BACKGROUND:Inflatable Penile Prosthesis (IPP) is the treatment for erectile dysfunction (ED) refractory to pharmacological therapies. Long-term data on factors associated with prosthesis survival remain unclear. This study aimed to analyze the long-term survival of penile prostheses and identify risk factors associated with survival without reintervention. METHODS:This is a retrospective, single-center study of patients who underwent IPP implantation between January 2014 and December 2022. Preoperative data related to the patient and the etiology of ED, as well as perioperative data, were collected. The primary outcome was survival without reintervention, defined as prosthesis revision or explantation due to mechanical dysfunction or infection. We conducted survival analyses without reintervention and searched for risk factors using a multivariate Cox model. RESULTS:In total, 33 out of 137 patients underwent reintervention (24.1%), including 24 (17.5%) prosthesis revisions and 9 (6.6%) had explantations. Median follow-up was 39 months with an interquartile range (IQR) of 9.00 to 62.00. Median survival without reintervention was 7 years. In univariate analysis, downsizing (p = 0.046) was associated with reintervention. Smoking (p = 0.003) and age (p = 0.034) were associated with prosthesis explantation. The number of implantations (p = 0.009) was associated with prosthesis revision. Multivariate analysis by the Cox model did not identify any independent predictive factors for reintervention. CONCLUSION:Smoking may play a role in infection post-IPP implantation. Primary implantations seem to be associated with better survival. Adjusting cylinder size, known as downsizing, is likely to be a proxy for the complexity of the procedure and thus linked to earlier reintervention.

Introduction: The average hospital length of stay after robotic-assisted partial nephrectomy (RAPN) is 3 days, with a current trend towards outpatient cases, although no population has been identified. The main objective of the study was to analyze the time to onset of post-operative complications, identify risk factors for significant early complications in order to define a population eligible for outpatient case. Material and method: The study included 3342 patients with clinically localized renal tumors who underwent RAPN surgery between 2010 and 2021. The primary endpoint was the occurrence of significant complications (SC) (Clavien Dindo > 2 [CD]). A CS-free survival analysis was performed. A multivariate logistic regression model was fitted to predict the risk of early significant complications (ESC) after RAPN. Results: The rates of total complications and SC were 14.99% and 3.59% respectively. Median time to SC was significantly longer at 3 days [3.9-5.7] versus 2 days [2.4-3] for total complications (P = 0.012). The majority of complications occurred within the first 72 h, and the risk factors for early SC (< 72 h) (ESC) were clamping time (P = 0.04) and ASA > 2 score (P = 0.007). Analysis of survival without ESC showed a significant impact of clamping time (P = 0.043) on complication-free survival. Conclusion: Using standard preoperative variables, we were able to determine that the only factor influencing the occurrence of postoperative ESC was ASA score > 2 and thus define it as a primary eligibility criterion for an indication of outpatient RAPN subject to a clamp time of less than 20 mins. (c) 2024 The Author(s). Published by Elsevier Masson SAS. This is an open access article under the CC BY license.

There is no holistic assessment of patient satisfaction with penile implants. The tools used are ill-adapted to the complexity of sexual disorders. The aim of our study was to assess patient satisfaction using a combined approach (sexological and validated questionnaire). Method : Our study included 13 patients undergoing penile implant surgery. A telephone interview combined with the "Satisfaction survey for inflatable penile implant" questionnaire enabled analysis of various satisfaction criteria. An analysis of mental associations with the prosthesis and a more specific sexological evaluation were also carried out. Results: This study found a median SSIPI score of 73/85, with 69% of patients using the implant more than once a week. We contrasted these results with a nuanced appropriation of the implant. Finally, 4 patients were no longer using the prosthesis after a median delay of 2.8 years, and sexological hypotheses for improving management were put forward in 3 out of 4 cases. Conclusion: Assessing patient satisfaction is difficult and subtle. Sexological analysis enables accurate assessment of patient satisfaction, and unmasks risk factors for dissatisfaction.

