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Objective: To describe a technique combining the implantation of fiducials and a prostatic spacer (hyaluronic acid [HA]) to decrease the rectal toxicity after an image-guided external beam radiotherapy (EBRT) with hypofractionation for prostate cancer and to assess the tolerance and the learning curve of the procedure.Materials and Methods: Thirty patients with prostate cancer at low or intermediate risk were included in a phase II trial: image-guided EBRT of 62 Gy in 20 fractions of 3.1 Gy with intensity-modulated radiotherapy. A transrectal implantation of 3 fiducials and transperineal injection of 10 cc of HA (NASHA gel spacer, Q-Med AB, Uppsala, Sweden) between the rectum and the prostate was performed by 1 operator. The thickness of HA was measured at 10 points on magnetic resonance imaging to establish a quality score of the injection (maximum score = 10) and determine the learning curve of the procedure.Results: The quality score increased from patients 1-10, 11-20, to 21-30 with respective median scores: 7 [2-10], 5 [4-7], and 8 [3-10]. The average thicknesses of HA between the base, middle part, and apex of the prostate and the rectum were the following: 15.1 mm [6.4-29], 9.8 mm [5-21.2], and 9.9 mm [3.2-21.5]. The injection of the HA induced a median pain score of 4 [1-8] and no residual pain at mid-long term.Conclusion: Creating an interface between the rectum and the prostate and the implantation of fiducials were feasible under local anesthesia with a short learning curve and could become a standard procedure before a hypofractionated EBRT for prostate cancer. [ABSTRACT FROM AUTHOR]

Objective: To analyze surgical and functional outcomes of bilateral pedicled scrotal flaps for penile shaft reconstruction., Materials and Methods: A retrospective analysis was performed on 22 patients who underwent penile shaft reconstruction with bilateral pedicled scrotal flaps between 2009 and 2017. Demographics, peri-operative data, and surgical complications were collected. Functional outcomes were analyzed using a questionnaire made of the erection hardness score, the patient and observer scar assessment scale, and a 10-point Likert scale measuring patients... satisfaction about their skin coloration, sensitivity, elasticity and thickness, penile size, scrotal volume, erection quality, penetration ability, pain, sexual satisfaction, body image, masculinity, self-esteem, and global satisfaction., Results: Patients exhibited a wide range of indications, including buried penis (27.2%), or subcutaneous injections of foreign material (27.2%). Early complications were suture dehiscence (31.8%), infection (13.6%) and hematoma (4.6%), associated with 9.1% of surgical revisions. Late complications were skin retraction (27.3%), testicular ascension (22.7%), pyramidal shape (4.6%) or shortening (13.6%) of the penis, associated with 27.3% of surgical revisions. For the 12 patients who answered the questionnaire, median erection hardness score and patient and observer scar assessment scale score [IQR] were 3.5 out of 4 [2.5-4] and 11.5 out of 60 [9.5-22], respectively. The patients reported a positive impact of the surgery on their psychological condition, with a median score of global satisfaction of 8 [IQR 7.5-9.5]., Conclusion: Bilateral pedicled scrotal flaps seem.ßto be a safe alternative for shaft defects reconstruction despite a potential need of surgical revision, providing satisfactory functional outcomes., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Objective: To assess the benefits and safety of noncatheterization during robot-assisted partial nephrectomy within an enhanced recovery protocol., Materials and Methods: A single-center retrospective comparative study was carried out of consecutive patients who underwent a robot-assisted partial nephrectomy between February 2015 and December 2017 within an early recovery program. The patients who received a urinary catheter were compared with those who did not in terms of postoperative complications, acute urinary retention rates, urinary tract infection rates, and lengths of hospital stay., Results: Of the 145 patients who followed an early recovery program after robot-assisted partial nephrectomy in the study period, 96 received a urinary catheter and 49 did not. There was no significant difference between these 2 groups in terms of the rates of acute urinary retention (3% vs 6%, respectively; P = .393), urinary tract infection (3% vs 2%; P = .707), postoperative complications (14% vs 18%; P = .445), or readmissions within 30 days (8% vs 6%; P = .636). However, patients who did not receive a catheter had shorter initial and total (including readmissions) lengths of hospital stay (respectively 2.16 days vs 2.56 days; P = .058, and 2.27 days vs 3.40 days; P <.001)., Conclusion: Our findings challenge the routine use of urinary catheterization during robot-assisted partial nephrectomies. Noncatheterization does not seem to increase the risk of postoperative urinary retention. Only catheterizing specific at-risk patients may prove beneficial., (Copyright © 2018. Published by Elsevier Inc.)

