Search

Background: Acquired bladder diverticula (BD) are a possible complication of bladder outlet obstruction (BOO) due to benign prostate enlargement (BPE). Robot-assisted bladder diverticulectomy (RABD) has been proposed as an alternative to open removal; however, only a few small series have been published., Objective: To describe our surgical technique for RABD and to assess perioperative results and functional outcomes at 6-mo follow-up., Design Setting and Participants: A prospective single-centre, single-surgeon cohort of 16 consecutive men with posterior or posterolateral BD due to BOO/BPE undergoing RABD between May 2017 and December 2021 was analysed., Surgical Procedure: RABD was performed with a four-arm robotic system via a transperitoneal approach. BD were identified intraoperatively via bladder distension with saline solution through an indwelling catheter with or without concomitant illumination using flexible cystoscopy and fluorescence imaging. Extravesical BD dissection and removal were performed., Outcome Measurements and Statistical Analysis: Operating room time, estimated blood loss, intraoperative and postoperative complications, indwelling catheter time, and timing of associated procedures for BOO/BPE were assessed. The International Prostate Symptom Score (IPSS) and postvoid residual volume (PVR) were compared between baseline and 6 mo after surgery., Results and Limitations: Median age and maximum BD diameter were 68 yr (interquartile range [IQR] 54-74) and 69 mm (IQR 51-82), respectively. The median operative time was 126 min (IQR 92-167) and the median estimated blood loss was 20 ml (IQR 15-40). No intraoperative complications were recorded. The urethral catheter was removed on median postoperative day 5 (IQR 5-7). Two men experienced 90-d postoperative complications (persistent urinary infection requiring prolonged antimicrobial therapy). Bipolar transurethral resection of the prostate was performed 3 wk before RABD in seven men and concomitant to RABD in nine men. Median IPSS significantly decreased from 25 (IQR 21-30) to 5 (IQR 5-6), and median PVR from 195 ml (IQR 140-210 ml) to 30 (IQR 28-40) ml (both p  < 0.001) at 6-mo follow-up in comparison to baseline. A limitation is the rather small cohort with no control group., Conclusions: RABD is a safe and effective minimally invasive option for treatment of acquired BD in men with BOO/BPE. Validation of our results in larger series with longer follow-up is warranted., Patient Summary: We describe our surgical technique for robot-assisted removal of pouches in the bladder wall (called diverticula) in men with bladder outlet obstruction caused by benign prostate enlargement, and report functional results at 6 months after the operation. This minimally invasive technique was found to be safe and effective., (© 2022 The Author(s).)

The aim of this study is to report outcomes of dogs undergoing cholecystectomy for gall bladder mucocele (GBM) without flushing and catheterization of the common bile duct (CBD). This is a retrospective multicentric study from three veterinary referral hospitals and included 82 dogs diagnosed with GBM. Medical records were reviewed for clinical and histopathological findings. Long-term outcome was assessed with an owner questionnaire. The common bile duct was considered normal (<4 mm), mildly dilated (5−6 mm) and moderately dilated (>7 mm) in 88%, 10% and 2.4% of dogs, respectively. Surgery was uncomplicated in 83% of dogs. Intraoperative complications were recorded in 21% of dogs, with hypotension being the most common, whereas postoperative complications were documented in 20% of dogs, with vomiting/regurgitation being the most common. Ninety-six percent of dogs that underwent cholecystectomy in this study survived to discharge. Follow-up ranged from 142 to 3930 days (median: 549 days). Eighty-five percent of dogs were alive at the time of follow-up. Dogs undergoing cholecystectomy for GBM without catheterization and flushing of the CBD have a favourable prognosis for recovery and quality of life.

Objective: To determine and compare median sternotomy (MS) closure-related complication rates using orthopedic wire or suture in dogs., Study Design: Multi-institutional, retrospective observational study with treatment effect analysis., Animals: 331 client-owned dogs, of which 68 were excluded., Methods: Medical records of dogs with MS were examined across nine referral centers (2004-2020). Signalment, weight, clinical presentation, surgical details, complications, and outcomes were recorded. Follow-up was performed using patient records and email/telephone contact. Descriptive statistics, treatment effect analysis and logistic regression were performed., Results: Median sternotomy closure was performed with wire in 115 dogs and suture in 148. Thirty-seven dogs experienced closure-related complications (14.1%), 20 in the wire group and 17 in the suture group. Twenty-three were listed as mild, four as moderate and 10 as severe. Treatment effect analysis showed a mean of 2.3% reduction in closure-related complications associated with using suture versus wire (95% CI: -9.1% to +4.5%). In multivariable logistic regression, the only factor associated with increased risk of closure-related complications was dog size (p = .01). This effect was not modified by the type of closure used (interaction term: OR = 0.99 [95% CI: 0.96/1.01])., Conclusion: The incidence of closure-related complication after MS was low compared to previous reports. The likelihood of developing a closure-related complication was equivalent between sutures and wires, independent of dog size, despite a higher proportion of complications seen in larger dogs (≥20 kg)., Clinical Significance: Use of either orthopedic wire or suture appear to be an appropriate closure method for sternotomy in dogs of any size., (© 2022 The Authors. Veterinary Surgery published by Wiley Periodicals LLC on behalf of American College of Veterinary Surgeons.)

Objectives: The aim of this retrospective observational study was to describe the clinical presentation, treatment and outcome of cats with sialocoele., Methods: Clinical records from seven referral hospitals were retrospectively searched to identify cats with sialocoele between 2007 and 2021., Results: Nineteen cats were identified. The most common clinical signs were ptyalism, dysphagia and anorexia. Localisation of the sialocoele was cervical (n = 6), sublingual (n = 6), cervical/sublingual (n = 3), facial (n = 2), cervical/pharyngeal (n = 1) and zygomatic (n = 1). The affected salivary glands were mandibular-sublingual (n = 15), mandibular-sublingual/parotid (n = 1), zygomatic/parotid (n = 1) and parotid (n = 2). The aetiology of the sialocoele was traumatic in two cases, neoplastic in one cat and unknown in 16 cats. Sialoadenectomy was performed in 11 cats. Other treatments included ranula marsupialisation (n = 3), needle drainage (n = 2), single stab incision (n = 2) and parotid duct ligation (n = 1). The median follow-up time was 399 days (range 15-1460). Postoperative seroma was the only complication observed in one cat. No recurrence was reported., Conclusions and Relevance: Feline salivary sialocoele are relatively rare and have a good prognosis. They can be managed successfully with sialoadenectomy; however, a more conservative approach can be used with appropriate case selection.

Objective: To assess the prevalence of bronchial wall thickening (BWT) and collapse in brachycephalic dogs with and without brachycephalic obstructive airway syndrome (BOAS) and in nonbrachycephalic dogs., Animals: 85 dogs with no history of lower respiratory tract disease that underwent CT of the thorax., Procedures: Electronical medical records for March 2011 through August 2019 were reviewed to identify brachycephalic dogs with BOAS (BOAS group) and brachycephalic dogs without BOAS (BDWB group) that did not have any evidence of lower respiratory tract disease and had undergone thoracic CT. A population of nonbrachycephalic dogs of similar weight (control dogs) was also retrospectively recruited., Results: BWT was identified in 28 of 30 (93.3%; 95% CI, 80.3% to 98.6%) dogs in the BOAS group, 15 of 26 (57.7%; 95% CI, 38.7% to 75.0%) dogs in the BDWB group, and 10 of 28 (35.7%; 95% CI, 20.1% to 54.2%) control dogs. On multivariable analysis, only brachycephalic conformation (P < 0.01) and body weight (P = 0.02) were significantly associated with the presence of BWT. Bronchial collapse was identified in 17 of 30 (56.7%; 95% CI, 39.0% to 73.1%) dogs in the BOAS group, 17 of 26 (65.4%; 95% CI, 46.3% to 81.3%) dogs in the BDWB group, and 3 of 28 (10.7%; 95% CI, 3.1% to 25.9%) control dogs. On multivariable analysis, only brachycephalic conformation was significantly (P < 0.01) associated with the presence of bronchial collapse., Clinical Relevance: A relationship between brachycephalic conformation and body weight with BWT was established, with heavier dogs having thicker bronchial walls. However, further studies are required to investigate the cause. Bronchial collapse was also more common in dogs with brachycephalic conformation, which is in agreement with the previously published literature.

