Owing to the scarcity of upper urinary tract urothelial carcinoma (UUT-UC) it is often necessary for investigators to pool data. A patient-specific survival nomogram based on such data is needed to ...predict cancer-specific survival (CSS) post nephroureterectomy (NU). Herein, we propose and validate a nomogram to predict CSS post NU.
Twenty-one French institutions contributed data on 1120 patients treated with NU for UUT-UC. A total of 667 had full data for nomogram development. Study population was divided into the nomogram development cohort (397) and external validation cohort (270). Cox proportional hazards regression models were used for univariate and multivariate analyses and to build a nomogram. A reduced model selection was performed using a backward step-down selection process, and Harrell's concordance index (c-index) was used for quantifying the nomogram accuracy. Internal validation was performed by bootstrapping and the reduced nomogram model was calibrated.
Of the 397 patients in the nomogram development cohort, 91 (22.9%) died during follow-up, of which 66 (72.5%) died as a consequence of UUT-UC. The actuarial CSS probability at 5 years was 0.76 (95% CI, 71.62-80.94). On multivariate analysis, T stage (P<0.0001), N status (P=0.014), grade (P=0.026), age (P=0.005) and location (P=0.022) were associated with CSS. The reduced nomogram model had an accuracy of 0.78. We propose a nomogram to predict 3 and 5-year CSS post NU for UUT-UC.
We have devised and validated an accurate nomogram (78%), superior to any single clinical variable or current model, for predicting 5-year CSS post NU for UUT-UC.
To answer the main clinical questions asked by practitioners and men consulting for a vasectomy request.
The CPR method was used. The clinical questions were formulated according to the PICO ...methodology. A Pubmed literature search for the period 1984-2021 identified 508 references, of which 79 were selected and analyzed with the GRADE grid.
Vasectomy is a permanent, potentially reversible contraception. It is a safe procedure. A second vasectomy is necessary in only 1 % of cases. Surgical complications (hematoma, infection, pain, etc.) are rare. The frequency of prolonged scrotal pain after vasectomy is about 5 %, and less than 2 % describe a negative impact of this pain on their quality of life. Vasectomy does not have negative consequences on sexuality. The only contraindication to vasectomy is the minor patient. Patients at increased risk of remorse are single, divorced or separated men under the age of 30. Sperm storage may be particularly appropriate for them. Whatever the reason, the law allows the surgeon to refuse to perform the vasectomy. He must inform the patient of this at the first consultation. The choice of the type of anesthesia is left to the discretion of the surgeon and the patient. It must be decided during the preoperative consultation. Local anesthesia should be considered first. General anesthesia should be particularly considered in cases of anxiety or intense sensitivity of the patient to palpation of the vas deferens, difficulty palpating the vas deferens, or a history of scrotal surgery that would make the procedure more complex. Concerning the vasectomy technique, 2 points seem to improve the efficiency of the vasectomy: coagulation of the deferential mucosa and interposition of fascia. Leaving the proximal end of the vas deferens free seems to reduce the risk of post-vasectomy syndrome without increasing the risk of failure or complications. No-scalpel vasectomy is associated with a lower risk of postoperative complications than conventional vasectomy. Regarding follow-up, it is recommended to perform a spermogram at 3 months post-vasectomy and after 30 ejaculations. If there are still a few non-motile spermatozoa at 3 months, it is recommended that a check-up be performed at 6 months post-vasectomy. In case of motile spermatozoa or more than 100,000 immobile spermatozoa/mL at 6 months (defining failure), a new vasectomy should be considered. Contraception must be maintained until the effectiveness of the vasectomy is confirmed.
Summary
Efficacy and safety of l‐arginine aspartate 8 g combined with 200 mg of adenosine monophosphate (AA) with placebo (PL) alone for intermittent treatment of mild‐to‐moderate erectile ...dysfunction (ED) were compared. The study design was a double‐blind, PL‐controlled, two‐way crossover randomized clinical trial with 26 patients. Efficacy was assessed by International Index of Erectile Function (IIEF) and two additional validated questionnaires the Erection Hardness Score (EHS) and the Erectile Dysfunction Inventory of Treatment Satisfaction (EDITS). During each crossover period, separated by a 2‐week wash‐out period, drugs were administered orally, 1–2 h before sexual intercourse. Primary endpoint was a change in the IIEF. Secondary endpoints were patient and investigator assessments of treatment success. Investigators’ and patients’ assessment of efficacy was significantly improved by the combination vs. PL (p = 0.01 and p = 0.04 respectively. EHS and EDITS questionnaires were both improved by the combination (p = 0.015 and p = 0.017 respectively). There was no significant difference in terms of tolerance between AA and PL or severe adverse events. ED patients demonstrated significant improvements in all IIEF domains with the exception of the Sexual Desire and Orgasmic Domains when treated with AA compared with PL. This pilot phase II study showed that the on‐demand oral administration at a high dosage of l‐arginine aspartate–adenosine monophosphate combination may be effective in patients with mild‐to‐moderate ED, is very well tolerated and could be tested as a safe first‐line therapy in a larger size phase III study.
