To evaluate urinary continence recovery time and risk factors of urinary continence recovery after robot-assisted laparoscopic radical prostatectomy (RARP).From January 2019 to January 2021, a consecutive series of patients with localized prostate cancer (cT1-T3, cN0, cM0) were prospectively collected. RARP with total anatomical reconstruction was performed in all the cases by an experienced surgeon. Lymph node dissection was performed if the patient was in high-risk group according to the D'Amico risk classification. The primary endpoint was urinary continence recovery time after catheter removal. Postoperative and pathological variables were analyzed. Continence was rigo-rously analyzed 48 hours, 1 week, 4 weeks, 12 weeks, and 24 weeks after catheter removal. Continence was evaluated by recording diaper pads used per day, and all the patients were instructed to perform the 24-hour pad weight test until full recovery of urinary continence. The patient was defined as continent if no more than one safety pad were needed per day, or no more than 20-gram urine leakage on the 24-hour pad weight test. Time from catheter removal to full recovery of urinary continence was recorded, and risk factors influencing continence recovery time evaluated.In total, 166 patients were analyzed. The mean age of the enrolled patients was 66.2 years, and the median prostate specific antigen (PSA) was 8.51 μg/L. A total of 59 patients (35.5%) had bilateral lymphatic dissection, and 28 (16.9%) underwent neurovascular bundle (NVB) preservation surgery. Postoperative pathology results showed that stage pT1 in 1 case (0.6%), stage pT2 in 77 cases (46.4%), stage pT3 in 86 cases (51.8%), and positive margins in 28 patients (16.9%). Among patients who underwent lymph node dissection, lymph node metastasis was found in 7 cases (11.9%). Median continence recovery time was one week. The number of the continent patients at the end of 48 hours, 1 week, 4 weeks, 12 weeks, and 24 weeks were 65 (39.2%), 32 (19.3%), 34 (20.5%), 24 (14.5%), and 9 (5.4%). Two patients remained incontinent 24 weeks after catheter removal. The continence rates after catheter removal at the end of 48 hours, 1 week, 4 weeks, 12 weeks, and 24 weeks were 39.2%, 58.4%, 78.9%, 93.4%, and 98.8%, respectively. Univariate COX analysis revealed that diabetes appeared to influence continence recovery time (OR=1.589, 95%CI: 1.025-2.462, P=0.038). At the end of 48 hours, 4 weeks, 12 weeks, and 24 weeks after catheter removal, the mean OABSS score of the continent group was significantly lower than that of the incontinent group.RARP showed promising results in the recovery of urinary continence. Diabetes was a risk factor influencing continence recovery time. Bladder overactive symptoms play an important role in the recovery of continence after RARP.
Purpose: Contrast enhanced magnetic resonance imaging (CE-MRI) has been validated with histology to accurately identify the lipid-rich necrotic core (LRNC), calcification (CA) and intra-plaque hemo...
Dyspnea due to tracheal invasion by malignant tumors is a common oncological emergency that is difficult to manage, and a common cause of death among patients with advanced cancer. Bronchoscopy-guided intervention therapy under conventional ventilation is very risky for patients with severe central airway stenosis. Extracorporeal membrane oxygenation (ECMO) provides strong cardiopulmonary support, but is rarely used in bronchoscopy-guided interventional therapy.The patient had advanced esophageal cancer with metastases to the trachea and left and right main bronchi. Despite several sessions of radiotherapy, chemotherapy, and bronchoscopy-guided intervention therapy, the tumor in the airway became enlarged, the lumen was severely narrow, and the patient experienced respiratory distress.A thoracic computed tomography scan performed at our hospital revealed invasion of the trachea and opening of the left and right main bronchi by the esophageal cancer, blockage of the stent by the tumor, and severe luminal narrowing. An emergency bronchoscopy showed slit-like stenosis of the middle and lower part of the trachea and the left and right main bronchi, and the tumor was highly vascular.To reduce the risk of major airway bleeding and asphyxia during bronchoscopy under conventional ventilation, we finally performed argon plasma coagulation with a high frequency electric knife and cryotherapy with ECMO support.We successfully cleared the tumor tissue in the airway under ECMO support. The trachea and left and right main bronchi recovered smoothly, and the patient was soon discharged.ECMO can meet the oxygenation needs during bronchoscopy-guided intervention therapy. For patients with severe central airway obstruction due to malignant tumors, ECMO should be considered if conventional respiratory support cannot guarantee the safety of surgery.
