Renal cell carcinoma metastasis to the ovary: a case report

A 54-year-old woman referred to a specialist unit for weight loss, lethargy, and a palpable pelvic mass. Thought to have ovarian cancer metastasized to the kidney, underwent a left nephrectomy and para-aortic clearance, with a total abdominal hysterectomy and bilateral salpingo-oophorectomy with peritoneal biopsies. Histology proved it was actually a renal cell carcinoma metastasized to the ovaries. During further follow ups she had developed bone and pulmonary metastasis and died shortly after the diagnosis of metastasis. With only 14 reported cases in the literature increased awareness would aid management of similar cases

Heminephrectomy in adults: a systematic review with cumulative analysis

Introduction: Duplex collecting system of the kidney is a relatively common abnormality, with the majority of symptomatic cases discovered in childhood. Treatment is commonly a heminephrectomy of the affected moiety. We aimed to conduct a systematic review of the literature to provide the best available evidence for heminephrectomy for duplex kidneys in the adult population. Materials and Methods: A literature search was conducted in September 2017 with no limitations being placed on language, region, date or publication type. Data were represented numerically and analysed cumulatively. Results: Seven retrospective studies with 66 patients were included. Of which, 56/66 operations were performed laparoscopically, 5/66 were robot-assisted and 5/66 were open procedures. Complete resolution of symptoms was reported in 53/55 (96.4%) of patients in five studies providing outcome data. Of the 6 studies reporting complications, there were a total of 9 complications (9/62, 14.5%), however 5 of these were found to be in one study alone. Conclusions: This review emphasises the scarcity of evidence for heminephrectomy in adults. Nonetheless, it has been shown that this operation may be effective in alleviating patients’ symptoms in addition to being safe in experienced hands

Can frozen-section analysis of ureteric margins at the time of radical cystectomy predict upper tract recurrence?

Objective: To summarise the currently available literature and analyse available results of the outcome of intraoperative frozen-section analysis (FSA) on upper urinary tract recurrence (UUTR) after radical cystectomy (RC). Materials and methods: A systematic review of the literature was performed according to the Cochrane Reviews guidelines and in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist. Articles discussing ureteric FSA with RC were identified. Results: The literature search yielded 21 studies, on which the present analysis was done. The studies were published between 1997 and 2019. There were 10 010 patients with an age range between 51 and 95 years. Involvement of the ureteric margins was noted in 2–9% at RC. The sensitivity and specificity of FSA were ~75% and 99%, respectively. Adverse pathology on FSA and on permanent section, prostatic urothelial carcinoma involving the stroma but not prostatic duct, and ureteric involvement on permanent section were all more likely to develop UUTR. Neither evidence of ureteric involvement nor ureteric margin status on permanent section were significant predictors of overall survival. Conclusion: Routine FSA is mandatory for a tumour-free uretero–enteric anastomosis and is predictive of UUTR. To lower the UUTR, FSA is not necessary if the ureters are resected at the level where they cross the common iliac vessels. FSA is indicated whenever the surgeon encounters findings suspicious of malignancy, e.g. ureteric obstruction, periureteric fibrosis, diffuse carcinoma in situ, induration or frank tumour infiltration of the distal ureter is discovered unexpectedly during surgery, and prostatic urethral involvement. Abbreviations CIS: carcinoma in situ; FSA: frozen-section analysis; HR: hazard ratio; PRISMA: Preferred Reporting Items for Systematic Reviews and Meta-Analyses; RC: radical cystectomy; (UT)UC: (upper tract) urothelial carcinoma; UUT(R): upper urinary tract (recurrence)

Laparoscopic versus percutaneous cryotherapy for renal tumours: a systematic review and meta-analysis

