% for NS grades 2, 76.9% and 69% for NS grades 3, and 64.8% and 57.7% for NS Grade 4 (P < 0.001).
CONCLUSIONS
•
The risk‐stratified approach and anatomical technique of neural‐hammock sparing described in the present manuscript was effective in improving potency outcomes of patients without compromising cancer control.
•
Patients with greater degrees of NS had higher rates of intercourse and return to baseline sexual function without an increase in PSM rates.
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BFBNIB, DOBA, FZAB, GIS, IJS, IZUM, KILJ, NLZOH, NUK, OILJ, PILJ, PNG, SAZU, SBCE, SBMB, UILJ, UKNU, UL, UM, UPUK
Abstract Background The impact of nerve sparing (NS) on urinary continence recovery after robot-assisted laparoscopic radical prostatectomy (RALP) has yet to be defined. Objective To evaluate the ...effect of a risk-stratified grade of NS technique on early return of urinary continence. Design, setting, and participants Data were collected from 1546 patients who underwent RALP by a single surgeon at a tertiary care center from December 2008 to October 2011. Patients were categorized preoperatively by a risk-stratified approach into risk grades 1–4, with risk grade 1 patients more likely to receive NS grade 1 or complete hammock preservation. This categorization was also conducted for risk grades 2–4, with grade 4 patients receiving a non-NS procedure. Intervention Risk-stratified grading of NS RALP. Outcome measurements and statistical analysis Univariate and multivariate analysis identified predictors of early return of urinary continence, defined as no pad use at ≤12 wk postoperatively. Results and limitations Early return of continence was achieved by 791 of 1417 men (55.8%); of those, 199 of 277 (71.8%) were in NS grade 1, 440 of 805 (54.7%) were in NS grade 2, 132 of 289 (45.7%) were in NS grade 3, and 20 of 46 (43.5%) were in NS grade 4 ( p < 0.001). On multivariate analysis, better NS grade was a significant independent predictor of early return of urinary continence when NS grade 1 was the reference variable compared with NS grade 2 ( p < 0.001; odds ratio OR: 0.46), NS grade 3 ( p < 0.001; OR: 0.35), and NS grade 4 ( p = 0.001; OR: 0.29). Lower preoperative International Prostate Symptom Score ( p = 0.001; OR: 0.97) and higher preoperative Sexual Health Inventory for Men score ( p = 0.002; OR: 1.03) were indicative of early return of urinary continence. Positive surgical margin rates were 7.2% (20 of 277) of grade 1 cases, 7.6% (61 of 805) of grade 2 cases, 7.6% (22 of 289) of grade 3 cases, and 17.4% (8 of 46) of grade 4 cases ( p = 0.111). Extraprostatic extension occurred in 6.1% (17 of 277) of NS grade 1 cases, 17.5% (141 of 805) of NS grade 2 cases, 42.5% (123 of 289) of NS grade 3 cases, and 63% (29 of 46) of NS grade 4 cases ( p < 0.001). Some limitations of the study are that the study was not randomized, grading of NS was subjective, and possible selection bias existed. Conclusions Our study reports a correlation between risk-stratified grade of NS technique and early return of urinary continence as patients with a lower grade (higher degree) of NS achieved an early return of urinary continence without compromising oncologic safety.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK
PURPOSEThe main objective of this study was to assess the prevalence and risk factors of male artificial urinary sphincter (AUS) mechanical failures and nonmechanical failures. MATERIALS AND ...METHODSThe charts of all male patients who underwent AUS implantation between 2004 and 2020 in 16 centers were retrospectively reviewed. Patients with neurogenic stress urinary incontinence (SUI) were excluded as well as revisions/explantations due to infections and/or erosions. The causes of revision were divided into mechanical failures (fluid loss or malfunction from any components of the AUS), nonmechanical failures (urethral atrophy, recurrence/persistence of SUI despite normally functioning device) and other (pump malposition, balloon herniation, hematoma, pain). Failure-free survival analysis was performed both for general and specific causes of revision. Predictors of mechanical and nonmechanical failures were determined by Cox proportional hazards model. RESULTSA total of 1,020 patients met the inclusion criteria. After a median followup of 20 months, the estimated 5-year and 10-year overall revision-free survival was 60% and 40%, respectively. There were 214 AUS revisions: 59 (27.6%) for mechanical failures, 121 (56.5%) for nonmechanical failures and 34 (15.9%) other causes of revision. In multivariable Cox regression analysis, larger cuff size was the only predictor of overall revisions (HR=1.04 1.01-1.07; p=0.01) and revision for nonmechanical failure (HR=1.05 1.02-1.09; p=0.004). CONCLUSIONSHalf of the male AUS patients underwent device revision within the first 10 years after implantation. Nonmechanical failures are the primary cause of AUS revision in nonneurological men. Larger cuff size appears to be the main determinant of AUS revision risk.
