Abstract Background While it is well known that clear cell renal cell carcinoma (ccRCC) that presents with lymphatic spread is associated with an extremely poor prognosis, its molecular and genetic ...biology is poorly understood. Objective Define the clinicopathologic, molecular, and genetic biological characteristics of these tumors in comparison to nonmetastatic (N0M0) renal cell carcinomas. Design, setting, and participants A retrospective study defined clinicopathologic features, expression of 28 molecular markers, and occurrence of chromosomal aberrations for their correlation with lymphatic spread in three cohorts of 502, 196, and 272 patients, respectively. Measurements Fisher exact test or the χ2 test were used to compare categorical variables; continuous variables were compared with the Mann-Whitney U test or student t test. Cut-off values were calculated based on receiver operating characteristic curves and the Youden Index. Uni- and multivariate regression analyses were used to investigate the correlation with lymphatic spread. Results and limitations In clinical analyses, a predictive model consisting of smoking history ( p = 0.040), T stage ( p < 0.0001), Fuhrman grade ( p < 0.0001), Eastern Cooperative Oncology Group performance status ( p < 0.0001), and microvascular invasion ( p < 0.0001) was independently associated with lymphatic spread. After adjustment with these clinical variables, low carbonic anhydrase IX (CAIX) ( p = 0.043) and high epithelial vascular endothelial growth factor receptor 2 ( p = 0.033) protein expression were associated with a higher risk of lymphatic spread, and loss of chromosome 3p ( p < 0.0001) with a lower risk. The current study is limited by its retrospective design, small sample size, and single-center experience. Conclusions The low rates of CAIX expression and loss of chromosome 3p suggest that lymphatic spread in ccRCC occurs independently of von Hippel-Lindau tumor suppressor inactivation.
Study Type – Therapy (case series)
Level of Evidence 4
What's known on the subject? and What does the study add?
Vasectomy reversal is often performed in general or neuraxial anaesthesia. Even though ...the site of vasectomy reversal is easily amenable to regional/local anaesthesia, spermatic cord blocks are rarely applied because of their risk of vascular damage within the spermatic cord. Recently, we described the technique of ultrasonography (US)‐guided spermatic cord block for scrotal surgery, which, thanks to the US guidance, at the same time avoids the risk of vascular damage of blindly performed injections and the risks of general and neuraxial anaesthesia.
Vasectomy reversal can easily be done in regional anaesthesia with the newly described technique of US‐guided spermatic cord block without the risks of vascular damage by a blindly performed injection and the risks of standard general and neuraxial anaesthesia. In addition, this technique grants long‐lasting postoperative pain relief and patients recover more quickly. Microsurgical conditions are excellent and patient satisfaction is high. Thanks to these advantages, more patients undergoing vasectomy reversal might avoid general or neuraxial anaesthesia.
OBJECTIVE
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To assess the success rate, microsurgical conditions, postoperative recovery, complications and patient satisfaction of ultrasonography (US)‐guided spermatic cord block in patients undergoing microscopic vasectomy reversal and to compare them to a control group with general or neuraxial anaesthesia.
PATIENTS AND METHODS
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The present study comprised a prospective series of 10 consecutive patients undergoing US‐guided spermatic cord block for microscopic vasectomy reversal.
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The cohort was compared with 10 patients in a historical control group with general or neuraxial anaesthesia.
RESULTS
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Nineteen of 20 (95%) blocks were successful, defined as no pain >3 on the Visual Analogue Scale (VAS), no additional analgesics and/or no conversion to general anaesthesia. Median pain was 0 on the VAS (range 0–5). Additional analgesics were requested in one (5%) block, and there was no conversion to general anaesthesia.
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Microsurgical conditions were excellent.
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In the spermatic cord block vs general/neuraxial anaesthesia groups, median times (range) between surgery and first postoperative analgesics, alimentation, mobilization and hospital discharge were 12 (2–14) vs 3 (1–6), 1 (0.25–3) vs 4 (3–6), 2 (1–3) vs 6 (3–10), and 4 (3–11) vs 8.5 (6–22) h, respectively.
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No complications were reported after the spermatic cord block.
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Patient satisfaction was excellent.
CONCLUSIONS
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US‐guided spermatic cord block for microscopic vasectomy reversal is highly successful and provides long‐lasting perioperative analgesia.
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Times to alimentation, mobilization and hospital discharge are shorter under US‐guided spermatic cord block than under general/neuraxial anaesthesia.
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Additional anaesthetic pain management might, however, be required unexpectedly with US‐guided spermatic cord block.
In this issue of European Urology, the European Organization for Research and Treatment of Cancer (EORTC) Genito-urinary Group presents the final results of a randomized phase 3 trial started 20 yr ...ago comparing radical nephrectomy with lymphadenectomy to radical nephrectomy alone 1. Seven hundred and thirty-two patients with preoperatively staged N0 M0 tumors were eligible. The 4% incidence of unsuspected lymph node metastases was (expectedly) low, and thus, no survival advantage of a regional lymph node dissection in conjunction with radical nephrectomy could be demonstrated.
