Urothelial bladder cancer (UBC) is characterised by a high risk of recurrence. Patient monitoring is currently based on iterative cystoscopy and on urine cytology with low sensitivity in ...non-muscle-invasive bladder cancer (NMIBC). Telomerase reverse transcriptase (TERT) is frequently reactivated in UBC by promoter mutations.
We studied whether detection of TERT mutation in urine could be a predictor of UBC recurrence and compared this to cytology/cystoscopy for patient follow-up. A total of 348 patients treated by transurethral bladder resection for UBC were included together with 167 control patients.
Overall sensitivity was 80.5% and specificity 89.8%, and was not greatly impacted by inflammation or infection. TERT remaining positive after initial surgery was associated with residual carcinoma in situ. TERT in urine was a reliable and dynamic predictor of recurrence in NMIBC (P<0.0001). In univariate analysis, TERT positive-status after initial surgery increased risk of recurrence by 5.34-fold (P=0.0004). TERT positive-status was still associated with recurrence in the subset of patients with negative cystoscopy (P=0.034).
TERT mutations in urine might be helpful for early detection of recurrence in UBC, especially in NMIBC.
Vesicourethral dysfunction is very frequent in multiple sclerosis (MS) and has functional consequences for patients' quality of life and also an organic impact following complications of the ...neurogenic bladder on the upper urinary tract. While the functional impact and its management are well documented in the literature, the organic impact remains underestimated and there are no consensual practical guidelines for the screening and prevention of MS neurogenic bladder complications. The aim of this review of the literature, focused on identifying the risk factors of urinary tract complications in MS, is to put forward well informed considerations to help in the definition of practical guidelines for the follow-up of the neurogenic bladder in MS in order to improve its prevention and patient management. Four main risk factors have been identified for upper urinary tract damage: the duration of MS, the presence of an indwelling catheter, high-amplitude neurogenic detrusor contractions and permanent high detrusor pressure. Detrusor-sphincter dyssynergia, age over 50 and male sex may form three additional risk factors. Recommendations for long-term urological follow-up, taking into account these specific risks are constructed according to the procedures recommended by the French Health Authorities. Multiple Sclerosis 2007; 13: 915-928. http://msj.sagepub.com
Purpose
To compare long-term outcomes between photoselective vaporization (PVP) and Open simple prostatectomy (OSP) for prostates > 80 cc.
Methods
Men operated either by PVP or OSP for BPH > 80 cc ...were included in two expert centres. Functional and uroflowmetric outcomes were assessed pre- and postoperatively. Data were collected prospectively in the PVP group and retrospectively in the OSP group and compared at long-term follow-up. Complications and re-intervention rates were used as main outcomes.
Results
332 men underwent surgery: 132 PVP were performed in a fist expert-centre and 200 OSP were performed in a second one with a median follow-up of 54 and 48 months, respectively. Mean Prostate volume was similar between OSP and PVP group (119 vs 116 cc). Major complications were more common in the OSP group (12.5 vs 1.5%,
p
< 0.001). At long-term follow-up, Qmax was higher and PVR was lower (
p
< 0.05) in the OSP group. IPSS score was similar between groups (
p
= 0.45) but the Qol was better in the OSP group (0.9 vs. 1.6;
p
< 0.05). There were more re-interventions in the PVP group compared to OSP (15.2 vs. 0%,
p
< 0.005).
Conclusion
PVP is a good alternative for prostates > 80 cc particularly for fragile patients as it is associated with a lower complication rate. At long-term follow-up, IPSS was similar between groups, but Qol was better in the OSP group. Patients treated by PVP should be informed that they could require reoperation in 15% of the cases.
Objective
To train and to test for prostate zonal segmentation an existing algorithm already trained for whole-gland segmentation.
Methods
The algorithm, combining model-based and deep learning–based ...approaches, was trained for zonal segmentation using the NCI-ISBI-2013 dataset and 70 T2-weighted datasets acquired at an academic centre. Test datasets were randomly selected among examinations performed at this centre on one of two scanners (General Electric, 1.5 T; Philips, 3 T) not used for training. Automated segmentations were corrected by two independent radiologists. When segmentation was initiated outside the prostate, images were cropped and segmentation repeated. Factors influencing the algorithm’s mean Dice similarity coefficient (DSC) and its precision were assessed using beta regression.
