blood loss (EBL) and complications, and after RALP were hospital stay, catheter time, pathology, PSA level, return of continence and potency. RESULTSThe mean (range) duration of RALP was 130 (51-330) min; all procedures were successful, with no intraoperative transfusions or deaths. The mean EBL was 10-300 mL; 97% of patients were discharged home on the first day after RALP with a mean haematocrit of 36%. The mean duration of catheterization was 6.9 (5-21) days. The positive margin rate was 9.4% for all patients; i.e. 2.5% for T2 tumours, 23% for T3a and 53% for T4. The overall biochemical recurrence free (PSA level < 0.1 ng/mL) survival was 95% at mean follow-up of 9.7 months. There was complete continence at 3 and 6 months in 89% and 95% of patients, respectively. At 1 year 78% of patients were potent (with or without the use of oral medications), 15%were not yet able to sustain erections capable of intercourse, and another 7% still required injection therapy. CONCLUSIONRALP is a safe, feasible and minimally invasive alternative for treating prostate cancer. Our initial experience with the procedure shows promising short-term outcomes.

ObjectivesPrompt antibiotic treatment of early stage Lyme borreliosis (LB) prevents progression to severe multisystem disease. There is a clinical need to improve the diagnostic specificity of early stage Lyme assays in the period prior to the mounting of a robust serology response. Using a novel analyte harvesting nanotechnology, Nanotrap particles, we evaluated urinary Borrelia Outer surface protein A (OspA) C-terminus peptide in early stage LB before and after treatment, and in patients suspected of late stage disseminated LB.MethodWe employed Nanotrap particles to concentrate urinary OspA and used a highly specific anti-OspA monoclonal antibody (mAb) as a detector of the C-terminus peptides. We mapped the mAb epitope to a narrow specific OspA C-terminal domain OspA236-239 conserved across infectious Borrelia species but with no homology to human proteins and no cross-reactivity with relevant viral and non-Borrelia bacterial proteins. 268 urine samples from patients being evaluated for all categories of LB were collected in a LB endemic area. The urinary OspA assay, blinded to outcome, utilized Nanotrap particle pre-processing, western blotting to evaluate the OspA molecular size, and OspA peptide competition for confirmation.ResultsOspA test characteristics: sensitivity 1.7 pg/mL (lowest limit of detection), % coefficient of variation (CV) = 8 %, dynamic range 1.7–30 pg/mL. Pre-treatment, 24/24 newly diagnosed patients with an erythema migrans (EM) rash were positive for urinary OspA while false positives for asymptomatic patients were 0/117 (Chi squared p < 10−6). For 10 patients who exhibited persistence of the EM rash during the course of antibiotic therapy, 10/10 were positive for urinary OspA. Urinary OspA of 8/8 patients switched from detectable to undetectable following symptom resolution post-treatment. Specificity of the urinary OspA test for the clinical symptoms was 40/40. Specificity of the urinary OspA antigen test for later serology outcome was 87.5 % (21 urinary OspA positive/24 serology positive, Chi squared p = 4.072e−15). 41 of 100 patients under surveillance for persistent LB in an endemic area were positive for urinary OspA protein.ConclusionsOspA urinary shedding was strongly linked to concurrent active symptoms (e.g. EM rash and arthritis), while resolution of these symptoms after therapy correlated with urinary conversion to OspA negative.Electronic supplementary materialThe online version of this article (doi:10.1186/s12967-015-0701-z) contains supplementary material, which is available to authorized users.

Total or near total removal of lower urinary tract (LUT) mesh perforation after mid-urethral polypropylene mesh sling can completely resolve LUT mesh perforation in a single operation. A concomitant pubovaginal sling can be safely performed in efforts to treat existing SUI or avoid future surgery for SUI.

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BackgroundPsychiatric comorbidities in epilepsy impose significant burdens on patients and their families. It affects their quality of life and medical care and results in cost increases. This study reports the impact of various psychiatric comorbidities in epilepsy patients regarding hospital outcomes and in-hospital mortality.MethodsWe used the Nationwide Inpatient Sample (NIS) from the Healthcare Cost and Utilization Project (HCUP) from years 2013-2014. We identified epilepsy as the primary diagnosis and psychiatric comorbidities, namely, alcohol abuse, depression, drug abuse, and psychosis, using validated International Classification of Diseases, 9th Revision, Clinical Modification (ICD-­9-­CM) codes. The differences in comorbidities were quantified using chi-square (χ2) tests and the multinomial logistic regression model was used to quantify associations among comorbidities using the adjusted Odds Ratio (aOR). ResultsWe analyzed 397,440 hospitalizations with epilepsy as the primary diagnosis. The most prevalent psychiatric comorbidities present in epilepsy were depression (13%) followed by psychosis (10.4%). The risk of inpatient death was only seen in epilepsy with comorbid alcohol abuse (aOR 1.164; 95%CI 1.043 – 1.300; p-value =0.007). Epilepsy with comorbid depression (aOR 1.473; 95% CI 1.391 – 1.559; p-value <0.001) was associated with a higher risk of a length of stay of more than three days (median), followed by comorbid psychosis (aOR 1.290; 95% CI 1.258 – 1.322; p-value <0.001). Epilepsy with comorbid depression (aOR 1.242; 95% CI 1.172 – 1.317; p-value <0.001) was associated with a higher risk of inpatient total charge of more than $21,000 (median), followed by comorbid psychosis (aOR 1.071; 95% CI 1.045 – 1.098; p-value <0.001).ConclusionPsychiatric comorbidities are influential factors that must be considered in models of Health-Related Quality of Life (HRQOL) in epilepsy. Further, efforts to improve HRQOL and reduce the burden of epilepsy require greater emphasis on the early diagnosis and treatment of comorbid psychopathology.