Complete puborectalis, puboperinealis muscle and urethral rhabdomyosphincter preservation in laparoscopic radical prostatectomy: Anatomical landmarks to achieve early urinary continence.

OBJECTIVES: To describe our surgical technique of "muscle-sparing" laparoscopic radical prostatectomy and to review relevant anatomical landmarks during the procedure. METHODS: This was a prospective non-controlled case series of 120 consecutive patients who underwent laparoscopic radical prostatectomy, always carried out by the same surgeon (OL). The median follow-up period was 33 months. Dissection of the puboperinealis and puborectalis muscle consists of the precise dissection of the puborectalis and puboperinealis muscles from the periprostatic fascia. Rhabdomyo-dissection consists of an approach that spares the external urethral sphincter from the ventral surface of the prostate and membranous urethra. Clinical data were collected in a dedicated database. Intraoperative variables, postoperative complications and outcomes of urinary continence were assessed. A descriptive statistical analysis was carried out. RESULTS: Continence rates were 70.8%, 83.3% and 92.5%, at 0-2, 3-4 and 5-8 weeks after removal of the urethral catheter, respectively; 96.6% and 98.3% at 6 and 12 months after surgery. The positive surgical margin rate associated with rhabdomyo-dissection was 8.3%. CONCLUSIONS: Laparoscopic radical prostatectomy with dissection of the puboperinealis and puborectalis muscle, and rhabdomyo-dissection is an oncologically safe procedure, associated with very early recovery urinary continence in most patients. It is a technique that can be applied in most cases, as long as there is no invasion of the ventral side of the prostate.

Metastasis of rectal adenocarcinoma to the penis.

OBJECTIVE: To report a clinical case of penile metastasis of a rectal adenocarcinoma. METHODS: We report the case of a 78-year-old male with a clinical history of rectum adenocarcinoma. The management included an anterior rectum-resection and postoperative combination of neoadjuvant chemo and radiotherapy. Eight months after the operation, a painful solitary nodular lesion on the glans penis was diagnosed. We performed a needle biopsy (Tru-cut). RESULTS: Histological examination confirmed metastasis of the rectal tumour. We performed partial penectomy. CONCLUSIONS: The incidence of penile metastasis is extremely low. In a large number of cases the primary tumour is localized in the genito-urinary tract, less likley they originate from other organs. The treatment, depending to each case, is mostly palliative due to the poor prognosis of disease.

Impact of Sarcopenia and Frailty in a Multicenter Cohort of Polypathological Patients.

The prevalence, relationships and outcomes of sarcopenia and frailty in polypathological patients remain unknown. We performed a multicenter prospective observational study in six hospitals in order to assess prevalence, clinical features, outcome and associated risk factors of sarcopenia and frailty in a hospital-based population of polypathological patients. The cohort was recruited by performing prevalence surveys every 14 days during the inclusion period (March 2012-June 2016). Sarcopenia was assessed by means of EWGSOP criteria and frailty by means of Fried's criteria. Skeletal muscle mass was measured by tetrapolar bioimpedanciometry. All patients were followed for 12 months. Factors associated with sarcopenia, frailty and mortality were analyzed by multivariate logistic regression, and Kaplan-Meier curves. A total of 444 patients (77.3 ± 8.4 years, 55% males) were included. Sarcopenia was present in 97 patients (21.8%), this being moderate in 54 (12.2%), and severe in 43 (9.6%); frailty was present in 278 patients (62.6%), and 140 (31.6%) were pre-frail; combined sarcopenia and frailty were present in the same patient in 80 (18%) patients. Factors independently associated to the presence of both, sarcopenia and frailty were female gender, older age, different chronic conditions, poor functional status, low body mass index, asthenia and depressive disorders, and low leucocytes and lymphocytes count. Mortality in the 12-months follow-up period was 40%. Patients with sarcopenia, frailty or both survived significantly less than those without these conditions. Sarcopenia and frailty are frequent and interrelated conditions in polypathological patients, shadowing their survival. Their early recognition and management could improve health-related outcomes in this population.

Maternal Hair and Neonatal Meconium to Assess Gestational Consumption and Prenatal Exposure to Drugs of Abuse and Psychoactive Drugs.

BACKGROUND: In the last two decades, the consumption of drugs of abuse among women of childbearing age has experienced a significant increase and results from analyses of surveys concerning maternal intake of psychoactive prescription drugs during pregnancy indicate that the rates of intake are increasing each year. Analyses of biological matrices such as maternal hair and neonatal meconium have recently been used for assessment of gestational consumption and consequent prenatal exposure to drugs of abuse in high-risk groups of women. METHODS: Maternal hair and neonatal meconium were analyzed by validated chromatographic-mass spectrometric methodologies to disclose the gestational use of drugs of abuse and psychoactive prescription drugs and consequent prenatal exposure in a cohort of 513 mother-newborn dyads at the Sant Joan de Déu Barcelona Hospital, Spain, during 2012-2013. RESULTS: A total of 3.9% women reported drugs of abuse or prescription psychoactive drug consumption at any time during pregnancy. The prevalence of gestational consumption and the consequent prenatal exposure to drugs of abuse (e.g. cannabis, cocaine and MDMA) was 1.2% in maternal hair and 0.4% in meconium; and of psychoactive prescription drugs (e.g. venlafaxine, citalopram, fluoxetine, clomipramine), was 1.7% in maternal hair and 1.2% in meconium. The prevalence of drugs of abuse and prescription psychoactive drug consumption was lower in our specific cohort of Spanish pregnant women than in other cohorts such as those from U.S. or Denmark. CONCLUSION: Analysis of materno-fetal matrices provides a viable alternative to study prenatal exposure to these substances and develop specific social and health intervention recommendations.