Involvement of medical students in a surgery congress: impact on learning motivation, decision-making for a career in surgery, and educational curriculum.

During the preclinical period of medical school, the clinical relevance of theoretical knowledge is given little attention. Medical students of the second year were invited to participate in an interdisciplinary congress for robot-assisted and digital surgery. The students had to evaluate the impact of the congress on their learning motivation, decision-making for a career in surgery, and relevance for their educational curriculum. Participation in the congress increased their learning motivation for preclinical subjects, and significantly increased their interest in a surgical career. Most students considered active involvement in medical congresses a valuable supplement to the medical curriculum. Congress participation during the preclinical period was ranked positively by medical students. Greater learning motivation and enthusiasm for the pilot teaching project as well as for surgical disciplines were registered. Thus, early involvement of medical students in scientific congresses should be an integral part of their educational curriculum.

Impact of Acoustic and Interactive Disruptive Factors during Robot-Assisted Surgery-A Virtual Surgical Training Model.

The use of virtual reality trainers for teaching minimally invasive surgical techniques has been established for a long time in conventional laparoscopy as well as robotic surgery. The aim of the present study was to evaluate the impact of reproducible disruptive factors on the surgeon's work. In a cross-sectional investigation, surgeons were tested with regard to the impact of different disruptive factors when doing exercises on a robotic-surgery simulator (Mimic Flex VRTM). Additionally, we collected data about the participants' professional experience, gender, age, expertise in playing an instrument, and expertise in playing video games. The data were collected during DRUS 2019 (Symposium of the German Society for Robot-assisted Urology). Forty-two surgeons attending DRUS 2019 were asked to participate in a virtual robotic stress training unit. The surgeons worked in various specialties (visceral surgery, gynecology, and urology) and had different levels of expertise. The time taken to complete the exercise (TTCE), the final score (FSC), and blood loss (BL) were measured. In the basic exercise with an interactive disruption, TTCE was significantly longer (p < 0.01) and FSC significantly lower (p < 0.05). No significant difference in TTCE, FSC, or BL was noted in the advanced exercise with acoustic disruption. Performance during disruption was not dependent on the level of surgical experience, gender, age, expertise in playing an instrument, or playing video games. A positive correlation was registered between self-estimation and surgical experience. Interactive disruptions have a greater impact on the performance of a surgeon than acoustic ones. Disruption affects the performance of experienced as well as inexperienced surgeons. Disruption in daily surgery should be evaluated and minimized in the interest of the patient's safety.

Long-Term Efficacy and Safety of OnabotulinumtoxinA in Patients with Neurogenic Detrusor Overactivity Who Completed 4 Years of Treatment.

PURPOSE: We assessed the year-to-year consistency of outcomes in patients with urinary incontinence due to neurogenic detrusor overactivity who completed 4 years of onabotulinumtoxinA treatment. MATERIALS AND METHODS: Eligible patients who completed a 52-week phase 3 trial of onabotulinumtoxinA for urinary incontinence could enter a 3-year open label extension study of onabotulinumtoxinA 200 or 300 U administered as needed for symptom control. This analysis focused on 227 patients who completed the 4-year study. Outcomes assessed by year of treatment included mean treatments per year, mean change from baseline at week 6 in urinary incontinence episodes per day and the I-QOL (Incontinence Quality of Life) total summary score, the proportion of patients with 50% or greater and 100% reductions in urinary incontinence episodes per day, duration of effect and adverse events. RESULTS: Patients reported 4.3 urinary incontinence episodes per day at baseline and received 1.4 to 1.5 onabotulinumtoxinA treatments per year. The decrease in urinary incontinence following onabotulinumtoxinA consistently ranged from -3.4 to -3.9 episodes per day across 4 years. A high proportion of patients achieved 50% or greater and 100% urinary incontinence reductions in each year (range 86.6% to 94.1% and 43.6% to 57.4%, respectively). Consistent and clinically relevant improvements in I-QOL scores were observed in each treatment year. The overall median duration of effect of onabotulinumtoxinA was 9.0 months or greater (range 3.0 to 49.2) and 26.0% or more of patients experienced a duration of effect of 12 months or greater. The most common adverse event was urinary tract infection with no increased incidence with time. CONCLUSIONS: Patients with neurogenic detrusor overactivity who completed 4 years of onabotulinumtoxinA treatment experienced a consistent duration of treatment effect and year-to-year improvements in urinary incontinence and quality of life with no new safety signals.

