Background and objectivesVesicovaginal fistula (VVF) is a devastating condition for female patients. We aimed to summarize our experience in the management of VVF and the surgical outcomes at our center and propose an algorithm for clinical practice.Materials and methodsWe conducted a retrospective study of patients with VVF who underwent surgical treatment at our center between January 2013 and December 2024. All patients were classified into non-irradiated and irradiated groups. Medical data were analyzed, including patient demographics, fistula characteristics, vaginal width, surgical procedures, surgical outcomes, and perioperative complications.ResultsWe included 64 patients with VVF (20 non-irradiated and 44 irradiated). The fistula size in the irradiated group was mostly > 1.5 cm, whereas the size was <1.5 cm in the non-irradiated group. The vaginal width was > 3 cm in the fistula repair group, whereas it was < 3 cm in the urinary diversion group. For the non-irradiated group, we all performed fistula repair surgery, while only 47.7% in the irradiated group, where the remaining underwent urinary diversion (29.5%) or fistula repair + urinary diversion (22.7%). The irradiated group had a higher fistula recurrence rate than the non-irradiated group in both transvaginal (18.5% vs. 6.25%) and transabdominal (50% vs. 0%) approaches.ConclusionWe proposed an algorithm for the surgical management of VVFs based on radiation history, fistula size (>3 cm), and vaginal width (<3 cm). We suggest that transvaginal approach is the first option for fistula repair. For irradiated VVFs, transvaginal fistula repair with tissue interposition combined with permanent cystostomy demonstrated high success in our series, which is a valuable method.

Urethral stricture, a fibrotic condition causing lumen narrowing, lacks effective pharmacological treatments, with autologous grafts facing donor-site limitations. Tissue engineering strategies, particularly anisotropic hydrogels, offer promising alternatives but remain unexplored in urethral repair. Here, we developed a multifunctional anisotropic polyvinyl alcohol/tannic acid (APVA/TA) hydrogel via mechanical training and hydrogen-bond crosslinking for urethral reconstruction. The APVA/TA hydrogel exhibited enhanced crystallinity, mechanical strength, and anti-swelling properties, with TA conferring potent antioxidant and broad-spectrum antibacterial activity. In vitro, TA suppressed LPS-induced inflammatory responses, while the anisotropic structure synergistically promoted endothelial cell migration and angiogenesis. In a rabbit urethral stricture model, the APVA/TA2.5 hydrogel significantly reduced stricture recurrence (12.6% obstruction rate) and facilitated improved repair through enhanced epithelial regeneration (pan-CK), vascularization (CD31), and smooth muscle regeneration (α-SMA). This study demonstrates the dual role of anisotropic structure and TA in enabling functional urethral reconstruction, providing a novel tissue-engineered solution for stricture management.

Detrusor underactivity (DU) is a prevalent bladder dysfunction for which effective treatment is lacking. A series of studies have shown that the 5-HT2A receptor is involved in the regulation of micturition, but its role in DU remains unknown. Besides, transient receptor potential vanilloid 4 (TRPV4) agonist has been demonstrated to improve bladder function in BPNI rats by increasing afferent signals and the 5-HT/5-HT2A receptor are functionally associated with TRPV4 in several pathophysiological processes. In the current study, we established a bilateral pelvic nerve injury (BPNI) model. Tissue staining and cystometry were performed and the results showed that the BPNI model exhibited DU in both histological and urodynamic manifestations. Intrathecal injection of the 5-HT2A receptor agonist TCB2 could facilitate the micturition reflex in BPNI rats, reducing intercontraction interval (ICI), residual volume (RV), and bladder capacity (BC), which could be reversed by the TRPV4 antagonist HC-067047. Western blot and immunofluorescence analyses revealed there was no significant difference in the expression of the 5-HT2A receptor in the L6-S1 dorsal root ganglia (DRG) and spinal dorsal horn between sham-operated and BPNI rats, whereas the expression of TRPV4 was significantly decreased in BPNI rats. Calcium imaging of DRG neurons showed an increased calcium influx induced by TCB2, which was blocked by HC-067047. These findings suggest that the 5-HT2A receptor agonist can improve bladder dysfunction in BPNI rats by regulating the micturition reflex via TRPV4. The 5-HT2A receptor may be a potential therapeutic target for the treatment of DU.

