Neurovascular Bundle Research Articles

Ischemic Risks Induced by Larger Orthodontic Forces on Dental Pulp and Neuro-Vascular Bundle in Reduced Periodontium

Background/Objectives: There are few data about the ischemic risks induced by the large orthodontic forces during periodontal breakdown in dental pulp and neuro-vascular bundle (NVB) and none on the individual tissular stress distribution, despite their great importance for orthodontic treatment planning. Our aim was to assess, by a numerical analysis, the biomechanical behavior of dental pulp and the NVB during a simulated horizontal periodontal breakdown (1–8 mm), under 2–4 N of applied orthodontic forces and five movements (rotation, translation, tipping, intrusion, and extrusion). Additionally, the ischemic and degenerative-resorptive risks were assessed. Methods: The analysis involved 72 3D models of nine patients, totaling 720 simulations. The models were CBCT-based, having the second lower premolar and surrounding periodontium, and they suffered 1 mm of gradual horizontal periodontal breakdown (up to 8 mm loss). Results: Both forces displayed a similar qualitative stress distribution in all five movements, but with a quantitative increase (doubling of stress amounts for 4 N when compared with 2 N). The highest amounts of stress were displayed at 8 mm of periodontal loss, which is lower than the 16 KPa of the maximum hydrostatic pressure. The NVB stress was higher than the pulpal stress. Rotation was the most stressful, closely followed by tipping, intrusion, and extrusion. Conclusions: A total of 4 N of applied force seems to not induce any ischemic or degenerative-resorptive risks for healthy intact teeth, in up to 8 mm of periodontal breakdown. Intrusion and extrusion determined the highest visible tissular deformation in the NVB, with potential ischemic and resorptive-generative risks for previously traumatized/injured teeth (i.e., occlusal trauma). Rotation and translation (in particular) showed the highest coronal and radicular pulpal stress with potential ischemic and resorptive-generative risks for previously injured/traumatized dental pulp (i.e., direct-indirect pulp capping). It seems that 4 mm of periodontal breakdown could signal a clinical stress increase with potential ischemic and degenerative-resorptive risks for the previously traumatized/injured tissues.

Impact of Intraoperative Prognostic Factors on Urinary Continence Recovery Following Open and Laparoscopic Radical Prostatectomy

Background and Objectives: Radical prostatectomy (RP) stands as the predominant instigator of postoperative stress urinary incontinence. Techniques such as the preservation of the neurovascular bundles, bladder neck preservation, and ensuring longer postoperative urethral length have shown positive impacts on continence. The posterior reconstruction is another method that aids in early continence recovery. Anterior suspension as simulator of puboprostatic ligaments is another factor. Materials and Methods: This study was conducted in the Clinic of Urology, University Clinical Center of Serbia, between December 2014 and January 2020, employing a prospective, non-randomized comparative design. Data were meticulously gathered from 192 consecutive patients. The process of regaining continence was monitored at intervals of 1, 3, 6, 12, and 24 months after surgery. The main criterion for assessing the level of urinary continence was the number of pads used daily. Results: The distribution of overall continence rates in the BNP vs. no-BNP group at 3, 6 and 12 months was 86% vs. 60% (p < 0.0001), 89% vs. 67% (p < 0.0001), 93% vs. 83% (p = 0.022). Continence rates in non-posterior reconstruction group (10%, 22%, 34%, and 54% at 1, 3, 6, and 12 months) were statistically significantly lower (p < 0.0001). The patients who underwent urethral suspension exhibited significantly higher rates of overall continence at 1 mo (73% vs. 29%, p < 0.0001), 3 mo (85% vs. 53%, p < 0.001), 6 mo (89% vs. 62%, p < 0.0001), 12 mo (95% vs. 76%, p < 0.0001), and 24 mo (93% vs. 81%, p = 0.007). Patients who underwent urethral suspension had a four-fold greater likelihood of regaining continence (p = 0.015). Conclusions: Patients who underwent urethral suspension or BNP or posterior reconstruction had higher continence rates. Only the urethral suspension was found to be a significant prognostic factor of continence recovery.

Rostral Mandibular Fracture and Dentoalveolar Trauma Secondary to Climbing Stairs With a Foreign Object in the Mouth in Four Dogs.