Value and efficiency of sentinel lymph node diagnostics in patients with penile carcinoma with palpable inguinal lymph nodes as a new multimodal, minimally invasive approach.

PURPOSE: The international guidelines recommend sentinel lymph node biopsy (SLNB) for lymph node staging in penile cancer with non-palpable inguinal lymph nodes (LN) but it is not recommended with palpable inguinal LN. The aim of this study was to evaluate the reliability and morbidity of SLNB in combination with an ultrasound-guided resection of suspect inguinal LNs as a new multimodal, minimally invasive staging approach in these patients. METHODS: We performed SLNB in 26 penile cancer patients with 42 palpable inguinal LNs. Prior to the combined staging procedures the patients underwent an ultrasound examination of the groins as well as planar lymphatic drainage scintigraphy and SPECT/CT scans. During the surgical procedure, the radioactive-labelled sentinel lymph nodes and, in addition, sonographically suspect LNs, were resected under ultrasound guidance. Follow-up screening was done by ultrasound examination of the groins according to the guidelines of the European Association of Urology. RESULTS: Nineteen groins of 42 preoperatively palpable inguinal findings were histologically tumor-positive. SLNB alone showed lymphogenic metastases in 14 groins. Sonography revealed five further metastatic groins, which would not have been detected during SLNB due to a tumor-related blockage of lymphatic drainage or a so-called re-routing of the tracer. During follow-up, none of the 28 groins with tumor-negative LN status showed any LN recurrence in this combined investigation technique. The median follow-up period was 46 (24 to 92) months. Morbidity of this procedure was low at 4.76 % in relation to the number of groins resp. 7.69 % in relation to the number of patients. CONCLUSIONS: The results show that this combined procedure is a reliable multimodal diagnostic approach for treatment of penile cancer patients with palpable inguinal LNs. It is associated with low morbidity rates. SLNB alone would lead to a significantly higher false-negative rate in these patients. The encouraging results of this work can extend the range of indications for nuclear medicine in the form of SLNB using radioactive tracers in this patient group.

Preserved micturition after intradetrusor onabotulinumtoxinA injection for treatment of neurogenic bladder dysfunction in Parkinson's disease.

BACKGROUND: To assess the efficacy and safety of intradetrusor onabotulinumtoxinA (OnabotA) injection treatment in patients with neurogenic lower urinary tract dysfunction (NLUTD), especially for patients with Parkinson disease (PD). METHODS: PD patients refractory to oral antimuscarinic participated in an off-label use study and were evaluated prior and after 200 IU OnabotA injection into detrusor muscle, including trigone. Changes due to treatment were evaluated using bladder diaries, urodynamics, and questionnaires. Statistical analysis comprised Wilcoxon rank-sum test. Values are presented as mean ± standard deviation. RESULTS: Ten PD patients (4 female and 6 male, mean age: 67.9 ± 5.36 years) with LUTD were enrolled. All patients tolerated the treatment. Bladder diary variables decreased significantly (p ≤ 0.011) after OnabotA injection compared to variables prior injection. Desire to void and maximum bladder capacity increased significantly in urodynamics (p ≤ 0.05). Maximum detrusor pressure during voiding phase normalised from 56.2 to 18.75 cm/H20. Detrusor overactivity was less often detectable. All patients voided spontaneously. Mean post void residual (PVR) volume was 77.0 ± 119.78 mL postoperatively. No urinary retention or side effects have been observed during/after treatment. Mean follow-up time was 4 months (range of 1-12). 4 patients requested repeated injection after a mean period of 10 months between first and second injection. CONCLUSIONS: Our data confirm the efficacy and safety of 200 IU OnabotA injection in patients with neurogenic LUTD due to PD. The risk of urinary retention or high post-urinary residual volumes seems to be minor after OnabotA-injection. More research is needed with larger sample size to confirm the significance of these findings. TRIAL NUMBER: ISRCTN 11857462 , Registration Date 2016/10/08.

