Linear Low-Intensity Extracorporeal Shockwave Therapy as a Method for Penile Rehabilitation in Erectile Dysfunction Patients after Radical Prostatectomy: A Randomized, Single-Blinded, Sham-Controlled Clinical Trial.

INTRODUCTION: The objective of this study was to investigate the effect and feasibility of linear low-intensity extracorporeal shockwave therapy (LI-LiESWT) as a penile rehabilitation method for erectile dysfunction (ED) after bilateral nerve-sparing (NS) radical prostatectomy (RP). METHODS: Patients who had undergone bilateral NS RP (either radical retropubic prostatectomy or robot-assisted laparoscopic RP), 3 or more months prior to the study, and who had no ED preoperatively and were suffering from mild to severe postoperative ED were included in the study. Four treatments were given over a 4-week period, using the PiezoWave2 device with a linear shockwave applicator and the linear shockwave tissue coverage (LSTC-ED®) technique. If the improvement in erectile function was still considered insufficient (less than an IIEF-5 score of 22-25) at 2 months after the start of LI-LiESWT, penile rehabilitation was supplemented by pharmacological penile rehabilitation. The final effect of treatment was evaluated after 12 months. The main outcome measure was changes in the five-item International Index of Erectile Function (IIEF-5) score. RESULTS: Between September 2019 and September 2020, a total of 40 patients were included in the study and randomly divided into 2 groups: treatment group and sham group. Eight patients were excluded from the study and were not evaluated due to other conditions which required additional treatment (COVID-19 disease, postoperative incontinence, urethral stricture, and ischemic stroke). Thirty-two patients were included in the final analysis: 16 in the control group and 16 in the intervention group. At 6 months from the end of treatment, patients in both the treatment and the sham group achieved physiological IIEF-5 values, and the beneficial effect persisted for 12 months after the end of treatment. CONCLUSIONS: LI-LiESWT using the LSTC-ED® technique is a suitable and safe method for penile rehabilitation in patients with ED after bilateral NS RP, not only because of the vasculogenic effect of LI-LiESWT but also because of its neuroprotective and/or regenerative effects.

Comparison of Different Treatment Modalities Outcomes in Clinically Node-positive Bladder Cancer: Analysis of a Population-based Cancer Registry.

INTRODUCTION: Patients with clinically node-positive bladder cancer were historically considered to have uniformly poor prognosis and were frequently treated with palliative chemotherapy (CHT) only. Although retrospective data show that long-term survival with combined treatment (surgery + CHT) is possible in one-third of these patients, consensus on a treatment algorithm is still lacking. The aim of the study is to compare the efficacy of different treatment modalities based on data from a population-based cancer registry. PATIENTS AND METHODS: The study comprises 661 patients identified from the Czech National Cancer Registry (1996-2015) with cTanyN1-3M0 bladder cancer; 195 were treated with CHT alone, 234 underwent radical cystectomy alone (RC), and 232 received a combination of RC and perioperative CHT (RC + CHT). Multivariate Cox proportional hazard regression analyses were used to evaluate the effectiveness of various treatments. RESULTS: The 5-year OS for CHT alone, RC alone, and RC + CHT were 21.7% (95% confidence interval [CI], 15.4%-28.0%), 12.1% (95% CI, 7.4%-16.7%), and 25.4% (95% CI, 18.9%-31.9%), respectively (P < .001). The median survivals were 17, 10, and 23 months, respectively. In multivariate analysis, age > 60 years (hazard ratio, 1.29; 95% CI, 1.06-1.56; P = .011) and clinical stage cT3-4 (hazard ratio, 1.39; 95% CI, 1.12-1.71; P = .002) were negative predictors of survival. When compared with CHT, RC + CHT reduced the risk of overall mortality by 21% (P = .044). CONCLUSION: Approximately one-quarter of clinically node-positive patients may achieve long-term survival with combined treatment integrating RC and perioperative CHT. The overall survival of patients is significantly improved with a multimodal approach in comparison to CHT alone.

Sentinel lymph node dissection combined with meticulous histology increases the detection rate of nodal metastases in prostate cancer.

