Low-rank fusion convolutional neural network for prediction of remission after stereotactic radiosurgery in patients with acromegaly: a proof-of-concept study.

Artificial intelligence approaches to analyze pathological images (pathomic) for outcome prediction have not been sufficiently considered in the field of pituitary research. A total of 5,504 hematoxylin & eosin-stained pathology image tiles from 58 acromegalic patients with a good or poor outcome were integrated with other clinical and genetic information to train a low-rank fusion convolutional neural network (LFCNN). The model was externally validated in 1,536 patches from an external cohort. The primary outcome was the time to the first endocrine remission after stereotactic radiosurgery (SRS). The median time of initial endocrine remission was 43 months (interquartile range [IQR]: 13-60 months) after SRS, and the 24-month initial cumulative remission rate was 57.9% (IQR: 46.4-72.3%). The patient-wise accuracy of the LFCNN model in predicting the primary outcome was 92.9% in the internal test dataset, and the sensitivity and specificity were 87.5 and 100.0%, respectively. The LFCNN model was a strong predictor of initial cumulative remission in the training cohort (hazard ratio [HR] 9.58, 95% confidence interval [CI] 3.89-23.59; p < 0.001) and was higher than that of established prognostic markers. The predictive value of the LFCNN model was further validated in an external cohort (HR 9.06, 95% CI 1.14-72.25; p = 0.012). In this proof-of-concept study, clinically and genetically useful prognostic markers were integrated with digital images to predict endocrine outcomes after SRS in patients with active acromegaly. The model considerably outperformed established prognostic markers and can potentially be used by clinicians to improve decision-making regarding adjuvant treatment choices. © 2022 The Pathological Society of Great Britain and Ireland.

[Transperitoneal laparoscopic ureterolithotomy for upper ureteral calculi: a report of 1171 cases].

OBJECTIVE: To evaluate clinical outcomes and values of transperitoneal laparoscopic ureterolithotomy. METHODS: A total of 1171 patients with upper ureteral calculi were recruited during September 1999 to February 2012. The etiologies included impacted calculi (n = 1100), non-impacted calculi (n = 71), multiple ureteral calculi (n = 51) and combined small calculi in unilateral kidney (n = 139). Maximum diameter of calculi was 1.5 (0.8-2.6) cm. All patients underwent transperitoneal laparoscopic ureterolithotomy and double J stent was implanted intraoperatively. RESULTS: Two cases were converted into open operation. Calculi moving up into pelvis occurred in 27 cases. And 25 cases converted into laparoscopic pyelolithotomy and stones were removed successfully. Two cases received extra extracorporeal shock wave lithotripsy postoperatively. The remaining 1142 cases were treated successfully with an operative duration of 56.1 (26-160) min and an estimated volume of blood loss at 45.2 (10-250) ml. The period of drainage tube was 3.1 (1-7) days. Postoperative hospitalization stay was 4.8 (3-9) days. One patient suffered urine leakage and healed at Day 6 days post-operation. Ten cases suffered D-J stent bladder non-arrival or retraction and double J stents were extracted by ureteroscopy. One case suffered paralytic ileus and recovered 7 days later. Another case suffered severe hematuria. No intestine or adjacent viscera injury was observed. The follow-up period of 827 cases was 7.3 (24-108) months. Among 12 cases of ureteral stricture, ureteral dilation (n = 7) and ureteral anastomosis (n = 3) were performed. For 5 cases of renal atrophy, 3 underwent nephrectomy because of recurrent lumbago or persistent urinary infection. CONCLUSIONS: Transperitoneal laparoscopic ureterolithotomy has the advantages of minimal morbidity, little postoperative discomfort and high stone clearance rate over open surgery. It should be widely adopted for the patients with upper ureteral impacted calculi.

Pure transperitoneal laparoscopic correction of retrocaval ureter.

BACKGROUND: Retrocaval ureter is a rare congenital abnormality. Operative repair is always suggested in cases of significant functional obstruction. Laparoscopic procedures have been employed as the minimally invasive therapeutic option for retrocaval ureter. However, the laparoscopic techniques for retrocaval ureter might be technically challenging to some surgeons. The aim of this article was to present our experience and surgical techniques of pure transperitoneal laparoscopic pyelopyelostomy and ureteroureterostomy in nine patients with retrocaval ureter. METHODS: A total of nine patients of retrocaval ureter underwent pure laparoscopic pyelopyelostomy or ureteroureterostomy. The operation was performed with the patients placed in the 70-degree lateral decubitus position via a three port transperitoneal approach with two 10-mm and one 5-mm ports. The distal part of the dilated renal pelvis was transected at the ureteropelvic junction and the ureter was relocated anterior to the inferior vena cava. The tension-free pyeloureteral or ureteroureteral anastomosis was completed with the intracorporal freehand suturing and in situ knot-tying techniques combined with interrupted and continuous fashion. A double J ureteral stent was inserted in an antegrade manner during laparoscopy. Intravenous urography or computerized tomography and renal ultrasonography were performed after 3 months postoperatively. RESULTS: All operations were completed laparoscopically, and no open conversion was required. The mean operative time was 135 minutes (range, 70 - 250 minutes), with minimal blood loss (less than 60 ml). No intra-operative complications or significant bleeding occurred. All patients presented mild postoperative pain and quick convalescence. The symptoms disappeared and hydronephrosis decreased substantially after surgery. CONCLUSIONS: Pure transperitoneal laparoscopic correction for retrocaval ureter was associated with an excellent outcome, minimal invasiveness and short hospital stay. It is technically feasible and reliable for retrocaval ureter treatment. Laparoscopic surgery could be the standard treatment for retrocaval ureter.