Cancer-specific and overall survival in patients with recurrent prostate cancer who underwent salvage extended pelvic lymph node dissection.

BACKGROUND: The aim was to evaluate cancer-specific survival (CSS) and overall survival (OS) in patients with prostate cancer (PCa) recurrence who underwent salvage extended pelvic lymph node dissection (ePLND), taking into consideration pre- and postoperative androgen deprivation therapy (ADT). METHODS: Salvage ePLND was performed in a cohort of 54 patients with PCa recurrence, and data from 45 patients were analyzed. The indications for salvage ePLND were biochemical recurrence (BCR) of PCa and suspect findings on (11)C-choline PET/CT. PSA-level, biochemical response (BR), duration of biochemical recurrence freedom (BCRF), number of metastases, OS and CSS were analyzed retrospectively. RESULTS: The average follow-up was 42.7 ± 20.8 months. Thirty-three patients (73.3 %, 95 % CI: 60.5-83.6 %) achieved BCRF during follow-up. The mean BCRF-period was 31.4 ± 19.7 months. CSS and OS were both 91.7 % ± 4.8 % (3-year survival) and 80.6 ± 8.6 % (5-year survival). Twenty-four patients (53.3 %, 95 % CI: 40.0-66.3 %) with castration-resistant PCa (CRPC) responded again to ADT after salvage ePLND. CONCLUSIONS: Salvage ePLND for selected patients with BCR and clinically recurrent nodal disease can achieve an immediate complete PSA response (i. e. BCRF) in nearly half of the patients. Patients with CRPC responded again to ADT after ePLND. Multicenter prospective studies with a control group are needed.

10-Year experience regarding the reliability and morbidity of radio guided lymph node biopsy in penile cancer patients and the associated radiation exposure of medical staff in this procedure.

BACKGROUND: The guidelines of the European Association of Urologists (EAU), of the German Society of Nuclear Medicine (DGN), and the European Society for Medical Oncology (ESMO) recommend sentinel lymph node biopsy (SLNB) for lymph node staging in penile cancer with non-palpable inguinal lymph nodes as one diagnostic method. Despite this, the method is neither widely nor regularly applied in Germany - the same applies to many other countries, which may be due to insecurity in dealing with open radioactive tracers. This study aims to assess the reliability and morbidity of this method, as well as the associated radioactive burden for clinical staff. METHODS: Between 2006 and 2016, 34 patients with an invasive penile carcinoma and inconspicuous inguinal lymph node status underwent SLNB in 57 groins after application of a radiotracer (Tc-99 m nanocolloid). We collected the results prospectively. The reliability of the method was assessed by determining the false-negative rate. In addition, we evaluated complication rates and determined the radioactive burden for the clinical staff both pre- and intraoperatively. RESULTS: SLNB was performed in 34 patients with penile cancer with non-palpable inguinal lymph nodes in 57 groins. In two patients inguinal lymph node metastases were detected by means of SLNB. In one patient recurrent inguinal lymph node disease was found after negative SLNB in both groins. Thus, the false negative rate was 3.13 % per patient (1/32 patients) and 3.51 % per groin (2/57 groins). The morbidity rate was 2.94 % per patient (1/34 patients) and 1.75 % per groin (1/57 groins). Radiation exposure for the clinical staff during this procedure was low at a maximum of ca. four µSV per intervention. CONCLUSIONS: SLNB is a reliable method with low morbidity that is associated with a low radiation burden for clinical staff. Due to the enhanced methodological and logistic demands, this intervention should be performed in specialized centres and in an interdisciplinary approach.

