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Urology Jun 2024To present an ex-vivo bovine model for retrograde intrarenal surgery (RIRS) training.
OBJECTIVES
To present an ex-vivo bovine model for retrograde intrarenal surgery (RIRS) training.
MATERIALS AND METHODS
The model was specifically developed for a pre-congress course organized as part of the National Pediatric Urology Congress. The course involved a two-day online theoretical segment followed by hands-on training. Bovine kidneys were chosen for their anatomical resemblance to human kidneys. The kidneys were sourced from a local slaughterhouse, ensuring the intactness of the pelvis, ureters, and perirenal fat. A Modified Larssen solution was used for tissue preservation. The tissue was positioned within a cardboard box, with specific preparation techniques to ensure realism. During the hands-on training, participants utilized a flexible ureterorenoscope for practice. After the course, participants completed an 18-question survey assessing the model and training experience.
RESULTS
24 participants completed the training and survey. Four out of eight procured kidneys were suitable. The model's cost was 18 euros. 87.5% of participants reported increased RIRS confidence. Those with prior course experience rated the model's anatomical resemblance higher (p=0.016). No significant difference was observed in feedback on the model's durability or tactile feedback based on prior experience (p>0.05).
CONCLUSION
The ex-vivo bovine model provides a promising alternative for RIRS training. While further studies are needed to validate its widespread application, initial feedback suggests it offers a balance between cost-effectiveness and realistic training experience.
PubMed: 38942389
DOI: 10.1016/j.urology.2024.06.053 -
Injury Jun 2024Pediatric pelvic fractures are uncommon, representing 0.2-3% of total pediatric fractures. The long-term patient-reported outcome in the pediatric population has not...
Epidemiology and patient-reported measurement outcome of pelvic fractures in children and adolescents - A population-based cohort study from the Swedish fracture register.
BACKGROUND AND PURPOSE
Pediatric pelvic fractures are uncommon, representing 0.2-3% of total pediatric fractures. The long-term patient-reported outcome in the pediatric population has not been evaluated yet. The purpose of the study was to describe the epidemiology of pelvic and acetabular fractures in pediatric patients including long-term patient-reported outcomes.
PATIENTS AND METHODS
The Swedish Fracture Register (SFR) was used to identify all patients aged 6-17 years at injury with a pelvic fracture between 2015 and 2021. All patients were invited to answer Patient-Reported measurement instruments in 2021.
RESULTS
The study cohort consisted of 223 patients with a median age at fracture of 15 years and with 62 % boys. 201 sustained a pelvic and 22 acetabular fractures. Falls were the leading cause of fracture, followed by transport accidents. Most fractures (both pelvis and acetabulum) were type A (73 %), and 21 fractures (9 %) could not be classified according to AO. 85 % of fractures were treated non-surgically. All Type C fractures were treated surgically. Seven PROMIS® profile domains were completed by 31 % of the sample at a mean follow-up time of 3.5 years after pelvic/acetabular fracture. Most patients had "no concern" or "mild concern" but those who had surgery had an inferior t-score in most domains.
CONCLUSION
Most fractures occurred in older individuals, with falls during sports activities being the most common cause. This raises important questions about prevention strategies. The PROMIS-Pain-Interference scale indicated that the younger the age at fracture, the more pain was reported at follow-up.
PubMed: 38941910
DOI: 10.1016/j.injury.2024.111700 -
Surgical and Radiologic Anatomy : SRA Jun 2024The incidence of osteoporotic pelvic fractures is increasing. The broken anterior pelvic ring is preferentially fixed with long intramedullary screws, which require a...
INTRODUCTION
The incidence of osteoporotic pelvic fractures is increasing. The broken anterior pelvic ring is preferentially fixed with long intramedullary screws, which require a good understanding of the patient-specific anatomy to prevent joint perforation. The aim of this study was to assess the variability of the superior pubic ramus and the supra acetabular corridors' length and width using statistical shape modelling.
MATERIALS AND METHODS
A male and female statistical shape model was made based on 59 forensic CT scans. For the superior pubic ramus and the supra acetabular corridor the longest and widest completely fitting cylinder was created for the first 5 principal components (PC) of both models, male and female pelvises separately.
RESULTS
A total of 59 pelvises were included in this study of which 36 male and 23 female. The first 5 principal components explained 75% and 79% of the pelvic variation in males and females, respectively. Within 3 PCs of the female statistical shape model (SSM) a superior pubic ramus corridor of < 7.3 mm was found, 5.5 mm being the narrowest linear corridor measured. Both corridors in all PCs of the male SSM measured > 7.3 mm.
