Pulmonary metastases in urogenital cancers: Surgical treatment and outcomes

IntroductionMetastasis is remaining one of the major problems in cancer treatment. Like many other malignancies, urogenital tumors originating from kidney, prostate, testes, and bladder tend to metastasize to the lungs.The aim of this retrospective study is to evaluate the operative results and prognosis of pulmonary metastasectomy in patients with primary urogenital tumors.MethodsThis study was approved by the local ethical committee. We retrospectively analyzed the surgical and oncological results of patients who underwent lung resections for urogenital cancer metastases in our department between 2002 and 2018. Demographic data and clinicopathological features were extracted from the medical records. Survival outcomes according to cancer subtypes and early postoperative results of VATS and thoracotomy were analyzed.Results22 out of 126 patients referred for pulmonary metastasectomy to our department had metastases from urogenital tumors. These patients consisted of 17 males and five females. Their metastasis originated from renal cell carcinoma (RCC; n = 9), bladder tumor (n = 7), testis tumors (n = 4), and prostate cancer (n = 2). There was no intraoperative complication. Postoperative complications were seen in 2 patients.ConclusionsAlthough pulmonary metastasectomy in various types of tumors is well known and documented, the data is limited for metastases of urogenital cancers in the literature. Despite the limitations of this study, we aim to document our promising results of pulmonary metastasectomy in patients with primary urogenital tumors and wanted to emphasize the role of minimally invasive approaches.     

Foot soft tissue myopericytoma: Case-report and review

IntroductionMyopericytoma is a rare tumor of deep soft tissues, originating from pericytes and characterized by numerous thin walled blood vessels.Case reportWe report a case of myopericytoma found at the level of the second toe of the right foot.A patient came to the Endocrinology Surgery Department of Catania Polyclinic because of a presence of a small swelling in the plantar region, between the 2nd and 3rd toe of the right foot. At the anatomopathological examination, the escalated lesion showed a neoformation of 0.6 cm in diameter, well circumscribed, capsulated, with myopericytoma diagnosis.DiscussionIts histopathological appearance is similar to myofibromatic lesions from glomic and angiomyoma tumors. It is a rare tumor that affects all ages with a peak after 50 years 3. The most frequent localization is at the lower extremities, particularly in soft subcutaneous tissues, but can rarely occur in other sites.ConclusionAt the anatomopathological evaluation, the immunohistochemical examination for the correct formulation of the diagnosis is essential and an adequate surgical excision is important.     

Safety and Efficacy of Mirabegron: Analysis of a Large Integrated Clinical Trial Database of Patients with Overactive Bladder Receiving Mirabegron,Antimuscarinics, or Placebo

BackgroundMirabegron, a β3-adrenoreceptor agonist, is an alternative drug to antimuscarinics for overactive bladder (OAB) symptoms.ObjectiveTo summarise safety and efficacy reporting of mirabegron treatment for OAB symptoms.Design, setting, and participantsPooled data analysed from 10 phase 2–4, double-blind, 12-wk mirabegron monotherapy studies in adults with OAB who had received one or more doses of study drug.InterventionMirabegron: 25 and 50 mg; antimuscarinics: solifenacin (2.5, 5, and 10 mg) and tolterodine extended release (4 mg).Outcome measurements and statistical analysisBaseline OAB-related characteristics, intrinsic and extrinsic factors, and analyses by age (<65 vs ≥65 yr and <75 vs ≥75 yr) and sex were assessed. Solifenacin 2.5 and 10 mg groups were not included in the efficacy analyses (small patient numbers). Safety was evaluated using the proportion of treatment-emergent adverse events. Efficacy variables were derived from bladder diaries (baseline and week 12).Results and limitationsBaseline hypertension and diabetes were more frequent across treatment groups in the older versus younger age groups and in men versus women. Within sexes, frequencies were similar between treatment groups. Some differences were observed in baseline characteristics, including type of incontinence and medical history between sexes. No previously unreported safety concerns were identified. Improvements in efficacy (mean number of incontinence episodes/24 h, micturitions/24 h, urgency episodes/24 h, volume voided/micturition, and nocturia episodes) versus placebo were observed in all treatment groups. Significant treatment-by-subgroup interactions included change from baseline in the mean number of incontinence episodes/24 h by age (<65 vs ≥65 yr), nocturia by age (<65 vs ≥65 yr and <75 vs ≥75 yr), and urgency episodes by previous OAB medication.ConclusionsData from this integrated database of 10 mirabegron studies reaffirm the safety and efficacy profiles of mirabegron, solifenacin, and tolterodine in adults of different age groups and sexes.Patient summaryOveractive bladder is a complex of symptoms including a compelling desire to pass urine that leads to increased frequency, which may lead to a degree of incontinence if you do not reach the toilet in time and may wake you from sleep. We pooled data from 10 different studies of mirabegron in patients with overactive bladder symptoms, and looked at the effect in the total number of patients who received the treatment, as well as in different age groups and between men and women. No new safety concerns were identified, and mirabegron improved the symptoms of overactive bladder.     

