Long-term outcomes and patient satisfaction after artificial urinary sphincter implantation.

PURPOSE: To evaluate long-term functional outcomes of artificial urinary sphincter implantation in men for the treatment of stress urinary incontinence. MATERIALS AND METHODS: Patients who underwent artificial urinary sphincter implant for non-neurogenic stress urinary incontinence between June 1989 and January 2020 were included in this single-centre retrospective series. All patients with a functional artificial urinary sphincter in situ were contacted to evaluate long-term functional outcomes using validated questionnaires. RESULTS: A total of 263 patients were included in this retrospective series with a mean follow-up of 61 months. Explant-free survival after 5 years was 75% with a median time to explant of 16.2 years. Revision-free implant survival was 62% after 5 years with a median revision-free implant survival rate of 10.8 years. Previous pelvic irradiation, history of stricture disease and previous artificial urinary sphincter implant were associated with decreased implant survival. Overall social continence rate after 5 years was 60%. Prior radiation therapy, anticoagulation therapy and previous anti-incontinence surgery were associated with a higher incontinence risk. On long-term evaluation of 158 patients with their artificial urinary sphincter currently in situ, 51% were socially continent and 29% reported they were totally dry. Of these patients, 92% indicated to be satisfied with their current continence status. CONCLUSION: A significant proportion of patients undergoing artificial urinary sphincter implant incontinence needed revision or explant surgery. Long-term continence rates are acceptable but tend to decrease by time. Nonetheless, if patients can maintain a functional AUS in situ, long-term patient satisfaction rates remain high.

Mucinous cystadenocarcinoma in the renal pelvis: primary or secondary? Case report and literature review.

INTRODUCTION: Cystic lesions in the renal pelvis may cause a diagnostic dilemma. These lesions may be benign or (pre)malignant and primary of secondary. CASE REPORT: A 65-year-old woman presents with a complex cystic mass in the lower pole of the left kidney measuring approximately 16 cm in size and classified as Bosniak type 2F with minimally thickened septa and thick calcifications on non-contrast-enhanced computed tomography. The histopathological findings are consistent with a mucinous cystadenocarcinoma in the renal pelvis. Given the absence of a primary focus and based on clinical and radiological examination, the diagnosis of a primary renal neoplasm is preferred. DISCUSSION: A review of the literature is performed to evaluate the histological differential diagnosis and confirm the diagnosis. Epidemiology with an overview of available similar cases since 2009, as well as etiological factors, treatment and prognosis was reviewed. CONCLUSION: Primary renal mucinous cystadenocarcinoma is an exceedingly rare tumor. Histopathology still remains the gold standard for the diagnosis of this tumor. Because of the rarity, secondary involvement from more common sites, such as ovary and gastrointestinal tract, should be thoroughly excluded.

Incidental breast carcinoma in reduction mammoplasty.

AIM: The objective of this study was to analyze the incidence and treatment options of occult cancer or atypical lesions found in the histopathological examination of reduction mammoplasty (RM) specimens. The role of preoperative mammography and systematic histopathological examination are discussed. METHODS: We performed a retrospective single-center database review of all patients who underwent a RM between January 2005 and December 2014. Preoperative examination, histopathological findings and follow-up were documented. RESULTS: A total of 1045 patients underwent RM, of which 97% were bilateral (1021). All patients received a mammography and routine clinical examination to exclude cancer preoperatively. The overall mean patient age was 40.2 years (14.2-73.4). A total of 19 patients (1.18%) had significant histopathological findings, all of whom were over 40 years of age. There were 4 incidental carcinomas (0.38%), of which 2 were DCIS (0.19%) and 2 invasive ductal carcinomas (0.19%). CONCLUSIONS: Incidence of postoperative diagnosis of occult breast cancer in RM specimens remains low, but poses significant therapeutic challenges. While emphasis should lay on preoperative diagnostics, routine histological analysis of RM specimens is recommended.

Idiopathic Partial Thrombosis (IPT) of the Corpus Cavernosum: A Hypothesis-Generating Case Series and Review of the Literature.

INTRODUCTION: Idiopathic partial thrombosis (IPT) of the corpus cavernosum is a rare condition. The etiology is not fully understood; however, the presence of an either or not congenital web in these patients may contribute to the development of IPT. AIM: The aim of this study was to describe 18 new IPT cases and compare these with 38 cases found in the literature. METHODS: A multicenter retrospective analysis was performed. Descriptive statistics are given. MAIN OUTCOME MEASURES: The main outcome measures used were clinical presentation, clinical and radiographical diagnostics, treatment and resolution of symptoms. RESULTS: Patients most frequently presented with perineal swelling (10/18; 56%) and pain (13/18; 72%), unilateral (12/18; 67%) or bilateral (4/18; 22%), and pain during erection (10/18; 72%). Penile curvature, dysuria or fever (each 1/18; 6%) were uncommon presenting symptoms. In our series, magnetic resonance imaging demonstrated a fibrous web in the corpus cavernosum in 100% of cases and was more bilaterally (11/18; 61%) than unilaterally (7/18; 39%) diagnosed. Cycling was found to be a provocative factor for IPT occurrence in patients at risk as 61% (11/18) of patients reported being a frequent cyclist with the episode of IPT occurring immediately after or during cycling activity in 8 out of 18 patients (8/18; 44%). In five centers, 15 patients were treated conservatively, the majority being treated with therapeutic doses of low molecular weight heparin and simultaneous anti-aggregant therapy. In one center, all three patients were treated with a surgical approach. Complete resolution of symptoms was noted in only 50% of cases. CONCLUSION: IPT is a condition that presents typically with perineal pain and swelling. Cycling is often seen as a provocative factor, while the presence of a fibrous web at the level of the crurocavernosal junction is the underlying disorder allowing for entrapment of blood in the crura. Conservative treatment provides a reasonably good outcome in most cases. For therapy resistant cases, surgery can be considered.

