Hemolysis during Venovenous Extracorporeal Membrane Oxygenation in Neonates with Congenital Diaphragmatic Hernia: A Prospective Observational Study.

OBJECTIVE: To investigate the incidence of hemolysis and its association with outcome in neonates with congenital diaphragmatic hernia (CDH) requiring venovenous extracorporeal membrane oxygenation (ECMO) treatment using a Medos Deltastream circuit with a DP3 pump, a hilite 800 LT oxygenator system, and a »' tubing. STUDY DESIGN: Plasma free hemoglobin (PFH) was prospectively measured once daily during ECMO using spectrophotometric testing. Patients (n = 62) were allocated into two groups according to presence or absence of hemolysis. Hemolysis was defined as PFH ≥ 50 mg/dL on at least 2 consecutive days during ECMO treatment. Hemolysis was classified as either moderate with a maximum PFH of 50-100 mg/dL or severe with a maximum PFH >100 mg/dL. RESULTS: Hemolysis was detected in 14 patients (22.6%). Mortality was 100% in neonates with hemolysis compared with 31.1% in neonates without hemolysis (P < .001). In 21.4% hemolysis was moderate and in 78.6% severe. Using multivariable analysis, hemolysis (hazard ratio: 6.8; 95%CI: 1.86-24.86) and suprasystemic pulmonary hypertension (PH) (hazard ratio: 3.07; 95%CI: 1.01-9.32) were independently associated with mortality. Hemolysis occurred significantly more often using 8 French (Fr) cannulae than 13 Fr cannulae (43% vs 17%; P = .039). Cutoff for relative ECMO flow to predict hemolysis were 115 ml/kg/ minute for patients with 8 Fr cannulae (Area under the curve [AUC] 0.786, P = .042) and 100 ml/kg/ minute for patients with 13 Fr cannulae (AUC 0.840, P < .001). CONCLUSIONS: Hemolysis in CDH neonates receiving venovenous ECMO is independently associated with mortality.

Precise Prediction of Long-Term Urinary Incontinence after Robot-Assisted Laparoscopic Radical Prostatectomy by Readily Accessible "Everyday" Diagnostics during Post-Surgical Hospitalization.

Aim and Objectives: We aimed to test the predictive value of readily accessible and easily performed post-surgical "bedside tests" on their validity of long-term urinary incontinence (UI) (≥12 months) in patients following robot-assisted laparoscopic radical prostatectomy (RALP). Material and Methods: Patients undergoing RALP between July 2020 and March 2021 were prospectively included and subdivided into two groups based on their pad usage after 12 months (0 vs. ≥1 pad). After catheter removal, patients performed a 1 h pad test, documented the need for pad change in a micturition protocol and received post-voiding residual urine volume ultrasound. Univariate and multivariable analyses were used to demonstrate the predictive value of easily accessible tests applied after catheter removal for UI following RALP. Results: Of 109 patients, 47 (43%) had to use at least one pad (vs. 62 (57%) zero pads) after 12 months. Univariate testing showed a significant difference in urine loss between both groups evaluated by the 1 h pad test performed within 24 h after catheter removal (70% < 10 mL, vs. 30% ≥ 10 mL, p = 0.004) and in the need for pad change within the first 24 h after catheter removal (14% dry pads vs. 86% wet pads, p = 0.003). In multivariable analyses, the combination of both tests (synoptical incontinence score) could be confirmed as an independent predictor for UI after 12 months (p = 0.011). Conclusions: Readily accessible "everyday" diagnostics (pad test/change of pads after catheter removal) following RALP seem to be associated with a higher rate of long-term UI. This finding is crucial since patients with a potentially higher need for patient education and counselling can be identified using these readily accessible tests. This could lead to a higher patient satisfaction and improved outcomes.

The influence of secondary resection using NeuroSAFE-technique on sexual function in unilateral nerve-sparing robot-assisted laparoscopic prostatectomies.

