Anatomic and Functional Outcome Following Distal Shunt and Tunneling for Treatment İschemic Priapism: A Single-Center Experience

BackgroundIschemic priapism (IP) is a urologic emergency that requires early intervention. The main aim of IP treatment is to relieve the cavernosal pressure and provide erectile function.AimThe aim of this study was to determine the correlation between preoperative risk factors (patient’s age, duration of priapism, preoperative erectile function) and postoperative erectile dysfunction (ED).MethodsThis retrospective study consisted of 25 patients diagnosed with refractory IP between 2009–2017. The diagnosis of IP was confirmed by medical history, physical examination, and cavernosal blood gas analysis. All of the patients underwent the T-shunt procedure ± tunneling after a failed initial intervention.ResultsThe mean age at the time of the IP diagnosis was 46.84 years (range 23–77). The average follow-up time of the study population was 40.4 months (range 3–114), and the median time from the occurrence of IP to surgery was 58 hours (range 24–240). In all cases, rapid resolution of the erection was achieved with the T-shunt ± tunneling procedure. In 1 patient, priapism recurred after 12 hours. Postoperative ED was reported by 16 (84.21%) patients, with degrees of mild, mild to moderate, and severe in 6, 1, and 9 of these cases, respectively. During the follow-up, the mean International Index of Erectile Function–5 (IIEF-5) score was 12.68 (range 5–23). Only 3 (15.78%) patients achieved successful sexual intercourse without any treatment. 6 (31.5%) patients required the aid of phosphodiesterase type 5 inhibitors, and 1 (5.26%) patient required the aid of a vacuum erection device. The 9 (47.36%) patients with severe ED failed to respond to medical treatment and were considered candidates for a penile implant. According to Kendall’s tau-b correlation coefficient analysis, there was a positive correlation between the preoperative and postoperative IIEF-5 scores (P = .005), whereas the patient’s age and duration of priapism were negatively correlated with the postoperative IIEF-5 score (P = .016 and P = .046, respectively).Clinical ImplicationsTreatment options of IP should be discussed with patients in terms of both preoperative erectile function and the duration of priapism.Strengths & LimitationsThe small sample size and retrospective nature of this study were the main limitations.ConclusionsDespite high success and low complication rates of T-shunt surgery, the rate of undisturbed erectile function is only 14.6%. The patient’s age, the existence of preoperative ED, and the duration of priapism are associated with postoperative IIEF-5 scores.Ortaç M, Çevik G, Akdere H, et al. Anatomic and Functional Outcome Following Distal Shunt and Tunneling for Treatment ?schemic Priapism: A Single-Center Experience. J Sex Med 2019;16:1290–1296.     

Prognostic value of quantitative p63 immunostaining in adenoid cystic carcinoma of salivary gland assessed by computerized image analysis

BACKGROUND:

In a long‐term retrospective immunohistochemical study of adenoid cystic carcinoma (ACC) of salivary gland, we investigated the relation of p63 immunodetection to prognosis. Although it is generally agreed that the solid pattern is the most aggressive pattern of growth, ACCs with predominantly cribriform or tubular patterns have an unpredictable clinical course, with a relatively favorable 5‐year survival but a low 20‐year survival.

METHODS:

Formalin‐fixed paraffin sections from 35 cases of ACC showing a predominantly better differentiated histopathology, ie, cribriform or tubular patterns of growth, were immunostained for p63. Automated image analysis was used to quantify p63 positivity, using a modification of a previously developed algorithm.

RESULTS:

Patients alive for more than 10 years had a lower extent of p63 expression than those who died of disease. Kaplan‐Meier analysis revealed that separation of patients with morbidity and mortality from those alive with no evidence of disease, could be achieved at a cutoff of 35% p63 positivity (P = .0031, log‐rank test). Multivariate analysis using the Cox proportional hazard model revealed p63 and tumor stage to be independent predictors of survival (P = .012 and P = .0003, respectively).

CONCLUSIONS:

To our knowledge, the present study is the first to report prognostic significance of p63 in salivary gland ACC and the first report of a robust and well‐studied immunohistochemical stain performable on routinely fixed and processed tissue with prognostic utility. Cancer 2010. © 2010 American Cancer Society.     

Treatment and results of chronic toxoplasmosis. Analysis of 33 cases.

Women who grew up in Turkey, where undercooked meat is part of the usual diet, have an increased risk of toxoplasmosis. This study covers treatment and prognosis of 33 cases with chronic toxoplasmosis. The study group was selected among the patients with a history of repeated abortions, recurrent preterm labor, stillbirths and babies with congenital anomaly after all other causative reasons were ruled out. IgG and IgM antibody titers were detected by Sabin-Feldman's dye test and indirect fluorescence antibody test. 33 patients, who had negative IgM and IgG antibody titers above 1/64, were accepted as having chronic toxoplasmosis and were included in our study group. These patients were treated with our pyrimethamine treatment protocol (Din?er Formula) for 36 days before their pregnancies. IgG antibody titers were repeated in the 8th and the 20th week of pregnancy. With the exception of 7 cases, 24 patients (72.7%) still had IgG antibody titers of more than 1/64 and were given the same treatment protocol in the 8th week of pregnancy. Very early abortions occurred in 2 cases. Of 24 patients, 8 had antibody titers still above 1/64 and were treated with spiramycine. While 28 cases (84.8%) had healthy and living infants, pregnancies of 3 cases are still continuing. No teratogenic effects of pyrimethamine on the fetuses were seen. As a result, we can say that a patient who presents with complaints of repeated abortions, recurrent preterm labor or stillbirth should be investigated for toxoplasmosis during pregnancy; even if the IgG antibody test is normal before pregnancy, she should be treated with the protocol mentioned above before pregnancy and in the 8th week of pregnancy when chronic toxoplasmosis is diagnosed.     

Cervical stromal involvement can predict survival in advanced endometrial carcinoma: a review of 67 patients

Purpose

To assess clinical, surgical and pathologic variables in survival of advanced endometrial cancer.

Methods

Sixty-seven advanced-stage (stages III and IV according to FIGO 2009) endometrial cancer cases were evaluated retrospectively. The effects on survival of age, histologic subtype, stage, grade, myometrial invasion, optimal cytoreduction, parity and cervical involvement were analyzed.

Results

Cervical involvement (P = 0.033) and nulliparity (P = 0.042) were worsening features in terms of survival. In 56 cases (83.5%) optimal cytoreduction could be achieved and survival was significantly longer in this group than the group who were not optimally cytoreduced (mean 30.4 vs. 9.6 months) (P < 0.01). Depth of myometrial invasion, histologic type of tumor, stage, grade, and age younger or older than 60 years were not found to be related to survival. Neither adjuvant therapy type nor their combination were superior to each other for improving survival.

Conclusions

Cervical stromal involvement is a poor prognostic factor in cases of advanced endometrial carcinoma. Further studies are required to describe the effect of different surgical approaches such as radical hysterectomy on survival in the presence of cervical stromal invasion.     

Laparoscopic management of a translocated intrauterine device perforating the bowel

A woman underwent operative laparoscopy to manage a dislocated intrauterine device that perforated her bowel. The surgical procedure was uncomplicated, and postoperative recovery was uneventful.