A Systematic Review and Framework for the Use of Hormone Therapy with Salvage Radiation Therapy for Recurrent Prostate Cancer

Context

Salvage radiotherapy (SRT) is a standard of care for men who recur postprostatectomy, and recent randomized trials have assessed the benefit and toxicity of adding hormone therapy (HT) to SRT with differing results.

Transplant nephrectomy after graft failure: is it so risky? Impact on morbidity,mortality and alloimmunization

Purpose

To determine the impact of transplant nephrectomy on morbidity and mortality and HLA immunization.

Methods

All patients who underwent transplant nephrectomy in our centre between 2000 and 2016 were included in this study. A total of 2822 renal transplantations and 180 transplant nephrectomies were performed during this period.

Results

The indications for transplant nephrectomy were graft intolerance syndrome: 47.2%, sepsis: 22.2%, vascular thrombosis: 15.5%, tumour: 8.3% and other 6.8%. Transplant nephrectomies were performed via an intracapsular approach in 61.7% of cases. The blood transfusion rate was 50%, the morbidity rate was 38% and the mortality rate was 3%. Transplant nephrectomies more than 12 months after renal transplant failure were associated with more complications (p?=?0.006). Transfusions in the context of transplant nephrectomy had no significant impact on alloimmunization.

Conclusion

The risk of bleeding, and therefore of transfusion, constitutes the major challenge of this surgery in patients eligible for retransplantation. Even if transfusions in this context of transplant nephrectomy had no significant impact on alloimmunization, this high-risk surgery, whenever possible, must be performed electively in a well-prepared patient.

     

Live surgery: highly educational or harmful?

Purpose

Live surgery (LS) is considered a useful teaching opportunity. The benefits must be balanced with patient safety concerns. To evaluate the rate of complications of a series of urologic LS performed by experts during the Congress Challenge in Laparoscopy and Robotics (CILR).

Methods

We present a large, multi-institution, multi-surgeon database that derives from 12 CILR events, from 2004 to 2015 with a total of 224 cases. Radical prostatectomy (RP) was the most common procedure and a selection of complex cases was noted. The primary measure was postoperative complications and use of a Postoperative Morbidity Index (PMI) to allow quantitative weighing of postoperative complications.

Results

From 12 events, the number of cases increased from 11 in 2004 to 27 in 2015 and a total of 27 surgeons. Of 224 cases (164 laparoscopic and 60 robotic), there were 26 (11.6%) complications: 5 grade I, 5 grade II, 3 grade IIIa, 12 grade IIIb and 1 grade V, the latter from laparoscopic cystectomy. Analysis of PMI was 23 times higher from cystectomy compared to RP.

Conclusions

In the setting of live surgery, the overall rate of complications is low considering the complexity of surgeries. The PMI is not higher in more complex procedures, whereas RP seems very safe.

     

Management of renal transplant urolithiasis: a multicentre study by the French Urology Association Transplantation Committee

Purpose

Urolithiasis is rare among renal transplant recipients and its management has not been clearly defined.

Methods

This multicentre retrospective study was organised by the Comité de Transplantation de l’Association Française d’Urologie (French Urology Association transplantation committee). Statistical analysis was performed with SPSS 19 software.

Results

Ninety-five patients were included in this study. Renal transplant urolithiasis was an incidental finding in 55% of cases, mostly on a routine follow-up ultrasound examination. One half of symptomatic stones were due to urinary tract infection and the other half were due to an episode of acute renal failure. The initial management following diagnosis of urolithiasis was double J stenting (27%), nephrostomy tube placement (21%), or watchful waiting (52%). Definitive management consisted of: watchful waiting (48%), extracorporeal lithotripsy (13%), rigid or flexible ureteroscopy (26%), percutaneous nephrolithotomy (11%) and surgical pyelotomy (2%). All transplants remained functional following treatment of the stone. The main limitation is the retrospective design.

Conclusions

The incidence of lithiasis could be higher in kidney transplanted patients due to a possible anatomical or metabolical abnormalities. The therapeutic management of renal transplant urolithiasis appears to be comparable to that of native kidney urolithiasis.

     

Relationship between heparin dosing and coagulation tests after cardiopulmonary bypass in young infants with congenital heart disease and low birth weight北大核心CSCD

ObjectiveTo explore the effect of early heparin anticoagulation on D-dimer of blood coagulation parameters in young and low-birth-weight congenital heart disease (CHD) after cardiopulmonary bypass (CPB). MethodsFrom December 2019 to December 2021, the relevant clinical data were retrospectively reviewed for 102 children undergoing CPB-assisted open-heart surgery for CHD at Shanxi Children's Hospital.There were 57 boys and 45 girls.Based upon an injection of heparin or not, they were assigned into two groups of observation (5 U·kg -1·h -1 low-dose heparin dosing) and control (non-heparin dosing). Fifty-four children in observation group were (119.81±66.90) day in age and (5.4±1.1) kg in weight.And 48 children in control group were (138.00±67.67) day in age and (5.65±1.31) kg in weight.Coagulation functions of two groups were detected preoperatively, postoperatively (admission into CCU), before medication (before heparin on the next day post-operation) and after medication (24h after heparin dosing). The change trends of D-dimer of coagulation function and the difference were observed between two groups.Pearson χ 2 test was utilized for counting data and t-test or Wilcoxon two-sample rank sum test for measurement data. ResultsNo significant inter-group differences existed in gender, age or weight ( P>0.05). No significant inter-group differences in D-dimer distribution pre/postoperatively or before medication ( P>0.05); After medication, D-dimer was significantly lower in observation group than that in control group and the difference was statistically significant ( Z=-2.21, P=0.027). The inter-group change of D-dimer after and before medication was statistically significant ( Z=-2.17, P=0.030). In observation group, D-dimer level continued rising pre/postoperatively and before medication and the difference was statistically significant ( P<0.05); No significant difference existed between before and after medication ( Z=-0.33, P=0.740). The difference was statistically significant after medication and post-operation ( Z=-3.41, P=0.001). The difference of D-dimer was statistically significant after medication as compared with that preoperatively ( Z=-3.06, P=0.002). It was still higher than that pre-operation.In control group, D-dimer continued rising from preoperative to after medication and statistically significant differences existed in D-dimer during each period ( P<0.05). ConclusionsEarly use of low-dose heparin anticoagulant therapy after CPB can relieve the coagulation dysfunction caused by CPB, and is conducive to the prevention of postoperative thrombosis and DIC. © 2023 Chinese Medical Journals Publishing House Co.Ltd. All Rights Reserved.