CONCLUSION
Within females a 7.3 mm and 6.5 mm screw won't always fit in the superior pubic ramus corridor, especially if a flat sacrum, a small pelvis or a wide subpubic angle are present. The supra acetabular corridor did not seem to have sex-specific differences. In the supra-acetabular corridor there was always enough space to accommodate a 7.3 mm screw, both in males and females.
PubMed: 38942934
DOI: 10.1007/s00276-024-03420-y -
PloS One 2024Obesity is a high-morbidity chronic condition and risk factor for multiple diseases that necessitate imaging. This study assesses the relationship between BMI and...
OBJECTIVE
Obesity is a high-morbidity chronic condition and risk factor for multiple diseases that necessitate imaging. This study assesses the relationship between BMI and same-year utilization of CT and MR imaging in a large healthcare population.
METHODS
In this retrospective population-based study, all patients aged ≥18 years with a documented BMI in the multi-institutional Cosmos database were included. Cohorts were identified based on ≥1 documented BMI in 2021 within pre-defined ranges. For each cohort, we assessed the percentage of patients undergoing head, neck, chest, spine, or abdomen/pelvis CT and MR during the same year. Disease severity was quantified based on emergency department (ED) visits and mortality.
RESULTS
In our population of 49.6 million patients, same-year CT and MR utilization was 14.5 ±0.01% and 6.0±0.01%, respectively. The underweight cohort had the highest CT (25.8±0.1%) and MR (8.01 ± 0.05) imaging utilization. At high extremes of BMI (>50 kg/m2), CT utilization mildly increased (18.4±0.1%), but MR utilization decreased (5.3±0.04%). While morbidity differences may explain some BMI-utilization relationships, lower MR utilization in the BMI>50 cohort contrasts with higher age-adjusted mortality (1.8±0.03%) and ED utilization (32.4±0.1%) in this cohort relative to normal weight (1.5±0.01% and 25.7±0.02%, respectively).
CONCLUSION
Underweight patients had disproportionately high CT/MR utilization, and high extremes of BMI are associated with mildly higher CT and lower MR utilization than the normal weight cohort. The elevated mortality and ED utilization in severely obese patients contrasts with their lower MR imaging utilization. Our findings may assist public health efforts to accommodate obesity trends.
Topics: Humans; Body Mass Index; Magnetic Resonance Imaging; Male; Female; Tomography, X-Ray Computed; Middle Aged; Retrospective Studies; Adult; Obesity; Aged; Emergency Service, Hospital; Morbidity
PubMed: 38941332
DOI: 10.1371/journal.pone.0306087 -
Journal of Medical Radiation Sciences Jun 2024Image quality reduction due to metallic artefacts is a significant challenge during vascular computed tomography (CT) imaging of the lower extremities in patients with...
INTRODUCTION
Image quality reduction due to metallic artefacts is a significant challenge during vascular computed tomography (CT) imaging of the lower extremities in patients with hip prostheses. This study aims to analyse various reconstruction algorithms' ability to reduce metal artefacts due to two types of hip prostheses during lower extremity CT angiography examinations.
METHODS
A pelvis phantom was fabricated with the insertion of a tube filled with contrast media to simulate the femoral artery, and the phantom was then CT scanned with and without hip prostheses. Multimodal images were acquired using different kilovoltage peak (kVp) settings and reconstructed with different algorithms, such as filtered back projection (FBP), iterative reconstruction (iDose), iterative model-based reconstruction (IMR) and orthopaedic metal artefact reduction (O-MAR). Image quality was assessed based on image noise, signal-to-noise ratio (SNR) and Hounsfield unit (HU) deviation.
RESULTS
The IMR approach significantly improved image quality compared to iDose and FBP. For the vascular region, O-MAR improves SNR by 5 ± 1, 23 ± 5 and 42 ± 9 for FBP, iDose and IMR respectively, and improves HU precision towards the baseline values by 49% and 83% for FBP and IMR, respectively. The noise reduction was 71% and 89% for FBP and IMR, and 57% for iDose. O-MAR greatly enhances SNR corrections among the most severe artefacts, with 29 ± 1 and 43 ± 4 for FBP and IMR, compared to iDose by 37 ± 7.
