The IDENTIFY study: the investigation and detection of urological neoplasia in patients referred with suspected urinary tract cancer - a multicentre observational study.

Funder: Action Bladder Cancer UKFunder: Rosetrees Trust; Id: http://dx.doi.org/10.13039/501100000833Funder: Urology Care Foundation; Id: http://dx.doi.org/10.13039/100006280OBJECTIVE: To evaluate the contemporary prevalence of urinary tract cancer (bladder cancer, upper tract urothelial cancer [UTUC] and renal cancer) in patients referred to secondary care with haematuria, adjusted for established patient risk markers and geographical variation. PATIENTS AND METHODS: This was an international multicentre prospective observational study. We included patients aged ≥16 years, referred to secondary care with suspected urinary tract cancer. Patients with a known or previous urological malignancy were excluded. We estimated the prevalence of bladder cancer, UTUC, renal cancer and prostate cancer; stratified by age, type of haematuria, sex, and smoking. We used a multivariable mixed-effects logistic regression to adjust cancer prevalence for age, type of haematuria, sex, smoking, hospitals, and countries. RESULTS: Of the 11 059 patients assessed for eligibility, 10 896 were included from 110 hospitals across 26 countries. The overall adjusted cancer prevalence (n = 2257) was 28.2% (95% confidence interval [CI] 22.3-34.1), bladder cancer (n = 1951) 24.7% (95% CI 19.1-30.2), UTUC (n = 128) 1.14% (95% CI 0.77-1.52), renal cancer (n = 107) 1.05% (95% CI 0.80-1.29), and prostate cancer (n = 124) 1.75% (95% CI 1.32-2.18). The odds ratios for patient risk markers in the model for all cancers were: age 1.04 (95% CI 1.03-1.05; P < 0.001), visible haematuria 3.47 (95% CI 2.90-4.15; P < 0.001), male sex 1.30 (95% CI 1.14-1.50; P < 0.001), and smoking 2.70 (95% CI 2.30-3.18; P < 0.001). CONCLUSIONS: A better understanding of cancer prevalence across an international population is required to inform clinical guidelines. We are the first to report urinary tract cancer prevalence across an international population in patients referred to secondary care, adjusted for patient risk markers and geographical variation. Bladder cancer was the most prevalent disease. Visible haematuria was the strongest predictor for urinary tract cancer

The IDENTIFY study: the investigation and detection of urological neoplasia in patients referred with suspected urinary tract cancer - a multicentre observational study

Objective To evaluate the contemporary prevalence of urinary tract cancer (bladder cancer, upper tract urothelial cancer [UTUC] and renal cancer) in patients referred to secondary care with haematuria, adjusted for established patient risk markers and geographical variation. Patients and Methods This was an international multicentre prospective observational study. We included patients aged ≥16 years, referred to secondary care with suspected urinary tract cancer. Patients with a known or previous urological malignancy were excluded. We estimated the prevalence of bladder cancer, UTUC, renal cancer and prostate cancer; stratified by age, type of haematuria, sex, and smoking. We used a multivariable mixed-effects logistic regression to adjust cancer prevalence for age, type of haematuria, sex, smoking, hospitals, and countries. Results Of the 11 059 patients assessed for eligibility, 10 896 were included from 110 hospitals across 26 countries. The overall adjusted cancer prevalence (n = 2257) was 28.2% (95% confidence interval [CI] 22.3–34.1), bladder cancer (n = 1951) 24.7% (95% CI 19.1–30.2), UTUC (n = 128) 1.14% (95% CI 0.77–1.52), renal cancer (n = 107) 1.05% (95% CI 0.80–1.29), and prostate cancer (n = 124) 1.75% (95% CI 1.32–2.18). The odds ratios for patient risk markers in the model for all cancers were: age 1.04 (95% CI 1.03–1.05; P < 0.001), visible haematuria 3.47 (95% CI 2.90–4.15; P < 0.001), male sex 1.30 (95% CI 1.14–1.50; P < 0.001), and smoking 2.70 (95% CI 2.30–3.18; P < 0.001). Conclusions A better understanding of cancer prevalence across an international population is required to inform clinical guidelines. We are the first to report urinary tract cancer prevalence across an international population in patients referred to secondary care, adjusted for patient risk markers and geographical variation. Bladder cancer was the most prevalent disease. Visible haematuria was the strongest predictor for urinary tract cancer

