Pelvic lymph node dissection at robot-assisted radical prostatectomy: Assessing utilization and nodal metastases within a statewide quality improvement consortium.

PURPOSE: Several guidelines recommend pelvic lymph node dissection (PLND) at robot-assisted radical prostatectomy (RARP) only when lymph node involvement (LN+) is \u3e2%. Individual surgeon use of PLND is not well-known. We sought to examine variability in PLND performance and detection of LN+ across the Michigan Urological Surgery Improvement Collaborative. METHODS: Data regarding all RARP (3/2012-9/2018) were prospectively collected, including patient and surgeon characteristics. Univariable and multivariable analyses of PLND rate and LN+ rate were performed. RESULTS: Among 9,751 men undergoing RARP, 79.8% had PLND performed (n = 7,781), of which 5.2% were LN+ (n = 404). In univariate and multivariable analyses, predictors of PLND included higher Prostate-Specific Antigen (PSA), biopsy Gleason grade (bGG), number of positive cores, and maximum core involvement at P \u3c 0.05 for each. Higher PSA, cT stage, bGG, number of positive cores, and maximum core involvement predicted LN+ when PLND was performed (P \u3c 0.05 for each). There was significant surgeon variation in the proportion of PLND performed at RARP, yet neither surgeon-annualized RARP volume nor % of PLND performed was associated with LN+ disease (P \u3e 0.05). Grade was associated with PLND (60.0%, 77.6%, 91.0%, 97.3%, and 98.5%; P \u3c 0.001) and LN+ (0.7%, 2.5%, 5.8%, 8.6%, and 19.9%; P \u3c 0.001) for bGG 1,2,3,4,5, respectively. Maximum core involvement also strongly predicted LN+ with rates of 1.5%, 3.8%, and 9.4% for65%, respectively (P \u3c 0.001). CONCLUSIONS: Nearly 80% of RARP in Michigan Urological Surgery Improvement Collaborative were performed with PLND, including 60% of bGG1 patients (with LN+ in only 0.7%), but significant variability exists between surgeons. Our data indicate limited benefit for favorable-risk CaP patients and support efforts to decrease PLND use going forward

Ejaculation disorders in male patients with cancer: a systematic review and meta-analysis of prevalence

Purpose: Ejaculatory dysfunction (EjD) and erectile dysfunction after cancer treatment are clinically important complications, but their exact prevalence by various kinds of cancer site and type of treatment is unknown. The aim of this systematic review and meta-analysis was to examine the available evidence and provide pooled estimates for prevalence of EjD and erectile dysfunction in relation to all cancer sites and identify characteristics associated with EjD in cancer patients. Materials and Methods: We performed a systematic review and meta-analysis of cross-sectional and case-control studies. We searched four electronic databases (Medline, CINAHL, PsychInfo and Embase) until 22nd July 2020. All retrospective or prospective studies reporting the prevalence of EjD in male patients with cancer were included in this review. A random effects meta-analysis was conducted calculating prevalence proportions with 95% confidence intervals (CIs). Prevalence proportions were calculated for the incidences of EjD by cancer site and type of treatment. Results: A total of 64 studies (a total of 10,057 participants) were included for analysis. The most common cancer sites were bladder, colon, testis and rectum. The prevalence rates of EjD after surgical intervention ranged from 14.5% (95% CI 2.2–56.3%) in colon cancer to 53.0% (23.3–80.7%) in bladder cancer. The prevalence rates of erectile dysfunction ranged from 6.8% (95% CI 0.8–39.1%) in bladder cancer to 68.7% (95% CI 55.2–79.6%) in cancer of the rectum. Conclusions: In a large study-level meta-analysis, we looked at a high prevalence of EjD and erectile dysfunction at various cancer sites and across different treatment types. Prospective studies of EjD and erectile dysfunction after various kinds of cancer treatments are warranted

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Production of Tense Morphology by Afrikaans-Speaking Children With and Without Specific Language Impairment

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Developmental sequences in L1 (normal and impaired) and L2 acquisition of Swedish

This article presents data from an on-going project comparing L1 and L2 acquisition of Swedish syntax. Within the L1 group, normal as well as specifically language impaired (SLI) children are included; the L2 group consists of pre-school immigrant children. The analyses of the data are made within a second language acquisition perspective with a focus on word order. One basic issue within second language acquisition research is the question of natural developmental sequences, i.e. do all learners follow the same development? Another important issue is whether the development in L2 acquisition is the same as or different from L1 acquisition. Both issues are addressed in the study. The results show interesting similarities between the SLI group and the L2 group. The L1 group differed from the other two groups in important ways. The findings suggest that there is no fundamental difference between L1 and L2 acquisition of syntax, as has been claimed