Male Pelvis Research Articles

No linear correlation between pelvic incidence and acetabular orientation: Retrospective observational study.

Links between sagittal spinal alignment and acetabular orientation attract considerable research attention with the goal of understanding “hip-spine syndrome.” However, whether pelvic incidence (PI) is related to acetabular orientation remains debatable. The purpose of the present study was to determine 1.whether the correlation between PI and acetabular orientation is present in pelvises of young healthy adults, and2.whether the correlation is present in subgroups of sex, or between the left and right pelvis.We analyzed 100 abdominopelvic computed tomography (CT) scans of skeletally healthy young adults. We measured PI and acetabular orientation with three-dimensional (3D) measurements. The orientation of 200 acetabula was measured using 3D reconstructed models of 100 pelvises in the coordinate system based on the anterior pelvic plane (APP). To quantify the acetabular orientation, the radiographic definitions of anteversion and inclination were used. To examine the correlation between acetabular orientation and PI, Pearson's correlation was used.The mean PI was 46.9° ± 10.2°, and the mean acetabular orientation 15.3° ± 5.7° anteverted and 37.5° ± 3.9° inclined. While no significant difference in the PI was observed, the average acetabular orientation of female pelvises (anteversion, 17.5° ± 5.6°; inclination, 36.7° ± 3.7°) was more anteverted and less inclined compared to that of male pelvises (anteversion, 13.2° ± 4.9°; inclination, 38.3° ± 3.9°, respectively; P values < .05). The correlation between PI and acetabular orientation was statistically not significant. After division of study group by sex, the linear correlation between PI and acetabular orientation was not statistically supported. The asymmetry of the acetabular orientation between the left and right sides was not significant.The linear relationship between anatomical acetabular orientation and PI was not evident in the normal population. Our finding thus proves the absence of a linear relationship between the upper and lower articular orientation of the pelvic segment and deepens the understanding of the characteristics of acetabular orientation and PI.

Optimal pin position in supraacetabular external fixation.

This study focuses on (i) the length of the intraosseous part of the supraacetabular pin using the insertion technique from the spina iliaca anterior inferior to the cortical part of the incisura ischiadica major, (ii) the angle of insertion of the supraacetabular pin in the transversal plane and (iii) gender-specific differences of the measured results. Images of uninjured pelves from 49 patients (64-line computed tomography scanner) were evaluated, and virtual external fixator pins were positioned using a three-dimensional reconstructions of computed tomography scans. The length of the pins and the insertion angle were investigated. Descriptive statistics were used, and gender-specific differences were calculated. A P-value of <0.05 was considered statistically significant. The results showed significant differences between male and female pelves concerning both pin length and insertion angel. For male pelves, the mean screw length was 82.7 mm (SD 5.1; range 72.9-94.3). For females, this was statistically significantly shorter (P ≤ 0.001), with an average of 74.1 mm (SD 5.0; range 63.1-81.9). In the male subgroup, the insertion angle was a mean of 22.6° (SD 3.4; range 12.4-31.8), and the female pelves had an average angle of 19.7° (SD 4.0; range 11.7-24.5). These values differed statistically significantly (P = 0.0032). Based on our measurements, we can confirm that both the length of the Schanz screws and the angle of insertion for the supraacetabular external fixator show a statistically significant difference between males and females.

Are seminal vesicles a potential pitfall during pelvic exploration using point-of-care ultrasound (POCUS)?

