BackgroundWhilst there is a trend away from aggressive nonorgan sparing surgical treatments for malignant penile disease, a variety of penile preservation options exist but functional outcomes and patient reported outcomes (PROs) in this area are poorly reported to date.AimThe aim of this study is to report functional outcomes and PROs of total glans resurfacing (TGR) in a consecutive series of patients with lichen sclerosis (LS) or localized penile cancer (PC).MethodsFrom 2004 to 2018 a consecutive series of patients underwent TGR for the management of LS or localized PC in a tertiary referral network. Patient clinical records and operative notes were retrospectively reviewed. Statistical analysis was conducted with Stata 12.OutcomesUrinary and sexual outcomes were recorded utilizing both the International Index of Erectile Function (IIEF) and International Prostate Symptom Score (IPSS) validated questionnaires while PROs were extrapolated from a 5-item “ad hoc” telephone questionnaire administered at 1 year post procedure.Results37 consecutive patients were enrolled. Histology results demonstrated LS in 16 patients, with the remaining 21 having a diagnosis of PC. The most common reasons for patient presentation were local pain (32.4%), pruritus (37.8%) and bleeding (29.7%). Median follow-up was 22 (IQR 13–77) months. Median age was 62 (IQR 55–68).Neither of the questionnaires assessing urinary and sexual function showed any significant deterioration after surgery. Glans sensitivity was fully maintained in 89.2% of cases. 94.5% of patients reported to be fully satisfied with the aesthetic appearance of the penis and would consider undergoing the same procedure again if necessary. 91.9% of patients would recommend the same procedure to someone else. An overall improvement of the quality of life was reported by 86.4% of patients.Clinical ImplicationsTGR should be considered a treatment of choice for selected cases of benign or malignant penile lesionsStrengths and LimitationsOur study has some limitations, the first being its retrospective nature. Furthermore, despite being one of the largest series to date, follow-up duration is somewhat limited and a control group is lacking.ConclusionTGR represents an excellent surgical option ensuring satisfactory voiding and sexual function, as well as cosmesis for selected cases of penile lesions.M. Preto, M. Falcone, G. Blecher, et al. Functional and Patient Reported Outcomes Following Total Glans Resurfacing. J Sex Med 2021;18:1099–1103.相似文献
Placement of flow-diverters across the ostia of major ICA branches carries a risk of arterial occlusion. We determined the rate of occlusion of the supraclinoid ICA branches and the related symptoms, following coverage with flow-diverters.
Materials and methods
A systematic search was performed in PubMed, MEDLINE, and EMBASE. We selected studies reporting treatments with flow-diverters in which the device was placed across the ostium of the OphtA, PcomA, or AchorA. Random-effects meta-analysis was used to pool the following outcomes: rate of arterial occlusion, diminished flow, incidence of related symptoms, factors associated with arterial occlusion.
Result
Twenty-one studies evaluating 1152 supraclinoid ICA branches were included in the meta-analysis. The incidence of OphtA occlusion and associated symptoms was 5.9% (95 CI%?=?3.1–8.6%) (incidence rate?=?6% per patient-year), and 0.8% (95% CI?=?0.1–1.4%) (incidence rate?=?0.8% per patient-year), respectively. Although asymptomatic in all cases, PcomA showed a higher occlusion rate (20.7%, 95% CI?=?8.9–32.4%) (incidence rate?=?19.5% per patient-year). AchorA was occluded in 1% (95% CI?=?0.3–2.4%) of cases, with approximately 1% (95% CI?=?0.4–2.3%) of transient neurological symptoms (incidence rate?=?0.96% per patient-year). There was a trend toward higher odds of arterial patency among arteries arising from the aneurysm (OR?=?2.94, P?=?0.06). Demographic factors and multiple stents were not associated with higher risk of arterial impairment. Adequate collateral circulation was reported in 94.5% of patients with arterial occlusion.
Conclusions
During aneurysm treatment, the ostium of the supraclinoid ICA branches can be covered with flow-diverter devices with low rates of neurological symptoms related to arterial occlusion. 相似文献
The aim of this study was to evaluate, ex vivo, the histological effects of 445-nm diode laser (Eltech K-Laser srl, Treviso, Italy), during an oral soft ti 相似文献
Evidence suggests that integrase strand transfer inhibitors (INSTIs) are associated with greater weight gain than other antiretrovirals. This real-world study compares weight/body mass index (BMI) change between insured US patients with human immunodeficiency virus (HIV-1) initiating a protease inhibitor (PI) or INSTI. 相似文献
In France, the most severe bone and joint infections (BJI), called “complex” (CBJI), are assessed in a multidisciplinary team meeting (MTM) in a reference center. However, the definition of CBJI, drawn up by the Health Ministry, is not consensual between physicians. The objective was to estimate the agreement for CBJI classification.
Methods
Initially, five experts from one MTM classified twice, one-month apart, 24 cases as non-BJI, simple BJI or CBJI, using the complete medical record. Secondly, six MTMs classified the same cases using standardized information. Agreements were estimated using Fleiss and Cohen kappa (κ) coefficients.
Results
Inter-expert agreement during one MTM was moderate (κ = 0.49), and fair (κ = 0.23) when the four non-BJIs were excluded. Intra-expert agreement was moderate (κ = 0.50, range 0.27–0.90), not improved with experience. The overall inter-MTM agreement was moderate (κ = 0.58), it was better between MTMs with professor (κ = 0.65) than without (κ = 0.51) and with longer median time per case (κ = 0.60) than shorter (κ = 0.47). When the four non-BJIs were excluded, the overall agreement decreased (κ = 0.40).
Conclusion
The first step confirmed the heterogeneity of CBJI classification between experts. The seemingly better inter-MTM than inter-expert agreement could be an argument in favour of MTMs, which are moreover a privileged place to enhance expertise. Further studies are needed to assess these results as well as the quality of care and medico-economic outcomes after a MTM. 相似文献
The aim of the review is to describe the different techniques and materials available to reconstruct the tarsoconjunctival layer of the eyelid; to analyze their indications, advantages, and disadvantages.
We searched the Cochrane, PubMed, and Ovid MEDLINE databases for English articles published between January 1990 and January 2017 using variations of the following key words: “posterior lamella,” “eyelid reconstruction,” “tarsoconjunctival,” “flap,” and “graft.” Two reviewers checked the abstracts of the articles found to eliminate redundant or not relevant articles. The references of the identified articles were screened manually to include relevant works not found through the initial search.
The search identified 174 articles. Only a few articles with a therapeutic level of evidence were found. Techniques for the posterior lamellar reconstruction can be categorized as local, regional, and distant flaps; tarsoconjunctival, heterotopic, homologous, and heterologous grafts. Several techniques and variations on the techniques exist to reconstruct the posterior lamella, and, for similar indications, there’s no evidence of the primacy of one over the other. Defect size and location as well as patient features must guide the oculoplastic surgeon’s choice. The use of biomaterials can avoid possible complications of the donor site. 相似文献