Purpose: We postulate that the number of lymph nodes examined in cystectomy specimens can have an impact on the outcome of patients with bladder cancer. Materials and Methods: We analyzed data on 322 patients with muscle invasive bladder cancer who underwent radical cystectomy and bilateral pelvic lymphadenectomy. We evaluated the associations of the number of lymph nodes identified by the pathologist in the surgical specimen with the local recurrence rate and survival outcome. Results: Patients were divided into groups by lymph node status and the distribution of the number of lymph nodes examined. In stages pN 0 and pN + cases improved survival was associated with a greater number of lymph nodes examined. We determined that at least nine lymph nodes should be studied to define lymph node status accurately. Conclusions: These results indicate that surgical resection and pathological assessment of an adequate number of lymph nodes in cystectomy specimens increases the likelihood of proper staging and impacts patient outcome. Such information is important not only for the therapy and prognosis of individuals, but also for identifying those who may benefit from adjuvant chemotherapy.

Impact of the number of lymph nodes retrieved on outcome in patients with muscle invasive bladder cancer.

https://www.europeanurology.com/article/S0302-2838(14)01263-9/pdf/systematic-review-and-cumulative-analysis-of-oncologic-and-functional-outcomes-after-robot-assisted-radical-cystectomy

Systematic Review and Cumulative Analysis of Oncologic and Functional Outcomes After Robot-assisted Radical Cystectomy

https://www.europeanurology.com/article/S0302-2838(10)00756-6/pdf/influence-of-modified-posterior-reconstruction-of-the-rhabdosphincter-on-early-recovery-of-continence-and-anastomotic-leakage-rates-after-robot-assisted-radical-prostatectomy

Influence of Modified Posterior Reconstruction of the Rhabdosphincter on Early Recovery of Continence and Anastomotic Leakage Rates after Robot-Assisted Radical Prostatectomy

Following curative treatment for localised renal cell carcinoma (RCC), up to 30% of patients develop tumour recurrence. Prognostic scores are essential to guide individualised surveillance protocols, patient counselling and potentially in the future to guide adjuvant therapy. In metastatic RCC, prognostic scores are routinely used for treatment selection in clinical practice as well as in all major trials. We performed a literature review on the current evidence based on prognostic factors and models for localised and metastatic RCC. A number of prognostic factors have been identified, of which tumour node metastasis classification remains the most important. Multiple prognostic models and nomograms have been developed for localised disease, based on a combination of tumour stage, grade, subtype, clinical features, and performance status. However, there is poor level of evidence for their routine use. Prognostic scores for patients with metastatic RCC receiving targeted treatments are used routinely, but have limited accuracy. Molecular markers can improve the accuracy of established prognostic models, but frequently lack external, independent validation. Several factors and models predict prognosis of localised and metastatic RCC. They represent valuable tools to provide estimates of clinically important endpoints, but their accuracy should be improved further. Validation of molecular markers is a future research priority.

Prognostic factors and prognostic models for renal cell carcinoma: a literature review.

This review summarizes all studies that compare the effect of a MBSR program to a control group intervention, in which the participants had been randomly allocated to be in either the MBSR group or a control group. The review summarizes the results in two categories. First, where the effect of the MBSR program was compared to an inactive group (either a wait list group or one receiving ordinary care also received by the MBSR group). Second, where MBSR was compared with an alternative active group intervention.

Based on this review it is reasonable to consider MBSR a moderately well-documented method for helping adults improve their health and cope better with the challenges and stress that life brings. New research should improve the way the trials are conducted addressing the pitfalls in research on mind-body interventions.

https://onlinelibrary.wiley.com/doi/pdf/10.4073/csr.2017.11

Mindfulness‐based stress reduction (MBSR) for improving health, quality of life and social functioning in adults: a systematic review and meta‐analysis

The case of a 50-year-old patient who had undergone male to female gender reassignment surgery is presented. She presented with mixed incontinence with symptoms of stress incontinence predominating. Initial conservative treatment was unsuccessful and subsequent videourodynamic assessment demonstrated urodynamic stress incontinence in association with a partially open bladder neck at rest. Also noted during the study was cough-induced detrusor overactivity. The option of inserting a pubo-vaginal sling using autologous rectus sheath was chosen. The procedure proved to be straightforward to perform and was uncomplicated. Subsequent follow-up demonstrated a resolution of her stress incontinence.

Stress urinary incontinence after male to female gender reassignment surgery: Successful use of a pubo-vaginal sling.

Testicular Hypoplasia Is Driven by Defective Vascular Formation.

314 active triacylglycerol metabolism and increased infiltrating adipocyte density in high grade prostate cancer

Robotic surgery is gaining acceptance in the management of diverse urological disorders. Any minimally invasive procedure carries a risk of open conversion either for complications or unexpected intraoperative findings, but the additional dexterity of robotic instrumentation may allow even complex situations to be managed laparoscopically. We report the case of an upper tract transitional cell carcinoma discovered at the time of robotic nephroureterectomy to be invading the duodenum that was successfully excised robotically.

Robotic nephroureterectomy with partial duodenectomy for invasive ureteral tumor.

Rectus sheath hematoma (RSH) is uncommon and is often reported in the setting of anticoagulation or trauma. Typically RSH presents with localized or diffuse abdominal pain and a fixed abdominal wall mass, however, various presentations and complications have been reported depending on the setting and extent of the hematoma. We report a case of a rapidly expanding RSH causing obstructive anuria and hydronephrosis in addition to a review of literature on this rare presentation of RSH.

Pankaj P. Dangle

Papers

Stress urinary incontinence after male to female gender reassignment surgery: Successful use of a pubo-vaginal sling.

Testicular Hypoplasia Is Driven by Defective Vascular Formation.

314 active triacylglycerol metabolism and increased infiltrating adipocyte density in high grade prostate cancer

Robotic nephroureterectomy with partial duodenectomy for invasive ureteral tumor.

Obstructive uropathy secondary to rectus sheath hematoma.