Objective: To evaluate predictive radiological elements for adherent perinephric fat (APF) and the Mayo adhesive probability (MAP) score in the setting of open partial nephrectomy, and to assess their reproducibility., Patients and Methods: We performed a retrospective case-control study involving 86 patients who had open partial nephrectomies performed by a single surgeon between January 1, 2009 and April 1, 2015. Radiological elements were assessed by 4 readers blinded to patient APF status. Univariate and multivariate analyses were performed for all radiological and clinical factors. Reproducibility was analyzed using agreement coefficients., Results: On univariate analysis for radiological findings, lateral and posterior fat thickness (odds ratio [OR]: 1.084 [1.033, 1.138], P < .001), stranding (OR: 2.179 [1.431, 3.318], P < .001), -80 HU fat area, and the MAP score (OR: 1.797 [1.332, 2.424], P < .001) were predictive of APF. On multivariate analysis, only age and the MAP score remained statistically significant (OR: 1.060 [1.005, 1.118], P = .03; and OR: 1.560 [1.137, 2.139], P = .0058, respectively). The reproducibility of the MAP score was fair (AC1 = 0.367 and kappa F = 0.353), as was that of stranding (AC1 = 0.499, kappa F = 0.376). The agreement was important if we defined a "low" (0 to 3) or "high" (4 or 5) score (AC1 = 0.706 and kappa F = 0.681)., Conclusion: The MAP score was the element that best predicted APF in our study, although its reproducibility among our readers was only fair. The agreement becomes important if we defined "low or high" score., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Objective: To assess the feasibility of laparoscopic nephrectomy with vaginal extraction in an ambulatory setting., Methods: Two patients underwent a laparoscopic (1 was robot assisted) nephrectomy with vaginal extraction for a nonfunctioning kidney in an ambulatory setting. Both interventions were performed by the same surgical team comprising a urologic surgeon and a gynecologic surgeon. The operative specimen was vaginally extracted via an incision in the posterior fornix at the end of the intervention. Patients had to respect very strict socioenvironmental and clinical criteria. Anesthesia was achieved using short-acting agents. Only first- and second-step analgesics were used (morphine-free protocol). The main judgment criteria were visual analog scale assessment for postoperative pain, the Clavien-Dindo classification for surgical complications, and the hospital readmission rate., Results: Two female patients (37 and 41 years old) have been successfully operated with this technique. No major perioperative or postoperative complications (Clavien-Dindo grade >2) were reported, and no patient readmission was required. Postoperative pain was well managed with visual analog scale scores ≤ 5. Both patients operated in the ambulatory setting had Chung scores of 10 before their discharge., Conclusion: Laparoscopic or robotic nephrectomy with vaginal extraction can be performed in an ambulatory setting in carefully selected patients. The association of fast-track surgical techniques and vaginal extraction by eliminating the abdominal wound extraction source of postoperative pain allows performing this operation in this setting with a high level of satisfaction., (Copyright © 2014 Elsevier Inc. All rights reserved.)

The prostate cancer 3 (PCA3) gene was discovered in 1999, on the basis of differential expression between cancer and noncancerous prostate tissue. Including the first study published in 2003, 11 clinical studies have evaluated its utility for the diagnosis of prostate cancer by measuring the number of PCA3 RNA copies in urine enriched with prostate cells. Although the sensitivity of the PCA3 test was less than that of serum prostate-specific antigen (PSA), its specificity appeared to be much better, particularly in patients with a previous negative biopsy. Recent studies also have suggested that this test could be used to predict cancer prognosis., (2010 Elsevier Inc. All rights reserved.)