ABSTRACT Formalin-fixed prostate tissue samples were imaged by propagation-based synchrotron phase contrast micro computed tomography ( µ CT) with a 3D spatial resolution of ca. 3 µ m. Post- µ CT, samples were prepared for histology with sections close to coplanar with the transverse µ CT image planes. Haematoxylin and eosin stained sections were examined by an expert prostate histopathologist and compared qualitatively with corresponding µ CT-visible microstructure features. There is potential for µ CT to provide complimentary information to conventional histology and light microscopy without the need for preparation of stained thin sections. For the imaging conditions and spatial resolution of our study, µ CT may provide tissue architectural features similar to those used in Gleason grading, albeit without clear subcellular microstructure detail. At the spatial resolution of our study µ CT may provide novel 3D microstructure information for validation of diffusion weighted magnetic resonance imaging (MRI) methods. As an example, we demonstrate a qualitative correlation between µ CT-derived stromal fibre orientation and preferential water diffusion direction measured by diffusion tensor MRI microscopy of the same sample.

Background and Objective Patients managed with trimodal therapy (TMT) for muscle-invasive bladder cancer (MIBC) remain at risk of intravesical recurrences. This retrospective analysis evaluates the efficacy and safety of dose escalation compared to standard dose radiotherapy, with differentiation between invasive and non-invasive local control. Methods A multicentre retrospective analysis was conducted on patients with MIBC who underwent TMT with contemporary radiotherapy techniques from 2015 to 2025. Patients in the standard dose cohort received either 55Gy in 20 fractions or 64Gy in 32 fractions. In the dose-escalation cohort, a simultaneous integrated boost approach was undertaken to deliver up to 60Gy in 20 fractions or 70Gy in 32 fractions to the primary lesion. The effect of dose escalation compared with standard dose on 2-year local control for invasive and non-invasive disease, metastasis-free survival, overall survival, bladder preservation, and toxicity was investigated. Results The cohort consisted of 107 patients with a median follow-up of 23 months. Dose escalation was significantly associated with improved local control of invasive disease (SHR 0.20 [0.05, 0.89], p = 0.035) compared to standard dosing, after adjusting for T stage. There were no differences in local control for non-invasive disease (p=0.8), metastasis-free survival (p=0.8) and overall survival (p=0.5). Both groups tolerated radiotherapy well, with no difference in grade 2 or greater genitourinary and gastrointestinal toxicity (p=0.8, p=0.9, respectively). No patients receiving dose escalation required salvage cystectomy for invasive disease recurrence, compared with two patients who received standard dosing. Conclusion Preliminary evidence suggests efficacy of dose escalation with good tolerability, high rates of bladder preservation, and potentially lower rates of invasive recurrences compared with standard dose radiotherapy. This study’s findings support the need for further prospective studies to evaluate dose escalation as a technique to maximise the efficacy of TMT.

PURPOSE:To characterize the diffusion properties of prostate epithelium and stroma in benign tissue and cancer. METHODS:Paired MR microscopy (20 μm) and multidimensional diffusion MRI (dMRI) (160 μm, b = 1000-2000 s/mm2, ∆ = 15-120 ms) were performed at 16.4 T on 17 fixed prostate tissue samples (14× benign, 2× Gleason 3 + 3, 1× Gleason 4 + 4). MR microscopy images were used to segment epithelial, stromal, and luminal components in each sample. For each dMRI sequence, aggregate epithelial and stromal signal contributions in benign tissue were estimated using a linear epithelium-stroma-lumen signal model. Four diffusion signal models were fit to these aggregate signals. Quality-of-fit was assessed using the small-sample corrected Akaike Information Criterion (AICc). Voxel-wise model fitting was also performed to compare parameter estimates in benign tissue and cancer. RESULTS:Aggregate dMRI signal estimates for both epithelium and stroma were best described by the Ball + Sphere model (lowest AICc). A higher sphere fraction (0.278 vs. 0.175) and lower ball-compartment diffusivity (0.611 vs. 0.943 μm2/ms) were estimated for epithelium compared to stroma. The ADC model provided the worst fit in both cases (highest AICc). For Gleason 3 + 3 cancer, ADC and Ball + Sphere parameter estimates were consistent with the values found for benign epithelium and stroma; however, raised sphere fraction estimates were seen in Gleason 4 + 4 cancer. CONCLUSION:Direction-averaged diffusion in fixed prostate epithelium and stroma is well described by the Ball + Sphere model. The diffusion properties of epithelium in Gleason 3 + 3 cancer and benign tissue appear to be similar; however, a marked increase to the volume fraction of restricted water was found for Gleason 4 + 4 epithelium.

