Sparing Technique Research Articles

The Impact of Cardiac Sparing Techniques on Heart and Lung Dose in the Setting of Partial Breast Irradiation: A Dosimetric Follow-up to the IMPORT Low Trial

The Impact of Cardiac Sparing Techniques on Heart and Lung Dose in the Setting of Partial Breast Irradiation: A Dosimetric Follow-up to the IMPORT Low Trial

Laparoscopic Nerve Sparing Technique for Bladder Endometriosis Infiltrating the Anterior Parametrium

Study Objective The purpose of this video is to demonstrate the Nerve Sparing (NS) technique for resection of infiltrating endometriosis on the upper part of the trigone, which extends to the left anterior parametric (deep portion of the vesicouterine ligament). Design The NS technique for resection of an endometriotic lesion infiltrating the anterior parametrium aims at preserving the anterior efferent bundles (vesical nerve), which transmit the parasympathetic stimuli for the contraction of the detrusor muscle (motor nerve). Setting Cystoscopy was used to determine the exact location of the lesion in relation to the trigone and ureteral openings. The laparoscopic procedure was performed with a 3D camera. Patients or Participants A 38-year-old patient presented with cyclic urinary pain. MRI showed a 3.0 cm endometriotic lesion located on the upper part of the trigone, close to the ureteral opening and extending to the deep portion of the vesicouterine ligament. The lesion was palpable upon vaginal touch. Interventions The vesicocervical and vesicovaginal spaces were dissected and the endometriotic lesion was individualized. The left vesicouterine ligament was isolated and the structures were individualized. The vesical arteries (superior, middle and inferior) were dissected and the first two were sectioned. The uterine artery and the ureter were individualized and isolated through dissection and sectioning of the intraligamentous connective tissue, thus, separating them from the infiltrative lesion. The lesion was removed and the bladder was sutured. The left anterior efferent bundles, coming from the inferior hypogastric plexus and originating from S2-S3-S4 (Pelvic Splancnic Nerves), were identified and preserved. Measurements and Main Results There were no intraoperative complications. After 1 year the patient remains asymptomatic. MRI in the 3rd postoperative month showed absence of endometriotic lesion. Conclusion The Laparoscopic Nerve Sparing technique is safe and effective to treat bladder endometriosis infiltrating the anterior parametrium.

Role of Cardiovascular Magnetic Resonance Imaging in Assessment of Myocardial Iron Overload in Thalassemic Patients

Background: Thalassemia major anemia patients require repeated blood transfusions, which improves their survival and quality of life, however it leads to iron overload and cellular damage. Serum ferritin and liver biopsy were used classically to measure iron overload and to monitor patient response to chelation therapy. Magnetic resonance imaging (MRI T2*) has proven to be a non-invasive, effective technique in detecting and quantifying iron in the heart and liver and in adjustment of iron chelation therapy. Objective: To assess myocardial siderosis among our patients using MRI T2* technique and correlate it with hepatic iron load and left ventricular ejection fraction (LVEF). Patients and methods: Our study included 42 cases of monthly transfused patients. Hepatic and myocardial iron overload were measured by multi-breath-hold MRI T2* technique and a cine view sequence was used to assess left ventricular function (EF). Results: Myocardial and hepatic iron overload were inter-correlated to each other and correlated to left ventricular function (LVEF). There was insignificant correlation between cardiac and hepatic T2* value results (k = 0.014, P > 0.05). However, there was a progressive and significant decline in left ventricular ejection fraction (r = 0·61, P < 0·001) in patients with low cardiac T2* values (T2* < 20 ms). Conclusion: MRI T2* technique is a precise, reproducible, and non-invasive technique for measuring tissue iron concentration and sparing the patients from an invasive biopsy technique. It also benefits in early detection of cardiac dysfunction and provides a follow up tool helping in chelation therapy adjustment.

