Subcutaneous wound infiltration of ketamine is superior to bupivacaine in terms of pain perception and opioid consumption after cesarean section: a double-blinded randomized placebo-controlled clinical trial.

OBJECTIVE: The aim of the present study was to evaluate the analgesic efficiency of SC ketamine, either alone or in combination with bupivacaine, following CS by means of postoperative pain and opioid need. PATIENTS AND METHODS: One hundred and twenty women were allocated into 4 groups in this prospective, double-blind, placebo-controlled, randomized trial. Group K (Ketamine, n=30) received SC 1 mg/kg ketamine. Group B (Bupivacaine, n=30) received SC 20 mL bupivacaine 0.5%. Group KB (Ketamine+Bupivacaine, n=30) received SC ketamine 1 mg/kg plus SC 20 mL bupivacaine 0.5%. Group P (Placebo, n=30) received SC 30 mL 0.9% saline (placebo). RESULTS: VAS scores at resting and on coughing and analgesic consumptions were compared. Visual analogue scale (VAS) pain scores at rest and coughing, at 15 and 60 minutes, and 2, 6 and 12 hours, and total opioid necessity were measured. VAS scores at rest in Group P were higher than in Group KB at the 6th hour, while lower in Group K and Group KB than in Groups B or P at the 12th hour. Patients receiving placebo had higher coughing VAS scores than those receiving ketamine or ketamine+bupivacaine at 2nd, 6th and 12th hours. Patients in Groups P and B required higher doses of morphine than those in groups K or KB. CONCLUSIONS: Subcutaneous ketamine, either alone or in combination with bupivacaine, provides a better postoperative pain relief and reduces postoperative opioid consumption when compared to use of bupivacaine alone.

The comparison of intraincisional bupivacaine infiltration and intravenous paracetamol administration for pain alleviation after cesarean section: a double-blinded randomized placebo controlled clinical trial.

OBJECTIVE: This study aimed to compare the analgesic effect of subcutaneous (SC) bupivacaine and intravenous (IV) paracetamol on postoperative pain and opioid requisites in patients undergoing cesarean delivery. PATIENTS AND METHODS: One hundred and five women were allocated into 3 groups in this prospective, double-blind, placebo-controlled, randomized trial. Group 1 received SC bupivacaine, Group 2 received IV paracetamol following surgery and every 6 hours for 24 hours in the postoperative period, Group 3 received SC 0.9% saline and IV 0.9% saline at similar periods. Visual analogue scale (VAS) pain scores at rest and coughing, at 15 and 60 minutes, and 2, 6 and 12 hours, and total opioid necessity were measured. RESULTS: VAS scores at rest were higher in placebo group than in bupivacaine and paracetamol groups at 15 minutes (p=0.047) and 2 hours (p=0.004). VAS scores at coughing were higher in placebo group than in bupivacaine and paracetamol groups at 2 hour (p=0.001) and 6 hours (p=0.018). Placebo group needed higher (p<0.001) doses of morphine than paracetamol or bupivacaine groups. CONCLUSIONS: Intravenous paracetamol decreases pain scores similar to SC bupivacaine in the postoperative period compared to placebo. Patients taking bupivacaine or paracetamol need fewer opioids than placebo.

Disrupted redox balance in utero-placenteal junction may be the main culprit in the occurrence of abruptio placenta.

OBJECTIVE: To determine the oxidant/antioxidant balance and proinflammatory status in amniotic fluids collected during cesarean section of patients diagnosed with abruptio placenta. PATIENTS AND METHODS: Twenty-five patients diagnosed with ablatio placenta with intact membranes who went to emergency cesarean section were included in the study. A diagnosis of AP was made in those who had at least one of the following criteria or, in suspicious cases, two findings. (i) Antepartum hemorrhage starting after 20 weeks of gestation, (ii) presence of retroplacental hematoma on ultrasonography, (iii) severe fetal distress or death, (iv) localized or diffuse uterine tenderness or pain. The control group consisted of 25 patients who presented for delivery, who were not diagnosed with AP, and whose membranes were intact. NF-κB, total oxidant capacity (TOC), total antioxidant capacity (TAC), and oxidative stress index (TOC/TAC=OSI) levels were measured in amniotic fluids collected during cesarean section from both groups. RESULTS: Amniotic fluid TAS values of the AP group were significantly lower than the healthy controls (1.14±0.33 vs. 9.05.±3.40, p<0.01). Amniotic fluid TOS values were significantly increased in the AP group (36.1±8.10 vs. 11.4±2.77, p<0.02). OSI values were significantly higher in the AP group (31.6±9.03 vs. 1.26±0.02, p<0.01). Amniotic fluid NF-κB expression of the AP group was approximately 5 times higher than the control group (10.4±2.56 ng/mL vs. 1.86±0.30 ng/mL, p<0.01). High blood pressure and smoking history were significantly higher in the AP group. Gestational age and fetal birth weight of the AP group were lower than the control group. CONCLUSIONS: Since the increase in amniotic fluid oxidant capacity and proinflammatory cytokine synthesis cannot be neutralized by the antioxidant system, hypoxic cell damage may lead to premature separation of the placenta.

