Timing of surgery following SARS‐CoV‐2 infection: an international prospective cohort study

Peri-operative SARS-CoV-2 infection increases postoperative mortality. The aim of this study was to determine the optimal duration of planned delay before surgery in patients who have had SARS-CoV-2 infection. This international, multicentre, prospective cohort study included patients undergoing elective or emergency surgery during October 2020. Surgical patients with pre-operative SARS-CoV-2 infection were compared with those without previous SARS-CoV-2 infection. The primary outcome measure was 30-day postoperative mortality. Logistic regression models were used to calculate adjusted 30-day mortality rates stratified by time from diagnosis of SARS-CoV-2 infection to surgery. Among 140,231 patients (116 countries), 3127 patients (2.2%) had a pre-operative SARS-CoV-2 diagnosis. Adjusted 30-day mortality in patients without SARS-CoV-2 infection was 1.5% (95%CI 1.4–1.5). In patients with a pre-operative SARS-CoV-2 diagnosis, mortality was increased in patients having surgery within 0–2 weeks, 3–4 weeks and 5–6 weeks of the diagnosis (odds ratio (95%CI) 4.1% (3.3–4.8), 3.9% (2.6–5.1) and 3.6% (2.0–5.2), respectively). Surgery performed ≥ 7 weeks after SARS-CoV-2 diagnosis was associated with a similar mortality risk to baseline (odds ratio (95%CI) 1.5% (0.9– 2.1%)). After a ≥ 7 week delay in undertaking surgery following SARS-CoV-2 infection, patients with ongoing symptoms had a higher mortality than patients whose symptoms had resolved or who had been asymptomatic (6.0% (95%CI 3.2–8.7) vs. 2.4% (95%CI 1.4–3.4) vs. 1.3% (95%CI 0.6–2.0%), respectively). Where possible, surgery should be delayed for at least 7 weeks following SARS-CoV-2 infection. Patients with ongoing symptoms ≥ 7 weeks from diagnosis may benefit from further delay

Anastomosi vescico-uretrale CAPIO™ RP assisted dopo prostatectomia radicale retropubica.

Vescico-urethral anastomosis following radical retrobupic prostatectomy (RRP) can sometime be extremely difficul due to a short uretheral end or to a narrow and deep pelvis, so that the suture stitches can be wrongly positioned , without passing through the uretheral wall, or the wrong position, and this can produce the onset of a urinary fistula, and sudsequently, stenosis of the anastomotic tract. The CAPIO tm RP suture device allows a perfect vesico-uretheral anastomosis end the suture stitches can be easilu positioned insidethe uretheral wall, and exactly where the surgenon decides to put them according to personal experience. Twenty-six patients age ranged fron 52 to 67 yrs, suffering from localized prostaic cancer, under nerce sparing RRP and subsequent CAPIO tm RP assisted vesico -uretheral anastomosis. In all patients, the catheter was removed 6 days after surgery: 22 patiens (84;6%) showed immediate urinary continence; and for patients (15,4%) had mild stress urinary incontinence , with disappeared after 2 weeks. Medium Qmax during follow-up from 1-8 mounth was 20 mL/sec. The CAPIO tm RP suture deviceis, in our experience, a valid tool in the hands of the urologist that makes any vesico-uretheral anastomosis extremely easy and safe, reducing the risk of complications

UTILIZZO DEL "CAPIO RP" NEL CONFEZIONAMENTO DELL'ANASTOMOSI VESCICO-URETRALE DOPO PROSTATECTOMIA RADICALE RETRO-PUBICA

L'anastomosi vescico-uretrale dopo prostatectomia radicale ? un tempo chirurgico di facile esecuzione che a volte pu˜ risultare estremamente indaginoso nei pazienti con bacino stretto o in presenza di un moncone uretrale troppo corto. Il Capio TM RP p un dispositivo per sutura, che consente di eseguire una perfetta anastomosi in quanto i punti vengono passati facilmente all'interno dell'uretra esattamente nella sede e nel numero che il chirurgo decide, in accordo con la propria esperienza. La stenosi dell'anastomosi p l'incontinenza urinaria sono complicanze che possono avere un impatto negativo sulla qualitˆ di vita del paziente. Scopo dello studio ? stato quello di valutare la continenza e l'incidenza delle stenosi in pazienti sottoposti a prostatectomia radicale retropubica (RRP) ed a successiva anastomosi mediante utilizzo del Capio TM RP

Liposarcoma mixoide del funicolo spermatico

The myxoid liposarcoma, a rare form of spermatic cord liposarcoma, is a neoplasia of adult men which arise from adipose tissue, with a slow and subdolous growth, showing good prognosis and low incidence of local or distant recurrence. The case came at our attention is the sixteenth described in literature. Orchifunicolectomy is the gold standard therapy, although in some cases in which this kind of surgery is not radical adjuvant inguinal or retroperithoneal and pelvic nodes radiotheraphy should be taken in consideratio

PROSTATECTOMIA RADICALE RETROPUBICA CON RISPARMIO DEL COLLO VESCICALE E DEI LEGAMENTI-PUBO PROSTATICI:QUALE OUTCOME.

La prostatectomia radicale è una procedura chirurgica caratterizzata da un rapporto rischi/benefici favorevole in quanto consente la preservazione della continenza urinaria con un’incidenza di positività dei margini chirurgici molto contenuti. Per raggiungere questo traguardo sono necessari uno staging preoperatorio e una tecnica chirurgica estremamente accurati

Paraurethral Leiomyoma

Paraurethral leiomyoma is a rare, benign, hormone-dependent neoplasm of mesenchymal origin affecting women. The clinical evidence varies, but it tends to be asymptomatic or associated with the sensation of a foreign body; urinary symptoms are rarely described. The distinction among urethral, paraurethral, and anterior vaginal wall leiomyoma can be very difficult owing to their anatomic proximity. Excision of the mass is the recommended treatment, and the diagnosis is confirmed by the pathologic finding to rule out the presence of a sarcoma. A case of paraurethral leiomyoma associated with dysuria, dyspareunia, and obstructive voiding symptoms is reported. UROLOGY 79: e51-e52, 2012. (C) 2012 Elsevier Inc