Background: Multiphoton microscopy (MPM) is a nonlinear optical imaging technology, allowing process-free imaging of fresh tissue up to a depth of 0.5 mm, with a combined signal of autofluorescence and second harmonic generation. The absence of bladder muscle in a transurethral resection of bladder tumor (TURBT) increases risk of residual disease, recurrence, and understaging, and an intraoperative assessment of resection depth and margins may avoid unnecessary second TURBTs. Objective: The objective of this study was to test the feasibility of MPM in the real-time detection of bladder muscle in cold cup biopsies of patients undergoing TURBT. Methods: This was a prospective feasibility study. Cold cup biopsies were taken intraoperatively from the resection bed during TURBT. Tissue was stored in phosphate buffered saline solution combined with fluorescent dyes (orange acridine and rhodamine). MPM imaging of the tissue was performed first, with z stack images of 100 µm maximum depth for 3D imaging. After MPM imaging, tissue was fixed in formalin and sent to the biorepository for standard histopathology. A descriptive analysis was performed between MPM tissue detection and final histopathology results. Results: Ten patients were included in this pilot study. Tissue was properly imaged for all patients, although 3 of them had artifacts, and we detected 5 times muscularis propria on MPM imaging. MPM average procedure time from biopsy to formalin fixation (MPM imaging) was 16.2 minutes (12-20 minutes). On final pathology, resection depth was correctly performed for only 4 patients of 10 (resection including bladder muscle). We found an 80% sensitivity on resection depth between first layer identified on MPM and final pathology (8/10 patients) and 100% correlation with final histopathology in specimens for the assessment of detrusor muscle. Conclusions: This study supports the use of MPM as a novel intraoperative tool which can evaluate cold cup biopsies during TURBT for resection depth and potentially avoid unnecessary second look procedure.

You have accessJournal of UrologySexual Function/Dysfunction: Surgical Therapy I (PD46)1 May 2024PD46-07 LONG-TERM COMPLICATIONS FREE SURVIVAL AND RISK FACTORS FOR REINTERVENTION AFTER PENILE PROSTHESIS IMPLANTATION Skander Zouari, Lionel Mendel, Flora Barthe, Arnoult Morrone, Paula Lorena Charry Gonima, Romain Haider, Younes Ahallal, Matthieu Durand, Daniel Chevallier, and Imad Bentellis Skander ZouariSkander Zouari , Lionel MendelLionel Mendel , Flora BartheFlora Barthe , Arnoult MorroneArnoult Morrone , Paula Lorena Charry GonimaPaula Lorena Charry Gonima , Romain HaiderRomain Haider , Younes AhallalYounes Ahallal , Matthieu DurandMatthieu Durand , Daniel ChevallierDaniel Chevallier , and Imad BentellisImad Bentellis View All Author Informationhttps://doi.org/10.1097/01.JU.0001008900.49567.2e.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Penile prosthesis implantation (PPI) is the treatment for erectile dysfunction (ED) refractory to pharmacological therapies. Long-term data on factors associated with prosthesis survival remains unclear. Our aim was to analyze the long-term complications free survival of penile prostheses and identify risk factors associated with complications free survival. METHODS: This is a retrospective, single-center study of patients who underwent PPI between January 2014 and December 2022. Preoperative data related to the patient and the etiology of ED, as well as perioperative data, were collected. The primary outcome was complications free survival. Complications were defined as prosthesis revision or explantation due to mechanical dysfunction or infection. We conducted survival analyses without reintervention and searched for risk factors using a multivariate Cox model. RESULTS: In total, 36 out of 137 patients had complications leading to reintervention (26.3%), including 24 (17.5%) prosthesis revisions and 9 (6.6%) explantations. Main characteristics of the study population are summarized in Table 1. The median survival without reintervention was 7 years (Figure 1-A). In univariate analysis, only downsizing (p=0.048) was associated with reintervention (Figure 1-B). The median complications free survival with downsizing was shorter (42 versus 84 months, p=0.028). Smoking (p=0.003) and age (p=0.034) were associated with prosthesis explantation. Number of implantation (p=0.009) was associated with prosthesis revision. Multivariate analysis by Cox model did not identify any independent predictive factors for reintervention (Figure 1-C). CONCLUSIONS: Smoking was the only risk factor for infection. Primary implantations were associated with better survival. These results are in accordance with the literature. Adjusting cylinder size, known as downsizing, is likely to be a proxy for the complexity of the procedure and thus linked to earlier reintervention. Download PPT Source of Funding: None © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e976 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Skander Zouari More articles by this author Lionel Mendel More articles by this author Flora Barthe More articles by this author Arnoult Morrone More articles by this author Paula Lorena Charry Gonima More articles by this author Romain Haider More articles by this author Younes Ahallal More articles by this author Matthieu Durand More articles by this author Daniel Chevallier More articles by this author Imad Bentellis More articles by this author Expand All Advertisement PDF downloadLoading ...