CONCLUSION
IMR combined with O-MAR could improve the CT angiography of the lower extremities of patients with a hip prosthesis.
PubMed: 38941235
DOI: 10.1002/jmrs.797 -
Emergency Radiology Jun 2024Infective endocarditis (IE) is a disease with high morbidity and mortality rate, but diagnosis is confounded by diverse clinical presentations, which mimic other...
Infective endocarditis (IE) is a disease with high morbidity and mortality rate, but diagnosis is confounded by diverse clinical presentations, which mimic other pathologies. A history of illicit intravenous drug use, previous cardiac valve surgery, and indwelling intracardiac devices increases the risk for developing infective endocarditis. The modified Duke criteria serve as the standard diagnostic tool, though its accuracy is reduced in certain cases. Radiologists in the Emergency Room setting reading body CT may be the first to identify the secondary extra-cardiac complications and facilitate expeditious management by considering otherwise unsuspected infective endocarditis. This review highlights common extracardiac complications of IE and their corresponding CT findings in the chest, abdomen, pelvis, and brain. If IE is suspected radiologists should suggest further investigation with echocardiography.
PubMed: 38941027
DOI: 10.1007/s10140-024-02257-7 -
Archives of Gynecology and Obstetrics Jun 2024Dense adhesion due to severe endometriosis between the posterior cervical peritoneum and the anterior sigmoid or rectum obliterates the cul-de-sac and distorts normal...
BACKGROUND
Dense adhesion due to severe endometriosis between the posterior cervical peritoneum and the anterior sigmoid or rectum obliterates the cul-de-sac and distorts normal anatomic landmarks. Surgery for endometriosis is associated with severe complications, including ureteral and rectal injuries, as well as voiding dysfunction. It is important to develop the retroperitoneal avascular space based on precise anatomical landmarks to minimize the risk of ureteral, rectal, and hypogastric nerve injuries. We herein report the anatomical highlights and standardized and reproducible surgical steps of total laparoscopic hysterectomy for posterior cul-de-sac obliteration.
OPERATIVE TECHNIQUE
We approach the patient with posterior cul-de-sac obliteration using the following five steps. Step 1: Preparation (Mobilization of the sigmoid colon and bladder separation from the uterus). Step 2: Development of the lateral pararectal space and identification of the ureter. Step 3: Isolation of the ureter. Step 4: Development of the medial pararectal space and separation of the hypogastric nerve plane. Step 5: Reopening of the pouch of Douglas.
CONCLUSION
Surgeons should recognize the importance of developing the retroperitoneal avascular space based on precise anatomical landmarks, and each surgical step must be reproducible.
PubMed: 38940845
DOI: 10.1007/s00404-024-07614-y -
European Journal of Nuclear Medicine... Jun 2024Despite growing evidence for bilateral pelvic radiotherapy (whole pelvis RT, WPRT) there is almost no data on unilateral RT (hemi pelvis RT, HPRT) in patients with nodal...
Whole pelvis vs. hemi pelvis elective nodal radiotherapy in patients with PSMA-positive nodal recurrence after radical prostatectomy - a retrospective multi-institutional propensity score analysis.
PURPOSE
Despite growing evidence for bilateral pelvic radiotherapy (whole pelvis RT, WPRT) there is almost no data on unilateral RT (hemi pelvis RT, HPRT) in patients with nodal recurrent prostate cancer after prostatectomy. Nevertheless, in clinical practice HPRT is sometimes used with the intention to reduce side effects compared to WPRT. Prostate-specific membrane antigen positron emission tomography / computed tomography (PSMA-PET/CT) is currently the best imaging modality in this clinical situation. This analysis compares PSMA-PET/CT based WPRT and HPRT.
METHODS
A propensity score matching was performed in a multi-institutional retrospective dataset of 273 patients treated with pelvic RT due to nodal recurrence (214 WPRT, 59 HPRT). In total, 102 patients (51 in each group) were included in the final analysis. Biochemical recurrence-free survival (BRFS) defined as prostate specific antigen (PSA) < post-RT nadir + 0.2ng/ml, metastasis-free survival (MFS) and nodal recurrence-free survival (NRFS) were calculated using the Kaplan-Meier method and compared using the log rank test.