BackgroundTrauma is a major cause of death among the working population. Many countries have now adopted a structured approach to trauma management in which ultrasound is used as a primary evaluation tool. While its use has direct therapeutic benefits, many artifacts and pitfalls are inherent to the technique. Knowledge of the most frequently encountered pitfalls in practice could thus help reduce the risk of error and lead to more accurate trauma assessments.ObjectiveThis study evaluates a potential pitfall caused by seminal vesicles during focused assessment with sonography for trauma examinations of the male pelvis performed by an emergency physician with experience in point-of-care ultrasound.MethodsWe took five static and five dynamic (3-s loops) transverse ultrasound images of the pelvis in five healthy males. The images and videos were then incorporated into an online survey and emailed through the World Interactive Network Focused On Critical UltraSound (WINFOCUS) in France and the Ultrasound and Emergency Medicine (UEM) Organization in Belgium. A questionnaire asked anonymous participants to assess the presence of free fluid in the static and dynamic images and to share information about their training and experience in point-of-care ultrasound. To validate the static and dynamic images, the survey was sent to three external radiologists for independent verification.ResultsA total of 191 individuals responded fully or partially to the survey, 114 of whom completed it. Among the 114 participants who completed the survey, the misinterpretation rate was 0.55 (95CI 0.51–0.60) for all static and dynamic ultrasound transverse pelvic views. The misinterpretation rate was 0.61 (95CI 0.55–0.66) and 0.50 (95CI 0.45–0.55) for static and dynamic ultrasound transverse pelvic views, respectively. The three external radiologists answered the questionnaire correctly without misinterpreting the survey ultrasound views.ConclusionsSeminal vesicles are a potential pitfall when interpreting transverse ultrasound images of the male pelvis in the context of point-of-care ultrasound.

Initial Experience with the Safe Implementation of Transanal Total Mesorectal Excision (TaTME) as a Standardized Procedure for Low Rectal Cancer

Introduction: The laparoscopic approach for TME is proven to be non-inferior in oncological outcome compared to open surgery. Anatomical limitations in the male and obese pelvis with resulting pathological shortcomings and high conversion rates were stimuli for alternative approaches. The transanal approach for TME (TaTME) was introduced to overcome these limitations. The aim of this study was to evaluate the outcomes of TaTME for mid and low rectal cancer at our center. Methods: TaTME is a hybrid procedure of simultaneously laparoscopic and transanal mesorectal excision. A retrospective analysis of all consecutive TaTME procedures performed at our center for mid and low rectal cancer between December 2014 and January 2020 was conducted. Results: A total of 157 patients underwent TaTME, with 72.6% receiving neoadjuvant chemoradiation. Mean tumor height was 6.1 ± 2.3 cm from the anal verge, 72.6% of patients had undergone neoadjuvant chemoradiotherapy, and 34.2% of patients presented with a threatened CRM upon pretherapeutic MRI. Abdominal conversion rate was 5.7% with no conversion for the transanal dissection. Early anastomotic leakage occurred in 7.0% of the patients. Mesorectum specimen was complete in 87.3%, R1 resection rate was 4.5% (involved distal resection margin) and in 7.6%, the CRM was positive. The three-year local recurrence rate of 58 patients with a follow-up ≥ 36 months was 3.4%. Overall survival was 92.0% after 12 months, and 82.2% after 36 months. Conclusion: TaTME can be performed safely with acceptable long-term oncological outcome. Low rectal cancer can be well addressed by TaTME, which is an appropriate alternative with low conversion, local recurrence, adequate mesorectal quality and CRM positivity rates.

Influence of pelvic shape on strain patterns: A computational analysis using finite element mesh morphing techniques

The pelvis functions to transmit upper body loads to the lower limbs and is critical in human locomotion. Semi-automated, finite element (FE) morphing techniques eliminate the need for segmentation and have shown to accelerate the generation of multiple specimen-specific pelvic FE models to enable the study of pelvic mechanical behaviour. The purpose of this research was to produce simulated human pelvic FE models representing android, gynecoid, anthropoid and platypelloid morphologies and to isolate differences in strain patterns due to anatomic shape under physiologic loading. Using five initially generated specimen-specific FE models, each specimen-specific FE model was reconfigured into three different morphologies using FE mesh morphing techniques. Significantly different strains were found comparing the gynecoid (classical female pelvis’) to the android (‘true male pelvis’) models (p = 0.040), with strains twice as high in the superior pubic rami. No significant differences were seen in comparing overall strains between the other pelvic shapes (p = 0.61–0.126). The highest strain regions in all models were found in the supra-acetabular regions, with high strains also found in the regions of the superior pubic rami, the greater sciatic notch and sacral regions about the L5 vertebrae. Quantifying the contributions of shape to strain in the pelvis may increase the understanding of sex and patient-specific differences in fracture risk and motivate the consideration of treatment strategies that account for anatomic pelvic differences.

