Semen parameters in testicular tumor patients before orchiectomy: What is the impact of testicular tumor stage and histology?

PURPOSE

To evaluate the influence of testicular cancer histology and stage on sperm parameters in cryopreserved samples collected prior to orchiectomy.

MATERIALS AND METHODS

We conducted a retrospective analysis of tumor histology, stage and sperm parameters of patients who underwent pre-orchiectomy sperm cryopreservation for testicular cancer between March 2010 and March 2023. The World Health Organization (WHO) 2010 sperm reference values were used to identify patients with subnormal semen parameters and to further categorize patients by sperm alteration. Localized disease was classified as Stage I, while metastatic disease encompassed Stages II and III. Continuous variables were compared using t-test or Mann Whitney U test, and categorical variables using Chi-square and Fishers exact test.

RESULTS

A total of 64 patients was identified, 48 (75%) classified as stage I and 16 (25%) classified as stage II/III. No difference was found in semen parameters between patients with seminoma and patients with non-seminoma germ cell tumor (NSGCT). Patients with stage II/III disease had significantly lower percentages of progressive motility (36% vs 53%, p=0.021) and total motility (60% vs 69%, p=0.015) than stage I patients. When categorizing by sperm alterations according to WHO 2010 reference values, patients with stage II/III disease had significantly higher proportions of asthenozoospermia (38% vs 15%, p=0.048) and teratozoospermia (63% vs 31%, p=0.027) than stage I patients. Elevated tumor markers were not associated with sperm abnormalities.

CONCLUSIONS

Patients with metastatic testicular cancer present with worse sperm quality than patients with localized disease. Sperm cryopreservation should be offered to all patients with testicular cancer, and especially emphasized in patients with metastatic disease.

Extraperitoneal robot-assisted radical prostatectomy with the Hugo™ RAS system: initial experience of a tertiary center with a high background in extraperitoneal laparoscopy surgery

PURPOSE

The Hugo™ RAS system is a novel robotic platform with innovative features. However, there are currently no available data on extraperitoneal robot-assisted radical prostatectomy (RARP) performed using this system. The objective of this study is to describe the surgical setup and assess the safety and feasibility of the extraperitoneal approach in robotic radical prostatectomy with the Hugo™ RAS system.

METHODS

Sixteen consecutive patients diagnosed with localized prostate cancer underwent extraperitoneal RARP ± lymph node dissection at our institution, between March and May 2023. All RARP procedures were performed extraperitoneal with a modular four-arm configuration. The focus was to describe the operative room setup, trocar placement, tilt and docking angles and evaluate the safety and feasibility of this approach with this robotic platform. Secondary outcomes recorded included, total operative time, console time, estimated bleeding, intra- and postoperative complications, and length of stay after surgery. A descriptive analysis was conducted.

RESULTS

We report on the first sixteen cases of extraperitoneal robot-assisted radical prostatectomy performed with the new Hugo™ RAS system. All procedures were completed, without the need for conversion or placement of additional ports. No intraoperative complications or major technical failures that would prevent the completion of surgery were recorded. The median operative time was 211 min (IQR 180-277), and the median console time was 152 min (IQR 119-196). The mean docking time was 4.6 min (IQR 4.1-5.2). The median estimated blood loss and the median time to remove the vesical catheter were 200 mL (IQR 150-400) and 8 days (IQR 7-8), respectively. The median length of stay was 2 days (IQR 2-2). Only one minor complication was registered in the first 30 days.

CONCLUSION

This study provides evidence of the safety and feasibility of the extraperitoneal approach in RARP with the Hugo™ RAS system. The description of the surgical setup in terms of trocar placement, arm-cart disposition, tilt and docking angles offers valuable information for surgeons interested in adopting this surgical approach with the Hugo™ RAS platform.

Mycobacteriophage Ms6 LysB specifically targets the outer membrane of Mycobacterium smegmatis

LysB, a mycobacteriophage Ms6-encoded protein, was previously identified as a lipolytic enzyme able to hydrolyse the ester bond in lipase and esterase substrates. In the present work, we show that LysB can hydrolyse lipids containing mycolic acids from the outer membrane of the mycobacterial cell wall. LysB was shown to hydrolyse the mycolic acids from the mycolyl-arabinogalactan-peptidoglycan complex where the mycolates of the inner leaflet of the outer membrane are covalently attached to an arabinosyl head group. In addition, treatment of the extractable lipids from Mycobacterium smegmatis, Mycobacterium bovis BCG and Mycobacterium tuberculosis H37Ra with LysB showed that trehalose 6,6'-dimycolate (TDM), a trehalose diester of two mycolic acid molecules, was hydrolysed by the enzyme. We have also determined the structures of the mycolic acid molecules that form the M. smegmatis TDM. The identification of a phage-encoded enzyme that targets the outer membrane of the mycobacterial cell wall enhances our understanding of the mechanism of mycobacteriophage lysis.