Background: We assessed urinary continence recovery and perioperative complications in patients operated on with the novel urethral fixation technique during open radical cystectomy (RC) with ileal orthotopic neobladder (IONB)., Methods: A retrospective cohort of 82 consecutive male patients undergoing open RC with IONB between 07/2013 and 06/2020 was analyzed. A study group of 48 patients operated on with the urethral fixation technique was compared with a control group of 34 patients receiving standard neovesico-urethral anastomosis. In the study group, the urethral stump was fixed to the dorsal median raphe posteriorly and to the medial portion of levator ani muscle postero-laterally in order to avoid urethral retraction/deviation. Urinary continence recovery and perioperative complications were assessed and compared between the two groups., Results: The two groups were comparable with regard to demographic, clinical and pathological variables. At the median follow-up of 36 months, 42 (87.5%) patients in the study, and 22 (64.7%) in the control group during daytime, and 32 (66.7%) patients in the study, and 15 (44.1%) patients in the control group during nighttime used no pads or a safety pad (P=0.01 and P=0.04, respectively). Ninety-day postoperative complications were observed in 14 (29.2%) patients in the study, and in 10 (29.4%) cases in the control group (P=0.77)., Conclusions: In our exploratory case-control study of male patients undergoing open RC with IONB, we observed a significant improvement in daytime and nighttime urinary continence recovery with no increase in perioperative complications using the novel urethral fixation technique compared to the standard neovesical-urethral anastomosis.

Objectives: The aim of this study was to determine closure-related complications and outcome after median sternotomy (MS) in cats., Methods: This was a retrospective, multicentric study. The medical records of cats undergoing MS from six referral hospitals were reviewed (2010-2020). Data retrieved included signalment, history, presenting complaints, surgery, patient outcomes and complications. Follow-up was performed via patient records and email/telephone contact with both owners and referring veterinarians. Descriptive statistics were performed., Results: Data on 36 cats were collected; four were excluded due to insufficient follow-up and six died less than 5 days after surgery. Twenty-six cats survived to discharge (survival rate 81%). Three cats had a full sternotomy (FS) performed and 23 cats a partial sternotomy (PS). Of the cats that underwent a PS, six included the manubrium (PSM) and three included the xyphoid process. For 14 cats, the length of sternotomy was unknown. Sternotomy closure was performed with suture in all cats. Two cats (7.7%) developed closure-related complications, both after PSM, during the long-term follow-up, one mild, slightly displaced sternal fracture and one severe, sternal dehiscence (without skin wound dehiscence) requiring revision surgery. No seroma, surgical site infection or wound dehiscence occurred. The most common reason for MS was the presence of a thoracic mass (17/26; 65%), with thymoma being the most common (11/17; 65%)., Conclusions and Relevance: MS has a low closure-related complication risk in cats when compared with dogs. Complications in cats present differently to what has been previously described in dogs.

Objective: To report complications and long-term outcomes after submucosal resections of benign and malignant epithelial rectal masses., Study Design: Retrospective multicentric study., Sample Population: Medical records of 93 dogs at 7 referral hospitals., Methods: Records were reviewed for surgical time, diagnosis, margins, complications, and recurrences. Survival of dogs was evaluated based on tumor types, categorized as benign, carcinoma in situ, and carcinoma. The Kaplan-Meier survival curve and Cox proportional hazards analysis were used to determine the association of a range of variables with recurrence and survival time., Results: Duration of follow up was 708 days (range, 25-4383). Twenty-seven dogs (29%) developed complications. Recurrence was identified in 20/93 (21%), with 12/20 recurrent masses treated with repeat submucosal resection. Median survival was not reached in any group. The 1-,2-, 5-year survival rates for carcinomas were 95%, 89%, and 73% respectively. However, overall survival was longer for benign tumors than carcinomas (P = .001). Recurrence was more likely when complications (P = .032) or incomplete margins (P = .023) were present. Recurrence was associated with an increased risk of death (P = .046)., Conclusion: Submucosal resection of both benign and malignant rectal masses was associated with a low rate of severe complications and prolonged survival in the 93 dogs described here., Clinical Significance: Submucosal resection is a suitable technique for resection of selected rectal masses., (© 2022 The Authors. Veterinary Surgery published by Wiley Periodicals LLC on behalf of American College of Veterinary Surgeons.)

Our study aimed to compare the incidence of infective complications after transrectal ultrasound-guided prostate biopsy (TRUSBx) when adopting different antimicrobial prophylaxis regimens. A multi-institutional cohort of 1150 patients who underwent TRUSBx was retrospectively analyzed. Procedures were performed between 2017 and 2019 (before and after the EMA warning about the use of fluoroquinolones for the antibiotic prophylaxis of patient candidates to TRUSBx). The primary endpoint was the occurrence of infective complications, including sepsis and/or fever. The population was stratified according to the antibiotic prophylaxis adopted: fluoroquinolones (levofloxacin, ciprofloxacin, prulifloxacin), cephalosporins (cefixime, ceftriaxone) or trimethoprim/sulfamethoxazole. Univariable and multivariable binomial logistic regression models were used to assess the odds ratio (OR) with 95% confidence interval (CI) testing of the risk of infective complication after adjusting for each prebiopsy covariate. In total, 478 (41.6%) patients received fluoroquinolone-based prophylaxis. Among these, 443 (38.5%), 25 (2.2%) and 10 (0.9%) patients received levofloxacin prophylaxis, ciprofloxacin and prulifloxacin, respectively while 14.6% received cefixime, 20.7% received the comedication of ceftriaxone/fosfomycin and 23.1% received trimethoprim/sulfamethoxazole. The trimethoprim/sulfamethoxazole and fluoroquinolone regimens were significantly associated with a lower risk of infective complications (OR 0.15, 95% CI 0.03−0.48, p = 0.003 and OR 0.17, 95% CI 0.06−0.43, p < 0.001, respectively). The ceftriaxone/fosfomycin (OR 0.21, 95% CI 0.04−0.92, p = 0.04) and fluoroquinolone (OR 0.07, 95% CI 0.00−0.70, p = 0.048) prophylaxis were associated with a lower risk of infective sequelae. Fluoroquinolone-based prophylaxis was associated with a lower risk of infective complications after TRUSBx compared to other prophylaxis regimens although its clinical application was recently forbidden by European Medical Agency restrictions.

Case Description: Three dogs were presented for investigation of chronic nasal discharge and epistaxis 141, 250, and 357 days after undergoing transfrontal craniotomy to treat an intracranial meningioma (2 dogs) or a meningoencephalocele (1 dog)., Clinical Findings: CT findings were consistent with destructive rhinitis and frontal sinusitis in all 3 dogs, with results of histologic examination and fungal culture of samples obtained during frontal sinusotomy confirming mycotic infection. Frontal sinusotomy revealed fungal plaques covering a combination of bone and residual surgical tissue adhesive at the site of the previous craniotomy in all 3 dogs. Aspergillus spp were identified in all 3 dogs, and Chrysosporium sp was also identified in 1 dog., Treatment and Outcome: Surgical curettage was followed by antifungal treatment (topical clotrimazole in 2 dogs and oral itraconazole for 3 months in 1 dog). Nasal discharge improved in the short-term but recurred in all dogs 99, 118, and 110 days after frontal sinusotomy. One dog received no further treatment, 1 dog received an additional 8.5 months of oral itraconazole treatment, and 1 dog underwent 2 additional surgical debridement procedures. At last follow-up, 2 dogs were alive 311 and 481 days after frontal sinusotomy; the third dog was euthanized because of status epilepticus 223 days after frontal sinusotomy., Clinical Relevance: Sinonasal mycosis should be considered as a potential complication in dogs developing persistent mucopurulent nasal discharge, intermittent epistaxis, and intermittent sneezing following transfrontal craniotomy. The pathophysiology may be multifactorial, and potential risk factors, including use of surgical tissue adhesive in the frontal sinus, require further investigation.