Conservative Hemodynamic Surgery in the Management of Primary Varicosities of the Long Saphenous Vein: Emerging Experience in Suez Canal University Hospital

Background: Contrary to traditional long saphenous vein (LSV) surgeries, stripping and endovenous laser ablation, using heat coagulation, ambulatory conservative hemodynamic correction of venous insufficiency (CHIVA) is LSV sparing technique. Aim: Based on the lack of studies discussing success and recurrence rate, this study was designed to assess the immediate and one-year follow-up of this technique, as well as its efficacy and safety. Patients and Methods: Thirty-three patients with primary LSV varicosities were included in this uncontrolled clinical trial. Patients with LSV diameter of ≥ 9.5mm or pregnancy were excluded. Results: The mean age of our patients was 33.36±8.865 years, and 54.5% of them were males. According to Hobb's score, 25 patients (75.7%) were completely cured, 6 patients (18.1%) were improved, while 2 patients (6.2%) were considered as failure. Most (87.9%) of the patients showed absent or no visible recurrence. The rest showed visible recurrence by duplex ultrasound. All patients had significant improvement of their symptoms (no pain, or edema) at the immediate follow-up after operation. No complication including hematomas, ecchymosis, hemorrhage, saphenous nerve neuralgia, phlebitis, infection, deep or LSV thrombosis was detected. Conclusion: CHIVA is a successful and effective option in managing patients with primary long Saphenous varicosities, with minimal recurrence rate, after one-year of follow-up.

Eagle’s Syndrome: Presentation, Diagnosis, and Management

Objective: To study the presentation, diagnosis, and treatment options in Eagle’s Syndrome in a tertiary care hospital.&#x0D; Material and Methods: The study was conducted at the ENT department of District Headquarter Hospital, Rawalpindi from 1st January 2016 to 31st March 2019. All the patients who presented in outpatient (OPD) of the ENT department with pain around the ear and throat and diagnosed as a case of Eagle’s syndrome were included in the study. All the data of gender, age, CT scan findings, pain score, and management were noted on a predesigned proforma. Percentages and frequencies were calculated for all the data by using SPSS 21 version.&#x0D; Results: A total of 12 patients were included in the study, with 5 (42%) females and 7 (58%) males. The patient’s age range was from 24 to 68 years. Sharp, sudden onset, nerve-like pain was the major symptom in all cases. The length of the styloid process in 6 patients was between 3-4 cm and in 6 patients between 4-5 cm on a 3-dimensional computerized tomography scan. 100% of patients were managed surgically. In Group A (50%) styloidectomy was done after tonsillectomy while in other Group B (50%) patients styloidectomy was done by tonsil sparing technique. The relief of pain was a little better in patients of Group B.&#x0D; Conclusion: Sudden onset, sharp, shooting pain in the jaw area, around-ear, and in the throat with no other co-morbid should be investigated for Eagle’s syndrome. 3 dimensional CT scan is the best modality to see the length of the styloid process. Styloidectomy with tonsil sparing technique is a little better than tonsillectomy and gives early and permanent relief from this painful condition.

Long term outcomes of ureteroscopic management of upper tract urothelial carcinoma

ObjectivesUpper tract urothelial carcinoma (UTUC) is relatively rare. While nephroureterectomy is considered the gold standard for treatment, endoscopic nephron- sparing techniques have emerged for select cases with equivalent cancer specific survival (CSS). We present the largest series with longest follow-up to date of retrograde ureteroscopy as the primary treatment of UTUC. MethodsA retrospective review was performed of 258 patients diagnosed with UTUC who were initially evaluated and managed by a single surgeon. Patients were followed from 1994 to 2017. Clinical records were evaluated for patient and tumor characteristics, operative parameters and outcomes. Statistical analysis was performed to identify risk of recurrence, progression, cancer and overall survival. ResultsFollowing exclusion criteria, 168 patients were evaluated. Average tumor size on initial excision was 16.8mm. Mean age of the cohort was 70 years, with mean follow-up of 5.53 years. The 5-year overall survival was 80.9%, but CSS was 92.6%. Recurrence free survival was 30% with average tumor size on recurrence of 6.39mm. Progression free survival was 75% with a renal preservation rate of 71.4%. ConclusionsUreteroscopic management of UTUC is a successful alternative to nephroureterectomy in select cases of UTUC. With strict surveillance protocols to manage frequent local recurrence rates, it is possible to achieve high renal preservation rates with acceptable CSS, even in the long-term.