The incidence of apparent congenital urogenital anomalies in North Indian newborns: A study of 20,432 pregnancies

Introduction and objectivesOver the last few decades, congenital anomalies of the urogenital system have increased globally as a consequence of advanced maternal age at pregnancy and developments in assisted reproductive techniques. The aim of this study was to determine the incidence of apparent congenital urogenital anomalies in North Indian newborns and the causative factors.Subjects and methodsThe data of all newborns delivered at our institute between September 2012 and August 2014 were collected for this prospective study. The predetermined data format included the newborns’ birth weight and gestational age, the maternal age, parity and infertility treatment, if any. Newborns weighing less than 1000 g or born before 32 weeks of gestation were excluded from the study.ResultsDuring the study period, 20,432 deliveries were recorded (10,952 male and 9480 female babies). Apparent urogenital congenital anomalies were diagnosed in 799, with an incidence of 39.1 per 1000 newborns. The most common anomaly was cryptorchidism found in 678 newborns, while hypospadias was noted in 61, ambiguous genitalia in 34, congenital hernia/hydrocele in 20 and an exstrophy–epispadias complex in 5 children. Prune belly syndrome was seen in 1 newborn. Newborns weighing less than 2500 g had a higher proportion of anomalies (9.64%) in comparison to those weighing over 2500 g (1.99%) (p = 0.0001). A maternal age >30 years, parity >2 and infertility treatment were recorded in 5.40%, 4.93% and 9.80%, respectively, and all were independently associated with an increased risk of urogenital anomalies (p = 0.0001).ConclusionsThe incidence of apparent congenital urogenital anomalies was 3.91%. Infertility treatment, parity >2 and a maternal age >30 years were independently associated with an increased risk of congenital urogenital anomalies.     

Detrusor wall thickness compared to other non-invasive methods in diagnosing men with bladder outlet obstruction: A prospective controlled study

IntroductionThe current study aims to compare the diagnostic accuracy of detrusor wall thickness to other noninvasive, tools, using pressure flow studies as a reference, in the assessment of bladder outlet, obstruction among men presenting with lower urinary tract symptoms.Patients and MethodsMen aged 50 or older presenting with lower urinary tract symptoms were evaluated for bladder outlet, obstruction using detrusor wall thickness (measured by a transabdominal 7.5 MHz ultrasound) and, other non-invasive tools (namely uroflowmetry, post-void residual, and prostate volume), and the results were compared to pressure flow study.ResultsDetrusor wall thickness ranged from 0.7 mm to 7 mm (mean ± SD of 2.39 ± 1.64 mm), and 21 patients, were classified as obstructed (thickness ≥ 2 mm). Based on pressure flow study 23 patients had, bladder outlet obstruction. Detrusor wall thickness had the highest accuracy (88.0%), the highest, specificity (92.6%) and the highest positive predictive value (90.5%) among the non-invasive tests.ConclusionsDetrusor wall thickness measurement can be used to diagnose and quantify bladder outlet obstruction, non-invasively in men with lower urinary tract symptoms, with an accuracy approaching that of the standard pressure flow studies.     