Psoriasis patients' characteristics associated with high PASI response to tildrakizumab: an international dual center study.

OBJECTIVE: Heterogeneous real-world evidence can complement the more strictly regulated clinical trial data. A benefit of this is the wide range of backgrounds, comorbidities and characteristics that can give additional insights into treatments. Observational, retrospective studies can help to fill in the mosaic that makes up a treatments landscape. Tildrakizumab, an interleukin 23p19 inhibitor, is approved for the treatment of plaque psoriasis and has been shown to be a safe and efficacious therapy in clinical trials and emerging real-world evidence. We aimed at confirming the efficacy of tildrakizumab in patients with plaque psoriasis in a dual center setting and identifying patients' characteristics leading to better treatment response. PATIENTS AND METHODS: Patients with moderate to severe plaque psoriasis, eligible for systemic biological treatment, and treated with tildrakizumab were included in the study and the routine clinical parameters - Psoriasis Area and Severity Index (PASI), Dermatology Life Quality Index (DLQI), and safety - were retrospectively analyzed. RESULTS: The combined cohorts included 89 patients, of which 64% were naïve to biologic therapies. At the time of analysis efficacy assessment was available for 39 patients after 12 months of treatment, 73 patients after 36 weeks, 79 patients after 16 weeks and 82 patients after 4 weeks. PASI and DLQI decreased significantly over time, with 52/73 (71.2%) patients achieving PASI 100 after 36 weeks. No severe side-effects were recorded in association with tildrakizumab. CONCLUSIONS: We confirmed the safety and efficacy of tildrakizumab in a real-world clinical setting. A higher proportion of patients naïve to biologics achieved a greater PASI response than patients who had previously been treated with biologics. The same was true for older patients and patients with a shorter history of disease.

The Resolution Rate of Pulmonary Embolism on CT Pulmonary Angiography: a Prospective Study.

PURPOSE: To prospectively assess the rate of clot resolution from CT pulmonary angiography (CTPA) in patients with acute pulmonary embolism (PE). MATERIALS AND METHODS: This prospective cohort study included 290 patients (136 men, 154 women; mean age, 51.9 years) with acute PE. All patients had a CTPA at the presentation and had at least one follow-up within 6 months (mean 72.7 days). Sixty-four percent of patients had follow-up scans for research purposes within a pre-determined period (between 28 and 184 days; mean, 78.27 days) and 36 % had (between 2 and 184 days; mean, 62.78 days) for a clinical indication. The volume of each clot was measured using a semi-automated quantification program. The resolution rate was evaluated by interval-censored analysis. RESULTS: The overall estimated probability of complete resolution was 42 % at 7 days, 56 % at 10 days, and 71 % at 45 days. Achieving complete resolution was significantly faster in patients with peripheral clots (HR: 1.78; CI: 1.05-3.03, p = 0.032) but slower in patients with consolidation and history of venous thromboembolism (VTE), (HR: 0.37; CI: 0.18-0.79, p = 0.01 and HR: 0.57; CI: 0.35-0.91, p = 0.019, respectively). Although the patients with cancer showed a faster resolution rate (HR: 1.67; CI: 1.05-2.68, p = 0.032), the mortality rate was significantly higher than non-cancer patients. CONCLUSION: The resolution rate of clot burden in acute PE was associated with patients' clinical presentation variables and CTPA imaging biomarkers. This information may be incorporated into designing a prediction rule and determining the appropriate duration of anticoagulation therapy in patients with acute PE.

Evolving Role and Translation of Radiomics and Radiogenomics in Adult and Pediatric Neuro-Oncology.