Introduction L’implantation de prothèses péniennes (IPP) est le traitement de référence de la dysfonction érectile (DE) résistante aux traitements de seconde ligne. Peu de données à long terme sont disponibles concernant les facteurs associés à la survie des prothèses. Notre objectif était d’analyser la survie à long terme des prothèses péniennes et rechercher les facteurs prédictifs impactant leur survie sans réintervention. Méthodes Il s’agit une étude rétrospective, monocentrique, des patients ayant eu une IPP, entre janvier 2014 et décembre 2022. Les données préopératoires liées au patient et à l’étiologie de la DE ainsi que les données peropératoires ont été recueillies. Le critère de jugement principal était la survie sans réintervention. Cette dernière était définie par la révision ou explantation de la prothèse pour dysfonction mécanique ou infection. Nous avons réalisé des analyses de survie sans réintervention ainsi qu’une recherche de facteurs prédictifs par modèle de Cox multivariée. Résultats Au total, 33 patients parmi 137 ont eu une réintervention (24,1 %) dont 24 (17,5 %) révisions de prothèse et 9 (6,6 %) explantations. Les caractéristiques de la population étudiée sont résumées dans la Figure 1. Le suivi médian était de 39 mois [9,00, 62,00] (Figure 2). La médiane de survie sans réintervention était de 7ans (Figure 3A). En analyse univariée, le downsizing (p=0,048) était associé à la réintervention (Figure 3B). La médiane de survie sans réintervention avec downsizing est plus courte (42 versus 84 mois p=0,028). Le tabagisme (p=0,003) et l’âge (p=0,034) étaient associés à une explantation de la prothèse. Le numéro d’épisode d’implantation (p=0,009) était associé à la révision de prothèse. L’analyse multivariée par modèle de Cox n’a retenu aucun facteur prédictif indépendant de réintervention (Figure 3C). Conclusion Le tabac était le seul facteur de risque d’infection après IPP. Les primo implantations sont associées à une meilleure survie sans révision. Ces résultats sont en accord avec la littérature. L’adaptation de la taille des cylindres de type downsizing est probablement un proxy de la complexité du geste et de ce fait lié à une réintervention plus précoce.

BACKGROUND: The aim of this study was to evaluate genomic risk of patients with persistent prostate specific antigen (PSA) using mRNA expression analysis and a validated prognostic genomic-risk classifier.METHODS: Monocentric retrospective study including all patients who underwent radical prostatectomy (RP) by one surgeon and Decipher Test from October 2013 to December 2018. PSA persistent population was defined as all patients with two consecutive PSA>0.1 ng/mL at follow-up after the surgery. Neurovascular Structure-adjacent Frozen-section Examination (NeuroSAFE) was performed intraoperatively for research of positive surgical margins. Multivariate analysis was performed for persistent PSA (pPSA) predictors. A specific localized, organ-confined, and negative margins sub-population with PSA persistence was compared to a similar sub-population without PSA persistence for genomic differential expression analyses.RESULTS: A total of 564 patients were included and 61 of them had pPSA. Preoperative PSA was higher in the PSA persistent group (11.6 [6.4, 21.2] vs. 6.2 [4.7, 9.2] P=0.00010), as well as PSA density (PSAd) (0.3 [0.2, 0.5] vs. 0.2 [0.1, 0.3] P=0.0001). Postoperative characteristics, Gleason Score, and positive surgical margins were significantly higher in the PSA persistent population. 31 patients had pPSA in our specific subpopulation and were compared to 217 patients with no pPSA. On multivariate analysis, only Decipher Score (OR=5.64 [1.28; 24.89], P=0.022) and preoperative PSA (OR=1.06, [1.02; 1.09], P=0.001) were significant predictors for PSA persistence. We found two genes to be significantly upregulated with a 2.5-fold change in our specific subpopulation (SERPINB11 and PDE11A).CONCLUSIONS: We found unique genomic features of patients with pPSA, whilst confirming previous clinical findings that this condition behaves to a worse prognosis. Given this high genomic risk, further imaging studies should be performed to select patients for early treatment intensification.

Background: Prediction of extracapsular extension (ECE) is essential to achieve a balance between oncologic resection and neural tissue preservation. Microultrasound (MUS) is an attractive alternative to multiparametric magnetic resonance imaging (mpMRI) in the staging scenario. Objective: To create a side-specific nomogram integrating clinicopathologic parameters and MUS findings to predict ipsilateral ECE and guide nerve sparing. Design, setting, and participants: Prospective data were collected from consecutive patients who underwent robotic-assisted radical prostatectomy from June 2021 to May 2022 and had preoperative MUS and mpMRI. A total of 391 patients and 612 lobes were included in the analysis. Outcome measurements and statistical analysis: ECE on surgical pathology was the primary outcome. Multivariate regression analyses were carried out to identify predictors for ECE. The resultant multivariable model's performance was visualized using the receiver-operating characteristic curve. A nomogram was developed based on the coefficients of the logit function for the MUS-based model. A decision curve analysis (DCA) was performed to assess clinical utility. Results and limitations: The areas under the receiver-operating characteristic curve (AUCs) of the MUS-based model were 81.4% and 80.9% (95% confidence interval [CI] 75.6, 84.6) after internal validation. The AUC of the mpMRI-model was also 80.9% (95% CI 77.2, 85.7). The DCA demonstrated the net clinical benefit of the MUS-based nomogram and its superiority compared with MUS and MRI alone for detecting ECE. Limitations of our study included its sample size and moderate inter-reader agreement. Conclusions: We developed a side-specific nomogram to predict ECE based on clinicopathologic variables and MUS findings. Its performance was comparable with that of a mpMRI-based model. External validation and prospective trials are required to corroborate our results. Patient summary: The integration of clinical parameters and microultrasound can predict extracapsular extension with similar results to models based on magnetic resonance imaging findings. This can be useful for tailoring the preservation of nerves during surgery.

