OBJECTIVE(S):Minimally invasive procedures are well established for patients with sialolithiasis involving single stones. For patients with multiple sialolithiasis, few data are available regarding the treatment approaches and outcomes with gland-preserving therapies. The aim of this study was to review current treatment concepts and postinterventional outcomes in these patients and to propose a treatment algorithm. STUDY DESIGN:Retrospective study. SETTING:University hospital and tertiary referral center. METHODS:The study was conducted to evaluate therapeutic effectiveness and outcome in patients who presented with multiple sialolithiasis in the major salivary glands between January 2016 and October 2022. All patients received minimally invasive treatment following established treatment algorithms. RESULTS:In 177 patients with multiple sialolithiasis, 556 stones were treated using a minimally invasive treatment regimen, with a mean of 2.55 interventions per patient. Monomodal therapy was carried out in 54.8% of the patients and multimodal therapy in 45.2%. Stone-free and/or symptom-free status was achieved for all patients with stones in the submandibular glands and for 97.6% of those with stones in the parotid glands. Gland preservation was possible in 97.2% of the patients, with no significant differences between the submandibular glands (97.8%) and parotid glands (95.2%; P = .371). CONCLUSION:Multiple sialolithiasis can be treated with high success rates. In nearly half of the patients, a multimodal minimally invasive treatment regimen is needed in order to achieve stone-free and/or symptom-free status and preservation of the gland-both possible in over 97% of cases.

There is a gap in real-world clinical adoption of machine learning (ML) solutions due to the inherent uncertainty and variability in treatment outcomes. To bridge this gap, we present a novel approach to the problem of medical treatment selection using ML models and we apply it to the case of submandibular sialolithiasis treatment. The study introduces a weakly supervised learning framework which allows for the inclusion of imprecise, incomplete, or noisy ground truth data. By applying this methodology to the specific medical problem of submandibular stone treatment, we demonstrate the potential of encoding treatment outcomes as credal sets—collections of probability distributions reflecting the uncertain nature of the optimal treatment—to improve surgical planning and decision-making. We validated our model using real-world patient data, showcasing its ability to offer personalized treatment recommendations based on radiological features of submandibular stones. Our study underscores the importance of incorporating proper uncertainty management into ML for clinical practice to support clinical decision-making, by showing a promising solution to improve the treatment of sialolithiasis.

BACKGROUND/OBJECTIVE:Tumor progression and first recurrence (TPR) after curative treatment for olfactory neuroblastoma can be regarded as primary treatment failure. Prognostic parameters for TPR and primary tumor-progression-free and recurrence-free survival (TPRFS) have not been sufficiently investigated in the literature. METHODS:Data for 43 patients were analyzed retrospectively to evaluate prognostic parameters for TPR after curative treatment for olfactory neuroblastoma: age, age < / ≥ 50 years, sex, tumor classifications, curative therapy (monotherapy vs. combined, R0 vs. R1/2/x resection), Hyams-grade (grades, grade I-II/III-IV), and Ki-67 labeling index (values, labeling index < / ≥ 10%). The primary endpoints were TPR and TPRFS. Parameters that were significant after univariate analysis and Kaplan-Meier survival analysis were included in multiple regression and Cox regression analysis. RESULTS:After univariate analysis, younger age (p = 0.032) and higher Ki-67 values (p = 0.001) were significantly negatively associated with time to the development of TPR. TPRFS according to Kaplan-Meier was significantly poorer with Hyams-grade III-IV (p = 0.002) and Ki-67 ≥ 10% (p = 0.001). After Cox regression analysis, TPRFS according to Kaplan-Meier was weekly significantly poorer for younger age (p = 0.033) and highly significantly worse for Hyams-grade III-IV (p = 0.005) and a Ki-67 LI ≥ 10% (p = 0.009). Tumor-stage classifications and all therapeutical parameters were not significantly associated with TPRFS. CONCLUSIONS:Out of a panel of parameters tested, younger age, Hyams-grade III-IV, and a Ki-67 LI ≥ 10% were significantly associated with a significantly worse TPRFS after multivariate Cox regression analysis. In particular, parameters such as Hyams-grade and the Ki-67 LI should be included in management considerations in olfactory neuroblastoma at an early stage. LEVEL OF EVIDENCE: 3:

In der Notaufnahme stellte sich ein 18-jähriger Patient mit rechtsseitiger Otorrhoe, Hörminderung und retroaurikulären, ausstrahlenden Schmerzen vor. Die zunehmenden Kopfschmerzen seien Anlass für die HNO-ärztliche Vorstellung gewesen. Leichter Schwindel und Tinnitus seien ebenfalls neu aufgetreten. Die Beschwerden bestünden seit 4 Wochen. Bei einer akuten Pansinusitis mit orbitaler Komplikation war 2 Jahre zuvor eine Nasennebenhöhlenoperation mit Septumkorrektur durchgeführt worden. Außerdem leide der Patient an Morbus Crohn (MC) und Psoriasis vulgaris, sei aber unter Therapie mit Adalimumab 40mg (alle 3 Wochen seit 5 Jahren) aktuell in klinischer Remission und habe dahingehend keinerlei Beschwerden.

AIM:This study aimed to assess and compare the performance of nomograms and machine learning (ML) techniques using preoperative biomarkers for predicting side-specific extraprostatic extension (EPE) in prostate cancer, which is linked to poor outcomes and early recurrence. Accurate preoperative prediction can guide clinical decisions and improve treatment. MATERIALS AND METHODS:A retrospective analysis was conducted using data from 108 prostate cancer patients undergoing radical prostatectomy. Clinical, imaging, and genomic data were collected, including PSA density, ISUP biopsy grade, fraction of positive biopsy cores, 68Ga-PSMA-11 PET, MRI, and Decipher Genomic Classifier (DGC) scores. Predictive models were built using logistic regression (LR) and extreme gradient boosting (XGBoost) algorithms, incorporating different combinations of these inputs. Model performance was evaluated using area under the ROC curve (AUC). RESULTS:The median patient age was 61.5 years. XGBoost outperformed LR across most biomarker combinations. PET+DGC models had the highest AUC (0.85 for XGBoost), followed by PET+MRI + DGC (0.83). XGBoost consistently achieved higher AUCs than LR, particularly for DGC and combined input models. PET-only predictions were stronger than those based solely on MRI or genomics, but multi-modal combinations significantly enhanced prediction accuracy. CONCLUSION:This is the first study to integrate PSMA-PET, MRI, and genomics in ML-based nomogram models for side-specific EPE prediction. XGBoost models demonstrated superior predictive power, especially when combining PET and DGC. These findings highlight the potential of a multi-biomarker, machine learning approach to improve preoperative risk stratification and support personalized treatment planning. Further studies will validate this model in larger cohorts.

OBJECTIVE To evaluate the outcomes of robot-assisted tubularized peritoneal vaginoplasty (RATPV) for trans-feminine patients desiring genital gender-affirming surgery (gGAS). METHODS We retrospectively reviewed all patients (adults >= 18 years old) who underwent RATPV for gGAS at our institution (July 2020-July 2022). Initial technique involved anastomosing the peritoneal flap to the introitus. The updated technique anastomosed the flap intraperitoneally to inverted penile shaft skin. Patient demographics, intraoperative details, and postoperative outcomes are described. RESULTS In 33 patients, the median age was 26 years old (IQR:24-37) and BMI 26 (IQR:23-32). Median operative time was 406 minutes (IQR: 370-434) and robotic console time 177 minutes (IQR:154-220). Intraoperatively, the median vaginal depth was 17 cm and diameter 3 +cm. Median length of stay was 7 days. One-third (n = 11) of patients had a complication within 30 days postoperatively (40% Clavien Dindo I and 60% Clavien II). No patient had a Clavien III+ complication. At a median follow-up of 499 days (range: 137-835), some degree of vaginal stenosis occurred in 48% (11/23) of patients with the original approach versus 10% (1/10) of those with the newer approach (P = .05). Median vaginal depth was 11.3 cm. Three patients (9%) required revision vaginoplasty, all of whom had the original approach and had difficulty dilating postoperatively. All had clitoral sensation. CONCLUSION RATPV is a safe and effective option for individuals seeking gender-affirming vaginoplasty that obviates the need for laser hair removal prior to surgery. More research is needed into long-term outcomes of this technique. UROLOGY 195: 191-198, 2025. (c) 2024 Elsevier Inc. All rights are reserved, including those for text and data mining, AI training, and similar technologies.