PURPOSE: To evaluate benefits of sentinel lymph node (SLN) biopsy for staging accuracy in prostate cancer. Extended pelvic lymph node dissection (ePLND) is a preferred staging tool; however, it may underestimate the incidence of nodal involvement. METHODS: Eighty patients with estimated risk of lymphadenopathy above 5 % based on Briganti nomogram had Tc-99m-labeled nanocolloid injected into the prostate. Planar lymphoscintigraphy and single-photon emission computed tomography/CT were performed to localize SLNs. Radioguided SLN dissection was followed by backup ePLND comprising external iliac, obturator and internal iliac regions. All SLNs were serially sectioned every 150 µm and examined using hematoxylin and eosin; immunohistochemical staining was applied every 300 µm. RESULTS: A total of 335 SLNs were detected, and 17 % were located outside ePLND template. Nodal metastases were diagnosed in 32 patients (40 %). Without radioguided SLN localization, solitary metastases posteriorly to the branches of the internal ilaic vessels, in pararectal and common iliac regions would not have been removed in five of 32 patients (16 %). Using standard histology protocol, we would have diagnosed metastases in 23 patients with median size of 2.8 mm. Serial sectioning of SLN and immunohistochemistry led to the detection of metastases in additional nine patients (28 %) with median size of 0.2 mm. CONCLUSION: ePLND comprised 83 % of SLNs, at least one SLN laid outside its template in 28 % of patients. ePLND and SLN dissection combined with nodal serial sectioning and immunohistochemistry increased the detection rate of nodal metastases by 68 % in comparison with ePLND alone and standard histology protocol.

Effect of ureterointestinal anastomosis on renal function and morbidity in intestinal urinary diversion.

OBJECTIVE: The authors previously successfully applied the "flap-and-trough" (FT) method of antireflux ureterointestinal anastomosis (UIA) in a pilot set of 81 patients. This randomized prospective trial tested the effectiveness of this method in protecting the upper urinary tract from obstruction, reflux and infections. MATERIAL AND METHODS: Forty-nine patients indicated for cystectomy and intestinal urinary diversion were randomly split into two groups, A and B. The FT antireflux UIA was applied in group A (n = 20), and refluxing direct elliptical UIA in group B (n = 29). Both groups were divided into two subcategories according to the type of diversion used: Ar (n = 10) and Br (n = 16) with low-pressure reservoirs and Ac (n = 10) and Bc (n = 13) with conduits. The follow-up evaluation compared the groups regarding perioperative complications, antireflux efficiency of FT, occurrence of obstruction and urinary infection, kidney morphology and glomerular filtration rate. RESULTS: During the follow-up period (median 31 months), the obstruction occurred only in group Br (insignificant difference compared to Ar). A significant decrease in glomerular filtration rate and shortening of the left kidney occurred in group Br during the period and in comparison with Ar. There were no other considerable divergences in other studied parameters. CONCLUSIONS: The antireflux FT anastomosis represents a low risk for stenosis. The reduced occurrence of obstructive complications in comparison with direct UIA was statistically insignificant. Its construction did not increase the frequency of complications; on the contrary, it guarantees a better protection of renal morphology and function.

Primary adenocarcinoma of the epididymis: the therapeutic role of retroperitoneal lymphadenectomy.

AIMS: This case report describes a rare case of adenocarcinoma of the epididymis and the role of locoregional surgery in the therapeutic algorithm. CLINICAL CASE: We report a case of primary adenocarcinoma of the epididymis in a 61-year-old man who was primarily examined for nodular enlargement of the head of the epididymis. Retroperitoneal lymphadenectomy which the patient underwent after radical orchiectomy revealed lymph node metastases, subsequently he received adjuvant chemotherapy. The patient remains free of disease for 20 months after surgery. CONCLUSIONS: Primary adenocarcinoma of epididymis is a rare finding with an unfavorable prognosis in higher stages as it responds poorly to radiotherapy and chemotherapy. Our case report confirms the importance of retroperitoneal lymphadenectomy in patients with local or locoregional disease. It may be curative even in case of proven lymphadenopathy and should be performed in all patients without distant metastases.