The advent of modern diagnostic techniques and improved patient monitoring in the setting of clinical trials has led to an increased diagnosis of oligometastatic prostate cancer (OMPC), defined as three-to-five metastatic deposits in a single organ or multiple organs. OMPC is increasingly diagnosed in men who were in the past considered to have organ-confined disease. OMPC occurs at the transition between localized prostate cancer and widespread metastases. Our review evaluates the available evidence regarding robot-assisted cytoreductive prostatectomy feasibility and oncological outcomes in oligometastatic settings. We also consider the limitations and future directions for this approach. We performed a non-systematic PubMed and Google Scholar search. We screened pertinent studies published from 2014 up to May 2021. Our search identified 524 records. After excluding duplication, 54 full-text articles were identified and were screened for eligibility. We found nine papers (863 patients) that met the inclusion criteria for the review. The outcomes evaluated were 1-, 3-, and 5-year progression-free survival, cancer-specific and overall survival rates. Our review article demonstrates the feasibility and safety of Robot-assisted radical prostatectomy in patients with OMPC with proven oncological benefits. Prospective studies are ongoing and may provide further solid evidence.

Introduction. - The development of robot-assisted urological surgery is held back by the lack of robust medico-economic analyses and their heterogeneity. We conducted a medico-economic study to evaluate the implementation of measures to optimize the transition to robotic surgery. Method. - We carried out a single-center, controlled study from the point of view of the public healthcare establishment for 4 years. Economic data collection was based on a micro-costing method and revenues from stay-related groups. Clinical data corresponded to mean lengths of stay, operating duration, complications and stays in intensive care. The measures to optimize the transition to robotic, implemented mid-study period, enabled before/after comparison. Results. - Altogether, 668 patients undergoing robotic surgery were included. Robotic activity increased significantly from periods 1 to 2 to 256% (P = <0.001) as did the overall proportion of robotic by 45% to 85% (P = <0.001). The mean lengths of stay fell significantly, 6.8 d vs. 5.1 d (P < 0.001). Costs and revenues increased significantly, resulting in a persistent deficit for the activity (sic)226 K vs. (sic)382 K (P = <0.001). With increased volume of activity, the deficit per operation and the cost per minute of robotic operating room fell significantly, (sic)3,284 vs. euro1,474/procedure (P = <0.001) and (sic)27 vs (sic)24/min (P = <0.029), tending towards a break-even point (=zero deficit) at 430 operations per year. Conclusions. - Robotic-assisted surgery can be significantly optimized by implementing measures for the robotic turn to reach a break-even point at 430 operations per year. A better multidisciplinary case mix could lower the break-even volume of activity in short term. (C) 2021 The Author(s). Published by Elsevier Masson SAS.

AbstractIntroductionVarious surgical centers tend to postpone a kidney transplantation (KT) to the following morning than to operate at night‐time.The objective of our study was to assess whether there was any difference between daytime and night‐time renal transplantation in our institution.MethodThis study is a retrospective monocentric study including all the KTs that were performed between 2012 and 2013 by transplant expert surgeons in our institution. Clavien‐Dindo (CD) complications were classified according to 7 variables going from 1 to 5. Time before postgraft diuresis and delayed graft function (DGF) were also analyzed. Two groups of patients were formed according to threshold value of incision time (6.30 p.m.). Data comparison were performed using the Kruskal–Wallis nonparametric test.ResultsA total of 179 patients were included. Median follow‐up was 24 months. Cold ischemia time was longer in the night‐time transplantation (1082 vs. 807 min, p < .001), but rewarming time was shorter (47.24 vs. 52.15 min, p = .628). No statistically significant differences were observed between the two groups using the Kruskal–Wallis method for CD complications (Qobs: 0.076; p = .735). CD complications proportion was similar, with a majority of grade II complications (72.7% daytime group vs. 75.4% night‐time group (p = .735). DGF (19 patients for daytime group vs. 13 patients for night‐time group, p = .359) and time before postgraft diuresis (4.65 days daytime group vs. 5.27 days night‐time group, p = .422) were similar between both groups. Multivariate analysis did not show significant predictors of CD complications Grade 3 and more.ConclusionNight‐time renal transplantation did not induce more postoperative CD complications than diurnal procedures in our cohort, challenging the false preconceptions that allow surgical teams to delay this surgery.

