Identifying Optimal Candidates for Trimodality Therapy among Nonmetastatic Muscle-Invasive Bladder Cancer Patients.

(1) Background: This research aims to identify candidates for trimodality therapy (TMT) or radical cystectomy (RC) by using a predictive model. (2) Methods: Patients with nonmetastatic muscle-invasive bladder cancer (MIBC) in the Surveillance, Epidemiology, and End Results (SEER) database were enrolled. The clinical data of 2174 eligible patients were extracted and separated into RC and TMT groups. To control for confounding bias, propensity score matching (PSM) was carried out. A nomogram was established via multivariable logistic regression. The area under the receiver operating characteristic curve (AUC) and calibration curves were used to assess the nomogram's prediction capacity. Decision curve analysis (DCA) was carried out to determine the nomogram's clinical applicability. (3) Results: After being processed with PSM, the OS of the RC group was significantly longer compared with the TMT group (p < 0.001). This remarkable capacity for discrimination was exhibited in the training (AUC: 0.717) and validation (AUC: 0.774) sets. The calibration curves suggested acceptable uniformity. Excellent clinical utility was shown in the DCA curve. The RC and RC-Beneficial group survived significantly longer than the RC and TMT-Beneficial group (p < 0.001) or the TMT group (p < 0.001). However, no significant difference was found between the RC and TMT-Beneficial group and the TMT group (p = 0.321). (4) Conclusions: A predictive model with excellent discrimination and clinical application value was established to identify the optimal patients for TMT among nonmetastatic MIBC patients.

Sequelae of long COVID, known and unknown: A review of updated information.

Over three years have passed since the COVID-19 pandemic started. The dangerousness and impact of COVID-19 should definitely not be ignored or underestimated. Other than the symptoms of acute infection, the long-term symptoms associated with SARS-CoV-2 infection, which are referred to here as "sequelae of long COVID (LC)", are also a conspicuous global public health concern. Although such sequelae were well-documented, the understanding of and insights regarding LC-related sequelae remain inadequate due to the limitations of previous studies (the follow-up, methodological flaws, heterogeneity among studies, etc.). Notably, robust evidence regarding diagnosis and treatment of certain LC sequelae remain insufficient and has been a stumbling block to better management of these patients. This awkward situation motivated us to conduct this review. Here, we comprehensively reviewed the updated information, particularly focusing on clinical issues. We attempt to provide the latest information regarding LC-related sequelae by systematically reviewing the involvement of main organ systems. We also propose paths for future exploration based on available knowledge and the authors' clinical experience. We believe that these take-home messages will be helpful to gain insights into LC and ultimately benefit clinical practice in treating LC-related sequelae.

A Modified Endoscopic Primary Realignment of Severe Bulbar Urethral Injury.

Purpose: Male urethral injury is a common urologic emergency in developing countries. Whether early or late treatment of urethral injuries is often multifactorial and controversial. The goal of this study is to determine whether early realignment can reduce postsurgical complications and evaluate the clinical feasibility of emergency endoscopic urethroplasty using single rigid ureteroscopy in the treatment of bulbar urethral severe injury. Patients and Methods: Between September 2013 and March 2019, 15 male adult patients (mean age 35 years; from 21 to 62 years) with severe bulbar urethral injury were enrolled into the current study. The patients mainly presented with dysuria or painful urination (15/15, 100%), urethral bleeding (13/15, 86.7%), and urinary retention (11/15, 73.3%). Six of them had swelling of perineal or scrotal soft tissue, while four had testicular contusion. No pelvic fracture was found in all cases with CT scanning of the pelvic cavity. The bulbar urethral at grade IV was confirmed to be completely ruptured in all cases by endoscopy during operation. The modified endoscopic primary realignment was performed. Results: This new urethral repair technique was effectively performed in all patients and none converted to open operation. Mean operation time was 42.3 ± 11.5 minutes (28-52 minutes) and the mean Foley catheter indwelling time was 34.5 ± 6.9 days (28-42 days). During a follow-up of 41.3 ± 22.8 months (12-64 months), mild urethral strictures (grade I) (19.7 ± 9.5 weeks, 10-27 weeks postsurgery) developed in 8 patients (53.3%) and then were all improved 2.1 ± 0.8 months (1.3-2.9 months) after periodic dilatations of the urethra (4-10 times). Erectile dysfunction (ED) occurred in three patients (20%) after surgery, who recovered from mild ED to normal by administration with oral sildenafil (100 mg, three times a week) for 12 weeks. The International Index of Erectile Function-5 (IIEF-5) score was significantly improved after surgery (M ± SD, 25 ± 3) compared with before (16.4 ± 3.5) (p < 0.05). No incontinence and other complications occurred in all cases. Conclusions: Early endoscopic realignment via suprapubic puncture cystostomy by single rigid ureteroscopy provides an effective, feasible, and safe procedure for severe bulbar urethral injury.

Challenges in the diagnosis of severe renal trauma in child: A case report and literature review.

INTRODUCTION: To report the management and outcome of one case of pediatric patient sustaining high-grade blunt renal trauma. We present and discuss the clinical characteristics and radiologic features of the patient. PATIENTS AND METHODS: A 10 years old child was admitted for serious blunt renal trauma formed a huge urinoma in the right renal after injury gradually in 2018. We treated the patient with synchronous percutaneous nephrostomy drainage and retrograde ureteral catheterization. A retrospective review was performed of this case, including the clinical features, imaging studies and short-term follow-up. A literature review was also performed to highlight the principals of diagnosis and treatment of severe blunt renal trauma in children. RESULTS: After drainage, the symptoms of abdominal distension gradually disappeared, and the physical examination shows that the abdomen gradually reduced to normal. The huge urinoma was cured by synchronous drainge. No complications occurred in short-term follow-up. COMMENTS: The choice of surgical treatment is based on the degree and location of renal trauma. Grade IV injuries are a heterogeneous group and management should be tailored to the patient, especially among pediatric patients. Persistent urinary extravasation and/or symptomatic urinoma is a common complication of high-grade renal trauma, which will be amenable to ureteral stent placement or percutaneous drainage. For huge urinoma, synchronous percutaneous nephrostomy drainage and retrograde ureteral catheterization can relieve symptoms quickly.

[Nine cases of laparoscopic retroperitoneal lymph node dissection].

OBJECTIVE: To assess the effects of laparoscopic retroperitoneal lymph node dissection in the treatment of stage I nonseminomatous testicular cancer. METHODS: From January 2001 to May 2002, laparoscopic retroperitoneal lymph node dissection was performed on 9 patients with stage I nonseminomatous testicular cancer. RESULTS: The procedure was successful in all patients. The mean operation time was 260 minutes. None of the patients required blood transfusion and had major complications intraoperatively or postoperatively. The average period of hospitalization after the operation was 5.5 days. With a mean following-up of 9 months, retroperitoneal recurrence was not seen. CONCLUSIONS: Laparoscopic retroperitoneal lymph node dissection is feasible for stage I nonseminomatous testicular cancer and its procedure is safe, effective and minimally invasive.