Indiscriminate ossification of ligaments in a dry adult human male pelvis– A rarity

Introduction: Human pelvis exhibits sacrotuberous, sacrospinous and transverse acetabular ligament performing the function of stabilisation of pelvis and hip joint respectively. The ossification of this ligaments has been reported solitary and rarely in composite. Materials and Methods: During undergraduate osteology teaching authors noticed a dry human male pelvis demonstrating compounded ossification of ligaments and bony distortions. Case Report: The left sacrotuberous ligament was partially ossified and demonstrated triangular anteroinferior and posterosuperior segments. The transverse acetabular ligament of right side was totally ossified and left was partially ossified. A bony mass was observed at the left ala of sacrum with fusion of pedicle and left lower part of body of fifth lumbar vertebra and ala of sacrum. Bilateral sharp bony spicules at iliopectineal lines and exostosis at bilateral iliac tuberosity was noticed. Conclusion: This exhibit brings out an unreported rare anatomical variant of bony pelvis, the knowledge of which will be of paramount importance to radiologists and orthopaedic surgeons. Keywords: Sacrotuberous ligament, Transverse acetabular ligament, Ossification, Sacralisation, Bony spicule.

Methodological approach to create an atlas using a commercial auto-contouring software.

PurposeThe aim of this work was to establish a methodological approach for creation and optimization of an atlas for auto‐contouring, using the commercial software MIM MAESTRO (MIM Software Inc. Cleveland OH).MethodsA computed tomography (CT) male pelvis atlas was created and optimized to evaluate how different tools and options impact on the accuracy of automatic segmentation. Pelvic lymph nodes (PLN), rectum, bladder, and femurs of 55 subjects were reviewed for consistency by a senior consultant radiation oncologist with 15 yr of experience. Several atlas and workflow options were tuned to optimize the accuracy of auto‐contours. The deformable image registration (DIR), the finalization method, the k number of atlas best matching subjects, and several post‐processing options were studied. To test our atlas performances, automatic and reference manual contours of 20 test subjects were statistically compared based on dice similarity coefficient (DSC) and mean distance to agreement (MDA) indices. The effect of field of view (FOV) reduction on auto‐contouring time was also investigated.ResultsWith the optimized atlas and workflow, DSC and MDA median values of bladder, rectum, PLN, and femurs were 0.91 and 1.6 mm, 0.85 and 1.6 mm, 0.85 and 1.8 mm, and 0.96 and 0.5 mm, respectively. Auto‐contouring time was more than halved by strictly cropping the FOV of the subject to be contoured to the pelvic region.ConclusionA statistically significant improvement of auto‐contours accuracy was obtained using our atlas and optimized workflow instead of the MIM Software pelvic atlas.

Association of Subpubic Angle Measurement with Age and Gender in a Group of Adult Sudanese Patients

Background: The measurement of the subpubic angle (SPA) has been used for determining gender with a high degree of accuracy in various ethnic groups. This measurement can also be helpful in forensic and physical anthropology. The aim of this study was to compare the SPA in different adult age groups (males and females) and to use the SPA to estimate the demarking point (DP) for the determination of gender.&#x0D; Methods: This study included 158 subjects – 59 male and 99 female. The SPA was measured electronically using antero-posterior pelvis X-rays. Measurements were taken retrospectively using the Picture Archiving and Communication System. SPA measurements were compared between the male and female participants in different adult age groups. To determine the gender, the DP was calculated from the means of SPA in male and female participants. &#x0D; Results: A comparison of the means of SPA between males and females showed that females (134.94 ± 15.33º) had wider SPA than males (105.88 ± 10.33) with a significant difference (P = 0.012). While a DP &gt; 126.5 is most likely indicative of a female pelvis, a DP &lt; 104.3 is indicative of a male pelvis. The accuracy levels based on the measured DP of participants in this study were 45.8% and 69.7% for males and females, respectively. Besides, with regards to age, the mean values for different age groups in males and females were statistically insignificant (P-values were 0.21 and 0.75, respectively). &#x0D; Conclusions: According to the obtained results, the variations in the measurements of the SPA from pelvic X-rays can be used to determine gender. The calculated SPA range and DP were found to predict female gender with higher accuracy. Age was not associated with any notable differences in SPA measurements.&#x0D; Keywords: subpubic angle, pelvis, Sudanese, sex differences