The thorax is the most frequent extrapelvic location of endometriosis. Thoracic endometriosis is probably responsible for the high rate of recurrent pneumothoraces in females. The goal of the present ...prospective study was to assess the value of cancer antigen (CA)125 measurement in the detection of endometriosis in order to further enable early and adequate treatment of catamenial pneumothorax. Between January 2004 and March 2006, 31 females (mean age 32 yrs) underwent pneumothorax surgery. The control group comprised 17 males (mean age 27 yrs), who underwent videothoracoscopic pleural abrasion. Serum CA125 was measured around a menstrual period in females and before surgery in males. Videothoracoscopically diagnosed endometriosis occurred in 29% of females. The CA125 concentration was significantly higher in females with endometriosis compared to disease-free females (76.1 versus 16 U x mL(-1)). The mean value in males was similar to that observed in disease-free females. The frequency of thoracic endometriosis-related pneumothorax corresponds to, on average, a third of females presenting with recurrent pneumothorax. Early detection can be achieved with serum cancer antigen 125 measurement and may be helpful in indicating videothoracoscopic surgery.
Abstract Objective To report on the effectiveness of the surgical management of renal cell carcinoma (RCC) in patients with a neoplastic thrombus of the vena cava. Patients and methods We examined ...pre- and post-operative clinical data for all patients who had received a nephrectomy for the management of RCC with a neoplastic thrombus of the vena cava between spanning 10 years. The procedure depended on the exact location and size of the thrombus according to the Mayo Clinic and the 2009 TNM classifications. Results A total of 32 patients underwent surgery. Eight of these patients had stage I, nine had stage II, six had stage III and nine had stage IV thrombi according to the Mayo Clinic staging, and twenty were T3b, eight were T3c and four were T4 according to the 2009 TNM classifications. An open abdominal approach was performed in patients with stage I and II thrombi, whereas five of the stage III patients and all of the stage IV patients required combined sternotomies. Five patients whose thrombi extended to the right atrium were treated with a cardiac bypass. The complication rate was 53% and the peri-operative mortality rate was 12.5%. The median follow-up interval was 64 months. The overall and cancer-specific five-year survival rates for all stages combined were 47% and 52%, respectively. Conclusion Surgical resection remains the first-line treatment for patients with RCC infiltrating the vena cava, but surgical morbidity is prevalent and survival is poor.
Our objective was to describe the progressive introduction of photoselective vaporization of the prostate (PVP) in an academic department of urology in an outpatient care setting and report our ...outcomes after the first 100 cases.
Since May 2014, XPS GreenLight™ (Boston Scientific-AMS, USA) PVP in the treatment of benign prostatic hyperplasia was introduced in our department. A prospective local registry was opened to collect patients' demographics, preoperative characteristics and surgical outcomes including operative time, length of stay, catheterization time, and postoperative complications as well as functional outcomes. We also assessed limitations to the outpatient care setting.
Conversion to TURP was reported in 6 % for uncontrolled bleeding. Overall, 21 % patients needed more than 1-day catheterization. After 6 months of follow-up, 3 patients (prostate volume 50, 117, and 178mL) had reintervention (second PVP). Ninety days' complications were reported to be up to 6 % (3 urinary obstructions, 1 prostatitis, 1 transfusion and a severe sepsis). After 8 months, an 80 % plateau of outpatient care setting was achieved. Anesthesiologists counter-indicated outpatient care in 59 % of the cases.
A progressive introduction of the PVP in an outpatient care setting is associated with a low complication rate. A plateau was achieved in less than 100 procedures. The major limitation of the outpatient care setting was patients' competitive comorbidities and not disease characteristics.
4.
Our aim was to present the indications and the outcomes of penile prosthesis implantation.
A literature review was performed through PubMed using the following keywords: penile implantation ; penile ...prosthesis; erectile dysfunction.
