Medical Advancements in Benign Prostatic Hyperplasia Treatments.

PURPOSE OF REVIEW: This review aims to identify and summarize the current literature on the most recent therapeutic agents and combination strategies for the medical management of lower urinary tract symptoms resulting from benign prostatic hyperplasia. RECENT FINDINGS: The latest advancements in BPH therapy have been in combination strategies. Alpha blockers continue to be the mainstay of treatment, but research is exploring the synergistic benefits of combining them with 5-alpha reductase inhibitors (5-ARIs), phosphodiesterase-5 (PDE5) inhibitors, and beta-3 agonists. The alpha-blocker + 5-ARI combination remains ideal for enlarged, significantly reducing clinical progression risk compared to monotherapy. Alpha-blocker + PDE5 inhibitor combinations appear safe and potentially beneficial for men with concomitant erectile dysfunction; sildenafil might hold an edge over tadalafil based on limited data. Beta-3 agonists show synergistic effects with alpha blockers for residual storage symptoms, offering similar efficacy to anticholinergics but with a better side effect profile.

Impact of American Society of Anesthesiologists score on postoperative holmium enucleation of the prostate outcomes and complications.

INTRODUCTIONS: The American Society of Anesthesiologists Physical Status Classification System (ASA) is a validated risk stratification method for patients undergoing surgery. There is an increased prevalence of benign prostatic hyperplasia and comorbidities in our aging population. The role of ASA related to postoperative complications in patients undergoing holmium laser enucleation of the prostate (HoLEP) has not been described. METHODS: A review of our database was performed for patients who underwent HoLEP from July 2018 to December 2020. Patients were stratified based on ASA score. Preoperative, perioperative, and complication data were analyzed using SAS analytics software. RESULTS: Of 472 patients undergoing HoLEP, 320 (67.8%) were ASA 3-4 patients. There was a statistically significant difference found in age (72.3 ± 9.8 vs. 69.1 ± 9.0 years, p < 0.001), body mass index (BMI) (29.0 ± 5.9 vs. 27.3 ± 4.2, p = 0.004), and use of antiplatelet/anticoagulant medications (14.6% vs. 2.6%, p < 0.001) in the ASA 3-4 group. There was no significant difference between prostate volume (p = 0.158) or catheter-dependent urinary retention (p = 0.376). No difference was found in enucleation time (52.76 ± 24.8 vs. 54.16 ± 23.7 min, p = 0.587), OR specimen weight (70.24 ± 58.5 vs. 81.53 ± 65.9, p = 0.094). or intraoperative complications (2.8% vs. 1.3%, p = 0.330). There were higher postoperative complications in the ASA 3-4 group (12.8% vs. 7.9%, p = 0.03), but no difference in Clavien ≥3 complications (p = 0.068). ASA 3-4 patients had similar postoperative international prostate symptom score (p = 0.159). CONCLUSION: HoLEP is feasible and effective in patients who are ASA 3-4. The high-risk cohort had an increased rate of low-grade complications. Patients with an ASA score of 3-4 should be counseled regarding a higher rate of low-grade complications.

Role of Small-Gauge Proportionate Reflux-Assisted Hydrodissection In Elevated Symptomatic Vitreofoveal Traction.

BACKGROUND/PURPOSE: To describe a new technique to release the elevated symptomatic vitreofoveal traction. METHODS: This was a retrospective, interventional case series where a new technique of hydrodissection by proportionate reflux property of small-gauge vitrectomy cutter was used in cases of elevated symptomatic vitreofoveal traction as evident on optical coherence tomography. After vitrectomy, an opening was made in the taut posterior hyaloid face around the foveal elevation. Then, the cutter tip was insinuated inside the hyaloid opening, and the port opening was directed toward the tip of the fovea at its hyaloid attachment. The proportionate reflux property of the cutter was then used to cause reflux of cassette fluid. The hydrostatic force thus generated separates the vitreofoveal attachment. End point was separation of vitreofoveal traction. RESULTS: Seven eyes of seven patients were operated by 27-gauge (n = 3) or 25-gauge (n = 4) vitrectomy system. Mean preoperative and postoperative BCVA were LogMAR 0.44 (20/55) ± 0.14 and LogMAR 0.27 (20/37) ± 0.11, respectively ( P = 0.23). Mean preoperative foveal elevation was 560.86 ± 196.57 µ m, which significantly decreased postoperatively to 251 ± 79.13 µ m ( P < 0.01). VMTs were successfully released in all cases. Mean follow-up was 184.00 ± 80.32 days. CONCLUSION: Small-gauge proportionate reflux-assisted hydrodissection is an innovative technique for management of elevated symptomatic cases of vitreofoveal traction.

