Extraperitoneal robot assisted laparoscopic prostatectomy with Versius system: single centre experience.

INTRODUCTION: Versius Surgical System (CMR Surgical, Cambridge, UK) is a novel tele-operated robotic surgical system designed to assist surgeons for minimally invasive surgery which is gaining momentum in the world of robotic surgery. We describe our single centre experience with Versius and report the advantages and challenges posed by this new robotic system in a series of 53 extraperitoneal robotic assisted laparoscopic prostatectomies (eRALP) for prostate cancer (PCa). MATERIALS AND METHODS: Data of 53 eRALP performed with Versius in our centre were collected and analysed, Descriptive statistics were used to report our results. RESULTS: In 16 months we performed 53 eRALP: 18 (34%) with PLND, 33 (62%) nerve sparing cases. Mean setup time was 15 min, mean console time was 100 min and mean operative time was 130 min. We observed a substantial reduction of console time and set-up time after only 5 procedures. In the first 4 procedures, the dissection of the neurovascular bundle was performed laparoscopically, to switch back to robotic assisted approach afterwards. No major system failures were observed. No major intra-operative and post-operative complications occurred. Mean follow-up time was 9 months (range 3-15 months); no patients experienced biochemical recurrence or metastatic progression over this period, 8 (15%) patients had adjuvant radiotherapy based on unfavourable pathology report (positive surgical margins or positive limphnodes). CONCLUSION: This represents to our knowledge the largest extraperitoneal RALP case series with Versius, and it aims to provide solid clinical proof of the safety, effectiveness and versatility of this innovative system. In our experience, this platform represents a good option for every urologic surgeon who wants to start a robotic programme and it appears particularly suitable for urologists with a large laparoscopic expertise.

Magnetic resonance spectroscopic imaging 3T and postate cáncer: correlation with transperineal ultrasound guided prostate biopsy

OBJETIVO: El objetivo de este estudio era correlacionar los resultados obtenidos con la resonancia magnética por espectroscopia 3T (RMNE3T) con los obtenidos por la evaluación histológica de las muestras de biopsia de próstata transperineal guiada por ecografía. MÉTODOS: 34 Pacientes fueron incluidos en el estudio. Todos los pacientes tenían la sospecha de cáncer de próstata por elevación del PSA y/o tacto rectal anormal. Los pacientes fueron sometidos a RMNE 3T y posteriormente biopsia transperineal guiada por ecografía. RESULTADOS: De los 22 pacientes (22/34) que presentaban anomalías en la RMNE 3T, 9 tuvieron el diagnóstico histológico de adenocarcinoma. De los 13 restantes, 6 fueron diagnosticados de hiperplasia benigna de próstata y 7 de inflamación intersticial crónica o PIN de alto grado. De 12 pacientes (12/34) que no presentaban alteraciones periféricas en la próstata en la RMNE 3T, ninguno tenía adenocarcinoma o inflamación en la histología. La sensibilidad, especificidad, valor predictivo positivo y valor predictivo negativo fueron del 100%, 48%, 40% y 100% respectivamente. DISCUSIÓN: En este estudio correlacionamos los valores obtenidos por RMNE 3T con los resultados del examen histológico de las biopsias de próstata. Nuestro trabajo muestra que el 72% de los voxeles en los que había un cambio en el cociente de Cit/(Cho+ Cr) correspondían con áreas de enfermedad del tejido prostático. De éstas, el 73,2% eran positivas para adenocarcinoma y el 26% para inflamación intersticial crónica o PIN de alto grado. En la literatura, se observa que el cáncer de próstata se puede distinguir de áreas de tejido benigno en la zona periférica, en base a los valores de la ratio Cit/(Cho+cr) (17), aunque algunas condiciones benignas, tales cómo la prostatitis o el PIN de alto grado, pueden alterar estos valores (18-19). CONCLUSIONES: En conclusión, el uso de la RMNE 3T antes de la realización de biopsias de próstata puede representar una ayuda válida para el urólogo en el diagnóstico de CaP, permitiéndole evitar biopsias de próstata innecesarias que pudieran ser negativas. Además, también sería posible reducir el número total de biopsias, disminuyendo así la exposición del paciente a riesgos innecesarios asociados con la biopsia

OBJECTIVES: The aim of our study was to correlate the results obtained by 3T Magnetic Resonance Spectroscopic Imaging (MRSI3T) with those obtained by histological examination of samples of the trans-perineal ultrasound-guided prostate biopsy (TPUS-B). METHODS: 34 patients were enrolled in the study. All patients had a clinical suspicion of cancer due to increased PSA and/or positive digital rectal examination. Patients were subjected to an MRSI 3T examination and subsequently to TPUS-B. RESULTS: Of the 22 (22/34) patients who presented abnormalities MRSI at 3T, 9 had a histological diagnosis of Prostate adenocarcinoma. Of the remaining 13 patients, 6 were found to be histologically positive for Benign Prostatic Hypertrophy and 7 Chronic Interstitial Inflammation or High Grade Prostatic Intraepithelial Neoplasia. 12 (12/34) patients found to have no peripheral alterations in their prostate on 3T MRSI, none were positive for ADK or inflammation on histology. The sensitivity, specificity, positive predictive value and negative predictive value were 100%, 48%, 40% and 100% respectively. DISCUSSION: In this study, we correlated the values obtained from 3T MRSI with the results of histologically examined prostate biopsies. Our work shows that 72.8% of the voxels in which there was a change in ratio of Cit/(Cho + Cr), corresponded to areas of prostate tissue disease. Of these, 73.2% were positive for ADK and 26.8% for CII or HG PIN. In literature, it is noted that PCa can be distinguished from areas of benign tissue, in the peripheral zone, on the basis of the values of the ratio Cit/(Cho + Cr) (17), although some benign conditions, such as prostatitis or PINHG, can alter these values (18-19). CONCLUSIONS In conclusion, the use of MRSI 3T before performing prostate biopsies may represent a valid aid for the urologist in the diagnosis of PCa, allowing them to avoid unnecessary prostate biopsies that may be negative. Furthermore, it would also be possible to reduce the total number of biopsies, thus decreasing patient ex posure to the unnecessary risks associated with biopsy

Early high CMV seroprevalence in pregnant women from a population with a high rate of congenital infection.

Congenital cytomegalovirus (CMV) infection rates increase with maternal seroprevalence due to transmission from maternal non-primary infection. CMV seroprevalence estimates of pregnant women are needed for planning strategies against congenital CMV transmission. We aimed to determine the age-specific prevalence of serum antibodies for CMV in a representative age-stratified sample of unselected pregnant women from a Brazilian population. A total of 985 pregnant women, aged 12­46 years (median 24 years), were enrolled. Overall CMV seroprevalence was 97% (95% confidence interval 95.8­98.0), with age-specific (years) prevalence as follows: 12­19 (96.3%), 20­24 (97.7%), 25­29 (97.1%), and 30­46 (96.7%). CMV seroprevalence is almost universal (97%) and is found at similar levels in pregnant women of ages ranging from 12 to 46 years. Because high CMV seroprevalence is found even in women of a younger age in this population, this finding suggests that the majority of primary CMV infections occur early, in infancy or childhood. As a consequence, vaccines currently under development to prevent primary infection may not be a solution for the prevention of congenital CMV infection in this population.