Prognostic significance of PI-RADS 5 lesions in patients treated by radical prostatectomy

PURPOSE

To analyse the pathological features and survival of patients with a PI-RADS 5 lesion on pre-biopsy MRI.

METHODS

We extracted from a European multicentre prospectively gathered database the data of patients with a PI-RADS 5 lesion on pre-biopsy MRI, diagnosed using both systematic and targeted biopsies and subsequently treated by radical prostatectomy. The Kaplan-Meier model was used to assess the biochemical-free survival of the whole cohort and univariable and multivariable Cox models were set up to study factors associated with survival.

RESULTS

Between 2013 and 2019, 539 consecutive patients with a PI-RADS 5 lesion on pre-biopsy MRI were treated by radical prostatectomy and included in the analysis. Follow-up data were available for 448 patients. Radical prostatectomy and lymph node dissection specimens showed non-organ confined disease in 297/539 (55%), (including 2 patients with a locally staged pT2 lesion and lymph node involvement (LNI)). With a median follow-up of 25 months (12-39), the median biochemical recurrence-free survival was 54% at 2 years (95% CI 45-61) and 28% at 5 years (95% CI 18-39). Among the factors studied, MRI T stage [T3a vs T2 HR 3.57 (95%CI 1.78-7.16); T3b vs T2 HR 6.17 (95% CI 2.99-12.72)] and PSA density (HR 4.47 95% CI 1.55-12.89) were significantly associated with a higher risk of biochemical recurrence in multivariable analysis.

CONCLUSION

Patients with a PI-RADS 5 lesion on pre-biopsy MRI have a high risk of early biochemical recurrence after radical prostatectomy. MRI T stage and PSA density can be used to improve patient selection and counselling.

Solitary prostate cancer liver metastasis: an exceptional indication for liver resection

INTRODUCTION

Prostatic cancer metastases (PCM) are usually systemic. Isolated PCM liver metastases (PCLM) are very rare. The treatment of PCM consists of hormono- and chemotherapy eventually combined with stereotactic radiation.

PATIENT AND DISCUSSION

A case of a 67-year old man presenting with a solitary, metachronous PCLM undergoing a left extended hepatectomy due to resistance to hormono- and chemotherapy is reported. He died of recurrent systemic disease 31 months later.

CONCLUSIONS

The very rare indication and possible role of liver resection in the treatment of PCLM is discussed.

Double Loop Ureteral Stent Encrustation According to Indwelling Time: Results of a European Multicentric Study

Introduction: Double-J ureteral stents are subject to encrustation. Studies have shown that the encrustation onset is linked with indwelling time. In prevention, it is admitted that the Double-J stent indwelt for medium or long term should be replaced periodically. However, in the absence of guidelines, indwelling durations vary with centers' habits, stent indication, and stent materials. Our target was to evaluate the actual ureteral stent medium-/long-term indwelling times and related encrustation rates perceived by urologists in daily practice. Methods: An observational retrospective study was performed over six European centers. All data of all consecutive removed stents of the same material implanted for more than 2 months within a same 2-year referred period were collected. Three stent types of various materials, with/without coating, were evaluated. Encrustation rates were analyzed according to indwelling times and stent indication. Results: Four hundred seventy-three stents were recorded with indwelling times between 60 and 679 days. An unexpected number of long-term indwelling times were noticed: globally one-third more than 6 months, and 9% more than 1 year. In case of malignant indication, these rates were, respectively, 44% and 17%. For nonstone indication, clinically significant encrustation rates stayed extremely low before 4 months (1.3%) and quite low before 6 months (5.2%), increasing with time to reach around 10% in the long term. However, as expected, the rate was higher for stone indication with a marked increase after 4 months (8% before 4 months, nearly 17% after). Conclusion: Our data confirm a higher encrustation risk for stone patients. Long indwelling times in nonstone patients beyond 6 months or even 12 months appear to be still requested and relatively well supported in usual practice by this population.

First case of a dog bite wound infection caused by Streptococcus minor in human

We report the first case of human infection caused by Streptococcus minor in a 51-year-old immunocompetent woman admitted for dog bite injuries. At present, the role of Streptococcus minor in bite wound infections is unknown. Further studies on virulence factors are needed to elucidate its pathogenicity mechanisms.

Long-Term Functional, Cosmetic and Sexual Outcomes of Hypospadias Correction Performed in Childhood

Objective: Hypospadias surgery, especially when performed early in life, may have a significant impact on the urinary and sexual functions in an adult. Because the literature is still limited, this paper assesses long-term functional, cosmetic and sexual results of hypospadias repair performed in childhood. Patients and Methods: The study includes 275 patients older than 12 years treated for a hypospadias by an Onlay, Mathieu, Duplay, or Duckett's technique between January 1990 and December 2000. Flowmetry results were retrospectively obtained from patients' charts. The Paediatric Penile Perception Score (PPPS), the Hypospadias Objective Scoring Evaluation (HOSE) and the IIEF-5 score (when older than 16 years old) questionnaires were used to assess cosmetic and sexual results. The PPPS is designed to assess both penile self-perception with regard to meatus, glans, skin and general appearance. The HOSE is a five-point scoring system designed to allow an objective appraisal of the outcome of hypospadias repair, based on evaluating meatal location, meatal shape, urinary stream, straightness of erection, and the presence and complexity of any complicating urethral fistula. Results: Qmax were within age-adjusted references, independent of the surgical technique, with median (range) Qmax of 18.8 ml/s (range 3-45, n = 136). Patients expressed a high satisfaction for every single item of the penile perception scale (PPPS), with mean values between 2 (satisfied) and 3 (very satisfied). Eighty-two percent were satisfied or very satisfied of the overall evaluation of penile appearance. Eighty-one percent of patients had a normal erectile function (IIEF-5 >22; n = 35/43). Conclusions: Taking into account the limitation of a small number of patients resulting from a low 21% questionnaire's response rate, the results of this study align with previous reports from the literature and confirms that hypospadias repair using standard techniques results in acceptable functional, cosmetic and sexual outcomes. This study highlights the need of developing a set of standard approved outcomes assessments tools for evaluating the long-term impact of hypospadias repair performed in infancy.

Which ureteral access sheath is compatible with your flexible ureteroscope?

PURPOSE

Our aim is to evaluate different ureteral access sheaths (UASs), which are available in the international market and their compatibility with different available flexible ureteroscopes (F-URSs) to help the urologist choose the proper ureteral access sheath for his or her endoscope before commencing the procedure.

MATERIALS AND METHODS

A total of 21 UASs and 12 F-URSs were evaluated. Measurements were obtained in French (F) units considering different characteristics for each UAS and each F-URS. Insertion test without friction between F-URS and UAS was considered as a successful test and was referred as (YES).

RESULTS

All UASs and F-URSs were successfully submitted to the insertion test. All F-URSs that were inserted into UASs without friction had an internal diameter of at least 12F. Different lengths of UAS did not influence the test outcome.

CONCLUSION

This study was able to establish a correlation table between different UASs and different flexible ureteroscopes. As of now, the 12/14F UAS is considered the universal UAS that accepts all F-URSs that are available in the endourology field. Nevertheless, we are expecting a significant change with the new standard size 10/12F UAS as well as huge advances in minimizing the size of different endoscopes.