Complete manuscript title: role of sub-silicone oil application of triamcinolone acetonide (TA) drops on outcomes after 360° relaxing retinectomy: a pilot study.

PURPOSE: To perform a pilot study to evaluate the role of sub-silicone oil Triamcinolone Acetonide (TA) crystal drops in complex Retinal Detachment (RD) with extreme proliferative vitreoretinopathy (PVR) requiring 360-degree relaxing retinectomy (RR). DESIGN: It was a retrospective pilot study. MATERIALS AND METHODS: It was a retrospective case-control pilot study. TA-assisted 23G or 25G vitrectomy was done in 24 complex RDs with extreme PVR where 360 degree RR had to be performed. Group A (n = 13) included cases where additional TA crystal drops were applied, after settling the detached retina, over the site of RR under silicone oil (SO 5000 CSt) tamponade. In the control arm, group B (n = 11), additional TA crystals were not applied. MAIN OUTCOMES MEASURED: Mean pre- and post-operative BCVA, ultra-widefield fundus photograph by Optos 200Tx, macular OCT and the propensity to remove silicone oil were measured. RESULTS: Mean pre-operative and post-operative BCVA at final follow-up were Log MAR 2.69 ± 0.41 and Log MAR 1.51 ± 0.90 (Mann-Whitney U test, p < 0.05), respectively, in Group A and Log MAR 2.9 and Log MAR 2.37 ± 0.86 (Mann-Whitney U test, p < 0.05), respectively, in group B. Visual improvement in group A was significantly better than group B (Wilcoxon W test, p < 0.025) with significantly less recurrence of RD (Fisher's Exact Test, p = 0.002). Silicone oil removal was done significantly more in group A (Fisher's Exact Test, p = 0.0017). CONCLUSION: Sub-silicone oil crystals application over sites of RR after 360-degree relaxing retinectomy leads to improved postoperative visual recovery as well as improved anatomical outcomes with fewer complications.

Outcomes of octogenarians undergoing holmium laser enucleation of prostate.

PURPOSE: Holmium laser enucleation of prostate (HoLEP) is an effective surgical procedure in men with BPH. Due to the increase in the use of medical therapy for BPH related lower urinary symptoms more octogenarians are presenting in a delayed fashion with significant symptoms and urinary retention. We evaluate the feasibility and safety of octogenarians undergoing HoLEP. METHODS: We performed a retrospective review of HoLEPs at our institution from July 2018 to December 2019. Patients were stratified into two groups based on age: < 80 and ≥ 80. RESULTS: A total of 458 patients were identified, with 74 (16.2%) ≥ 80. In patients ≥ 80, prostate volume was higher (p < 0.0005), there was a higher rate of antiplatelet/anticoagulation (p = 0.029) use, and a lower rate of alpha-blocker use (p = 0.0016). As expected, ASA scores which correlate with increasing number of concomitant diseases were greater in the ≥ 80 cohort (p = 0.016). There was no significant difference in intraoperative complications (p = 0.14), 90 day complication (p = 0.34), readmission rates (p = 0.425) or emergency room visits between groups (p = 0.15). CONCLUSIONS: Despite higher medical comorbidities and increased rates of anticoagulation in octogenarians, there is no increase in operative or postoperative complication rates. Age alone should not be used as exclusion criteria for HoLEP.

Laser fiber degradation following holmium laser enucleation of the prostate utilizing Moses technology versus regular mode.

