Chronic Idiopathic Penile Edema: Three Cases and a Review of the Literature

peer reviewedAbstract: Chronic idiopathic penile edema (CIPE) is an exceptional entity with disabling persistent lymphedema of the penis, affecting accessorily the scrotum and the pubis. The onset presents with recurrent swelling of the external genitalia, regressing spontaneously. After 2-3 years the swelling becomes progressively persistent. Mictional and erectile dysfunctions are not uncommon. A thorough work-up including RX, ultrasound examination, CT scanning, MRI imaging, serology and extensive blood testing should be performed to exclude underlying causes, including neoplastic, infectious, vascular and inflammatory diseases. CIPE is associated with significant psychological and functional impact. Surgical correction is the sole therapeutic option. Three patients with CIPE and a review of the literature are presented in order to increase awareness of this rare condition

Identification of stromal proteins overexpressed in nodular sclerosis Hodgkin lymphoma

Hodgkin lymphoma (HL) represents a category of lymphoid neoplasms with unique features, notably the usual scarcity of tumour cells in involved tissues. The most common subtype of classical HL, nodular sclerosis HL, characteristically comprises abundant fibrous tissue stroma. Little information is available about the protein composition of the stromal environment from HL. Moreover, the identification of valid protein targets, specifically and abundantly expressed in HL, would be of utmost importance for targeted therapies and imaging, yet the biomarkers must necessarily be accessible from the bloodstream. To characterize HL stroma and to identify potentially accessible proteins, we used a chemical proteomic approach, consisting in the labelling of accessible proteins and their subsequent purification and identification by mass spectrometry. We performed an analysis of potentially accessible proteins in lymph node biopsies from HL and reactive lymphoid tissues, and in total, more than 1400 proteins were identified in 7 samples. We have identified several extracellular matrix proteins overexpressed in HL, such as versican, fibulin-1, periostin, and other proteins such as S100-A8. These proteins were validated by immunohistochemistry on a larger series of biopsy samples, and bear the potential to become targets for antibody-based anti-cancer therapies

Surgical repair of parastomal hernia after Bricker procedure: consecutive experience of a tertiary center

peer reviewedBackground: Parastomal hernia (PH) is the most frequent surgical complication after radical cystectomy with ileal conduit urinary diversion (Bricker's procedure). There are few studies that specifically assess results of PH repairs after Bricker. The aim of this study was to review our experience of surgical repair of PH after Bricker. Methods: We retrospectively reviewed the medical files of a consecutive series of 23 patients (13 male, 10 females; median age 67) who underwent PH repair after Bricker's procedure between 2014 and 2020. Demographic characteristics, intraoperative data, postoperative complications and follow-up were collected. Pre et post CT imaging was specifically reviewed by a radiologist to confirm the PH stage and the CT follow-up according to the Moreno-Matias classification. Data are presented as median and ranges. Results: Preoperatively, all patients suffered from Moreno-Matias type III PH. 16 patients (70%) underwent Sugarbaker repair and 7 (30%) a “sandwich” technique combining Sugarbaker and keyhole repairs. 16 patients (70%) underwent laparoscopic repair (2 conversions). 9 patients underwent a repair of a midline incisional hernia during the same procedure. 4 patients developed severe (> Clavien 3a) complications (two 3b and two IVa). Median hospital stay was 4 days (1-25). Two patients required Bricker reoperation, one for acute ileal conduit ischemia due to peroperative vascular lesion, and one for mesh migration. One patient developed early recurrence after Sugarbacker repair due to mesh migration, and all other patients (n=22, 95.6%) did not develop clinical recurrence at follow-up. Within the no clinical recurrence group (n=22), 20 patients underwent at least one abdominal CT during the follow-up (median 36 months; 1-92). Two asymptomatic Moreno-Matias type Ia recurrences were detected on CT. Conclusions: This significant series confirm that repair of PH after Bricker is a challenging procedure that may be performed by minimal invasive techniques with intraperitoneal meshes and should be performed in experienced centres

Open and Laparoscopic Partial Nephrectomy: Comparison and Validation of Preoperative Scoring Systems, Including PADUA, RENAL, ABC Nephrometric Scores and Perinephric Fat Evaluation with Mayo Adhesive Probability Score

peer reviewedPurpose: To evaluate potential associations between 4 nephrometric scoring systems, namely the PADUA (preoperative aspects and dimensions used for anatomical classification), RENAL (radius endophytic/exophytic nearness anterior posterior location), ABC (arterial-based com- plexity), and MAP (Mayo adhesive probability) scores and their individual components, with surgical and oncological outcomes of patients undergoing a partial nephrectomy. Materials and Methods: A consecutive, monocentric cohort of partial nephrectomy patients was retrospectively analyzed. PADUA, RENAL, ABC and MAP nephrometry scores were determined from preoperative axial images. Unadjusted and adjusted associations between overall scores, individual components, surgical approach, complications and onco- logical outcomes were determined using univariate and multivariate logistic regressions. Results: A total of 189 partial nephrectomies were performed in 181 patients, via an open or a laparoscopic approach. Among scoring systems, only the MAP classification, which assesses adherent perinephric fat, was associated with severe surgical complications as well as with operative time (p<0.05). Among all components of the PADUA and RENAL scores, only proximity of the tumor to the collecting system was associated with overall surgical complication rates, while the diameter of the tumor influenced the operative time (p<0.05). The ABC score was not relevant. Male gender, antiplatelet therapy, and a laparoscopic approach were associated with higher overall surgical complication rates (p<0.05). The number of oncologic recurrences during follow-up was too low to run statistical analyses. Conclusion: Nephrometry scores could be simplified to predict surgical complications after partial nephrectomy. In this framework, adherent perinephric fat seemed to be strongly associated with an increased risk of surgical complications

Repair of parastomal hernia after Bricker procedure: retrospective consecutive experience of a tertiary center.

peer reviewed[en] BACKGROUND: Ileal conduit parastomal hernias (ICPHs) are frequent after radical cystectomy with ileal conduit urinary diversion, but their management is debated. This study aimed to review the results of ICPH repair according to Sugarbaker or Sandwich techniques, with special interest in ICPH recurrence and urological complications. METHODS: The authors reviewed a consecutive series of patients undergoing ICPH repair between January 2014 and December 2020. Primary endpoints were ICPH recurrences at clinical exam and cross-sectional abdominal computed tomography (CT) scans. Secondary endpoints were any other complications possibly related to the ICPH repair. RESULTS: Twenty-three patients underwent ICPH repair surgery (16 Sugarbaker and 7 Sandwich techniques) during the study period. Sixteen patients underwent a primary laparoscopic approach. All but one patient underwent at least one abdominal CT during the follow-up. Median clinical and CT scan follow-up times were 57 and 50.5 months, respectively. Clinical and CT ICPH recurrence rates were 4.5% and 13% at 5 years, respectively. Eighteen patients (78%) suffered no urological complications during the follow-up period, but three patients (13%) needed redo surgery on the urinary ileal conduit. CONCLUSION: The modified Sugarbaker or Sandwich techniques might be considered as promising techniques for ICPH repair with a low rate of recurrence. The urological complications, and particularly the ileal conduit-related issues, need to be evaluated in further studies. Controlled and prospective data are required to compare the Sugarbaker and Sandwich techniques to the Keyhole approach for ICPH repairs