The aim of this study was to analyze thyroglossal duct cyst carcinoma (TDCC) in a single-center retrospective analysis, supplemented by a systematic literature review to inform treatment approaches. Patient records from a tertiary referral center were analyzed for individuals diagnosed with TDCC between 2002 and 2023. A systematic review followed the PRISMA guidelines, encompassing studies from Medline and PubMed. Patient data, including demographics, imaging results, and histological findings were extracted. The primary outcome assessed was tumor-free and recurrence-free survival, while additional variables included treatment regimens and follow-up data. The analysis identified a total of 484 TDCC cases, confirming papillary thyroid carcinoma (PTC) as the predominant type (94.2%), with synchronous thyroid gland carcinomas observed in 34.6%. The age range was 8 to 76 with median age of 40 years. Women were affected in 62%, men in 36%. The recurrence rate was 7.4%, with distant metastases observed in 1% of cases. The overall survival rate was 99.1%, regardless of the treatment regimen. Although rare, TDCC predominantly presents as PTC, with a favorable prognosis. Sistrunk's procedure remains the primary surgical approach, but optimal management regarding therapies such as total thyroidectomy, neck dissection, or radioiodine ablation requires careful evaluation of risk factors like rare tumor types, suspicious lymph nodes, thyroid nodules, age, radiation exposure, and molecular patterns. Emphasizing more individualized treatment strategies, we propose an algorithm that can help to reduce invasiveness and overtreatment risks in selected cases.

Tumors of the parotid gland are rare and predominantly benign. The surgical management is challenging due to the close anatomical relationship to the facial nerve. Pleomorphic adenoma and cystadenolymphoma are among the most frequently occurring lesions. The surgical approach depends on the location, size and suspected diagnosis of the lesion. While radical surgical techniques were favored in the past, current practice emphasizes reducing surgical morbidity through less invasive resection methods. In this context, extracapsular dissection offers functional advantages over more extensive resections, with similarly low recurrence rates. Complications such as facial nerve palsy, salivary fistulas and Frey's syndrome occur less frequently with milder severity and are generally well-treatable, for example, with botulinum toxin. In selected cases, such as confirmed bilateral cystadenolymphoma, a conservative wait-and-scan approach may be considered as an alternative to surgery. The goal remains the complete resection of the lesion with maximum preservation of function.

Objectives: Since the peri- and intraoperative management of patients with inflammatory and obstructive sialadenitis (IOS) differs significantly between treating centers worldwide, we investigated whether these patients can be treated successfully, resource-savingly and with high patient satisfaction using minimally invasive procedures under local anesthesia (LA). Methods: We developed a comprehensive, stratified routine anesthesia and pain management protocol based on our proposed classification of invasiveness (grade 1–4), for almost all available IOS treatment procedures. We included 377 patients with 470 LA-conducted interventions in our study and evaluated their perceptions during and after the treatment. Results: The protocol was applied to all 377 study participants for all 470 interventions. The mean grade of invasiveness was 2.49 ± 1.31, with a mean procedure duration of 30 ± 20 min. We found a significant positive association between invasiveness levels and procedure duration (p = 0.001) or pain directly after surgery (p = 0.004). Patients rated the procedures as ”well acceptable” or better in a large majority (88.1–97%) regarding the administration and potency of LA, procedure duration, and pain during and directly after surgery. In total, 96.4% of patients would have the treatment repeated under the same conditions. Conclusions: The proposed anesthesia and pain management regimen, respecting invasiveness levels, enables IOS patients to undergo treatment under LA with high success rates, serving as a potential guide for performing physicians.