Objectives: To determine if early (three months) and late (one year) post-operative continence is improved by performing a novel retropubic vascularised fascial sling (RoboSling) procedure concurrently with robot-assisted radical prostatectomy in men undergoing treatment for localised prostate cancer. To additionally assess surgical outcomes, quality of life and health economic outcomes in patients undergoing the novel RoboSling technique. Methods: This study aims to recruit 120 consecutive patients with clinically localised prostate cancer who have chosen to undergo robot-assisted radical prostatectomy in the Sydney Local Health District, Australia. A prospective assessment of early and late post-operative continence following robot-assisted radical prostatectomy with and without a RoboSling procedure will be performed in a two-group, 1:1, parallel, randomized controlled trial. Four surgeons will take part in the study, all of whom are beyond their learning curve. Patients will be blinded as to whether the RoboSling procedure is performed for them, as will be the research officers collecting the post-operative data on urinary function. Trial Registration: ACTRN12618002058257. Results: The trial is currently underway. Conclusions: The RoboSling technique is unique in that the sling is vascularised and has a broad surface area compared to previously described slings in the literature. If a clinically significant improvement in post-operative continence is established with the RoboSling, then, we can in turn expect improvements in quality of life for men undergoing this technique with radical prostatectomy.

This case report details a fatal rectal perforation and sepsis in a comorbid 96-year-old male after traumatic urinary catheterization, highlighting the risks of IDC management in elderly patients with complex health backgrounds. Despite maximal medical therapy, including escalated antibiotics and ICU care, the patient died from septic shock linked to improper catheter insertion by a non-specialist nurse in the community. This case emphasizes the urgent need for better catheterization practices, specialized nursing education, and clear guidelines to prevent such outcomes.

