Pardeep Kumar

What surgical resection margins are required to achieve oncological control in men with primary penile cancer

To evaluate the surgical excision margin required for local oncological control in primary penile cancers, as patients with penile cancer who undergo radical amputation suffer marked psychological, functional and cosmetic sequelae, and although organ‐sparing surgery has improved the quality of life of these men, the optimum surgical excision margin to achieve oncological control is unknown.

Standard versus Tubeless Percutaneous Nephrolithotomy: A Systematic Review

Objective: This article systematically analyses comparative studies to evaluate the efficacy and safety of tubeless percutaneous nephrolithotomy (PCNL) versus standard PCNL. Methods: The Medline, EMBASE, PsycINFO, Cochrane and DARE databases were searched from 1997 to February 2011. Comparative studies evaluating outcomes from standard versus tubeless PCNL were included. Primary outcome measures were post-operative pain scoring, analgesic requirements, duration of hospitalisation/convalescence, operation time, major/minor complications and stone-free rates. Results: Twenty-four studies were included (11 randomised control trials and 13 retrospective or prospective studies). Levels of pain recorded, analgesic requirements, duration of inpatient stay and convalescence time were all significantly reduced in the tubeless PCNL group. Cost was reduced in two studies. Morbidity was not significantly different between the groups. There was no significant difference between groups regarding stone-free status. Discussion: This systematic review has demonstrated that tubeless PCNL is a viable alternative to tubed PCNL in uncomplicated cases. Benefits are as described above. There is no evidence suggesting that patient safety is compromised by the absence of post-operative nephrostomy. The tubeless method has been reported in challenging cases such as stag-horn stones, horseshoe or ectopic kidneys. Promising outcomes have been demonstrated in elderly patients and when clinical needs demand a supracostal approach. Multi-centre randomised controlled trials are needed to fully establish the effectiveness of the tubeless method.

Urology training: past, present and future

Whats known on the subject? and What does the study add?

The addition of the surgical robot to skin cancer management

We present the introduction of the surgical robot for pelvic lymphadenectomy for skin cancer through a cross-specialty collaboration. In this prospective series, we include the first report of cases undergoing robot-assisted pelvic lymph node dissection for Merkel cell carcinoma and melanoma in the recognised scientific literature.

REDUCING THE TIME TO CONTINENCE AFTER RADICAL PROSTATECTOMY

B J U I N T E R N A T I O N A L

Ex vivo study of prostate cancer localization using rolling mechanical imaging towards minimally invasive surgery

Rolling mechanical imaging (RMI) is a novel technique towards the detection and quantification of malignant tissue in locations that are inaccessible to palpation during robotic minimally invasive surgery (MIS); the approach is shown to achieve results of higher precision than is possible using the human hand. Using a passive robotic manipulator, a lightweight and force sensitive wheeled probe is driven across the surface of tissue samples to collect continuous measurements of wheel-tissue dynamics. A color-coded map is then generated to visualize the stiffness distribution within the internal tissue structure. Having developed the RMI device in-house, we aim to compare the accuracy of this technique to commonly used methods of localizing prostate cancer in current practice: digital rectal exam (DRE), magnetic resonance imaging (MRI) and transrectal ultrasound (TRUS) biopsy. Final histology is the gold standard used for comparison. A total of 126 sites from 21 robotic-assisted radical prostatectomy specimens were examined. Analysis was performed for sensitivity, specificity, accuracy, and predictive value across all patient risk profiles (defined by PSA, Gleason score and pathological score). Of all techniques, pre-operative biopsy had the highest sensitivity (76.2%) and accuracy (64.3%) in the localization of tumor in the final specimen. However, RMI had a higher sensitivity (44.4%) and accuracy (57.9%) than both DRE (38.1% and 52.4%, respectively) and MRI (33.3% and 57.9%, respectively). These findings suggest a role for RMI towards MIS, where haptic feedback is lacking. While our approach has focused on urological tumors, RMI has potential applicability to other extirpative oncological procedures and to diagnostics (e.g., breast cancer screening).

Problema: emergenze in andrologia

La torsione del testicolo e stata inizialmente descritta da Delasiauve nel 1840 (Delasiauve 1840). Il primo caso di torsione di un testicolo completamente sceso e stato riportato da Langton nel 1881 (Williamson 1976). Nel 1893, Nash ha descritto la prima detorsione manuale del testicolo (Nash 1893). Curling (1857) ha citato un caso riportato da Rosenmerkel di Monaco, che ha detorto un criptorchidismo e lo ha fissato nello scroto con una sutura attraverso la tunica dartos (Noske et al. 1998). Defontaine ha descritto il primo caso di riparazione operatoria di una torsione intrascrotale nel 1893 (Sparks 1971). Mosby ha descritto la prima torsione sopravaginale nel 1897 (Taylor 1897).