Objective:The aim of this study was to investigate the feasibility and accuracy of the ceMRI to detect the viable myocardium.Methods:In 13 OMI patients analyze ceMRI,TIMI results of coronary angiography and myocardial viability score of SPECT.Determining the diagnostic accuracy of the ceMRI and TIMI by receiver operating characteristic curve(ROC) analysis.Results:The area under the curve(AUC) of transmural ratio with ceMRI was 0.953 and AUC of TIMI was 0.935.The sensitivity and specificity of transmural ratio 26%-50% to detect viable myocardium were 88.9% and 82.7% respectively.The sensitivity and specificity of transmural ratio 51%-75% to detect viable myocardium were 74.1% and 98.7% respectively.Conclusion:Contrast-enhanced MRI can clearly display the location,dimension and extention of myocardial infarction.The accuracy of the ceMRI to detect viable myocardium was very high.
// Yuke Chen 1,2,* , Wei Yu 1,2,* , Yu Fan 1,2 , Liqun Zhou 1,2 , Yang Yang 1 , Huihui Wang 3 , Yuan Jiang 3 , Xiaoying Wang 3 , Shiliang Wu 1,2 and Jie Jin 1,2 1 Department of Urology, Peking University First Hospital, Xicheng, Beijing, China 2 Institute of Urology, Peking University, National Urological Cancer Center, Beijing, China 3 Department of Radiology, Peking University First Hospital, Xicheng, Beijing, China * These authors have contributed equally to this work Correspondence to: Shiliang Wu, email: // Jie Jin, email: // Keywords : prostate cancer, radical prostatectomy, extracapsular extension, nomogram, multi-parametric magnetic resonance imaging Received : March 28, 2016 Accepted : July 10, 2016 Published : August 23, 2016 Abstract Purpose: To improve the performation of a nomogram for predicting side-specific extracapsular extension (SS-ECE). Results: One hundred and ninety-six patients (55.5%) had ECE on final pathology. Bilateral and unilateral ECE rate was 13.9% (49/353) and 41.6% (147/353), respectively. The mean age was 65.9 years and the mean serum prostate specific antigen (PSA) was 15.0 ng/ml. Based on multivariate logistic regression analysis, clinical stage (cStage), PSA, Gleason sum, percentage of positive cores, and ECE risk score were significant predictors of ECE. The current nomogram had higher predictive accuracy (0.851) and superior calibration. According to the decision curve analysis (DCA) results, the updated nomogram demonstrated a high net benefit across a wide range of threshold probabilities. Materials and Methods: We studied 353 patients with cStage T1c-T3 prostate cancer underwent radical prostatectomy. The candidate predictors associated with ECE were cStage, PSA, Gleason sum, percentage of positive cores, maximum cancer percentage and ECE risk score from multi-parametric magnetic resonance imaging (MP-MRI). The receiver operating characteristic (ROC) analysis was performed and an updated nomogram was constructed. The DCA was performed to test the predictive ability of the nomogram. In addition, the validation and calibration of the Memorial Sloan-Kettering cancer center (MSKCC) nomograms were performed in the current subjects. Conclusions: Predictors, including cStage, PSA, Gleason sum, percentage of positive cores, maximum cancer percentage, and ECE risk score, were combined to construct a SS-ECE prediction nomogram. And the current nomogram might help urologists in decision-making process of preserving or resecting neurovascular bundles preoperatively.
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