5 research outputs found
Management of Panurethral Strictures by Preputial Graft Urethroplasty: Outcomes From a Tertiary Care Centre
No full textA decade's experience of robotic buccal ureteroplasty for post-ureteroscopic laser lithotripsy-induced strictures—Should this be the new standard?
No full textObjective: To present the surgical technique of robotic buccal ureteroplasty for strictures after laser lithotripsy and its outcomes. Methods: This was a retrospective study conducted at the Department of Urology, Apollo Hospitals, Chennai, India from October 2012 to October 2022. Indications for surgery included worsening hydronephrosis, declining renal function, and recurrent urinary tract infections with obstruction. Apart from liberal exposure of the stricture, we stress upon use of indocyanine green to assess vascularity and quilting of the graft to bare area of the psoas muscle to increase graft vascularity. Results: Among the 15 patients, ureteropelvic junction strictures were observed in eight (53%), while five (33%) had proximal ureteric strictures, and two (13%) had mid-ureteral strictures. Notably, eight of the 15 patients (53%) had previous unsuccessful double-J stenting. The median stricture length was 3.5 (range: 2.0–5.0) cm, with a mean operative time of 167 (range: 126–214) min and estimated blood loss of 60 (range: 40–100) mL. After a median follow-up of 12 (range: 4–32) months, 13 out of the 15 patients (87%) showed significant improvement in their follow-up functional scans. Conclusion: Robotic buccal ureteroplasty is a very effective technique for the management of laser-induced ureteral strictures with good long-term results and minimal morbidity. The results are comparable irrespective of previous failed stenting
Correlation of gallium-68 prostate-specific membrane antigen positron emission tomography – Computed tomography/magnetic resonance imaging with histopathology characteristics in carcinoma prostate patients undergoing radical prostatectomy
No full textIntroduction:
Gallium-68 prostate-specific membrane antigen positron emission tomography (68Ga-PSMA PET) is being increasingly used in patients with prostate cancer (PCa) for the staging and detection of lymph node (LN) metastases, despite a lack of prospective, validated evidence. We aimed to investigate the relationship between the PSMA PET findings (maximum standardized uptake [SUVmax] value) and the final histopathology results (Gleason Grade [GG], and LN positivity) in patients undergoing radical prostatectomy.
Methods:
This is a single centre, prospective, observational study of 63 consecutive eligible patients treated at a tertiary care centre in India. Patients underwent 68Ga-PSMA PET computed tomography with fusion magnetic resonance imaging for staging, followed by a Transrectal ultrasound guided prostate biopsy. All patients underwent robotic-assisted radical prostatectomy with extended pelvic LN dissection as per the standard protocol. Clinical parameters and SUVmax values were collected and analysed.
Results:
The median preoperative prostate specific antigen (PSA) was 15.0 ng/ml (interquartile range: 9.4–28.0). A statistically significant correlation was observed between the PSA values and the SUVmax uptake (P < 0.001). Additionally, there was a statistically significant correlation between the SUVmax of the prostatic lesion and the GG on the radical prostatectomy specimens (P = 0.025), and SUVmax of LN and LN involvement (P < 0.001). The sensitivity and specificity of the 68Ga-PSMA PET scan were 77.8% and 88.7%, respectively.
Conclusions:
SUVmax of the PCa lesion and the GG Group on the final histopathology correlates significantly. There is an increased SUV uptake in Gleason’s Score (GS) 8, 9 tumours as compared to GS 6 and 7
Does age affect functional and perioperative outcomes after robotic-assisted prostatectomy in localized prostate cancer?
No full textRESECT: A Randomised Controlled Trial of Audit and Feedback in Non-muscle-invasive Bladder Cancer Surgery
No full textBACKGROUND AND OBJECTIVE: We aimed to determine whether audit, feedback, and education improves surgical performance after transurethral resection of bladder tumour surgery for non-muscle-invasive bladder cancer and as a secondary aim if it reduced recurrence rates. METHODS: This cluster randomised controlled trial compared audit and feedback plus peer comparison and education, with audit alone for four coprimary outcomes: (1) Single-instillation chemotherapy, (2) detrusor muscle sampling, (3) documentation of tumour features, and (4) resection completeness. Early recurrence was a secondary outcome. KEY FINDINGS AND LIMITATIONS: A total of 100 sites were randomised to intervention and 101 to control. In total, 14 915 patients were included. Intervention sites significantly improved documentation of tumour features (adjusted mean difference [95% confidence interval {CI}]: 6.0 [1.8, 10], p = 0.005) and of resection completeness (adjusted mean difference [95% CI]: 5.5 [1.5, 9.5], p = 0.007). There was no statistically significant difference in chemotherapy use (adjusted mean difference [95% CI]: 0.3 [-4.7, 5.3], p = 0.9) or detrusor muscle sampling (adjusted mean difference [95% CI]: 2.6 [-1.3, 6.4], p = 0.2). There was no statistically significant difference in early recurrence rate between arms (adjusted odds ratio [95% CI]: 1.02 [0.8, 1.4], p = 0.9); however, in the control arm, the early recurrence rate reduced compared with baseline (adjusted odds ratio [95% CI]: 0.7 [0.6, 0.9]). CONCLUSIONS AND CLINICAL IMPLICATIONS: Audit and feedback with education improved the documentation of important surgical findings that influence clinical management, but not the performance of detrusor muscle sampling, adjuvant chemotherapy use, or early recurrence rates. Improvements observed in the control arm may explain a lack of effect of the intervention in some outcomes
