No abstract

Rationale:Primitive small cell carcinoma of the ureter is extremely rare, in this case report is meticulously described its aggressive clinical course and the pathological clues that help with the diagnosis. Also, a detailed table with the clinico-pathological features of analogous case reports in literature is provided.Patient concerns:A 79-year-old female presented with gross hematuria and flank pain.Diagnoses:Small cell carcinoma of the ureter. The surgical specimen showed a mixed histology of small cell carcinoma and transitional cell carcinoma; the common neuroendocrine markers (chromogranin A, synaptophysin, CD56) were positive, and vimentin and thyroid transcription factor 1 were negative. The patient had an advanced stage at presentation with regional nodes involvement (pT3N1).Interventions:Segmental ureterectomy was performed but it was only possible to administer 1 cycle of platinum-based adjuvant chemotherapy due to the rapid decline of her clinical parameters.Outcomes:The disease rapidly spread locally and metastasized.Lesson:The clinicians must be aware of this aggressive tumor with silent clinical course and advanced stages at presentation.

Background. Post-prostatectomy stress urinary incontinence (PPSUI) is one of the major complaints after radical prostatectomy. Transoburator male sling (TMS) placement is indicated in persistent mild to moderate PPSUI. External beam radiation therapy (EBRT) might be a negative prognostic factor for TMS outcomes. Study objective was to analyze EBRT impact on TMS outcome. Methods. We retrospectively investigated patients submitted to TMS for PPSUI, with or without previous EBRT, in two tertiary referral centers since 2010. Objective outcome was measured through ICIQ-SF, 1-hour pad test, and pad per die and subjective improvement through PGI-I. Patients were divided according to EBRT to make in-group and between-group comparisons. Results. Patients were 56, 18 (32.1%) had previous EBRT. Median follow-up was 43.0 months (IQR: 22.3–64.0). TMS was placed at mean 18.8 months (SD 4.6) after EBRT. TMS determined a statistically significant reduction of pads, 1-hour pad test, and ICIQ-SF score ( P<.05). Improvement diminished during long-term follow-up. At last follow-up, 12 patients (21.4%) used 1 safety pad, while 15 (26.8%) used 0 pads. Median PGI-I was 2 (IQR 2–3). Recorded complications were 9 (16.1%) and none exceeded Clavien–Dindo grade 2. There were no differences in outcomes, failures, and complications between groups. TMS failures were 6 (10.7%), 2 of whom in the EBRT group. Four of them (7.1%) subsequently placed an artificial urinary sphincter (AUS). Conclusion. Advance XP© placement seems effective and safe in well-selected patients complaining with PPSUI, even after EBRT. Surgical outcomes slightly deteriorate over time. Further studies are needed in these patients to assess TMS efficacy.

Objective To present the results of a nationwide survey among urological patients to evaluate their perception of the quality of care provided by residents. Methods An anonymous survey was distributed to patients who were referred to 22 Italian academic institutions. The survey aimed to investigate the professional figure of the urology resident as perceived by the patient. Results A total of 2587 patients were enrolled in this study. In all, 51.6% of patients were able to correctly identify a urology resident; however, almost 40% of respondents discriminated residents from fully trained urologists based exclusively on their young age. Overall, 98.2% patients rated the service provided by the resident as at least sufficient. Urology trainees were considered by more than 50% of the patients interviewed to have good communication skills, expertise and willingness. Overall, patients showed an excellent willingness to be managed by urology residents. The percentage of patients not available for this purpose showed an increasing trend that directly correlated with the difficulty of the procedure. Approximately 5–10% of patients were not willing to be managed by residents for simple procedures such as clinical visits, cystoscopy or sonography, and up to a third of patients were not prepared to undergo any surgical procedure performed by residents during steps in major surgery, even if the residents were adequately tutored. Conclusions Our data showed that patients have a good willingness to be managed by residents during their training, especially for medium‐ to low‐difficulty procedures. Furthermore, the majority of patients interviewed rated the residents' care delivery as sufficient. Urology trainees were considered to have good communication skills, expertise and willingness.