‘Sequence graphics’ for gross anatomy diagrams and their objective evaluation

Background and Objectives: Drawing diagrams is an integral part of learning anatomy. The objective of the study was to evaluate sequence graphics to impart drawing skills among medical undergraduates. The other objective of the study was to design and evaluate an objective method of assessment of clinically relevant moderately complex gross anatomy diagrams. Methodology: In an experimental study, participated by 92 students, were asked to draw coronal section of male pelvis (moderately complex diagram) projected on the board. The same diagram was redone with PowerPoint in such a way that each component appears sequentially on command from the teacher, technique called sequence graphics. Sequence labelling followed appearance of each component. The perineal membrane was the key component. Prostate gland (with urethra), deep transverse perineal muscle (with bulbourethral glands) and Colle’s fascia were accessory components. Both diagrams were analyzed for the centeredness, appropriate color usage, bilateral symmetry, and representation of key and accessory components and labelling. Deviation of three accessory components of student images of more than one grid was considered as grossly disproportional diagram. Results: Sequence graphics image scores were significantly more than the scores from projected image tracing (6.04+2.03 vs. 4.72+2.18). The improvement was particularly in terms of symmetry, representation of key and accessory components, labelling and use of appropriate colors. Conclusions: Sequence graphics resulted in drawings with predefined components with labelling. Defining key component and accessory components for moderately difficult diagrams shall result in objective evaluation. Sequence graphics principles aids better drawing skills. Keywords: Artistic anatomy, Medical illustrations, Drawings, Sectional anatomy, Graphics.

A new deep convolutional neural network design with efficient learning capability: Application to CT image synthesis from MRI.

Despite the proven utility of multiparametric magnetic resonance imaging (MRI) in radiation therapy, MRI-guided radiation treatment planning is limited by the fact that MRI does not directly provide the electron density map required for absorbed dose calculation. In this work, a new deep convolutional neural network model with efficient learning capability, suitable for applications where the number of training subjects is limited, is proposed to generate accurate synthetic computed tomography (sCT) images from MRI. This efficient convolutional neural network (eCNN) is built upon a combination of the SegNet architecture (a 13-layer encoder-decoder structure similar to the U-Net network) without softmax layers and the residual network. Moreover, maxpooling indices and high resolution features from the encoding network were incorporated into the corresponding decoding layers. A dataset containing 15 co-registered MRI-CT pairs of male pelvis (1861 two-dimensional images) were used for training and evaluation of MRI to CT synthesis process using a fivefold cross-validation scheme. The performance of the eCNN model was compared to an atlas-based sCT generation technique as well as the original U-Net model considering CT images as reference. The mean error (ME), mean absolute error (MAE), Pearson correlation coefficient (PCC), structural similarity index (SSIM), and peak signal-to-noise ratio (PSNR) metrics were calculated between sCT and ground truth CT images. The eCNN model exhibited effective learning capability using only 12 training subjects. The model achieved a ME and MAE of 2.8±10.3 and 30.0±10.4HU, respectively, which is substantially lower than values achieved by the atlas-based (-0.8±35.4 and 64.6±21.2) and U-Net (7.4±11.9 and 44.0±8.8) methods, respectively. The proposed eCNN model exhibited efficient convergence rate with a low number of training subjects, while providing accurate synthetic CT images. The eCNN model outperformed the original U-Net model and showed superior performance to the atlas-based technique.

Knowledge about male pelvis anatomy and prostate cancer in men

Knowledge about male pelvis anatomy and prostate cancer in men

Statistical Shape Modeling to Determine the Anterior Pelvic Plane for Total Hip Arthroplasty.

