Treatment for bladder diverticula may become necessary in case of incomplete bladder emptying or recurrent urinary tract infections (UTIs). When bladder outlet obstruction is present, a simultaneous ...desobstructive procedure can be performed. In this video, we present our technique for a transvesical approach in robot-assisted bladder diverticulectomy (RABD) and discuss its outcomes.
We retrospectively analyzed the outcomes of 23 patients who underwent a transvesical RABD between March 2015 and May 2020 at the OLV hospital of Aalst. After retrograde filling, a cystotomy is performed. The orifices are identified and the bladder diverticulum is observed. The mucosa covering the diverticular neck is incised and the plane between the mucosa and the muscularis is identified. The mucosa is separated from the surrounding structures. The base of the diverticulum is transected using cautery. The defect is closed with a barbed suture.
Median age was 66 years (interquartile range IQR 60-69). The number of diverticula removed ranged from 1 to 3. Ten patients were treated with diverticulectomy alone, 12 underwent a simultaneous adenomectomy, 1 a radical prostatectomy. Median operative was 140 minutes (IQR 120-180), median estimated blood loss was 250 mL (IQR 28-438). Median catheterization time was 2 days (IQR 1-5), median hospitalization time 3 days (IQR 2-4). One patient developed urinary leakage after catheter removal, one patient developed a UTI. Median follow-up was 9 months (IQR 3.5-14). No late postoperative complications nor relapse were recorded. Average postvoid residual was 42 mL (IQR 0-111), with a median decline of 120 mL (IQR -402 to -33).
Transvesical approach for RABD is a safe and reliable technique that gives the advantage of a quick localization of the diverticulum and orifices, and direct access to the prostate when simultaneous desobstruction is necessary. Catheterization time is short. No relapse has been observed.
•Transperineal prostate biopsies are the new gold standard in the diagnosis of prostate cancer according to most recent international guidelines.•Transperineal prostate biopsies under local ...anesthesia can be performed with similar pain scores and complication rates compared to the transrectal procedure.•Transperineal biopsies are feasible in the outpatient clinic.
An increasing number of urologists is switching from transrectal (TR) to transperineal (TP) biopsy procedures for the diagnosis of prostate cancer. Local anesthesia (LA) might be advantageous in terms of patient management, risks and costs. We aimed to evaluate the tolerability and complication rates of TP prostate biopsy performed under LA.
This is a monocentric, prospective, comparative, observational cohort study. Between July 2020 and July 2021 we included 128 consecutive patients (TR, n = 61; TP, n = 67), with a suspicion of prostate cancer. Transrectal vs. transperineal prostate biopsies were both performed under LA. To evaluate the tolerability we administered a validated visual analog pain score (VAS) during the different steps of the biopsy procedure as well as at 12-, 24- and 48-hours post procedure. The International Prostate Symptom Score (IPSS) questionnaire was administered before the procedure and at the same time intervals. The presence of hematuria, hematospermia, rectal blood loss, acute retention and febrile urinary tract infection (UTI) were also monitored.
There were no significant differences in pain or IPSS between groups, except for a significantly higher pain score during the LA of the prostate in the TP group. In general, complication rates were similar, only the prevalence of hematuria at 24 hours was significantly higher in the TP group, as was rectal blood loss at 12 hours postprocedure in the TR group.
In conclusion, our study showed that transperineal prostate biopsy under local anesthesia could be performed with similar pain scores and complication rates, compared to the transrectal procedure.
The rapid advancement in the development of non-fullerene acceptors has led to single-junction polymer solar cells with efficiencies over 18%. Even with these novel acceptor materials, the choice of ...the donor polymer remains important. Tuning of the donor and acceptor compatibility in terms of absorption, frontier orbital energy levels, mixing enthalpy and charge carrier mobility is routinely performed by side chain variation. Fluorination presents an additional powerful approach to optimize these parameters. Although significantly less studied, chlorination can give rise to similar effects, while donor-acceptor phase separation due to fluorophobic interactions is less of an issue. Moreover, from a material synthesis point of view, the introduction of chlorine groups is in many cases much more straightforward. In this work, we present a series of push-pull type benzo1,2-b:4,5-b'dithiophene-alt-quinoxaline donor polymers and compare the behavior of the non-halogenated, fluorinated and chlorinated derivatives in polymer solar cells when combined with small molecule and polymer type non-fullerene acceptors. The solar cell efficiencies vary from 2.4 to 8.4%, elucidating the large impact of these small structural variations. Best results are achieved for the chlorinated donor polymer, affording a high open-circuit voltage, balanced charge carrier mobilities and favorable donor-acceptor interactions. Combined with the easier synthesis of chlorinated materials, this suggests that more emphasis should be put on chlorination as a valuable approach to tune the properties of organic semiconductors for solar cell blends (and other optoelectronic applications).
