Satisfaction with penile appearance after hypospadias surgery: The patient and surgeon view

Purpose: We studied the degree of agreement between hypospadias patient and surgeon satisfaction with the cosmetic surgical result, and the relation between penile length, meatal position and patient satisfaction. Materials and Methods: Cosmetic and functional results in 35 boys with hypospadias were assessed, and a standardized questionnaire was completed by patients and surgeon. Results: There was hardly any agreement between patient and surgeon satisfaction with patient penile appearance. Patients were less satisfied than the surgeon. No significant correlation was noted between penile satisfaction and penile length. Patients with a retracted meatus were less satisfied with the meatal position than those with a glanular meatus. Of the 35 patients 4 underwent repeat surgery after our study. Conclusions: Hypospadias surgeons should explicitly ask if patients are satisfied and they should follow patients through adolescence

Curatieve resectie van solitaire claviculametastase

Achtergrond Het gemetastaseerd mammacarcinoom wordt beschouwd als niet-curabele ziekte waarbij patiënten alleen in aanmerking komen voor palliatieve systemische behandeling. Bij geselecteerde patiënten met beperkte metastasen wordt echter langdurige ziektevrije overleving beschreven na chirurgische resectie als onderdeel van de multidisciplinaire behandeling. Casus Een 49-jarige vrouw had pijn en een zwelling ter plaatse van haar linker sleutelbeen. Zij was 4 jaar eerder behandeld met mammasparende therapie en adjuvante systemische therapie voor een lobulair mammacarcinoom links (stadium pT1N0M0). Aanvullend beeldvormend onderzoek en histologisch onderzoek van een biopt resulteerden in de diagnose ‘solitaire claviculametastase’. Er werd besloten in opzet curatief te behandelen met inductiechemotherapie gevolgd door een mediale clavicularesectie en aanvullende radiotherapie, en een wijziging van de endocriene therapie. Conclusie Een solitaire claviculametastase van een mammacarcinoom is zeldzaam. Bij patiënten met een solitaire ossale metastase van een mammacarcinoom met gunstige prognostische factoren kan chirurgische resectie worden overwogen als onderdeel van een multidisciplinaire behandeling met curatieve intentie

The effect of immediate breast reconstruction on the timing of adjuvant chemotherapy: a systematic review

Adjuvant chemotherapy is often needed to achieve adequate breast cancer control. The increasing popularity of immediate breast reconstruction (IBR) raises concerns that this procedure may delay the time to adjuvant chemotherapy (TTC), which may negatively impact oncological outcome. The current systematic review aims to investigate this effect. During October 2014, a systematic search for clinical studies was performed in six databases with keywords related to breast reconstruction and chemotherapy. Eligible studies met the following inclusion criteria: (1) research population consisted of women receiving therapeutic mastectomy, (2) comparison of IBR with mastectomy only groups, (3) TTC was clearly presented and mentioned as outcome measure, and (4) original studies only (e.g., cohort study, randomized controlled trial, case–control). Fourteen studies were included, representing 5270 patients who had received adjuvant chemotherapy, of whom 1942 had undergone IBR and 3328 mastectomy only. One study found a significantly shorter mean TTC of 12.6 days after IBR, four studies found a significant delay after IBR averaging 6.6–16.8 days, seven studies found no significant difference in TTC between IBR and mastectomy only, and two studies did not perform statistical analyses for comparison. In studies that measured TTC from surgery, mean TTC varied from 29 to 61 days for IBR and from 21 to 60 days for mastectomy only. This systematic review of the current literature showed that IBR does not necessarily delay the start of adjuvant chemotherapy to a clinically relevant extent, suggesting that in general IBR is a valid option for non-metastatic breast cancer patients

Virtual and augmented reality for preoperative planning in plastic surgical procedures: A systematic review

Summary Background: Virtual and augmented reality (VR and AR) are fast-developing technologies that allow the three-dimensional visualization of digital information. Objective: This systematic review aimed to compare the application of VR and AR to conventional methods in preoperative planning of plastic surgical procedures. Method: A systematic literature search was conducted in Embase, Medline (Ovid), Web-ofScience, Cochrane, and Google Scholar databases on October 11, 2019. All literature comparing AR and/or VR with conventional methods for preoperative planning was collected. Only articles that studied at least one of the following outcomes were included: technical accuracy of the procedure, operative time, complications, and costs of total intervention. Results: No articles on VR were found. Six articles were found on interventions performed with AR assistance. AR showed to be significantly better for the accuracy of osteotomies in mandibular angle osteotomies and intraoral mandible distraction compared to conventional methods. For synostotic plagiocephaly and orbital hypertelorism correction, the use of AR demonstrated a precise osteotomy. Intraoperative perforator identification in DIEP flap procedures was more accurate with AR compared to Doppler ultrasound. Harvesting time (p < 0.012) and operative time (p < 0.01) in DIEP-flap procedures and mandibular angle osteotomies, respectively, were significantly reduced if AR was used. No articles were found regarding the costs of using AR for preoperative planning