Salvage stereotactic body radiation therapy for locally recurrent prostate cancer following primary radiation therapy, are benefits worth toxicity risks?: A systematic review.

INTRODUCTION: Salvage stereotactic body radiation therapy (SBRT) for localized prostate cancer recurrence following radiation therapy remains controversial. We performed a systematic review to assess the efficacy and side effect profile of salvage SBRT for locally recurrent prostate cancer to define the role of salvage SBRT in clinical practice. METHODS: A systematic review was carried out using Pubmed (MEDLINE) and Scopus databases. Inclusion and exclusion criteria were satisfied if studies reported on patients with prior radiation therapy for prostate cancer who had subsequently had a local recurrence. Those studies included were quality assessed using the ROBINS-I checklist. RESULTS: Five studies in total met criteria for inclusion and included all reportable outcomes. A total of 265 participants are reported on in total. Median doses for SBRT ranged from 30 to 36 Gy delivered over 5-6 fractions. Recurrence free survival ranged from 40% to 76% at 2 years. Genitourinary toxicity was more prevalent than gastrointestinal toxicities. Grade 2 and 3 genitourinary complication rates ranged from 5% to 22% and 0% to 9%, respectively. Gastrointestinal grade 2 complication rates ranged from 0% to 11% and no grade 3 complications were recorded. DISCUSSION: Salvage SBRT appears to be comparable and potentially superior in some aspects to other salvage therapies, taking into account the limitations in cross-study comparisons. This systematic review serves as one of the first to characterize SBRT as a salvage option for locally recurrent prostate cancer.

Secondary tumours in orthotopic neobladder using isolated gut segment post radical cystectomy for urothelial carcinoma: a systematic review.

BACKGROUND: Urothelial carcinoma recurrence of an orthotopic neobladder created from bowel segment is a rare occurrence. The usage of bowel segments to create neobladder following cystectomy for urinary diversion is growing yet there still remains a large gap in the literature about recurrence in neobladder. We carry out the first systematic review to outline current details of urothelial cancer recurrences in a neobladder, diagnostic approach, management and long term prognosis. METHOD: We carried out a systematic review searching databases PubMed (MEDLINE), Scopus and Web of Science. Only studies reporting on urothelial carcinoma recurrence of the neobladder with or without multi-focal disease were reported. A quality assessment tool was utilized to ensure all studies met quality standards. RESULTS: Fifteen studies were included in the systematic review meeting inclusion criteria. Fourteen of these studies were cases in men where pT3 disease was the most prevalent (29%). The most common symptomology was macroscopic haematuria seen in eight patients (53.33%). Management varied among cases and including adjuvant chemotherapy regimens and surgical interventions consisting of endoscopic resection to robotic neocystectomy and nephroureterectomy. Follow up period for these patients was up to 38 months and 55% of patients did not see a recurrence. CONCLUSION: The nature of recurrence is hypothesised to be due to seeding of urothelial cells into the non-urothelial surfaces compatible for both implantation and growth. We present the first systematic review to report on recurrence rates and details of diagnosis and outcomes of various management regimes for urothelial carcinoma of the neobladder.

Penile strangulation secondary to a plastic bottle neck.

Penile strangulation from a foreign body is a rare presentation to the emergency department. It must be treated as soon as possible as any delay in management can lead to complications such as gangrene and amputation of the penis. There is no superior standard of care as each case needs to be managed individually depending on clinical findings. We present a 40 year old male with a plastic bottle neck strangulating his penis requiring a medical cast saw to successfully free it.

Penile strangulation due to metallic foreign body; A rare case report highlighting effective management strategies for clinicians.

Penile strangulation from a foreign body is a time critical and rare presentation to the emergency department. The rarity of the presentation leads to its management being haphazard by the treating clinicians leading to suboptimal outcomes. We present a 44-year-old male with nine metal rings strangulating his penis and scrotum who failed multiple attempts by the department to free the penis and required an industrial circular saw provided by the fire-brigade to successfully cut the rings. We utilise this rare case of penile strangulation to outline steps health professionals can take to manage this condition in a timely fashion.