PURPOSE: We sought to objectively compare laser fiber degradation for holmium laser enucleation of the prostate (HoLEP) cases performed with 550 µm standard fibers versus 550 µm Moses 2.0 fiber in BPH mode on a macroscopic and microscopic level. METHODS: We prospectively collected outcomes for 50 standardized HoLEP cases using 550 µm Moses fiber with 2.0 BPH mode compared to our historical cohort of 50 patients using 550 µm standard fibers on regular mode. Macroscopic degradation length was the difference in length of exposed fiber at the start and end of each case. Five consecutive 550 µm standard fibers, five 550 µm Moses fibers and their respective controls underwent novel utilization of three objective corroborating imaging techniques: Brightfield high resolution microscopy, high resolution 3-D microCT and Confocal Reflection Surface Analysis. Mann-Whitney U, 2-tailed T tests and Chi-squared tests were used. RESULTS: Standard fibers demonstrated greater degradation than the Moses fibers with 2.0 BPH mode [2.9 cm (IQR 1.7-4.3 cm) vs 0.2 cm (IQR 0.1-0.4 cm), p < 0.01]. This difference remained significant when comparing degradation per energy used, per minute enucleation and per gram enucleated (all p < 0.05). None of the cases with Moses fiber and 2.0 BPH mode required intraoperative interruption to re-strip the fiber. Objective fiber degradation by three microscopic techniques confirmed more damage to the standard fibers with regular mode. CONCLUSION: Overall, use of the 550 µm Moses fiber with 2.0 BPH mode resulted in less fiber degradation compared to a standard 550 µm fiber with regular mode as confirmed using 4 corroborating macroscopic and microscopic techniques.

Determining the threshold of acute renal parenchymal damage for intrarenal pressure during flexible ureteroscopy using an in vivo pig model.

PURPOSE: To identify a threshold for intrarenal pressure (IRP), that if exceeded, will result in renal parenchymal damage. Herein, we attempt to identify an IRP threshold by subjecting in vivo porcine kidneys to various levels of extreme pressurized irrigation. Our objective was not to simulate ureteroscopy treatment, but to attempt identify a threshold of IRP injury. METHODS: Ten female pigs were intubated and sedated. The abdomen was opened; the ureters were isolated and incised. A LithoVue™ (Boston Scientific) ureteroscope was inserted. A 0-silk tie was then used to tie the ureter around the scope to create a closed system (to achieve a constant level of pressure). Real-time IRPs were measured using the Comet™ Pressure guidewire (Boston Scientific). Kidneys were exposed to pressurized, saline for 36 min (at control, 50, 100, 150 mmHg and higher pressures). Kidneys were then immediately harvested. Two expert histologists independently analyzed kidney slides to identify areas of renal damage. RESULTS: The two kidneys exposed to IRPs > 185 mmHg resulted in forniceal rupture and large areas of hematoma. The other IRP groups (control, 50, 100, and 150 mmHg) had no identifiable gross or histologic renal parenchymal damage. CONCLUSIONS: No differences in renal parenchymal morphology were identified between pressure groups of control, 50, 100, or 150 mmHg. However, IRPs > 185 mmHg did result in forniceal rupture in this closed-system in vivo porcine model. Further study is required to elucidate the damage threshold.

Postoperative Respiratory Failure After Elective Abdominal Surgery: A Case-Control Study.

INTRODUCTION: Postoperative respiratory failure (PRF) contributes significantly to morbidity and mortality. We sought to identify patient characteristics and perioperative risk factors associated with PRF in patients undergoing elective abdominal surgery to improve patient outcomes. METHODS: We retrospectively reviewed patients undergoing elective abdominal surgery from 2011 to 2016 at our institution. An experimental group consisting of adult patients with the Patient Safety Indicator 11 diagnosis of PRF was compared with a time-matched control group. RESULTS: Each group consisted of 233 patients. Comorbidities associated with PRF included ascites, coronary artery disease, chronic kidney disease, chronic obstructive pulmonary disease, diabetes mellitus type II, hypertension, and hypoalbuminemia (P < 0.05). American Society of Anesthesiologists score IV (20.2% versus 3.95%; P < 0.001), operative time (4.13 versus 2.55 h; P < 0.001), laparotomy with open operation (77.7% versus 45.5%; P < 0.001), and net intraoperative fluid balance (3635 versus 2410 mL; P < 0.001) were higher in patients with PRF. On multivariate analysis, age, American Society of Anesthesiologists score, chronic obstructive pulmonary disease, diabetes mellitus type II, laparotomy, and net intraoperative fluid balance maintained significance (P < 0.05). CONCLUSIONS: We identified contributing pre- and intra-operative risk factors for PRF undergoing elective abdominal surgery. These findings may help identify those at increased risk for respiratory failure and mitigate complications.

