The impact of chemotherapy-naïve open radical cystectomy delay and perioperative transfusion on the recurrence-free survival: A perioperative parameters-based nomogram

Objective: To develop and internally validate a nomogram to predict recurrence-free survival (RFS) including the time to radical cystectomy (RC) and perioperative blood transfusion (PBT) as potential predictors.Methods: Patients who underwent open RC and ileal conduit between January 1996 to December 2016 were split into developing (n=948) and validating (n=237) cohorts. The time to radical cystectomy (TTC) was defined as the interval between the onset of symptoms and RC. The regression coefficients of the independent predictors obtained by Cox regression were used to construct the nomogram. Discrimination, validation, and clinical usefulness in the validation cohort were assessed by the area under the curve, the calibration plot, and decision curve analysis.Results: In the developing dataset, the 1-, 5-, and 10-year RFS were 83.0%, 47.2%, and 44.4%, respectively. On multivariate analysis, independent predictors were TTC (hazards ratio [HR] 1.07, 95% confidence interval [CI] 1.05-1.08, p<0.001), PBT (one unit: HR 1.40, 95% CI 1.03-1.90, p=0.03;two or more units: HR 1.72, 95% CI 1.29-2.29, p<0.001), bilateral hydronephrosis (HR 1.54, 95% CI 1.21-1.97, p<0.001), squamous cell carcinoma (HR 0.60, 95% CI 0.45-0.81, p=0.001), pT3-T4 (HR 1.77, 95% CI 1.41-2.22, p<0.001), lymph node status (HR 1.53, 95% CI 1.21-1.95, p<0.001), and lymphovascular invasion (HR 1.28, 95% CI 1.01-1.62, p=0.044). The areas under the curve in the validation dataset were 79.3%, 69.6%, and 76.2%, for 1-, 5-, and 10-year RFS, respectively. Calibration plots showed considerable correspondence between predicted and actual survival probabilities. The decision curve analysis revealed a better net benefit of the nomogram.Conclusion: A nomogram with good discrimination, validation, and clinical utility was constructed utilizing TTC and PBT in addition to standard pathological criteria.

Diagnosis and Treatment of Penile Fractures: A Single Center Series

Objectives: The aim of this study is to review the diagnostic work-up, treatment methods and outcomes in patients treated for penile fractures. Methods: Thirty-one patients were treated for penile fracture during the period 2006-2014. Data were retrieved from patients’ journals and analyzed retrospectively. Follow-up data were available for 23 patients. Results: Twenty-eight patients (90%) experienced immediate pain at incidence;29 (94%) experienced immediate swelling;23 (74%) heard a cracking sound;20 (65%) observed a blue discoloration immediately afterwards and 20 (65%) got immediate detumescence. Magnetic Resonance Imaging was used preoperatively in 10 patients and demonstrated the side and localization of the rupture in tunica albuginea in all cases. A longitudinal incision over the suspected site of the rupture was used in 20 patients and a sub-coronal de-gloving incision of the penile skin was used in 10 patients. The average operation time with longitudinal incision method and de-gloving was 43 minutes and 57 minutes, respectively. Short term complications were seen in four patients and long term complications were seen in 14 patients of which deviation of penis during erection was most common. Conclusions: Immediate pain, swelling and hearing a cracking sound are predominant features in the history of patients with penile fracture. Magnetic Resonance Imaging is recommended for localizing the rupture site. A longitudinal incision over the rupture site means significantly shorter operation time than de-gloving.

Comparison of urinary telomerase,CD44,and NMP22 assays for detection of bladder squamous cell carcinoma

Background:Squamous cell carcinoma(SCC)of the bladder is common in many regions around the world.Prognosis is very poor,as most cases are diagnosed at an advanced stage due to a lack of affordable and valid screening markers for this type of cancer.The diagnostic accuracy of urinary nuclear matrix protein-22(NMP22),telomerase activity,and CD44 were evaluated in urine samples of patients with bladder SCC.Materials and methods:We conducted a case-control study comprised of 60 consecutive newly diagnosed bladder SCC patients diagnosed by cystoscopy and histopathological examination,and controls were 60 outpatients with benign urologic conditions and healthy clinic visitors.Urine samples collected from each subject underwent testing for NMP22,telomerase activity,and CD44.Descriptive and correlational statistical analysis of cases and controls were carried out and receiver operating characteristic curve analysis was used to determine optimal cut-off points for the three assays.Results:Area under the curve was calculated at 0.96,0.93,and 0.62 for NMP22,telomerase,and CD44,respectively.Urine levels of NMP22 and telomerase activity were significantly higher in the SCC group compared to controls(p<0.001).Urine CD44 levels were not significantly higher in the SCC group compared to controls(p=0.111).The overall sensitivity of NMP22,telomerase,and CD44 was 96.7%,87%,and 45%,respectively,while the specificity was 85%,88.6%,and 86.7%,respectively.Conclusions:Urinary telomerase activity,followed by NMP22 urine levels,showed high diagnostic yield and could hold potential promise as urinary biomarkers for the diagnosis of bladder SCC.