Objectives: To assess perioperative outcomes, complications, and rate of uretero-ileal anastomotic stricture (UAS) in patients undergoing retrosigmoid ileal conduit after radical cystectomy (RC)., Patients and Methods: Clinical records of consecutive patients receiving retrosigmoid ileal conduit after open RC for bladder cancer between March 2016 and June 2020 at two academic centres were prospectively collected. Two expert surgeons performed all cases. Operating room (OR) time, estimated blood loss (EBL), transfusion rate, and 90-day postoperative complications classified according to the Clavien-Dindo system, were assessed. In particular, rate of UAS, defined as upper urinary tract dilatation requiring endourological or surgical management, was evaluated., Results: A total of 97 patients were analysed. The median (interquartile range [IQR]) OR time was 245 (215-290) min, median (IQR) EBL was 350 (300-500) mL, and blood transfusions were given to 15 (15.5%) cases. There were no intraoperative complications. There were 90-day postoperative complications in 33 patients (34%), being major (Grade III-V) in 19 (19.6%). Two patients died from early postoperative complications. At a median (IQR) follow-up of 25 (14-40) months, there was only one case (1%) of UAS, involving the right ureter and requiring an open uretero-ileal re-implantation., Conclusion: The retrosigmoid ileal conduit is a safe and valid option for non-continent urinary diversion after RC, ensuring a very low risk of UAS at an intermediate-term follow-up., (© 2021 The Authors BJU International © 2021 BJU International Published by John Wiley & Sons Ltd.)

Objective: To describe the clinical presentation, treatments, and long-term outcomes following cholecystectomy in cats., Study Design: Clinical retrospective study., Animals: Twenty-three client-owned cats., Methods: Medical records of all cats undergoing cholecystectomy between 2005 and 2021 at a single referral hospital were retrospectively reviewed. No cats were excluded. An owner questionnaire assessed long-term outcomes., Results: Vomiting, jaundice, and abdominal pain were the most common clinical signs; median duration of signs was 4 days (range 1-21). Cholelithiasis was the major indication for cholecystectomy followed by cholecystitis. Intraoperative hypotension and postoperative anemia were commonly encountered. Nine cats required a postoperative blood product transfusion. Cardiopulmonary arrest and death occurred in five cats. Eighteen cats (78.3%) survived to discharge. Long-term follow up (>60 days) was available for 16 cats at a median of 1003 days (range 81-4995). Fifteen cats survived over 6 months with eight cats (44.4%) surviving over 3 years. The most common short-term and long-term postoperative complication was vomiting. Owners assessed postoperative outcome as excellent in all cats and quality of life as excellent or good., Conclusion: The most common indication for cholecystectomy was cholelithiasis. Perioperative complications were commonly encountered. Perioperative mortality rate was 21.7%. Long-term owner evaluation of clinical outcome was considered excellent., Clinical Significance: Cats undergoing cholecystectomy for non-neoplastic causes can have a favorable prognosis for recovery and quality of life. Concurrent extrahepatic biliary duct obstruction is not a contraindication for cholecystectomy provided that patency of the common bile duct is restored., (© 2021 American College of Veterinary Surgeons.)

Objective: To evaluate ultrasound-guided placement of an anchor wire (AW) or injection of methylene blue (MB) to aid in the intraoperative localization of peripheral lymph nodes in dogs and cats., Animals: 125 dogs and 10 cats with a total of 171 lymphadenectomies., Procedures: Medical records of dogs and cats that underwent peripheral lymphadenectomies with or without (N) the AW or MB localization technique were reviewed. Data retrieved included clinical, surgical, and histologic findings. The proportions of successful lymphadenectomies, lymph node characteristics, and complications among the 3 groups were analyzed., Results: 143 (84%) lymph nodes were successfully excised. Lymphadenectomy success was significantly affected by the localization technique, with 94% for group AW, 87% for group MB, and 72% for group N. Lymph node size was smaller in groups AW and MB, compared with group N. Duration of lymphadenectomy was shorter in group AW, compared with groups MB and N, and in group MB, compared with group N. Intra- (7%) and postoperative (10%) complications and final diagnosis did not significantly differ among groups., Conclusions and Clinical Relevance: Both lymph node localization techniques were highly successful and reduced surgery time, compared with unassisted lymphadenectomy. Specifically, these techniques were effective for localization of normal-sized and nonpalpable lymph nodes and were efficient and practical options for peripheral lymphadenectomies, particularly for those that were small or nonpalpable.

Background: Iatrogenic ureteral injuries are devastating complications potentially resulting in irreversible impairment of renal function and/or infectious sequelae. Only few data are available on the management of such injuries to the abdominal ureter., Objective: To report the etiology, perioperative outcomes, and treatment failure rate of different reconstructive surgical interventions for iatrogenic injuries to the abdominal ureter in a contemporary case series., Design, Setting, and Participants: We retrospectively analyzed consecutive patients who underwent reconstructive surgery for iatrogenic injuries to the abdominal ureter at our academic centers between July 2013 and April 2019. All interventions were performed via either an open or a robot-assisted approach by a single expert surgeon., Surgical Procedure: Different surgical reconstructive procedures, such as Boari bladder flap, ureteroureterostomy, ileal replacement, and pyeloureteroplasty, have been adopted., Measurements: Outcome measures were the etiology of iatrogenic injuries, rate of postoperative complications, and rate of treatment failure, defined as upper urinary tract obstruction requiring permanent urinary drainage., Results and Limitations: Nineteen patients were included. Injuries were consequent to endourological procedures in nine (47.4%), gynecological procedures in two (10.5%), colonic surgery in two (10.5%), vascular surgery in two (10.5%), and other surgeries in four (21.1%) cases. Boari bladder flap was performed in 12 (63.2%), ureteroureterostomy in two (10.5%), ileal substitution in two (10.5%), and pyeloureteroplasty in three (15.8%) cases. Only four (21.1%) procedures were performed robotically. Major postoperative complications were recorded in three (15.8%) patients. After a median follow-up of 16 (interquartile range 12-24) mo, treatment failure was observed in two (15.8%) cases. We accept the limitations of a small retrospective single-surgeon series with preference-based management choice., Conclusions: In our series, endourological procedures were the most frequent cause of iatrogenic injuries to the abdominal ureter requiring reconstructive surgery. A Boari bladder flap was the preferred option to bridge extensive ureteral defects. Despite the complexity of such procedures, major postoperative complications were infrequent and treatment failure rate was low., Patient Summary: We report on a contemporary series of patients with disparate iatrogenic injuries to the abdominal ureter requiring complex reconstructive surgery. Despite the difficulty of such procedures, we found that major postoperative complications were infrequent and treatment failure rate was low., (Copyright © 2020 European Association of Urology. Published by Elsevier B.V. All rights reserved.)

(1) Background: Water and solid fuel collection and transport are domestic duties for millions of households across the globe. People in areas with limited or no access to safely managed sources of water and household energy must fetch these resources on a frequent basis. The health, gender, and economic impacts associated with water and solid fuel collection labor have not been systematically reviewed. (2) Methods: Studies were identified through database searches and included using a list of inclusion and exclusion criteria. Studies were summarized and grouped into one of eight thematic categories. (4) Conclusions: The findings suggest that a diverse and heavy health burden is associated with water and solid fuel collection and transport. The literature also suggests that the provision of safely managed and accessible water and improved fuel options can mitigate these negative outcomes. Filling research gaps and utilizing results to guide policy and funding would likely be an effective way to ensure low- and middle-income countries are not left behind as the world strives to meet the sustainable development goals.

This study assessed the performance of modeling approaches to estimate personal exposure in Kenyan homes where cooking fuel combustion contributes substantially to household air pollution (HAP). We measured emissions (PM 2.5 , black carbon, CO); household air pollution (PM 2.5 , CO); personal exposure (PM 2.5 , CO); stove use; and behavioral, socioeconomic, and household environmental characteristics (eg, ventilation and kitchen volume). We then applied various modeling approaches: a single-zone model; indirect exposure models, which combine person-location and area-level measurements; and predictive statistical models, including standard linear regression and ensemble machine learning approaches based on a set of predictors such as fuel type, room volume, and others. The single-zone model was reasonably well-correlated with measured kitchen concentrations of PM 2.5 (R 2  = 0.45) and CO (R 2  = 0.45), but lacked precision. The best performing regression model used a combination of survey-based data and physical measurements (R 2  = 0.76) and a root mean-squared error of 85 µg/m 3 , and the survey-only-based regression model was able to predict PM2.5 exposures with an R 2 of 0.51. Of the machine learning algorithms evaluated, extreme gradient boosting performed best, with an R 2 of 0.57 and RMSE of 98 µg/m 3 ., (© 2021 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Objective: To describe the technique and outcomes after placement of sutures around the sacrotuberous ligament during perineal hernia (PH) repair in dogs., Study Design: Retrospective single-center study., Animals: Dogs (n = 47) with PH., Methods: Medical records of dogs treated for PH between 2002 and 2020 were reviewed. Dogs were included when sutures had been placed around the sacrotuberous ligament. Short-term outcomes and intraoperative and postoperative complications were recorded. Long-term outcome was assessed with a questionnaire completed by owners., Results: Twenty-eight of 47 dogs were medium or large breeds. The primary clinical sign was tenesmus in 43 dogs and dysuria-stranguria in four dogs. Bilateral hernias were detected in 17 dogs. No intraoperative complications occurred. Median surgical time was 50 minutes for unilateral PH and 120 minutes for bilateral PH. Minor postoperative complications consisting of surgical wound swelling (9), wound dehiscence (4), and temporary tenesmus (2) occurred in 10 dogs. No major complications or recurrence were reported. The only factors associated with an increased risk of complications included increasing age (P = .019) and surgical treatment of a recurrent PH (P = .043). Owners consistently reported good long-term outcomes., Conclusion: The PH repair described in this study resulted in good long-term outcomes without major complications., Clinical Significance: Placement of sutures around the sacrotuberous ligament represents an alternative during PH, but anatomical knowledge of the sciatic nerve and caudal gluteal vessels is required., (© 2021 The American College of Veterinary Surgeons.)