Robotic-assisted laparoscopic radical cystectomy: evaluation of functional and oncological results

Purposeradical cystectomy remains the most effective treatment for patients with localized, invasive bladder cancer and recurrent noninvasive disease. We report our experience with 84 consecutive cases of robotic assisted laparoscopic radical cystectomy with regard to perioperative results, pathological outcomes and surgical complications.Materials and methodsa total of 84 consecutive patients (70 male and 14 female) underwent robotic radical cystectomy and urinary diversion at our institution from January 2007 to August 2010 for clinically localized bladder cancer. Outcome measures evaluated included operative variables, hospital recovery, pathological outcomes and complication rate.Resultsmean age of this cohort was 65.5 years (range 28 to 82). Of the patients 62 underwent ileal conduit diversion, 22 received a neobladder. Mean operating room time for all patients was 261 min. (range: 243-618 min.) and mean surgical blood loss was 298 ml (range: 50-2000 ml). 29% of the cases were pT1 or less disease, 38% were pT2, 26% and 7% were pT3 and T4 disease respectively, 15% were node positive. Mean number of lymph nodes removed was 15 (range 1 to 33). In 2 cases (2.4%) there was a positive surgical margin. Mean days to flatus were 2.12, bowel movement 2.87 and discharge home 17.7 (range: 10-33). There were 45 postoperative complications with 11.9% having a major complication (Clavien grade 3 or higher). At a mean followup of 16.7 months 10 patients (11%) had disease recurrence and 2 died of disease.Conclusionsour experience with robotic radical cystectomy for the treatment of bladder cancer suggests that in proper hands this procedure provides acceptable surgical and pathological outcomes.     

Evaluation of HER2 protein overexpression in non-muscle-invasive bladder cancer with emphasis on tumour grade and recurrence

Objectiveto evaluate the prognostic value of HER2 expression in non-muscle invasive bladder transitional cell carcinoma (TCC) with special emphasis in the high grade population.Materials and methods (patients)Tissue microarrays (TMA) were performed with representative TUR-B specimens from 84 patients with non-muscle invasive bladder TCC (40 pT1GII and 44 pT1GIII) treated in our institution. Depth of invasion and grade were uniformly assigned by the same pathologist who performed blind immunohistochemical analysis with Hercep test: 3+ was considered strong positive HER2 overexpression. Other clinico-pathological variables were also assessed.ResultsHER2 protein overexpression was detected in 30/44 (68.2%) pT1GIII lesions and predicted recurrence in this subgroup of bladder TCC (p < 0.01). Negative HER2 expression was detected in 26/40 (65%) cases with pT1GII TCC, and this condition was more frequent in unifocal tumours, without angiogenesis, with low recurrence rate and without progression. Recurrence-free survival can also be anticipated by HER 2 expression within pT1GII tumours (p < 0.01).ConclusionHER2 expression using Hercep test may be useful to predict recurrence in non-muscle invasive bladder TCC. The potential application of this study, especially regarding prediction of response to BCG, should be prospectively confirmed in multi-institutional trials.     

Preservación vesical electiva en tumor vesical músculo invasivo

ObjetivesRadical cystectomy is the standard treatment for localised muscle invasive bladder cancer (MIBC). We offer a bladder-sparing treatment with TURB +/− Chemotherapy + Radiotherapy to selected patients as an alternative.Material and methodsWe analyze, retrospectively, 30 patients diagnosed with MIBC from March 1991 to October 2010. The mean age was 62.7 years (51-74). All patients were candidates for a curative treatment, and underwent strict selection criteria: T2 stage, primary tumor, solitary lesion smaller than 5 cm with a macroscopic disease-free status after TURB, negative random biopsy without hydronephrosis. Staging CT evaluation was normal. Restaging TURB or tumor bed biopsy showed a disease-free status or microscopic muscle invasion. 14 patients underwent TURB alone, 13 TURB + Chemotherapy and 3 TURB + Chemotherapy + Radiotherapy.ResultsThe mean follow up was 88.7 months (19-220). 14 patients remained disease free (46.6%), 10 had recurrent non-muscle invasive bladder cancer (33%). 81.3% complete clinical response. 71% bladder preserved at 5-years. Overall, 5-years survival rate was 79% and 85% cancer-specific survival rate.ConclusionsAlthough radical cystectomy is the standard treatment for localised MIBC, in strictly selected cases, bladder-sparing treatment offers an alternative with good long term results.     