Synthesis and Anti-Cancer Activity of New Pyrazolinyl-Indole Derivatives: Pharmacophoric Interactions and Docking Studies for Identifying New EGFR Inhibitors.

Newly designed series of indole-containing pyrazole analogs, pyrazolinylindoles, were synthesized, and their structures were confirmed based on the spectral data of the 1H NMR, 13C NMR, and HR-MS analyses. Preliminary anti-cancer activity testings were carried out by the National Cancer Institute, United States of America (NCI, USA). Compounds HD02, HD05, and HD12 demonstrated remarkable cytotoxic activities against nine categories of cancer types based cell line panels which included leukemia, colon, breast, melanoma, lungs, renal, prostate, CNS, and ovarian cancer cell lines. The highest cytotoxic effects were exhibited by the compounds HD02 [1-(5-(1-H-indol-3-yl)-3-(p-tolyl)-4,5-dihydro-1H-pyrazol-1-yl)-2-phenylethanone], HD05 [1-(3-(4-chlorophenyl)-5-(1H-indol-3-yl)-4,5-dihydro-1H-pyrazol-1-yl)-2-phenoxyethanone], and HD12 [(3-(4-chlorophenyl)-5-(1H-indol-3-yl)-4,5-dihydro-1H-pyrazol-1-yl)(pyridin-4-yl)methanone] against some of the 56 types of NCI-based cell lines in different panels. Compound HD05 showed the maximum range of cancer cell growth inhibitions against all categories of the cell lines in all nine panels. On average, in comparison to the referral standard, imatinib, at a dose level of 10 µM, the HD05 showed significant activity against leukemia in the range of 78.76%, as compared to the imatinib at 9% of cancer cells' growth inhibitions. Molecular docking simulation studies were performed in silico on the epidermal growth factor receptor (EGFR) tyrosine kinase, in order to validate the activity.

Contemporary practice patterns of transurethral therapies for benign prostate hypertrophy: results of a worldwide survey.

PURPOSE: To perform a global survey to identify contemporary practice patterns of transurethral therapies for benign prostatic hypertrophy. METHODS: A REDCap survey was distributed to the ~ 3500 members of the Endourological Society. Surgeons completed demographic information and then selected the BPH therapies they perform 10 cases/year. There were four categories of BPH therapies: ablation, enucleation, resection/vaporization, and MIST (minimally invasive surgical technique). Within each category, there were subcategories to account for different energy modalities. All statistical analyses were performed using SAS 9.4. RESULTS: A total of 175 surgeons responded to our survey. Prostate resection/vaporization remained the most commonly utilized technique (51.9%, n = 147/283) followed by enucleation (22.6%, n = 64/283). Bipolar TURP (bTURP) was the most common modality for prostate resection (69.4%, n = 102/147). Holmium laser enucleation (HoLEP) was the most common modality for enucleation (46.9%, n = 30/64). Urolift® was performed more often than Rezum™ (55.9% vs. 44.1%, n = 19/34 vs. 15/34, respectively). Among surgeons performing ablation, country of practice was a significantly associated with length of stay (LOS), p < 0.0001. For surgeons performing enucleation, academic institution and completion of a fellowship were associated with postoperative day (POD) 1 catheter removal (p = 0.0240 and p = 0.020, respectively). CONCLUSIONS: In this contemporary, global survey of the Endourology Society, resection/vaporization techniques were the most commonly performed. Rates of MISTs remained relatively low at 12.1%. Academic institution and fellowship status were associated with shorter catheterization times and LOS for certain surgical categories.

Transcriptome analysis of Clarias magur brain and gonads suggests neuro-endocrine inhibition of milt release from captive GnRH-induced males.

Transcriptome analysis of Clarias magur brain and gonads at preparatory, mature, 6 and 16 h post-GnRH injection (hpi) stages yielded 9.5 GB data with 39,738 contigs. Sequences of 45 reproductive genes were identified for the first time in C. magur along with unique and differentially expressed genes. The expression of 20 genes was validated by qRT-PCR. Upregulation of Cyp11A1, Cyp17A1 and FTZF1 genes in the 16hpi testis accompanied by the 17ß-HSD3 expression indicates testosterone (T) synthesis in response to LH surge, while reduced expression of CYP11B1 suggests a high T: 11-KT ratio. It is evident by the gene expression analysis that the inhibitory neurotransmitter GABA, altered T: 11-KT, increased testicular bile acids, and oxytocin-like neuropeptide in the male brain, appear to be involved in arresting the pulsatile motion of testicular smooth muscles. The work generates important leads for an effective induced breeding strategy for silurid catfish.