An 11 yr old female neutered domestic shorthair presented for an 8 mo history of an asymptomatic abdominal mass. Computed tomography described an irregular, cystic structure closely associated with the duodenum, and focal ultrasonography confirmed the mass shared outer layers with the intestinal wall. Coeliotomy revealed the mass was originating from, and firmly adhered to, the antimesenteric border of the duodenum but was not communicating with the intestinal lumen. En bloc mass resection with omentalization was performed without small intestinal resection. Histopathology confirmed an enteric duplication cyst. The cat made a full recovery and remained asymptomatic postoperatively with no evidence of recurrence. A review of the literature confirms the duodenum to be the most common location of enteric duplication cysts in felines and that subtotal excision is curative in most cases. This differential should be considered in cases of cystic gastrointestinal structures in juvenile and adult felines, with or without associated clinical signs. In cases of luminal involvement or malignant transformation, intestinal resection and anastomosis is more appropriate. This report describes the presentation, investigations, and treatment of an asymptomatic duodenal duplication cyst in an adult feline and summarizes and compares current knowledge of the condition between veterinary and human literature., (© 2021 by American Animal Hospital Association.)

Objectives: To assess whether bladder neck angle and position on cystogram predict early urinary continence in patients scheduled for early catheter removal after radical prostatectomy (RP)., Methods: A total of 103 patients undergoing open or robot-assisted RP by one expert surgeon between January and December 2019 were retrospectively analyzed. A cystogram was performed on postoperative day 3 or 4 to evaluate anastomotic leakage, and, if none or minimal, the catheter was removed. Urinary continence was evaluated with a validated questionnaire at 1 week, 1 month, and 3 months after RP. Four investigators of different experience assigned bladder neck angle and relative position of bladder neck to pubic symphysis on archived cystogram images. Association between these two parameters and urinary continence rates at different follow-up times was assessed with logistic regression analysis adjusting for patient and tumor characteristics, and surgical technique. Interobserver agreement in assigning the two parameters was measured with k statistic., Results: Catheter was removed immediately after cystogram in 101 (98%) patients. On multivariable analysis, only relative position of bladder neck to pubic symphysis was an independent predictor of 1-week (odds ratio [OR] 30. 95% confidence intervals [CIs] 6-138, p  < 0.001), 1-month (OR 11. 95%CIs 3.8-32, p  < 0.001), and 3-month (OR 19. 95%CIs 3.6-98, p  < 0.001) urinary continence. Interobserver agreement for bladder neck and relative position of bladder neck to pubic symphysis was fair to moderate, and substantial to almost perfect, respectively., Conclusions: Relative position of bladder neck to pubic symphysis on cystogram is a strong and reproducible predictor of early urinary continence after RP.

Objective: To compare complications of dogs treated with mandibular and sublingual sialoadenectomy for sialocele using a lateral (LAT) or ventral paramedian (VPM) approach., Study Design: Retrospective multicenter study., Animals: Dogs (140) with mandibular and sublingual sialocele., Methods: Medical records of dogs that underwent mandibular and sublingual sialoadenectomy through a LAT or VPM approach from 2004 to 2020 were reviewed. Clinical and histopathological findings were analyzed to compare the groups., Results: Seventy dogs were included in each group. The most represented breed was crossbreed (26%), and males (99/140 [71%], intact/neutered) were overrepresented. Dogs in the VPM approach group were more likely to undergo digastricus tunnelization and placement of a drain or a bandage. Dogs in the LAT approach group were heavier and more likely to undergo excision of an inflammatory pseudocapsule. No difference was detected in complication rates between groups (LAT [20%], VPM [31%], P = .116). Recurrences were more likely after LAT approach (5/70 vs 0/70, respectively; P = .029), whereas wound-related complications were more likely after VPM approach (20/70 vs 9/70, respectively; P = .018). Prolonged duration of surgery was associated with an increased risk of recurrence, and none of the other variables affected the complication rate., Conclusion: Ventral paramedian approach for mandibular and sublingual sialoadenectomy was associated with a lower risk of recurrence but a higher risk of wound-related complications compared with LAT approach., Clinical Significance: Ventral paramedian approach for mandibular and sublingual sialoadenectomy may be preferred to reduce recurrence in dogs with sialoceles, but wound-related complications are common., (© 2021 The American College of Veterinary Surgeons.)

Background: Urinary continence recovery after radical prostatectomy is a major issue even in the robotic era. Surgical techniques aimed at improving earlier return to continence are continuously sought., Objective: To describe our novel surgical technique of urethral fixation during robot-assisted radical prostatectomy (RARP) and to assess early urinary continence recovery and perioperative complications., Design, Setting, and Participants: A prospective, single-center, single-surgeon cohort of 70 consecutive patients undergoing RARP between January and December 2019 was analyzed. A study group of 35 patients operated on with the urethral fixation technique was compared with a control group of 35 patients receiving standard vesicourethral anastomosis., Surgical Procedure: Urethral fixation versus standard vesicourethral anastomosis during RARP was evaluated. In the study group, the urethral stump was fixed to the dorsal median raphe posteriorly and to the medial portion of the levator ani muscle posterolaterally. The same posterior musculofascial reconstruction incorporating the vesicourethral anastomosis was performed in both groups., Measurements: Urinary continence recovery, perioperative complications, operating room time, and estimated blood loss were recorded and compared between the two groups., Results and Limitations: The two groups were comparable with regard to all demographic, clinical, and pathological variables. Recovery of urinary continence at 3 mo after catheter removal was reported by 34 (97.1%) patients in the study and 28 (80%) patients in the control group (p =  0.02). Patients in the study group reported significantly higher rates of urinary continence even at 1 wk and 1 mo after catheter removal compared with the control group (68.6% vs 45.7%, p =  0.04, and 80% vs 54.3%, p =  0.04, respectively). No differences were observed in operating room time (p =  0.7) or estimated blood loss (p =  0.65). Ninety-day postoperative complications were observed in one (2.9%) patient in the study and in four (11.4%) in the control group (p =  0.3). The main limitation is the nonrandomized comparison of relatively small cohorts., Conclusions: In our study, we observed a significant improvement in early urinary continence recovery, with no increase in operating room time or perioperative complications, using the novel urethral fixation technique compared with the standard vesicourethral anastomosis during RARP., Patient Summary: We describe our novel surgical technique of urethral fixation during robot-assisted radical prostatectomy. Compared with the standard technique, utilization of our technique was found to be associated with an improved early recovery of urinary continence, with no increase in operating room time or perioperative complications., (Copyright © 2021 European Association of Urology. Published by Elsevier B.V. All rights reserved.)

The aim of this study was to identify and standardize computed tomography (CT) features having a potential role in predicting aggressiveness of malignant parenchymal renal tumors suitable for partial nephrectomy (PN). We performed a non-systematic review of the recent literature to evaluate the potential impact of CT variables proposed by the Society of Abdominal Radiology Disease-Focused Panel on Renal Cell Carcinoma in predicting aggressiveness of newly diagnosed malignant parenchymal renal tumors. The analyzed variables were clinical tumor size, tumor growth rate, enhancement characteristics, amount of cystic component, polar and capsular location, tumor margins and distance between tumor and renal sinus. Unfavorable behavior was defined as: 1) renal cell carcinoma (RCC) with stage ≥pT3; 2) nuclear grade 3 or 4; 3) presence of sarcomatoid de-differentiation; or 4) non-clear cell subtypes with unfavorable prognosis (type 2 papillary RCC, collecting duct or renal medullary carcinoma, unclassified RCC). Beyond clinical tumor size, tumor growth rate, enhancement characteristics, amount of cystic component, tumor margins and distance between tumor and renal sinus are highly relevant features predicting an unfavorable behavior. Moreover, several studies supported the role of necrosis as preoperative predictor of tumor aggressiveness. Peritumoral and intratumoral vasculature as well as capsule status are emerging variables that need to be further evaluated. Tumor size, enhancement characteristics, tumor margins and distance to the renal sinus are highly relevant CT features predicting biological aggressiveness of malignant parenchymal renal tumors. Combination of these parameters might be useful to generate tools to predict the unfavorable behavior of renal tumors suitable for PN.