Background Penoscrotal Paget's disease (PPD) is a rare malignant skin tumor, and consensus on reconstruction, treatment strategies, and prognosis remains elusive. We aimed to elucidate the clinical features, surgical outcomes, and prognosis, proposing a tailored Perineal Reconstruction (PR) strategy. Methods We conducted a retrospective cohort study using pathologically confirmed 233 PPD cases from a large tertiary hospital pathology registry between May 2004 and February 2021. Clinical features, surgical treatment patterns, sexual function, and prognosis were analyzed. Kaplan-Meier analysis, univariate and multivariate Cox regression were performed to identify prognostic factors. Results PR strategy-based reconstruction was applied on all postsurgical defects. Kaplan-Meier analysis indicated worse disease free-survival (DFS) in the high-PR score (≥4) group compared to the low-PR score (≤3) group. Age, tumor thickness, and lymph node invasion emerged as independent predictors of overall survival (OS). Conclusions Early evaluation and intervention are crucial to prevent vertical and lymph node invasion. Wide local excision provides low recurrence, high overall survival rates, and acceptable sexual function. The PR strategy serves as a promising approach to assess lesions, guide reconstruction, and predict prognosis, potentially improving treatment and management of this rare malignancy.

Venous thromboembolism (VTE) is a serious complication in patients undergoing brain tumor surgery, particularly those requiring neurological intensive care unit (NICU) monitoring. Risk factors for VTE vary among tumor types, and effective early warning tools remain scarce. This study aimed to develop a nomogram-based clinical prediction model to identify independent risk factors for postoperative VTE in brain tumor patients. A total of 400 NICU patients (aged 18–82 years; mean age 52.5 ± 15.6 years; 46.5

The nasty urine microenvironment (UME) impedes neourethral regeneration by inhibiting angiogenesis and inducing an excessive inflammatory response. Cellular adaptation to hypoxia improves regeneration in numerous tissues. In this study, heterogeneous porous hypoxia-mimicking scaffolds were fabricated for urethral reconstruction via promoting angiogenesis and modulating the inflammatory response based on sustained release of dimethyloxalylglycine (DMOG) to promote HIF-1α stabilization. Such scaffolds exhibit a two-layered structure: a dense layer composed of electrospun poly (l-lactic acid) (PLLA) nanofibrous mats and a loose layer composed of a porous gelatin matrix incorporated with DMOG-loaded mesoporous silica nanoparticles (DMSNs) and coated with poly(glycerol sebacate) (PGS). The modification of PGS could significantly increase rupture elongation, making the composite scaffolds more suitable for urethral tissue regeneration. Additionally, sustained release of DMOG from the scaffold facilitates proliferation, migration, tube formation, and angiogenetic gene expression in human umbilical vein endothelial cells (HUVECs), as well as stimulates M2 macrophage polarization and its regulation of HUVECs migration and smooth muscle cell (SMCs) contractile phenotype. These effects were downstream of the stabilization of HIF-1α in HUVECs and macrophages under hypoxia-mimicking conditions. Furthermore, the scaffold achieved better urethral reconstruction in a rabbit urethral stricture model, including an unobstructed urethra with a larger urethral diameter, increased regeneration of urothelial cells, SMCs, and neovascularization. Our results indicate that heterogeneous porous hypoxia-mimicking scaffolds could promote urethral reconstruction via facilitating angiogenesis and modulating inflammatory response.

