Abstract Context The European Association of Urology (EAU) guidelines panel on upper urinary tract urothelial cell carcinoma (UTUC) has prepared updated guidelines to aid clinicians in the current ...evidence-based management of UTUC and to incorporate recommendations into clinical practice. Objective To provide a brief overview of the EAU guidelines on UTUC as an aid to clinicians. Evidence acquisition The recommendations provided in the current guidelines are based on a thorough review of available UTUC guidelines and articles identified following a systematic search of Medline. Data on urothelial malignancies and UTUC were searched using these keywords: urinary tract cancer; urothelial carcinomas; upper urinary tract, carcinoma; renal pelvis; ureter; bladder cancer; chemotherapy; nephroureterectomy; adjuvant treatment; instillation; neoadjuvant treatment; recurrence; risk factors; and survival. References were weighted by a panel of experts. Evidence synthesis Due to the rarity of UTUC, there are insufficient data to provide strong recommendations (ie, grade A). However, the results of recent multicentre studies are now available, and there is a growing interest in UTUC. The 2009 TNM classification is recommended. Recommendations are given for diagnosis and risk stratification as well as radical and conservative treatment, and prognostic factors are discussed. A single postoperative dose of intravesical mitomycin after nephroureterectomy reduces the risk of bladder tumour recurrence. Recommendations are also provided for patient follow-up after different therapeutic strategies. Conclusions These guidelines contain information on the management of individual patients according to a current standardised approach. Urologists should take into account the specific clinical characteristics of each patient when determining the optimal treatment regimen, based on the proposed risk stratification of these tumours. Patient summary Urothelial carcinoma of the upper urinary tract is rare, but because 60% of these tumours are invasive at diagnosis, an appropriate diagnosis is most important. A number of known risk factors exist.
Masas pélvicas quísticas no ginecológicas Jesús D. Venegas; Juan C. Ruiz-Jaureguizuria; Aurora Ferrero-Collado ...
Revista chilena de radiología,
04/2024, Letnik:
30, Številka:
2
Journal Article
Odprti dostop
Las masas pélvicas quísticas son un hallazgo frecuente en las diferentes pruebas de imagen. En ocasiones, determinar su origen es dificultoso, sobre todo en el sexo femenino. Sin embargo, la historia ...clínica y las diferentes pruebas de imagen pueden ayudar a una correcta aproximación diagnóstica. Nuestro propósito es mostrar diferentes diagnósticos diferenciales de lesiones pélvicas quísticas de origen no ginecológico estudiadas en nuestro hospital.
Purpose
To describe and categorize the angiographic findings regarding prostatic vascularization, propose an anatomic classification, and discuss its implications for the PAE procedure.
Methods
...Angiographic findings from 143 PAE procedures were reviewed retrospectively, and the origin of the inferior vesical artery (IVA) was classified into five subtypes as follows: type I: IVA originating from the anterior division of the internal iliac artery (IIA), from a common trunk with the superior vesical artery (SVA); type II: IVA originating from the anterior division of the IIA, inferior to the SVA origin; type III: IVA originating from the obturator artery; type IV: IVA originating from the internal pudendal artery; and type V: less common origins of the IVA. Incidences were calculated by percentage.
Results
Two hundred eighty-six pelvic sides (
n
= 286) were analyzed, and 267 (93.3 %) were classified into I–IV types. Among them, the most common origin was type IV (
n
= 89, 31.1 %), followed by type I (
n
= 82, 28.7 %), type III (
n
= 54, 18.9 %), and type II (
n
= 42, 14.7 %). Type V anatomy was seen in 16 cases (5.6 %). Double vascularization, defined as two independent prostatic branches in one pelvic side, was seen in 23 cases (8.0 %).
Conclusions
Despite the large number of possible anatomical variations of male pelvis, four main patterns corresponded to almost 95 % of the cases. Evaluation of anatomy in a systematic fashion, following a standard classification, will make PAE a faster, safer, and more effective procedure.