RESULTS
Median follow-up was 29 months. After propensity matching, both groups were mostly well balanced. However, in the WPRT group there were still significantly more patients with additional local recurrences and biochemical persistence after prostatectomy. There were no significant differences between both groups in BRFS (p = .97), MFS (p = .43) and NRFS (p = .43). After two years, BRFS, MFS and NRFS were 61%, 86% and 88% in the WPRT group and 57%, 90% and 82% in the HPRT group, respectively. Application of a boost to lymph node metastases, a higher RT dose to the lymphatic pathways (> 50 Gy EQD2) and concomitant androgen deprivation therapy (ADT) were significantly associated with longer BRFS in uni- and multivariate analysis.
CONCLUSIONS
Overall, this analysis presents the outcome of HPRT in nodal recurrent prostate cancer patients and shows that it can result in a similar oncologic outcome compared to WPRT. Nevertheless, patients in the WPRT may have been at a higher risk for progression due to some persistent imbalances between the groups. Therefore, further research should prospectively evaluate which subgroups of patients are suitable for HPRT and if HPRT leads to a clinically significant reduction in toxicity.
PubMed: 38940843
DOI: 10.1007/s00259-024-06802-x -
Medeniyet Medical Journal Jun 2024The gluteus maximus (GM) is a big quadrilateral musculature that lines the rear portion of the pelvis. It is innervated by the inferior gluteal nerve. The sciatic nerve,...
The gluteus maximus (GM) is a big quadrilateral musculature that lines the rear portion of the pelvis. It is innervated by the inferior gluteal nerve. The sciatic nerve, inferior gluteal nerve, and posterior cutaneous nerve of the thigh are branches of the sacral plexus. The superior and inferior gluteal arteries are the chief arterial supply to the gluteal region. In the present case, there was a dual innervation of the GM. The superior gluteal artery and the superior gluteal nerve was piercing the piriformis and the inferior gluteal artery was running between the posterior cutaneous nerve of the thigh and the inferior gluteal nerve. According to our literature review, anatomical studies in which this cadaveric procedure has been performed have not been previously reported. The anatomical variations of the gluteal region are important to surgeons, physicians, anatomists, and nurses.
PubMed: 38940504
DOI: 10.4274/MMJ.galenos.2024.83652 -
Annals of Laparoscopic and Endoscopic... Jan 2024Flaps and grafts are used for filling dead space, ureteral substitution, and as mesh alternatives. The surgical robot is invaluable in urologic reconstructive surgery...
BACKGROUND AND OBJECTIVE
Flaps and grafts are used for filling dead space, ureteral substitution, and as mesh alternatives. The surgical robot is invaluable in urologic reconstructive surgery due to the ability of the robot to reach the deep pelvis, its minimally invasive access, the ability to use indocyanine green to identify structures and assess tissue perfusion and viability, and ergonomics for the surgeon. Robotic reconstruction can involve tissue transfer in the form of flaps and grafts to provide form and function to organs that have been damaged by iatrogenic injuries, trauma, infections, cancer, radiation injury, or congenital abnormalities. Common flaps and grafts can be readily adapted to the robotic approach. In this literature review, we examine the robotic use of flaps and grafts in reconstructive urology.
METHODS
A thorough literature review was conducted via a PubMed search for predefined terms.
KEY CONTENT AND FINDINGS
Flaps and grafts in reconstructive urology are used for interposition, ureteral substitution, and as mesh alternatives. Omental flaps are used for tissue interposition, or to provide structure and nutrients, and are easily employed with the robot. Various robotic applications of peritoneal flaps have been described. Vascular rectus abdominis musculocutaneous flaps are well-vascularized flaps that occupy dead space and provide structural support, which can be harvested readily with the robot. Sigmoid epiploica are an excellent flap for pelvic reconstruction. Gracilis flaps and fascia lata grafts are well-tolerated and provide space occupying tissue. Boari flaps aid in robotic ureteral reconstruction, especially in the setting of long defects. Oral mucosa is excellent for ureteral or bladder neck reconstruction. Rectal mucosa is well-tolerated and easy to harvest robotically for a variety of urinary tract reconstructive applications. The appendix or ileum can be interposed for repair of damaged ureters.
CONCLUSIONS
Various flaps and grafts have been adapted for robotic reconstructive urology. As the field develops, refinement of techniques and innovation in flaps and employment of the robot will propel this field forward. More studies, especially comparative studies, are needed to elucidate the flaps and grafts that are most likely to be successful with the least morbidity for each use case.
PubMed: 38938988
DOI: 10.21037/ales-23-36