Spare Roof Technique Versus Component Dorsal Hump Reduction: A Randomized Prospective Study in 250 Primary Rhinoplasties, Aesthetic and Functional Outcomes.

Most Caucasian aesthetic rhinoplasty patients complain about having a noticeable hump in profile view. Taking the integrity of the middle vault into consideration, there are 2 ways to dehump a nose: the structured technique and the preservation technique. The aim of this study was to compare the aesthetic and functional outcomes of 2 reduction rhinoplasty techniques. We performed a prospective, randomized, interventional, and longitudinal study on 250 patients randomly divided into 2 groups: the component dorsal hump reduction group (CDRg) (n = 125) and the spare roof technique group (SRTg) (n = 125). We utilized the Utrecht Questionnaire for Outcome Assessment in Aesthetic Rhinoplasty. Patients answered the questionnaire before the surgery, and at 3 and 12 months after surgery. In addition, we utilized a visual analog scale (VAS) to score nasal patency for each side. Analyses of the preoperative and postoperative aesthetic VAS scores showed a significant improvement in both groups, from 3.66 to 7.00 (at 3 months) to 7.35 (at 12 months) in the CDRg, and from 3.81 to 8.14 (at 3 months) to 8.45 (at 12 months) in the SRTg. Analyses of postoperative means of aesthetic VAS scores showed a significant improvement in both groups over time. However, aesthetic improvement was higher in the SRTg than in the CDRg at both 3 (P < 0.001) and 12 months (P < 0.001) postsurgery. Analyses of the mean functional VAS scores showed a significant improvement with both techniques, with a better result for the SRTg. The SRT is a reliable technique that can help deliver consistently better aesthetic and functional results than CDR for reduction rhinoplasty in Caucasian patients with a dorsal hump.

Risk of erectile dysfunction after modern radiotherapy for intact prostate cancer.

Erectile dysfunction (ED) is a prevalent side effect of prostate cancer treatment. We hypothesized that the previously reported rates of ED may have improved with the advent of modern technology. The purpose of this project was to evaluate modern external beam radiotherapy and brachytherapy techniques to determine the incidence of radiotherapy (RT) induced ED. A systematic review of the literature published between January 2002 and December 2018 was performed to obtain patient reported rates of ED after definitive external beam radiotherapy, ultrafractionated stereotactic radiotherapy, and brachytherapy (BT) to the prostate in men who were potent prior to RT. Univariate and multivariate analyses of radiation dose, treatment strategy, and length of follow-up were analyzed to ascertain their relationship with RT-induced ED. Of 890 articles reviewed, 24 met inclusion criteria, providing data from 2714 patients. Diminished erectile function status post RT was common and similar across all studies. The median increase in men reporting ED was 17%, 26%, 23%, and 23%, 3DCRT, IMRT, low dose rate BT, and SBRT, respectively, at 2-year median follow-up. ED is a common side effect of RT. Risk of post-RT ED is similar for both LDR brachytherapy and external beam RT with advanced prostate targeting and penile-bulb sparing techniques utilized in modern RT techniques.

A Concise Paradigm on Radical Hysterectomy: The Comprehensive Anatomy of Parametrium, Paracolpium and the Pelvic Autonomic Nerve System and Its Surgical Implication.

The current understanding of radical hysterectomy is more centered on the uterus and little is discussed regarding the resection of the vaginal cuff and the paracolpium as an essential part of this procedure. The anatomic dissections of two fresh and 17 formalin-fixed female pelvis cadavers were utilized to understand and decipher the anatomy of the pelvic autonomic nerve system (PANS) and its connections to the surrounding anatomical structures, especially the paracolpium. The study mandates the recognition of the three-dimensional (3D) anatomic template of the parametrium and paracolpium and provides herewith an enhanced scope during a nerve-sparing radical hysterectomy procedure by precise description of the paracolpium and its close anatomical relationships to the components of the PANS. This enables the medical fraternity to distinguish between direct infiltration of the paracolpium, where the nerve sparing technique is no longer possible, and the affected lymph node in the paracolpium, where nerve sparing is still an option. This study gives rise to a tailored surgical option that allows for abandoning the resection of the paracolpium by FIGO stage IB1, where less than 2 cm vaginal vault resection is demanded.