Rostral mandibular injuries present unique challenges for repair. The presence of strategically important teeth which occupy a large volume of the mandible, multiple tooth roots and the mental neurovascular bundle all combine to limit treatment options that serve to preserve the form and function of the involved structures. This case series describes the approach to treatment for rostral mandibular trauma seen in four dogs with a unique etiology that has not been previously described.

A Delphi-based exploration of factors impacting blood loss and operative time in robotic prostatectomy.

This study aims to investigate factors influencing the implementation of robotic-assisted radical surgery, with a specific focus on their effects on blood loss and operative time. Radical prostatectomy was chosen as the case study due to its complexity and diverse surgical activities. The study employed a three-round Delphi approach involving 25 surgeons from three countries: UK, Australia, and China. The collected data were analysed using non-parametric tests. The Delphi study showed significant correlations between the degree of difficulty and blood loss (Z = 2.698, ρ < 0.007), as well as between team coordination and blood loss (Z = 3.499, ρ < 0.0001). However, no significant relationship was found between operative time and blood loss. Surgeons reported that neurovascular bundle (NVB) release and pelvic lymph node dissection require high team coordination. NVB release is particularly challenging and poses a higher risk of blood loss. Additionally, a large prostate increases the difficulty of prostate dissection, prolongs operative time for bladder neck and NVB dissection, and leads to a considerable overall increase in operative time. The manuscript shows that effective team coordination plays a crucial role in reducing blood loss and operative time during surgical activities. When the team coordinates well, clear and efficient verbal communication suffices, reducing the need for physical proximity during robotic-assisted surgeries.

MRI genicular nerve mapping: a novel approach to sagittal genicular nerve localization

Background and objectivesChronic knee pain, including postarthroplasty knee pain, is a major cause of morbidity. Radiofrequency ablation of genicular nerve branches is a treatment option. The literature to date has...

PPP04 Presentation Time: 10:57 AM: Long-Term Sexual Health Related Quality of Life after Whole Gland MRI-Guided High Dose-Rate Prostate Brachytherapy Boost: Impact of the Dose to the Neurovascular Bundles

PPP04 Presentation Time: 10:57 AM: Long-Term Sexual Health Related Quality of Life after Whole Gland MRI-Guided High Dose-Rate Prostate Brachytherapy Boost: Impact of the Dose to the Neurovascular Bundles

Saturday, July 13, 202411:30 AM - 12:30 PMPSOR01 Presentation Time: 11:30 AM: Dosimetric Comparison of Standard Low-Dose-Rate Prostate Brachytherapy versus Focal Sparing to One of the Prostatic Neurovascular Bundles: An Early Analysis from the PRIAPUS Trial

Saturday, July 13, 202411:30 AM - 12:30 PMPSOR01 Presentation Time: 11:30 AM: Dosimetric Comparison of Standard Low-Dose-Rate Prostate Brachytherapy versus Focal Sparing to One of the Prostatic Neurovascular Bundles: An Early Analysis from the PRIAPUS Trial

The Effect of Larger Orthodontic Forces and Movement Types over a Dental Pulp and Neuro-Vascular Bundle of Lower Premolars in Intact Periodontium-A Numerical Analysis.

This numerical analysis of stress distribution in the dental pulp and neuro-vascular bundle (NVB) of lower premolars assessed the ischemic and degenerative-resorptive risks generated by 2 and 4 N during orthodontic movements (rotation, translation, tipping, intrusion and extrusion) in intact periodontium. The numerical analysis was performed on nine intact periodontium 3D models of the second lower premolar of nine patients totaling 90 simulations. In intact periodontium, both forces displayed a similar stress distribution for all five orthodontic movements but different amounts of stress (a doubling for 4 N when compared with 2 N), with the highest values displayed in NVB. In intact periodontium, 2 N and 4 N induced stresses lower than the maximum hydrostatic pressure (MHP) with no ischemic risks for healthy intact teeth. The rotation was seen as the most stressful movement, closely followed by intrusion and extrusion. Translation was quantitatively seen as the least stressful when compared with other movements. Larger orthodontic forces of 2 N and 4 N are safe (with any expected ischemic or resorptive risks) for the dental pulp and NVB of healthy intact teeth and in intact periodontium. Nevertheless, rotation and translation movements can induce localized circulatory disturbances in coronal pulp (i.e., vestibular and proximal sides) generating ischemic and resorptive risks on previously treated teeth (i.e., direct and indirect dental pulp capping). The intrusion and extrusion movements, due to the higher NVB-induced deformation when compared with the other three movements, could trigger circulatory disturbances followed by ischemia on previously traumatized teeth (i.e., occlusal trauma).