You have accessJournal of UrologyReconstruction: Augmentation, Substitution, Diversion (PD21)1 May 2024PD21-02 MANAGEMENT OF COMPLICATIONS OF ILEAL OR COLONIC CONDUITS FOLLOWING PELVIC EXENTERATION Catalina A. Palma, Charlotte van Kessel, Scott Leslie, David Eisinger, Arthur Vasilaras, Paul Sved, Peter Lee, Kirk Austin, Michael Solomon, and Nicola Jeffery Catalina A. PalmaCatalina A. Palma , Charlotte van KesselCharlotte van Kessel , Scott LeslieScott Leslie , David EisingerDavid Eisinger , Arthur VasilarasArthur Vasilaras , Paul SvedPaul Sved , Peter LeePeter Lee , Kirk AustinKirk Austin , Michael SolomonMichael Solomon , and Nicola JefferyNicola Jeffery View All Author Informationhttps://doi.org/10.1097/01.JU.0001008888.07102.14.02AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Pelvic exenteration (PE) can potentially be curative in advanced pelvic malignancies. When cystectomy is required, urinary reconstruction is typically performed with the formation of ileal or colonic conduit. Urological complications following urinary reconstruction include anastomotic strictures and urine leaks. Urine leaks can be a devastating long term complication, adding significant length to inpatient and outpatient management and impacting quality of life. The aim of this study was to assess the presentation, diagnosis and management of urological complications post PE with a focus on urinary leaks. METHODS: This was a cohort study of patients who had PE at a single centre (1998 to 2021). Patients were identified from a prospectively maintained database. Outcomes were post-operative complications and diagnosis methods employed to detect these. Interventions (surgical and radiological) used to manage complications were examined in detail. RESULTS: 419 patients were enrolled. 60% of patients had PE for rectal cancer. 70 patients suffered conduit-related complications. Ileal conduits had lower complication rates than colonic conduits (24% vs 42%, p=0.029). Patients with conduit complications had more extensive surgery with significantly higher intraoperative blood loss and longer length of surgery. Urinary complications included: uretero-intestinal anastomotic strictures (31), urine leak originating from conduit body defect (22), urine leak from uretero-intestinal anastomosis (16), nephrolithiasis (9), parastomal hernia (6), distal conduit stenosis (5), distal conduit ischemia (5), malignant ureteric strictures from tumour recurrence (5), hemorrhage from conduit (4). Urinary leaks from anastomosis were initially managed with percutaneous nephrostomy diversion, with 2/16 requiring open surgical primary repair due to persistence of leak, 2 patients required permanent nephrostomy tubes, and 2 developed post-leak anastomotic strictures. Urine leaks from the conduit body were resistant to percutaneous management in 21/22 cases. 12 patients required open surgical primary repair, 7 patients (with large fistulas) required complete refashioning of new conduit, and 3 patients required permanent nephrostomy tubes. CONCLUSIONS: Urine leaks from ileal/colonic conduits present the heaviest urological complication burden to PE patients. While anastomotic leaks were successfully managed percutaneously in most cases, urine leaks from a defect in the conduit body required surgical management with primary repair or reconstruction of the conduit. Source of Funding: No external funding or support was received for this study © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e453 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Catalina A. Palma More articles by this author Charlotte van Kessel More articles by this author Scott Leslie More articles by this author David Eisinger More articles by this author Arthur Vasilaras More articles by this author Paul Sved More articles by this author Peter Lee More articles by this author Kirk Austin More articles by this author Michael Solomon More articles by this author Nicola Jeffery More articles by this author Expand All Advertisement PDF downloadLoading ...

AbstractObjectiveTo describe a novel RoboSling technique performed at the time of robot‐assisted radical prostatectomy (RARP) and its utility for enhancing urinary function recovery postoperatively.Materials and MethodsThe surgical technique involves harvesting a vascularised, fascial flap from the peritoneum on the posterior aspect of the bladder. Following completion of prostatectomy, the autologous flap is tunnelled underneath the bladder and incorporated into the rectourethralis and vertical longitudinal detrusor fibres at the posterior bladder neck with a modified Rocco suture. After urethra‐vesical anastomosis is completed, the corners of the flap are hitched up to Cooper's ligament bilaterally with V‐Loc sutures, tensioned and secured creating a bladder neck sling. A prospective, longitudinal cohort study was performed of 193 consecutive patients undergoing RARP between December 2016 and September 2019. The first 163 patients underwent standard RARP, and the last 30 patients had the RoboSling technique performed concurrently. Continence outcomes were the primary outcomes assessed using pad number and Expanded Prostate Cancer Composite (EPIC)‐urinary domain questionnaire. Operative time (OT), estimated blood loss (EBL), complications and oncological outcomes were secondary outcomes.ResultsThe two groups were comparable for demographics and clinicopathological variables. At 3 months, zero pad usage (p = 0.005) and continence rates, defined as EPIC score ≥ 85 (p = 0.007), were both higher in the RoboSling group. EBL, complication rate and positive surgical margin rate did not differ between the two groups. Superior zero pad usage was observed at 1 year in the RoboSling group (p = 0.029). The RoboSling technique added on average 16 min to OT.ConclusionsThe RoboSling procedure at the time of RARP was associated with earlier return to continence without negatively impacting other postoperative outcomes. This improvement in continence outcomes was maintained long term.