Objective: To describe and report the outcomes after closure of median sternotomies with crimped monofilament nylon leader (MNL) in dogs., Study Design: Retrospective observational study., Animals: Dogs (n = 10) that underwent intrathoracic surgery through a median sternotomy approach., Methods: The median sternotomy was closed in a peristernal figure eight pattern with crimped MNL. Medical records were reviewed for clinical and histopathological findings and complications. Owners or veterinarians were contacted to collect long-term follow-up information., Results: The technique was simple, with no intraoperative complications. Postoperative infection was documented in one dog, requiring removal of a single MNL and associated crimp clamp. Delayed healing of the surgical incision in one dog was managed conservatively. No other complications were documented throughout long-term follow-up at a median of 488 days (range, 199-608)., Conclusion: Median sternotomies were successfully closed with crimped MNL and were associated with a low complication rate., Clinical Significance: Crimped MNL represents an alternative method to close median sternotomies in dogs., (© 2020 The American College of Veterinary Surgeons.)

The evaluation of loco-regional lymph nodes (LN) plays an important prognostic role and assists the clinical decision making in canine cancer patients. Excision of non-palpable LN can be challenging. The aim of the study was to evaluate surgical time, successful excision rate and surgical complications associated with the use of an ultrasound-guided hook-wire (UGHW) LN localization method for non-palpable superficial inguinal LN (SILN) in dogs. Dogs that presented for excision of non-palpable SILN, performed with the aid of an UGHW placement, were enrolled. Information including signalment, SILN width, UGHW placement and surgical procedure time, hook-wire position, successful excision and intra- and post-operative complications were reviewed. Seventeen dogs were enrolled. Median LN width was 3 mm (range 2-11). Median time of preoperative UGHW placement and surgical LN excision was 8 min and 15 min, respectively. Successful SILN excision was achieved in all cases. Two minor intra-operative (hook migration and wire fragmentation) and one minor post-operative complications (seroma) were observed. No major intraoperative or post-operative complications occurred. The UGHW LN localization method is safe and effective and may allow a high rate of successful SILN excisions in dogs. This method has the potential to facilitate LN excision for other superficial LN locations.

Intravascular lymphoma (IVL) is a rare, high-grade, extranodal lymphoma characterized by selective proliferation of neoplastic lymphocytes within the lumen of small vessels. A 10 yr old female intact mixed-breed dog was presented with a 7 mo history of vomiting and anorexia. Physical examination revealed abdominal discomfort. Ultrasonography and endoscopy identified a submucosal gastric mass. Excision was performed by partial gastrectomy and histopathology and immunohistochemistry confirmed a T-cell IVL. The owner declined chemotherapy, and the dog was instead treated palliatively with prednisolone. Two months after surgery, vomiting recurred and abdominal ultrasonography revealed a large gastric ulcer with focal peritonitis. The dog was euthanized 4 mo after initial presentation and postmortem examination confirmed IVL recurrence in the stomach and an isolated nodule of neoplastic cells in the omentum. No involvement of other organs was found following histopathological examination. This is the first description of primary gastric intravascular lymphoma causing chronic vomiting in a dog.

Objective: To report outcomes of dogs treated for lung lobe torsion (LLT) and to determine prognostic factors for survival., Study Design: Retrospective multicenter study from four veterinary teaching hospitals., Animals: Dogs (n = 80) with LLT., Methods: Medical records were reviewed for clinical and histopathological findings. Long-term outcome was assessed with an owner questionnaire. Lung lobe torsion was classified as idiopathic or secondary on the basis of the etiology., Results: The most represented breeds were pugs (47.5%) and sighthounds (16.2%). The cause of the LLT was considered primary in 77%, secondary in 21%, and unknown in 2% of dogs. Postoperative complications were recorded in 14% of dogs. Overall, 95% of dogs survived to discharge, and median follow-up was 1095 days (range, 7-3809). Owners assessed outcomes and quality of life as excellent in 93% and 89% of dogs, respectively. Primary LLT was associated with a longer survival (median not reached in the study) compared with secondary LLT (921 days; range, 7-2073; P = .001)., Conclusion: Overall long-term survival after lung lobectomy for LLT was excellent. Primary LLT was associated with longer survival compared with secondary LLT. Long-term owner evaluation of clinical outcome for dogs undergoing lung lobectomy for LLT was considered excellent., Clinical Impact: Dogs with primary LLT undergoing lung lobectomy have a longer survival time compared with dogs with secondary LLT and have an excellent postoperative outcome., (© 2020 The American College of Veterinary Surgeons.)

Background: To compare perioperative and functional outcomes associated with renorrhaphy performed with two different types of clips (Absolok® vs. Hem-o-Lok®) in a contemporary series of patients who underwent partial nephrectomy., Methods: Patients in whom Absolok® clips were used to perform haemostasis at the level of tumor bed or to block the running sutures during sliding-clip renorrhaphy (study group) were compared with a contemporary control group of patients in whom renorrhaphy was performed with Hem-o-Lok® clips. Both groups received the same surgical technique via an open or robot-assisted approach. Inner renorrhaphy was performed with one or more 3-0 (26 mm needle) monofilament running suture(s) preloaded with medium Absolok® clips in the study group, and with medium Hem-o-Lok® clips in the control group. Cortical renorrhaphy was performed using interrupted 2-0 (26 mm needle) polyfilament sutures placed at intervals of 1 cm using the sliding-clip technique with Absolok® clips in the study group and with Hem-o-Lok® clips in the control group. Intraoperative and postoperative outcomes were compared., Results: Absolok® clips were used in 57 patients, while Hem-o-Lok® clips were used in 40 patients. The two groups were comparable for all preoperative patient and tumor characteristics. No differences were observed in terms of operating room time (P=0.29), off-clamp technique rate (P=0.96), warm ischemia time (P=0.19) and estimated blood loss (P=0.18). No difference in the rate of positive surgical margins was detected (P=0.21). Ninety-day complications were observed in 32 (33%) cases. No difference in overall and major postoperative complications were observed between the two groups (P=0.20). Abdominal CT scan performed after 3 months following surgery showed no Absolok® clips in all cases., Conclusions: Absolok® clips are a valid alternative to Hem-o-Lok® clips to secure blood vessels at the level of tumor bed and to perform a sliding-clip renorrhaphy in patients who underwent open or robot-assisted partial nephrectomy.

Background: Globally, an estimated 3.6 billion people rely on solid fuels for cooking over open fires or in simple cookstoves. Universal access to clean cooking fuels and technology by 2030 is a United Nations' Sustainable Development Goal., Methods: The Mediae Company created a home makeover television and radio show, Shamba Chef , designed to promote modern, cleaner, safer cooking methods and improved nutrition in Kenya, which reached 5 million homes in late 2017. This was accompanied by a mobile phone platform called iChef. Researchers evaluated the effects of Shamba Chef on cookstove purchase, use, and attitudes, beliefs, and intentions., Results: The study revealed dose-response effects of Shamba Chef exposure on several key outcomes. Exposure to the program was associated with an awareness of improved biomass stoves (OR 4.4; 95% CI 2.8 to 6.9), and aspirations to own an improved biomass stove (OR 2.0; 95% CI 1.4 to 2.9). Receiving information about modern stoves from two or more sources generated greater awareness of liquefied petroleum gas (LPG) stoves (OR 2.0; 95% CI 1.3 to 3.1). The qualitative study revealed that Shamba Chef explained how the stoves worked, communicated their benefits, and encouraged participants to trust and purchase those cookstoves., Conclusion: Shamba Chef was successful in influencing determinants of cookstove purchase and use, and there is evidence from the qualitative study that it influenced the purchase and use of improved biomass stoves.