Establishment and characterization of primary cell lines of squamous cell carcinoma of the penis and its metastasis.

PURPOSE: We established cell lines from penile squamous cell carcinoma and its lymph node metastasis, and investigated the role of chemokines, chemokine receptors and podoplanin in cancer progression. MATERIALS AND METHODS: Tumor specimen of primary tumors, and lymph node and distant metastases were cultured in vitro and xenotransplanted in SCID beige mice. Specimens were analyzed by hematoxylin and eosin staining, and immunohistochemistry. Comparative screening for chemokines, chemokine receptors and podoplanin was done by polymerase chain reaction, fluorescence activated cell sorting and enzyme-linked immunosorbent assay. RESULTS: We established 2 cell lines from a primary tumor and its corresponding lymph node metastasis, respectively. Heterotopic xenotransplantation revealed reliable tumor growth in vivo. Morphological and immunohistological analysis showed comparable features for human tumors, cell lines in vitro and xenotransplanted tumors in mice regarding the primary tumor and metastasis. Comprehensive analysis of chemokines and chemokine receptors in the metastasis derived cell line and in the cell line originating from the primary tumor revealed the most pronounced changes for CXCL14. This pattern was confirmed on the protein level. Comparative analysis of podoplanin showed marked down-regulation in the metastatic variant on the mRNA and protein levels. CONCLUSIONS: To our knowledge we established the first pair of cell lines of a human primary penile tumor and the corresponding lymph node metastasis. These cell lines offer unique possibilities for further comparative functional investigations in in vitro and in vivo settings. They enable studies of new potential therapeutic agents and other assays to better understand the molecular mechanisms of penile cancer progression.

Urinary urgency: a review of its assessment as the key symptom of the overactive bladder syndrome.

PURPOSE: Overactive bladder (OAB) is a common condition that is associated with a negative impact on quality of life. Urgency is the essential symptom when making a diagnosis, and its effective treatment is a principal aim in OAB management. However, urgency has often been relatively neglected as an outcome measure in clinical trials. The aim of this review is, first, to describe the background to urgency in OAB; second, to determine whether results provided by several tools used to measure urgency in clinical trials could be cross-related to each other in a meaningful way. METHODS: The wording of various tools used to measure urgency in OAB was compared against the definition of urgency proposed by the International Continence Society (ICS). Urgency data were evaluated from two randomised, double-blinded, placebo-controlled trials with solifenacin in which seven tools were used to measure urgency as a primary or secondary outcome. In particular, subanalyses were available from these tools, which measured urgency equating to the ICS definition, excluding data points that could be interpreted as normal/strong desire to void. RESULTS: Baseline scores for ICS-defined urgency differed between the tools, which might reflect imprecision in their wording and consequent overlap between urgency and normal/strong desire to void. All the tools detected broadly similar mean percentage reductions in the number of urgency episodes from baseline to the endpoint of the studies. CONCLUSIONS: Urgency should be the primary or co-primary endpoint for future studies of OAB and detrusor overactivity. Greater clarity is needed in the development of instruments for measuring urgency, so that they do not confuse urgency with normal bladder sensations; more education and guidance are needed on how urgency is defined.

[Side-specific correlation between tumor location determined by biopsy and HistoScanning and nodal metastases in prostate cancer]. / Zusammenhang zwischen der seitenabhängigen präoperativ bestimmten intraprostatischen Tumorlokalisation mittels Stanzbiopsie und HistoScanning und der Lymphknotenmetastasierung des Prostatakarzinoms.