Introduction Conventional treatments for localized prostate cancer (PCa) are effective but can leave men with significant functional impairment. In selected patients, ablative therapies are positioned as a safer alternative to radiation therapy or radical prostatectomy (RP), although the establishment of ablative therapies in the standard of care awaits level one evidence. Historically, randomized controlled trials (RCTs) in this setting have struggled or even failed to recruit due to poor patient acceptance of randomization. Here, we report the design of a RCT comparing TULSA (MRI-guided transurethral ultrasound ablation of the prostate) against RP. Based on TULSA safety and efficacy data from the 115-patient TACT pivotal study and accumulating real-world evidence, CAPTAIN was designed to test a superiority hypothesis for safety, and non-inferiority for efficacy. Strategies to mitigate the risk of failure to recruit include a 2:1 TULSA:RP allocation strategy, peer-to-peer education, and expansion into additional sites and sub-sites. Methods The CAPTAIN study (NCT05027477) is a multi-center, open-label, randomized controlled trial that will enroll 201 patients with organ-confined, NCCN intermediate-risk GG 2/3 PCa. Patients will be randomized to receive up to two TULSA procedures with subtotal to whole-gland ablation plans, or RP without restriction on surgical approach. Crossover is not permitted. The primary safety endpoint (superiority) is preservation of IIEF Q2≥2 potency and EPIC Q5 pad-free continence at 1 year. The primary efficacy endpoint (non-inferiority within a margin of 10%) is freedom from additional intervention for PCa, metastatic disease, or PCa-specific death. Secondary endpoints include PSA and survival to 10 years, complications to 5 years, and post-TULSA MRI and biopsy. From Jan 2022-July 2024, 18 sites were activated including 4 sub-sites. During this period, 145 patients (>70%) were randomized. 16 patients (11%) withdrew consent after randomization and before treatment: 4 developed comorbidities and became medically unfit for treatment, and 12 refused allocation. Experience at top-recruiting sites underscores the importance of departmental engagement, streamlined processes for identifying candidates, and having high-volume prostatectomy groups offer the study to patients who favor RP.

Background: The objective of this study was to compare results after endoscopic (ES) and open surgery (OpS) for esthesioneuroblastoma over a 40-year period. Methods: In a retrospective study, patients who had undergone ES and OpS for esthesioneuroblastoma with curative intent were included. The following outcome parameters were compared after ES and OpS: epidemiologic, clinical (including known tumor classifications), histopathologic, therapeutic (resection state, adjuvant therapy), and development of recurrences. Crude survival and Kaplan–Meier 10 y, 20 y, and 35 y actuarial survival were calculated. Results: Between 1981 and 2021, 15 patients were operated with ES and 28 with OpS. Advanced-stage tumors were significantly more often treated using OpS. For all other parameters, there were no other significant differences between ES and OpS. After ES, the 35 y OS, DSS, and DFS were 48.1%, 100%, and 55.9%, respectively. After OpS, they were 40.5%, 77.5%, and 35.3%. Conclusions: ES is an effective approach in esthesioneuroblastoma, even in the long-term course over decades, if the appropriate indication compared to OpS is respected.

Objective:Esthesioneuroblastoma (ENB) is treated using several open surgery (OpS) methods, with or without endoscopic assistance ( ± E-ass) or endoscopic surgery (ES). This systematic review compared the results with various approaches using OpS ± E-ass and ES. Data sources:A systematic PubMed/Medline search was conducted for the period 1990-2023. Review methods:Keywords were "esthesioneuroblastoma" or "olfactory neuroblastoma" and "surgery," "surgical," "resection," "approach," "open," and "endoscopic." Studies/case series and case reports were included. Results with OpS ± E-ass (stratified into various approaches) were compared with ES results. Parameters assessed were follow-up period, frequencies of advanced tumor stages, Hyams grade III-IV tumors, negative margins/gross total resection, postoperative complication rates, preoperative/postoperative radiation therapy/chemotherapy, primary tumor progression, and frequency of/time to first recurrence. Results:A total of 88 studies/case series or single cases/case reports (SC/CR) with results after OpS ± E-ass (850 cases) and 84 with results after ES (584 cases) were included. Compared with OpS ± E-ass, after ES, the average follow-up was significantly shorter (p=0.048) and mean crude disease-free survival (DFS) significantly better (studies/case series, p=0.0001; SC/CR, p=0.001). Compared with OPS ± E-ass, after ES, significantly fewer advanced tumors were treated (studies/case series, p=0.0001; SC/CR, p=0.001); negative margins were significantly less frequent (studies/case series, p=0.009); surgical complications were less frequent (studies/case series, p=0.022); less radiation therapy (studies/case series, p=0.043) and/or chemotherapy (SC/CR, p=0.022) was performed; and recurrences were noted significantly less often (studies/case series, p=0.0001; SC/CR, p=0.034). Among OpS ± E-ass, craniofacial resection ± E-ass showed most significant differences from ES. Conclusions:These data support that ES can be regarded as the surgical method of first choice in less advanced ENB but may also be a good choice in carefully selected advanced ENB.

