Fan Zhang

Objectives: The objective of this study was to evaluate the efficacy and safety of an autologous vas deferens (AVD) sling for improving early urinary continence after Retzius-sparing robot-assisted radical prostatectomy (RS-RARP). Methods: In this single-center, prospective, randomized trial, 200 patients at high risk for postoperative urinary incontinence were randomized to undergo RS-RARP with or without AVD sling suspension. The primary endpoint was immediate urinary continence, defined as the use of 0–1 safety pads/day within 7 days after catheter removal. Secondary outcomes included continence recovery up to 3 months, EPIC-26 and IPSSs, and subgroup analysis according to the preoperative membranous urethral length (MUL). Multivariable logistic regression was performed to identify predictors of continence recovery. Results: The AVD sling group showed higher immediate (69.0% vs. 55.0%; p = 0.041) and 1-month continence rates (81.0% vs. 67.0%; p = 0.024) than the RS-RARP group. EPIC-26 scores and IPSSs also favored the AVD sling group during the early postoperative period (both p < 0.01). In exploratory subgroup analyses, patients with preoperative MUL < 12 mm appeared to derive greater early continence benefit from the sling procedure. The AVD sling remained independently associated with continence recovery at the immediate (adjusted OR 2.23, p = 0.014) and 1-month (adjusted OR 2.60, p = 0.008) assessments. Differences between groups decreased after postoperative month 2. The operative time was longer in the AVD sling group, whereas complication rates and short-term oncological outcomes were similar between groups. Conclusions: The AVD sling may improve early urinary continence recovery during the first postoperative month after RS-RARP, particularly in high-risk patients with shorter preoperative MUL.

Objectives: To investigate the causes of missed diagnosis in mpMRI/TRUS fusion-guided targeted prostate biopsy. Methods: The clinical data of 759 patients who underwent transperineal prostate biopsy from March 2021 to June 2021 at Nanjing DrumTower Hospital were retrospectively analyzed. Twenty-one patients had MRI contraindications. Ultimately, 738 patients completed mpMRI/TRUS fusion-guided targeted prostate biopsy + 12-core transperineal systematic biopsy after mpMRI and PI-RADS scoring. The pathological diagnoses from targeted and systematic biopsy were compared to evaluate and analyze the reasons for missed diagnoses in targeted biopsy. Results: A total of 388 prostate cancer patients were identified, including 37 (9%) missed diagnoses with targeted biopsy and 44 (11.34%) with systematic biopsy. Between the target biopsy missed diagnosis group and not missed diagnosis group, there was no significant difference in age (71.08 ± 7.11 vs. 71.80 ± 7.94), but PSA (13.63 ± 12.41 vs. 54.54 ± 177.25 ng/ml), prostate volume (61.82 ± 40.64 vs. 44.34 ± 25.07 cm³), PSAD (0.27 ± 0.28 vs. 1.07 ± 2.91), and ISUP grade [1(1) vs. 3(2)] were significantly different. The pathological results of the 37 targeted biopsy missed diagnoses were recompared with MRI: 21 prostate cancers were normal on MRI; 9 cancer areas were abnormal on MRI; and 7 cancer areas on MRI were PI-RADS 3. Conclusions: Early prostate cancer, large prostate, effect of local anesthesia, doctor–patient cooperation, MRI diagnosis, and operator technology were possible factors for missed diagnosis in targeted biopsy. Improvements imaging technology, greater experience, and personalized biopsy may lead to an accurate pathological diagnosis.

To estimate oncologic and functional outcomes for radiofrequency ablation (RFA) versus partial nephrectomy (PN) for tumors in a solitary kidney. Nineteen patients with sporadic renal cell carcinoma in a solitary kidney were treated with RFA, and 21 patients were treated with PN between November 2008 and September 2015. Basic demographic information including age, gender, operative and pathological data, complications, renal function, oncological outcomes, was obtained for each patient. Statistical analysis was done to test for the correlation of clinical and pathological features, renal function outcomes, as well as oncological outcomes of RFA and PN. All statistical tests were 2-sided, and p-value < 0.05 was considered significant. Statistical analyses were performed using SPSS 19.0. No significant differences were indicated between the RFA and PN with respect to mean patient age, tumor size, as well as intraoperative or postoperative complications. The mean length of hospitalization (P = 0.019) and mean operative time (P = 0.036) was significantly shorter in RFA, with the median estimated blood loss being greater in PN (P = 0.001). The mean serum creatinine level 24 h following operation were significantly higher than preoperative creatinine in PN (P = 0.009), but did not reach statistical significance in RFA. Local recurrence were detected in only 1 patient (5%) in PN and 3 patients (18.75%) in RFA (P = 0.4). One patient developed pulmonary metastasis and one exhibited tumor persistence in RFA, none were present in PN. Radiofrequency Ablation and Partial Nephrectomy for Tumors in a Solitary Kidney were all safe and effective, with each method having distinct advantages. It is the decision of the patient and urologist to pick the best approach.