Omer Burak Argun

Introduction: Although laparoscopic total extraperitoneal (TEP) procedure has gained wide acceptance for inguinal hernia repair, there is still debate on the optimal technique in patients with a history of previous radical prostatectomy (RP). We aimed to evaluate the feasibility and safety of laparoscopic TEP in patients with a previous history of RP using a propensity score case-match analysis. Methods: This study included male patients undergoing laparoscopic TEP repair between 2013 and 2024. According to the RP status, patients were case-matched based on age, BMI, ASA score, site of hernia and the year of surgery. A total of 162 patients were matched in a 1:5 ratio. The RP and non-RP groups were compared with respect to perioperative outcomes. Results: The RP and non-RP group included 27 and 135 patients, respectively. The rate ofconversion to transabdominal preperitoneal repair (11.1%) or open surgery (14.8%) was significantly higher in the RP group (p<0.001). The RP group had longer operative times (160±57 vs. 94±38, p0.05). Conclusion: Laparoscopic TEP inguinal hernia repair in patients with a history of RP is feasible and safe with a similar morbidity profile but an increased conversion rate and operative time compared to those with no history of RP.

Background: Emerging evidence suggests multiparametric prostate MRI's role in evaluating prostate cancer (PCa) aggressiveness. Purpose: To evaluate the utility of quantitative sequences in prostate MRI for assessing peripheral zone PCa aggressiveness, focusing on added value of relaxation maps to ADC. Material and Methods: In total, 64 men undergoing preoperative bi-parametric prostate MRI with synthetic sequences were retrospectively enrolled. Radiologists delineated lesions on ADC maps and synthetic MRI, matched with digitized whole-mount specimens. PCa was graded as low, intermediate, or high based on Gleason grade. Statistical analyses assessed differences in T1, T2, PD, and ADC values across grades. For significant variables, AUC curves were generated. A logistic regression model evaluated the added diagnostic value of relaxation maps to ADC. Results: Of the 95 PCa foci, 11 were low-grade, 45 intermediate-grade, and 39 high-grade. T1 ( P = 0.4) and PD ( P = 0.3) showed no significant differences, while T2 and ADC differed significantly ( P < 0.001). Median T2 values were 98 ms (low-grade), 81 ms (intermediate), and 73 ms (high-grade), and median ADC values were 1006 mm²/s, 836 mm²/s, and 721 mm²/s, respectively. ADC yielded AUCs of 0.888 (95% CI=0.794–0.963; P < 0.0001) for low- versus intermediate-to-high-grade PCa, and 0.825 (95% CI=0.724–0.901; P < 0.0001) for low-to-intermediate versus high-grade. T2 AUCs were 0.770 (95% CI=0.605–0.908; P = 0.021) and 0.755 (95% CI=0.648–0.864; P = 0.0051), respectively. A logistic regression model combining T2 and ADC showed no significant improvement over ADC alone in differentiating low- versus intermediate-to-high-grade and low-to-intermediate versus high-grade PCa ( P > 0.05). Conclusion: T1 and PD maps from synthetic MRI showed limited utility in grading PCa. Although T2 values were effective, ADC values were superior in assessing PCa aggressiveness. The addition of T2 to ADC did not significantly improve diagnostic performance.

In this study, we assessed the performance of apparent diffusion coefficient (ADC) and diffusion-weighted imaging (DWI) metrics and their ratios across different magnetic resonance imaging (MRI) acquisition settings, with or without an endorectal coil (ERC), for the evaluation of prostate cancer (PCa) aggressiveness using whole-mount specimens as a reference. We retrospectively reviewed the data of prostate carcinoma patients with a Gleason score (GS) of 3+4 or higher who underwent prostate MRI using a 3T unit at our institution. They were divided into two groups based on the use of ERC for MRI acquisition, and patients who underwent prostate MRI with an ERC constituted the ERC (n = 55) data set, while the remaining patients accounted for the non-ERC data set (n = 41). DWI was performed with b-values of 50, 500, 1000, and 1,400 s/mm2, and ADC maps were automatically calculated. Additionally, computed DWI (cDWI) was performed with a b-value of 2000 s/mm2. Six ADC and two cDWI parameters were evaluated. In the ERC data set, receiver operating characteristic (ROC) curves were plotted for each metric to determine the best cutoff threshold values for differentiating GS 3+4 PCa from that with a higher GS. The performance of these cutoff values was assessed in non-ERC dataset. The diagnostic accuracies and area under the curves (AUCs) of the metrics were compared using Fisher's exact test and De Long's method, respectively. Among all metrics, the ADCmean-ratio yielded the highest AUC, 0.84, for differing GS 3+4 PCa from that with a higher GS. The best threshold cutoff values of ADCmean-ratio (£0.51) for discriminating GS 3+4 PCa from that with a higher GS classified 48 patients out of 55 with an accuracy of 87.27%. However, there was no significant difference between each metric in terms of accuracy and AUC (p = 0.163 and 0.214). Similarly, in the non-ERC data set, the ADCmean-ratio provided the highest diagnostic accuracy (82.92%) by classifying 34 patients out of 41. However, Fisher's exact test yielded no significant difference between DWI and ADC metrics in terms of diagnostic accuracy in non-ERC data (p = 0.561). The mean ADC ratio of the tumor to the normal prostate showed the highest accuracy and AUC in differentiating GS 3+4 PCa and PCa with a higher GS across different MRI acquisition settings; however, the performance of different ADC and DWI metrics did not differ significantly.