INTRODUCTION: This study investigates whether it is possible to predict the side of lymph node metastasis in prostate cancer preoperatively by evaluating biopsy or HistoScanning results. MATERIAL: This is a retrospective study including 56 patients. Prostatectomy, extended lymphadenectomy and lymph node metastasis were chosen as inclusion criteria. We analysed the relation between the preoperatively determined side of the tumour in the prostate and the side of pelvic lymph node metastases. METHODS: Microsoft® Office 365 Excel and IBM® SPSS® Statistics Subscription were used as statistic tools. For the statistical analysis, the Fisher exact test was employed. P values of < 0.05 were rated as statistically significant. RESULTS: A significant correlation between the location of the tumour in the prostate determined by biopsy and the side of lymph node metastasis has been shown. A share of 83 % of all patients with unilateral prostate cancer diagnosed by biopsy have lymph node metastases on one side (ipsilateral or contralateral); 75 % of those patients have exclusively ipsilateral metastases. The results of using HistoScanning as a diagnostic instrument are not convincing. The histopathological analysis after prostatectomy showed tumour growth in both prostate lobes in 89 % of the patients. CONCLUSION: Both biopsy and HistoScanning seem to underestimate the tumour spread in the prostate. Due to this inaccuracy, a recommendation to restrict lymphadenectomy to one side cannot be given although some significant correlation has been found.

Laparoscopic varicocelectomy in male infertility : Improvement of seminal parameters and effects on spermatogenesis.

BACKGROUND: The suitability of laparoscopic varicocelectomy for assisted reproductive technology depends on the improvement of semen parameters. The present study analyzed the improvement of semen parameters following laparoscopic varicocele ligation. MATERIAL AND METHODS: A retrospective study of the laparoscopic varicocele clippings at the Department of Urology of University Hospital of Kiel between the years 2007 and 2019 was conducted. The semen analyses according to WHO standards (sperm count, density, motility and morphology) were conducted before and 12 months after surgery. Screening for surgical complications took place at the time of the follow-up seminal analysis. Included were patients with oligozoospermia, asthenozoospermia and/or teratozoospermia (group 1, OAT) or with nonobstructive azoospermia (group 2, NOA). RESULTS: This study included data of 27 patients and 22 patients presented preoperative OAT (81%, group 1). Another 5 patients showed NOA (19%, group 2). Data of group 1 showed that semen parameters normalized in 32% of the patients after surgery. Significant improvement in total sperm count (p < 0.005), sperm density (p < 0.005) and total motile sperm count (p < 0.005) was observed. No deterioration of semen parameters was observed. In group 2 we detected spermatozoa in 1 case in the postoperative ejaculate. None of the patients showed complications according to the Clavien-Dindo classification, postoperative hydrocele formation or recurrence of varicocele at the time of control spermiogram. CONCLUSION: Laparoscopic varicocelectomy is a valid therapeutic approach to improve semen parameters for further assisted reproductive techniques. Spermatogenesis may be induced for patients with NOA. Normalization of semen parameters can be achieved for patients with OAT.

[Evaluation of the Padua and R.E.N.A.L. scores regarding their validity and implication in the perioperative management during partial nephrectomy]. / Evaluation von Padua- und R.E.N.A.L.-Score hinsichtlich ihrer Aussagekraft und Implikationen auf das perioperative Management bei der partiellen Nephrektomie.