Long-term Functional Outcomes and Patient Satisfaction After AdVance and AdVanceXP Male Sling Surgery.

BACKGROUND: Transobturator male sling has gained increasing acceptance for the treatment of male urinary incontinence. Several prospective trials have demonstrated the safety and efficacy of the AdVance and AdVanceXP slings. OBJECTIVE: To evaluate long-term functional outcomes after AdVance or AdVanceXP sling implant for non-neurogenic male stress urinary incontinence and identify factors associated with a higher risk for incontinence or decreased satisfaction. DESIGN, SETTING, AND PARTICIPANTS: Patients who underwent AdVance or AdVanceXP implant surgery between June 2007 and April 2018 were retrospectively included in this single-institution, consecutive series. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: In April 2020, patients were recontacted to evaluate long-term functional outcomes and satisfaction by standardized, validated questionnaires. RESULTS AND LIMITATIONS: A total of 216 patients were included in this study; 172 of them could be contacted for the assessment of long-term patient reported outcomes. The median follow-up period was 49 mo. Overall social continence (ie, needing no more than one pad per 24 h) at 5-yr follow-up was 66% (confidence interval [CI]: 58-73%). In an ideal population (ie, needing no more than four pads per 24 h and naïve for pelvic radiotherapy, prior incontinence surgery, or urethral stricture surgery), 5-yr social continence rates were markedly better and reached 79% (CI: 69-85%). Overall social continence rates tended to decrease at 10-yr follow-up to 42% (CI: 33-52%). Overall, totally dry rate at 5-yr follow-up was 53% (CI: 46-60%), which again was significantly better in the ideal population (62%, CI: 51-70%). According to the Patient Global Improvement Indices score, 71% (CI: 63-78%) of patients indicated to be satisfied after 5 yr, which improved to 77% (CI: 67-85%) in the ideal patient population. In a multivariate analysis, prior pelvic radiotherapy and previous incontinence or urethral stricture surgery were associated with decreased continence rates and patient satisfaction. CONCLUSIONS: In general, long-term continence rates and patient satisfaction after AdVance and AdVance XP sling surgery are acceptable but deteriorate significantly as time from surgery progresses. Especially patients with a history of pelvic radiotherapy, prior incontinence surgery, or urethral stricture surgery should be counseled properly about their higher risk for sling failure. PATIENT SUMMARY: In this report, we investigated long-term outcomes after Advance and AdvanceXP sling implant for male stress urinary incontinence. We found that, in general, continence and patient satisfaction are acceptable but deteriorate significantly as time from surgery progresses. Patients with previous pelvic radiotherapy, incontinence surgery, or urethral stricture surgery are at higher risk for sling failure.

Kidney Stone Dissolution Therapy in Phosphate Stones: A Case Report.

Background: Phosphate stones can be divided into struvite (7%), apatite (20%), and brushite stones (2%). They often present as large staghorn calculi and, therefore, can be challenging to treat. Moreover, it is crucial to obtain a stone-free patient to prevent recurrence. Therefore, local chemolysis can be an interesting tool when complete surgical removal of the stone is impossible or as an adjuvant treatment for residual stone fragments after surgery. Case Presentation: We present a case of an 84-year old Caucasian man in whom local chemolysis therapy with a citric acid solution resulted in a rapid reduction of the stone load, making less invasive therapy possible. Conclusion: We describe the procedure, (dis)advantages, and possible indications for local chemolysis.

A Giant Phyllodes Tumor of the Breast.

Phyllodes tumors of the breast are rare, accounting for less than 1% of the breast tumors. They are mostly seen in women between 45 and 49 years old. These are fast growing tumors with a large spectrum of behavior (from benign to metastatic) and can resemble fibroadenomas. Correct diagnosis mostly through core needle biopsy is important to decide whether a surgical excision has to be done. Here we report a case of a 57-year-old woman with a fast growing, ulcerated tumor in the left breast. Core needle biopsy suggested a malignant phyllodes tumor with heterologous liposarcomatous differentiation. Treatment with total mastectomy and adjuvant radiotherapy followed. Primary treatment is always surgery, whether radiotherapy or chemotherapy has to follow remains uncertain. There is a high-recurrence rate, especially when the surgical margins are narrow.