Exponential technologic advancements in imaging, high-performance computing, and artificial intelligence, in addition to increasing access to vast amounts of diverse data, have revolutionized the role of imaging in medicine. Radiomics is defined as a high-throughput feature-extraction method that unlocks microscale quantitative data hidden within standard-of-care medical imaging. Radiogenomics is defined as the linkage between imaging and genomics information. Multiple radiomics and radiogenomics studies performed on conventional and advanced neuro-oncology image modalities show that they have the potential to differentiate pseudoprogression from true progression, classify tumor subgroups, and predict recurrence, survival, and mutation status with high accuracy. In this article, we outline the technical steps involved in radiomics and radiogenomics analyses with the use of artificial intelligence methods and review current applications in adult and pediatric neuro-oncology.

Imaging findings of a rare pararectal splenosis and literature review.

Pararectal splenosis is an extremely rare lesion caused by ectopic auto-transplantation of splenic tissue after splenic trauma or splenectomy. It is often asymptomatic and detected incidentally during radiologic evaluation. We present a 24-year-old male with pararectal splenosis. The patient had a history of splenectomy and presented with complaints of abdominal discomfort and chronic constipation. Contrast-enhanced computed tomography (CT) revealed multiple well-enhanced masses located in the abdominal cavity and one mass in pararectal area. Additionally, the pararectal lesion showed diffusion restriction on diffusion-weighted magnetic resonance imaging (DW-MRI). In this case report, we aim to highlight the significance of taking a detailed medical history; and using DW-MRI for diagnosis of splenosis by presenting a case in a rare location.

Pythagorean fuzzy VIKOR-based approach for safety risk assessment in mine industry.

INTRODUCTION: Underground mining is considered one of the most hazardous industries and is often associated with serious work-related fatalities; this paper addresses job-related hazards and associated risks. METHOD: A risk assessment approach is proposed (Pythagorean fuzzy environment) and a case study is carried out in an underground copper and zinc mine. RESULTS: Results of the study demonstrate that hazards can be categorized into different risk levels via compromised solutions of the fuzzy approach. CONCLUSION: The study provides a theoretical contribution by suggesting a Pythagorean fuzzy numbers-based VlseKriterijumska Optimizacija I Kompromisno Resenje (PFVIKOR) approach. Moreover, it contributes to improving overall safety levels of underground mining by considering and advising on the potential hazards of risk management. Practical applications: The proposed approach will improve the existing safety risk assessment mechanism in underground copper and zinc mining.

Comparison of EDCs removal in full and pilot scale membrane bioreactor plants: Effect of flux rate on EDCs removal in short SRT.

Currently, it is estimated that over 1 billion people are short of adequate portable water and this is expected to increase to 2.5 billion in the year 2025. Membrane Bioreactors (MBR) are now accepted as important tools to extend the availability of water by facilitating the reuse of wastewaters. Sludge Retention Time (SRT) and liquid flux rate are the two most important parameters for controlling the MBR process. In this study, the removal of selected endocrine disrupter compounds (EDCs), diltiazem, progesterone, estrone (E1), carbamazepine (Cbz) and acetaminophen (Acet), by one full scale (VRM) and one pilot scale (clear-box) MBR plants was investigated. During the study, sludge age was set at 10 days and the sludge concentration was fixed at about 5.0 g/L. The transmembrane pressure (TMP) got higher with either increasing flux or sludge concentration in the membrane chamber. Therefore, changing the flux from 13 to 30 L/m2-h in both plants caused enhancement in TMP from -25 to -300 mbar in the clear-box and from -160 to over -350 in the full scale MBRs. It was understood that flux had very little effect on the removal of EDCs at very low concentrations. Moreover, diltiazem was completely removed in the full scale whereas no removal was achieved in the pilot scale. Estrone and progesterone were completely removed by biodegradation in both plants. Acetaminophen was completely removed in the full scale plant whereas over 95% removal was achieved in the pilot scale MBR.

The evaluation of blood concentrations of testosterone, 17ß-oestradiol and anti-Mu¨llerian hormone in dogs with cryptorchidism and testicular tumours.

