Abstract Objective To investigate utility and limitations of 3-Tesla diffusion-weighted (DW) magnetic resonance imaging (MRI) for differentiation of benign versus malignant renal lesions and renal ...cell carcinoma (RCC) subtypes. Materials and methods Sixty patients with 71 renal lesions underwent 3 Tesla DW-MRI of the kidney before diagnostic tissue confirmation. The images were retrospectively evaluated blinded to histology. Single-shot echo-planar imaging was used as the DW imaging technique. Apparent diffusion coefficient (ADC) values were measured and compared with histopathological characteristics. Results There were 54 malignant and 17 benign lesions, 46 lesions being small renal masses ≤4 cm. Papillary RCC lesions had lower ADC values ( p = 0.029) than other RCC subtypes (clear cell or chromophobe). Diagnostic accuracy of DW-MRI for differentiation of papillary from non-papillary RCC was 70.3% resulting in a sensitivity and specificity of 64.3% (95% CI, 35.1–87.2) and 77.1 (95% CI, 59.9–89.6%). Accuracy increased to 83.7% in small renal masses (≤4 cm diameter) and sensitivity and specificity were 75.0% and 88.5%, respectively. The ADC values did not differ significantly between benign and malignant renal lesions ( p = 0.45). Conclusions DW-MRI seems to distinguish between papillary and other subtypes of RCCs especially in small renal masses but could not differentiate between benign and malignant renal lesions. Therefore, the use of DW-MRI for preoperative differentiation of renal lesions is limited.
Evaluation of the true incidence of balanitis xerotica obliterans (BXO) among boys younger than 10 years.
In a period of 13 months, 75 boys younger than 10 years were treated for phimosis. Suspicion ...of BXO was raised in phimosis grade 2 or 3 (classification by Kikiros). Patients were offered primarily either circumcision or conservative therapy and circumcision secondarily (if treatment failed in the conservative group). Each circumcision specimen was examined histopathologically.
Circumcision was primarily performed in 29 and secondarily in 17 patients. The mean age was 3.7 years (range 1-10). BXO, chronic inflammation, and normal histological results were found in 8/26/12 (17.4/56.5/26.1%) cases, respectively. The mean follow-up was 8.1 months. No recurrences were reported.
The incidence of BXO appears to be higher than previously reported. The clinical appearance in children may be confusing. The preoperative BXO suspicion did not correlate with the final histopathological results.
Purpose
To evaluate the ability of dynamic contrast-enhanced (DCE) 3-T MRI for preoperative differentiation between benign and malignant renal tumors and RCC subtypes.
Methods
Sixty consecutive ...patients undergoing preoperative DCE 3-T MRI of the kidney were evaluated in this retrospective IRB-approved evaluation. Fifty-four malignant tumors and 17 benign tumors upon surgical verification were included. Relative enhancement values of complete lesions and the most enhancing part of the lesions (hotspot) were measured using four repetitions: precontrast, arterial, venous, and delayed.
Results
Mean relative enhancement patterns between malignant and benign lesions did not differ significantly during any postcontrast phase (
p
> 0.05). The highest mean enhancement during all postcontrast phases was identified in clear cell RCC followed by chromophobic RCC. The enhancement pattern in papillary RCC was significantly less than that of non-papillary RCC lesions. Arterial enhancement was an independent predictor for RCC subtypes (papillary vs. non-papillary,
p
= 0.008). The diagnostic accuracy for differentiation of papillary from non-papillary RCC based on ROC analysis was 76.4 % 95 % CI 62.2–87.2 %;
p
< 0.0001.
Conclusions
Dynamic contrast-enhanced MRI at 3 T showed intermediate diagnostic capability for differentiation between papillary and non-papillary RCC subtypes but could not differentiate between benign and malignant renal lesions.
Objective To compare oncologic outcomes in an international cohort of patients who underwent either partial ureterectomy (PU) or radical nephroureterectomy (RNU) for upper tract urothelial carcinoma ...(UTUC). Methods A subgroup of patients from the UTUC Collaboration with operation classified as PU or RNU was used (n = 835). Clinicopathologic outcomes were evaluated. Survival was assessed using the Kaplan-Meier method. Cox regression addressed recurrence-free survival (RFS) and cancer-specific survival (CSS). Results Median age and follow-up were 69 years (range 32-97 years) and 34 months (range 1-246 months), respectively. Relapse occurred in 28.5% of patients (19.6% local, 8.9% systemic). At analysis, 180 patients (21.6%) died of UTUC. Eighty-one patients (9.7%) underwent PU and 754 (90.3%) underwent RNU. High tumor grade (77.3% vs 55.6%, P <.001) and advanced T stage (>T1, 41.7% vs 30.9%, P <.001) were significantly more common in the RNU cohort. Significantly more patients in the PU group received adjuvant chemotherapy than the RNU arm (25.9% vs 16.8%, respectively, P = .05). Kaplan-Meier median 5-year survival probabilities for RFS (69.4% vs 75.9%, P = .06) and CSS (67.5% vs 72.1%, P = .06) were not significantly different between PU and RNU. On multivariable analysis, Eastern Cooperative Oncology Group (ECOG) performance status, tumor stage, tumor necrosis, and lymph node (LN) status were significantly associated with CSS. Conclusion In patients with UTUC, PU seems to provide oncologic efficacy equal to RNU. Ability to maximize global renal function with utilization of PU is an attractive strategy in carefully selected patients.
