INTRODUCTION:We examined the pathology and safety outcomes associated with the extent of pelvic lymph node dissection in patients with high-risk prostate cancer undergoing radical prostatectomy. MATERIALS AND METHODS:We retrospectively identified men with prostate cancer who underwent robot-assisted radical prostatectomy with pelvic lymph node dissection between May 2016 and September 2021. Cases were categorized using Current Procedural Terminology (CPT) codes (38571) for extended lymph node dissection and super-extended lymph node dissection (38572). Using logistic regression, we compared the groups on a number of factors, including recurrence. RESULTS:Super-extended lymph node dissection had significantly higher median prostate-specific antigen and National Comprehensive Cancer Network risk classification prior to surgery. Significant differences were observed in the pathologic T stage and pathology grade group. Time on robot was significantly longer for the super-extended group, while estimated blood loss was lower. No differences were observed in length of stay or any complication-related variable. Super-extended had significantly higher node positivity (36.1% vs. 7.6%, p < 0.001) and recurrence. 10.0% of super-extended cases had node positivity in the aortic bifurcation, the common iliac, or the pre-sacral chains that would have been missed with an extended dissection. 2.2% of patients had node positivity in these chains only. CONCLUSIONS:Super-extended lymph node dissection is safe and feasible for patients with high-risk prostate cancer. Further research is needed to better understand its clinical benefit and to further inform optimal patient selection.

Introduction The quality of Transurethral resection of bladder tumor (TURBT) procedures is associated with risk stratification and determines a recurrence risk for patients with bladder cancer. One element of a high-quality TURBT is the presence of detrusor muscle (DM) in specimens. Unfortunately, there are currently no adjunct tools available to urologists to determine intraoperatively whether the resected specimen contains DM.;;Consequently, urologists typically rely on a combination of cystoscopic appearance and resection-based experience judgment to assess if TURBT specimens contain DM. In this proof-of-concept study, we sought to determine if multi-spectral autofluoresence imaging (MS-AFI) can detect DM in near real-time from freshly resected bladder specimens and used intraoperatively for the determination of depth of resection during TURBT. The underlying rationale is that multispectral images can provide a snapshot of the various endogenous tissue fluorophores and, when combined with advanced machine learning, can capture intrinsic biomolecular and morphological differences for DM identification. Methods Fresh tissue specimens were imaged in a suite adjacent to the operating theater following tissue excision during TURBT. To maintain tissue integrity and preserve the routine clinical workflow, no chemicals or other processing steps were applied. After imaging, the tissue specimens underwent formalin fixation and routine tissue processing for histopathologic comparison. The corresponding Hematoxylin and Eosin (H&E) slides of the imaged tissue specimens were digitized and digitally annotated by two pathologists. The original H&E image of the tissue specimen was geometrically transformed to spatially register with the multispectral images acquired for the same specimen, and “tiles” of 1 mm x 1mm were identified from the annotated areas consisting of homogeneous DM and other diverse tissue types and transcribed onto the multispectral images. We performed this preliminary assessment of our multispectral imaging system AURORA™ on 544 tiles (class balance DM+ / DM-; 119/425);from 158 tissue specimens obtained from 91 patients. Results The results from the proof-of-concept study on the tiles using leave-one-patient-out cross-validation provide promising levels of performance in detecting DM with an accuracy of 89.0%, sensitivity of 79.8%, specificity of 91.5%, and a negative predictive value of 94.2%. We used the trained classifier to create a heat map at the full specimen level. The heat maps in Figure 1 display the probability (0%: blue, 80%: red) of DM-presence generated using the classifier trained as reported above. Example representative heatmaps in Figure 1A and 1C show the presence and absence of DM on the tissue specimens respectively and spatially correlate well with the corresponding H&E images of histologically confirmed tissue blocks containing DM (Fig 1B) and devoid of DM (Figure 1D). Conclusions We have developed and tested an autofluorescence-based intraoperative imaging modality featuring multispectral excitation and emission wavelength bands to identify DM in TURBT specimens. This preclinical research study demonstrates that our device is suitable for the detection of DM in freshly excised bladder specimens with good accuracy. The availability of an intraoperative tool to ensure adequate depth of resection could enable surgeons to perform higher quality tumor resections. Additionally, improving quality of initial TURBT procedures could reduce the need for re-TURBTs, and have a positive impact on lowering tumor recurrence. Further clinical studies are needed to validate the clinical application and merit of this device.

The identification of detrusor muscle (DM) in bladder specimens is crucial for the successful TURBT procedure. This study conducted on 103 patients demonstrates the potential of multispectral imaging in accurately identifying DM during surgery.

Minocycline-induced hyperpigmentation of tissues has been documented previously, but extensive cardiovascular involvement is rarely described in literature. We report a case of marked cardiovascular hyperpigmentation resulting from approximately 4 years of minocycline exposure. We will highlight how intraoperative differentiation of minocycline-induced hyperpigmentation from more sinister causes of discoloration led to the appropriate surgical management. (C) 2017 by The Society of Thoracic Surgeons

International Journal of UrologyVolume 21, Issue 6 p. 622-623 Letter to the Editor Angiosarcoma of the corpora cavernosa Fernando Abarzua-Cabezas M.D., Fernando Abarzua-Cabezas M.D. [email protected] Urology Division, Hartford Healthcare Medical Group, Hartford, Connecticut, USASearch for more papers by this authorJonathan Earle M.D., Jonathan Earle M.D. Urology Division, Hartford Healthcare Medical Group, Hartford, Connecticut, USASearch for more papers by this authorAnoop Meraney M.D., Anoop Meraney M.D. Urology Division, Hartford Healthcare Medical Group, Hartford, Connecticut, USASearch for more papers by this author Fernando Abarzua-Cabezas M.D., Fernando Abarzua-Cabezas M.D. [email protected] Urology Division, Hartford Healthcare Medical Group, Hartford, Connecticut, USASearch for more papers by this authorJonathan Earle M.D., Jonathan Earle M.D. Urology Division, Hartford Healthcare Medical Group, Hartford, Connecticut, USASearch for more papers by this authorAnoop Meraney M.D., Anoop Meraney M.D. Urology Division, Hartford Healthcare Medical Group, Hartford, Connecticut, USASearch for more papers by this author First published: 09 January 2014 https://doi.org/10.1111/iju.12385Citations: 3Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL No abstract is available for this article.Citing Literature Volume21, Issue6June 2014Pages 622-623 RelatedInformation