Modified three-layer vesicourethral reconstruction in robot-assisted radical prostatectomy can change cystography pattern and improve early recovery of continence.

BACKGROUND AND OBJECTIVES: To determine early continence outcomes after three-layer vesicourethral reconstruction during robot-assisted radical prostatectomy (RARP) and the role of postoperative cystography pattern. METHODS: Between May 2015 and January 2019, a total of 170 consecutive patients with localized prostate cancer who underwent RARP, were divided into one- and three-layer groups based on the method of vesicourethral reconstruction. Continent status, preoperative, intraoperative, postoperative, clinicopathological variables, and cystography parameters were analyzed. The patients were followed up for at least 12 months. RESULTS: Of the 170 consecutive patients, 85 with one-layer vesicourethral anastomosis, and 85 with three-layer reconstruction. The continence rates immediately after catheter removal, 4, 12, and 24 weeks after RARP were 47.1%, 75.3%, 92.9%, and 98.8% in the three-layer group; compared to 15.3%, 60%, 78.8%, and 90.6% in the one-layer group, respectively. In the multivariate analysis, three-layer reconstruction was the only independent variable with a 42% risk reduction of postprostatectomy incontinence (hazard ratio (HR): 0.58, 95% confidence interval (CI) = 0.42-0.80, p = 0.001). Cystography in the three-layer group revealed less anastomotic leakage, less sharp bladder neck angle, and higher bladder neck level category. CONCLUSIONS: Three-layer anatomical reconstruction demonstrated promising early continence outcomes, and postoperative cystography revealed a specific pattern more associated with continence.

Femoral neck system versus multiple cannulated screws for the fixation of Pauwels classification type II femoral neck fractures in older female patients with low bone mass.

BACKGROUND: Femoral neck fractures in older adult patients are a major concern and often necessitate surgical intervention. This study compared the clinical outcomes of 2 surgical techniques: the femoral neck system (FNS) and cannulated compression screws (CCSs). METHODS: A total of 40 female patients (mean age 73.50 ± 11.55 years) with femoral neck fractures of Pauwels classification type II and receiving surgical fixation between 2020 and 2022 were enrolled. The patients were categorized into an FNS group (n = 12) or a CCS group (n = 28), and surgical duration, intraoperative blood loss, length of hospital stay, and incidence of postoperative adverse events were analyzed. RESULTS: No significant intergroup differences in demographic characteristics were discovered. The mean surgical duration for all patients was 52.88 ± 22.19 min, with no significant difference between the groups. However, the FNS group experienced significantly higher intraoperative blood loss (P = 0.002) and longer hospital stay (P = 0.023) than did the CCS group. The incidence of osteonecrosis was higher in the CCS group, whereas the incidence of nonunion or malunion was higher in the FNS group. The surgical method did not appear to be a significant risk factor. The main risk factor for revision surgery was longer duration until the first adverse event (P = 0.015). CONCLUSION: The FNS does not appear to provide superior surgical outcomes compared with CCSs in older adult women with Pauwels classification type II femoral neck fractures. A longer duration between surgical fixation and the first adverse event before stabilization of the fracture site may be a risk factor for revision surgery.

The Evolution of Upper Tract Urothelial Carcinoma Management in Kidney Recipients.

INTRODUCTION: Urothelial cancers were one of the most common malignancies in patients with kidney transplants. Although radical nephroureterectomy is still the standard of care in current guidelines, studies have shown that significantly improved perioperative outcomes can be achieved for patients who underwent bilateral nephroureterectomy. Our study provides evidence on the outcome of bilateral nephroureterectomy and unilateral nephroureterectomy in kidney recipients with upper tract urothelial carcinoma. MATERIAL AND METHODS: In the study, the data of patients from a single center, Chang Gung Memorial Hospital Linkou branch, were collected retrospectively from 1981 to 2023. The patient's detailed information was collected through the medical records in the hospital. RESULTS: A total of 44 cases of kidney recipients with upper urinary tract urothelial carcinoma were collected in this study. Of the patients, 19 nephroureterectomies were performed before 2008 and 24 afterward. Incidental findings of contralateral tumors were noted in 3 out of 6 patients who underwent bilateral nephroureterectomy before 2008 and 3 out of 12 after 2008. Contralateral upper urinary tract urothelial carcinoma after unilateral nephroureterectomy was noted in 3 patients within a median of 8.1 years. The progression-free survival of bilateral nephroureterectomy was significantly better compared with a unilateral group (not reached, 15.8 years, respectively). DISCUSSION: Our study, along with previous studies, provides evidence that bilateral nephroureterectomy may be a better treatment option in kidney recipients with upper tract urothelial carcinoma. Our study has several limitations based on its retrospective nature.

Assessment of the psychometric properties of the traditional Chinese version of the cancer survivors' self-efficacy scale.

