Does postoperative radiation therapy impact survival in non-metastatic sarcomatoid renal cell carcinoma? A SEER-based study

The effect of adjuvant radiation therapy on survival in sarcomatoid renal cell carcinoma (sRCC) with no evidence of distant metastasis remains unclear. Subjects diagnosed with non-metastatic sRCC were identified using the Surveillance Epidemiology and End Results (SEER) (2004-2012) database and divided into groups based on their surgical treatment (ST): no surgery or radiation therapy (NSR); partial nephrectomy (PNE); radical nephrectomy with ureterectomy and bladder cuff resection (RNE + UE + BLAD); and radical nephrectomy (RNE). Certain radical nephrectomy cases also received adjuvant external-beam radiation therapy (RNE + RAD). The Kaplan-Meier method was used to estimate overall survival (OS). A multivariable competing risks regression analysis was used to calculate disease-specific survival (DSS) probability and to determine factors associated with cause-specific mortality (CSM). A total of 408 patients were included in this study. The 5-year OS and predicted DSS were significantly higher in the patients who underwent STs (i.e., PNE, RNE + UE + BLAD, RNE, and RNE + RAD) (20.1-54.0 and 20.1-59.9 %, respectively) than in the NSR group (9.0 and 11.6 %, respectively) (P < 0.001). ST was independently associated with a decreased CSM (P < 0.0001). No significant differences in OS or the 1-, 3-, or 5-year DSS probabilities between the RNE and RNE + RAD groups were observed. RNE + RAD was not significantly associated with a decrease in 1-year CSM [subhazard ratio (SHR) 0.95; 95 % CI 0.23-3.96; P = 0.947]. Adjuvant external-beam radiation therapy did not increase OS in non-metastatic sRCC patients

Surgical management of female stress urinary incontinence

Stress urinary incontinence in women is a common problem in Germany, with approx. 5 million women suffering from incontinence symptoms. These numbers are increasing, due to demographic changes; the suspected numbers are even higher. Prior to treatment, an extended diagnostic approach - including urodynamics and cystoscopy when necessary - is essential for optimal treatment selection. Primary treatment should be conservative, with pelvic floor training as an essential part of a multi-modal treatment concept. If conservative treatment fails, surgery is necessary and an increasing number of women are being treated with sub-urethral slings. The use of classical and well-known reconstructive surgeries-such as colposuspensions-is decreasing. An artificial urinary sphincter is a seldom indication in women, but a feasible option if the patient is physically and manually fit enough. The following article will summarise current diagnostic approaches and treatment options

Losses of ion energy in the multicomponent beam

Energy losses of near axis ions and decreases in ion current density in the center of a beam were observed in a liquid metal source operating under a charged nanodroplets (In, Sn, Au, Ge) generation regime. In experiments, nanodroplets with the sizes of 2–20 nanometers and a characteristic specific charge of 5 × 104 C/kg were revealed. Energy spectra of ions were defined by means of the filter of speeds with cross-section static electromagnetic fields. A reduction of 4% of the In+ ions energy was observed under the conditions of the curried out measurements. The stream of nanoparticles, in contrast to an ion beam, has a small radial divergence; outside of this stream, change of ion speeds is not observed. Energy losses of ions occur during their flight through small nanoparticles. Penetration depth of the accelerated ions in liquid indium is estimated within the framework of the Lindhard-Scharff-Schiott model. Similar interaction between components occurs in ion-beam systems of complex composition where there is a relative movement of various charged particles

Reconstructive urethral surgery

Urethral strictures are independent of a patient's age and can happen in every life period. They are often iatrogenic, resulting from a transurethral surgical procedure or traumatic catheterisation. Endoscopic slotting is the surgery of choice; although this method is frequently associated with recurrence. Retrograde urethrography or cystourethrography continue to play a central role in diagnostic evaluation and treatment. There is no standardised procedure regarding the surgical technique, perioperative management, and postoperative follow-up. Evidence-based recommendations or guidelines do not exist. For a successful surgical treatment of the urethra it is important to have an excellent knowledge of the urethral and urogenital anatomy. The permanent removal of urethral strictures can only be achieved by open reconstructive surgery. Direct end-toend urethroplasty is used, in general, for short bulbar urethral strictures, while urethroplasty with oral mucosa is used for longer bulbar and penile strictures. Urethral reconstruction using a patient-specific autologous cell transplant with MukoCell (R) is an alternative to the conventional transplantation with native oral mucosa. Urethral reconstruction should be performed in specialised centres with appropriate expertise

Surgical treatment of pelvic organ prolapse

Female pelvic organ prolapse is a widely prevalent condition and is associated with variable morbidity. It encompasses a number of clinical conditions, including subvesical obstruction, overactive bladder symptoms, sexual dysfunction and urinary und fecal incontinence. The prevalence of pelvic insufficiency is estimated to be between 30 and 50%. As life expectancy is increasing and the elderly population is growing, there will be an increased incidence of the condition and growing demand for pelvic floor treatment in the future. The incidence of recurrent pelvic floor prolapse is also growing. The goal of surgical management is the restoration of pelvic anatomy and bladder, vaginal and bowel function, resolution of patient symptoms and improvement in quality of life. The objective of this review is to present the main surgical procedures for different subtypes of genital prolapse and to evaluate their outcomes and complications. During the last ten years, technologies for the minimally invasive approach have advanced and robotic assisted sacrocolpopexy is now equivalent to classical vaginal and transabdominal procedures