Cryptorchidism and testicular tumours are very common disorders in dogs genitalia. The aim of the present study was o obtain an overview of serum 17ß-oestradiol, anti-Muellerian hormone (AMH) and testosterone levels in intact dogs compared to dogs with different testicular tumours and dogs with cryptorchidism. Testosterone, AMH and 17ß-oestradiol concentrations were measured in peripheral and local spermatic venous blood in dogs with unilateral cryptorchidism (n=8), dogs with neoplastic testicular diseases (n=8) and in a control group of mature intact dogs (n=8). Results confirmed significantly higher concentrations of testosterone in local venous blood (control group: right testicle (RT) 46.23 ± 40.88 ng/ml and left testicle (LT) 50.76 ± 43.76 ng/ml; cryptorchid group: RT 23.91 ± 22.79 ng/ml and LT 10.52 ± 7.37 ng/ml; tumour group: RT 37.26 ± 25.26 ng/ml and LT 44.86 ± 19.03 ng/ml) (p<0.05) compared to their concentrations in peripheral blood (PB) in a control (4.92 ± 3.3 ng/ml) and in a cryptorchid group (0.89 ± 0.78 ng/ml), but not in the tumour group (11.37 ± 10.86 ng/ml). However, we have found increased level of testosterone in PB in the tumour group compared to its PB concentrations in the control or the cryptorchid group. Concentrations of AMH in PB observed in the cryptorchid group was 54.98 ± 30.07 µg/ml and in the control group was 6.49 ± 3.24 µg/ml (p<0.05). The same was observed in the case of local blood concentrations, which were significantly higher in the cryptorchid group (RT 51.92 ± 30.59 µg/ml; LT 46.33 ± 34.86 µg/ml) (p<0.05). We also observed high oestradiol concentrations in the cryptorchid group in both peripheral and local blood (PB: 30.86 ± 20.28 pg/ml; RT: 55.71 ± 34.7 pg/ml; LT: 78.99 ± 47.72 pg/ml), and even higher in the tumour group (PB: 52.46 ± 34.02 pg/ml; RT: 188.16 ± 132.67 pg/ml; LT: 297.14 ± 245.56 pg/ml). AMH has been shown to be a specific biomarker of gonadal tumours originated in Sertoli cells. It is also useful marker for confirmation of the existence of a functional cryptorchid testis. According to us, the scientific work dealing with a disorder of testicular descent in dogs, regarding the evaluation of sex hormones levels and the formation of the testes using modern diagnostic methods, significantly contribute to the clarification of some processes, leading to pathophysiological disturbances during this process.

Comparison of the effects of dexmedetomidine and remifentanil on potential extreme haemodynamic and respiratory response following mask ventilation and laryngoscopy in patients with mandibular fractures.

OBJECTIVE: The safety profile and efficacy were compared for remifentanil and dexmedetomidine with respect to haemodynamic and respiratory response during mask ventilation and laryngoscopy in patients with mandibular fractures. PATIENTS AND METHODS: Seventy patients undergoing elective mandibular fracture surgery were randomly assigned to the remifentanil group (Group R, n = 35) or the dexmedetomidine group (Group D, n = 35). The primary outcomes were preoperative pain scores caused by jaw movement; haemodynamic response; intubation score; and side effects, such as the incidence of oxygen desaturation and muscle rigidity. Other side effects, such as tachycardia, bradycardia, hypertension and hypotension, were also compared. RESULTS: Preoperative pain scores caused by jaw movement were significantly high for both groups, but there were no statistically significant differences between the groups. The incidence of oxygen desaturation and muscle rigidity was significantly lower in Group D than in Group R (p = 0.025). No significant differences existed between the groups in terms of intubation score, haemodynamics, and other side effects (p > 0.05). DISCUSSION: Dexmedetomidine and remifentanil had equal effectiveness on the control of haemodynamic response due to mask ventilation and intubation in patients with mandibular fractures. However, at the doses used in this study, dexmedetomidine had a significant advantage over remifentanil in terms of respiratory stability.

Human milk banking and milk kinship: perspectives of religious officers in a Muslim country.