OBJECTIVE: To demonstrate the surgical influence of secondary resection on sexual function in finally unilateral nerve-sparing robot- assisted laparoscopic prostatectomies (RALPs) performed with the 'neurovascular structure-adjacent frozen-section examination' (NeuroSAFE) technique by prospectively collecting EPIC-26-questionnaires. MATERIAL & METHODS: Sexual function status measured by the sexual-symptom-score (SexSS) in the EPIC-26-questionnaires was collected preoperatively and 12 months after RALP from 378 patients between 09/2019 and 04/2021. Cohorts of interest were defined as those patients undergoing unilateral nerve-sparing by secondary resection of the other neurovascular bundle (NVB), and as those patients undergoing primarily planned and successful unilateral nerve-sparing (unilateral nerve-sparing without secondary resection) in ≤cT2 prostate cancer. NeuroSAFE frozen section technique was performed in all nerve-sparing RALPs, and in case of cancer-positive surgical margins, the complete NVB was resected. RESULTS: In 109 RALPs with unilateral nerve-sparing (48 primarily vs. 61 by secondary resection), analyses showed a significant difference in postoperative SexSS for 'unilateral nerve-sparing by secondary resection' compared with 'unilateral nerve-sparing without secondary resection' (43 [interquartile range (IQR): 14;50] vs. 26 [IQR: 22;62], P = 0.04). In multivariable analyses, the preoperative SexSS was predictive for postoperative erectile dysfunction (OR = 0.96, 95% confidence interval: 0.93-0.98, P < 0.001). Oncological safety was not compromised by secondary resection (prostate-specific antigen after 12 months 0.01 ng/mL vs. 0.01 ng/mL [P = 0.3] for unilateral nerve-sparing by secondary resection vs. unilateral nerve-sparing without secondary resection). CONCLUSION: The results of this study suggest that nerve-sparing attempts applying the NeuroSAFEtechnique should be generously performed since a unilateral complete secondary resection leading to a unilateral nerve-sparing RALP did not seem to have a negative influence on sexual function and did not seem to compromise oncological safety compared with primarily performed and successful unilateral nerve-sparing RALP.

Understanding long-term continence rates after robot-assisted laparoscopic prostatectomy - one-year follow-up on "Cognitive ability as a non-modifiable risk factor for post-prostatectomy urinary incontinence".

Purpose: To evaluate long-term continence rates (12 months) in patients after robot-assisted laparoscopic prostatectomy (RALP) in relation to their cognitive ability (CoAb), which proved to be a predictor for early post-prostatectomy incontinence. Material & Methods: This is the 12-month follow-up evaluation of our previously published observational single-center, prospective evaluation of 84 patients who underwent RALP as treatment of their localized prostate cancer between 07/2020 and 03/2021. Post-prostatectomy incontinence (PPI) was measured by asking patients about their 24 h pad usage, whereby 0 pads were considered continent and ≥1 pad was considered incontinent. CoAb was evaluated by performing the Mini-Mental State Examination prior to surgery. Possible predictors for PPI were evaluated using univariate and multivariable logistic regression models. Results: Multivariable logistic regression analyses identified early incontinence status and nerve sparing (NS) as independent predictors for PPI after 12 months, resulting in a 5.69 times higher risk for PPI when the loss of urine was between 10 and 50 ml during the early performed pad test (one day after catheter removal) compared to 0-1 ml loss of urine [95% confidence interval (CI): 1.33-28.30, p = 0.024] and a 6.77 times higher risk for PPI, respectively, when only unilateral NS was performed compared to bilateral NS (95% CI: 1.79-30.89, p = 0.007). CoAb lost its predictive value for long-term PPI (p = 0.44). Conclusion: The results of this study suggest that PPI is a dynamic, rather than a static condition with a dynamically changing pathophysiology within the first 12 months after RALP. Coping methods and therapies should adapt to this circumstance.