Background: Advance Directives (ADs) play a critical role in ensuring patient autonomy, particularly among patients with Head and Neck Cancer (HNC). However, the factors influencing AD utilization among HNC patients, especially with respect to varying cancer stages and patient care settings, remain understudied. Our study aims to compare the use of AD between patients Free of Recurrence and/or Metastasis (FRM) from HNC with patients with Recurrent and/or Metastatic (RM) HNC. Methods: In this comparative observational study at a tertiary cancer care center, we analyzed the utilization of ADs in two distinct patient cohorts diagnosed with HNC: Recurrent and/or Metastatic (RM, n = 96) and Free of Recurrence and/or Metastasis (FRM, n = 389). Data collection involved examining the frequency, motivations, and modes of AD creation of both cohorts Results: Our comparative analysis revealed a higher presence of ADs in the RM cohort compared to the FRM cohort (58.3% vs. 46.5%, p = 0.038). The type of AD or the reasons against its creation were similar in both groups. Motivations differed notably: 52.4% of the RM cohort was influenced by advice from acquaintances or professionals versus 27.6% in the FRM cohort (p = 0.054, Cramer’s V = 0.223). Concerns about abandonment or over-therapy motivated 23.4% of the FRM cohort, but only 16.7% of the RM group (p = 0.054, Cramer’s V = 0.223). Decisions to defer AD creation were pronounced in the RM group at 67.4% compared to 55.1% in the FRM group. In terms of AD forms, the RM cohort prepared multiple forms significantly more frequently (9.3% vs. 0.7%, p = 0.002*, Cramer’s V = 0.294). Both groups predominantly sought legal (26.5% vs. 22.9%, p = 0.624, phi = 0.034) or other consultation (20.0% vs. 39.6%, p = 0.006*, phi = 0.193) during AD formation, with no significant differences in medical consultation (12.9% vs. 12.5%, p > 0.999, phi < 0.001) preferences. Conclusion: While approximately every other patient with localized disease had an AD, the rate in patients with recurrent and/or metastatic disease was only slightly higher. Related to the drastically worse prognosis of recurrent and/or metastatic disease, effort should be made to encourage these patients to create an AD. This analysis provides evidence that advice from acquaintances or professionals effectively motivated patients with recurrent and/or metastatic disease to consider their end-of-life wishes and document them in the form of an AD or other advance care directives.

Head and neck cancer (HNC) patients experience a variety of post-treatment symptoms that affect their quality of life (QoL). This study aims to assess the most prevalent symptoms and their relationship to cancer stage (UICC I–IV) while identifying areas for targeted intervention. A cross-sectional study was conducted involving 340 HNC patients at the University Hospital Erlangen from January to December 2019. QoL and its domains were assessed using the German version of the University of Washington Quality of Life Questionnaire Version 4 (UW-QoL v.4), with comparisons made between early-stage (UICC I II, n = 180) and advanced-stage (UICC III IV, n = 160) patients. Statistical analysis examined differences in QoL and its individual domains. Advanced-stage patients reported significantly greater impairments in several QoL domains, including swallowing (p = 0.003, η2 = 0.038), saliva production (p < 0.001, η2 = 0.104), and taste (p = 0.009, η2 = 0.030), compared to early-stage patients. Psychological symptoms, such as anxiety and mood disturbances, were prevalent across all stages, but no significant differences were found between early- and advanced-stage patients for pain, speech, mood, or anxiety (p > 0.05). Patient demographics, including age, gender, and comorbidities, were similar between groups. The greater impairments in QoL domains observed in advanced-stage patients are likely due to more intensive treatments, such as multimodal therapy and radiochemotherapy. Advanced-stage HNC patients experience a significantly higher burden of physical symptoms, particularly issues with swallowing, saliva, and taste, necessitating early and targeted interventions. Psychological issues are also prevalent and should be addressed in both early- and advanced-stage patients. Despite non-significant differences in some symptoms, their clinical relevance may still be important, particularly in individual cases. Comprehensive care, including physical and emotional support, is essential to improving long-term QoL for HNC patients. Further research should focus on longitudinal assessments and clinically meaningful thresholds for symptom management.