Transperitoneal laparoscopic adrenalectomy for adrenal metastasis.

AIM: The treatment of adrenal metastasis using laparoscopic surgery is evolving. The aim of this study was to evaluate the feasibility of laparoscopic adrenalectomy (LA) in patients who have adrenal metastases. METHODS: From September 1998 to November 2010, 12 patients underwent LA for adrenal metastatic tumors. Three cases were bilateral and 9 were unilateral. We retrospectively reviewed the clinical and histopathologic data of all 12 patients. RESULTS: The operations of all the 12 cases were successful. There were no intraoperative complications. The mean follow-up time was 17.2 months (range, 2 to 56 mo). We found no intraperitoneal and/or port-site recurrence. One patient had died from metastatic disease. CONCLUSIONS: Our experience leads us to feel that LA is feasible when the primary tumor is well controlled, there are no other metastases clinically and radiologically, when the adrenal metastasis is confined to the adrenal gland, and there is no radiologic evidence of local extension into tissue around the adrenal gland.

[Diagnosis and surgical management of renal cell carcinoma with inferior vena cava tumor thrombus--a report of 6 cases with literature review].

BACKGROUND & OBJECTIVE: The management of renal cell carcinoma (RCC) with inferior vena cava (IVC) tumor thrombus is difficult in clinical practice. Complete surgical removal of the primary tumor with its extension along the IVC is the only hope for a potential cure. The diagnosis of vena caval invasion, especially the determination of tumor thrombus extension, is important for surgical approach planning. This report was to summarize our experiences on treating RCC with IVC tumor thrombus, and explore the diagnosis and surgical management. METHODS: Clinical data, including preoperative diagnosis, operation pattern, and prognosis, of 6 RCC patients with IVC tumor thrombus, treated from 2000 to 2004 in our hospital, were reviewed retrospectively. RESULTS: Diagnoses of the 6 cases of RCC with IVC tumor thrombus were made by ultrasonography, computed tomography (CT), or magnetic resonance imaging (MRI) preoperatively. Of the 6 cases, 1 was renal vein thrombus, 3 were infrahepatic thrombus, 2 were hepatic thrombus. Operations were performed for all 6 patients with 5 successes except 1 death during the operation. The patients were followed-up for 3-30 months after operation; 2 died of distant metastases 3 and 9 months after operation, and the other 3 survived disease-freely. CONCLUSIONS: CT and MRI are the best ways to diagnose RCC with IVC tumor thrombus. Surgical treatment is the preferred approach for the patients without distant metastases and lymph node involvement. Surgical strategy depends on the tumor thrombus extension and the vena wall involvement status.

[Effect of finasteride on intraoperative bleeding and irrigating fluid absorption during transurethral resection of prostate: a quantitative study].

OBJECTIVE: To evaluate the effect of pretreatment with finasteride in decreasing intraoperative bleeding and irrigating fluid absorption during transurethral resection of prostate (TURP). METHODS: Eighty patients with benign prostate hypertrophy undergoing TURP were divided into two groups: 40 patients were pretreated with finasteride for 7 to 14 days before TURP and 40 patients without pretreatment. Absorption of irrigating fluid was quantified by analyzing the serum concentration of gentamycin. Intraoperative blood loss was calculated based on hemoglobin concentrations before and after operation. RESULT: The whole blood loss, hemoglobin concentration of irrigating fluid used, blood loss per minute, blood loss per gram tissue resected, whole irrigation absorption, irrigation absorption per minute and per gram tissue resected in patients pretreated with finasteride were significantly less than those in patients without pretreatment (P<0.05). The blood transfusion volume, the incidence of hypotension and hyponatremia in patients pretreated with finasteride were significantly less than those in patients without pretreatment (P<0.05). CONCLUSION: Pretreatment with finasteride is of value in reducing intraoperative bleeding, irrigation absorption and perioperative complication during TURP.

[Spiral CT urography and CT virtual endoscopy in detecting urological diseases].

OBJECTIVE: To evaluate spiral CT urography (SCTU) and CT virtual endoscopy (CTVE) in detecting urologic diseases. METHODS: SCTU was performed in 46 patients with urological diseases including renal neoplasms (2), paropelvic cysts (2), ureteral calculi (6), ureteral stenosis (4), ureteral neoplasms (2), double kidneys and ureter malformation (1), bladder neoplasms (28) and bladder endometreosis (1). The 6 patients with ureteral diseases and 29 patients with bladder diseases underwent CTVE based on spiral CT scan. All CTVE findings were compared with those of B-mode ultrosonography, intravenous urography (IVU), retrograde pyelography (RGP), conventional CT or cystoscopy. RESULTS: All upper urinary tract diseases and bladder diseases (28 cases) were detected by SCTU and CTVE scans and they were confirmed operatively or pathologically except one case of bladder neoplasm (diameter less than 5 mm) was missed. CONCLUSION: SCTU and CTVE have proved to be non-invasive and reliable in the diagnosis of urological diseases and are superior to IVU or conventional CT. CTVE can serve as a supplementary method to fiberoptic cystoscopy or ureteroscopy.