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Ductal adenocarcinoma (DA) and intraductal carcinoma (IDC) of the prostate are associated with higher stage disease at radical prostatectomy (RP). We evaluated diagnostic accuracy of biopsy, MRI-visibility, and outcomes for patients undergoing RP with DA/IDC histology compared to pure acinar adenocarcinoma (AA) of the prostate.A retrospective cohort study of men receiving RP between 2014 and 2021 revealing AA, DA, or IDC on final pathology was conducted. Multivariable logistic regression and Cox proportional hazards regression models were employed.A total of 609 patients were included with 103 found to have DA/IDC. Patients with DA/IDC were older and had higher PSA, biopsy grade group (GG), RP GG, and other pathologic findings (extraprostatic extension, lymphovascular invasion, perineural invasion, pN stage) compared to AA patients (all P0.05). On multivariable analysis, higher age, RP GG, and pT3a were associated with DA/IDC on RP (all P0.05). Sensitivity and specificity of biopsy compared to RP for diagnosis of DA/IDC was 29.1% (16.7% DA, 27.8% IDC) and 96.6% (99.3% DA, 96.6% IDC), respectively. In a subset of 281 men receiving MRI, PI-RADS distribution was similar for patients with DA/IDC vs. AA (90.7% vs. 80.7% with PI-RADS 4-5 lesions, P = 0.23) with slightly higher biopsy sensitivity (41.9%). DA/IDC was associated with worse BCR (HR = 1.77, P = 0.02) but not biopsy DA/IDC (P = 0.90).Sensitivity of prostate biopsy was low for detection of DA/IDC histology at RP. Patients with DA/IDC histology had unfavorable pathologic features at RP and worse BCR. Of patients with DA/IDC at RP, 90.7% were categorized as PI-RADS 4 to 5 on preoperative MRI.

Standard margin partial nephrectomy (SPN) with sharp incision across normal renal parenchyma carries perioperative morbidity and renal functional implications. Tumor enucleation (TE) is an alternative approach using a natural plane of dissection around the tumor pseudocapsule to maximize parenchymal preservation. We compared perioperative, functional, and oncologic outcomes for robotic-assisted TE to SPN.Patients ≥18 years of age undergoing robotic-assisted TE or SPN were included (2008-2020). Baseline demographics and tumor characteristics were compared. Perioperative, renal functional, and oncologic outcomes were assessed for comparative effectiveness.A total of 467 patients were included with 176 (37.7%) TE and 291 (62.3%) SPN. Baseline characteristics and final histology were comparable; 18% of patients had baseline stage 3 chronic kidney disease. TE had lower median blood loss, operative time, length of stay, and fewer complications compared to SPN. Positive margin rates were higher for TE vs. SPN (8.5% vs. 3.4%, P = 0.04) with similar recurrence rates (2.3% vs. 3.4%, P = 0.48) and no difference in cancer-specific or overall survival with median 4.0 years follow-up. Baseline estimated glomerular filtration rate was comparable (76.1 vs. 78.2, P = 0.63) while renal function in the first year was better preserved with TE (74.6 vs. 68.1, P0.001) showing an 8-point estimated glomerular filtration rate (P = 0.001) advantage after adjustment. The rate of stage ≥3 chronic kidney disease by 12 months was lower for TE compared to SPN (21.5% vs. 34.1%, P = 0.006).TE is an alternative approach to SPN associated with favorable perioperative and renal functional outcomes. While positive margin rates are higher, longer-term recurrence rates are no different suggesting pseudocapsule disruption during TE has limited impact on oncologic outcomes.

Summary Objective The objective is to describe our experience with robot-assisted laparoscopic diverticulectomy with extravesical ureteral reimplantation in a pediatric patient. Methods A 7-year-old male presented with a symptomatic urinary tract infection secondary to Staphylococcus epidermidis. The patient was found to have a large congenital paraureteral bladder diverticulum on work-up. His options were discussed and he proceeded with robotic diverticulectomy. Intraoperatively, the diverticulum was found to obscure the left ureteral orifice, which necessitated synchronous dismembered extravesical ureteral reimplantation. Results Robot-assisted laparoscopic diverticulectomy with extravesical ureteral reimplantation was performed. The procedure time was 283 min, and estimated blood loss was 3 mL. The patient was discharged home on post-operative day 1. He was last seen in clinic six months after surgery and was doing well without any recurrent urinary tract infections. Conclusion This video demonstrates a robotic approach for the treatment of complex congenital bladder diverticula. Robotic surgery offers the benefits of good visualization in the pelvis, minimal blood loss, and quick convalescence. Key portions of the diverticulectomy and ureteral reimplantation are clearly illustrated in this video, which can help other surgeons adopt this technique.

Immature anterior teeth are at high risk of root fracture following root canal treatment. The literature was explored to determine the current status for post-endodontic restorative management of these teeth.The authors explored multiple search engine databases to November 2008. Experiments included in the review involved simulated human or animal immature teeth with mineral trioxide aggregate as an apical plug. The experiments were designed to assess and compare the fracture strength of teeth restored with various materials. Studies that did not fulfil inclusion criteria were omitted from the review.Four in vitro studies fulfilled selection criteria and were systematically reviewed. All studies differed in sources of teeth, their simulated immature tooth model and mode of force application.Current evidence, mostly from laboratory studies, suggests the use of composite resin materials placed deep into the coronal aspect of the root canal to impart superior fracture resistance. Further clinical research is needed to assess other reinforcing materials, which include a variety of post systems and luting agents.

The aim of this review was to consider laboratory experiments and clinical studies of calcium hydroxide-based root canal sealers. An extensive search of the endodontic literature was made to identify publications related to calcium hydroxide-based root canal sealers. The articles were assessed for the outcome of laboratory and clinical studies on their biological properties and physical characteristics. Comparative studies with other sealers were also considered. Several studies were evaluated covering different properties of calcium hydroxide-based sealers including physical properties, biocompatibility, leakage, adhesion, solubility, antibacterial properties, and periapical healing effect. Calcium hydroxide-based root canal sealers have a variety of physical and biological properties. Comparative studies reveal their mild cytotoxicity, but their antibacterial effects are variable. Further research is required to establish the tissue healing properties of calcium hydroxide in root canal sealers.

The definition of a successful ablation of atrial fibrillation can vary among electrophysiologists. A commonly described endpoint is bidirectional block of the four pulmonary veins. A case is described in which entrance block into a pulmonary vein was achieved early during pulmonary vein isolation. However, triggers from the pulmonary vein continued to conduct into the atrium, revealing the block was only unidirectional. Further ablation resulted in true electrical isolation and highlights the importance of achieving bidirectional block.