BACKGROUND:Nuclear receptor subfamily 5 group A member 1 (NR5A1) plays pivotal roles in steroidogenesis and gonadal development. 46, XY disorder of sexual development (DSD) caused by NR5A1 mutations is a rare genetic condition. This study aimed to provide a comprehensive analysis of the clinical characteristics and molecular defects observed in 19 Chinese patients with NR5A1 variants, including assessing the deleterious effects of novel variants in vitro and evaluating their functional impact on the gonad and adrenal glands in vivo. MATERIALS AND METHODS:Subjects with NR5A1 variants were identified from 223 Chinese 46, XY DSD patients via next-generation sequencing. In-silico analysis and functional assays were performed to evaluate the transcriptional activity, expression levels and nuclear localization of novel NR5A1 variants. The histological structure of the gonads was evaluated via immunohistochemistry (IHC). RESULTS:Patients with NR5A1 gene variants presented with serious conditions, including micropenis, cryptorchidism, azoospermia, and radiological abnormalities of the spleen. Five novel NR5A1 variants were identified, including heterozygous p.Y5*, p.Q42E and p.L359_L363del, as well as copy number variation (CNV) of chr9:127213317-127570245_del and an exon 6 duplication. A total of 63.2% (12/19) of patients harbored additional variants other than NR5A1. Defective transcriptional regulatory activities and abnormal protein expression levels were observed in NR5A1 variants. The reduced levels of DHEA-S and 11-oxygenated steroids indicate a mild impairment in adrenal function among certain patients. The IHC analysis of the testis revealed intact expression levels of SOX9 in Sertoli cells, while significant differences were observed in the expression pattern of CYP17A1 in Leydig cells among patients. The preserved maturation of adult Leydig cells in the patients may trigger spontaneous puberty. CONCLUSIONS:Patients with NR5A1 mutations exhibit complex phenotypes. The observed clinical heterogeneity may be attributed to oligogenic mutations, dysregulated Leydig cell function, as well as the impaired ability to modulate the transcription of target genes.

OBJECTIVE:To describe the potential effects of Intracranial pressure monitoring on the outcome of patients with spontaneous intracerebral hemorrhage (ICH). METHODS:This study is a systematic review with meta-analysis. Patients with spontaneous ICH treated with intracranial pressure monitoring were included. The primary outcome was mortality at 6 months and in-hospital mortality. The secondary outcome was poor neurological function outcome at 6 months. RESULTS:This analysis compares in-hospital and 6-month mortality rates between patients with intracranial pressure monitoring (ICPm) and those without (no ICPm). Although the ICPm group had a lower in-hospital mortality rate, it was not statistically significant (24.9% vs. 34.1%; OR 0.51, 95% CI 0.20 to 1.31, P = 0.16). Excluding patients with intraventricular hemorrhage revealed a significant reduction in in-hospital mortality for the ICPm group (23.5% vs. 43%; OR 0.39, 95% CI 0.29 to 0.53, P < 0.00001). For 6-month mortality, the ICPm group showed a significant reduction (32% vs. 39.6%; OR 0.76, 95% CI 0.61 to 0.94, P = 0.01), with the effect being more pronounced after excluding intraventricular hemorrhage patients (29.1% vs. 47.2%; OR 0.45, 95% CI 0.34 to 0.60, P < 0.0001). However, there were no statistically significant differences in 6-month functional outcomes between the groups. Increased ICP was associated with higher 3-month mortality (OR 1.12, 95% CI 1.07 to 1.18, P < 0.00001) and lower likelihood of good functional outcomes (OR 1.11, 95% CI 1.04 to 1.18, P < 0.00001). CONCLUSIONS:Elevated ICP is associated with increased mortality and poor prognosis in ICH patients. Although continuous intracranial pressure monitoring may reduce short-term mortality rates in specific subgroups of ICH patients, it does not improve neurological functional outcomes. While potential patient populations may benefit from ICP monitoring, more research is needed to screen suitable populations for ICP monitoring.

OBJECTIVE:To investigate the clinical effect of pulsed thulium laser (PTL) combined with triamcinolone acetonide injection in the treatment of failed posterior urethral anastomosis (FPUA). METHODS:This retrospective study included 35 male patients treated in Gongli Hospital for failed posterior urethral anastomosis from January 2018 to December 2023. All the patients underwent direct-vision internal urethrotomy (DVIU) with transurethral PTL (the PTL group, n = 15) or transurethral plasma (the TUP group, n = 20), and all received intralesional injection of triamcinolone acetonide. We followed up the patients for a median of 21 months, recorded the age, length of urethral stricture, operation time, pre- and post-operative maximum urinary flow rate (Qmax), postoperative complications and recurrence of urethral stricture, and compared the data obtained between the two groups. RESULTS:All the patients smoothly completed the treatment procedures. No statistically significant differences were observed in the age, length of urethral stricture, operation time and postoperative complications between the two groups (P > 0.05). The median follow-up time for the thulium laser group and plasma group was 21.0 months (IQR 16.0－24.0) and 21.0 months (IQR 17.0－25.0), respectively, with a statistically significant difference observed in the maximum urine flow rate before and after surgery at the 12-month mark (P < 0.01). No significant disparity was found in terms of relapse-free survival between the two groups (P = 0.398) Conclusion: Pulsed thulium laser combined with triamcinolone acetonide injection can effectively maintain a short-term cicatricial stability of the urethral stricture and satisfactory urethral patency, obviously superior to plasmotomy as a remedial treatment of urethral stricture after failed posterior urethral anastomosis.