Otoplasty Using Dermoperichondrial Flap as an Adjunct to Mustarde Suture Technique

Prominent ears are congenital deformities that are challenging to correct due to the risk of postoperative recurrence. While they have been traditionally reconstructed with cartilage excision or scoring and with cartilaginous sutures, flap techniques have been developed over the last 2 decades to improve the structural integrity of these repairs. The addition of a local flap helps to sustain long standing operative correction while maintaining optimal cosmetic outcomes that have been reported, particularly after cartilage sparing techniques. The authors describe a lateral dermoperichondrial flap on the posterior ear as an adjunct to the use of Mustarde sutures and contextualize its use in the landscape of existing otoplasty techniques.

EARLY COMPLEX REHABILITATION TREATMENT OF PATIENTS WITH FRACTURE OF DISTAL METAEPIPHYSIS OF THE RADIUS

Relevance. Fractures of the distal metaepiphysis of the radial bone among all fractures range from 11% to 30%. Unsatisfactory results of treatment in patients over 70 years old are found in 44% of cases. Timely and adequate rehabilitation treatment is important for obtaining good results in the treatment of such patients.&#x0D; Objective: to improve the results of the treatment of patients with fractures of the distal metaepiphysis of the radial bone based on early comprehensive individual rehabilitation treatment.&#x0D; Materials and methods. 97 patients with displaced fractures of the distal metaepiphysis of the radius were observed. Among them, 67 are women (69.1%), over 50 years old – 64 (66%). Used conservative treatment with a sparing technique of one-stage reduction. Upon completion of the correction, according to the indications, measures were prescribed for the prevention of neurodystrophic syndrome, depending on the likelihood of its development (according to the temperature gradient of the fingers of the extremities) in the form of drug therapy. Massage, kinesiotherapy, and physiotherapy began on the second day. The pain intensity was determined using a visual analog scale. The nature of pain was determined by the DN4 questionnaire (questionnaire for the diagnosis of neuropathic pain). For subjective unified assessment of hand function in the long term after a hand injury, I used a specific questionnaire DASH (Disability of the Arm, Shoulder and Hand Outcome Measure) – a questionnaire of outcomes and disability of the hand and hand.&#x0D; Results. Rehabilitation treatment at admission and at the early outpatient stage was complex, individual, taking into account the periods of illness. The debris correction was painless, low-traumatic, rational fixing bandages were used. The volume of drug therapy was determined by the value of the temperature gradient of the fingers.&#x0D; Conclusion. The proposed method for the rehabilitation of patients with fractures of the distal metaepiphysis of the radius is highly effective: good and satisfactory (according to the DASH scale) results were obtained in 97.8% of cases, unsatisfactory – in 2.2%.

Opioid free anesthesia: feasible?

The present review aims to address the feasibility of opioid free anesthesia (OFA). The use of opioids to provide adequate perioperative pain management has been a central practice of anesthesia, and only recently has been challenged. Understanding the goals and challenges of OFA is essential as the approach to intraoperative analgesia and postsurgical management of pain has shifted in response to the opioid epidemic in the United States. OFA is an opioid sparing technique, which focuses on multimodal or balanced analgesia, relying on nonopioid adjuncts and regional anesthesia. Enhanced recovery after surgery protocols, often under the auspices of a perioperative pain service, can help guide and promote opioid reduced and OFA, without negatively impacting perioperative pain management or recovery. The feasibility of OFA is evident. However, there are limitations of this approach that warrant discussion including the potential for adverse drug interactions with multimodal analgesics, the need for providers trained in regional anesthesia, and the management of pain expectations. Additionally, minimizing opioid use perioperatively also requires a change in current prescribing practices. Monitors that can reliably quantify nociception would be helpful in the titration of these analgesics and enable anesthesiologists to achieve the goal in providing personalized perioperative medicine.

