Treatment options in stage I seminoma

Seminomas are most commonly diagnosed in clinical stage I(CSI).After orchiectomy,approximately 15%of patients in this stage have subclinical metastases.Adjuvant radiotherapy(ART)delivered to the retroperitoneum and ipsilateral pelvic lymph nodes has been the mainstay of treatment for many years.Although highly efficient,with long-term cancer-specific survival(CSS)rates approaching almost 100%,ART is associated with considerable long-term consequences,particularly cardiovascular toxicity and increased risk of secondary malignancies(SMN).Therefore,active surveillance(AS)and adjuvant chemotherapy(ACT)were developed as alternative treatment options.While AS prevents patient overtreatment,it is associated with strict follow-up regimens and increased radiation exposure due to repeated imaging.Due to equivalent CSS rates to ART,and lower toxicity,one course of adjuvant carboplatin presents the cornerstone of chemotherapy for CSI patients.CSS is almost 100%for patients with CSI seminoma,regardless of the chosen treatment option.Therefore,a personalized approach in treatment selection is preferred.Currently,routine radiotherapy for CSI seminoma patients is no longer recommended.Instead,it should be reserved for patients who are unfit or unwilling for AS or ACT.Identification of prognostic factors for disease relapse allowed for the development of risk-adapted treatment strategy and stratification of patients in low-risk and high-risk groups.Although risk-adapted policy needs further validation,surveillance is currently recommended in low-risk patients,while ACT is reserved for patients with a higher risk of relapse.

Repeated penile girth enhancement with biodegradable scaffolds： microscopic ultrastructural analysis and surgical benefits

Autologous tissue engineering using biodegradable scaffolds as a carrier is a well-known procedure for penile girth enhancement. We evaluated a group of previously treated patients with the aim to analyze histomorphometric changes after tissue remodeling and to estimate the benefits of repeated procedure. Between February 2012 and December 2016, a group of 21 patients, aged 22-37 （mean 28.0） years, underwent a repeated penile girth enhancement procedure with biodegradable scaffolds. Procedure included insertion of two poly-lactic-co-glycolic acid scaffolds seeded with laboratory-prepared fibroblasts from scrotal tissue specimens. During this procedure, biopsy specimens of tissue formed after the first surgery were taken for microscopic analysis. The mean follow-up was 38 months. Connective tissue with an abundance of connective tissue fibers, small blood vessels, and inflammatory cells were observed in all analyzed surgically removed tissue. Ultrastructural analysis of these tissue samples discovered the presence of large quantities of collagen fibrils running parallel to each other, forming bundles, with a few widely spread fibroblasts. In total, the mean values of flaccid and erect gain in girth after the second surgery were 1.1 ± 0.4 （range： 0.6- 1.7） cm and 1.0±0.3 （range： 0.6-1.5） cm, respectively. Microscopic evaluation of newly formed tissue, induced by autologous tissue engineering using biodegradable scaffolds, showed the presence of vascularized loose connective tissue with an abundance of collagen fibers, fibroblasts, and inflammatory cells, indicating active neovascularization and fibrinogenesis. The benefit of the repeated enhancement procedure was statistically significant.