Intravesical botulinum toxin for overactive bladder syndrome without detrusor overactivity

ObjectiveTo report our experience of intravesical botulinum toxin for idiopathic overactive bladder syndrome (OAB) without detrusor overactivity (DOA) on urodynamic assessment.Patients and methodsData regarding presentation, diagnosis, urodynamic findings, date and dose of treatment, and outcomes were recorded prospectively for 94 patients undergoing intravesical botulinum toxin injection for idiopathic overactive bladder syndrome at our institution. The cohort included 19 patients without DOA on urodynamics. A positive response to treatment was defined as patient-reported improvement without the need for further treatment. ICIQ-OAB and UI scores, and bladder diary parameters were also recorded. Rates of urinary retention requiring intermittent or indwelling catheterisation were noted.ResultsThe overall response rate to treatment was 82% (n = 94). Patients without DOA (n = 19) had a response rate of 89%, which compared favourably with a response rate of 81% in patients with DOA (n = 75).Overall, 29% of patients who were voiding normally prior to treatment required intermittent self-catheterisation after the procedure. The requirement for self-catheterisation did not appear to be influenced by urodynamic findings.ConclusionThese preliminary, non-randomised data suggest that intravesical botulinum toxin injection may be efficacious in patients with OAB symptoms without DOA. Further evaluation by means of a randomised, controlled trial is suggested.     

Prevalencia y factores de riesgo de dolor pélvico

ObjetivesTo determine the prevalence of Chronic Pelvic Pain (CPP) symptoms in Malaga and its province and to identify risk factors associated.Methoda cross-sectional study was carried out in Malaga and its province, 18-65 years-old throughout a non-probability sampling by quotas (n = 887), stratified by sex, age and counties. All participants completed the QCPP-M, a self-administered questionnaire, validated tool due to its ability to discriminate patients with and without CPP.Resultsprevalence of symptoms of CPP in subjects between 18-65 years-old was 22.8% in general population (30.9% women and 15.6% men) (RR = 1.974 for women versus men, 95% CI 1.53-2.55, P < .001). After correction by sex and age individuals who practice physical activity had a lower score in QCPP-M that others who do not not (mean difference −0.65 ± 0.27). They were significantly associated with higher scores in the following factors: lifting and/or moving weights in activities of daily life (1.34 ± 0.33), laxatives intake and/or high-fiber diet (2.09 ± 0.48), having suffered from urogenital infectious disease in the past: vulvovaginitis, cystitis and prostatitis (1.77 ± 0.55), hemorrhoids/anal fissure (1.31 ± 0.40) or pelvic trauma (1.21 ± 0, 61) respectively. Individuals who spend more time standing had a tendency to have higher scores on QCPP-M (coefficient of regression adjusted for sex and age of 0.078 points/hour, SE = 0.04, P < .068).ConclusionsHigh prevalence of CPP symptoms in Málaga (22.8%), this is related with significantly several risk factors.     

Factors associated with the non-completion of conventional anti-tuberculosis treatment in Peru