Three-Dimensional Reconstruction of Pelvicalyceal System of the Kidney Based on Native CT Images Are 1-Step Away from the Use of Contrast Agents

Objective: To describe special algorithm for the semi-autonomous 3-dimensional reconstruction of the pelvicalyceal system based on native computed tomography images of patients with upper urinary tract obstruction. Materials and Methods: Fifty patients with renal colic fitting to inclusion criteria were enrolled. All patients underwent computed tomography urography to perform 3-dimensional reconstruction of the pelvicalyceal system on the affected size based on excretory phase representing gold standard and on native phase. which was performed via Medical Imaging Interaction Toolkit program updated with the described algorithm. Five urologists estimated their similarities and the potential use of non-contrast models for interventional planning. Contralateral non-distended pelvicalyceal system was reconstructed to evaluate the viability of the proposed technology in such cases. Surface areas of contrast and non-contrast models were compared. Distended pelvicalyceal system of 1 patient was used to reconstruct virtual endoscopic view. Obtained 3-dimensional noncontrast pelvicalyceal system models were analyzed by an engineer for suitability for 3-dimensional printing. Results: The average surface area of contrast and non-contrast models was 3513 and 3371 mm(2), respectively (P= .0818). Non-contrast 3-dimensional reconstruction was possible with all distended pelvicalyceal systems and with 9 non-distended cases. Properties of non-contrast models were estimated as 4.3 out of 5. Obtained models were suitable for their intraluminal reconstruction and potential 3-dimensional printing. Conclusion: Described semi-autonomous approach allows for 3-dimensional reconstruction of dilated pelvicalyceal system based on non-contrast computed tomography images

Female urethral diverticulum with calculus formation imitating stress incontinence

A female urethral diverticulum (UD) is a rare condition with a prevalence of 0.6 - 4.7%. Possible aetiologies include chronic infection of the periurethral glands, childbirth trauma, and iatrogenic lesions after urethral manipulation. The main symptoms are recurrent urinary tract infections, post-void dribbling and leakage of urine or purulent discharge by movement, which is caused by the emptying of the diverticular lumen (paradoxical incontinence). As this may imitate stress urinary incontinence, the final diagnosis is a challenge for urologists. We report the case of a female UD containing multiple calculi, which were diagnosed during diagnostic work-up of incontinence. Based on this case report, we want to present and analyse the symptoms as well as the diagnostic evaluation and treatment of UD as reported in the literature. Also we wish to emphasise that the differential diagnosis between a complicated diverticulum and stress urinary incontinence requires a precise knowledge of the symptoms and the diagnostic algorithm for the detection of a DU because the symptoms of these two conditions are similar

Vesicouterine fistula after caesarean section

Vesicouterine fistulas (VUFs) are a pathological communication between uterus and urinary bladder, which are mainly related to iatrogenic lesions during caesarean sections or occur during vaginal deliveries after a previous caesarean section. The main symptoms are menstruation through the bladder (menouria), amenorrhea and urinary incontinence. Treatment can be conservative, hormonal or surgical; however, a spontaneous closure of the fistula is rare (5%). We report a case of a female VUF with menouria after caesarean section with a successful surgical fistula excision. Based on this case report, we analyse the causes, symptoms, diagnostics and treatment of VUF as reported in the literature

Safety and mid-term surgical results of anterior urethroplasty with the tissue-engineered oral mucosa graft MukoCell(R): A single-center experience

Objective To assess the mid-term efficacy and safety of anterior urethroplasty using an autologous tissue-engineered oral mucosa graft (MukoCell(R)). Methods The data of 77 patients with anterior urethral strictures undergoing treatment with MukoCell(R) at a tertiary center from June 2016 to May 2019 were analyzed. Patients' characteristics, pre- and postoperative diagnostics, perioperative complications, and follow-up data were obtained. The overall stricture-free survival, outcomes of the different surgical techniques, stricture localizations, stricture length, early complications of the procedure and risk factors of recurrence were assessed. Results The median follow-up period was 38 months (interquartile range 31-46). The overall recurrence-free rate of anterior urethroplasty using MukoCell(R) was 68.8%, 24 patients (31.2%) developed a recurrence of the stricture. The stricture recurrences were observed at a median of 7 months (interquartile range 3-13) only in patients with at least one previous surgery or repeated dilatations in their medical history. No oral-urethral adverse events related to the use of MukoCell(R) were observed, except for a urethrocutaneous fistula (1.3%) requiring reoperation. Conclusions Anterior one-stage urethroplasty using MukoCell(R) showed in our hands a mid-term success rate of up to 68.8% without significant adverse events after a median follow-up period of 38 months. This procedure might be an alternative option for long-segment urethral reconstruction