MtF sex reassignment surgery: Trombetta technique

Aim of the Study: To describe our surgical technique highliting several steps we experienced differently from the traditional Petrovich technique. Materials and Methods: Surgical equipe consists of two couples of surgeons working toghether at the beginning and at the end of surgery, separately at the central time. Patient position is lithotomic: two surgeons stand at the hips facing eachother, other two sit in front of perineum. Preoperative skin marking and penile lenght measuring is performed to obtain satisfacting results in terms of depth of neovagina and external genitalia reconstruction. Perifunicular fat is saved during orchifuniculectomy to add volume in labia majora construction. Spongious tissue of bulbar urethra and erectile tissue of corpora cavernosa is totally removed. Mucosa of neourethral meatus is everted using 3/0 resorbable suture. Neovaginal cavity is created by smooth dissection of Denovillier fascia. Anterior neovaginal wall consists of penile skin flap, posterior wall of scrotal skin flap. Scrotal and penile flaps are sutured along lateral borders forming a unique tubular flap, apex of neovaginal tubular flap is not sutured. Neoclitoris is proceeded from a piece of dorsal glans toghether with neurovascular penile bundle that is fixed above the symphysis by 4/0 suture. Neoclitoris/neourethral complex is lodged in a mucosal environment by a two-layered suture to connect both mucosal and spongiosal tissue. Lateral suture of labia majora is done with intradermal self-lock suture thread. Results: Contemporary surgical working allows shortening of operative time until 4 hours. Preoperative skin marking and measuring of penis lenght ensures simmetry and gives a preliminar aesthethic and function outcome. Perifunicular fat conferes natural aspect to labia majora. Total removal of erectile tissue prevents from dispareunia. Mucosal eversion of neourethral meatus prevents from stenosis. Leaving the apex of tubular neovaginal flap open allows the gain of lenght after surgery protecting from scar retraction. Adequate isolation of neurovascular bundle permits to reach orgasm by tactile stimulation and prevents from neoclitoral necrosis. Mucosal environment of neoclitoris/neourethral complex is fundamental for natural aesthetic outcome and lubrication. Intradermal lateral suture guarantees good wound healing and less infections. Discussion: The challenging of male-to-female sexual reassignment surgery requires good surgical technique and well-trained surgeons. The technique we reported has been developed after 30 years of experience and after more than 400 patients treated

Analysis of clinical utility of abdominopelvic computer tomography in the follow up of Stage I Seminoma. A single center evaluation

BACKGROUND: Abdominopelvic computer tomography (CT) is widely used in the follow up of seminoma patients after radical orchidectomy. The aim of this study is to evaluate the clinical utility of abdominopelvic computer tomography in the follow-up of patients with Stage I seminoma. METHODS: The pathological reports of all patients that have undergone radical orchidectomy in our tertiary referral center between January 2002 and January 2018 have been retrospectively reviewed. All patients with Stage I seminoma and negative serum tumor markers after radical orchidectomy were included. Patients with follow-up shorter than 12 months were excluded. Surveillance records of every patient were reviewed with particular regard to abdominopelvic imaging. RESULTS: Of the 133 patients who have undergone radical orchidectomy in our center, 55 had stage I pure seminoma with normal levels of serum tumor markers after surgery. Two patients were excluded as the follow-up was inadequate. Mean follow-up was 63,2 months (IQR: 30-73). The results of 211 abdominopelvic CTs performed as part of the follow up were reviewed. Two (3,7%) patients developed recurrence; one consisted of a scrotal lump and was diagnosed with ultrasonography (US) while the second appeared as paraaortic nodal metastasis and was diagnosed with abdominopelvic CT. The recurrence was successfully treated in both patients. A single abdominopelvic CT was useful for the detection of recurrent disease in our entire study population. No cancer specific death has been reported in the study population. CONCLUSIONS\u2d0 Follow-up schedules for stage I seminoma exposes patients to potential risks of radiation- induced tumors, emotional distress and represent a significant burden for the healthcare system. The current series suggests that a better risk adapted patient-tailored follow-up program is needed in order to avoid unnecessary investigations

Management of stuttering priapism

Stuttering priapism is a variation of ischemic priapism, generally transient and self-limiting, occurring during sleep and lasting less than 3-4 hours. It may progress to episodes of complete ischemic priapism in approximately one third of cases, necessitating emergent intervention

MP80-05 TREND, CHARACTERISTICS AND IMPACT ON CANCER-SPECIFIC MORTALITY OF INCIDENTAL RENAL MASSES: RESULTS FROM A LARGE SERIES OF AUTOPSIES