Background: Cryoablation has emerged as an alternative to the more invasive partial nephrectomy for small renal masses. The approach can be carried out by two techniques, either laparoscopic cryoablation (LCA) or percutaneous cryoablation, (PCA) with CT guidance. We aimed to compare between the two procedures. Materials and Methods: A systematic review and meta-analysis was conducted, including studies comparing the two techniques. Outcomes included incomplete ablation, late local recurrence, cancer-specific survival, procedure time, transfusion rates, hospital stay, and complications. Results: A total of 1475 patients were included, 788 patients in the laparoscopic group and 687 patients in the percutaneous group. There was statistical difference favoring the laparoscopic group with regard to having less incomplete ablation (p = 0.0008) and higher cancer-specific survival patients (p = 0.04). However, there was longer hospital stays in the LCA group (p < 0.00001) and was found to be more costly than the PCA group. There was significantly more Clavien-I complications in the PCA group (p = 0.001) and more Clavien-III complications in the LCA group (p = 0.001). Otherwise, there were no differences in any other outcome parameter. Conclusion: LCA was found to have less incomplete tumor ablation rates and higher cancer-specific survival rates, however, higher hospitalization time, more major complications (Clavien III), and was costlier compared with PCA

“Is percutaneous extraction of gallstones safe and effective in high-risk patients? Evidence from a systematic review”

Gallstone disease in high-risk patients presents a management dilemma as cholecystectomy is often not performed due to their co-morbidities. Alternatively, such patients can be managed by percutaneous removal of gallstones. To date, there is paucity of high-quality evidence addressing the safety and efficacy of percutaneous cholecystolithotomy in high-risk patients.We aimed to conduct a systematic review on the feasibility of percutaneous gallstone removal in high-risk patients. MethodsA literature review was conducted using the Cochrane review and preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines without setting the time limits to assess the outcomes of percutaneous gallstone removal in high-risk patients. ResultsTwelve studies were identified. A total of 435 patients underwent percutaneous gallstone removal. Success rate was 91%. Overall complications (including minor and major) were 28%. The mean length of stay was 7 days (range, 1–80). Procedure related mortality was 0.7%. The recurrence rate was 7%. ConclusionPercutaneous cholecystolithotomy is a safe and effective technique. Although, it cannot substitute the current standard treatment for gallstones i.e., laparoscopic cholecystectomy. However, it may be considered for the patients who cannot undergo laparoscopic cholecystectomy due to their comorbid conditions

Robotic inguinal hernia repair: systematic review and meta-analysis

Background: We aimed to conduct a systematic review and meta-analysis of RHR's efficiency and safety, in addition to comparison between open and laparoscopic techniques. Methods: A literature review was conducted from 2000 to 2020 including studies reporting on their centre's outcomes for robotic hernial repairs. A meta-analysis was conducted. For continuous data, Mantel-Haenszel chi-squares test was used and inverse variance was used for dichotomous data. Results: In total, 19 studies were included. A total of 8987 patients were treated for hernia repairs, 4248 underwent open repairs, 2521 had robotic repairs and 1495 had laparoscopic repair. Cumulative analysis of robotic series: The overall average operative time was 90.8 min (range 25-180.7 min). The overall conversation rate was 0.63% (10/1596). The overall complication rate was 10.1% (248/2466). The overall recurrence rate was 1.2% (14/1218). Readmission rate was 1.6% (28/1750). Comparative meta-analysis outcomes include robotic versus open and robotic versus laparoscopic. Robotic versus open: The robotic group had significantly longer operative times and less readmission rates. There was no difference between the two groups regarding complications, post-operative pain occurrence and hernia recurrence rates. Robotic versus laparoscopic: The robotic group had significantly longer operative times and less complications. There was no difference regarding post-operative pain occurrence, hernia recurrence rates or readmission rates. Conclusion: Robotic hernia repair is a safe and efficient technique with minimal complications and a short learning curve; however, it remains inferior to the standard open technique. It does, however, have a role in minimally invasive technique centres. A multicentre randomized control trial is required comparing robotic, open and laparoscopic techniques.Scopu

Clinical outcome of OviTex reinforced tissue matrix in hernia repair: A systematic review and meta-analysis