Simulating Upper Eyelid Ptosis During Neuromodulator Injections-An Exploratory Injection and Dissection Study.

Aesthetic neuromodulator injections of the upper face are frequently performed to temporarily block muscular actions of the periorbital muscles to ultimately reduce skin rhytids. However, the adverse event rate in the literature for toxin-induced blepharoptosis ranges from 0.51% to 5.4%. To identify access pathways by which injected neuromodulator product can travel from extra- to intra-orbital and therefore affect the levator palpebrae superioris muscle. Nine non-embalmed human body donors were investigated in this study with a mean age at death of 72.8 (16.1) years. The 18 supraorbital regions were injected in 28 times (14 for supratrochlear and 14 for supraorbital) with 0.5 cc, whereas eight cases (four for supratrochlear and four supraorbital) were injected with 0.1 cc of colored product. Anatomic dissections were conducted to identify structures stained by the injected color. The results of this injection- and dissection-based study revealed that both the supratrochlear and the supraorbital neurovascular bundles are access pathways for injected neuromodulator products to reach the intra-orbital space and affect the levator palpebrea superioris muscle. Out of 36 conducted injection passes, seven (19.44%) resulted in affection of the sole elevator of the eyelid of which 100% occurred only at an injection volume of 0.5 cc and not at 0.1 cc. Clinically, the results indicate that a low injection volume, a superficial injection for the supraorbital location, and angling the needle tip away from the supratrochlear foramen (toward the contralateral temple) when targeting the corrugator supercilii muscles, can increase the safety profile of an aesthetic toxin glabellar treatment.

Ninth Version of the AJCC and UICC Nasopharyngeal Cancer TNM Staging Classification

Accurate staging is a fundamental step in treating patients with nasopharyngeal carcinoma (NPC) worldwide; this is crucial not only for prognostication, but also for guiding treatment decisions. The American Joint Committee on Cancer (AJCC)/Union for International Cancer Control (UICC) tumor-node-metastasis (TNM) system is the global language for clinicians, researchers, and cancer registries. Continual improvement that aligns with contemporary pattern of care is essential. To improve the prognostic accuracy and clinical applicability of the eighth edition (TNM-8) for NPC. This multicenter study analyzed patients with NPC with detailed tumor features during January 2014 and December 2015 and was reviewed by experienced radiologists. The data analysis was completed in December 2023. The findings were further confirmed with internal and external validation. Statistical analyses and clinical considerations were reviewed by the AJCC/UICC multidisciplinary head and neck panels and attained consensus. The recommendations were evaluated by the AJCC Evidence-Based Medicine Committee before final endorsement as the ninth version (TNM-9). The primary end point was overall survival. Adjusted hazard ratios of different subgroups were then assessed for confirmation of optimal stage grouping. Of the 4914 patients analyzed, 1264 (25.7%) were female and 3650 (74.3%) were male; the median (SD) age was 48.1 (12.0) years. Advanced radiological extranodal extension (with involvement of adjacent muscles, skin, and/or neurovascular bundles) was identified as an independent adverse factor for all end points: this was added as a criterion for N3. Patients with nonmetastatic disease were regrouped into stages I to III instead of TNM-8 stages I to IVA. Significant hazard discrimination was achieved by grouping T1-2N0-1 as stage I, T3/N2 as stage II, and T4/N3 as stage III. Although the T1-2N0-1 subgroups had comparable 5-year overall survival, subdivisions into IA (T1-T2N0) and IB (T1-T2N1) were recommended due to the distinction in adjusted hazard ratios following adjustment for chemotherapy use. Metastatic disease was exclusively classified as stage IV, and prognostication was further refined by subdivision into IVA (M1a, ≤3 lesions) and IVB (M1b, >3 lesions). TNM-9 demonstrated superiority compared with TNM-8 in major statistical aspects. The results of this diagnostic study suggest that the ninth version of TNM staging for NPC, based on robust analyses and a comprehensive review by the AJCC/UICC staging committees, provides an improved staging system for global application and a framework for future incorporation of nonanatomical factors. This will be launched for global application in January 2025.