The anterior pelvic plane (APP) defined by both iliac spines and the pubic symphysis, is essential in total hip arthroplasty (THA) for the orientation of the prosthetic cup. However, the APP is nowadays still difficult to determine in computer assisted orthopedic surgery (CAOS). We propose to use a statistical shape model (SSM) of the pelvis to estimate the APP from ipsilateral anatomical landmarks, more easily accessible during surgery in computer assisted THA with the patient in lateral decubitus position. A SSM of the pelvis has been built from 40 male pelvises. Various ipsilateral anatomical landmarks have been extracted from these data and used to deform the SSM. Fitting the SSM to several combinations of these landmarks, we were able to reconstruct the pelvis with an accuracy between 2.8mm and 4.4mm, and estimate the APP inclination with an angular error between 1.3° and 2.8°, depending on the landmarks fitted. Results are promising and show that the APP could be acquired during the intervention from ipsilateral landmarks only.

Influence of different urinary bladder filling levels and controlling regions of interest selection on deformable image registration algorithms

PurposeEvaluation of Raystation ANAtomically CONstrained Deformation Algorithm (ANACONDA) performance to different urinary bladder filling levels in male pelvis anatomic site varying the controlling Regions Of Interest (ROIs). MethodsDifferent image datasets were obtained with ImSimQA (Oncology System Limited, Shrewsbury, UK) to evaluate ANACONDA performances (RaySearch Laboratories, Stockholm, Sweden). Deformation vector fields were applied to a synthetic man pelvis and a real patient computed tomography (CT) dataset (reference CTs) resulting in deformed CTs (target CTs) with various bladder filling levels. Different deformable image registrations (DIRs) were generated between each target CTs and reference CTs varying the controlling ROIs subset. Deformed ROIs were mapped from target CT to reference CT and then compared to reference ROIs. Evaluation was performed by Dice Similarity Coefficient (DSC), Correlation Coefficient (CC), Mean Distance to Agreement (MDA), maximum Distance to Agreement (maxDA) and with the introduction of global DSC (global_DSC) and global CC (global_CC) parameters. ResultsIn both synthetic and real patient CT cases, DSC scored less than 0.75 and MDA greater than 3 mm when no ROIs or only bladder were exploited as controlling ROI. DSC and CC increased by increasing the number of controlling ROIs selected whereas, an opposite behavior was observed for MDA and maxDA. ConclusionsANACONDA performances can be influenced by bladder filling fluctuation if no controlling ROIs are selected. Global_DSC and global_CC are useful parameters to quantitatively compare DIR algorithms. DIR performances improve by increasing the number of controlling ROIs selected, reaching a saturation level after a defined ROIs subset selection.

Generalization vs. Specificity: In Which Cases Should a Clinic Train its Own Segmentation Models?

As artificial intelligence for image segmentation becomes increasingly available, the question whether these solutions generalize between different hospitals and geographies arises. The present study addresses this question by comparing multi-institutional models to site-specific models. Using CT data sets from four clinics for organs-at-risk of the female breast, female pelvis and male pelvis, we differentiate between the effect from population differences and differences in clinical practice. Our study, thus, provides guidelines to hospitals, in which case the training of a custom, hospital-specific deep neural network is to be advised and when a network provided by a third-party can be used. The results show that for the organs of the female pelvis and the heart the segmentation quality is influenced solely on bases of the training set size, while the patient population variability affects the female breast segmentation quality above the effect of the training set size. In the comparison of site-specific contours on the male pelvis, we see that for a sufficiently large data set size, a custom, hospital-specific model outperforms a multi-institutional one on some of the organs. However, for small hospital-specific data sets a multi-institutional model provides the better segmentation quality.

Evolution of Transanal Total Mesorectal Excision.

Minimally invasive techniques continue to transform the field of colorectal surgery. Because traditional surgical approaches for rectal cancer are associated with significant mortality and morbidity, developing less invasive approaches to this disease is paramount. Natural orifice transluminal endoscopic surgery (NOTES), commonly known as "no incision surgery," represents the ultimate minimally invasive approach to disease. Although transgastric and transvaginal approaches for NOTES surgery were the initially explored, a transrectal approach for colorectal disease is intuitive given that it makes use of the resected organ for transluminal access. Furthermore, the transanal approach allows for improved, precise visualization of the presacral mesorectal plane compared with an abdominal viewpoint, particularly in the narrow, male pelvis. Finally, experience with existing transanal platforms that have been used for decades for local excision of rectal disease made the development of a transanal approach to total mesorectal excision (TME) feasible. Here, we will review the evolution of minimally invasive and transanal surgical techniques that allowed for the development of transanal TME and its introduction into clinical practice.