ObjectiveThe current study sought to clarify the role of lysozyme-regulated gut microbiota and explored the potential therapeutic effects of lysozyme on ileum injury induced by severe traumatic brain injury (sTBI) and bacterial pneumonia in vivo and in vitro experiments.MethodsMale 6–8-week-old specific pathogen-free (SPF) C57BL/6 mice were randomly divided into Normal group (N), Sham group (S), sTBI group (T), sTBI + or Lysozyme-treated group (L), Normal + Lysozyme group (NL) and Sham group + Lysozyme group (SL). At the day 7 after establishment of the model, mice were anesthetized and the samples were collected. The microbiota in lungs and fresh contents of the ileocecum were analyzed. Lungs and distal ileum were used to detect the degree of injury. The number of Paneth cells and the expression level of lysozyme were assessed. The bacterial translocation was determined. Intestinal organoids culture and co-coculture system was used to test whether lysozyme remodels the intestinal barrier through the gut microbiota.ResultsAfter oral administration of lysozyme, the intestinal microbiota is rebalanced, the composition of lung microbiota is restored, and translocation of intestinal bacteria is mitigated. Lysozyme administration reinstates lysozyme expression in Paneth cells, thereby reducing intestinal permeability, pathological score, apoptosis rate, and inflammation levels. The gut microbiota, including Oscillospira, Ruminococcus, Alistipes, Butyricicoccus, and Lactobacillus, play a crucial role in regulating and improving intestinal barrier damage and modulating Paneth cells in lysozyme-treated mice. A co-culture system comprising intestinal organoids and brain-derived proteins (BP), which demonstrated that the BP effectively downregulated the expression of lysozyme in intestinal organoids. However, supplementation of lysozyme to this co-culture system failed to restore its expression in intestinal organoids.ConclusionThe present study unveiled a virtuous cycle whereby oral administration of lysozyme restores Paneth cell’s function, mitigates intestinal injury and bacterial translocation through the remodeling of gut microbiota.

The precise determination of surgical margins is essential for the management of multifocal cutaneous cancers, including extramammary Paget’s disease. This study introduces a novel strategy for precise margin identification in such tumors, employing multichannel autofluorescence lifetime decay (MALD), fluorescence lifetime imaging microscopy (FLIM), and machine learning, including confidence learning algorithms. Using FLIM, 51 unstained frozen sections were analyzed, of which 13 (25%) sections, containing 5003 FLIM patches, were used for training the residual network model (ResNet–FLIM). The remaining 38 (75%) sections, including 16 918 patches, were retained for external validation. Application of confidence learning with deep learning reduced the reliance on extensive pathologist annotation. Refined labels obtained by ResNet–FLIM were then incorporated into a support vector machine (SVM) model, which utilized fiber-optic-based MALD data. Both models exhibited substantial agreement with the pathological assessments. Of the 35 MALD-measured tissue segments, six (17%) segments were selected as the training dataset, including 900 decay profiles. The remaining 29 segments (83%), including 2406 decay profiles, were reserved for external validation. The ResNet–FLIM model achieved 100% sensitivity and specificity. The SVM–MALD model demonstrated 94% sensitivity and 83% specificity. Notably, fiber-optic-MALD allows assessing 12 sites per patient and delivering predictions within 10 min. Variations in the necessary safe margin length were observed among patients, highlighting the necessity for patient-specific approaches to determine surgical margins. This innovative approach holds potential for wide clinical application, providing a rapid and accurate margin evaluation method that significantly reduces a pathologist’s workload and improves patient outcomes through personalized medicine.