Right renal mass diagnosed as focal splenosis; a rare differential for a small renal mass highlighting utility of heat damaged Tc-99m RBC scintigraphy to avoid unnecessary surgery.

Small renal masses (SRM) represent a heterogenous group of kidney lesions that are often found incidentally and can represent a diagnostic dilemma. Herein, we report a 55 year old female who presented with a 25mm right renal mass. She had no symptomology or significant medical history but did report undergoing a traumatic splenectomy 30 years prior. Using Tc-99 m heat damaged RBC scintigraphy, the renal mass was confirmed as focal splenosis. Right sided renal splenosis is almost unheard of. Our case illustrates how good clinical history and correct imaging can prevent unnecessary investigations and surgery for a rare differential of SRMs.

Vasitis mimicking an inguinal hernia: A diagnostic dilemma.

Vasitis is a rare disorder characterised by inflammation of the vas deferens. It presents with scrotal or inguinal pain/swelling, mimicking the more commonly occurring conditions such as epididymitis, orchitis, testicular torsion or an incarcerated inguinal hernia. While ultrasound may exclude some of these differential diagnoses, computed tomography (CT) or Magnetic resonance imaging (MRI) is needed to distinguish vasitis from an incarcerated inguinal hernia. Vasitis is classically treated with antibiotics so proper diagnosis is essential to avoid unnecessary surgery. We present the case of a 20-year-old male with CT diagnosed vasitis, whose condition resolved within six weeks without administering antibiotics.

Benefits of Robotic Assisted vs. Traditional Laparoscopic Partial Nephrectomy: A Single Surgeon Comparative Study.

PURPOSE: The current study aims to compare peri-operative and post-operative outcomes between robotic assisted vs. laparoscopic partial nephrectomy. Multiple reviews of the current literature have detailed the lack of single surgeon studies in this domain. To limit inter-operator bias, we utilise a single surgeon experienced in both approaches to reduce this bias seen in other multi-centre studies. METHODS AND MATERIALS: We retrospectively compared patient demographics, tumour characteristics, peri-operative and post-operative outcomes of all partial nephrectomies undertaken by a single surgeon between 2014 and 2021 with experience in both laparoscopic and robotic surgery. The Da Vinci surgical system was utilized. Statistical analysis was carried out using GraphPad prism software version 7.03, San Diego, CA, USA. RESULTS: Warm ischemia time was reduced by 2.6 min, length of stay reduced by 1.3 days and acute renal function deterioration was reduced by 55% with all these results being significant with robotic assisted partial nephrectomy compared to laparoscopic partial nephrectomy. CONCLUSION: This study highlights the benefits of robotic assisted in comparison to laparoscopic partial nephrectomy. Further large-scale prospective studies and cost-benefit analysis of robotic assisted partial nephrectomy would be valuable in confirming these findings and justifying the usage against their financial cost.

Metastatic urothelial carcinoma of the bladder with sarcomatoid differentiation showing large cell neuroendocrine transformation in the liver; an unusual behaviour of a rare disease.

Metastatic urothelial carcinoma of the bladder is generally considered to be an aggressive disease with many recognised variants, however what is unique about our patient is the metastatic transformation from a urothelial primary malignancy with sarcomatoid variation to a neuroendocrine deposit within the liver. From what we have identified, this pattern of pathological transformation has not been reported for a urothelial malignancy in the literature. We present a 64 year old male who we believe is the first reported case of a primary urothelial malignancy presenting de-novo with metastatic liver deposits showing neuro-endocrine transformation.

Symptomatic giant renal oncocytoma with an incidental papillary adenoma.

Renal oncocytomas are benign, slow-growing tumours accounting for 3-7% of all solid renal neoplasms. These tumours tend to be small, unilateral and asymptomatic and are often discovered incidentally on imaging. Large oncocytomas are rare and can be difficult to distinguish from renal cell carcinoma based off clinical findings or imaging characteristics alone. Papillary adenomas are also benign renal neoplasms but arising from the renal tubular epithelium and almost always located within the cortex. We present a case of a 63-year-old Caucasian male with a large symptomatic renal oncocytoma with an incidental concurrent papillary adenoma.