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•Benzo1,2-b:4,5-b'dithiophene-alt-quinoxaline push-pull copolymers are synthesized.•The effect of backbone halogenation (fluorination vs chlorination) is studied.•Organic solar cells are prepared from the donor polymers and non-fullerene acceptors.•Best results are achieved for the chlorinated polymer (affording 8.4% efficiency).•Chlorination is an undervalued approach to tune organic semiconductor properties.
Radiation therapy (RT) for prostate cancer (PCa) treatment is burdened by high rates of late urinary adverse events (UAEs). The feasibility of robot-assisted cystectomy (RAC) with intracorporeal ...urinary diversion (ICUD) for treatment of high-grade UAEs has never been assessed.
To report perioperative outcomes, early (≤90 d) and late (>90 d) complications among patients undergoing RAC for UAEs after RT.
We retrospectively evaluated 32 patients undergoing RAC with ICUD for UAEs in a single tertiary centre.
Surgery was performed using a da Vinci Xi system with adaptation for the primary treatment.
Perioperative outcomes included estimated blood loss (EBL), operative time (OT), intraoperative complications, and length of stay (LOS). Data for early and late postoperative complications were collected using the quality criteria recommended by the European Association of Urology. Univariate logistic regressions were performed to test the effect of baseline and perioperative characteristics on early postoperative complications.
The median age-adjusted Charlson comorbidity index (ACCI) was 6 (IQR 5–7). The indication for RAC was hemorrhagic radiation cystitis in 29 cases (91%), contracted bladder in two cases (6.2%), and urinary fistula in one case (3.1%). The median EBL, OT, and LOS were 250 ml, 330 min, and 10 d, respectively. A total of 31 (97%) patients received an ileal conduit. The 90-d rate of Clavien-Dindo grade ≥IIIa complications was 28%. The late complication rate was 46% and the perioperative mortality rate was 0%. On univariate analyses, ACCI was the only parameter correlated with the risk of early complications (odds ratio 1.75, 95% confidence interval 1.05–2.9; p = 0.03). The median follow-up was 30 mo (IQR 15–40). The lack of comparison with open cystectomy represents the main limitation.
RAC for UAEs in patients with a history of pelvic irradiation is a feasible option in high-volume centers. The use of new technologies can help to overcome some of the technical difficulties and reduce the risk of perioperative and late complications.
We report our experience with robot-assisted surgery for removal of the bladder in the management of urinary problems after radiation therapy for prostate cancer. When performed by highly experienced surgeons, this is a feasible procedure with outcomes and early and late complication rates that are acceptable.
Robot-assisted cystectomy with intracorporeal urinary diversion, especially with the use of new technologies, should be considered in high-volume centers for patients with grade 4 or refractory lower-grade urinary adverse events after radiotherapy for prostate cancer.
Robot-assisted simple prostatectomy (RASP) and holmium laser enucleation of the prostate (HoLEP) are both well-established, minimally invasive surgical treatment options for lower urinary tract ...symptoms caused by benign prostatic enlargement. We have reported the first comparative analysis of both techniques in patients with prostates of ≥200 cc.
Between 2009 and 2020 a total of 53 patients with a prostate volume of ≥200 cc were surgically treated at OLV Hospital Aalst (Belgium): 31 underwent RASP and 22 underwent HoLEP. Preoperative and postoperative assessments included uroflowmetry with maximum urinary flow rate (Qmax) and postvoid residual volume (PVR), as well as the International Prostate Symptom Score (IPSS) and quality of life (IPSS-QoL). The complication rates were evaluated according to the Clavien-Dindo Classification.
Patients treated with RASP had significantly larger prostate volumes compared with HoLEP (median 226 cc
204.5 cc,
= 0.004). After a median follow-up of 14 months, both groups showed a significant improvement in the maximum flow rate (+10.60 mL/s
+10.70 mL/s,
= 0.724) and a reduction of the IPSS score (-12.50
-9,
= 0.246) as well as improvement of the QoL (-3
-3,
= 0.880). Median operative time was similar in both groups (150 minutes
132.5 minutes,
= 0.665). The amount of resected tissue was lower in the RASP group (134.5 g
180 g,
= 0.029) and there was no significant difference in postoperative prostate-specific antigen (1.2 ng/mL
0.8 ng/mL,
= 0.112). Despite a similar median catheterization time (3 days
2 days,
= 0.748), the median hospitalization time was shorter in the HoLEP group (4 days
3 days,
= 0.052). Complication rates were similar in both groups (32%
36%,
= 0.987).