Le délai moyen d'hospitalisation après une néphrectomie partielle assistée par robot (RAPN) est de 3 jours avec une tendance actuelle à la réalisation de cas ambulatoires sans qu'aucune population n'ait été identifiée. Nous avons réalisé une analyse descriptive du délai de survenue des complications postopératoires, identifié les facteurs de risque de survenue précoce et défini une population éligible à l'ambulatoire. L'étude a inclus 3342 patients présentant une tumeur rénale localisée, opérés d'une néphrectomie partielle robotisée (RAPN) entre 2010 et 2021. Le critère de jugement principal était la survie sans complications. Une analyse descriptive des complications postopératoire a été réalisée. L'analyse de la survie sans complication a été réalisée ainsi qu'une analyse multivariée par modèle de Cox. Un modèle de régression logistique multivarié a été ajusté pour prédire le risque de complications précoces après RAPN. Le taux de complications total était de 14,99 % et 3,59 % de complication majeure (CD > 2) (Fig. 1). L'analyse multivariée par modèle de Cox retrouvait la créatininémie (HR = 1,01 ; p < 0,001), le temps de clampage (HR = 1,02, p < 0,001), et les pertes sanguines (HR = 1, p < 0,001) comme facteurs influençant significativement la survie sans complication. Le délai moyen de survenue de complication majeure était significativement plus long avec 5,7 jours contre 3,43 jours pour les complications totales (p = 0,012). La majorité des complications survenait dans les 72 premières heures et les facteurs de risque de complication précoce (< 72 h) en l'absence de complication peropératoire en analyse multivariée par régression logistique étaient la créatininémie (OR = 1,01, [1,0 ; 1,01], p = 0,0355), la taille tumorale (OR = 1,16, [1,07 ; 1,26], p = 0,0002) et le score ECOG > 0 (OR = 1,48, [1,05 ; 2,08], p = 0,0253). L'étude a montré une incidence des complications bien inférieure à la littérature avec un délai moyen de survenue des complications supérieur au délai moyen d'hospitalisation. En utilisant les variables préopératoires standard, nous avons pu déterminer les facteurs influant le délai des complications postopératoires après RAPN et ainsi définir une population éligible à une indication de RAPN en ambulatoire.

OBJECTIVE To develop and validate a prediction model to predict the risk of adverse pathology outcome on final pathology in low-risk prostate cancer (PCa) men. MATERIALS AND METHODS This study was a monocentric retrospective analysis of 426 men who underwent radical prostatectomy (RP) for low-risk PCa. The validation cohort included 103 men from another hospital. Adverse pathology outcome was defined either by upgrading on RP Gleason Score (GS) (from GS 3+3 to GS >= 3+4 with Gleason pattern 4 >= 10%) or a non-organ confined disease (pathologic stage >= pT3a). Multivariable logistic regression analysis was performed to build nomogram for predicting adverse pathology outcome. Nomogram validation was performed by calculating the area under receiver operating characteristic curves (AUC) and comparing nomogram-predicted probabilities with actual rates of adverse pathology outcome in the external cohort. The Kaplan-Meier method was used to estimate and compare the biochemical recurrence-free survival rates between the two groups. RESULTS Of 426 men in the development cohort, 45.7% showed adverse pathology outcome on RP. Age, body mass index, prostate specific antigen density, history of prior negative biopsy, magnetic resonance imaging prostate imaging reporting and data system score 4-5 and percentage of positive biopsies were significant predictors in multivariate analysis. A nomogram was constructed with an area under curve of 87%. There was agreement between predicted and actual rates of adverse pathology outcome in the validation cohort. The 5-year biochemical recurrence-free survival rates in patients with and without adverse pathology outcome was 70% and 98%, respectively. CONCLUSION This novel nomogram would help identify low-risk PCa men at risk of adverse pathology outcome and can be relevant for treatment decision-making. (c) 2022 Elsevier Inc.