The Lewinnek “safe zone” is not always predictive of stability after total hip arthroplasty (THA). Recent studies have focused on functional hip motion as observed on lateral spine-pelvis-hip x-rays. ...The purpose of this study was to assess the correlation between the Lewinnek safe zone and the functional safe zone based on hip and pelvic motion in the sagittal plane.
Three hundred twenty hips (291 patients) underwent primary THA using computer navigation. Two hundred ninety-six of these hips (92.5%) were within the Lewinnek safe zone as determined by inclination of 40° ± 10° and anteversion of 15° ± 10°. All patients had preoperative and postoperative standing and sitting lateral spinopelvic x-rays. The combined sagittal index (CSI), a combination of sagittal acetabular and femoral position, was measured for each patient and used to assess the functional safe zone. Data analysis was performed to identify hips in the Lewinnek safe zone inside and outside the sagittal functional safe zone. Predictive factors for hips outside the functional safe zone were identified.
Of the 296 hips within the Lewinnek safe zone, 254 (85.8%) were also in the functional safe zone. Forty-two patients were outside the functional safe zone based on CSI; 19 had an increased standing CSI and 23 had a decreased sitting CSI, all were considered at risk for dislocation. Predictive factors for falling outside the functional safe zone were increased femoral mobility (P < .001, r = 0.632), decreased spinopelvic mobility (P < .001, r = 0.455), and pelvic incidence (P < .001, r = 0.400).
In this study, 14.2% of hips within the Lewinnek safe zone were outside the functional safe zone, identifying a potential reason hips dislocate despite having “normal” cup angles. The best predictor for falling outside the functional safe zone, both preoperatively and postoperatively, was femoral mobility, not the sagittal cup position (ie, cup anteinclination).
Level III, retrospective review.
Reconstruction of the hip joint in the setting of metastatic lesions of the acetabulum is particularly challenging and can carry significant morbidity for patients who are already medically frail. ...Novel techniques to minimize morbidity and optimize function warrant exploration for these patients. Here, we present a 50-year-old woman was unable to walk secondary to metastatic breast cancer involving the acetabulum with articular disruption. A primary reconstruction technique was used that combined percutaneous stabilization of the acetabulum and cemented total hip arthroplasty using primary components. Existing reconstructive techniques for metastatic lesions of the acetabulum often require extensive open surgical approaches and revision components. Percutaneous acetabular stabilization combined with cemented total hip replacement may be a less-morbid and equally durable option.
INTRODUCTION Lateral lumbar interbody fusion (LLIF) is a less disruptive approach to the lumbar spine that allows for decompression and reconstruction of the intervertebral disk. Despite minimizing ...damage, this approach risks damage to the lumbar plexus during the operative traverse of the psoas muscle. We propose that pelvic anatomy variations can render the previously-defined operative safe-zones unsafe and have significant impact on surgical access. METHODS We reviewed imaging on 99 consecutive patients (42 M; 57 F) that underwent LLIF at our institution. We categorized patients based on 3-feet standing x-rays and preoperative MRI, assessed for position of the iliac crest and percentage obscuration with respect to the L4/5 disc space. We further classified the location of both the L3 and L4 nerve roots into 4 equidistant zones along the AP axis of the disc spaces well as anterior/posterior subzones in Zones 1 and 2. The distance between the anterior aspect of the psoas (ATP) and closest great vessel was measured as well. Pelvis types were assessed for ability to perform the ‘orthogonal maneuver’ in the ATP approach. RESULTS 52% of the male subjects compared to 33% of female subjects had an iliac crest above the L4 pedicle on lateral xray. The percent obscuration of the L4/5 disc space by the iliac crest revealed a binary distribution with the majority of L4/5 disc space either completely obscured or completely visible allowing full lateral access. 95% of the L4 nerve root was found in zone 1, while the L3 nerve root was more heterogeneous in location. The average distance between psoas muscle and the vessel was 16.25mm implying binary ability to perform the ATP approach in most cases. The gynecoid and android pelvis were the most and least favorable pelvis types respectively in performing the ATP orthogonal maneuver. CONCLUSION Understanding psoas and pelvic anatomy plays a critical role in determining optimal operative approach for lateral and ATP interbody fusion.
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