BackgroundThe non-adherence to tuberculosis treatment is associated with increased infection, antibiotic resistance, increased costs and death. Our objective was to identify factors associated with lack of completion of conventional treatment for tuberculosis in Peru.Patients and methodsAn unmatched case–control study in patients diagnosed with tuberculosis from 2004 to 2005 who completed treatment until September 2006. The cases were defined as patients who discontinued treatment for ≥30 consecutive days, while the controls were defined as those who completed treatment without interruption. The factors were identified by logistic regression, calculating odds ratios (OR) and 95% confidence intervals (CI).ResultsWe studied 265 cases and 605 controls. The non-adherence to treatment in our study was associated with the male sex (OR = 1.62; CI: 1.07–2.44), having felt discomfort during treatment (OR = 1.76; CI: 1.19–2.62), a prior history of non-compliance (OR = 7.95; CI: 4.76–13.27) and illegal drug use (OR = 3.74; CI: 1.25–11.14). Also, if we consider the interaction of previous non-adherence history and poverty, the risk of non-completion increases (OR = 11.24; CI: 4–31.62). Conversely, having been properly informed about the disease (OR = 0.25; CI: 0.07–0.94) and being able to access health-care services within office hours (8 am–8 pm) (OR = 0.52; CI: 0.31–0.87) were associated with better adherence.ConclusionsThe non-compliance with anti-tuberculosis treatment was associated with non-modifiable factors (male sex, previous non-compliance) and with others whose control would improve compliance (malaise during treatment, illegal drug use and poverty). Likewise, providing access to the health-care system and improving the information given about tuberculosis should be the priorities.     

Residuo posmiccional y síntomas de disfunción de vaciado en mujeres con prolapso de órganos pélvicos antes y después de la cirugía vaginal. Estudio de cohortes multicéntrico

ObjectivesThe present study evaluates the impact of vaginal surgery for pelvic organ prolapse (POP) on voiding dysfunction (VD) symptoms and post-void residual (PVR) one year after the intervention.Material and methodsEpidemiological, longitudinal, prospective study. Thirty-nine gynecology units included women with symptomatic POP grade 2 or higher according to the Pelvic Organ Prolapse Quantification (POP-Q) system, who would undergo surgery for vaginal prolapse (CIRPOP-IUE study). Sociodemographic and clinical variables were collected before and after the intervention. At both visits, patients completed the ‘Epidemiology of Prolapse and Incontinence Questionnaire’ (EPIQ) and ‘Pelvic Floor Distress Inventory’ (PFDI-20) questionnaire. PVR volume was measured by bladder catheterization immediately after spontaneous urination.ResultsVD symptoms were present in 50% cases before the intervention. PVR was measured in 277 women of which 116 (41.87%) were > 50 ml and 42/277 (15.2%) were > 100 ml. Objective and subjective reduction in VD symptoms was observed one year after the intervention. Mean PVR volume was reduced with statistical significance, from a mean (SD) of 66.4 (68.9) ml to 48.3 (51.3) ml. The number of patients who reported difficulty in emptying and sensation of incomplete emptying on the EPIQ and PFDI-20 questionnaires also decreased.ConclusionsIn general, improved voiding functions were observed in the CIRPOP-IUE study through a decrease in specific VD symptoms and a reduction in mean PVR volume.     

Efficacy,safety, and tolerability of mirabegron in patients aged ≥65 yr with overactive bladder wet: a phase IV,double-blind,randomised, placebo-controlled study (PILLAR)

BackgroundThe majority of patients with overactive bladder (OAB) are aged >65 yr. There has been no prospectively designed study assessing treatment efficacy with the β3-adrenoreceptor agonist, mirabegron, specifically in this age group.ObjectiveA phase IV study comparing flexibly dosed mirabegron versus placebo in elderly patients with OAB and urgency incontinence.Design, setting, and participantsCommunity-dwelling patients aged ≥65 yr with OAB for ≥3 mo.InterventionFollowing a 2-wk placebo run in, patients with one or more incontinence episodes, three or more urgency episodes, and an average of eight or more micturitions/24 h were randomised 1:1 to double-blind 25 mg/d mirabegron or matched placebo, for 12 wk. After week 4 or 8, the dose could be increased to 50 mg/d mirabegron/matched placebo based on patient and investigator discretion.Outcome measurements and statistical analysisCoprimary endpoints: change from baseline to end of treatment (EOT) in the mean numbers of micturitions/24 h and incontinence episodes/24 h. Secondary endpoints: change from baseline to EOT in the mean volume voided/micturition, mean number of urgency episodes/24 h, and mean number of urgency incontinence episodes/24 h. Analysis of covariance (ANCOVA) was used for the mean number of micturitions/24 h, mean volume voided/micturition, and mean number of urgency episodes/24 h. Stratified rank ANCOVA was used for the mean numbers of incontinence episodes/24 h and urgency incontinence episodes/24 h.Results and limitationsStatistically significant improvements were observed for mirabegron versus placebo in change from baseline to EOT in the mean number of micturitions/24 h, mean number of incontinence episodes/24 h, mean volume voided/micturition, mean number of urgency episodes/24 h, and mean number of urgency incontinence episodes/24 h. Safety and tolerability were consistent with the known mirabegron safety profile.ConclusionsMirabegron efficacy, safety, and tolerability over 12 wk were confirmed in patients aged ≥65 yr with OAB and incontinence.Patient summaryWe examined the effect of mirabegron compared with placebo in people aged 65 yr or older with overactive bladder and incontinence. Mirabegron improved the symptoms of overactive bladder compared with placebo. Side effects were similar to those already known for mirabegron.     