Chronic pelvic pain: from correct diagnosis to adequate therapy

Management of patients with chronic pelvic pain (CPP) is an actual interdisciplinary problem of modern clinical medicine. CPP is chronic or persistent pain lasting more than 6 months, which is located in the structures related to the male or female pelvis and is associated with negative cognitive, behavioral, and emotional consequences, as well as with lower urinary tract, bowel, and pelvic floor symptoms, and reproductive and sexual dysfunction. In accordance with the biopsychosocial model, CPP is the result of a dynamic interaction of biological, psychological and sociocultural factors. When diagnosing CPP, it is most acceptable to phenotype patients according to the UPOINTS classification. To implement the treatment strategy, it is necessary to adhere to a multidisciplinary personalized approach to pain management with active patient participation. Cognitive behavioral therapy (CBT) occupies an important place in the treatment of CPP. There is clinical and neurophysiological evidence of the efficiency of CBT in patients with CPP, a protocol has been developed for the combined use of CBT and physical therapy. CBT is recommended to be included in a comprehensive treatment and rehabilitation program for patients with CPP.

V07-12 DEVELOPMENT OF A HIGH FIDELITY 3-PIECE INFLATABLE PENILE PROSTHETIC (IPP) MODEL USING 3D-PRINTING AND HYDROGEL MOLDING

You have accessJournal of UrologyLower-Tract Reconstruction II: ED/Infertility & Transgender Surgery (V07)1 Apr 2020V07-12 DEVELOPMENT OF A HIGH FIDELITY 3-PIECE INFLATABLE PENILE PROSTHETIC (IPP) MODEL USING 3D-PRINTING AND HYDROGEL MOLDING Patrick Saba, Rachel Melnyk, Michael Witthaus*, Gareth Warren, Divya Ajay, Alexander Cranwell, Ricardo Munarriz, and Ahmed Ghazi Patrick SabaPatrick Saba More articles by this author , Rachel MelnykRachel Melnyk More articles by this author , Michael Witthaus*Michael Witthaus* More articles by this author , Gareth WarrenGareth Warren More articles by this author , Divya AjayDivya Ajay More articles by this author , Alexander CranwellAlexander Cranwell More articles by this author , Ricardo MunarrizRicardo Munarriz More articles by this author , and Ahmed GhaziAhmed Ghazi More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000897.012AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: This video demonstrates a high-fidelity, anatomical, full procedural simulation for placement of a 3-piece IPP. METHODS: Anatomical penile models consisting of a male pelvis, penis, urethra, corporal bodies, inguinal canals, iliac vessels and relevant adjacent structures were created using 3D-printed injection molds. The molds are filled with a poly-vinyl alcohol, a hydrogel that can be modified to replicate realistic tissue consistency. Relevant procedural steps: corporal exposure, dilation, measurement, scrotal pump placement, reservoir placement, prosthesis assembly and closure can be simulated using both an infrapubic or penoscrotal approach. The model has the ability to detect surgical errors including perforation of corpora during dilation, damage to iliac vessels or urethra and improper prosthesis placement. Twelve surgeons: three experts (>250 caseload), three low volume faculty (>50 caseload) and six novices (residents), completed an IPP insertion on the model under operating room conditions, after which a survey assessing realism and usefulness as a training tool was completed. RESULTS: When compared to live surgery, over 83.3% of the participants agreed that the model realistically replicated the skin retraction, placement of corporal stay sutures, corporotomy, distal dilation, prosthesis measurement, and IPP placement (Figure 1). Skin incision, proximal dilation, reservoir placement, corporal closure and skin closure was found to be realistic in above 66.7% of participants. On average experts agreed that the model could function as a training tool, assessment tool, prerequisite for IPP accreditation, and a requirement prior to live surgery. Experts stated ideally, they would have their trainees complete an average of 3.33 models before live surgical training. CONCLUSIONS: This video presents a high-fidelity, anatomical, hydrogel simulation platform for 3 piece IPP placement. With the ability to replicate surgical errors, its educational effectiveness as a training tool is further supported. This platform requires no specialized facilities and offers the basis for future male genital reconstruction simulations such as correction of Peyronie’s disease and artificial urinary sphincter insertions. Source of Funding: None © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e646-e646 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Patrick Saba More articles by this author Rachel Melnyk More articles by this author Michael Witthaus* More articles by this author Gareth Warren More articles by this author Divya Ajay More articles by this author Alexander Cranwell More articles by this author Ricardo Munarriz More articles by this author Ahmed Ghazi More articles by this author Expand All Advertisement PDF downloadLoading ...