Evolution of penile prosthesis devices led to get a fiable and effective treatment for men with erectile dysfunction who do not respond to less invasive therapy. Penile implant can also be useful in the treatment of Peyronie's disease, priapism and transgender surgery. Precise information related to this surgery, especially complications, permits to obtain high satisfaction scores.
Penile implant is a reliable and safe solution for the management of erectile dysfunction resulting to high couple satisfaction ratings.
Background: Epithelial damage and modifications of cell differentiation are frequent in airway diseases with chronic inflammation, in which transforming growth factor‐β1 (TGF‐β1) plays an important ...role. The aim of this study was to evaluate the differentiation of human nasal epithelial cells (HNEC) after wound healing and the potential effects of TGF‐β1.
Methods: Basal, mucus, and ciliated cells were characterized by cytokeratin‐14, MUC5AC, and βIV tubulin immunodetection, respectively. Their expression was evaluated in situ in nasal polyps and in an in vitro model of wound healing in primary cultures of HNEC after wound closure, under basal conditions and after TGF‐β1 supplementation. Using RT‐PCR, the effects of TGF‐β1 on MUC5AC and DNAI1 genes, specifically transcribed in mucus and ciliated cells, were evaluated.
Results: In situ, high TGF‐β1 expression was associated with low MUC5AC and βIV tubulin expression. In vitro, under basal conditions, MUC5AC expression remained stable, cytokeratin‐14 expression was strong and decreased with time, while βIV tubulin expression increased. Transforming growth factor‐β1 supplementation downregulated MUC5AC and βIV tubulin expression as well as MUC5AC and DNAI1 transcripts.
Conclusion: After a wound, differentiation into mucus and ciliated cells was possible and partially inhibited in vitro by TGF‐β1, a cytokine that may be involved in epithelial remodeling observed in chronic airway diseases.
Compared to the 2007 edition, the 2010 French urological association onco-urology guidelines boarded the indications of partial nephrectomy (PN) as long as the procedure is technically feasible. The ...aim of this study was to assess national practice with respect to kidney surgery in the 2 years before and after current guidelines.
The national database of the Agence Technique de l'Information sur l'Hospitalisation (ATIH) was queried for procedures performed between 2009 and 2010 (era 1) and between 2011 and 2012 (era 2). The coding system of the Classification Commune des Actes Médicaux (CCAM) was used to extract kidney related procedures. For each era, procedures were sorted into partial versus radical nephrectomy (RN), laparoscopic/robotic versus open approach, and private versus public hospital. The two eras were then compared.
Overall, 28,000 and 28,907 procedures were reported in era 1 and 2 with mean 14,000 and 14,450 procedures per year respectively. PN increased from 30% to 35% (P<0.0001) between the two eras. This uptake was similar in public and private hospitals. Accordingly, laparoscopic/robotic approach has significantly increased between the two eras (35% versus 39%, P<0.0001) and even more importantly in public hospitals (P=0.0017). There was a significant increase in laparoscopic/robotic PN as well as a decrease in open RN over the years of the study period.
This study showed the development of PN and the minimally invasive approach. Over the study period, minimally invasive procedure uptake was higher in public hospitals.
Summary
Purines and more specifically adenosine monophosphate (AMP) and adenosine triphosphate (ATP) have a strong relaxant effect on smooth muscle cells of the dog, rabbit and human corpus ...cavernosum, to approximately the same degree as nitric oxide (NO). However, purines are considered as modulators of erectile function rather than key mediators. This suggests that the use of purines combined with NO donors could be effective to treat some specific erectile disorders. The relaxation induced by the combination of l‐arginine (Arg), a natural substrate for NO synthase, was assessed with a purine‐nucleotide (AMP, ATP) on a rabbit corpus cavernosum model, to determine if these substances could potentiate each other’s effect. When a pre‐contraction was induced by phenylephrine, AMP alone induced a 43% CC relaxation rate and ATP alone a 26% rate. The relaxation rate induced by Arg was lower in comparison (8% at 5.10−4 m vs. 25% at AMP 5.10−4 m and 15% at ATP 5.10−4 m). NO synthase inhibitor n‐nitro‐l‐arginine did not modify the relaxing effect provoked by AMP suggesting that the mechanism of action of this nucleotide does not involve the NO pathway. The combination of Arg at 5.10−4 m with either AMP or ATP at different doses ranging from 5.10−4 to 10−3 m significantly enhanced the relaxing response reaching rates of 62 and 80% respectively, leading to a synergistic effect. The present data indicate that a ‘NO donor’ combined with an ‘adenosine donor’ could be an effective therapeutic approach.
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