You have accessJournal of UrologyReconstruction: External Genitalia and Urotrauma (including transgender surgery and traumatic fistula) I (PD31)1 May 2024PD31-09 SURGICAL STRATEGY AND OUTCOMES OF PENOSCROTAL PAGET's DISEASE: A LARGE RETROSPECTIVE COHORT STUDY IN A CHINESE TERTIARY CENTER Xiang Wan, Bin Xu, and Haijun Yao Xiang WanXiang Wan , Bin XuBin Xu , and Haijun YaoHaijun Yao View All Author Informationhttps://doi.org/10.1097/01.JU.0001009432.48553.4f.09AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Penoscrotal Paget's disease is a rare malignant skin tumor, and consensus on assessment, reconstruction, treatment strategies, and prognosis remains elusive. We aimed to elucidate the clinical features, surgical outcomes, and prognosis, proposing a tailored Perineal Reconstruction (PR) strategy. METHODS: We conducted a retrospective cohort study using pathologically confirmed penoscrotal Paget's disease cases from a large tertiary hospital pathology registry between May 2004 and February 2021. Clinical features, surgical treatment patterns, sexual function, and prognosis were analyzed. The PR strategy was proposed to assess the lesion and guide surgery. Kaplan-Meier analysis, univariate and multivariate Cox regression were performed to identify prognostic factors. RESULTS: In total, 233 penoscrotal Paget's disease patients were included. The median age was 71 years, with a median diagnostic delay of 28 months. Most patients presented with large defects, thin tumors, and erythematous plaques. Of the patients, 233 underwent frozen biopsy-guided wide local excision, and 17 received lymph node dissection. Additionally, 16 patients required re-excision with positive margins. PR strategy-based reconstruction was applied on all postsurgical defects. The median follow-up was 67 months. No significant difference in preoperative and postoperative overall satisfaction was found. Kaplan-Meier analysis indicated worse disease free-survival (DFS) in the high-PR score (≥ 4) group compared to the low-PR score (≤ 3) group. Age, tumor thickness, and lymph node invasion emerged as independent predictors of OS. CONCLUSIONS: Early evaluation and intervention are crucial to prevent vertical and lymph node invasion. Wide local excision provides low recurrence, high overall survival rates, and acceptable sexual function. The PR strategy serves as a promising approach to assess lesions, guide reconstruction, and predict prognosis, potentially improving treatment and management of this rare malignancy. Download PPTDownload PPT Source of Funding: The manuscript was supported by the Project of Biobank of Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine (YBKB202119); Medical Research Foundation of Shanghai Science and Technology Commission (20Y11904300); Clinical Research Foundation of Shanghai Municipal Health Commission (202040437); National Natural Science Foundation of China (82200745) © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e633 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Xiang Wan More articles by this author Bin Xu More articles by this author Haijun Yao More articles by this author Expand All Advertisement PDF downloadLoading ...

Objective: How to choose the appropriate antibiotics and dosage has always been a difficult issue during the treatment of multi-drug-resistant bacterial infections. Our study aims to resolve this difficulty by introducing our multi-disciplinary treatment (MDT) clinical decision-making scheme based on rigorous interpretation of antibiotic susceptibility tests and precise therapeutic drug monitoring (TDM)-guided dosage adjustment.Method: The treatment course of an elderly patient who developed a multi-drug-resistant Pseudomonas aeruginosa (MDRPA) bloodstream infection from a brain abscess was presented.Results: In the treatment process, ceftazidime-avibactam (CAZ-AVI) was used empirically for treating the infection and clinical symptoms improved. However, the follow-up bacterial susceptibility test showed that the bacteria were resistant to CAZ-AVI. Considering the low fault tolerance of clinical therapy, the treatment was switched to a 1 mg/kg maintenance dose of susceptible polymyxin B, and TDM showed that the AUC(24h, ss) of 65.5 mgh/L had been achieved. However, clinical symptoms were not improved after 6 days of treatment. Facing the complicated situation, the cooperation of physicians, clinical pharmacologists, and microbiologists was applied, and the treatment finally succeeded with the pathogen eradicated when polymyxin B dose was increased to 1.4 mg/kg, with the AUC(24h, ss) of 98.6 mgh/L.Conclusion: MDT collaboration on the premise of scientific and standardized drug management is helpful for the recovery process in patients. The empirical judgment of doctors, the medication recommendations from experts in the field of TDM and pharmacokinetics/pharmacodynamics, and the drug susceptibility results provided by the clinical microbiology laboratory all provide the direction of treatment.