Our results suggest similar outcomes for RASP and HoLEP in patients with very large prostates ≥200 cc. These findings will require external validation at other high-volume centers.
Research regarding socio-economic differences in alcohol and drug use in adolescence yields mixed results. This study hypothesizes that (1) when using education type as a proxy of one's social ...status, clear differences will exist between students from different types of education, regardless of students' familial socio-economic background; (2) and that the effects of education type differ according to their cultural background.
Data from the Brussels youth monitor were used, a school survey administered among 1,488 adolescents from the 3rd to 6th year of Flemish secondary education. Data were analyzed using multilevel logistic regression models.
Controlling for their familial background, the results show that native students in lower educational tracks use alcohol and cannabis more often than students in upper educational tracks. Such a relationship was not found for students from another ethnic background.
Results from this study indicate that research into health risks should take into account both adolescents' familial background and individual social position as different components of youngsters' socio-economic background.
Nature-based solutions to mitigate the impact of future climate change depend on restoring biological diversity and natural processes. Coastal foredunes represent the most important natural flood ...barriers along coastlines worldwide, but their area has been squeezed dramatically because of a continuing urbanization of coastlines, especially in Europe. Dune development is steered by the development of vegetation in interaction with sand fluxes from the beach. Marram grass (
Calamagrostis arenaria
, formerly
Ammophila arenaria
) is the main dune building species along most European coasts, but also in other continents where the species was introduced. Engineering of coastal dunes, for instance by building dunes in front of dikes, needs to be based on a solid understanding of the species’ interactions with the environment. Only quantitative approaches enable the further development of mechanistic models and coastal management strategies that encapsulate these biomorphogenic interactions. We here provide a quantitative review of the main biotic and physical interactions that affect marram grass performance, their interactions with sand fluxes and how they eventually shape dune development. Our review highlights that the species’ spatial organization is central to dune development. We further demonstrate this importance by means of remote sensing and a mechanistic model and provide an outlook for further research on the use of coastal dunes as a nature-based solution for coastal protection.
The feasibility and safety of robot-assisted radical cystectomy (RARC) may be undermined by unfavorable preoperative surgical characteristics such as previous prostate surgery (PPS).
To compare ...perioperative outcomes for patients undergoing RARC with versus without a history of PPS.
The study included 220 consecutive patients treated with RARC and pelvic lymph node dissection for bladder cancer at a single European tertiary centre. Of these, 43 had previously undergone PPS, defined as transurethral resection of the prostate/holmium laser enucleation of the prostate (n=21) or robot-assisted radical prostatectomy (n=22).
RARC in patients with a history of PPS.
Data on postoperative complications were collected according to the quality criteria for accurate and comprehensive reporting of surgical outcomes recommended by the European Association of Urology guidelines. Multivariable logistic, linear, and Poisson regression analyses were performed to test the effect of PPS on surgical outcomes.
Overall, 43 patients (20%) were treated with RARC after PPS. Operative time (OT) was longer in the PPS group (360 vs 330min; p<0.001). Patients with PPS experienced higher rates of intraoperative complications (19% vs 6.8%) and higher rates of 30-d (67% vs 39%), and Clavien-Dindo >3 (33% vs 16%) postoperative complications (all p<0.05). Moreover, the positive surgical margin (PSM) rate after RARC was higher in the PPS group (14% vs 4%; p=0.03). On multivariable analyses, PPS at RARC independently predicted higher risk of intraoperative (odds ratio OR 2.10, 95% confidence interval CI 1.04–6.21; p=0.01) and 30-d complications (OR 2.26, 95% CI 1.05–5.22; p=0.02), as well as longer OT (relative risk RR 1.03, 95% CI 1.00–1.05; p=0.02) and length of stay (RR 1.13, 95% CI 1.02–1.26; p=0.02). Lack of randomization represents the main limitation.
RARC in patients with a history of PPS is feasible, but it is associated with a higher risk of complications and longer OT and length of stay. Moreover, higher PSM rates have been reported for these patients. Thus, measures aimed at improving surgical outcomes appear to be warranted.
We investigated the effect of previous prostate surgery (PPS) on surgical outcomes after robot-assisted removal of the bladder. We found that patients with PPS have a higher risk of complications and longer hospitalization after bladder removal. These patients deserve closer evaluation before this type of bladder operation.
Robot-assisted radical cystectomy for bladder cancer in patients with a history of previous prostate surgery is feasible, even if it is associated with worse perioperative outcomes. Thus, measures aimed at improving surgical outcomes in this patient population appear to be warranted.
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