contributed equally to the work.What's known on the subject? and What does the study add?• Surgical treatment options for male stress urinary incontinence (SUI) include collagen injection, artificial urinary sphincter, or male sling placement. In recent years, various minimally invasive sling systems have been investigated as treatment options for post-prostatectomy SUI. One of the drawbacks of using male slings is the lack of ability to make postoperative adjustments. To overcome the challenges associated with peri-and postoperative adjustment of male sling systems, the adjustable transobturator male system (ATOMS®) was introduced.• Our initial European multicentre experience with this device treatment shows a significant improvement in the severity of incontinence and mean pad use as well as quality-of-life scores. Our data suggest that the ability at any time to make adjustments in male sling systems should be considered as a prerequisite when managing men with SUI. Objective• To report our experience with a new self-anchoring adjustable transobturator male system (ATOMS®; AMI, Vienna, Austria) for the treatment of stress urinary incontinence (SUI) in men. Patients and Methods• A total of 99 men, in a number of centres, were treated for SUI with the new ATOMS® device.• The device was implanted in all patients using an outside-in technique by passing the obturator foramen and anchoring the device to the inferior pubic ramus. The titanium port was placed s.c. on the left symphysis region. Adjustments were performed via port access.• Postoperative evaluation consisted of physical examination, 24-h pad test, and 24 h-pad count. Preoperatively and at 6-month follow-up, patients completed a validated quality-of-life questionnaire.• Two-way ANOVA was used to analyse changes over time.Within-group effects for time were tested using post hoc Dunnett's contrasts of baseline values vs subsequent measurements. Results• The most common indication was SUI after radical prostatectomy (92.9%). Failure of previous surgeries was present in 34.3% patients and 31.3% patients had undergone secondary radiation. • The mean (SD; range) surgery time was 47 (13.8; 29-112) min.• Temporary urinary retention occurred in two patients (2%) and transient perineal/scrotal dysaesthesia or pain was reported by 68 patients (68.7%) and resolved after 3-4 weeks of non-opioid analgesics.• There were four (4%) cases of wound infection at the site of the titanium port leading to explantation. No urethral or bladder injuries related to the device or erosions occurred.• The mean (SD; range) number of adjustments to reach the desired result (dryness, improvement and/or patient satisfaction) was 3.8 (1.3; 1-6). After a mean (SD; range) follow-up time of 17.8 (1.6; 12-33) months, the overall Functional Urology success rate was 92% and the mean pad use decreased from 7.1 to 1.3 pads/24 h (P < 0.001). Overall, 63% were considered dry and 29% were improved. Conclusion• Treatment of male SUI with this self-anchored adjustable system is safe and effective.
What's known on the subject? and What does the study add?• Whereas open nephron-sparing surgery (NSS) represents the 'gold standard' in the surgical therapy of T1 renal tumours, with the advances in laparoscopic surgery, the refinement of intracorporeal suturing and the availability of haemosealant substances, the laparoscopic approach to NSS is increasingly used. Laparoscopic partial nephrectomy (LPN), however, is currently performed in just a few high-volume reference centres, and its diffusion has been limited by the steep learning curve. Conversely, robot-assisted LPN is emerging as a promising procedure, able to tackle the technical difficulties of LPN and leading to a broader diffusion of minimally invasive treatment of small renal masses.• Our study provides long-term follow-up outcomes concerning surgical and oncological outcomes and a detailed evaluation of the renal function in patients affected by T1 renal cancers who underwent LPN and OPN. We showed that LPN could be safely performed in the therapy of T1 renal cancer, without impairing renal function. Objective• To evaluate the long-term oncological and functional outcomes of laparoscopic partial nephrectomy (LPN) compared with open partial nephrectomy (OPN) for pT1 renal tumours. Patients and Methods• In this retrospective single-centre study, 340 consecutive patients underwent LPN and OPN for localized, incidentally discovered, renal masses of <7 cm (cT1).• The patients were matched for age, sex, body mass index, American Society of Anesthesiology score, tumour side (right or left kidney) and tumour characteristics (RENAL nephrometry score).• Demographic data, peri-and postoperative variables, including operating time, estimated blood loss, complications, hospital stay, renal function, histological tumour staging and grading, and metastasis rates were collected and analysed. Results• The median (SEM) operating time for LPN and OPN was 145.3 (45.4) min and 155.2 (35.6) min, respectively (P = 0.07). The median (SEM) warm ischaemia time was 11.7 (2.2) min in the LPN and 14.4 (1.9) min in the OPN group (P = 0.03).• The median (SEM) RENAL nephrometry scores for LPN and OPN were 5.9 (1.6) and 6.1 (0.3), respectively (P = 0.11).• During follow-up, the biochemical markers of glomerular filtration were completely normalized, showing the absence of renal injury and there was no significant difference in glomerular filtration rate between the groups, with median (SEM) rates of 79.8 (3.0) mL/min/1.72m 2 for the LPN and 80.2 (2.7) mL/min/1.72m 2 for the OPN group at 5-year follow-up.• The 5-year overall survival and cancer-specific survival rates, calculated using the Kaplan-Meier method, were 94% and 91% in the LPN group, and 92% and 88% in the OPN group. Conclusion• LPN and OPN provide similar long-term oncological outcomes in the therapy of T1 renal cancer. With regard to renal function, no damage to the kidney was found after LPN and OPN, with a complete normalization of renal function at the 5-year follow-up in both groups.
Background. This study compares neoadjuvant chemoradiotherapy (nCRT) with perioperative chemotherapy (pCT) for patients with resectable esophageal or gastroesophageal junction (GEJ) adenocarcinoma in terms of toxicity, postoperative complications, pathologic response, and survival. Methods. This study retrospectively analyzed and compared 313 patients with resectable esophageal or GEJ adenocarcinoma treated with either nCRT (carboplatin/paclitaxel 41.4 Gy, n = 176) or pCT (epirubicin, cisplatin and capecitabine, n = 137).
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