You have accessJournal of UrologyCME1 Apr 2023PD12-08 A NOVEL THERAPEUTIC STRATEGY FOR THE MANAGEMENT OF PENOSCROTAL PAGET'S DISEASE Xiang Wan, Zhong Wang, Bin Xu, and Haijun Yao Xiang WanXiang Wan More articles by this author , Zhong WangZhong Wang More articles by this author , Bin XuBin Xu More articles by this author , and Haijun YaoHaijun Yao More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003259.08AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Penoscrotal Paget’s disease is a rare type of intraepithelial adenocarcinoma. Postsurgical reconstruction is a major challenge for surgeons. In this study, we evaluated the surgical outcomes after reconstruction surgery in patients with penoscrotal Paget's disease and proposed a novel strategy. METHODS: In this study, patients with penoscrotal Paget's disease who were referred to Shanghai Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine between May 2004 and February 2021, were included. We proposed a three-step Perineal Reconstruction (PR) strategy to describe the location and extent of the defect and provide a reconstructive surgical method. Accordingly, all the postsurgical defects were reconstructed based on our strategy. The clinical data and outcomes during the follow-up were recorded and analyzed. RESULTS: Patients were 42–91 years old with a diagnostic delay of 2–201 months. Further, most patients had large defects, thin tumors, and erythematous plaques. All patients underwent frozen biopsy-guided wide local excision and lymph node biopsy or dissection. Further, 16 patients underwent re-excision with positive margins. According to the PR strategy, 54, 41, 58, and 80 of the patients underwent primary closure, skin grafting, flap coverage, or skin grafting combined with flap coverage, respectively. Three patients underwent multimodal treatment. The results showed no obvious difference between preoperative and postoperative sexual satisfaction. The follow-up time ranged from 9 to 210 months. Further, 3 patients died from metastasis and 10 patients died from other cancers, natural death, or other reasons. CONCLUSIONS: Wide local excision achieves a relatively low recurrence rate and preserves sexual function in patients with penoscrotal Paget's disease. The PR strategy is a promising method to assess defects and guide reconstruction. Source of Funding: The manuscript was supported by the Project of Biobank of Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine (YBKB202119); Medical Research Foundation of Shanghai Science and Technology Commission (20Y11904300); Clinical Research Foundation of Shanghai Municipal Health Commission (202040437); Cross Research Fund of Medicine and Engineering of Shanghai 9th People's Hospital, Shanghai Jiao Tong University, School of Medicine (JYJC201912). © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e403 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Xiang Wan More articles by this author Zhong Wang More articles by this author Bin Xu More articles by this author Haijun Yao More articles by this author Expand All Advertisement PDF downloadLoading ...

Long-segment lichen sclerosus (LS) urethral stricture is a challenge for urologists. Limited data are available for surgeons to make a surgical decision between Kulkarni and Asopa urethroplasty. In this retrospective study, we investigated the outcomes of these two procedures in patients with LS urethral stricture. Between January 2015 and December 2020, 77 patients with LS urethral stricture underwent Kulkarni and Asopa procedures for urethroplasty in the Department of Urology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine (Shanghai, China). Of the 77 patients, 42 (54.5%) underwent the Asopa procedure and 35 (45.5%) underwent the Kulkarni procedure. The overall complication rate was 34.2% in the Kulkarni group and 19.0% in the Asopa group, and no difference was observed ( P = 0.105). Among the complications, no statistical difference was observed in the incidence of urethral stricture recurrence ( P = 0.724) or glans dehiscence ( P = 0.246) except for postoperative meatus stenosis ( P = 0.020). However, the recurrence-free survival rate between the two procedures was significantly different ( P = 0.016). Cox survival analysis showed that antiplatelet/anticoagulant therapy use ( P = 0.020), diabetes ( P = 0.003), current/former smoking ( P = 0.019), coronary heart disease ( P < 0.001), and stricture length ( P = 0.028) may lead to a higher hazard ratio of complications. Even so, these two techniques can still provide acceptable results with their own advantages in the surgical treatment of LS urethral strictures. The surgical alternative should be considered comprehensively according to the patient characteristics and surgeon preferences. Moreover, our results showed that antiplatelet/anticoagulant therapy use, diabetes, coronary heart disease, current/former smoking, and stricture length may be contributing factors of complications. Therefore, patients with LS are advised to undergo early interventions for better therapeutic effects.

