The Role of Exenterative Surgery in Advanced Urological NeoplasmsCunneen, Colla; Kelly, Michael; Nason, Gregory; Ryan, Eanna; Creavin, Ben; Winter, Des
2020 Current Urology
doi: 10.1159/000499258pmid: 32774229
Pelvic exenterative surgery is both complex and challenging, especially in the setting of locally recurrent disease. In recent decades, improved surgical techniques have facilitated more extensive resection of both locally advanced and recurrent pelvic malignancies, but its role in urological cancer surgery is highly selective. However, it remains an important part of the armamentarium for the management of bladder and prostate cancer cases where there is local invasion into adjacent organs or localized recurrence. Better diagnostics, reconstructive options and centralized care have reduced associated morbidity considerably, and it is still used rarely in palliative settings. Despite this, there is sparse prospective evidence reporting on long-term oncological or quality of life outcomes.
Survival Outcomes of Early versus Deferred Cystectomy for High-Grade Non-Muscle-Invasive Bladder Cancer: A Systematic ReviewWan, Jonathan C. M.
2020 Current Urology
doi: 10.1159/000499257pmid: 32774230
Background: Studies report that survival outcomes in patients with non-muscle-invasive bladder cancer (NMIBC) are worse when cystectomy is delayed. However, no systematic evidence is available. Objective: The aim of this study was to systematically review the literature to compare the long-term survival outcomes of patients with high-grade NMIBC (T1G3, including carcinoma in situ) who have early cystectomy compared to deferred radical cystectomy post-diagnosis. Materials and Methods: A systematic review was carried out by searching MEDLINE and related databases (Google Scholar, National Health Service Evidence) for all relevant studies published from 1946 to present. Additional studies were identified through following the references of relevant papers. Studies were included if they met the following criteria: inclusion of at least 30 patients having high-grade NMIBC, 2 groups treated with either early or deferred cystectomy with a clear temporal cut-off between groups and reported data on survival rate of at least 5 years. Results: Literature was systematically reviewed, and 10 studies were included, totaling 1,516 patients who underwent either primary cystectomy or deferred cystectomy. It was found that patients who underwent early cystectomy show improved 5- to 10-year cancer-specific survival (relative risk = 0.81, p = 0.029) suggesting a significant survival benefit when compared to deferred cystectomy. Conclusions: This study provides systematically gathered evidence showing benefit of early cystectomy. Despite this result, radical cystectomy greatly impairs quality of life and represents overtreatment for a significant minority. This result highlights the importance of a decisive treatment plan to minimize treatment delay.
Penoscrotal Incision for the Primary Implantation of an Artificial Urinary SphincterJamaer, Caroline; De Bruyn, Helene; Van Renterghem, Alexander; Baten, Evert; Van Renterghem, Koenraad
2020 Current Urology
doi: 10.1159/000499256pmid: 32774231
Background: The artificial urinary sphincter (AUS) has become the gold standard to treat severe stress urinary incontinence in men. The traditional placement of an AUS requires 2 incisions. The cuff is placed through a perineal incision and the reservoir and pump are placed via an inguinal incision. The implantation of an AUS is also possible via a single penoscrotal approach. Objectives: The objective is to demonstrate that the penoscrotal approach is not inferior to the perineal approach. Methods: Retrospective review of a single surgeon database from 2014 to 2019 was performed. A total of 40 patients have undergone implantation of an AUS via a penoscrotal incision. The outcome of patients was followed for an average of 31.3 months for adverse outcomes. Results: A primary American Medical Systems 800 sphincter was placed in 40 patients via a penoscrotal incision. The average age was 72 years. The average operating time was 35 minutes. The average cuff size was 4 cm. There were no infections of the prothesis so far. Three patients required a revision, 2 other patients needed an explant of the AUS, 1 patient underwent a cystectomy because of persistent radiocystitis. After activation of the sphincter, 33 patients (82.5%) were completely dry or using 1 pad per day for accidents. The remainder were all improved. Conclusions: AUS implantation via a single penoscrotal approach is not inferior to the perineal approach and has several advantages. The operating time is shorter and the procedure requires only 1 incision which both reduce the risk of infections, while the continence results are similar for both approaches.