INTRODUCTION AND OBJECTIVE: Doubtless, advances in imaging technology such as abdominal ultrasounds, computed tomography(CT) and multiparametric magnetic resonance imaging (mpMRI) are playing an important role in the diagnosis of renal masses(RM) and so of renal cell carcinoma (RCC) before the presence of clinical symptoms. This aspect has prompted interest in active surveillance (AS) as a treatment option for the small renal masses (sRM), especially if supported by an imaging-guided biopsy that can characterize the tumor, that most likely will not contribute to cancer-specific mortality. To the best of our knowledge, contemporary data evaluating the temporal trend of pathological characteristics and the relationship with cancer-related death of the incidental RM are not available, especially in a setting of an elderly population. The aim of this study was to analyze incidence trend, changes in clinical characteristics, pathological features and cancer-related death of RM incidentally discovered at time of autopsy in a long period of time. METHODS: Data were retrieved from the autopsy register of the Pathology Department of a single tertiary referral academic center from 15086 consecutive autopsies performed between January 2004 and December 2017. Patients with previous history of primary RCC and patient with a kidney metastatic involvement from other tumors were excluded from this study. RESULTS: Overall, 184 (1.22%) RM were found. Benign and malignant lesions were 32 (17.4%) and 152 (82.6%) respectively. The median age at death was 84 years (IQR, 76.8-90) and the majority of patients were female (56,5%). Histologically were oncocytoma 13 (7.1%), angiomyolipoma 13 (7.1%), papillary adenoma 4 (2.2%), cystic nephroma 3 (1.6%), metanephric tumor 2 (1.1%), clear-cell RCC 136 (73.9%) in which occured 2 (1.5%) sarcomatoid variant, papillary RCC 2 (1.1%), chromophobe RCC 5 (2.7%), carcinoma of the collecting ducts of Bellini 5 (2.7%), nephroblastoma 1 (0.5%). Considering the malignancies, pathological stage was: pT1 126 (80.3%), pT2 10 (6.4%), pT3 16 (10.2%) and pT4 5 (3.2%). Overall, in 16 (10.2%) cases RM was cause-related death. Considering time between 2004 and 2010 vs 2011 and 2017, temporal trend of incidence of RM and consequently of RCC decreased significantly over the years (p=0.01, p=0.01 respectively). While the median age at death, sex and the distribution of the different histological types remained constant over the time, RM found in the last years are increasingly smaller(p=0.04) and only in one case in the last seven years RM was associated with cancer-specific mortality. CONCLUSIONS: The autopsy finding of incidental RM is decreasing. Although the distribution of the different kidney tumor histological types appears constant, the mean size of the lesions that are incidentally identified at autopsy are increasingly smaller and more harmless

Analysis of clinical utility of abdominopelvic computer tomography in the follow up of Stage I Seminoma. A single center evaluation

Abdominopelvic computer tomography (CT) is widely used in the follow up of seminoma patients after radical orchidectomy. The aim of this study is to evaluate the clinical utility of abdominopelvic computer tomography in the follow-up of patients with Stage I seminoma

Impact of the controlling nutritional status (CONUT) score on perioperative morbidity and oncological outcomes in patients with bladder cancer treated with radical cystectomy

Introduction and objectives: To evaluate the impact of the Controlling Nutritional Status (CONUT) score on perioperative morbidity and oncological outcomes of bladder cancer (BC) patients treated with radical cystectomy (RC). Materials and methods: We retrospectively analyzed a multi-institutional cohort of 347 patients treated with RC for clinical-localized BC between 2005 and 2019. The CONUT-score was defined as an algorithm including serum albumin, total lymphocyte count, and cholesterol. Multivariable logistic regression analyses were performed to evaluate the ability of the CONUT-score to predict any-grade complications, major complications and 30 days readmission. Multivariable Cox' regression models were performed to evaluate the prognostic effect of the CONUT-score on recurrence-free survival (RFS), overall survival (OS), and cancer-specific survival (CSS). Results: A cut-off value to discriminate between low and high CONUT-score was determined by calculating the receiver operating characteristic (ROC) curve. The area under the curve was 0.72 hence high CONUT-score was defined as ≥3 points. Overall, 112 (32.3%) patients had a high CONUT. At multivariable logistic regression analyses, high CONUT was associated with any-grade complications (OR 3.58, P = 0.001), major complications (OR 2.56, P = 0.003) and 30 days readmission (OR 2.39, P = 0.01). On multivariable Cox' regression analyses, high CONUT remained associated with worse RFS (HR 2.57, P < 0.001), OS (HR 2.37, P < 0.001) and CSS (HR 3.52, P < 0.001). Conclusions: Poor nutritional status measured by the CONUT-score is independently associated with a poorer postoperative course after RC and is predictive of worse RFS, OS, and CSS. This simple index could serve as a comprehensive personalized risk-stratification tool identifying patients who may benefit from an intensified regimen of supportive cares