Introduction: Among the measures taken in the recent years to reduce the morbidity and improve functional recovery after radical cystectomy (RC), the optimization of perioperative care pathways is gaining a prominent role. The aim of this systematic review of the literature with meta-analysis is to assess the impact of enhanced recovery after surgery (ERAS) protocols vs. standard of care on perioperative outcomes of patients undergoing RC., Evidence Acquisition: A systematic review with meta-analysis was performed according to Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines. MEDLINE, SCOPUS and Web of Science databases were searched. Only comparative studies evaluating the impact of ERAS protocols vs. standard of care on intraoperative and postoperative outcomes of patients undergoing RC were included. Cumulative analysis was conducted using Review Manager v.5.3 software. Statistical heterogeneity was tested using the χ2 Test, and a P value <0.10 was used to indicate heterogeneity. Random-effects and fixed-effects models were used as appropriate depending on heterogeneity status., Evidence Synthesis: A total of 27 studies were included, namely 3 randomized and 24 non-randomized controlled studies, resulting in 4712 patients, 2690 (57%) participants to some ERAS protocol and 2022 (43%) controls receiving standard of care. A number of primary and secondary outcome measures were assessed in the original studies. Pooled data showed that ERAS protocols were associated with significantly faster recovery of bowel function, faster return to regular diet and shorter hospital stay with no increase in 30-day and 90-day major complication, mortality or readmission rates compared to standard of care. The magnitude of benefit of the various ERAS protocols tested had, however, a non-negligible inter-study variability., Conclusions: This systematic review with meta-analysis of comparative studies showed that ERAS protocols applied to patients undergoing RC enabled a faster recovery of bowel function, a faster return to regular diet and a shorter hospital stay with no increase in major complication or readmission rate compared to standard perioperative care. RC with ERAS protocols should be considered the new standard of care.

Male lower urinary tract symptoms are frequently due to benign prostatic enlargement. Medical therapy is strongly recommended in patients with moderate to severe symptoms. Lower urinary tract symptoms may require a different medical approach using drugs with different mechanisms of action. Alpha-1 blockers, muscarinic receptor antagonists and phosphodiesterase type 5 inhibitors are the most frequently used drugs. 5-Alpha reductase inhibitors are commonly prescribed to reduce prostate volume and to prevent benign prostatic hyperplasia progression. Currently, medical treatment of lower urinary tract symptoms suggestive of benign prostatic enlargement can be tailored according to different symptom characteristics and severity, and to different patient comorbidities and preferences. For this reason, the decision-making process should be based on an accurate patient counselling with detailed clarification of potential benefits and, above all, potential side effects of different drugs. This non-systematic review of the literature presents an update of the current options for medical treatment of lower urinary tract symptoms suggestive of benign prostatic enlargement, helping urologists in the decision-making and counselling process.

Objective:  The aim of this study was to report the prevalence and to identify the risk factors associated with postoperative tibial tuberosity fracture following a triple tibial osteotomy. This article also evaluates the outcome of these patients treated conservatively., Materials and Methods:  Medical records of 100 dogs (113 limbs) that underwent triple tibial osteotomy procedure were evaluated. Information obtained included signalment, preoperative, immediate postoperative and 6-week postoperative radiographic findings, intraoperative and postoperative complications. Long-term outcome was assessed using an owner questionnaire., Results:  Postoperative tibial tuberosity fracture was identified in 25/113 stifles. The only variable associated with the presence or absence of postoperative tibial tuberosity fracture within 6 weeks of surgery was postoperative cortical hinge width (CHW) or an indexed value of CHW to tibial width (TW). Using either a cut-off value of CHW of ≥ 5.5 mm or a cut-off value of CHW/TW of ≥ 0.21, only 1/27 stifle in our study developed tibial tuberosity fracture. Long-term owner evaluation of outcome was considered excellent or good in 65/70 stifles., Conclusion:  A narrow CHW at the distal cortical attachment of the tibial crest had a strong association with the development of postoperative tibial tuberosity fracture. No other patient or surgical variables were associated with tibial tuberosity fracture. Patients that developed tibial tuberosity fracture and were conservatively managed did not have a worse clinical outcome than patients that did not develop tibial tuberosity fracture., Competing Interests: The authors have no conflict of interests with regard to this manuscript., (Georg Thieme Verlag KG Stuttgart · New York.)

Objective:  The main aim of this study was to describe complications in dogs weighing < 20 kg treated for medial patellar luxation and to determine risk factors associated with these complications., Materials and Methods:  Medical records were reviewed and cases were grouped based on four techniques of stabilization for the tibial tuberosity transposition (TTT). Variables including animal signalment, clinical presentation, TTT technique, other concurrent surgical techniques and associated complications were investigated. Multiple logistic regression was used to determine the association of the same variables with specific complications such as tibial tuberosity fractures or avulsions, patellar reluxation and implant-related complications., Results:  Of the 100 procedures performed, 37 suffered a complication. There were no significant differences in the overall complication rate between TTT stabilization techniques. Preservation of the tibial tuberosity distal cortical attachment was associated with a reduced risk of implant-related complications, whereas adding a medial release to the surgical techniques was associated with an increased risk of medial patellar reluxation. The type of trochleoplasty performed did not affect the complication rate., Conclusions:  In the current study, a high rate of complications was found in dogs < 20 kg undergoing medial patellar luxation surgery. Performing a medial release and preserving the distal cortical attachment of the tibial tuberosity were the only variables associated respectively with an increase and a reduction in the risk of postsurgical complications., Competing Interests: Dr. GERMAN reports grants, personal fees, non-financial support and other from ROYAL CANIN/MARS PETCARE, other from RAW FEEDING VET SOCIETY, non-financial support and other from PURINA, personal fees and non-financial support from SCIVAC, non-financial support and other from NORDIC PETFOOD CONFERENCE, personal fees, non-financial support and other from AAFP CONFERENCE, personal fees, non-financial support and other from AUSTRIAN ASSOC SMALL ANIMAL PRACT, personal fees and non-financial support from ICVC MEETING, personal fees and non-financial support from VMX CONFERENCE, personal fees and non-financial support from LONDON VET SHOW, non-financial support and other from ECVIM, non-financial support and other from BSAVA, non-financial support from CABI SYMPOSIUM, personal fees, non-financial support and other from UNIVERSITY OF CAMBRIDGE, non-financial support and other from WSAVA, personal fees, non-financial support and other from EEVC CONGRESS, personal fees, non-financial support and other from ISFM/ICC, personal fees, non-financial support and other from SLOVAKIAN VET CONGRESS, rants from ZOETIS, outside the submitted work. His academic post at the University of Liverpool is financially supported by Royal Canin. Other authors do not have any affiliation, financial support or conflict of interest with the technique or products used., (Georg Thieme Verlag KG Stuttgart · New York.)

A catalytic rocket stove was developed to reduce emissions and improve efficiency compared to open cooking fires or traditional semienclosed cookstoves, called poyos, typical of rural Guatemala. Traditional stoves often emit particulate matter and carbon monoxide at sufficient levels to cause respiratory illnesses and other health problems. Using focus group results, the stove was tailored to the needs of Guatemalan cooks. Field trial participants were provided with stove training to ensure that stoves were operated correctly. Somewhat surprisingly, the field trial demonstrated a high level of user acceptance in rural Guatemala, where users cooked 93% of the time with the catalytic stove despite having to change some cooking practices. In the field trial, the stove reduced emissions by as much as 68% and improved fuel efficiency by as much as 61% during real-world cooking events relative to the traditional poyo. An additional qualitative portion of the field study identified strengths and weaknesses of the stove that are being addressed as part of an iterative design process., Competing Interests: The authors declare no competing financial interest.