Effectiveness of a web-based learning module on oral health promotion for nursing and allied health professionals.

Background Nursing and allied health professionals are helping hands for healthcare and are important in the training cascade. We aimed to develop and validate the effectiveness of a web-based learning module on oral health promotion among nursing and allied health professionals. Methods We developed and validated an oral health module focused on prevention and promotion for a web-based intervention among nurses and allied health professionals. Pre- and post-test assessment was conducted to evaluate the effectiveness of the programme. Results Of a total of 347 participants, 170 (48.9%) had a good knowledge score in the pre-test, and after attending the oral health module their number increased to 267 (76.9%). The mean difference between the pre-test and post-test scores was statistically significant (p<0.005). Conclusions Training of nurses and allied health professionals on oral health through a web-based module showed improvement in oral health literacy.

Treatment of non-obstructive, non-struvite urolithiasis is effective in treatment of recurrent urinary tract infections.

PURPOSE: To determine if treatment of non-obstructing urolithiasis is effective in management of recurrent UTI. MATERIALS AND METHODS: A retrospective review was performed of patients undergoing elective management of non-struvite upper tract urinary calculi with recurrent UTI from 2009 to 2016. Recurrent UTI was defined at ≥ 3 UTI in 12 months, with symptoms and documented urine culture. Preoperative CT was performed in all patients to determine stone burden. All patients had postoperative imaging and ≥ 12 months of follow-up. Pre- and postoperative variables were between patients who had recurrent UTI after treatment versus those who did not. RESULTS: 46 patients met inclusion criteria. 42 (91.3%) were female. Median age was 63.7 years (IQR 49.1, 73.4) and median total stone burden was 20 mm (IQR 14-35). Within the cohort, 20 (43.5%) underwent ureteroscopy only, 26 (56.5%) underwent PCNL ± URS, and none underwent ESWL. Median postoperative follow-up was 2.9 years (IQR 2.0, 4.3). Only five patients (10.9%) had recurrent UTI after treatment. 80% were with the preoperative pathogen. The presence of residual stone was an independent risk factor for recurrent UTI after treatment (p < 0.046). Diabetes, hypertension, immunosuppression and chronic kidney disease were not. CONCLUSIONS: Stone removal for patients with recurrent UTIs was associated with a high rate of success (89.1%) in elimination of further recurrent UTIs. Residual fragments are independently associated with persistent recurrent UTIs and thus, complete stone removal is of paramount importance in treatment of this patient population.

Molecular characterization and expression profiling of 17-beta-hydroxysteroid dehydrogenase 2 and spermatogenesis associated protein 2 genes in endangered catfish, Clarias magur (Hamilton, 1822).

The 17-beta-hydroxysteroid dehydrogenase 2 (17ß-HSD2) enzyme regulates steroid levels by the inactivation of estrogen and androgens. Spermatogenesis associated protein 2 (SPATA2) plays a vital role in spermatogenesis in vertebrates including fish. We report cloning and characterization of full cds of 17ß-HSD2 and SPATA2 genes in Clarias magur. The full-length cDNA sequences of 17ß-HSD2 and SPATA2 were 1187 bp (ORF 1125 bp) and 1806 bp (ORF 1524 bp) encoding 375 and 508 amino acids, respectively. Signal peptide analysis revealed SPATA2 is nonsecretory, while 17ß-HSD2 is a secretory protein. Hydropathy profiles showed both proteins are hydrophilic in nature. Tissue distribution of both the genes revealed high mRNA level of SPATA2 in all tissues examined indicating its wide range of expression. 17ß-HSD2 indicated higher expression in preparatory phase compared to spawning phase in ovary while it was opposite in case of testis. SPATA2 showed significantly higher expression in preparatory phase compared to spawning phase in both ovary and testis. Administration of OvatideTM (GnRH analog) resulted in upregulation of SPATA2 expression at 6 and 16 h post-injection while 17ß-HSD2 showed upregulation only at 6 h post-injection. To the best of our knowledge, this is a first report on characterization of 17ß-HSD2 and SPATA2 full-length cDNA in catfish.