National survey of enhanced recovery after thoracic surgery practice in the United Kingdom and Ireland

BackgroundEvidence that Enhanced Recovery After Thoracic Surgery (ERAS) improves clinical outcomes is growing. Following the recent publications of the international ERAS guidelines in Thoracic surgery, the aim of this audit was to capture variation and perceived difficulties to ERAS implementation, thus helping its development at a national level.MethodsWe designed an anonymous online survey and distributed it via email to all 36 centres that perform lung lobectomy surgery in the UK and Ireland. It included 38 closed, open and multiple-choice questions on the core elements of ERAS and took an average of 10 min to complete.ResultsEighty-two healthcare professionals from 34 out of 36 centres completed the survey; majority were completed by consultant thoracic surgeons (57%). Smoking cessation support varied and only 37% of individuals implemented the recommended period for fluid fasting; 59% screen patients for malnutrition and 60% do not give preoperative carbohydrate loading. The compliance with nerve sparing techniques when a thoracotomy is performed was poor (22%). 66% of respondents apply suction on intercostal drains and although 91% refer all lobectomies for physiotherapeutic assessment, the physiotherapy adjuncts varied across centres. Perceived barriers to implementation were staffing levels, lack of teamwork/consistency, limited resources over weekend and the reduced access to smoking cessation services.ConclusionCentres across the UK are working to develop the ERAS pathway. This survey aids this process by providing insight into “real life” ERAS, increasing exposure of staff to the ESTS- ERAS recommendations and identifying barriers to implementation.

Neue Herausforderungen für die Anästhesie durch den Klimawandel

The climate crisis is the most serious threat to global health in the twenty-first century. In western countries 5-10% of all greenhouse gas emissions originate from the healthcare sector and the main contributing factors are energy-intense departments (intensive care units, operating suits and prehospital emergency services). The aim of this review is to provide background knowledge and practical ideas to achieve climate-neutral hospitals. Narrative review with information on the topics of (I)volatile anesthetics as greenhouse gases, (II)energy supply in hospitals and (III)solid waste management. (I)Volatile anesthetics are highly potent greenhouse gases, especially desflurane has amajor global warming potential. Total intravenous anesthesia (TIVA) with propofol or regional anesthetic techniques have a much lower impact on the climate. (II)Using sustainable energy sources as well as initiating energy sparing techniques, such as light-emitting diodes (LED) and motion sensors, can reduce CO2 emissions. (III)Waste can be managed by the reduce, reuse, recycle, rethink and research concept. Doctors should actively contribute to reach the climate goals.

Are physical therapy pain levels affected by surgical approach in total hip arthroplasty? A randomized controlled trial.

The main objective of this study was to evaluate the difference in pain levels during postoperative physical therapy pathways in patients who underwent a cement less total hip replacement either through a muscle sparing direct anterior approach (DAA), or the classic trans-gluteal lateral approach (LA). One hundred and twelve (112) patients were randomized into two equal groups. Baseline values of myoglobin levels were acquired prior to surgery and repeated at 6 hours postoperatively as a biomarker for muscle damage. Pain levels during the first passive and consecutive 3 active physical therapy sessions were noted using a visual analogue-numeric scale (VAS). Pain levels were also acquired at 6 weeks, 3 months, 6 months and 1 year, following a 20-meter (65.6 feet) walking test. Postoperative myoglobin (ng/mL) levels were significantly higher (p< 0.05) in the LA group (335.05±83.54) then the DAA group (237.71±57.54). Pain levels were significantly lower (p<0.001) in the DAA group for both passive (2.5±1.45 vs. 4.28±2.19) and active physical therapy sessions and there was a positive correlation between postoperative myoglobin levels and pain levels until 6 postoperative weeks. There was no significant difference in demographics between the two groups except for gender distribution. The direct anterior approach’s main advantage of being a minimally invasive muscle sparing technique is showing a better rehabilitation experience with lower pain levels during passive and active physical therapy when compared to the classic trans-gluteal lateral approach.