A two-headed accessory muscle on the sole of the foot

Anatomical variations include the absence of a muscle or tendon or its presence as an accessory muscle or tendon. Clinically, anatomic variations play an important role in diagnosis and theraphy. In anatomy dissection laboratory, during routine dissection for educational purposes, a 83 -year- old male cadaver was dissected and a two-headed accessory muscle was observed on the plantar surface of the left foot. The medial and lateral heads of the muscle were observed close to the medial and lateral plantar neurovascular bundles. The accessory muscle was pierced by the tendon of the flexor digitorum longus muscle and both muscles were inserted to the distal phalanx of the fifth toe. The variations of the accessory muscles should be taken into consideration in surgical interventions, since, they may change the course of the intervention or as in the case of abductor hallucis muscle, they may be used in reconstructive procedures as grafts. Therefore, it is crucial for surgeons, orthopedic physicians, and anatomists to have a detailed knowledge of the intrinsic muscles of the foot.22-07-2024

Surgical Anatomy of the Supraretinacular Fat Pad: Sensory Innervation and Preservation in Open Carpal Tunnel Release

BACKGROUND AND OBJECTIVES: Postoperative pain may occur following open carpal tunnel release (OCTR). Various causes have been postulated. During OCTR, adipose tissue located between the palmar aponeurosis and the flexor retinaculum is exposed. It is unknown whether damage to this pad of supraretinacular fat (SRF) might contribute to postoperative palmar pain or tenderness. We studied the sensory innervation of the SRF exposed in OCTR to assess whether SRF damage could potentially generate pain. METHODS: A microanatomic dissection of the innervation and vascular supply of the SRF was performed in 25 embalmed human cadaveric upper limbs. Eight fat pads were removed en bloc for histological evaluation. Three-dimensional reconstructions were made based on immunohistochemically stained sections using computer-assisted microscopy. RESULTS: The SRF is the radial continuation of the hypothenar fat pad that covers the neurovascular bundle in the Guyon canal. The fat pad is richly innervated and contains Pacinian corpuscles. The sensory innervation originates exclusively from the ulnar nerve (palmar branch) and its vascular supply from the ulnar artery. The integrity of the SRF can be preserved by detaching it from the flexor retinaculum in a radial to ulnar fashion. CONCLUSION: The SRF, which is exposed during OCTR, is richly innervated by sensory fibers from the ulnar nerve. It is the radialmost extension of the hypothenar fat pad. In view of its rich innervation, damage to the SRF during OCTR might generate postoperative pain. Preserving its integrity during OCTR is technically possible and even simplifies the procedure. Clinical trials are needed to corroborate whether preservation of the SRF during OCTR indeed makes a clinical difference in postoperative pain generation.

An extensive infiltrative diffuse tenosynovial giant cell tumor in both compartment of the forearm: A case report

Diffuse tenosynovial giant cell tumors are relatively rare but second most common tumor effecting the synovial containing tissues. The study aim was to present a case involving a 40-year-old male patient with a complaint of a progressively enlarging swelling on the radial side of right wrist. On local examination, there was a bi-lobed swelling 7×9 and 6×5 cm on the dorsolateral and anterolateral aspect of right wrist respectively. Through Hennery’s modified approach tumor was exposed. It was extending from dorsolateral to anteromedial wrist encasing the flexors, extensor and abductor tendons of thumb and radial neurovascular bundle and adjacent wrist and finger flexors. The tumor surrounding the tendons was carefully removed, and carpal tunnel release was performed to address the tingling sensation. The patient managed was having lobulated diffuse type tumor involving the both flexor and extensor compartment. Better outcome, less morbidity and least chance of recurrence can be expected if the tumor had been operated earlier.