OBJECTIVE: The present study aims to determine the knowledge, attitudes and views of the Muslim religious officers regarding infant feeding, breast milk, wet nursing, milk kinship and human milk banks (HMBs). STUDY DESIGN: A total of 401 religious officers were included in the study. Participants included 355 community service religious officers and 46 faculty religious officers. RESULTS: Two hundred fifty-four (63.3%) participants were in favor of administering donor human milk when breast milk is not available from the mothers. To the question 'What kind of human milk bank would you approve as far as the religious sensitivity is concerned?' a majority of the religious officers (71.3%) responded that they would only approve if the milk pool contained a restricted HMB where a limited number of recipients were allowed to use the mixtures in these milk pools. Only 7 (1.7%) participants advocated initiating Western-style HMBs in Turkey. CONCLUSION: Turkish religious officers have revealed that they would only approve the establishment of an alternative HMB by a maximum three donors where up to three recipients whose identities are known by one another are allowed to use donor milk from each milk pool.

A different placement of the stone; rhinolithiasis.

INTRODUCTION: Rhinolithiasis is a rare disease and formed by mineralization in the nasal cavity. Precipitated calcareous material on intranasal foreign substances forms the rhinoliths. It is start time could have since childhood. MATERIALS AND METHODS: In this article, we present eight cases of rhinolithiasis who admitted to our Clinic between January 2001 and December 2010 with unilateral chronic nasal discharge, nasal obstruction and oral malodor. CONCLUSIONS: Rhinolithiasis mostly manifests itself with unilateral purulent rhinorrhea, nasal obstruction and facial pain symptoms. We aimed to discuss these entity with similar cases in the literature.

Multiple dural arteriovenous fistulas involving the cavernous sinus, transverse sinus, sigmoid sinus and spinal drainage: CT angiography findings in 14-year-old boy.

Dural arteriovenous fistulas (DAVF) are rare and constitute 10% to 15% of all intracranial arteriovenous malformations. Only few cases of DAVFs are reported in children. Here is the first case report describing CT angiographic findings in a 14 year old child having multiple DAVFs involving spinal canal, both cavernous and cerebral sinuses.

The incidence of non-proliferative and precancerous lesions of reduction mammoplasty: evaluation of 273 cases.

BACKGROUND: Reduction mammoplasty (RM) is one of the most commonly performed plastic surgery procedures to treat symptomatic macromasty or to correct asymmetry. Occult breast carcinomas were rarely defined in RM specimens. There are few studies aiming to define the incidence of non-proliferative and precancerous lesions. MATERIAL AND METHODS: We evaluated the pathological findings of the RM specimens that have been submitted to our Center for the last 6 years (2005-2011). RESULTS: A total of 273 cases with bilateral RM were enrolled to the study. Of them, 229 cases had pathological changes. Eight cases (2.9%) had atypical ductal/lobular hyperplasia. One case (0.3%) had lobular carcinoma in situ; however, no invasive breast carcinoma was detected. Other pathological findings included fibrocystic changes, fibrosis, adenosis, fibroadenoma (without complex features), mastitis and duct ectasia. CONCLUSIONS: Pathological examination of the RM specimens is quite important to define the lesions precancerous of breast carcinoma. Unknown occult breast lesions could be identified and early interventions may be taken into account.

[Surgical repair of bladder rupture associated with the pelvic fracture without suprapubic tube--a case report]. / Osetrení ruptury mocového mechýre pri zlomenine pánve bez epicystostomie--kazuistika.

The authors are presenting a case of 42-year-old polytraumatized man with pelvic fracture associated with extraperitoneal urinary bladder rupture. This was verified by intraoperative retrograde cystography and treated with suture without making suprapubic tube drainage. Urinary draining was assured with a transurethral permanent urinary catheter. Conversion from external fixation to internal osteosynthesis of pelvic fracture was performed as far as 26 days after admission for significantly poor overall condition of the patient. Injury of the bladder and pelvic fracture healed without any complications. This case review points to the possibility of surgical repair of bladder rupture without epicystostomy, which is an obstacle or an increased risk of infection for internal fixation of anterior part of the pelvic ring. Suprapubic tube is not beneficial in surgical repair of urinary bladder rupture. However, it is normal practice that the suprapubic tube associated with bladder suture is indicated according to urology department tradition or by an individual physician - urologist himself. In the choice of surgical treatment tactics in these types of injuries proper communication between the urologist and the surgeon dealing with complex pelvic trauma is important.

[Biochemic evidence of the presence of urine in a drain following surgery]. / Biochemický prukaz prítomnosti moci v drénu po chirurgickém výkonu.