V08-10 MILLIN, FREYER AND MADIGAN ROBOT-ASSISTED SIMPLE PROSTATECTOMY: SURGICAL TECHNIQUE, PERIOPERATIVE AND 1 YR FUNTIONAL OUTCOMES

You have accessJournal of UrologyBPH & Bladder Outlet Obstruction (V08)1 Apr 2020V08-10 MILLIN, FREYER AND MADIGAN ROBOT-ASSISTED SIMPLE PROSTATECTOMY: SURGICAL TECHNIQUE, PERIOPERATIVE AND 1 YR FUNTIONAL OUTCOMES Alfredo Bove*, Riccardo Mastroianni, Gabriele Tuderti, Umberto Anceschi, Aldo Brassetti, Mariaconsiglia Ferriero, and Giuseppe Simone Alfredo Bove*Alfredo Bove* More articles by this author , Riccardo MastroianniRiccardo Mastroianni More articles by this author , Gabriele TudertiGabriele Tuderti More articles by this author , Umberto AnceschiUmberto Anceschi More articles by this author , Aldo BrassettiAldo Brassetti More articles by this author , Mariaconsiglia FerrieroMariaconsiglia Ferriero More articles by this author , and Giuseppe SimoneGiuseppe Simone More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000909.010AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Robot assisted simple prostatectomy (RASP) is an established surgical procedure for the management of obstructive symptoms caused by large adenomas. Traditionally this is performed according to the Freyer (trans-vescically) or Millin (trans-capsular) technique. These are known to cause retrograde ejaculation which limits their application in younger patients. We have recently described a novel urethra sparing (Madigan) technique which has shown some promising preliminary results. In this video we report our surgical technique and a retrospective comparison of perioperative and 1-yr functional outcomes between Freyer, Millin, and Madigan robot-assisted simple prostatectomy. METHODS: The video shows our surgical techniques for three different approaches of RASP: Freyer, Millin and Madigan. Standardized indications to the available techniques were: bladder diverticula or stones and/or large median lobe for Freyer technique, patients’ desire to preserve antegrade ejaculation in absence of any of the above mentioned criteria for Madigan procedure, Millin procedure in all other cases. Baseline and one-yr functional outcomes assessed by means of self-reported validated questionnaires (IPSS, IIEF, ICIQ short form, MSHQ Short Form) were analyzed. Categorical and continuous variables were compared with chi square and Student t test, respectively. RESULTS: Between June 2012 and September 2019, 45 patients underwent RASP: 23 (51%) Millin, 8 (18%) TVA, and 14 (31%) Madigan. The median follow-up was 37 months (18–63.5). Demographic and clinical data were homogeneous for BMI, prostate volume and ASA score (p=0.34, 0.23, 0.57 respectively), while patients who underwent Madigan were younger (median 66) compared to the Millin (72) and Freyer (74) cohorts (p=0.013). Baseline IPSS, IIEF, ICIQ, or MSHQ scores were comparable between groups (all p>0.17). Similarly, operative time, hospital stay and complication rates were comparable between groups (p=0.28, 0.27 and 0.32, respectively). The Madigan procedure provided higher 1-yr MSHQ score (median 10.5), mostly based on preserved antegrade ejaculation, compared with Millin (median 2) and Freyer (median 2) cohorts (p=0.04) and also a trend towards significantly higher IIEF score (p=0.05). CONCLUSIONS: Robot-assisted simple prostatectomy sounds a safe and feasible procedure. Freyer, Millin and Madigan techniques are comparable in terms of resolution of obstructive symptoms, regardless of the prostate size. Robotic Madigan simple prostatectomy has demonstrated a promising surgical approach to preserve ejaculatory function, ensuring resolution of obstructive symptoms, in particular for young patients strongly motivated to preserve antegrade ejaculation. Source of Funding: none © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e737-e738 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Alfredo Bove* More articles by this author Riccardo Mastroianni More articles by this author Gabriele Tuderti More articles by this author Umberto Anceschi More articles by this author Aldo Brassetti More articles by this author Mariaconsiglia Ferriero More articles by this author Giuseppe Simone More articles by this author Expand All Advertisement PDF downloadLoading ...