L’exstrophie vésicale chez l’adulte: A propos de 5 cas

Objectivethe aim of this study is to analyze sexual, psycho-social and surgical particularities of bladder exstrophy in adulthood.Patients and methodsa retrospective study was performed including 5 patients, from 18 to 25 years old, admitted for management of bladder exstrophy. ICIQ-SF and MCS-SF36 scores were used to assess respectively urinary continence and quality of life before and after continent ileo-coecal bladder.Resultsa significant improvement was noted in both urinary continence and quality of life: the ICIQ-SF after 6 months was 4.2 + /- 4.02 against 18.8 + /- 2.28 before surgery (p = 0.0003), and MCS-SF at 6 months was 57.15 + /-13.37 against 37.2 + /-13.22 before surgery (p = 0.045). Stomal complications were recorded in the long term.Conclusionthe continent ileocoecal bladder improves the quality of life and urinary continence in adult patients with bladder exstrophy, but at the cost of long-term stomal complications.     

Efecto de la mitomicina en comparación con la gemcitabina intravesical en el tratamiento del cáncer de vejiga sin invasión muscular: metaanálisis

IntroductionWe performed a meta-analysis to evaluate the effect of intravesical mitomycin compared with gemcitabine on the treatment of non-muscle invasive bladder cancer.MethodsA systematic literature search up to November 2021 was done and 6 studies included 389 subjects with non-muscle invasive bladder cancer at the start of the study; 197 of them were provided with intravesical-mitomycin and 192 with intravesical gemcitabine. The studies reported the relationships about the effect of intravesical mitomycin compared with gemcitabine on the treatment of non-muscle invasive bladder cancer. We calculated the odds ratio (OR) with 95% confidence intervals (CIs) to assess the effect of intravesical mitomycin compared with gemcitabine on the treatment of non-muscle invasive bladder cancer using the dichotomous method with a random or fixed-effect model.ResultsIntravesical mitomycin had significantly higher recurrence rates (OR, 2.41; 95% CI, 1.43-4.08, P = .001) and chemical cystitis (OR, 4.39; 95% CI, 2.27-8.51, P < .001) compared to intravesical gemcitabine in subjects with non-muscle invasive bladder cancer. However, intravesical mitomycin had no significant difference in its effect on hematuria (OR, 1.71; 95% CI, .68-4.33, P = .26), skin reaction (OR, 2.04; 95% CI, .59-7.07, P = .26), and liver and kidney functions damage (OR, 1.96; 95% CI, 0.35-10.96, P = .44) compared to intravesical gemcitabine in subjects with non-muscle invasive bladder cancer.ConclusionsIntravesical mitomycin had significantly higher recurrence rates and chemical cystitis and no significant difference in its effect on hematuria, skin reaction, and liver and kidney functions damage compared to intravesical gemcitabine in subjects with non-muscle invasive bladder cancer. Further studies are required to validate these findings.     