You have accessJournal of UrologyBladder Cancer: Non-invasive I (PD09)1 Sep 2021PD09-12 MULTIPHOTON MICROSCOPY: A NEW INTRA-OPERATIVE TOOL FOR TURBT DIAGNOSIS Patrick Julien Treacy, Matthieu Durand, Z. S. Dovey, I. Pavlova, J. Sfakianos, R. Mehrazin, U. G. Falagario, E. Wajswol, V. M. Padilla, Imad Bentellis, Flora Barthe, Daniel Chevallier, R. Cabal, J. Walz, N. Tzavaras, A. K. Tewari, and P. Wiklund Patrick Julien TreacyPatrick Julien Treacy More articles by this author , Matthieu DurandMatthieu Durand More articles by this author , Z. S. DoveyZ. S. Dovey More articles by this author , I. PavlovaI. Pavlova More articles by this author , J. SfakianosJ. Sfakianos More articles by this author , R. MehrazinR. Mehrazin More articles by this author , U. G. FalagarioU. G. Falagario More articles by this author , E. WajswolE. Wajswol More articles by this author , V. M. PadillaV. M. Padilla More articles by this author , Imad BentellisImad Bentellis More articles by this author , Flora BartheFlora Barthe More articles by this author , Daniel ChevallierDaniel Chevallier More articles by this author , R. CabalR. Cabal More articles by this author , J. WalzJ. Walz More articles by this author , N. TzavarasN. Tzavaras More articles by this author , A. K. TewariA. K. Tewari More articles by this author , and P. WiklundP. Wiklund More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000001977.12AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Test the capacity of multiphoton microscopy (MPM) in bladder Muscularis Propria (MP) detection of patients undergoing TURBT (Trans-Urethral Resection of Bladder Tumor), as a real-time imaging tool. METHODS: Prospective feasibility study, all patients were consented (IRB: GCO#14-0318/HSM14-0024). Cold cup biopsies were taken from the bladder resection bed during TURBT. Tissue was stored in PBS solution with fluorescent dyes (orange acridine and rhodamine). MPM Imaging of the tissue was done first, with z stack images for 3D imaging (Figure 1). Procedure time, MPM imaging depth, After MPM imaging, tissue was fixed in formalin and sent to biorepository for standard histopathology, and correlation analysis was performed. RESULTS: 10 patients were included (Table 1). Tissue was properly imaged for all patients, although 3 of them had artifacts, and we detected 5 times MP on MPM imaging. MPM average procedure time from biopsy to formalin fixation was 16.2 minutes (12-20 min). On final pathology, resection depth was correctly performed for only 4 patients out of 10 (resection including MP)( Figure 2). We found an 80 % sensitivity on resection depth between first layer identified on MPM and final pathology (8/10 patients), and 100% correlation with final histopathology in specimens for the assessment of MP. CONCLUSIONS: This study supports the use of MPM as a novel intra operative tool which can evaluate cold cup biopsies during TURBT for resection depth, and potentially avoid unnecessary second look procedure. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e124-e125 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Patrick Julien Treacy More articles by this author Matthieu Durand More articles by this author Z. S. Dovey More articles by this author I. Pavlova More articles by this author J. Sfakianos More articles by this author R. Mehrazin More articles by this author U. G. Falagario More articles by this author E. Wajswol More articles by this author V. M. Padilla More articles by this author Imad Bentellis More articles by this author Flora Barthe More articles by this author Daniel Chevallier More articles by this author R. Cabal More articles by this author J. Walz More articles by this author N. Tzavaras More articles by this author A. K. Tewari More articles by this author P. Wiklund More articles by this author Expand All Advertisement Loading ...

Faced with the first wave of Covid-19 pandemic, guidelines for surgical triage were developed to free up healthcare resources. The aim of our study was to assess clinical characteristics and surgical outcomes of triaged patients during the first Covid-19 crisis.We conducted a cohort-controlled, non-randomized, study in a University Hospital of south-eastern France. Data were collected prospectively from consecutive patients after triage during the period from March 15th to May 1st and compared with control data from outside pandemic period. Primary endpoint was intensive care unit (ICU) admissions for surgery-related complications. Rates of surgery-specific death, postponed operations, positive PCR testing and Clavien-Dindo complications and data from cancer and non- cancer subgroups were assessed.After triage, 96 of 142 elective surgeries were postponed. Altogether, 71 patients, median age 68 y.o (IQR: 56-75 y.o), sex ratio M/F of 4/1, had surgery, among whom, 48 (68%) had uro-oncological surgery. No patients developed Covid-19 pneumonia in the post-surgery period. Three (4%) were admitted to the ICU, one of whom died from multi-organ failure due to septic shock caused by klebsiella pneumonia following a delay in treatment. Three Covid-19 RT-PCR were done and all were negative. There was no difference in mortality rates or ICU admission rates between control and Covid- era patients.Surgery after triage during the first Covid-19 pandemic was not associated with worse short-term outcomes. Urological cancers could be operated on safely in our context but delays in care for aggressive genitourinary diseases could be life threatening.3.