ObjectiveThe objective of this study was to investigate potential correlations between skull density and the progression of chronic subdural hematoma (CSDH).MethodsPatients with unilateral CSDH were retrospectively enrolled between January 2018 and December 2022. Demographic and clinical characteristics, as well as hematoma and skull density (Hounsfield unit, Hu), were collected and analyzed.ResultsThe study enrolled 830 patients with unilateral CSDH until the resolution of the CDSH or progressed with surgical treatment. Of the total, 488 patients (58.80%) necessitated surgical treatment. The study identified a significant correlation between the progression of CSDH and three variables: minimum skull density (MiSD), maximum skull density (MaSD), and skull density difference (SDD) (p < 0.001). Additionally, in the multivariable regression analysis, MiSD, MaSD, and SDD were independent predictors of CSDH progression. The MiSD + SDD model exhibited an accuracy of 0.88, as determined by the area under the receiver operating characteristic curve, with a sensitivity of 0.77 and specificity of 0.88. The model’s accuracy was validated through additional analysis.ConclusionThe findings suggest a significant correlation between skull density and the CSDH progression.

You have accessJournal of UrologyCME1 Apr 2023MP33-09 GLANSECTOMY AND NEOGLANS RECONSTRUCTION USING SPLIT-THICKNESS SKIN GRAFT / ACELLULAR DERMAL MATRIX FOR PENILE CANCER Haijun Yao, Dachao Zheng, Jianshu Ni, Xiang Wan, and Zhong Wang Haijun YaoHaijun Yao More articles by this author , Dachao ZhengDachao Zheng More articles by this author , Jianshu NiJianshu Ni More articles by this author , Xiang WanXiang Wan More articles by this author , and Zhong WangZhong Wang More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003266.09AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Penectomy as the traditional surgical treatment of penile cancer has substantial adverse functional and psychological impact. Organ-sparing surgery is recommended in selected penile cancer patients.Glansectomy and Neoglans reconstruction aims to provide curative resection while maximizing functional outcomes and minimizing psychological harm.To show the efficacy and safety of glansectomy and neoglans reconstruction using split-thickness skin graft (STSG) and Acellular Dermal Matrix (ADM). METHODS: Using our prospectively derived database, we identified 25 patients with penile squamous-cell carcinoma involving the glans, who were treated using glansectomy and neoglans reconstruction between March 2015 and December 2021. All the patients underwent total glansectomy and reconstruction of a new glans, of whom 18 (82%) with STSG and 7 with ADM. Deep spongiosal biopsies are taken to exclude invasion as a standard practice. The glans is excised and a neoglans is created using STSG/ADM. These 25 patients represent the subject of our study (mean age 57 years, range 45 to 71 years). RESULTS: 92% of patients (23/25) reported to be fully satisfied with the postoperative aesthetic appearance. The apex of corpora cavernosa was transected in 5 cases due to local invasion. Positive surgical margins were no detected in all the cases. 2 patients (8%) experienced local recurrence during the follow-up period. 4 patients had early partial loss of the graft (STSG 2 vs ADM 2). Two late complications occurred with urethral meatus stricture. CONCLUSIONS: Glansectomy and Neoglans reconstruction using STSG/ADM comprise a safe procedure in terms of oncologic control and complications for patients with penile cancer confined to the glans. Further studies are required to assess functional and sexual outcomes in these patients.The overall satisfaction rate and recovery of the sexual function are acceptable, and it can be considered an ideal procedure to treat superficial penile cancer. Source of Funding: The Project of Biobank (No. YBKB202119) from Shanghai 9th People's Hospital,Shanghai Jiao Tong University,School of Medicine © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e453 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Haijun Yao More articles by this author Dachao Zheng More articles by this author Jianshu Ni More articles by this author Xiang Wan More articles by this author Zhong Wang More articles by this author Expand All Advertisement PDF downloadLoading ...