PD61-06 ANTEGRADE EJACULATION PRESERVING TECHNIQUE WITH GREEN LIGHT XPS

You have accessJournal of UrologyBenign Prostatic Hyperplasia: Surgical Therapy & New Technology IV (PD61)1 Apr 2020PD61-06 ANTEGRADE EJACULATION PRESERVING TECHNIQUE WITH GREEN LIGHT XPS Pablo Contreras*, Nicolás Bonanno, Leandro Blas, Nicolás Villasante, Hernando Ríos Pita, and Carlos Ameri Pablo Contreras*Pablo Contreras* More articles by this author , Nicolás BonannoNicolás Bonanno More articles by this author , Leandro BlasLeandro Blas More articles by this author , Nicolás VillasanteNicolás Villasante More articles by this author , Hernando Ríos PitaHernando Ríos Pita More articles by this author , and Carlos AmeriCarlos Ameri More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000978.06AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Retrograde ejaculation is one of the most common complication BPH surgery and has been reported in up to 70 % of cases. Our objective was to analize the results of Ejaculatory sparing technique (EST) with Green Light XPS METHODS: Between January 2016 and January 2018, 117 patients were treated with an anatomical prostate vaporization, with a 3 lobe technique. A “U” shape incision preserving 1 cm. proximal to the veru montanum was made the biginning of the procedure. Incisions were made using 120 Watts and vaporization of dissected prostate was made with 180 Watts. Bladder neck was widely opened in all patients. the Male Sexual Health Questionnaire (MSHQ-EjD Short Form) was used for assessing ejaculatory dysfunction (EjD) 43 questionnaires were completed. RESULTS: Mediam age 67 y (48-85). Mediam prostate size 57 g. (19 - 177 gr). Antegrade ejaculation (AE) was found in 37 (86%). Of them 29 (78.4%) had antegrade eyaculation all the time or most of the time and 8 (21.6%) had AE about half of the time or less than a half of time. Strength, 22 (59.4%) had as strong as it always was or a little less, 11 (29.7%) had somewhat less strong or much less strong and 4 (10.8%) had none AE. Volume 18 (48.6%) had as much as it always was or a little less, 15 (40.5%) had somewhat less that it used to be or much less than it used to be and 4 (10.8%) had none AE. About bother or satisfaction, for those patients with AE the average rate was 1.08. and for those without AE the average rate was 3.2 (0 means No problem with ejaculation and 5 extremely bothered). CONCLUSIONS: Using a preserving antegrade ejaculation technique with Green Light XPS, antegrade ejaculation was found in most of treated patients wich had a strong impact in quality of life. Source of Funding: None © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e1282-e1282 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Pablo Contreras* More articles by this author Nicolás Bonanno More articles by this author Leandro Blas More articles by this author Nicolás Villasante More articles by this author Hernando Ríos Pita More articles by this author Carlos Ameri More articles by this author Expand All Advertisement PDF downloadLoading ...

Letter to the editor: applications of rib sparing technique in internal mammary vessels exposure of abdominal free flap breast reconstructions: a 12-year single-center experience of 215 cases.

We read with great interest the article by Zhang and colleagues on the applications of rib sparing technique in internal mammary vessel (IMV) exposure for microvascular breast reconstruction (1). They report a retrospective single institutional study of 215 women who underwent 218 abdominal free flap breast reconstructions, 70 of them using rib-preserving exposure of the IMVs. They compared these with 102 flaps in which the costal cartilage was sacrificed. Their findings that rib sparing IMV exposure is a safe technique with a shorter surgery and hospital stay as well as lower complication rate compared to rib-sacrifice are consistent with our results from a study of the pertinent anatomy of the IMVs during total rib-sparing free flap breast reconstruction (2). Our comments are based on a prospectively collected database of such reconstructions performed by a single surgeon (CMM) using the total rib preservation technique of IMV exposure (3,4).