Combined robotic and cystoscopic surgery for rectal cancer invading urinary bladder.

Although the application of laparoscopic rectal surgery has been widely accepted by accumulated evidence, it remains technically difficult in some cases of obesity, narrow male pelvis, bulky tumors, or involvement of adjacent organs. After robotic rectal surgery has been covered by the health insurance system in Japan since April 2018, we have employed robotic rectal surgery for an increasing number of cases by taking advantages of its 3D vision and wrist function. When a colorectal cancer involves the urinary bladder, the surgical treatment of choice is an anterior resection with en bloc (partial or total) bladder resection, depending on the site and extent of bladder involvement. In the attached video, robotic surgery was conducted with the aid of intraoperative cystoscopy, which resulted in curative resection with negative margin. Given that the robotic system provides excellent stability and dexterity for bladder reconstruction, the robotic approach can be technically suitable for locally advanced T4 colorectal cancer with urinary involvement.

Robotic urethral reconstruction: redefining the paradigm of posterior urethroplasty.

Outlet procedures for benign prostatic hypertrophy, prostate cancer therapy, and trauma can result in stenosis of the posterior urethra, a complex reconstructive problem that often fails conservative endoscopic management, necessitating more aggressive and definitive reconstructive solutions. This is typically done with an open technique which may require a combined abdominoperineal approach, pubectomy, and/or flap interposition. Implementation of a robot-assisted platform affords several potential advantages including smaller incisions, magnified field of vision, near-infrared fluorescence (NIRF) imaging to characterize tissue integrity, enhanced dexterity within the deep and narrow confines of the male pelvis, sparing of the perineal planes, and shorter convalescence. Herein, we describe important surgical considerations for robotic posterior urethral reconstruction.

Morphology of the fetal renal pelvis during the second trimester: Comparing genders

ObjectivesMany studies of neonates have shown that renal pelvis ectasia is more common in boys. The aim of this study was to determine whether there are structural differences in the renal pelvis between male and female fetuses in the second trimester of gestation. Material and methodsWe studied 34 renal pelvises obtained from 34 human fetuses (17 males and 17 females), ranging in age from 13 to 23 weeks postconception. The renal pelvis tissue was stained with Masson’s trichrome to quantify connective and smooth muscle cells (SMC). The tissue also was fixed for scanning electron microscopy (SEM) in a modified Karnovsky solution. The images were captured with an Olympus BX51 microscope and Olympus DP70 camera. The stereological analysis was done with the Image-Pro and ImageJ programs, using a grid to determine volumetric densities (Vv). Means were statistically compared using simple linear correlation and the Mann-Whitney test (p<0.05). ResultsQuantitative analysis indicated differences (p=0.0275) in Vv of connective tissue in male renal pelvises (mean=55.3%) compared to female ones (mean=51.46%). Quantitative analysis indicated a significant difference (p=0.0002) in SMC in male renal pelvises (mean=12.57%) compared to female ones (mean=16.22%). When we compared the SMC at different ages, we did not find any correlation in male (r2=0.2657, p=0.3027) or female fetuses (r2=0.3798, p=0.1326). When we compared the connective tissue at different ages, we did not find any correlation in female fetuses (r2=0.3798, p=0.2870), but we did observe a positive correlation between the connective tissue and age in male fetuses (r2=0.8308, p<0.0001). SEM showed that the collagen fibers had no differences between male and female. ConclusionThe renal pelvis presents significant structural differences between male and female fetuses. The renal pelvis in males had less SMC and presented a positive correlation of connective tissue with age and the renal pelvis in female had less connective tissue without correlation with the age. Level of evidenceIII