To find an association between genomic features of connective tissue and pejorative clinical outcomes on radical prostatectomy specimens. We performed a retrospective analysis of patients who ...underwent radical prostatectomy and underwent a Decipher transcriptomic test for localized prostate cancer in our institution (
= 695). The expression results of selected connective tissue genes were analyzed after multiple
tests, revealing significant differences in the transcriptomic expression (over- or under-expression). We investigated the association between transcript results and clinical features such as extra-capsular extension (ECE), clinically significant cancer, lymph node (LN) invasion and early biochemical recurrence (eBCR), defined as earlier than 3 years after surgery). The Cancer Genome Atlas (TCGA) was used to evaluate the prognostic role of genes on progression-free survival (PFS) and overall survival (OS). Out of 528 patients, we found that 189 had ECE and 27 had LN invasion. The Decipher score was higher in patients with ECE, LN invasion, and eBCR. Our gene selection microarray analysis showed an overexpression in both ECE and LN invasion, and in clinically significant cancer for
,
,
,
,
,
,
,
,
,
,
, and underexpression in
and
. In the TCGA population, overexpression of these genes was correlated with worse PFS. Significant co-occurrence of these genes was observed. When presenting overexpression of our gene selection, the 5-year PFS rate was 53% vs. 68% (
= 0.0315). Transcriptomic overexpression of connective tissue genes correlated to worse clinical features, such as ECE, clinically significant cancer and BCR, identifying the potential prognostic value of the gene signature of the connective tissue in prostate cancer. TCGAp cohort analysis showed a worse PFS in case of overexpression of the connective tissue genes.
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IZUM, KILJ, NUK, PILJ, PNG, SAZU, UL, UM, UPUK
Objectives
To assess oncological (biochemical and histological recurrence) and functional (urinary and potency) outcomes in patients with unilateral low‐risk organ‐confined prostate cancer (PCa) ...treated with focal cryoablation (FC).
Patients and Methods
From January 2009 to March 2012, patients with localized PCa who refused active surveillance were assigned to a FC protocol.
This was a prospective, single‐arm cohort study. Inclusion criteria were: unilateral disease, clinical stage T1c to T2a, prostate‐specific antigen (PSA) concentration <10 ng/mL, low volume index lesion and Gleason score ≤6 (3+3). Hemi‐ablation was carried out using the PreciseTM cryoablation system (Galil Medical, Inc., Arden Hills, MN, USA).
Oncological (PSA values) and functional (International Prostate Symptom Score and International Index of Erectile Function (IIEF)‐5 score) outcomes were analysed at 3‐, 6‐ and 12‐month follow‐up.
The primary endpoint for oncological efficacy, no cancer in ipsilateral side, was based on the 12‐month mandatory biopsy.
Results
A total of 48 consecutive patients with a mean age of 67 years were included. The median (interquartile range) follow‐up was 13.2 (7.4–26.5) months.
Follow‐up prostate biopsies were negative for the treated lobe in 86% of patients.
The mean PSA concentration dropped significantly at 3 months (by 55%) but did not correlate well with positive biopsy results.
Urinary symptoms were unchanged. A slight decrease in the IIEF‐5 score was present at 3 months, but did not differ significantly from baseline at 6‐month follow‐up.
There were 15% grade 1 and 4% grade 2 complications (Clavien classification).
Conclusions
Focal cryoablation is a low‐morbidity option in selected patients with low‐risk PCa.
We showed PSA concentration to be an unreliable marker for monitoring FC and recommend a protocol of mandatory biopsies for follow‐up.
A multicentre randomized controlled trial is necessary to confirm the low‐morbidity and the biopsy‐proven PCa cure rates.
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BFBNIB, DOBA, FZAB, GIS, IJS, IZUM, KILJ, NLZOH, NUK, OILJ, PILJ, PNG, SAZU, SBCE, SBMB, UILJ, UKNU, UL, UM, UPUK
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