You have accessJournal of UrologyProstate Cancer: Advanced (including Drug Therapy) I (PD01)1 May 2024PD01-05 ANALYZING THE PERCENTAGE OF POSITIVE 68GA-PSMA-PET/CT SCANS BASED ON PSA RANGES ACROSS DISTINCT INDICATIONS FOR THE SCAN Shayan Ahmad, Maya N. Ataya, Clint D. Bahler, Michael O. Koch, Mark A. Green, Mark Tann, Ethan L. Ferguson, and Heather L. Huelster Shayan AhmadShayan Ahmad , Maya N. AtayaMaya N. Ataya , Clint D. BahlerClint D. Bahler , Michael O. KochMichael O. Koch , Mark A. GreenMark A. Green , Mark TannMark Tann , Ethan L. FergusonEthan L. Ferguson , and Heather L. HuelsterHeather L. Huelster View All Author Informationhttps://doi.org/10.1097/01.JU.0001009540.33579.43.05AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Gallium-68 prostate-specific membrane antigen positron emission tomography/computed tomography (PSMA-PET) is an imaging technique used to identify patients with biochemically recurrent (BCR) prostate cancer and determine their plan of treatment. This study aims to analyze the percentage of positive PSMA-PET scans based on prostate specific antigen (PSA) ranges and the indications for the scans. METHODS: A retrospective analysis was conducted on a cohort of 347 patients, with BCR prostate cancer, who underwent PSMA-PET scans at Indiana University Hospital from May 2017 to November 2021. These scans were categorized into 4 different groups according to their indications: BCR post prostatectomy, BCR post radiation, BCR post prostatectomy and radiation, and Stage 4, defined as patients who had chemotherapy, CRPC, or evidence of distant metastasis. The results of the PSMA-PET scans were documented, the PSA values were divided into distinct ranges for each indication, and the percentage of positive scans for each range was evaluated. RESULTS: The probability of having a positive scan was 60% for patients with BCR post prostatectomy, 86.3% for patients with post radiation, 67.1% post prostatectomy and salvage radiation, and 95% for stage 4. Furthermore, when PSA values were stratified into different ranges, an increasing trend in the probability of positive scans was seen with rising PSA values for patients in the BCR post prostatectomy, and BCR post radiation groups. A threshold PSA value of 1 was observed for patients in stage 4, above which 100% of the scans were positive. Interestingly, across all indications, a PSA value of 10 or higher was almost certain to yield a positive scan, with the only exception being a patient in the BCR post prostatectomy and radiation group. Positive scans for a PSA value of<0.1 were not noticed within any indication, but at a PSA>0.2 resulted in a positive scan greater than 50% of the time. CONCLUSIONS: This study illustrates the relationship between the PSA values and the probability of a positive PSMA-PET scan according to the indication for the scan. From this we can conclude that stage 4 has the highest probability of a positive scan. In addition, in the majority of scans, a PSA of greater than 10 was associated with being 100% positive. Source of Funding: Telix Pharmaceuticals and Al Christy Prostate Cancer Foundation © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e64 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Shayan Ahmad More articles by this author Maya N. Ataya More articles by this author Clint D. Bahler More articles by this author Michael O. Koch More articles by this author Mark A. Green More articles by this author Mark Tann More articles by this author Ethan L. Ferguson More articles by this author Heather L. Huelster More articles by this author Expand All Advertisement PDF downloadLoading ...