Abstract Background Little is known about the physiologic role of seminal vesicles beyond their fertility function. It has been suggested repeatedly that seminal vesicles have an impact on sexual ...activity. Although this has been investigated in various animal models, such a role has never been found. Objective To assess in a novel mouse model whether occlusion of seminal vesicles affects sexual activity. Design, setting, and participants Adult male CD1 mice ( n = 77) were assigned randomly to the experimental groups: (1) seminal vesicle occlusion (SVO) ( n = 24), (2) seminal vesicle resection (SVR) ( n = 23), and (3) sham operation (SO) ( n = 30). Adult females were brought into estrus by the Whitten effect. After recuperation, mouse pairs were observed during sessions of 3 h each. Sexual activity was analyzed separately by three observers blinded to the experimental conditions. Intervention SVO, SVR, and SO. Outcome measurements and statistical analysis The primary end point was percentage of sessions with intromission; secondary end points were number of intromissions and latency until first intromission. A logistic regression model and the Kruskal-Wallis test were used. Results and limitations A total of 141 sessions for a total of 423 h were analyzed. Intromission was scored in 20 of 42 sessions (48%) with SVO mice, a significantly higher rate than the 8 of 39 sessions (21%) with SVR mice ( p = 0.001) and 18 of 60 sessions (30%) with SO mice ( p = 0.004). Secondary end points were comparable in all three groups ( p = 0.303 and 0.450, respectively). Conclusions Males with SVO were significantly more often sexually active than males undergoing SVR or SO. This suggests that occluded, and thus engorged, seminal vesicles increase sex drive in male mice. Since the potential clinical benefit might be highly relevant, further studies should confirm these promising results and investigate the potential application in men.
We compared brain activity of men with filled and emptied seminal vesicles by functional magnetic resonance imaging. We found that men with filled seminal vesicles had higher activation of brain ...areas involved in arousal and sexual desire.
Whether seminal vesicles play a role in sexual activity in men is unknown. No study so far has compared the neural processing of visual sexual stimuli in men depending on the filling state of the seminal vesicles.
To evaluate potential specific cortical activation by visual sexual stimuli with distended and empty seminal vesicles.
A prospective case-control trial was conducted. Six male individuals underwent two visits on 2 consecutive days for hormone analyses; Derogatis Interview for Sexual Functioning (DISF) questionnaire; functional magnetic resonance imaging (fMRI) with passively viewing sexual, neutral, positive, and negative emotional pictures; and structural pelvic MRI. After the first visit, the participants had to empty seminal vesicles by masturbation. During fMRI, every participant viewed alternating blocks of sexual, neutral, positive, and negative emotional pictures.
Comparisons between days 1 and 2 were evaluated using paired t tests.
No significant differences were observed regarding hormone analyses, DISF questionnaire score, and arousal scoring between days 1 and 2. Seminal vesicle volume was significantly lower on day 2 (p = 0.003). Significantly higher activation was observed in the right precentral gyrus, middle frontal gyrus, and right superior temporal sulcus when contrasted for sexual over neutral (p < 0.05).
In response to pictures with sexual emotional content, significantly higher activation was detected in brain areas involved in motor preparation (arousal) and coding of desirability of visual sexual stimuli in men with distended seminal vesicles than in the same men with emptied seminal vesicles. This suggests that the filling state of the seminal vesicles may influence sexual desire in men.
We compared brain activity of men with filled and emptied seminal vesicles by functional magnetic resonance imaging. We found that men with filled seminal vesicles had higher activation of brain areas involved in arousal and sexual desire.
What's known on the subject? and What does the study add?
For urinary tract infection (UTI) rates the concept of a peri‐interventional antibiotic prophylaxis during endoscopic JJ stent implantation ...is known to be better than no antibiotic coverage and is therefore recommended by the European Association of Urology. However, there is a lack of evidence concerning the exact antibiotic strategy for the entire stent‐indwelling time. In clinical routine, it is an applied practice among urologists to continue antibiotic treatment in a low‐dose fashion, even after previous uncomplicated implantations. The intention is to lower the rates of UTIs and to achieve a positive effect on stent‐related symptoms (SRSs). This practice is supported by controversial recommendations from sparse publications. However, there exists neither evidence for the benefit, nor for the potential disadvantages of such empiric prevention. Moreover, increasing rates of bacterial drug resistances, growing overall healthcare costs and drug side‐effects require a critical antibiotic prescription policy.
We analysed UTI and SRS rates in patients given a peri‐interventional antibiotic prophylaxis only vs a continuous low‐dose antibiotic treatment for the entire stent‐indwelling time and showed that the continuous antibiotic low‐dose treatment did not reduce the quantity or severity of UTIs and had no effect on SRSs, but involves undesirable disadvantages, e.g. increased drug side‐effects and higher rates of resistant bacterial strains, and should therefore be avoided.
Objective
To evaluate the antibiotic treatment regime in patients with indwelling JJ stents, the benefits and disadvantages of a peri‐interventional antibiotic prophylaxis were compared with those of a continuous low‐dose antibiotic treatment in a prospective randomised trial.
Patients and Methods
In all, 95 patients were randomised to either receive peri‐interventional antibiotic prophylaxis during stent insertion only (group A, 44 patients) or to additionally receive a continuous low‐dose antibiotic treatment until stent removal (group B, 51).
Evaluations for urinary tract infections (UTI), stent‐related symptoms (SRSs) and drug side‐effects were performed before stent insertion and consecutively after 1, 2 and 4 weeks and/or at stent withdrawal. All patients received a peri‐interventional antibiotic prophylaxis with 1.2 g amoxicillin/clavulanic acid. Amoxicillin/clavulanic acid (625 mg) once daily was administered for continuous low‐dose treatment (group B).
Primary endpoints were the overall rates of UTIs and SRSs. Secondary endpoints were the rates and severity of drug side‐effects.
Results
Neither the overall UTI rates (group A: 9% vs group B: 10%), nor the rates of febrile UTIs (group A: 7% vs group B: 6%) were different between the groups.
Similarly, SRS rates did not differ (group A: 98% vs group B: 96%).
Antibiotic side‐effect symptoms were to be increased in patients treated with low‐dose antibiotics.
Conclusion
A continuous antibiotic low‐dose treatment during the entire JJ stent‐indwelling time does not reduce the quantity or severity of UTIs and has no effect on SRSs either compared with a peri‐interventional antibiotic prophylaxis only.
