The Prognostic Impact of the Surgical Margin in Renal Cell Carcinoma Treated with Partial Nephrectomy: A Multi-Center Study.

Background: Partial nephrectomy (PN) is the preferred treatment for small, localized kidney tumors. Incomplete resection resulting in positive surgical margins (PSM) can occur after PN. The impact of PSM on the risk of recurrence and survival outcomes is not fully understood. We aimed to explore the relationship between PSM, the risk of recurrence and impact on survival after PN in a large multicenter cohort from Denmark. Methods: This was a retrospective cohort study including patients who underwent PN for renal cell carcinoma (RCC) at three departments in Denmark between 2010 and 2016. Data including pathological features, surgical techniques, and patient follow-up was retrieved from electronic medical health records and national databases. We used a combination of descriptive statistics, comparative analysis (comparisons were carried out by Mann-Whitney Test, independent Student's t-test, or Pearson's chi-Square Test), univariate and multivariate logistic regression analyses, and survival analysis methods. Results: A total of 523 patients were included, of which 48 (9.1%) had a PSM. Recurrence was observed in 55 patients (10.5%). Median follow-up time was 75 months. We found a lower incidence of PSM with robot-assisted PN (p = 0.01) compared to open or laparoscopic PN. PSM was associated with a higher risk of recurrence compared to negative margins in univariate analysis, but not multivariate analysis. However, the study was underpowered to describe this association with other risk factors. Overall survival did not differ between patients with PSM and negative margins. Conclusions: Our study presents further evidence on the negative impact of PSM on recurrence after PN for RCC, highlighting the importance of achieving NSM, thus potentially improving clinical outcomes. A surgical approach was found to be the only predictive factor influencing the risk of PSMs, with a reduced risk observed with robot-assisted laparoscopy.

Implantation of the argus sling in a hard-to-treat patient group with urinary stress incontinence.

INTRODUCTION: Awareness of prostate cancer is growing in the Western population, and an increasing number of patients are being referred to prostate surgery. This is a significant contributor to male stress urinary incontinence (SUI). Implantation of an artificial sphincter (AUS) is considered the gold standard treatment of SUI. This study investigates the role of minimally invasive treatment with the Argus sling in a heterogenic hard-to-treat patient group. METHOD: The study was a retrospective follow-up study with patients as their own controls. Forty-one patients were enrolled and treated with the Argus sling. Patients enrolled had persisting SUI after prostate surgery for more than 12 months, despite conservative treatment. The pre-operative daily usage of pads and the 24 hours urinary leakage were compared to the post-operative findings. The primary goal was to achieve complete continence or a reduction of more than 50% in pad usage or urinary leakage. RESULTS: In total, 71% of the 41 patients enrolled met our primary objective. Complete continence was obtained in 56%, and a reduction of 50% or more was obtained in an additional 15%. CONCLUSION: This study has reproduced continence rates seen in previous studies, but in the hard-to-treat patients with urgency or formerly failed surgery, the continence rate was found to be inferior. The AUS has produced similar results and must still be considered the gold standard treatment of SUI, but the Argus sling is an alternative for patients who want a passive system or for patients not suitable for AUS.

Delayed healing at transurethral resection of bladder tumour sites after immediate postoperative mitomycin C instillation.

The most common reactions to mitomycin C are dysuria and drug-related palmar and genital desquamation. This report describes two cases of delayed healing of the mucosa at resection sites after transurethral resection of bladder tumours, most likely due to immediate postoperative mitomycin C instillation of the bladder.

Transurethral microwave thermotherapy treatment of chronic urinary retention in patients unsuitable for surgery.

OBJECTIVE: The aim of this study was to evaluate transurethral microwave thermotherapy (TUMT) in the treatment of chronic urinary retention due to benign prostatic hyperplasia (BPH) in patients unsuitable for surgery. MATERIAL AND METHODS: The study enrolled 124 patients with chronic urinary retention due to BPH. The median age was 80 years (61-92 years). Of the enrolled patients, 77 (62%) were assessed by an anaesthesiologist as being unsuitable for surgery owing to cardiac, pulmonary, neurological or other diseases. Overall, 115 patients (93%) had an indwelling catheter. The remaining nine patients (7%) performed clean intermittent self-catheterization. The treatment was performed under local anaesthesia in the outpatient department using the ProstaLund Coretherm Device. At the 6-month follow-up, the Danish version of the International Prostate Symptom Score (DAN-PSS), postvoiding residual volume and urinary peak flow were measured. Improvement in quality of life was also registered. RESULTS: The success of TUMT was assessed by looking at the percentage of patients relieved of their catheter and by the improvement in quality of life. Overall, 77% of patients were relieved of their catheter and 79% reported an improvement in their quality of life. CONCLUSION: In this study, both the median age and the percentage of patients unsuitable for surgery were larger than in previous studies. Despite this, TUMT relieved 77% of their catheter and 79% reported an improvement in their quality of life. This study shows that TUMT is an effective treatment for patients unsuitable for surgery and with chronic urinary retention.