BACKGROUND: Due to the rapid development of minimally-invasive surgery, there is a broader indication for surgical preservation of renal tissue. Current research suggests that, apart from the size of the tumour, its exact anatomical position should be considered when seeking optimal surgical treatment for individual patients. Therefore, numerous nephrometry scores have emerged, the Padua score and the R.E.N.A.L. score being most commonly used. Based on our patient population, we aimed to shed light on the question which score is best suited to assess the feasibility of nephron-sparing surgery and which can predict complications most accurately. PATIENTS AND METHODS: This study included 117 patients treated with partial nephrectomy at the University Hospital in Kiel (UKSH, Campus Kiel) between 2014 and 2017. The imaging results (computed tomography and magnetic resonance tomography) were retrospectively evaluated according to the Padua and R.E.N.A.L. score criteria. In some cases, radical nephrectomy became necessary despite the planned partial nephrectomy. We evaluated group differences regarding both nephrometry scores in these cases and the cases without radical nephrectomy. Then we performed correlation analyses regarding score outcome, operation time as well as perioperative, postoperative and overall complications. RESULTS: The tumours requiring treatment by radical nephrectomy (10 out of 117) had significantly higher scores only when the R.E.N.A.L. score was applied (mean difference 1.059, p < 0.05). Both the Padua and the R.E.N.A.L. score were positive correlated with operation time (R.E.N.A.L. score: correlation coefficient 0.284, p < 0.05, Padua score: coefficient 0.312, p < 0.05) as well as perioperative, postoperative and overall complications (R.E.N.A.L. score: coefficient 0.216, p < 0.05, Padua score: coefficient 0.192, p < 0.05). CONCLUSION: Each of the examined scores can be used to assess the risk of partial nephrectomy. For our patients, the preoperative application of the R.E.N.A.L. score would have been advantageous. Preoperative nephrometry scores are a useful tool and should be applied in addition to the surgeon's subjective evaluation. There is a lack of prospective studies investigating this issue.

Detection of Cancer Mutations by Urine Liquid Biopsy as a Potential Tool in the Clinical Management of Bladder Cancer Patients.

The standard diagnostic and follow-up examination for bladder cancer is diagnostic cystoscopy, an invasive test that requires compliance for a long period. Urine cytology and recent biomarkers come short of replacing cystoscopy. Urine liquid biopsy promises to solve this problem and potentially allows early detection, evaluation of treatment efficacy, and surveillance. A previous study reached 52-68% sensitivity using small-panel sequencing but could increase sensitivity to 68-83% by adding aneuploidy and promoter mutation detection. Here, we explore whether a large 127-gene panel alone is sufficient to detect tumor mutations in urine from bladder cancer patients. We recruited twelve bladder cancer patients, obtained preoperative and postoperative urine samples, and successfully analyzed samples from eleven patients. In ten patients, we found at least one mutation in bladder-cancer-associated genes, i.e., a promising sensitivity of 91%. In total, we identified 114 variants, of which 90 were predicted as nonbenign, 30% were associated with cancer, and 13% were actionable according to the CIViC database. Sanger sequencing of the patients' formalin-fixed, paraffin-embedded (FFPE) tumor tissues confirmed the findings. We concluded that incorporating urine liquid biopsy is a promising strategy in the management of bladder cancer patients.

External validation of the proposed T and N categories of squamous cell carcinoma of the penis.

OBJECTIVES: The aim of this study was to validate recently proposed modifications to the current TNM classification of penile squamous cell carcinoma (PSCC) by using data from four German urological centers. METHODS: We identified 89 patients treated for histologically confirmed PSCC between 1996 and 2008 and reclassified them according to the proposed TNM staging revisions. The proposed changes restricted T2 to tumoral invasion of the corpus spongiosum, whereas invasion of the corpus cavernosum was considered as T3. No changes were made to T1 and T4. Furthermore, N1 was limited to unilateral and N2 to bilateral inguinal lymph node involvement regardless of their number. Pelvic lymph node involvement and fixed lymph node were considered as N3 tumors. The range of follow up after initial treatment was 1-142 months (mean 38). RESULTS: Node-negative cases following the current classification were 65.2% (30/46), 48.5% (16/33) and 87.5% (7/8) for T1, T2 and T3, respectively. According to the proposed classification, N0 cases were markedly reduced in the T3 group (55.5%, 10/18) and relatively changed in the T2 group (56.5%, 13/23). T4 patients had no negative disease status. The 3-year disease-specific survival (DSS) rates for the proposed categories were 85.4%, 71.6% and 62.4% for T1, T2 and T3, respectively. For the current categories, the 3-year DSS rates were 85.4%, 66.9% and 100% for T1, T2 and T3, respectively. The 3-year DSS of the current N categories was 78.7%, 51% and 13.3% for N1, N2 and N3, respectively. According to the newly proposed categories, the 3-year DSS was 70%, 50% and 13.3% for N1, N2 and N3, respectively. CONCLUSION: Tumor and nodal staging of the newly proposed TNM classification show a more distinctive survival compared to the current one. However, a multi-institutional validation is still required to further corroborate the proposed modifications.

