Purpose: This review compared outcomes and complications of dorsal plication (DP) and ventral lengthening (VL). Materials and methods: We included English-language studies (2000–2023) reporting outcomes of DP or VL in hypospadias with chordee. Eligible designs were cohort, retrospective, and case reports with extractable complication or outcome data. Searches were performed in PubMed/MEDLINE, Cochrane Library, Web of Science, and Google Scholar using the terms DP, VL, hypospadias, chordee/penile curvature, and complication/outcome/success rate with the last update in December 2023. Two reviewers independently assessed risk of bias using the Newcastle–Ottawa Scale. Due to heterogeneity, results were synthesized narratively and tabulated. Results: Seven studies involving 537 patients were included. VL demonstrated lower recurrence of ventral curvature (9.4%) compared with DP (27.9%), with success rates up to 97.7%. Both techniques were associated with complications including fistula, diverticulum, stricture, and dehiscence, though recurrence was more frequent after DP. Study quality was limited by small sample sizes, retrospective designs, and inconsistent reporting of functional outcomes. Conclusion: VL may offer advantages in terms of lower recurrence rates and fewer complications compared with DP; however, high-quality prospective studies with standardized outcome reporting and long-term follow-up are required to confirm these findings.
Purpose: In Taiwan and other Asian countries, the role of focal cryoablation for prostate cancer remains underexplored. While cryoablation is recognized as a minimally invasive treatment, data on its long-term outcomes, especially in patients with higher-risk or locally advanced disease, have been scarce. Materials and methods: We reviewed 34 men treated with primary focal cryoablation at our institution between 2008 and 2020. Clinical characteristics, prostate-specific antigen kinetics, oncological outcomes, functional results, and complications were analyzed. Potency and continence were assessed by patient report and validated questionnaires. Results: After a median follow-up of more than 11 years, biochemical recurrence (BCR) was observed in 21 patients (61.7%). Five-year BCR-free survival differed markedly by risk groups: 77.8% in low-risk disease, 48.5% in intermediate-risk disease, and 0% in high-risk disease. Despite the high BCR rates, 10-year cancer-specific and overall survival were excellent (100%), largely due to timely salvage therapies. Functional outcomes were encouraging. Nearly 80% of men who were potent before treatment retained erectile function, and continence was preserved in all patients. Complications were minor and manageable. Conclusion: Our long-term experience suggests that focal cryoablation can maintain good urinary and sexual function while providing reasonable cancer control in selected patients with low- to intermediate-risk disease. However, the unsatisfactory outcomes in high-risk patients highlight the need for careful selection and integration with other treatment strategies.
Purpose: This study aimed to identify clinical and psychosocial factors associated with caregiver and patient acceptance of clean intermittent catheterization (CIC) in pediatric patients with spina bifida, with a specific focus on gender-related disparities in an Asian population. Materials and methods: We conducted a retrospective review of 72 pediatric patients (35 boys and 37 girls) with spina bifida evaluated for CIC initiation at a single Japanese center between 2011 and 2024. Data on caregiver consent and transition to self-catheterization were collected. Multivariate logistic regression was used to assess the impact of demographic and clinical variables on CIC acceptance. Results: Caregiver consent for CIC was obtained in 73.6% of cases. Girls were significantly more likely to receive caregiver consent (89.1%) than boys (57.1%, P = 0.0038), and more likely to achieve self-catheterization (83.8% vs. 42.8%, P < 0.001). Female sex independently predicted higher odds of both caregiver consent (OR = 5.14; P = 0.0205) and patient self-consent (OR = 5.58; P = 0.0101). A history of follow-up interruption was also a strong negative predictor. Other factors, such as wheelchair use, cognitive disability, and residential location, were not significantly associated. Conclusion: This study is the first to quantitatively demonstrate gender-based disparities in CIC acceptance among Asian pediatric patients with spina bifida. Our findings suggest that boys encounter greater psychosocial barriers to CIC, likely influenced by family dynamics and cultural norms. Targeted, gender-sensitive education and continuous caregiver support are essential for improving CIC uptake and adherence in this population.
Purpose: Laparoendoscopic single-site donor nephrectomy (LESSDN) is a well-accepted technique in renal transplantation, yet data on the retroperitoneal (RP) approach are sparse. We compared LESSDN outcomes via transperitoneal (TP) and RP approaches against conventional laparoscopic donor nephrectomy (CLDN). Materials and methods: This retrospective study evaluated patients undergoing CLDN, LESSDN-TP, and LESSDN-RP from May 2002 to April 2023, analyzing donor characteristics, perioperative outcomes, complications categorized by the Clavien-Dindo classification, and cosmetic outcomes using a body image questionnaire (BIQ), as well as donor renal function. We also assessed recipient outcomes for one year. All comparisons were unadjusted and exploratory. Results: Of the 36 laparoscopic donor nephrectomies, 13 were CLDN, 10 were LESSDN-TP, and 13 were LESSDN-RP. The median operative time of LESSDN-RP (180 minutes) was shorter than that of LESSDN-TP (245 minutes) and CLDN (260 minutes). Median warm ischemia times were shorter for LESSDN-TP (3.1 minutes) and LESSDN-RP (2.8 minutes) than for CLDN (4.3 minutes). LESSDN-RP patients had the shortest hospital stays (median 4 days). Half of the LESSDN-TP cases required an extra port. Median incision lengths for LESSDN-TP (6.0 cm) and LESSDN-RP (7.0 cm) were shorter than CLDN (10.0 cm). Pain scores were similar on postoperative day 3. No significant differences were found in complication rates, cosmetic outcomes, or recipient results across the three approaches. Conclusion: In this small retrospective cohort, LESSDN-RP was associated with shorter operative time, warm ischemia time, and hospital stay than CLDN. Larger adjusted studies are needed to confirm these associations.