Background: Ureteroileal anastomotic stricture (UAS) after ileal conduit diversion occurs in a non-negligible proportion of patients undergoing radical cystectomy (RC). Surgical techniques aimed at preventing this potential complication are sought., Objective: To describe our surgical technique of retrosigmoid ileal conduit, and to assess perioperative outcomes and postoperative complications with a focus on UAS rate., Design, Setting, and Participants: A prospective single-centre, single-surgeon cohort of 67 consecutive patients undergoing open RC with ileal conduit urinary diversion between July 2013 and April 2017 was analysed. A study group of 30 patients receiving retrosigmoid ileal conduit was compared with a control group of 37 patients receiving standard Wallace ileal conduit., Surgical Procedure: Retrosigmoid versus Wallace ileal conduit diversion after open RC., Measurements: Operative room (OR) time, estimated blood loss (EBL), transfusion rate, and 90-d postoperative complications were recorded and compared between the two groups. In particular, rate of UAS, defined as upper collecting system dilatation requiring endourological or surgical management, was assessed and compared., Results and Limitations: The two groups were comparable with regard to all demographic, clinical, and pathological variables. No differences were observed in terms of OR time (p=0.35), EBL (p=0.12), and transfusion rate (p=0.81). Ninety-day postoperative complications were observed in 11 (36.7%) patients who underwent a retrosigmoid ileal conduit and 20 (54.1%) patients who received a traditional ileal conduit (p=0.32). Major complications (grade 3-4) were observed in three (10%) cases in the former group and in 12 (32.4%) cases in the latter group (p=0.08). Mean (standard deviation) follow-up time was 10.8±4.0 mo in the study group and 27.5±9.5 mo in the control group (p<0.001). No single case of UAS was observed in the study group, whereas six (16.2%) cases of UAS occurred in the control group (p=0.02). The main limitation is a nonrandomised comparison of a relatively small cohort with short-term follow-up., Conclusions: In our study, we observed a significantly reduced rate of UAS and no increase in postoperative complications with the retrosigmoid ileal conduit diversion compared with standard Wallace ileal conduit diversion after open RC., Patient Summary: We describe our surgical technique of retrosigmoid ileal conduit as urinary diversion after open radical cystectomy. Compared with traditional techniques, our technique for ileal conduit was found to be safe and reduce the risk of ureteric strictures., (Copyright © 2018 European Association of Urology. Published by Elsevier B.V. All rights reserved.)

OBJECTIVE To determine the mean diameter of the main portal vein (PV) in healthy dogs by use of CT angiography, identify any associations between PV diameter and certain dog characteristics, and validate a clinically valuable ratio for quantifying the size of the PV. ANIMALS 100 dogs with no hepatic, cardiac, or vascular anomalies that underwent abdominal CT angiography. PROCEDURES Diameters of the main PV, abdominal aorta (Ao), and caudal vena cava (CVC) were measured by 2 observers at a defined location on postcontrast CT angiographic images in axial, sagittal, and transverse planes. Dog characteristics were evaluated for associations with PV diameter, and a PV:Ao diameter ratio was calculated. Intraclass correlations were calculated to assess intra- and interobserver agreement in vessel diameter measurements. RESULTS Mean diameter values were 7.9 mm (range, 4.1 to 14.8 mm) for the PV, 8.9 mm (range, 3.7 to 13.7 mm) for the Ao, and 11.4 mm (range, 4.4 to 22.5 mm) for the CVC. The PV:Ao diameter ratio was 0.91 mm. The PV diameter was significantly associated with dog body weight but not with dog age, sex, or neuter status. Intra- and interobserver reliabilities for measurements of all 3 vessels were considered excellent (intraclass correlation coefficients > 0.85). CONCLUSIONS AND CLINICAL RELEVANCE Findings indicated that the PV:Ao diameter ratio was a repeatable measurement that may be useful for evaluating the size of the portal vasculature in dogs and possibly for distinguishing healthy PVs from abnormal PVs in dogs with hepatic vascular anomalies.

Objective: To assess the accuracy of Prostate Imaging Reporting and Data System version 2 (PI-RADS v2) in detecting clinically significant prostate cancer (csPCa) on multiparametric magnetic resonance imaging (mpMRI) using whole-mount sections after radical prostatectomy (RP) as reference standard., Methods: Forty-eight patients undergoing mpMRI before RP were prospectively enrolled. Two experienced radiologists independently scored and mapped imaging findings according to PI-RADS v2. One experienced uropathologist mapped cancers detected on whole-mount sections using the PI-RADS v2 sector scheme. Per-lesion and per-patient analyses were run. Primary outcomes were sensitivity and false discovery rate (FDR) in detecting csPCa using PI-RADS v2 score ≥3 and ≥4 as thresholds. Secondary outcome was inter-reader agreement., Results: On the per-lesion analysis, sensitivity and FDR at the PI-RADS v2 threshold score ≥3 were 0.75 and 0.17 for Reader 1, and 0.67 and 0.13 for Reader 2, respectively. At the PI-RADS v2 threshold score ≥4, sensitivity was slightly lower, and FDR nearly halved for both readers. On the per-patient analysis, sensitivity for csPCa at the PI-RADS v2 threshold score ≥3 was 0.85 for Reader 1, and 0.78 for Reader 2. At the PI-RADS v2 threshold score ≥4, sensitivity was slightly lower for both readers. Inter-reader agreement was substantial (k 0.72 and 0.65 for PI-RADS v2 threshold score ≥3 and ≥4, respectively)., Conclusion: In our prospective study with pathology after RP as standard of reference, PI-RADS v2 showed good sensitivity in detecting csPCa on mpMRI with substantial agreement between 2 experienced readers. Threshold score ≥4 had lower FDR., (Copyright © 2018. Published by Elsevier Inc.)

Eosinophilic cystitis is a rare disease that presents with either urinary frequency, hematuria, suprapubic pain or urinary retention. Although benign, this entity may progress to diffuse bladder involvement with the need for surgical treatment. We report on 2 cases of advanced disease that required cystectomy with very complex lower urinary tract reconstruction, and review the literature of surgically treated cases., (© 2018 S. Karger AG, Basel.)

Introduction: the aim of this work is to assess whether renorrhaphy with the sliding-clip technique improves perioperative and early functional outcomes compared with traditional renorrhaphy in a contemporary series of patients undergoing open partial nephrectomy (PN)., Material and Methods: A single-center single-surgeon cohort of 107 consecutive patients treated with open PN between July 2013 and March 2017 was analyzed. A study group of 48 patients undergoing renorrhaphy with the sliding-clip technique was compared with a control group of 59 patients receiving traditional renorrhaphy. Outcome measures were operative room (OR) time, warm ischemia time (WIT), estimated blood loss (EBL), rate of overall 90-day postoperative complications, and percentage change in estimated glomerular filtration rate (PCE) > 10% and >20% 1 month postoperatively., Results: OR time (p = 0.02), WIT (p = 0.01) and EBL (p < 0.001) were significantly lower in the study versus control group. Overall 90-day postoperative complications were observed in 8 (16.7%) versus 21 (35.7%) patients in the study versus control group (p = 0.02). PCE > 10% and >20% 1 month postoperatively were observed in approximately 40% and 20% of patients, respectively, with no significant differences between groups. On multivariable analysis, a sliding-clip technique was an independent predictor of WIT >20 min and/or EBL >500 ml (OR 0.238, 95%CI 0.074-0.767; p = 0.01) and overall 90-day postoperative complications (OR 0.360, 95%CI 0.151-0.856; p = 0.02)., Conclusions: In patients undergoing open PN, renorrhaphy with the sliding-clip technique was associated with better intraoperative and postoperative outcomes compared with traditional renorrhaphy. No significant differences were observed in terms of early renal function change.

Background: The purpose of the present study was to investigate the potential impact of catheter removal time on immediate and early urinary continence recovery in a series of patients who underwent radical prostatectomy (RP)., Methods: We prospectively collected and analyzed the clinical records of 197 patients who underwent open RP between January 2014 and December 2016. A single surgeon using the urethral fixation technique performed all procedures. Patients receiving surgery between Monday and Wednesday performed a cystogram on postoperative day (POD) 2. Conversely, other cases treated on a Thursday or Friday performed a cystogram on the following Monday (POD 3 or 4). The catheter removal was planned the day after the cystogram if there was a watertight anastomosis or with a little extravasation (<5%). Urinary continence recovery was evaluated 1 week, 1, 2 and 3 months after catheter removal. Patients self-reporting no urine leak were considered continent. Logistic regression analysis was used to identify independent predictors of urinary continence recovery at different follow-up durations., Results: The median catheterization time was 3 (IQR: 3-4.2) days and acute urinary retention (AUR) was observed in 13 (6.5%) cases. At median follow-up of 12 (IQR: 9-12) months, no case of bladder neck contracture was observed. Urinary continence probabilities were 43%, 63%, 87%, 91% and 95% after 1 week, 1, 3, 6, and 12 months, respectively. On multivariable analyses, time of catheter removal was an independent predictor of urinary continence recovery after 1 week (OR 1.2; P=0.02); 1 month (OR 1.2; P=0.01); 3 months (OR 1.1; P=0.04) and 6 months (OR 1.1; P=0.03) after catheter removal., Conclusions: Time of catheterization should be considered as a postoperative parameter able to influence the immediate and early urinary continence recovery in patients undergoing RP. The impact of new surgical techniques on urinary continence recovery should be tested also considering such potential confounding factor.