Robot-assisted partial nephrectomy: A single-center matched-pair analysis of the retroperitoneal versus the transperitoneal approach.

OBJECTIVE: Comparison of the retroperitoneal (RRPN) perioperative variables and the transperitoneal (TRPN) robot-assisted partial nephrectomy (RPN) using a matched-pair analysis. MATERIAL AND METHODS: A retrospective review was carried out for 224 patients who underwent RPN between 2014 and 2019. A matched-pair analysis was performed on 51 pairs of patients. The matching criteria were age, Charlson comorbidity index, body mass index, the grade of renal insufficiency, tumor diameter, and Preoperative Aspects and Dimensions Used for an Anatomical Classification of Renal Tumors score. RESULTS: The time to reach the renal hilum (P < .001), the overall complication rate (P » .008), and the major complication rate (P » .01) were lower in the RRPN group. The operative time was 143 vs 150minutes (P » .63) in RRPN vs TRPN, respectively. Warm ischemia time was 10minutes in RRPN vs 12minutes in TRPN (P » .07). Early unclamping was used in 71% in RRPN vs 48% in TRPN (P » .02). The length of hospital stay was 6 days in both groups (P » .11). The cases' complexity, the rate of positive surgical margins, and postoperative kidney function were comparable in both groups (P > .05). CONCLUSION: The advantages of RRPN lie in the shorter time to reach the renal hilum and the lower complication rates; the comparability with the other parameters proves the safety and feasibility of the RRPN access for localized kidney tumors.

Study and detection of potential markers for predicting metastasis into lymph nodes in prostate cancer.

Hormone-refractory prostate carcinoma has a different cell surface protein profile than hormone-sensitive prostate carcinoma, which provides migration ability and interactions with organs/tissues. Detection and association of these proteins with lymph node metastasis via lymphadenectomy might be beneficial for patients. Gene expression analysis in hormone-refractory and hormone-sensitive commercial cancer cell lines was performed and, after co-cultivation with osteoblasts or endothelial cells, knockdown experiments followed to validate potential biomarkers. "Myeloid-associated differentiation markers, myosin 1b and phosphatidylinositol-4-phosphate-5-kinase type 1 alpha are implicated in metastasis", their knockdown altered the expression of key regulators of endothelial-mesenchymal transition, invasion, motility and migration. In primary prostate tumors, these genes could be an indicator for future metastasis into lymph nodes.

Robot assisted spinal surgery- A technical report on the use of DaVinci in orthopaedics.

BACKGROUND: Robot assisted procedures have evolved during the last years, today many surgical, units perform laparoscopic procedures with DaVinci on a regular Basis. The major advantages of Robot assisted procedures comprise technical factors and improved visualization. In Spinal surgery endoscopic stabilization of fractures has become a Standard for many. PURPOSE: We have employed DaVinci as an access tool for a retroperitoneal lumbar approach followed by a DaVinci assisted corpectomy and cage implantation to treat a fracture of L3. STUDY DESIGN: A single operation as proof of concept and demonstration of the method was performed. METHODS: The whole procedure was video recorded. Time factors and clinical outcome were documented. RESULTS: The procedure was performed safely with no complications. The operating time was longer than usual but within reasonable limits. The postoperatrive outcome did not differ from the usual procedure. The visualization of critical structure during preparation of the vertebral body was superior along with superior soft tissue management with DaVinci. CONCLUSION: An endoscopic robotic instrument can be used for endoscopic access surgery. Despite major advantages in visualization and handling of the endoscopic instruments all bone and cartilage preparation must be performed in a traditional endoscpic way because no appropriate instruments are available at present. In order to perform full robotic assisted procedures, new instruments need to be developed.