Percutaneous resection of metastatic renal cell carcinoma.

INTRODUCTION: Metastasis-directed therapy of small solitary foci of metastatic renal cell carcinoma has been associated with improved survival. Percutaneous resection of tumors in the upper tract urinary system has been widely used for treatment of localized urothelial carcinoma, however, its role in renal cell carcinoma has not been described. Herein, we present the first case of patient undergoing percutaneous resection of renal cell carcinoma in the contralateral renal pelvis. MATERIALS AND METHODS: This is a case report describing the diagnosis, management and surgical approach to renal cell carcinoma recurrence in the contralateral renal pelvis. RESULTS: Our patient was a 75-year-old male with a history of renal cell carcinoma status post radical nephrectomy who developed a solitary 2 cm recurrence in the contralateral renal pelvis, which was found after he presented with gross hematuria. He underwent successful percutaneous resection of this recurrence with final pathology showing clear cell renal cell carcinoma. CONCLUSION: We present the first case of renal cell carcinoma recurrence in the contralateral renal pelvis treated with percutaneous resection.

Holmium laser enucleation of the prostate is an effective treatment in patients with concomitant bladder diverticula and outlet obstruction.

INTRODUCTION: Bladder diverticula can be congenital or secondary to benign prostatic hyperplasia with bladder outlet obstruction, and be a source of high postvoid residuals prompting surgical intervention. We sought to evaluate the outcomes of patients with bladder diverticula undergoing holmium laser enucleation of the prostate (HoLEP) for bladder outlet obstruction. METHODS: We retrospectively reviewed HoLEP patients with at least one bladder diverticulum at two high volume institutions. All cases were performed in similar fashion. Preoperative, perioperative, and postoperative patient variables were obtained and assessed. RESULTS: Of 2746 HoLEP patients, 51 were diagnosed with bladder diverticula before surgery. Mean prostate size was 80.8 ± 50.0 g and mean diverticulum size (largest if multiple) was 5.5 ± 2.6 cm. Preoperatively, urinary retention requiring catheterization was present in 28 (55%) patients. In the remainder, mean preoperative AUASI was 19.7, peak flow 7.2 ml/s, and post-void residual (PVR) 365 ml. At most recent follow-up (mean 12.2 months), mean total AUASI was 8.6, peak flow 27.1 ml/s, and PVR 145 ml with 71, 276, and 221% improvement, respectively. All patients were voiding and none required catheterization. Only three (6%) patients required diverticulectomy at a mean of 15.2 months after HoLEP for the following indications: hematuria (one patient) and urinary retention (two patients). CONCLUSIONS: HoLEP is an effective method of outlet obstruction treatment in patients with bladder diverticula. Most patients, even with large diverticula, do not require further treatment after the outlet obstruction has been relieved and can avoid more invasive surgical interventions.

Molecular characterization of inhibin-A: Structure and expression analysis in Clarias batrachus.

The inhibins are disulphide-linked heterodimeric glycoproteins that belong to the TGFß superfamily. Inhibins have been well studied in mammals but the information about their structure and function is very limited in lower vertebrates. The aim of the present study was to characterize inhibin-A and to understand its receptor binding interaction, and to evaluate its biological function in Clarias batrachus. Structure prediction of inhibin-A revealed two glycosylation sites on inhibin-α (Asp262 and Asn334). Docking of inhibin-A with its receptor; betaglycan and Act RIIA showed that residues Ser321, Gly324 and Leu325 of inhibin-α are involved in high affinity binding with betaglycan while inhibin-ßA bound to Act RIIA by forming hydrogen bonds. The mRNA transcript analysis of various tissues indicated the presence of higher to moderate expression of inhibin-α and inhibin-ßA in the gonads and the extra-gonadal tissues. Further, stage specific expression showed decreased levels of inhibin-α in the gonads during the annual reproductive cycles. Inhibin-ßA, activin-ßB and Act RIIA increased in the brain during spawning while FSHr increased in the gonads during the preparatory phase. Our study provides molecular, structural and functional insights of inhibin-A for the first time in C. batrachus.