Objective: To assess whether an Enhanced Recovery After Surgery pathway was associated with a faster bowel function recovery and no increase in morbidity compared with standard perioperative care in a contemporary series of patients undergoing radical cystectomy., Methods: A prospective single-center single-surgeon cohort of 114 consecutive patients treated with open radical cystectomy between July 2013 and June 2016 was analyzed. A study group of 74 patients with Enhanced Recovery After Surgery pathway was compared with a control group of 40 patients with standard perioperative care. Primary outcome was recovery of bowel function, measured by resumption of bowel sounds, passage of flatus, and passage of stool. Secondary outcome was rate of overall and major 90-day postoperative complications., Results: Bowel function recovery was significantly faster in the study group. Resumption of bowel sounds on postoperative day 1 was recorded in 43 (58%) vs 4 (10%) patients, passage of flatus within postoperative day 2 in 41 (55%) vs 11 (28%) patients, and passage of stool within postoperative day 3 in 37 (50%) vs no patients in the study vs control group, respectively (P < .01 for all). Overall and major 90-day complications were observed in 35 (47.3%) and 13 (17.6%) patients in the study group, and in 25 (62.5%) and 9 (22.5%) patients in the control group (P = .14 and 0.38, respectively)., Conclusion: In patients undergoing open radical cystectomy, an Enhanced Recovery After Surgery pathway allowed a significantly faster bowel function recovery with no increase in 90-day postoperative complications compared with standard perioperative care., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Elderly men are likely to be diagnosed with clinically localized prostate cancer, however only few studies have assessed the appropriate treatment in such patients. Radical prostatectomy is one valid alternative. Perioperative outcomes, functional outcomes and oncological outcomes have to be carefully discussed in patient counselling. Fewer perioperative complications, lower perioperative mortality, and shorter hospitalization times have been reported for patients undergoing radical prostatectomy by high-volume surgeons at high-volume centers. Although elderly patients are more likely to be preoperatively incontinent, and increasing age impacts negatively on continence recovery, long-term urinary continence rates have been reported to be satisfactorily high also in older patients. Potency should not be considered as a relevant outcome, since many elderly patients already suffer from longstanding erectile dysfunction and advanced age itself is associated with low chances of recovery. Although some inter-study variability exists in different oncological outcomes measured, most studies are consistent in showing no different cancer-specific survival rates between younger and older patients, thus implying that even elderly patients may benefit from radical treatment. Biological rather than chronological age should be used to base the decision as to whether a patient will profit from definitive treatment. Therefore, elderly men should undergo a health assessment using validated tools before any treatment decision. Only fit and motivated individuals with a reasonable life expectancy and, above all, high-risk disease should be offered radical prostatectomy. In these patients, high-volume surgeons and minimally invasive approaches should be preferable to minimize perioperative complications.

Objectives: To validate Graves' classification of the intrarenal arteries and to verify the absence of collateral arterial blood supply between different renal segments, in order to maximize peri-operative and functional outcomes of partial nephrectomy., Materials and Methods: The study was performed on 15 normal kidneys sampled from eight unembalmed cadavers. Kidneys with the surrounding perirenal fat tissue were removed en bloc with the abdominal segment of the aorta. The renal artery was injected with acrylic and radiopaque resins, with the specimen suspended in water. CT examination of the injected kidneys was performed to analyse the branches located deeply. After imaging acquisition, the specimens were treated with sodium hydroxide for removal of the parenchyma to obtain vascular casts., Results: Ten casts (66.6%) showed the classic subdivision of the main artery into single posterior and anterior branches. With regard to the distribution of the segmental or second-order arteries, only two casts (13%) showed a pattern similar to that described by Graves, characterized by four segmental (second-order) branches coming from the anterior renal artery (apical, superior, middle and inferior). In the remaining 13 kidneys (87%) a different arterial vascular network was detected. In 10 casts (80%) a single renal segment was vascularized by two or more different branches coming from an artery leading to another segment (multiple vascularization). Multiple vascularization was observed in three (20%) apical segments, five (33%) superior segments, six (40%) middle segments, seven (47%) inferior segments and two (13%) posterior segments., Conclusions: This study shows that in the human kidneys the arterial vasculature is frequently different from that described by Graves. Moreover, in a significant percentage of cases, a single renal segment receives two or more branches that originate from an artery leading to another segment., (© 2017 The Authors BJU International © 2017 BJU International Published by John Wiley & Sons Ltd.)

Retroperitoneal lymph node dissection (RPLND) is a fundamental surgical step in the treatment of testicular cancer. Nowadays, primary RPLND has partially lost its role in favour of active surveillance (for low risk stage I disease) and short cycle chemotherapy in non-seminomatous germ cell tumor (NSGCT). Conversely, post-chemotherapy RPLND (PC-RPLND) remains the standard treatment for residual masses after chemotherapy. In consideration of curability rate of testicular cancer and the life expectancy of testicular cancer survivors the identification and the prevention of andrological complications became fundamental. Erectile dysfunction (ED) is generally transitory and interests about 25% of patients, conversely retrograde ejaculation (RE) is definitive. Antegrade ejaculation is guaranteed by the sparing of at least one paravertebral sympathetic trunks and the postganglionic sympathetic fibers, which travel dorsal to the inferior vena cava and cross ventrally to the aorta. The maintenance of antegrade ejaculation can be obtained by a bilateral sparing of these fibers or by the modification of templates. In primary RPLND setting RE ranged between 2-6.7% and 1.2-61% in the major open and laparoscopic series respectively. In PC-RPLND series it ranged between 21-36% and 4-7.1% for open and laparoscopic approach respectively with the limitation of the restrictive indications of laparoscopic approach. The setting of this surgery and the importance of the oncological and functional outcomes that are pursued reinforced following the evidence that RPLND is a highly technical demanding procedure, whose best performances are achieved only when delivered in referral, high-volume centers.

Objectives: To describe step-by-step an original urethrovesical anastomosis technique (urethral fixation) in patients undergoing retropubic radical prostatectomy (RRP), to compare their early urinary continence recovery with those in a control group receiving a standard anastomosis technique and to identify the predictors of early urinary continence recovery., Patients and Methods: We compared 70 patients who underwent RRP with the urethral-fixation technique with a contemporary control group of 51 patients who received RRP with a standard urethrovesical anastomosis. In the urethral-fixation group, the urethrovesical anastomosis was made using eight single sutures. Specifically, to avoid retraction and/or deviations, we fixed the urethral stump laterally to the medial portion of levator ani muscle. Also, to maintain the normal position in the context of the pelvic floor, we fixed the urethral sphincter deeper to the medial dorsal raphe using a 3-0 polydioxanone suture at the 6 o'clock position before completing the incision of the urethral wall. Urinary continence recovery was evaluated at 1, 4, 8 and 12 weeks after catheter removal. Patients self-reporting no urine leak were considered continent. Uni- and multivariable analyses were used to identify predictors of urinary incontinence at the different follow-up time-points., Results: The evaluated groups had comparable preoperative variables. At 1 week after catheter removal, 32 (45.7%) patients in the urethral-fixation group and 10 (19.6%) in the control group were continent (P = 0.01). At 4 weeks after catheter removal, 46 (65.7%) patients in the urethral-fixation group and 16 (31.4%) in the control group were continent (P = 0.001). At 8 weeks after catheter removal, 59 (84.3%) patients in the urethral-fixation group and 21 (41.2%) in the control group were continent (P < 0.001). Finally, at 12 weeks after catheter removal, 63 (90%) patients in the urethral-fixation group and 32 (62.7%) in the control group were continent (P = 0.001). The urethral-fixation technique was an independent predictor of urinary continence recovery at 1 week [odds ratio (OR) 4.305; P = 0.002); 4 weeks (OR 4.784; P < 0.001); 8 weeks (OR 7.678; P < 0.001) and 12 weeks (OR 5.152; P = 0.001) after catheter removal., Conclusions: The urethral-fixation technique significantly improves early urinary continence recovery in comparison with the standard technique. Moreover, our study confirmed that this surgical technique is an independent predictor of urinary continence recovery at 1, 4, 8 and 12 weeks after catheter removal., (© 2016 The Authors BJU International © 2016 BJU International Published by John Wiley & Sons Ltd.)