Purpose
To evaluate the diagnostic potential of choline measurements by in vivo magnetic resonance spectroscopy (MR spectroscopy) for diagnosis of renal masses.
Methods
Twenty-eight patients with 29 ...renal lesions underwent prospectively preoperative 3 T MR spectroscopy of renal masses before diagnostic tissue confirmation. A respiratory-triggered single-voxel MR spectroscopy was performed in these masses using the point-resolved spectroscopy (TR, 2,000 ms, TE, 135 ms) sequence. The spectra were analyzed for choline resonances at 3.23 ppm, which were normalized by the noise outside the diagnostic range of the spectra. Image and spectra analyses were conducted blinded to all patient-related data. Histological results of the surgical resection or image-guided biopsy specimen were defined as the standard of reference. Appropriate statistical tests were used.
Results
Seventeen lesions were histopathologically malignant, and 12 lesions were benign. Mean choline SNR in malignant lesions was 2.9 and 1.33 in benign lesions (
P
= 0.019). ROC analysis revealed an area under the curve of 0.721 and SE 0.0763 with a
P
value of 0.0038. A Cho SNR ≥2 as cutoff for malignancy resulted in a sensitivity and specificity of 52.9 % (95 % CI 27.8–77.0 %) and 91.7 % (61.5–99.8 %), respectively. Although not significant, choline was observed more regularly in G3 (4 out of 5) compared with G2 (5 out of 12) RCC (
P
> 0.05).
Conclusions
We could demonstrate the potential role of in vivo MR spectroscopy as a tool for differentiating benign from malignant masses with a high positive predictive value of 90 %. Furthermore, choline may be a biomarker of RCC aggressiveness.
Purpose
To evaluate the
Single-Incision Transumbilical Surgery
(SITUS) technique as compared to an established laparoendoscopic single-site surgery (LESS) technique (
Single-Port Laparoscopic Surgery
..., SPLS) and conventional laparoscopy (CLS) in a surgical simulator model.
Methods
Sixty-three medical students without previous laparoscopic experience were randomly assigned to one of the three groups (SITUS, SPLS and CLS). Subjects were asked to perform five standardized tasks of increasing difficulty adopted from the
Fundamentals of Laparoscopic Surgery
curriculum. Statistical evaluation included task completion times and accuracy.
Results
Overall performances of all tasks (except precision cutting) were significantly faster and of higher accuracy in the CLS and SITUS groups than in the SPLS group (
p
= 0.004 to
p
< 0.001). CLS and SITUS groups alone showed no significant difference in performance times and accuracy measurements for all tasks (
p
= 0.048 to
p
= 0.989).
Conclusions
SITUS proved to be a simple, but highly effective technique to overcome restrictions of SPLS. In a surgical simulator model, novices were able to achieve task performances comparable to CLS and did significantly better than using a port-assisted LESS technique such as SPLS. The demonstrated advantages of SITUS may be attributed to a preservation of the basic principles of conventional laparoscopy, such as the use of straight instruments and an adequate degree of triangulation.
Blunt trauma to the lower urinary tract is usually associated with pelvic fractures. The European Association of Urology (EAU) provides guidelines to diagnose and treat these injuries. The guidelines ...summarise the available evidence and provide recommendations on diagnosis and treatment of these patients. Therefore, these guidelines are important adjuncts to the urologist and emergency physician in the clinical decision-making. However, strict adherence to the guidelines is not always easy or possible because of concomitant injuries obscuring the clinical picture. This is illustrated by two case reports of concomitant injuries of the lower urinary tract (bladder with urethral injury). The clinical decisions will be discussed point by point and should serve as a practical teaching moment for the reader.
The recently introduced Freiburg index of patient satisfaction (FIPS) is a new questionnaire to assess treatment-related patient satisfaction after surgery and interventional procedures. The ...questionnaire had first been tested psychometrically in a mixed population of urology patients. The current study describes the results of an interdisciplinary validation. In addition, an English version is presented.
The questionnaire was used in two cohorts of cardiology (n = 120) and surgical (n = 127) patients. The evaluation included a comprehensive methodological and statistical evaluation including validation in comparison to the ZUF-8 questionnaire.
The psychometric evaluation showed good results. The analyzed samples showed no missing values or ceiling effects. Furthermore, a high reliability (Cronbach's alpha 0.82), unidimensionality, sufficient distribution of values and validity (high correlation to the ZUF-8, r = 0.65, p < 0.001) of the questionnaire could be confirmed.
The FIPS constitutes an interdisciplinary validated questionnaire to evaluate treatment-related patient satisfaction which can be used to objectify and compare results from clinical studies and quality in patient care. Colleagues of English-speaking countries are invited to participate in the validation of the hereby presented English version.
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