Subungal squamous cell carcinoma of the thumb - Implications for patient setup and radiotherapy planning.

Subungal squamous cell carcinoma (SSCC) is a rare malignancy of the nail bed. We present the case of a woman diagnosed with a SSCC of the right thumb. Initial management consisted of surgically excision followed by adjuvant radiotherapy due to a positive bone margin. We describe the patient set-up, immobilisation technique, target volume delineation, radiotherapy planning, fractionation schedule, image guidance and patient outcomes.

Efficacy of urodynamic studies in predicting long-term outcomes of the transobturator tape: do they augment clinical assessment?

INTRODUCTION: Some controversy exists regarding necessity for urodynamic evaluation prior to surgical management of stress urinary incontinence (SUI). We aimed to interrogate the role of pre and post-operative urodynamic studies versus clinical assessment in predicting long-term patient reported outcomes of transobturator tape (TOT) placement. MATERIAL AND METHODS: A 100 patient cohort of women post TOT insertion for stress/mixed urinary incontinence 2005-2010, under a single surgeon, was identified. Results of pre and post-operative clinical assessment and urodynamic studies were retrospectively evaluated. Long-term patient reported outcome measures (PROMs) were assessed using the International Consultation on Incontinence Questionnaire (ICIQ) Short Form, Patient Global Impression of Severity (PGI-S) and Patient Global Impression of Improvement (PGI-I) questionnaires. The role of urodynamic studies in predicting postoperative voiding dysfunction, and long-term procedure outcomes was analysed. Statistical correlations were performed using SPSS. RESULTS: Questionnaire response rate was 76/100 (76%) at mean follow-up 9.4 years (7.25-12.75). Mean ICIQ score was 6.32 (1-20). No significant correlations between preoperative pDet QMax and postoperative uroflow/duration of intermittent self catheterisation (ISC), or between preoperative leak-point pressures and outcome were observed. Postoperative urodynamic tests did not reliably predict long-term success in SUI cure. Preoperative clinical urgency was a more reliable predictor of long-term clinical urgency than urodynamic detrusor overactivity. Whilst patients with mixed urinary incontinence at long-term follow-up tended to have the highest (worst) overall ICIQ-SF and ICIQ quality of life score, no studied variables on preoperative CMG were significantly correlated with long-term PROMs. CONCLUSIONS: Whilst urodynamic studies provide important baseline bladder function data, prior to mid-urethral sling placement, this study finds no specific value of either pre or postoperative urodynamics in predicting long-term patient reported outcomes of transobturator tape placement.