Hydrolysis of sucrose using sulfonated poly(vinyl alcohol) as catalyst

The hydrolysis of sucrose was carried out over poly(vinyl alcohol) (PVA) with sulfonic acid groups, at 80 degrees C. The products of sucrose hydrolysis were glucose and fructose. A series of PVA with different crosslinking degree were prepared. It was observed that the catalytic activity of PVA matrix increases with the crosslinking degree, due to the increases of the amount of sulfonic acid groups on PVA. Further, the influence of various reaction parameters, such as, catalyst loading, initial concentration of sucrose and temperature, on the hydrolysis of sucrose over PVA_40 was studied. It was found that at 80 degrees C, with 0.511 g of catalyst loading and with an initial concentration of sucrose of 0.6M, a sucrose conversion of about 90%, after 3h, could be obtained. The PVA_40 catalyst was recycled and reused with negligible loss in the activity. A simple kinetic model was developed assuming that the sucrose hydrolysis is an irreversible reaction and the first order with respect to the sucrose concentration. Since the concentration profiles of the reactant and the products do not exhibit any pronounced initial inductive period, the external and internal diffusion of the reactant and products on the catalyst were not considered. It was observed that the kinetic model fits experimental concentration data quite well.

Sinonasal hemangiopericytoma of the middle turbinate: a case report and brief review of the literature

Hemangiopericytomas (HPCs) are rare vascular neoplasms that arise from the pericytes of Zimmerman. They account for 2-3% of all soft tissue sarcomas in humans and they occur mainly in the musculoskeletal system. 15 to 30% of all HPCs occur in the head and neck region. Only 5% are located in the sinonasal region, where they display a more benign behaviour than in other parts of the body. We will describe a case of a right-sided HPC, in the posterior third of the middle turbinate. We will also discuss the epidemiology, the macro- and microscopical characteristics, the clinical and pathological findings and the treatment of this particular neoplasia.

[Postoperative compressive spinal epidural hematomas. 15 cases and a review of the literature]

PURPOSE OF THE STUDY

In the literature, the frequency of postoperative compressive spinal epidural hematomas (SEH) appearing very low, we conducted the present study to determine the frequency of this complication in their unit and look for causative and predisposing factors.

MATERIAL AND METHODS

Among the 1,487 spinal operations performed in our unit between September 1997 and August 1998, fifteen patients had postoperative compressive SEH; their files were retrospectively analyzed regarding the initial intervention, postoperative period, revision operation and neurologic follow-up.

RESULTS

Five women and ten men were involved ranging in age from 47 to 70 years (average, 59.5 years). The primary intervention concerned the cervical spine in one case, the thoracic spine in seven and the lumbar spine in seven. Ten of the fifteen cases including all seven of the thoracic SEH (performed for compressive metastatic epiduritis) involved a laminectomy. A stenotic canal was the indication for the primary intervention in six of the seven lumbar cases. The average delay before onset of symptoms was 1.5 hours, 3.7 hours, and 5.3 hours after the cervical, thoracic, and lumbar interventions, respectively. The clinical pattern began with segmental pain rapidly followed first by bilateral radicular sensory deficit, then unilateral or bilateral motor deficit, except in the patients with thoracic SEH in whom segmental pain was followed by signs of cord impingement. Excluding the four cases in which diagnosis was retarded by work-up examinations (3 cases) or a misleading picture (1 case), revision surgery was performed from 1.25 to 4 hours after onset of symptoms (average, 2.75 hours). In the patients for whom reoperation was delayed, SEH resulted in permanent complete paralysis or sphincter dysfunction. In contrast, eight of the ten patients who were reoperated within four hours of the onset of symptoms either recovered completely or recovered their former neurologic status.

DISCUSSION

Compressive SEH after spinal surgery is rare, only 41 cases having been reported aside from the series of Deburge et al. In the literature, the frequency is around 1 to 2 for 1000 operations for some authors, as opposed to 3 p. 100 and 6 p. 100 found by two other groups. The 1 p. 100 of the present series is close to the latter values. Nonetheless, it is probably important to take the type of surgery into account, as shown by the current series in which SEH occurred after 5.9 p. 100 of the operations for metastasis, but only once out of 304 anterior cervical interventions. To reduce the risk as much as possible, it is important to be aware of the factors that may contribute to this complication. Several recommendations concerning prevention of SEH are thus discussed. Once SEH has occurred, the only modifiable prognostic factor appears to be the delay before reintervention.

CONCLUSION

Although postoperative SEH is relatively rare, it may have dramatic consequences. In our opinion, reintervention must be performed as soon as possible after the onset of neurologic deficit, the work-up investigations only prolonging the critical surgical delay, which is probably the only alterable prognostic factor.