BACKGROUND: The reliability and validity of the traditional Chinese version of the Cancer Survivors' Self-Efficacy Scale (CS-SES-TC) has not been assessed. OBJECTIVE: To assess the psychometric properties of the Traditional Chinese version of the CS-SES-TC. METHODS: Participants were recruited from the outpatient departments of a hospital in Taiwan. A single questionnaire was administered to 300 genitourinary cancer survivors. The scales included in the initial questionnaire were the CS-SES-TC, the General Self-Efficacy Scale, the Center for Epidemiologic Studies Depression Scale (CES-D), and the Functional Assessment of Cancer Therapy-General scale (FACT-G). Data obtained from 300 survivors were used to confirm the structure through confirmatory factor analysis (CFA). RESULTS: The CFA results indicate that the 11-item CS-SES-TC is consistent with the original scale. Furthermore, it was identified as a unidimensional scale, with the model showing acceptable goodness-of-fit (CFI = 0.99, TLI = 0.97). The factor loading of each item in the CS-SES-TC was above 0.6 and had convergent validity. Based on multiple-group CFA testing, the change (ΔCFI) between the unconstrained and constrained models was ≤ 0.01, indicating that measurement invariance holds for gender. The participants' CS-SES-TC scores were positively correlated with their FACT-G scores and negatively correlated with their CES-D scores. The scales exhibited concurrent validity and discriminant validity. The CS-SES-TC had a Cronbach's α in the range of .97-.98. CONCLUSION: The CS-SES-TC had acceptable reliability and validity. Healthcare workers can use this scale for ongoing assessment of the cancer-related self-efficacy of cancer survivors.

Body image in patients with prostate cancer undergoing treatment with hormone therapy: Observational study using both a cross-sectional and longitudinal design.

This study aims to examine changes in body image (BI) over time and factors related to BI among patients with prostate cancer who receive hormone therapy (HT). A cross-sectional design and longitudinal design were utilized. Patients with prostate cancer who received HT were recruited from the urology outpatient departments in two hospitals in Taiwan between August 2017 and December 2020. Cross-sectional data were collected from 177 patients who had started HT for prostate cancer. Longitudinal data were collected from 34 newly diagnosed patients before receiving HT and at 1, 3, 6, and 12 months after HT. The variables measured included hormonal symptoms and distress, self-efficacy, and BI. The results showed that BI dissatisfaction ranged from 6.1% to 17.2%. Hormonal symptoms and distress (e.g. lack of vitality) were correlated with BI dissatisfaction. Education on the side effects of HT and coping strategies can be provided to patients to prevent BI dissatisfaction.

Prediction of Early Kidney Transplant Graft Outcome: Insulin Resistance Index.

BACKGROUND: New-onset diabetes after transplantation and increased insulin resistance have both been shown to affect graft performance and survival after kidney transplantation. Thus, we aimed to evaluate the predictive roles of different insulin resistance indices on early graft function in kidney transplant recipients. MATERIALS AND METHODS: We conducted a retrospective analysis of non-diabetic patients who received kidney transplantation between January 1, 2018 and December 31, 2021. The primary outcome was the predictive role of different insulin resistance indices on early graft function of serum creatinine level and estimated glomerular filtration rate at 1, 3, 6, and 12 months. The secondary outcome analyzed was the possible clinical predictive factors for poor kidney graft function at 12 months. RESULTS: Among 123 kidney transplantation patients, stratification with homeostatic model assessment for insulin resistance showed no significant difference in kidney graft function outcome at 1, 3, 6, and 12 months. However, patients with a higher insulin-to-glucose ratio exhibited a significantly higher serum creatinine level at 3 and 6 months and a significantly lower estimated glomerular filtration rate level at 3, 6, and 12 months. Using multivariate logistic regression analysis, patients with a higher insulin-to-glucose ratio were associated with a poorer kidney graft function 12 months after transplantation. CONCLUSION: Patients with a higher baseline insulin resistance with an insulin-to-glucose ratio ≥of 0.092 exhibited a significantly worse early kidney graft function. Thus, with the identification of patients with increased insulin resistance, early intervention, and preventive measures can be implemented to enhance graft performance further.

Multimedia-based hormone therapy information program for patients with prostate cancer: the result of a randomized pilot study.

Few studies have explored the feasibility and efficacy of a multimedia information intervention for patients with prostate cancer who are undergoing hormone therapy. Thus, the purpose of the study was to assess the feasibility, acceptability, and the preliminary results of a multimedia-based hormone therapy information program (HTIP) on positive thinking and quality of life (QOL; primary outcomes) as well as social support and self-efficacy (secondary outcomes) of patients with prostate cancer. Patients with prostate cancer who were receiving hormone therapy were recruited from hospitals. After completing the pre-test questionnaire, patients were randomly divided into the multimedia information group (MIG; n = 40) and the control group (CG; n = 40). Patients in the MIG received a multimedia-based HTIP once a week for 6 weeks. Data were collected at 8 and 12 weeks after the pre-test. Measurement variables included positive thinking, QOL, social support, self-efficacy, and satisfaction with the program. The recruitment rate and retention rate were calculated for assessment of feasibility. The study had a 96.3% retention rate, and patients in the MIG were satisfied with the program. Preliminary results showed that, compared with those in the CG, patients in the MIG tended to exhibit higher positive thinking, prostate cancer-specific QOL, and social support at 8 weeks and 12 weeks after pre-test; however, the effect did not reach a statistically significant level. A multimedia-based HTIP is considered feasible and acceptable in patients with prostate cancer who underwent hormone therapy. Further research with a larger sample size, patients with high homogeneity in early-stage disease and long-term follow-up is needed to assess the efficacy of the intervention program.Trial registration: ClinicalTrials.gov (NCT04693910); Registered 05/01/2021.