TREATMENT OF PROSTATE CANCER USING ROBOT-ASSISTED LAPAROSCOPIC RADICAL PROSTATECTOMY WITH RECONSTRUCTION OF THE PROXIMAL PROSTATIC URETHRA

Introduction: Prostate cancer (PCa) has been one of the leading oncologic pathologies for decades. In the low-risk group the nerve-sparing technique of surgery is used, which is supplemented by preservation and reconstruction of the prostatic urethra. The effectiveness of this technique in preserving the quality of urination, a significant reduction in the rehabilitation time of patients without reducing the quality of the oncologic result of the operation is described. The aim of the study: To evaluate the long-term results of robot-assisted laparoscopic radical prostatectomy with prostatic urethra reconstruction. Materials and Methods: 60 patients were included in the study. Patients’ selection criteria: low risk of disease prevalence, focal form, tumor location more than 4 mm from the prostatic urethra. During the operation a precision dissection of the prostatic urethra from the prostate is performed. Up to 2cm of the proximal section is preserved, a similar manipulation is performed with the distal urethra. After removal of the prostate, the integrity of the urethra is restored by applying urethro-urethral anastomosis. Before the operation the patients underwent standard examination, including general clinical tests, blood test for prostate-specific antigen (PSA), ultrasound, magnetic resonance imaging (MRI) with 3D modeling. There are also results of pathohistological report, International Prostate Symptom Score (IPSS), International Index of Erectile Function (IIEF), Quality of Life due to urinary disorders, Partin nomogram. Results: All studied parameters showed good results after 1 month, which were maintained after 6 and 12 months. In 1 patient (1.67%) there was a biochemical recurrence after 6 months (PSA 0.35 ng/ml), which was visualized by MRI as an area of contrast accumulation in the area of neurovascular bundles, the preserved urethra was intact. Conclusion: Based on the results of the study, there is preservation of the quality of life and no increase in oncologic risk one year after surgery. It is possible to expand the selection criteria and perform prostatic urethra preservation without performing nerve-sparing.

Arthroscopic Iliopsoas Fractional Lengthening After Total Hip Arthroplasty: Utilization of the Iliopsoas Air Bursogram Technique for Safe and Efficient Access

Background: Patients with persistent symptomatic iliopsoas tendonitis following total hip arthroplasty may benefit from iliopsoas fractional lengthening. We present an arthroscopic approach utilizing an air bursogram that provides safe and predictable access to the iliopsoas tendon for efficient tendon lengthening without violating the capsule or unintentional instrumentation of the nearby medial neurovascular bundle. Indications: Arthroscopic iliopsoas fractional lengthening is indicated for patients with clinical evidence of symptomatic iliopsoas tendonitis following total hip arthroplasty and have no radiographic evidence of frank acetabular malpositioning. A diagnosis of iliopsoas tendinitis amenable to surgical management can be established with substantial but nondurable relief following image-guided anesthetic injection to the iliopsoas bursa. Technique Description: Under fluoroscopic guidance, an air bursogram is employed in the anatomic plane of the iliopsoas tendon to accurately identify its course. This allows for hip portal placement with precise subsequent instrumentation. This technique is preferred in the setting of postarthroplasty anatomy because it avoids capsular violation and the challenge of working in an altered anatomic space with a nearby, medially based neurovascular bundle. Results: Arthroscopic and endoscopic approaches to iliopsoas release have been shown to provide excellent functional and patient-reported outcomes in &gt;85% of patients, and several studies have shown that an arthroscopic approach not only provides a less invasive technique but also results in comparable or improved clinical outcomes with lower revision rates compared to open release or acetabular cup revision. Our technique for arthroscopic iliopsoas fractional lengthening using the air bursogram is both safe and reproducible and offers distinct advantages, including maintenance of an intact capsule, visual confirmation of the correct anatomic structure to be released, and percutaneous access with standard arthroscopic access cannulas without the need for hip distraction. Conclusions: Arthroscopic fractional iliopsoas lengthening is a minimally invasive and successful treatment option for patients with persistent groin pain after total hip arthroplasty, especially without substantial acetabular component malpositioning. This technique includes using an air bursogram to safely identify and navigate to the iliopsoas tendon without violating the hip capsule, thereby reducing the risk of inadvertent instrumentation of adjacent critical neurovascular structures. Patient Consent Disclosure Statement: The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.