OBJECTIVE: Evaluation of the laboratory investigations of the postoperative wound drains liquids containing urine and establishing the borderline levels for confirmation of the urine presence. PATIENTS GROUP AND THE METHODS: Biochemical analysis of the drain liquids, urine and blood serum from the 34 patients with confirmed urine leak out of the urinary tract. The urea, creatinine, natrium, potassium and chloride levels were measured in all samples. RESULTS: The mean natrium, potassium, chlorides, urea and creatinine mean levels were 93.8 mmol/l, 15.9 mmol/l, 77.0 mmol/l, 73.3.

[Changes in target volumes definition by using MRI for prostate bed radiotherapy planning--preliminary results]. / Zmeny cílových objemu pri pouzití magnetické rezonance pro plánování radioterapie luzka prostaty--predbezné výsledky.

BACKGROUNDS: Magnetic resonance imaging (MRI) is used quite routinely in radiotherapy treatment planning in the primary radiotherapy of prostate cancer as it provides more contrast imaging of soft tissues in the small pelvis than planning CT, thanks to which it allows more exact delineation of target volumes and thus the saving of organs at risk We tried to verify whether it is possible to use MRI by analogy in the planning of prostate bed radiotherapy. PATIENTS AND METHODS: Twentyone patients indicated for prostate bed radiotherapy were considered in this study. Here we present the preliminary results of 10 of them. Four patients were indicated for adjuvant, 6 for salvage radiotherapy. All the patients underwent, besides standard planning CT, MRI in the same position. Target volumes and organs at risk were delineated into CT,T1 and T2 MRI images - clinical target volume (CTV), planning target volume (PTV), urinary bladder and rectum. Based on the merging of images, the volumes delineated in MRI were copied into planning CT, where the evaluation was done. We evaluated the volumes of each structure, agreement in contouring with the help of the rate of union and intersection of the volumes and with Cohen's kappa, and 3D differences between volumes of CTV on CT, T1 and T2 MRI. RESULTS: Statistically, volumes of CTV and PTV are not significantly different. The volume of the rectum is significantly smaller on T1 and also T2 MRI images. The index of agreement (union/intersection) is statistically significantly different from 1 for CTV and PTV as well. Cohen's kappa indicates moderate agreement for CTV CT and T1, T1 and T2 MRI, fair agreement for CTV CT and T2 MRI, and substantial agreement for PTV. In the superior and superolateral direction, the CTV volume on MRI in the central plane is smaller on T1 and T2 images. In the area of seminal vesicles (SV) the cranial border is similar on CT and MRI. In the superoposterior direction, the volume of CTV is smaller on CT than on T1 and T2 MRI, which means, that seminal vesicles are delineated larger in the posterior direction on MRI (about 0.24cm on T1; by about 0.20cm on T2 images). In the posterior direction, there are no differences in CTV on CT and T1 while on T2 the CTV is larger (a difference of 0.29 cm). In the posterolateral direction, CTV is smaller on T1 MRI than on CT on both sides, on the right as well as on the left. CONCLUSION: Preliminary results suggest that clinical target volume defined with the help of MRI is shifted compared with CTV defined on planning CT. The agreement of CTV delineation by one radiation oncologist is moderate to fair and is similar to interobserver variability in the contouring of the prostate bed in the planning CT. MRI provides more contrast imaging of the anterior rectal wall, where we have confirmed the most differences in contouring. Moreover, it provides better imaging of local recurrences and seminal vesicles, where the most differences in our group of patients were seen in comparison with planning CT.

[Prostate bed radiotherapy--when and what?]. / Radioterapie luzka prostaty--kdy a co lécit?

BACKGROUNDS: Recently, prostate bed irradiation has, due to the results of randomized trials which confirmed its benefit in adjuvant treatment, become the standard treatment for patients with risk factors after radical prostatectomy. It is also irreplaceable in the treatment of biochemical progression caused by local recurrence. In most cases, the tumour is not visible on planning CT, so it is necessary to use all available information to define the target volume to treat all the sites where the recurrence could be present. DESIGN: The aim of this review is to provide a compendium of radiotherapy after radical prostatectomy, its indications and especially the localization of recurrences, which implicates the clinical target volume definitions. CONCLUSION: The treatment of prostate cancer requires close co-operation between urologists and radiation oncologists, especially now when the indication of radiotherapy includes patients with risk factors after radical prostatectomy where adjuvant treatment should be performed early after surgery. It is of the utmost importance to precisely define the target volume for radiotherapy to fully prevent local recurrence without unnecessary complications for the patient.