Introduction. - Faced with the first wave of Covid-19 pandemic, guidelines for surgical triage were developed to free up healthcare resources. The aim of our study was to assess clinical characteristics and surgical outcomes of triaged patients during the first Covid-19 crisis. Method. - We conducted a cohort-controlled, non-randomized, study in a University Hospital of south-eastern France. Data were collected prospectively from consecutive patients after triage during the period from March 15th to May 1st and compared with control data from outside pandemic period. Primary endpoint was intensive care unit (ICU) admissions for surgery-related complications. Rates of surgery-specific death, postponed operations, positive PCR testing and Clavien-Dindo complications and data from cancer and non- cancer subgroups were assessed. Results. - After triage, 96 of 142 elective surgeries were postponed. Altogether, 71 patients, median age 68 y.o (IQR: 56-75 y.o), sex ratio M/F of 4/1, had surgery, among whom, 48 (68%) had uro-oncological surgery. No patients developed Covid-19 pneumonia in the post-surgery period. Three (4%) were admitted to the ICU, one of whom died from multi-organ failure due to septic shock caused by klebsiella pneumonia following a delay in treatment. Three Covid-19 RT-PCR were done and all were negative. There was no difference in mortality rates or ICU admission rates between control and Covid- era patients. Conclusions. - Surgery after triage during the first Covid-19 pandemic was not associated with worse short-term outcomes. Urological cancers could be operated on safely in our context but delays in care for aggressive genitourinary diseases could be life threatening. (C) 2021 Elsevier Masson SAS. All rights reserved.

You have accessJournal of UrologyImaging/Radiology: Uroradiology II (MP42)1 Apr 2020MP42-04 EX-VIVO REAL TIME IMAGING OF COLD CUP BIOPSIES AFTER TURBT AS AN INTRAOPERATIVE TOOL FOR RESECTION DEPTH DIAGNOSIS: A FEASIBILITY STUDY Patrick-Julien Treacy*, Matthieu Durand, Ina Pavlova, John P. Sfakianos, Reza Mehrazin, Ugo Giovanni Falagario, Ethan Wajswol, Flora Barthe, Nikos Tzavaras, Daniel Chevallier, Ashutosh K. Tewari, and Peter Wiklund Patrick-Julien Treacy*Patrick-Julien Treacy* More articles by this author , Matthieu DurandMatthieu Durand More articles by this author , Ina PavlovaIna Pavlova More articles by this author , John P. SfakianosJohn P. Sfakianos More articles by this author , Reza MehrazinReza Mehrazin More articles by this author , Ugo Giovanni FalagarioUgo Giovanni Falagario More articles by this author , Ethan WajswolEthan Wajswol More articles by this author , Flora BartheFlora Barthe More articles by this author , Nikos TzavarasNikos Tzavaras More articles by this author , Daniel ChevallierDaniel Chevallier More articles by this author , Ashutosh K. TewariAshutosh K. Tewari More articles by this author , and Peter WiklundPeter Wiklund More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000891.04AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Multiphoton microscopy (MPM) is a non-linear optical imaging technology, allow a process-free imaging of fresh tissue up to a depth of 0.5 mm, with a combined signal of autofluorescence (AF) and second harmonic generation (SHG). The absence of bladder muscle in a Trans-Urethral Resection of Bladder Tumor (TURBT) increases risk of residual disease, recurrence and understaging, and there is a need for intra-operative diagnosis of resection depth in order to avoid for unnecessary 2nd look TURBT. The objective of the study was to evaluate the detection rate of bladder muscle and residual tumor cells on a cold cup biopsy of a resected bladder wall, after TURBT, using the MPM as a real-time imaging. METHODS: Cold cup biopsies were taken intra-operatively, in final part of procedure, directly after TURBT. Tissue was stored in PBS solution combined with fluorescent dyes (orange acridine and rhodamine). MPM Imaging of the tissue was first done, with z stack images of 100 micrometer depth for 3D imaging. After imaging, tissue was fixed in formalin and sent to biorepository for standard histopathology comparison. RESULTS: 9 patients were included in this feasibility study. MPM allowed to show nuclear atypia of the carcinoma cells, elastin fibers (AF, green channel), collagen fibers (SHG, blue channel) of the lamina propria, and the large bundles of regularly oriented muscle fibers, later confirmed by H and E staining histopathology. There was an 88.8% accuracy on resection depth (8/9 patients), with 6 patients having a resection not including bladder muscle after histology results. MPM average procedure time from biopsy to formalin fixation was 16.2 minutes (12-20 min). Presence of tumor cells on Multiphoton images were confirmed with final pathology showing positive surgical margins on 1 patient (Figure 1A). CONCLUSIONS: MPM could be an interesting intra operative tool in order to evaluate both depth and margins of a TURBT, in order to avoid for unnecessary 2nd look procedure in case of resection not including bladder muscle. Source of Funding: None © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e604-e604 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Patrick-Julien Treacy* More articles by this author Matthieu Durand More articles by this author Ina Pavlova More articles by this author John P. Sfakianos More articles by this author Reza Mehrazin More articles by this author Ugo Giovanni Falagario More articles by this author Ethan Wajswol More articles by this author Flora Barthe More articles by this author Nikos Tzavaras More articles by this author Daniel Chevallier More articles by this author Ashutosh K. Tewari More articles by this author Peter Wiklund More articles by this author Expand All Advertisement PDF downloadLoading ...