Introduction: Renal colic is a common emergency department (ED) presentation. Variations in assessment and management of suspected renal colic may have significant implications on patient and hospital outcomes. We developed a clinical practice guideline to standardize the assessment and management of renal colic in the ED. We subsequently compared outcomes before and after guideline implementation. Methods: The guidelines standardized the analgesia regimen, urology consult criteria, imaging modality, patient education, and followup instructions. This is a single-center, observational cohort study of patients presenting to the ED with renal colic prospectively collected after guideline implementation (December 2018 to May 2019), compared to a control group retrospectively collected before guideline implementation (December 2017 to May 2018). A total of 528 patients (pre-guideline n=283, post-guideline n=245) were included. Statistical analysis was performed with SPSS using multivariate linear regression. Results: ED length of stay (LOS) was significantly shorter after guideline implementation (pre-guideline 295.82±178.8 minutes vs. post-guideline 253.2±118.2 minutes, p=0.017). The number of computed tomography (CT) scans patients received was significantly less after guideline implementation (pre guideline 1.35±1.34 vs. post-guideline 1.00±0.68, p=0.034). Patients discharged for conservative management had a lower re-presentation rate in the post-guideline group (12.6%) than the pre-guideline group (17.2%); however, this did not reach statistical significance (p=0.18). Conclusions: Implementation of a clinical practice guideline for ureteric stones reduces the ED LOS and the total number of CT scan in patients who present with renal colic. Standardizing assessment and management of ureteric stones can potentially improve patient and hospital outcomes without compromising the quality of care.

Purpose Renal angiomyolipoma (AML) is the most common benign renal tumor. Whilst generally asymptomatic, they can cause life-threatening bleeding. Selective angioembolization (SAE) may be used to treat large symptomatic and asymptomatic AMLs. We aimed to evaluate the efficacy of SAE for symptomatic and asymptomatic renal AMLs and determine characteristics that predict spontaneous bleeding. Patients and Methods Data were retrospectively collected from a prospectively maintained database from July 2011 to April 2022. Patients were included if AML was >4cm and they underwent subsequent SAE. Follow-up imaging was analyzed to calculate mean reduction in AML size. Clinical notes were reviewed to analyze lesion characteristics including vascularity, fat content and presence of aneurysm as well as post-procedural complications. Results 26 patients with 30 AMLs were identified. Interval of follow-up imaging ranged from 1 to 60 months. 25 AMLs were embolized electively with 5 emergency embolizations performed for bleeding. Mean reduction in AML volume was 41% at 3 months (p=0.013) and 63% at 12 months (p=0.007). All 5 bleeding AMLs had a rich vascularity with 60% also having either aneurysms or a low fat content. Complications included post-embolic syndrome (n=9), segmental renal parenchyma devascularization (n=3), acute bleeding requiring re-embolization (n=2), nephrectomy for ongoing bleeding (n=1) and delayed bleeding managed conservatively (n=1). No deterioration in renal function was observed. Conclusion SAE is an effective procedure for managing symptomatic and asymptomatic renal AML, with minimal significant complications. AML vascularity, fat content and aneurysms may be useful characteristics to assess future risk of bleeding in patients with renal AML.

Basal cell carcinoma (BCC) is rare on non-sun exposed skin such as the scrotum and thus diagnosis is often delayed. This case highlights an approach to scrotal skin lesions, risk factors and diagnostic features of BCC. Importantly, scrotal BCCs are more likely to metastasise than non-scrotal BCCs. Management should consist of wide local excision and recommended follow up with thorough clinical history, skin examination and imaging in high-risk patients.