A new approach: Cervical approach for marginal resection of the posterior mandible

Gingival squamous cell carcinoma (SCC) of the posterior mandible often requires marginal resection of the mandible in conventional surgery. However, the posterior location of the lesion can limit surgical visibility, which is critical for complete tumor removal and minimizing recurrence. Typically, marginal resection of the posterior mandible is achieved through a midline lower lip incision and mental nerve transection, providing adequate exposure but resulting in nerve damage, lip numbness, and facial scarring. In this paper, we describe a case using a submandibular incision for neck dissection, extending from the mandibular angle to the mental foramen, to fully expose the posterior mandible. The intraoral incision, extending 1 cm beyond the tumor margin, connected with the submandibular incision. Under direct vision, we performed a marginal resection of the mandible, preserving the inferior alveolar neurovascular bundle and the mental nerve, and maintaining at least 1 cm of the inferior mandibular margin. This technique achieved complete tumor removal while preserving mental nerve function and lower lip integrity, reducing surgical difficulty and patient trauma. This approach maintains nerve function and aesthetics as much as possible, with a faster postoperative recovery. In treating gingival SCC of the posterior mandible, it is essential to preserve surrounding healthy tissue and critical anatomical structures, minimizing postoperative complications while ensuring complete tumor resection.

Impact of Cryopreserved Placental Allografts on Biochemical Recurrence in Prostate Cancer.

Human placental allografts are widely used to promote wound healing. Placental (or amniotic membrane/umbilical cord) allografts are placed along the neurovascular bundles during radical prostatectomy to improve continence and erectile function recovery. It is unknown whether placental allografts impact biochemical recurrence (BCR). This was a single-surgeon retrospective study of 566 robotic radical prostatectomies performed from April 2015 to March 2021. The patients were divided into three groups: the negative control, Brand A, and Brand B. Brand A and Brand B were both cryopreserved amniotic membrane (CAM) allografts. A total of 324 cases were included for BCR Kaplan-Meier and risk-adjusted multivariate analyses (362 for continence analysis). In vitro analyses were performed to determine the effect of CAM allografts on prostate cancer (PCa) cell line growth. For propensity score-matched analysis (adjusting for pre-operative PSA, tumor stage, Gleason Grade, and margin status), (1) the allograft groups did not show differences in time to BCR vs. the negative control group (p = 0.7), and (2) combined allograft treatment groups showed better continence recovery vs. the negative controls (p = 0.01). In vitro, placental allografts reduced PCa cell line growth in co-culture assays. cryopreserved AM allografts (combined or individual brands) did not show a significant effect on BCR but improved continence recovery for PCa patients.

Lessons learned from the Sexual Medicine Society of North America fellowship bootcamp.

Sexual Medicine Society of North America (SMSNA) fellowships offer variable experience in sexual health domains: erectile dysfunction, Peyronie's disease, male infertility, male hypogonadism (low testosterone), reconstruction (including male incontinence), benign prostatic hyperplasia, gender affirmation surgery, sexual mental health, and female sexual dysfunction. To evaluate baseline and postbootcamp understanding and trust in these domains. In 2023, 28 of 31 urologists currently enrolled in SMSNA-endorsed fellowships participated in a 3.5-day training bootcamp in Minneapolis, Minnesota. Participants were asked to complete pre- and postbootcamp surveys. The bootcamp curriculum offered American Urological Association guidelines and case-based lectures, hands-on clinical training with cadavers (penile surgery) and models (collagenase training), and interaction with industry. Changes in knowledge, independence, and trust in performing the procedures, as well as billing issues and feedback for future bootcamps. Prebootcamp surveys revealed vastly varied residency experience. Reported time with an expert faculty member was greatest for benign prostatic hyperplasia and least for female sexual dysfunction, gender affirmation surgery, and low testosterone. The lowest prebootcamp confidence in performing surgery independently was for penile grafting procedures and elevating the neurovascular bundle. Postbootcamp results revealed several areas of significant improvement in confidence (P ≤ .03): intralesional injections for Peyronie's disease, manual modeling, penile plication, penile grafting procedures, and elevating the neurovascular bundle. There was a trend for improved confidence with the insertion of inflatable (P = .05) and semirigid (P = .08) penile prostheses. Nonsignificant improvement occurred in artificial urinary sphincter surgery (P = .12). Participants graded the bootcamp very highly and requested that next year's bootcamp have more content on female sexual dysfunction, male incontinence, and low testosterone, as well as more hands-on skills sessions and case-based lecture formats. Offering a bootcamp with hands-on instruction could significantly improve urologists' knowledge and confidence. As the main strength, this study was the first specialized bootcamp for urologists in the subject of men's health, taking into account hands-on and cadaver laboratories, as well as highlighting industrial and pharmaceutical products. The small sample size was the major limitation. Current SMSNA fellows present with varied levels of experience and confidence across sexual health domains. Notable confidence improvements were seen with topics that combined didactic lectures with hands-on trainings.