Focus on Characteristics of COVID-19 with the Special Reference to the Impact of COVID-19 on the Urogenital SystemYang, Mu; Li, Hui; Sun, Jiao; Zhao, Yi; Tang, Dongqi
2020 Current Urology
doi: 10.1159/000499255pmid: 32774232
Coronavirus disease 2019 (COVID-19) is a new infectious disease that first emerged in December 2019. It has infected more than 4,890,000 people in more than 200 countries. This virus can cause progressive respiratory symptoms and severe diseases such as organ failure and death. The complete genomic sequence of SARS-CoV-2 was determined after the virus's identification, and the sequence analysis showed that SARS-CoV-2 strains are genetically similar to SARS-CoV. Angiotensin converting enzyme II is an entry receptor for SARS-CoV-2, which is highly expressed in the kidney, so some patients had symptoms of kidney damage. Here we reviewed the current progress of COVID-19 and its urogenital manifestations. In this rapidly moving field, this review was comprehensive as of May 30, 2020.
Experience of a Tertiary-Level Urology Center in Clinical Urological Events of Rare and Very Rare Incidence. V. Urological Tumors: 1. Adrenal MyelolipomaGadelkareem, Rabea A.; Moeen, Ahmed M.; Khalil, Mahmoud; Reda, Ahmed; Farouk, Mahmoud; Abdelkawi, Islam F.; Makboul, Rania; Mohammed, Nasreldin; Hameed, Dia A.
2020 Current Urology
doi: 10.1159/000499254pmid: 32774233
Objectives: To present our center's experience in the management of adrenal myelolipoma in the context of shifting from the open to the laparoscopic adrenalectomy approach. Materials and Methods: A retrospective search of our center's records was done for reported cases of adrenal myelolipoma during the period July 2001-June 2016. All the cases with histopathologically-documented adrenal myelolipoma diagnosis were included. Relevant demographic and clinical variables were studied with a comparison between the open and laparoscopic approaches. Results: Of more than 82,000 urological surgeries, 238 adrenalectomies were done with only 22 cases of myelolipoma that had a mean age and body mass index of 52.4 ± 10.3 years and 30.23 kg/m<sup>2</sup>, respectively. The main clinical presentation was accidental discovery. The largest dimension of tumors varied from 6 to 16 cm. Computed tomography described a characteristic picture of hypodense heterogeneous adrenal tumors in all cases, while magnetic resonance imaging was indicated for malignancy suspicion in only 5 cases. Adrenal tumor markers were normal in all cases. Open and transperitoneal laparoscopic adrenalectomies were used in 14 and 8 cases, respectively. The latter approach was insignificantly advantageous in the need for blood transfusion, postoperative pain degree, need for analgesia, and hospital stay duration (p = 0.22). Histo-pathological examination revealed benign adipose tissue and myeloid cells and confirmed the diagnosis of adrenal myelolipoma in all cases. Conclusions: Adrenal myelolipoma is a rare non-functioning benign tumor. Laparoscopic excision seems to be a promising alternative approach to the traditional open adrenalectomy, even in the context of large tumors and obesity.
Evaluation of Testicular Self Examination and Testicular Partner Examination in Medical versus Non-Medical StudentsVallo, Stefan; Kloft, Jennifer; Jones, Jon; John, Patricia; Khoder, Wael; Mahmud, Walid; Mani, Jens
2020 Current Urology
doi: 10.1159/000499253pmid: 32774234
Objectives: Although testicular cancer (TC) is the most common tumor in young men in Western countries, there is no official cancer detection/screening program for young men in Germany. The most important TC detection tool is self-examination of the testis. Hypothetically medical students may have a diagnosis lead time and detection superiority. This study was designed to analyze whether medical students have a possible knowledge advantage over students of other faculties concerning TC and to compare male and female cancer screening demeanor and mentality. Methods: Male and female students of various faculties at the Goethe University Frankfurt/Main, Germany were invited to participate in this internet-based anonymous questionnaire with questions about TC awareness/knowledge, testicular (self) examination, and cancer screening behavior. Results: In total 1,049 students (329 medical and 716 non-medical students) completed the questionnaire. In general, medical students had a significantly higher TC knowledge, especially in the more advanced stages of their medical studies (year 3-6). About 50% of medical students had knowledge of TC whereas only 21.3% of non-medical students knew about the disease (p < 0.01). In addition, medical students conducted scrotal examinations more frequently (34.7%) than non-medical students (18.8%). Conclusion: The knowledge about TC is low among students. In general, medical students are more aware of TC and perform more frequent testicular examinations compared to non-medical students. Female TC knowledge rises in the clinical part of studies to the same level as their male counterparts, with the result of more testicular partner examinations.