Interobserver variation in grading and staging of squamous cell carcinoma of the penis in relation to the clinical outcome.

OBJECTIVE: To examine interobserver variations in assessing grade and stage of penile squamous cell carcinoma (SCC). PATIENTS AND METHODS: We retrospectively reviewed the pathological features and clinical outcome in 75 patients with SCC of the penis, who were treated in participating urological centres between 1996 and 2005; the assessments of the local pathologists and the review pathologists were compared. RESULTS: There was conformity in tumour grade in 67% and the assessment of tumour stage conformed in 84%; the combination assessment of both grade and stage conformed in 56%. CONCLUSION: Accurate histological subtyping by the surgical pathologist demands standardized guidelines, in particular for histological grading, which is crucial for clinical treatment, but shows significant interobserver variation.

Should being aged over 70 years hinder penile prosthesis implantation?

OBJECTIVE: To assess the satisfaction profiles following penile prosthesis surgery in patients with erectile dysfunction (ED) in their seventh decade of life. PATIENTS AND METHODS: In all, 174 patients received, for the first time, a penile prosthesis between 1990 and 2007 in our department. Among these, 35 patients were aged > or =70 years at prosthesis implantation. Of these, 18 patients were still alive at the time of follow-up. Using a telephone survey, patients were asked to answer the Erectile Dysfunction Inventory of Treatment Satisfaction (EDITS) as well as the International Index of Erectile Dysfunction (IIEF). Another question in the survey was developed by the authors based on a comprehensive review of the literature, which assessed the usefulness of the device for the patient and the degree of their usage. This was formulated as follows: How many times per 2 weeks do you have a sexual intercourse? RESULTS: In all, 15 of 18 patients were either very or somewhat satisfied (83%). At follow-up 11 out of 15 (73%) patients were using their prosthesis regularly. The mean IIEF and EDITS scores were 21.80 and 75.20, respectively. CONCLUSION: A penile prosthesis remains a highly promising treatment in older patients with a similar satisfaction rate to those published for younger patients. Thus, the motivation of the patient and not the age of the patient should be the main determinant factor in this surgical procedure.

Spatio-temporal deep learning models for tip force estimation during needle insertion.

PURPOSE: Precise placement of needles is a challenge in a number of clinical applications such as brachytherapy or biopsy. Forces acting at the needle cause tissue deformation and needle deflection which in turn may lead to misplacement or injury. Hence, a number of approaches to estimate the forces at the needle have been proposed. Yet, integrating sensors into the needle tip is challenging and a careful calibration is required to obtain good force estimates. METHODS: We describe a fiber-optic needle tip force sensor design using a single OCT fiber for measurement. The fiber images the deformation of an epoxy layer placed below the needle tip which results in a stream of 1D depth profiles. We study different deep learning approaches to facilitate calibration between this spatio-temporal image data and the related forces. In particular, we propose a novel convGRU-CNN architecture for simultaneous spatial and temporal data processing. RESULTS: The needle can be adapted to different operating ranges by changing the stiffness of the epoxy layer. Likewise, calibration can be adapted by training the deep learning models. Our novel convGRU-CNN architecture results in the lowest mean absolute error of [Formula: see text] and a cross-correlation coefficient of 0.9997 and clearly outperforms the other methods. Ex vivo experiments in human prostate tissue demonstrate the needle's application. CONCLUSIONS: Our OCT-based fiber-optic sensor presents a viable alternative for needle tip force estimation. The results indicate that the rich spatio-temporal information included in the stream of images showing the deformation throughout the epoxy layer can be effectively used by deep learning models. Particularly, we demonstrate that the convGRU-CNN architecture performs favorably, making it a promising approach for other spatio-temporal learning problems.