Patients with brain injuries are at a heightened susceptibility to bacterial pneumonia, and the timely initiation of empiric antibiotic treatment has been shown to substantially reduce mortality rates. Nevertheless, there is a need for knowledge regarding the resistance and prevalence of pulmonary bacterial infections in this patient population. To address this gap, a retrospective study was conducted at a neurosurgical emergency center, focusing on patients with brain injuries. Among the entire patient population, a total of 739 individuals (18.23%) were identified as having bacterial pneumonia, consisting of 1489 strains of Gram-negative bacteria and 205 strains of Gram-positive bacteria. The resistance of Klebsiella pneumoniae to imipenem exhibited a significant increase, rising from 21.74% in 2009 to 96.67% in 2018, and subsequently reaching 48.47% in 2021. Acinetobacter baumannii displayed resistance rates exceeding 80.0% against multiple antibiotics. The resistance profile of Pseudomonas aeruginosa was relatively low. The proportion of Staphylococcus aureus reached its peak at 18.70% in 2016, but experienced a decline to 7.83% in 2021. The abundance of Gram-negative bacteria exceeded that of Gram-positive bacteria by a factor of 5.96. Klebsiella pneumoniae, Acinetobacter baumannii, and Staphylococcus aureus are prominent pathogens characterized by limited antibiotic choices and scarce treatment alternatives for the isolated strains.

Ischemic stroke often leads to permanent neurological impairments, largely due to limited neuroplasticity in adult central nervous system. Here, we first showed that the expression of Sonic Hedgehog (Shh) in corticospinal neurons (CSNs) peaked at the 2nd postnatal week, when corticospinal synaptogenesis occurs. Overexpression of Shh in adult CSNs did not affect motor functions and had borderline effects on promoting the recovery of skilled locomotion following ischemic stroke. In contrast, CSNs-specific Shh overexpression significantly enhanced the efficacy of rehabilitative training, resulting in robust axonal sprouting and synaptogenesis of corticospinal axons into the denervated spinal cord, along with significantly improved behavioral outcomes. Mechanistically, combinatory treatment led to additional mTOR activation in CSNs when compared to that evoked by rehabilitative training alone. Taken together, our study unveiled a role of Shh, a morphogen involved in early development, in enhancing neuroplasticity, which significantly improved the outcomes of rehabilitative training. These results thus provide novel insights into the design of combinatory treatment for stroke and traumatic central nervous system injuries.

OBJECTIVES:Carbapenem-resistant Klebsiella pneumoniae (CRKP) pose an emerging clinical threat. We investigated its introduction and transmission in a new hospital, evaluating the effect of whole-genome sequencing (WGS) as an infection control measure. METHODS:Based on WGS of identified K. pneumoniae (Kpn) strains, a prospective molecular epidemiological study of nosocomial transmission of CRKP in a newly established Chinese hospital was conducted. RESULTS:Between September 2018 and August 2020, 206 Kpn strains were isolated, including 180 CRKP, from 152 patients. The first imported and nosocomial transmission cases were recorded in December 2018 and April 2019, respectively. Overall, 22 nosocomial transmission clusters involving 85 patients were identified, among which 5 were large-size clusters comprising 5-18 patients. Index cases of the large-size clusters were more likely associated with lower Glasgow Coma Scale scores than those of small-size clusters. Furthermore, results of multivariable logistic regression indicated that Kpn tended to transmit more among patients in the ICU [adjusted odds ratio (aOR) = 4.96, 95% confidence interval (CI) 1.97-13.47] and those infected with a ST11 strain (aOR = 8.04, 95% CI 2.51-29.53) or tetracycline-resistant strains (aOR = 17.63, 95% CI 6.32-57.32). However, transmission was less likely in strains bearing the rmpA gene (aOR = 0.12, 95% CI 0.03-0.37). The rate of nosocomial CRKP cases decreased by 2.25 with the intervention of WGS-based infection control. CONCLUSIONS:Kpn transmission in the newly established hospital originated from several imported cases. Rates of nosocomial CRKP infection were reduced considerably through precise infection control measures.