Microvascular decompression for hemifacial spasm: A systematic review of vascular pathology, long term treatment efficacy and safety.

INTRODUCTION: Hemifacial spasm (HS) is a rare disorder caused by the compression of facial nerve root exit zone (REZ) at the brainstem by a vascular loop. Microvascular decompression (MVD) is a popular treatment modality for HS. OBJECTIVE: The purpose of this study was to determine the long-term efficacy and safety of MVD for HS by assessing the effect of the procedure from the literature published over the last 25 years. MATERIALS AND METHODS: A systematic data review from 1992 to 2015 using specific eligibility criteria yielded 27 studies on MVD for HS, the data of which were pooled and subjected to a meta-analysis. RESULTS: The pooled odds ratio (OR) revealed by the meta-analysis showed that anterior inferior cerebellar artery was the most common offending vessel in 37.8% (95% confidence interval [CI]: 27.8-47.7%) of the patients. Complete resolution of HS was seen in 88.5% (95% CI: 86.7-90.4%) of the patients after a long-term follow up. The complication rate was low following MVD, the most common being temporary facial paresis in 5.9% (95% CI: 4.3-7.5%) of patients. CONCLUSIONS: MVD is a safe and effective treatment for HS with long-term benefits and a low complication rate.

Artificial urinary sphincter urethral erosions: Temporal patterns, management, and incidence of preventable erosions.

INTRODUCTION: The artificial urinary sphincter (AUS) is the mainstay of surgical treatment for male stress urinary incontinence. Although urethral erosions are a known complication, their temporal distribution and optimal management have not been well characterized. We seek to evaluate the timing, etiologies, and management of urethral erosions in primary AUS implantations. MATERIALS AND METHODS: 1802 male patients underwent AUS procedure at Mayo Clinic (Rochester) from 1983 to 2011, including 1082 primary placements. Of primary placements, 63 had a urethral erosion of their device requiring explanation and were included in our analysis. All cases of urethral erosion were confirmed at the time of explantation through cystoscopy and direct visualization. At our institution, explantation is typically performed without primary urethral repair. RESULTS: There were 63 cases (5.8%) of urethral erosions of primary AUS devices during the study time frame. The median age at AUS implantation was 74 years (interquartile range [IQR] 68-77 years) and median time to explantation was 21 months (IQR 5-59 months). The temporal trend of AUS erosions demonstrates a peak in the 1st year, with a gradual tapering of cases thereafter, persisting beyond 10 years. Three of 36 (8.3%) patients with follow-up developed a urethral stricture. Overall, 32/63 patients (51%) underwent salvage AUS reimplantation at a median of 7.1 months (IQR 3.1-12.9 months). CONCLUSIONS: Urethral erosions tend to occur early (within 1-2 years), with gradual tapering over time. However, continued vigilance is needed after AUS placement to decrease late erosions. These data can be used for counseling and to help guide follow-up care of patients with AUS.

Medial sphenoid wing meningiomas: Experience with microsurgical resection over 5 years and a review of literature.

BACKGROUND: Medial sphenoid wing meningiomas are medially located tumors on the sphenoid wing with attachment over the anterior clinoid process. They represent a distinct entity. These medial sphenoid wing meningiomas present a more difficult problem for the neurosurgeons because in a majority of cases, they involve the anterior visual pathways and arteries of the anterior circulation and may invade the cavernous sinus (CS). Higher morbidity, mortality and recurrence rates have been observed in these tumors compared with meningiomas in other locations. The rate of recurrence for medial sphenoid wing meningiomas is reported as being one of the highest amongst intracranial meningiomas. MATERIAL AND METHODS: The authors retrospectively analyzed 78 consecutive patients with the diagnosis of medial sphenoid wing meningioma who were operated in our department from January 2008 to December 2012. RESULTS: These patients, having a meningioma of the medial sphenoid ridge, were divided into two types depending on the involvement of CS. Diplopia, internal carotid artery encasement, and postoperative visual deterioration were more common in Type 2 tumors. Similarly, extent of resection and postoperative morbidity were greater in Type 2 patients. CONCLUSIONS: CS invasion confers an added risk to the surgical morbidity and outcomes. However, with proper surgical techniques, optimum outcomes can be achieved and overall surgical results at our center are found to be comparable to that of the current literature.