Background: This review provides a comprehensive and current overview of the clinical outcomes associated with the use of OviTex reinforced tissue matrix (RTM) in hernia repair. Methods: We conducted a systematic review and meta-analysis according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Our search included research publications related to clinical outcomes involving the use of OviTex RTM in hernia repair up to August 2023. We extensively examined and extracted relevant data from databases such as Embase, PubMed, and Scopus. The meta-analysis included comparisons related to body mass index (BMI) in hernia treatment, primary abdominal wall hernias treated with OviTex, and other relevant factors. The quality of the included studies was assessed using the MINORS (Methodological Index for Non-Randomized Studies) scale. Our systematic review protocol was registered with PROSPERO (International Prospective Register of Systematic Reviews) under registration number CRD42023456009. Results: A total of 9 observational studies involving 990 patients from three countries (USA, Netherlands, and Germany) were included in our study. Pooled results show that the risk of the OviTex group was lower than that of the comparison group (pooled risk ratio (RR) = 0.84; 95% confidence interval (CI): 0.67–1.05; Z = -1.514; p = 0.13). The prevalence rate of primary abdominal wall hernia among the included studies ranged from a minimum of 43% (95% CI: 30–58) to a maximum of 81% (95% CI: 64–91%), the risk was not significantly higher in the comparison group compared with the OviTex group (pooled RR = 1.11; 95% CI: 0.29–4.30; Z = 0.155; p = 0.877), the prevalence of laparoscopic surgery was 12% (95% CI: 6–19%), the BMI was favorable in the comparison group but was not statistically significant (mean difference = 25; 95% CI: -0.02, 0.52; p = 0.073). Conclusion: OviTex RTM has shown promising outcomes in abdominal wall reconstruction and hernia repair. However, it is crucial to conduct further research and clinical studies to confirm these findings and unlock the capabilities of OviTex across different medical scenarios.This article was funded by the Qatar National Library

Testosterone and Covid‐19: An update

Abstract: There is overwhelming evidence to suggest that male gender is at a higher risk of developing more severe Covid‐19 disease and thus having poorer clinical outcomes. However, the relationship between testosterone (T) and Covid‐19 remains unclear with both protective and deleterious effects on different aspects of the disease suggested. Here, we review the current epidemiological and biological evidence on the role of testosterone in the process of SARS‐CoV‐2 infection and in mediating Covid‐19 severity, its potential to serve as a biomarker for risk stratification and discuss the possibility of T supplementation as a treatment or preventative therapy for Covid‐19

Voiding function improves under long-term testosterone treatment (TTh) in hypogonadal men, independent of prostate size

Background Functional hypogonadism is a condition in which some, but not all, older men have low testosterone levels. Rather than chronological age per se, the causality of hypogonadism includes obesity and impaired general health (e.g., metabolic syndrome). An association between testosterone deficiency and lower urinary tract symptoms (LUTS) has been reported, yet due to prostate safety concerns, men with severe LUTS (IPSS score > 19) have invariably been excluded from entering testosterone trials. Irrespective, exogenous testosterone has not been demonstrated to cause de novo or worsen mild to moderate LUTS. Objective This study investigated whether long-term testosterone therapy (TTh) could have a protective effect on improving the symptoms of LUTS in hypogonadal men. However, the exact mechanism by which testosterone exerts is beneficial effect remains uncertain. Patients and methods In this study 321 hypogonadal patients with an average age of 58.9 ± 9.52 years received testosterone undecanoate in 12-week intervals for 12 years. One hundred and forty-seven of these males had the testosterone treatment interrupted for a mean of 16.9 months before it was resumed. Total testosterone, International Prostate Symptom Scale (IPSS), post-voiding residual bladder volume and aging male symptoms (AMS) were measured over the study period. Results Prior to TTh interruption, it was observed that testosterone stimulation improved the men’s IPSS, AMS and post-voiding residual bladder volume, while their prostate volume significantly increased. During the TTh interruption, there was a significant worsening in these parameters, although the increase in prostate volume continued. When TTh was resumed, these effects were reversed, implying that hypogonadism may require lifelong treatment

Updates on androgen replacement therapy and lower urinary tract symptoms: a narrative review

Lower urinary tract symptoms (LUTS) are caused by higher tension at the bladder neck level (due to fibrosis or stiffness) or benign prostatic hyperplasia, which causes static obstruction of the bladder outlet. Both forms cause a group of symptoms such as hesitancy, intermittency, weak stream, nocturia, urine frequency, and urgency. Additionally, LUTS (obstructive or irritative symptoms) are common in elderly men with hypogonadism, identified as the reduced testes capability in producing sex steroids and sperm, and are categorized as testosterone deficiency. Even though the mode of action (MoA) of testosterone therapy (TTh) on hypogonadal men needs more researched and understanding, the effectiveness of TTh in the development of male genital organs has been reported in several studies. This review shows the latest updates of TTh in LUTS including potential adverse effects, advantages, and disadvantages