Impact of radiation therapy on perineal urethrostomy for penile cancer.

OBJECTIVE: A lack of demonstrated clinical benefit precludes radiotherapy (RT) from being recommended for pN1/pN2 penile cancer (PeCa) lesions; but it may be recommended in case of extranodal (pN3) disease or for positive resection margins. Perineal urethrostomy (PU) is a technique of urinary diversion in patients with PeCa requiring total or subtotal penectomy as primary therapy. Prior studies suggest PU failure rates of up to 30%, without specific mention of the potential role of RT. When RT is delivered for PeCa it is usually to the pre-pubic fat, groin and lateral pelvis, and not to the region of the PU. Here we describe the role of perioperative RT in a large, multi-institutional registry of PU for PeCa. METHODS: In our cohort, 299 patients from seven international, high-volume centers in Belgium, Brazil, China, Netherlands, United Kingdom and the United States underwent PU as urinary diversion for PeCa between 2000 and 2020. Demographic and clinicopathologic characteristics were reviewed. RESULTS: Median patient age was 67 years and median follow-up was 19 months. Seven patients (2.3%) received pre-operative RT; six of them with chemotherapy. 37 received RT post-operatively, 21 (57%) with chemotherapy. Stenosis of the PU occurred in 35 (12%) of the total population. The majority of these patients (74%) required surgical revision at a median of 6.1 months post-operatively. RT delivery was neither significantly related to PU stenosis (p = 0.16) or to subsequent revision (p = 0.75). CONCLUSION: Receipt of RT was not significantly associated with increased stenosis risk in PeCa patients who underwent PU.

Outcomes of perineal urethrostomy for penile cancer: A 20-year international multicenter experience.

PURPOSE: Perineal urethrostomy (PU) is often the definitive form of urinary diversion in patients with locally-advanced or anatomically unfavorable penile cancer (PC) requiring total penectomy. Here, we report post-operative PU-related complications and PU stenosis rates after total penectomy with PU in a large multicenter cohort of PC patients. METHODS: We retrospectively reviewed the medical records of 299 patients who underwent PU as a means of urinary diversion for primary PC across seven international centers from 2000 to 2020. The Clavien-Dindo grading system was used to record 30-day post-operative complications. Cumulative incidence of stenosis was evaluated using the Kaplan-Meier method. RESULTS: Median patient age was 67 years (interquartile range (IQR) 58-74), and median follow-up was 19 months (IQR 7.2-57). A total of 58 patients (19%) developed a 30-day post-operative complication, of which 45 (79%) were deemed minor (CD Grade I and II). Wound infection (11%; CD grade I-III) and dehiscence (4.0%; CD grade I-III) were the more common complications. The overall incidence of stenosis was 12% (35/299 patients), of which 26 (74%) needed surgical revision (probability of stenosis revision at one year of 9.3%, median time until the revision: 6.1 months (IQR 3.0-13)). Only two stenoses were seen after two years of follow-up. CONCLUSION: We present the most extensive series of PU in the management of PC to date. Wound infections of the primary surgical site were the most common complication. Stenosis occurred mostly within one and a half years after treatment.

The family empowerment program: an interdisciplinary approach to working with multi-stressed urban families.

The family empowerment program (FEP) is a multi-systemic family therapy program that partners multi-stressed families with an interdisciplinary resource team while remaining attached to a "traditional" mental health clinic. The rationale for this model is that far too often, families presenting at community mental health centers struggle with multiple psychosocial forces, for example problems with housing, domestic violence, child care, entitlements, racism, substance abuse, and foster care, as well as chronic medical and psychiatric illnesses, that exacerbate symptoms and impact traditional service delivery and access to effective treatment. Thus, families often experience fragmented care and are involved with multiple systems with contradictory and competing agendas. As a result, services frequently fail to harness the family's inherent strengths. The FEP partners the family with a unified team that includes representatives from Entitlements Services, Family Support and Parent Advocacy, and Clinical Staff from the agency's Outpatient Mental Health Clinic practicing from a strength-based family therapy perspective. The goal of the FEP is to support the family in achieving their goals. This is accomplished through co-construction of a service plan that addresses the family's needs in an efficient and coherent manner-emphasizing family strengths and competencies and supporting family self-sufficiency.

Using prayer in psychotherapy: applying Sue's differential to enhance culturally competent care.

In this article, the authors discuss the application of Sue's cultural competence differential of hypothesis testing, dynamic sizing, and cultural specific expertise as a model for considering cultural factors in the treatment of an African American family. Three cultural dimensions are highlighted: spirituality, womanism, and community exposure to trauma. Given the centrality of spirituality for this African American family, prayer is used to facilitate the therapeutic process. Discussion from a womanist perspective highlights the spiritual, communal, and personal dimensions that the aunt faces as an African American woman. Consideration of the community context and potential exposure to trauma and loss allows for a fuller appreciation of the psychosocial context of the nephew. Sue's differential guides the case discussion.

Invisibility syndrome: a clinical model of the effects of racism on African-American males.

Adaptive behavior and psychological well-being of African Americans can be affected by prejudice and discrimination. Encountering repeated racial slights can create "psychological invisibility." The invisibility syndrome is presented as a conceptual model for understanding the inner evaluative processes and adaptive behavior of African Americans in managing experiences of racism.

Parent and family support groups with African American families: the process of family and community empowerment.

This article describes a process of family and community empowerment in which psychologists, along with community, school and religious leaders, intervened on a multisystemic level and formed a parent and family support group to empower families in helping their at-risk adolescents to succeed. The adolescents, who were predominantly African American, had been arrested for fighting at school and were experiencing academic and behavioral difficulties. Critical incidents in the group development and the family and community empowerment process are described.

A multisystems approach to the treatment of a black, inner-city family with a schizophrenic mother.

Many clinicians working in inner-city community mental health centers find themselves overwhelmed by the complexity of the treatment cases presented. This paper illustrates the application of a multisystems model of family therapy that allows the clinician to organize and implement a treatment plan at the nuclear family, extended family, and systems levels.

Group therapy for black women: a therapeutic support model.

The development of a group therapy approach for black women is reported. The therapeutic and support functions of the group are discussed and the recurrent themes arising in group sessions are examined. Many group members achieved their goals of self-exploration, insight, and significant behavioral change.