Results
Eighty-two test datasets were selected; one was excluded. In 13/81 datasets, segmentation started outside the prostate, but zonal segmentation was possible after image cropping. Depending on the radiologist chosen as reference, algorithm’s median DSCs were 96.4/97.4%, 91.8/93.0% and 79.9/89.6% for whole-gland, central gland and anterior fibromuscular stroma (AFMS) segmentations, respectively. DSCs comparing radiologists’ delineations were 95.8%, 93.6% and 81.7%, respectively. For all segmentation tasks, the scanner used for imaging significantly influenced the mean DSC and its precision, and the mean DSC was significantly lower in cases with initial segmentation outside the prostate. For central gland segmentation, the mean DSC was also significantly lower in larger prostates. The radiologist chosen as reference had no significant impact, except for AFMS segmentation.
Conclusions
The algorithm performance fell within the range of inter-reader variability but remained significantly impacted by the scanner used for imaging.
Key Points
•
Median Dice similarity coefficients obtained by the algorithm fell within human inter-reader variability for the three segmentation tasks (whole gland, central gland, anterior fibromuscular stroma)
.
•
The scanner used for imaging significantly impacted the performance of the automated segmentation for the three segmentation tasks
.
•
The performance of the automated segmentation of the anterior fibromuscular stroma was highly variable across patients and showed also high variability across the two radiologists
.
Introduction and hypothesis
The aim of our study was to evaluate the efficiency and safety of synthetic mid-urethral slings (sMUS) for the treatment of stress urinary incontinence (SUI) in women with ...neurogenic lower urinary tract dysfunction (NLUTD).
Methods
A systematic review was performed and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. MEDLINE, Embase and Cochrane controlled trials databases were systematically searched from January 1995 to April 2021. Studies including adult women with NLUTD who had a sMUS for SUI were considered for inclusion. Primary outcome was success of the surgery according to study criteria. Secondary outcomes were complications, especially de novo urgency, urinary retention, tape exposure and revision for complications.
Results
A total of 752 abstracts were screened and 9 studies were included, representing 298 patients. The mean age was 52 years and median follow-up was 41.3 months. sMUS insertion was successful in 237 patients (79.5%). The median rate of de novo urgency was 15.7% (range 8.3–30%). In patients with spontaneous voiding, the median rate of retention was 19.3% (range 0–46.7%) and 21 out of 26 patients required intermittent self-catheterisation. Four cases of tape exposure were reported, and 8 patients underwent a revision for complications.
Conclusions
This review suggests that sMUS might offer interesting success rates and acceptable morbidity and could be considered for the treatment of SUI in women with NLUTD. Further studies are required to define which patients would be more likely to benefit from this intervention, as well as its place among the other surgical treatments for SUI.
Background
In central sterile services departments (CSSD), the functionality of rigid endoscopes, which are complex and fragile reusable devices, is usually controlled visually and is considered a ...complex and subjective task. ScopeControl® was developed to provide an automated quality control of rigid endoscopes by measuring the value of six parameters: viewing angle (VA), field of view (FV), color correctness (CC), light transmission (LT), fibers transmission (FT), and focus (FC). The aim of the present study was to assess the ability of ScopeControl® to pre-emptively identify endoscope defects before the surgeon considers them as defective.
Methods
The same endoscope was evaluated by surgeons during surgery using a scoring scale as well as the CSSD staff using the ScopeControl® during reprocessing. The ScopeControl® categorized the endoscope into 3 groups: “passed,” “in danger,” and “failed.” Correlations between the surgeon’s evaluation and results of the ScopeControl® were calculated.
Results
One hundred sixty-six controls were carried out concerning 51 different endoscopes. According to the surgeon’s evaluation, 78.9% and 80.7% of controls were considered as satisfactory for image and brightness quality, respectively. Results obtained using ScopeControl® found that 13.3% of controls were considered as “passed,” 31.3% “in danger,” and 55.4% “failed,” with poor correlation with the surgeons’ evaluation. LT and FT parameters represented 95.2% of the reasons for failures. The ability of the ScopeControl® to detect endoscope defects earlier than surgeons was validated by tracking the results of endoscopes used and controlled several times.
Conclusion
The ScopeControl® achieved an objective and consistent quality control of endoscopes and showed poor correlation with the surgeon’s opinion. In practice, the ScopeControl® could avoid the use of defective endoscopes in the surgery unit and thus improve the quality of the surgical procedure.