Three-Dimensional Quantitative Analysis of Internal Limiting Membrane Peeling Related Structural Changes in Retinal Detachment Repair

PurposeTo assess macular microstructural changes associated with internal limiting membrane peeling (ILMP) using three-dimensional optical coherence tomography (3D-OCT) in primary macula-off rhegmatogenous retinal detachment (RRD) repairs with vitrectomy and silicone oil (SO) tamponade. DesignRetrospective, consecutive, interventional case series. MethodsSetting: Institutional practice. Patient Population: Patients who received primary RRD repair by a single experienced surgeon between January 2017 and December 2021. Main Outcome Measures: In the qualitative comparative analysis, the presence of macular changes among patients who underwent primary RRD repair with (21 eyes) or without ILMP (20 eyes) were observed. Subsequently, a detailed quantitative analysis of ILMP-related microstructural changes in 56 eyes using both 3D and 2D-OCT images were performed. ResultsIn the qualitative comparative analysis, macular microstructural changes were observed in 95% of ILMP eyes and 5% of non-ILMP eyes (p < 0.001). In the quantitative analysis, four major macular microstructural changes were detected: dimple (75%), dissociated nerve fiber layer (DONFL) (55%), ILM peeling edge thinning (IPET) (64%), and temporal macular groove (TMG) (23%). Dimples (n = 251, average 4.5 ± 5.8 per eye) could be further classified into type I (confined to the inner plexiform layer [IPL]; 73%) and type II (beyond IPL, 27%). The average depth of the deepest dimples was 58 ± 18 μm. The extent of IPET was 6.0 ± 3.7 clock hours. The average length of TMG was 1.8 ± 0.4 mm. Comparing to unoperated fellow eyes, the eyes after ILMP showed decreased inner temporal over nasal retinal thickness ratio (0.86 ± 0.07 versus 0.96 ± 0.03, p < 0.001), shorter disc-fovea distance (4.61 ± 0.32 µm versus 4.78 ± 0.37 µm, p = 0.041), and wider retinal vein trajectories (c’ = 2.48 ± 0.84 versus 3.39 ± 1.61, p = 0.002). ConclusionsMacular microstructural changes are common after ILMP in RRD repair, encompassing both focal changes (dimples, DONFL) and zonal changes (IPET, TMG). DONFL and dimples may be part of a continuum of findings stemming from the same mechanism. IPET and TMG are the results of macular tissue shift due to contracture of the optic disc and neurovascular bundle.

Popliteal Vein Entrapment as a Rare Form of Popliteal Entrapment Syndrome.

Popliteal entrapment syndrome (PES) describes a cluster of symptoms related to the compression of the neurovascular bundle in the popliteal fossa, most commonly involving the popliteal artery. In approximately 10-15% of the cases of popliteal entrapment syndrome, the popliteal vein is compressed. Symptoms of popliteal vein entrapment can mimic venous insufficiency or deep venous thrombosis, causing the diagnosis to be missed or delayed. Diagnosis of popliteal vein entrapment can be done with duplex imaging with flexion and extension maneuvers; however, venography is the gold standard for diagnosis. While popliteal vein entrapment is commonly associated with younger individuals, it may also be an underdiagnosed condition in older patients. We describe two cases of successful diagnosis and treatment of late-onset presentation of popliteal vein entrapment.