MP25-07 EJACULATORY SPARING PHOTO SELECTIVE VAPORIZATION OF THE PROSTATE VS BIPOLAR BUTTON PLASMA VAPORIZATION OF THE PROSTATE IN THE SURGICAL MANAGEMENT OF BPH

You have accessJournal of UrologyBenign Prostatic Hyperplasia: Surgical Therapy & New Technology I (MP25)1 Apr 2020MP25-07 EJACULATORY SPARING PHOTO SELECTIVE VAPORIZATION OF THE PROSTATE VS BIPOLAR BUTTON PLASMA VAPORIZATION OF THE PROSTATE IN THE SURGICAL MANAGEMENT OF BPH Mitali Kini*, Alexis Te, James Kashanian, Steven Kaplan, and Bilal Chughtai Mitali Kini*Mitali Kini* More articles by this author , Alexis TeAlexis Te More articles by this author , James KashanianJames Kashanian More articles by this author , Steven KaplanSteven Kaplan More articles by this author , and Bilal ChughtaiBilal Chughtai More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000864.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: After transurethral prostatectomy, erectile dysfunction (ED) and ejaculatory dysfunction (EjD) are significant concerns for patients. We compared ejaculatory hood sparing technique in patients who underwent Photo Selective Vaporization of the Prostate using the Greenlight Laser (EjS-PVP) to the Bipolar Button Plasma Vaporization of the Prostate (EjS-BPVP) in the surgical management of BPH. METHODS: 27 patients were randomized to either undergo EjS-PVP or EjS-BPVP from August 2016 to March 2018. All of the patients were sexually active with antegrade ejaculation prior to prostatectomy. We evaluated International Prostate Symptom Score (IPSS), Quality of Life (QoL), peak flow rate (Qmax), post-void residual urine (PVR), International Index of Erectile Function (IIEF) and ejaculatory function by the Male Sexual Health Questionnaire (MSHQ). Men were evaluated preoperatively and at 1, 3 and 6 months postoperatively. The primary outcome was ejaculation preservation measured as no change or preservation in antegrade ejaculate at the last follow-up visit by MSHQ (6-months). RESULTS: 27 patients with a mean age of 65.6 years (±8.4) underwent either EjS-BPVP or EjS-PVP (Table 1). There were no differences in baseline characteristics between the two groups. Improvements in IPSS, QoL, Qmax and PVR were durable throughout the study period in both groups. There was no difference in outcomes between groups. Postoperatively, there was no change in ejaculatory function with ejaculatory hood sparing EjS-BPVP utilizing either 180W EjS-PVP or bipolar energy. The change in MSHQ Ejaculation Scale was -2.1 and -5.4 at 6 months in both arms. The 6-month ejaculatory preservation rate was 85% in the EjS-PVP group and 78% in the EjS-BPVP group. CONCLUSIONS: Ejaculatory Hood Sparing Greenlight photoselective vaporization and bipolar plasma button vaporization is a safe and effective method for treating men with LUTs secondary to BPH with maintenance of antegrade ejaculation. Source of Funding: Boston Scientific © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e393-e393 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Mitali Kini* More articles by this author Alexis Te More articles by this author James Kashanian More articles by this author Steven Kaplan More articles by this author Bilal Chughtai More articles by this author Expand All Advertisement PDF downloadLoading ...

Fertility-sparing Surgery (FSS) in Epithelial Ovarian Cancer (EOC): A Case Report

Background: Epithelial ovarian cancer is the most common and lethal ovarian cancer. Now a days Fertility preservation is an important issue because of the constant shifting of childbearing age towards higher ages. The increasing incidence of epithelial ovarian cancer in women with active childbearing potential constitutes a therapeutic dilemma. Fertility sparing techniques are being increasingly incorporated in the therapeutic strategies in early stages of the disease. Established organ-preserving techniques in early stage epithelial ovarian cancer includes preservation of the contralateral ovary and uterus.&#x0D; Aim: To report the case of a Epithelial Ovarian Cancer, who had conservative surgery followed by chemotherapy with a good fertility outcome.&#x0D; Case presentation: A 31-year-old nulliparous woman with a right sided ovarian mucinous cystadenocarcinoma was treated by right adnexectomy and omentectomy followed by chemotherapy. A 3years follow-up showed no signs of relapse, and she completed a fullterm natural pregnancy which was delivered by caesarean section.&#x0D; Conclusion: Fertility sparing surgery in early stage Epithelial Ovarian Cancer has good prognosis. However, due to the rarity of the disease in early stages, the fertility outcome of this group of patients has not been established.&#x0D; Bangladesh J Obstet Gynaecol, 2020; Vol. 35(1): 46-48