Prophylactic surgical mesh placement as a prevention of parastomal hernia in open radical cystectomy with ileal conduit diversion - pilot study.

INTRODUCTION: This study examines the efficacy of prophylactic mesh implantation during open radical cystectomy with ileal conduit diversion in preventing parastomal hernias (PH). Despite PH being a common complication, prophylactic methods have been underexplored. METHODS: A pilot, single-center, prospective cohort study was conducted involving five patients undergoing surgery with mesh implantation. Demographic and clinical characteristics were monitored, including the incidence of PH, operation time, blood loss, and hospitalization duration. RESULTS: During the mean follow-up period of 9.1±3.2 months post-operation, no occurrences of PH were observed in the patient group. Despite the risks associated with implanting foreign material in an area of surgery involving open small intestine, no infectious complications were noted. CONCLUSION: Prophylactic mesh implantation in radical cystectomy with ileal conduit diversion appears to be an effective preventive measure against PH. Further extensive studies are required to definitively confirm the efficacy and safety of mesh use in this context.

High-Dose Rate Brachyther-apy in the Treatment of Early Stages of Penile Carcinoma.

BACKGROUND: Interstitial low dose rate brachyther-apy is established organ spar-ing treatment of T1- T2 penile carcinoma. Experience with high-dose rate brachyther-apy is limited in this indication. MATERIALS AND METHODS: Twenty-six patients with early penile carcinoma were treated by high-dose rate brachyther-apy at dose 18 × 3 Gy per fraction twice daily between 2002- 2018 at the Department of Oncology and Radiother-apy, University Hospital in Hradec Kralove. Breast interstitial brachyther-apy template was used for fixation and precise geometry reconstruction of stainless hollow needles. RESULTS: Median follow up was 85 months (range 7- 200 months). Acute reaction usually consisted of grade 2 mucositis that dissolved dur-ing 8 weeks after the treatment. Local recurrence occurred in 6 patients, 5 of them were successfully treated with partial amputation. One patient had a nodal recurrence successfully salvaged by lymphadenectomy. One patient developed necrosis of the glans requir-ing partial amputation. Currently, there are 24 patients alive without signs of dis-ease. One patient died of cardiac comorbidity, one died of duplicate lung cancer. Nineteen patients have a preserved penis (73%), 18 of them sexually active before treatment report satisfactory intercourse. CONCLUSION: Hyperfractionated interstitial high-dose rate brachyther-apy with 18 × 3 Gy per fraction twice daily is a promis-ing method in selected patients with penile carcinoma and deserves further evaluation in a larger prospective study. Key words penile neoplasms -  conservative treatment -  brachyther-apy This work was supported by programm Progres Q40. The authors declare they have no potential conflicts of interest concerning drugs, products, or services used in the study. The Editorial Board declares that the manuscript met the ICMJE recommendation for biomedical papers. Submitted: 8. 1. 2019 Accepted: 15. 1. 2019.

[Tissue cyanoacrylate glue in partial nephrectomy - our own experience and assessment]. / Tkánové kyanoakrylátové lepidlo u resekce ledviny - zhodnocení vlastních zkuseností.

INTRODUCTION: The effect of cyanoacrylate glues was repeatedly evaluated in resections of liver, lungs and others organs, but minimally in kidney resection. The aim of our study was to evaluate the use of cyanoacrylate tissue glue in open and laparoscopic partial nephrectomy. METHOD: We evaluated a cohort of 32 patients who underwent partial nephrectomy with treatment of the resected area using cyanoacrylate glue. Laparoscopic resection was done in 23 patients, while 9 patients underwent an open procedure. Surgical results, complications and oncologic results were assessed. RESULTS: The median follow-up duration was 46 months. The mean time of open partial nephrectomy was 104 minutes and that of laparoscopic resection was 154 minutes; blood losses reached 250 ml and 184 ml, respectively. No serious complications occurred, and all patients survived the 3-year follow-up without any tumor recurrence. CONCLUSION: Hemostasis using the cyanoacrylate glue Glubran II was effective and safe. On the other hand, it increased the costs of the surgery and was not necessary.Key worlds: partial nephrectomy laparoscopic resection of kidney cyanoacrylate tissue glue.

[Five-year follow up in patients after surgery for clear cell renal carcinoma]. / Petileté sledování nemocných po operaci svetlobunecného karcinomu ledviny.

OBJECTIVE: Evaluation of the five-year follow-up of patients treated for clear-cell renal carcinoma in dependency on its characteristic and extension. PATIENTS' COHORT AND METHODS: Retrospective analysis of five-year follow-up of 269 patients treated for clear-cell renal carcinoma in dependency on T, N, M and clinical tumor stage; presence of lymphatic and distant metastases, cellular grade and tumor necrosis. Tumor-specific surviving is presented on Kaplan-Meier curves. RESULTS: Five-year patients surviving with tumor T1, T2 and T3 were 91.8%, 70.7% and 34.6% respectively. Surviving patients without lymphatic metastases was 85%; with metastases was 6.9%. Surviving patients without distant metastases was 84.1%; with metastases was 0%. Surviving of patients with clinical tumor stage I, II, III and IV were 94.6%, 83.8%, 48.7% and 0% respectively. Surviving of patients with tumor cellular grade G1, G2, G3 and G4 were 87.5%, 95.5%, 64.2% and 27.6% respectively. Surviving patients without tumor necrosis was 92.4%; with metastases was 31.9%. CONCLUSION: Tumor size and the presence of metastases are very significant factors to patient survival. Histological characteristics as a nuclear grade and a tumor necrosis have been important prognostic factors for the future of the patient. Early diagnosis and aggressive surgical treatment are the most important for the positive course of the disease.

[Antibiotic prophylaxis in urology]. / Antibiotická profylaxe v urologii.

Antibiotic prophylaxis is an important measure aimed at reduction of infectious complications after urologic procedures. The goal of this prospective study is assessment of the efficacy, safety and cost of short-time antibiotic prophylaxis before planned urologic surgery. Uncomplicated cystoscopy, urodynamic examination and ESWL were performed without antibiotic prophylaxis. Oral quinolones were effective in prostate biopsy. In open, laparoscopic or endoscopic surgery intravenous prophylaxis by cephalosporins had excellent efficacy. All types of prophylaxes were very safe and without adverse effects, and could be applied at low economic cost.

The General Practice Rural Incentives Program, development and implementation: progress to date.

The General Rural Practice Incentives Program (GPRIP) part of the General Practice Strategy has progressively been introduced since 1992 to address a number of impediments to rural general practice. This article provides an overview of the GPRIP and an indication of its early successes.