A 41 years-old male patient presented acutely with severe right testicular pain, and fever for 48 hours. Patient had a backround of previous left orchidectomy for epididymo-orchitis and sexually-transmitted disease. A clinical diagnosis of right epididymo-orchitis was made and patient was treated with intravenous broad-spectrum antibiotic. However subsequent ultrasound revealed imminent testicular ischaemia. Given the challenging nature of the case, i.e. single testicle with testicular ischaemia, surgical exploration, fasciotomy and tunica vaginalis grafting was performed to the patient. The patient recovered fully post-operatively with ultrasound proving restoration of end-diastolic flow to the testicle.

You have accessJournal of UrologyProstate Cancer: Staging I (MP62)1 Apr 2020MP62-15 IDENTIFYING THE PATHOLOGICAL PREDICTORS OF PSMA AVIDITY- COMPARISON OF PREOPERATIVE LOCOREGIONAL GA-68 PSMA PET-CT RESULTS WITH RADICAL PROSTATECTOMY HISTOPATHOLOGY Jonathan Kam*, Neel Gore, Rebecca Lai, Hilary Fernando, John Boulas, David Eisinger, Paul Sved, Arthur Vasilaras, Geoff Watson, and Scott Leslie Jonathan Kam*Jonathan Kam* More articles by this author , Neel GoreNeel Gore More articles by this author , Rebecca LaiRebecca Lai More articles by this author , Hilary FernandoHilary Fernando More articles by this author , John BoulasJohn Boulas More articles by this author , David EisingerDavid Eisinger More articles by this author , Paul SvedPaul Sved More articles by this author , Arthur VasilarasArthur Vasilaras More articles by this author , Geoff WatsonGeoff Watson More articles by this author , and Scott LeslieScott Leslie More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000937.015AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The use of Ga-68 PSMA PET/CT for primary staging of prostate cancer has increased significantly in the past few years. The majority of PSMA PET/CT literature are performed on patients with biochemical recurrence post primary treatment for prostate cancer and suffer from a lack of histopathological correlation and retrospective study design. We aimed to compare the performance of PSMA PET/CT to radical prostatectomy histopathology to determine the pathological predictors of PSMA PET/CT accuracy METHODS: We analysed our prospectively maintained Urological database for patients who had a PSMA PET/CT prior to radical prostatectomy between Jan 2019-Nov 2019. For each tumour foci correlation between histopathological results and PSMA PET/CT were defined for tumour localisation, extra-prostatic extension, invasion of seminal vesicles and bladder neck invasion. Regional lymph node dissections were also correlated to PSMA PET/CT results. Data was analysed using SPSS 24.0. RESULTS: Twenty-six tumour foci were identified for analysis. 54% of these were detected on PSMA PET/CT. Predictors of PSMA PET/CT concordance were index lesion (100% vs. 20%, p<0.001), Gleason pattern ≥4 (77% vs. 11%, p=0.003), size (detected lesions mean 22.2mm vs. non-detected lesions mean 4.3mm). Correlation analysis showed showed no significant relationship between SUVMax and Gleason grade (R2= 0.231, p=0.08). In patients with histopathologically proven seminal vesicle invasion, evidence of this on PSMA was only found in 50% of cases. Extracapsular extension was correctly predicted by PSMA in 50% cases. Lymph node metastasis were present in three cases and identified on PSMA in 33% of cases. Lymph node cases which were missed on PSMA were only 1mm and 2mm in size. CONCLUSIONS: PSMA provides excellent detection of index lesions. EPE and SVI prediction rates were lower than that reported in the MRI literature and is likely due to the lower spatial resolution of PSMA PET/CT. Predictive pathological factors of PSMA PET/CT concordance were index lesion, Gleason grade ≥4 and size. Source of Funding: Nil © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e951-e951 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Jonathan Kam* More articles by this author Neel Gore More articles by this author Rebecca Lai More articles by this author Hilary Fernando More articles by this author John Boulas More articles by this author David Eisinger More articles by this author Paul Sved More articles by this author Arthur Vasilaras More articles by this author Geoff Watson More articles by this author Scott Leslie More articles by this author Expand All Advertisement PDF downloadLoading ...