Predictive Ability for Disease-Free Survival of the GRade, Age, Nodes, and Tumor (GRANT) Score in Patients with Resected Renal Cell CarcinomaCortellini, Alessio; Buti, Sebastiano; Bersanelli, Melissa; Cannita, Katia; Pinterpe, Giada; Venditti, Olga; Verna, Lucilla; Porzio, Giampiero; Natoli, Clara; Tinari, Nicola; Cindolo, Luca; Di Clemente, Luigi; Grassadonia, Antonino; De Tursi, Michele; Ficorella, Corrado
2020 Current Urology
doi: 10.1159/000499252pmid: 32774235
Background: Recently, the GRANT (GRade, Age, Nodes, and Tumor) score was validated through an adjuvant trial population. Methods: This retrospective study evaluated the performance of the GRANT score as a prognostic model for disease-free survival (DFS), compared to the University of California Los Angeles Integrated Staging System (UISS) score, in a “real-life” population of early renal cell carcinoma patients. A uni-/multivariate analysis of DFS was also performed, to weigh the roles of baseline clinical factors. Results: From February 1998 to January 2018, 134 consecutive patients were enrolled, of which 85 patients (63.4%) had a favorable GRANT score, 49 (36.6%) an unfavorable GRANT score, and 21 (15.7%), 84 (62.6%), and 29 (21.6%) patients had a low, intermediate, or high risk of recurrence according to the UISS score, respectively. The median follow-up was 96 months. The median DFS of the overall study population was 53.7 months (95% CI: 38.4-87.8). Only bilateral renal cell carcinoma (p = 0.0041), Fuhrman grade 3/4 (p = 0.0008), pT3b- 4 (p = 0.0324), and pN1-2 (p = 0.0303) pathological status were confirmed as independent predictors of a shorter DFS by the multivariate analysis. The median DFS of patients with favorable and unfavorable GRANT scores were 84.9 (95% CI: 49.8-129) and 38.4 months (95% CI: 24.4-87.8), respectively, with a statistically significant difference (p = 0.0147). The median DFS of patients with low, intermediate, and high risk of recurrence according to the UISS score were 92.3 (95% CI: 18.1-153.9), 51.7 (95% CI: 36.2-87.8), and 49.8 months (95% CI: 31.3-129), respectively, without statistically significant differences (p = 0.4728). DFS c-statistic values were 0.59 (95% CI: 0.51-0.67) and 0.51 (95% CI: 0.42-0.60) for the GRANT and the UISS scores, respectively. Conclusion: The GRANT score might be a useful tool that is user-friendly and easy to perform in clinical practice.
High Riding Prostate: Epidemiology of Genitourinary Injury in Motorcyclists from a UK Register of over 12,000 VictimsMoss, Basil F.; Moss, Catherine E.; Dervin, Patrick; Lawrence, Thomas; Jones, Sophie; Thomas, Stephen
2020 Current Urology
doi: 10.1159/000499251pmid: 32774236
Background: The mechanism of motorcycle accidents (high speeds, pelvis behind fuel tank) may predispose to genitourinary injury (GUI) but the epidemiology is poorly understood. Previous studies have assessed GUI patterns in cyclists, and road traffic accident victims in general, but no study has analyzed GUI patterns in a large cohort of motorcyclists. Objectives: We aimed to better understand patterns of urological injuries among motorcyclists admitted to hospital. We aimed to determine any relationship between pelvic fracture and GUI patterns or severity. Methods: The Trauma Audit Research Network was reviewed to identify motorcyclists admitted between January 2012 and December 2016 (n = 12,374). Cases were divided into riders (n = 11,926) and pillion passengers (n = 448), and the data analyzed to identify urological injuries and their associations. The associations between pelvic fracture and other injury types were tested for significance by one- and two-way χ<sup>2</sup>. Results: GUI was identified in 6%. Renal trauma was the most common GUI among riders (4%) and pillions (2%). There was no statistically significant relationship between grade of renal trauma and presence of pelvic fracture. Urethral injury occurred in 0.2% of riders and passengers, and bladder injury in 0.4% of riders and 0.7% of pillions. Urethral and bladder injuries were positively associated with pelvic fracture, which was present in 81 and 92%, respectively. Testicular trauma occurred in 0.4% of riders and 0.7% of pillions. Body armor was recorded in 3% of casualties with urological trauma, and 3% overall. Conclusions: A significant proportion of motorcyclists brought to accident and emergency department have GUI, most commonly renal trauma. Pelvic fracture is more common in pillion passengers than riders, and associated with urethral and bladder injuries, but it does not predict severity of renal trauma. External genital injuries are rare, but we recommend examination in the tertiary survey, as consequences of missed injury are severe. Further research is needed to explore protective effects of motorcyclist clothing.