Prevalence of COVID-19 among patients with chronic inflammatory rheumatic diseases treated with biologic agents or small molecules: A population-based study in the first two months of COVID-19 outbreak in Italy

ObjectiveThe aim of this study is to determine the prevalence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) disease 2019 (COVID-19) among adult patients treated with biologic agents or small molecules for chronic inflammatory rheumatic diseases, in particular for chronic inflammatory arthritides.MethodsTo this end, a population-based study, in the province of Udine (466,700 inhabitants, with age > 15 years old, Friuli Venezia Giulia region, Italy) was planned. The primary outcome was the prevalence of COVID-19 in the first two months of the outbreak. All the rheumatic patients treated with biologic agents or small molecules in the last 6 months in our province were included (N = 1051).ResultsFrom February 29 to April 25, 2020, 4 adult patients (4/1051, i.e. 3.8/1000, 95% Confidence Interval 1.5–9.7/1000) were registered as swab test positive by PCR for COVID-19. Overall, a total of 47/1051 (4.5%) cases were tested for COVID-19 by PCR in the same period, and 15 of them due to symptoms compatible with COVID-19. In the general population, the prevalence was 937 cases/466700 (2/1000, 95% Confidence Interval 1.9–2.1/1000, P-value = 0.33, chi square test), and 20,179/466,700 (4.3%) swab tests for COVID-19 were performed.ConclusionThe risk of COVID-19 in rheumatic patients under biologic agents or small molecules does not appear different from that observed in the general population. Patients should be informed to safely proceed with their treatment and follow the rules for self-protection to COVID-19.     

Simplified percutaneous large bore suprapubic cystostomy for acute urinary retention—A cost saving procedure

Introduction and objectivesCommercial cystostomy kits/trocars are not always readily available in regions with insufficient funding. Open suprapubic cystostomy procedures are yet prevalent. This paper presents a simplified percutaneous suprapubic cystostomy technique that utilizes specially selected surgical blades in the place of commercial trocars.Subjects and methodsEighty-nine male patients with acute urinary retention underwent puncturing of the visibly and palpably distended bladder with surgical blade size 20 (7 mm diameter), 21 or 22 (9 mm diameter) to allow resistance-free placement of Foley catheter size 18 Fr (maximum diameter of 6 mm) or size 20 (maximum diameter of 6.7 mm) respectively under local anesthesia along the mid abdominal line in a sagittal direction – two finger breadths above the pubic symphysis. The main outcome measures were to determine the success rate and the encountered complications.ResultsSuccessful bladder puncture and insertion of the Foley catheter of choice was possible in all cases. There was no mortality and no adjacent visceral injury. There were two cases of catheter blockage with clots that were easily flushed out.ConclusionsEmergency cystostomy can be safely achieved through direct puncture of the visibly and palpably distended bladder with appropriately selected surgical blades that will subsequently allow resistance-free placement of sizable Foley catheters.     

Presacral extramedullary haematopoiesis: A diagnostic update and case report of a late diagnosis

INTRODUCTIONWe report a rare case of presacral extramedullary haematopoiesis, which manifested as a tumoural mass on a routine ultrasonography in a patient presenting with symptoms of cholecystitis. Since Ask-Upmark in 1945 reported 3 cases of pelvic extramedullary haematopoiesis, we are aware of only published 14 additional cases.PRESENTATION OF CASEA 73-year-old female patient presented with abdominal pain in the right hypochondrium. An abdominal ultrasonography revealed cholecystitis with cholecystolithiasis and a coincidental hyperreflective mass of 9.5 cm was visualised behind the bladder. A clinical examination identified a mass in the pelvis that could be palpated vaginally. A computerised tomography scan showed a large presacral, inhomogeneous, multilobular and nodular tumour. The patient was admitted for laparoscopic resection of the gall bladder and laparoscopic exploration of the presacral mass. An anatomopathological examination of the tissue revealed the presence of extramedullary haematopoietic tissue. A postoperative haematological investigation indicated that the extramedullary haematopoiesis was idiopathic.DISCUSSIONPresacral EMH may occasionally present with symptoms of nerve compression. Symptoms of haematologic disorders may accompany EMH.Barium enema, abdominal ultrasound, CT scan, MRI and radionuclide bone marrow imaging have all been used by previous authors in establishing the diagnosis. Tissue samples may be misdiagnosed when atypical megakaryocytes are misinterpreted as malignant cells, which occurred in this case. Misdiagnosis can occur even more often when EMH is not considered in the differential diagnosis due to its rare occurrence. In this case, the final diagnosis was made tissue sampling after surgery.Treatment of EMH is only necessary when it is symptomatic.CONCLUSIONThis case report shows that extramedullary haematopoiesis is very rare and that it is a difficult diagnostic challenge when its location is unusual and when it is not associated with a haematologic disorder. Together with this case report, we present an update of the available diagnostic methods.     

