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Objective To describe a protocol for transperineal sector biopsies ( TPSB) of the prostate and present the clinical experience of this technique in a UK population., Patients and Methods A retrospective review of a single-centre experience of TPSB approach was undertaken that preferentially, but not exclusively, targeted the peripheral zone of the prostate with 24-38 cores using a 'sector plan'. Procedures were carried out under general anaesthetic in most patients., Between January 2007 and August 2011, 634 consecutive patients underwent TPSB for the following indications: prior negative transrectal biopsy ( TRB; 174 men); primary biopsy in men at risk of sepsis (153); further evaluation after low-risk disease diagnosed based on a 12-core TRB (307)., Results Prostate cancer was found in 36% of men after a negative TRB; 17% of these had disease solely in anterior sectors., As a primary diagnostic strategy, prostate cancer was diagnosed in 54% of men (median PSA level was 7.4 ng/mL)., Of men with Gleason 3+3 disease on TRB, 29% were upgraded and went on to have radical treatment., Postoperative urinary retention occurred in 11 (1.7%) men, two secondary to clots. Per-urethral bleeding requiring hospital stay occurred in two men. There were no cases of urosepsis., Conclusions TPSB of the prostate has a role in defining disease previously missed or under-diagnosed by TRB. The procedure has low morbidity. [ABSTRACT FROM AUTHOR]

In this article, the authors discuss flexible robotics and evolving clinical applications which are used to make surgeries less invasive. They investigate the engineering solutions for further clinical problems related to flexible robotics. They state the usefulness of 5-millimeter (mm) instruments during robot-assisted radical prostatectomy (RARP) in patients with narrow pelvises. They mention that remote access technologies will have new application when combined with image-guided navigation.

We performed a prospective study of 134 consecutive patients undergoing elective surgery in a single centre between March and July 2022, patients undergoing expedited surgery were excluded (Chelsea and Westminster NHS Foundation Trust; Ref: RIQI117) (Fig. In our study the mean SDM-Q-9 statement scores were in keeping with those previously reported in a cohort study of 81 patients undergoing elective breast surgery using this digital consent platform (mean [SD] 4.1 [ 1.3] to 4.8 [0.5]) [[3]]. Abbreviations SDM shared decision making SDM-Q-9 nine-item SDM Questionnaire Informed consent for surgery is a core component of urological practice [[1]]. [Extracted from the article]

Objective: To present the long‐term adjuvant radiotherapy outcomes of patients with pN3 squamous cell carcinoma of the penis (SCCp) treated at two UK centres. Patients and Methods: We conducted a retrospective audit of all pN3 SCCp patients, deemed suitable for adjuvant therapy by a specialist multidisciplinary team at St George's and Leeds Hospitals, who received adjuvant radiotherapy. Primary outcomes were recurrence‐free survival (RFS), cancer‐specific survival (CSS) and overall survival (OS). Secondary outcomes were time to adjuvant treatment, frequency of in‐field recurrence, site and side of recurrence, and dose and schedule of radiotherapy. Results: A total of 146 patients were included: 121 completed radiotherapy, 4 did not complete radiotherapy and 21 did not start it. The median (interquartile range [IQR]) age was 59 (54–70)years. The 5‐year RFS was 51%, CSS was 51% and OS was 44%. Adjuvant radiotherapy was started at a median (IQR) of 75 (48–106) days. A dose of 45 Gy in 20 fractions was most commonly used. Of the 125 patients who started adjuvant treatment, 55 relapsed. Of these relapses, 30 occurred in an inguinal or pelvic nodal station and 26 of the 30 were in a radiation field. Relapses in 18 of the 55 cases were in visceral sites only and seven were in both nodal (non‐irradiated sites) and visceral sites. Doses of <50 Gy were used more commonly before 2013 and higher doses (>50 Gy) were more commonly used after 2013. Conclusions: Application of a standard radiotherapy protocol within a centralized supra‐network setting has achieved survival outcomes that would appear better than those previously documented for either radiotherapy or chemotherapy in a cohort with solely pN3 disease. The addition of adjuvant chemotherapy may improve these outcomes further. These data suggest that adjuvant radiotherapy has a role to play in the management of men with pN3 SCCp. [ABSTRACT FROM AUTHOR]

Objective: To describe our technique and determine the feasibility and tolerability of transperineal template prostate (TP) biopsies under local anesthesia (LA). Methods: Fifty consecutive patients underwent TP biopsies under LA for investigation of an elevated prostate-specific antigen level or risk stratification as part of our active surveillance protocol. Tolerability was evaluated with a visual analog scale assessing probe discomfort, LA infiltration, and the biopsy procurement. Patients were also asked if they would have the procedure again, and in those who had undergone previous transrectal biopsies, how the TP technique compared. Pathologic data, clinical outcomes, and complications were recorded at 2 weeks. Results: Mean age was 62.8 years (standard deviation [SD], 6.34 years) and the mean prostate-specific antigen level was 8.49 ng/mL (SD, 6.36 ng/mL). Mean prostate volume was 48.2 mL (SD, 19.4 mL). Mean visual analog scale scores for discomfort caused by the ultrasound probe, LA injections, and biopsies were 3.08 (SD, 1.64), 3.29 (SD, 1.13), and 2.88 (SD, 1.28), respectively. Thirty-four of 50 men (68%) had positive histology, 26 men had Gleason score ≤3 + 4, 5 men had Gleason score ≥4 + 3, and 3 had recurrent adenocarcinoma after radiotherapy. There were 2 complications: 1 Clavien score 1 and 1 Clavien score 3a. Conclusion: LA TP biopsies are well tolerated, acceptable, and feasible when carried out within an outpatient setting. [ABSTRACT FROM AUTHOR]