L’objectif de cette vidéo était de montrer l’intérêt de la fluorescence proche infrarouge au vert d’indocyanine (Système de visualisation Firefly) dans le repérage anatomique de la voie excrétrice du greffon pour anastomose urétéro-urétérale cœlioscopiquebot-assistée au robot Da Vinci Xi dans le cadre de la prise en charge des reflux vésico-urétérale après transplantation rénale. La patient âgée de 71 ans présentait un reflux vésico-urétéral à 10 ans post-opératoire d’une transplanation rénale de donneur en état de mort encéphalique. e premier temps opératoire consiste en la mise en place d’une sonde urétérale par voie endoscopique. es principales étapes de la réimplantation ont été : la dissection de l’uretère natif ipsilatéral puis l’injection d’une solution contenant 2 mg/mL de vert d’indocyanine diluée dans du sérum glucosé à5 % avec activation du mode Firefly permettant d’obtenir une fluorescence urétérale du greffon. eci permet une dissection élective de la voie excrétrice du greffon. a dernière étape consiste en l’anastomose urétéro-urétérale termino-terminale après spatulation et mise en place d’une sonde double J. L’injection per-opératoire par une sonde urétérale de vert d’indocyanine a permis la fluorescence, par utilisation du système Firefly, de l’ensemble de la voie excretrice supérieure du greffon. Cet outil a facilité ainsi le repérage et la dissection des différentes structures anatomiques. Le temps opératoire était de 1h45. La reprise de la diurèse s’est faite à J0 avec une créatininémie de sortie à 105micromol/L. La patiente est sortie à J 7. Il n’y a eu aucune complication en per- et post-opératoire. Il n’y a pas eu de fistule urinaire, de sténose ou de récidive du reflux. L’utilisation de la fluorescence proche infrarouge au vert d’indocyanine avec le système Firefly du robot Da Vinci Xi a permis de repérer aisément l’uretère du greffon et de faciliter sa dissection pour la réimplantation urétérale par coelioscopie robot-assistée pour traitement d’un reflux vésicourétéral à 10 ans d’une transplantation rénale. Cette technique est également utilisée dans notre centre pour l’ensemble des chirurgies urétérales sur greffon.

La microscopie multiphotonique (MMP) permet l’analyse quantitative du collagène entourant les cellules cancéreuses grâce au signal de deuxième génération harmonique (SHG) (Fig. 1). Decipher est un test génétique de score prédictif métastatique. L’objectif était de mesurer le pourcentage de fibres de collagène de lames histologiques de biopsies prostatiques cancéreuses grâce au MMP et les mettre en corrélation avec le Gleason Group Grade (GGG) et le Decipher Score. L’imagerie MMP des lames de biopsies prostatiques cancéreuses était réalisée sur des patients ayant eu une prostatectomie radicale et un test Decipher. Cinq à 10 images de 0,5 par 0,5 mm par lame étaient réalisées, et le pourcentage moyen de collagène était mesuré en divisant les pixels de l’image acquise par SHG par les pixels de l’image complète, en utilisant le logiciel ImageJ (Fig. 2). Le pourcentage de collagène était analysé pour chacun des 5 GGG et en fonction du score Decipher. Un test de corrélation de Spearman entre le score de Decipher et le pourcentage de collagène était également réalisé. Trente et un patients étaient sélectionnés, 22 patients avec le test Decipher. Le pourcentage moyen de collagène était plus élevé à mesure que le GGG augmentait (p = 0,026, Tableau 1). L’ensemble des patients avec un score Decipher élevé avaient un pourcentage de collagène plus élevé (23,35 % vs. 21,9 % [17,35–30] pour la population risque intermédiaire et 17,8 % [11,6–24] pour la population faible risque Decipher, p = 0,006) et la population GGG 1 avec un risque Decipher élevé avait une augmentation du pourcentage de collagène par rapport à la même population GGG1 avec un score Decipher faible (24 % [21–31,50] vs. 17,5 % [14,5–23], p = 0,01). La corrélation de Spearman entre le score Decipher et le pourcentage de collagène était significative dans la population GGG 1-2 regroupée (Spearman's rho = 0,3204, p = 0,0009). Le pourcentage de collagène augmente avec le score de Gleason et le score de risque Decipher. L’imagerie MPM des biopsies de la prostate peut être un outil complémentaire intéressant dans la prise en charge thérapeutique des populations GGG 1 et 2. Une étude de corrélation du score de Gleason entre deux uropathologistes sur les images MMP est en cours.