Prevalence,mortality, and treatment of patients with rheumatoid arthritis: A cohort study of the French National Health Data System, 2010–2019

ObjectivesRheumatoid arthritis (RA) is a chronic inflammatory disease mostly affecting the joints. Data on the prevalence of RA differ widely, depending on the study and country. Our objectives were to estimate the prevalence of RA in France and the mortality rate, characterise the causes of death, and identify prescribed treatments.MethodsThis nationwide cohort study was based on data of the French National Health Data System (SNDS) which covers 99% of the French population. All patients identified with RA based on specific ICD-10 codes (M05 and M06, except M06.1) between 2010 and 2019 were included.ResultsWe identified 385,919 RA cases between 2010 and 2019, 318,243 of which were followed in 2019 (65.8 ± 16.8 years, 72% women). The overall crude prevalence rate in 2019 was 0.47%: 0.66% for women and 0.28% for men. The crude annual mortality rate was 3.1%. The overall standardised mortality ratio (SMR) of RA patients relative to the French general population decreased over time, reaching 1.21 in 2019. Cause-specific mortality was increased in RA patients for cardiovascular (SMR 1.40, 95% confidence interval 1.36–1.43), respiratory system (1.80, 1.73–1.87), digestive system (1.73, 1.59–1.88), and urogenital system (1.73, 1.59–1.88) diseases and infections (1.91, 1.76–2.06). We found no excess mortality due to tumours. The prevalence of treatment with conventional synthetic and biological/targeted synthetic disease-modifying antirheumatic drugs for RA in 2019 was 41.9% (n = 133,477) and 18.7% (n = 59,409), respectively.ConclusionOur results may provide a better understanding of RA and its care in France.     

Outcome of the TURP-TUVP sandwich procedure for minimally invasive surgical treatment of benign prostatic hyperplasia with volume larger than 40cc over a 4-year period in Nigeria

IntroductionTransurethral resection of the prostate (TURP) remains the reference standard for the surgical treatment of infravesical obstruction due to benign prostatic hyperplasia (BPH). While TURP has proven long-term efficacy, it has some associated morbidities. This has fuelled the drive to develop alternative cost-effective options with comparable functional outcomes and a superior safety profile.ObjectivesThe aim of this study was to evaluate transurethral electro-vaporization of the prostate (TUVP) combined with TURP as a “sandwich” procedure in relieving the obstruction caused by BPH with volume of 40-80cc.Patients and MethodsThe medical notes of 57 consecutive patients with moderate to severe bladder outflow symptoms due to BPH who underwent TURP-TUVP as a sandwich procedure from April 2007 to March 2011 were reviewed for prostatic volume, duration of surgery, volume of irrigation fluid used intra-operatively and post-operative hospital stay. Similarly, the patients IPSS, Qmax and PVR were evaluated pre- and postoperatively.ResultsThe mean patient age was 64.1 years (SD = 9.1), mean prostatic volume was 56.8 cc (SD = 8.9), mean resection time was 69.5 minutes (SD = 23.9) and mean volume of irrigation fluid (1.5% Glycine) used was 21.5 L (SD = 4.9).The mean post-operative hospital stay was 3.5 days (range 3- 4 days). Overall, 11 (19%) patients had blood transfusion, there was no incidence of TUR syndrome and one mortality was recorded from primary plasminolysis. Compared with baseline values, on follow-up at 3 months the IPSS, Qmax and PVR had improved significantly. Bladder neck stenosis occurred in 3 patients and was successfully treated with bladder neck incision.ConclusionsThe sandwich combination of TURP and TUVP for the surgical treatment of BPH with volume larger than 40cc had satisfactory patient safety profile and resulted in significant improvement in IPSS, Qmax and PVR on follow-up at 3 months.