Objective To evaluate predictive radiological elements for adherent perinephric fat (APF) and the Mayo adhesive probability (MAP) score in the setting of open partial nephrectomy, and to assess their ...reproducibility. Patients and Methods We performed a retrospective case-control study involving 86 patients who had open partial nephrectomies performed by a single surgeon between January 1, 2009 and April 1, 2015. Radiological elements were assessed by 4 readers blinded to patient APF status. Univariate and multivariate analyses were performed for all radiological and clinical factors. Reproducibility was analyzed using agreement coefficients. Results On univariate analysis for radiological findings, lateral and posterior fat thickness (odds ratio OR: 1.084 1.033, 1.138, P < .001), stranding (OR: 2.179 1.431, 3.318, P < .001), −80 HU fat area, and the MAP score (OR: 1.797 1.332, 2.424, P < .001) were predictive of APF. On multivariate analysis, only age and the MAP score remained statistically significant (OR: 1.060 1.005, 1.118, P = .03; and OR: 1.560 1.137, 2.139, P = .0058, respectively). The reproducibility of the MAP score was fair (AC1 = 0.367 and kappa F = 0.353), as was that of stranding (AC1 = 0.499, kappa F = 0.376). The agreement was important if we defined a “low” (0 to 3) or “high” (4 or 5) score (AC1 = 0.706 and kappa F = 0.681). Conclusion The MAP score was the element that best predicted APF in our study, although its reproducibility among our readers was only fair. The agreement becomes important if we defined “low or high” score.
In all, 30% to 90% of prostate cancer patients undergoing radical prostatectomy (RP) recover their erectile capacity. No effective post RP erectile rehabilitation program exists to date. The aim of ...this exploratory qualitative study is to explore the needs of these patients and to develop a patient education program (PEP) which meets these needs. Interviews were carried out by a socio-anthropologist with prostate cancer patients treated by RP within the 6 previous months. The needs and expectations identified led to the choice of a logical model of change for the construction of the PEP. Nineteen patients were included in the study; 17 of them were living with a partner. Two categories of patients appeared during the interviews: informed patients resigned to lose their sexuality and patients misinformed about the consequences of the surgery. The tailored program was built on the Health Belief Model and provides six individual sessions, including one with the partner, to meet the needs identified. This study designed the first program to target comprehensively the overall sexuality of the patient and his partner, and not only erection issues. To demonstrate the effectiveness of this program, a controlled, multicentric clinical trial is currently ongoing.
Objective
Annual countrywide data are scarce when comparing surgical approaches in terms of hospital stay outcomes and costs for radical prostatectomy (RP). We aimed to assess the impact of surgical ...approach on post-operative outcomes and costs after RP by comparing open (ORP), laparoscopic (LRP), and robot-assisted (RARP) RP in the French healthcare system.
Patients and methods
Data from all patients undergoing RP in France in 2020 were extracted from the central database of the national healthcare system. Primary endpoints were length of hospital stay (LOS including intensive care unit (ICU) stay if present), complications (estimated by severity index), hospital readmission rates (at 30 and 90 days), and direct costs of initial stay.
Results and limitations
A total of 19,018 RPs were performed consisting in ORP in 21.1%, LRP in 27.6%, and RARP in 51.3% of cases. RARP was associated with higher center volume (
p
< 0.001), lower complication rates (
p
< 0.001), shorter LOS (
p
< 0.001), and lower readmission rates (
p
= 0.004). RARP was associated with reduced direct stay costs (2286 euros) compared with ORP (4298 euros) and LRP (3101 euros). The main cost driver was length of stay. The main limitations were the lack of mid-term data, readmission details, and cost variations due to surgery system.
Conclusions
This nationwide analysis demonstrates the benefits of RARP in terms of post-operative short-term outcomes. Higher costs related to the robotic system appear to be balanced by patient care improvements and reduced direct costs due to shorter LOS.
The prostate cancer 3 (PCA3) gene was discovered in 1999, on the basis of differential expression between cancer and noncancerous prostate tissue. Including the first study published in 2003, 11 ...clinical studies have evaluated its utility for the diagnosis of prostate cancer by measuring the number of PCA3 RNA copies in urine enriched with prostate cells. Although the sensitivity of the PCA3 test was less than that of serum prostate-specific antigen (PSA), its specificity appeared to be much better, particularly in patients with a previous negative biopsy. Recent studies also have suggested that this test could be used to predict cancer prognosis.
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