Quality of life after radical cystectomy for bladder cancer in men with an ileal conduit or continent urinary diversion: A comparative study.

AIM: To investigate quality of life (QoL) domains with three forms of urinary diversions, including ileal conduit, MAINZ pouch, and orthotopic ileal neobladder after radical cystectomy in men with muscle-invasive bladder cancer. MATERIALS AND METHODS: In a prospective study, 149 men underwent radical cystectomy and urinary diversion (70 ileal conduit, 16 MAINZ pouch, and 63 orthotopic ileal neobladder). Different domains of QoL, including general and physical conditions, psychological status, social status, sexual life, diversion-related symptoms, and satisfaction with the treatment were assessed using an author constructed questionnaire. Assessment was performed at three months postoperatively. RESULTS: In questions addressing psychological status, social status, and sexual life, patients with continent diversion had a more favorable outcome (P = 0.002, P = 0.01, and P = 0.002, respectively). The rate of erectile dysfunction did not differ significantly between the three groups (P = 0.21). The rate and global satisfaction was higher with the MAINZ pouch (68.7%) and ileal neobladder (76.2%) as compared with the ileal conduit group (52.8%) (P = 0.002). CONCLUSION: Continent urinary diversion after radical cystectomy provides better results in terms of QoL as compared with ileal conduit diversion.

Sexual function after non-nerve-sparing radical cystoprostatectomy: a comparison between ileal conduit urinary diversion and orthotopic ileal neobladder substitution.

OBJECTIVE: To compare the erectile function (EF) and sexual desire (SD) in men after radical cystoprostatectomy (RCP) who had either an ileal conduit urinary diversion or orthotropic ileal neobladder substitution. MATERIALS AND METHODS: Eighty one sexually active men with bladder cancer were enrolled in this prospective study. After RCP according to patients' preferences they underwent either ileal conduit urinary diversion (n = 41) or orthotropic ileal neobladder substitution (n = 40). EF and SD were assessed using International Index of Erectile Function (IIEF) questionnaire. Patients were assessed at 4-week before surgery and were followed up at 1, 6, and 12-month postoperatively using the same questionnaire. RESULTS: Postoperatively the EF and SD domains deteriorated significantly in both groups, but in a small proportion of the patients submitted to ileal neobladder they gradually improved with time (P = 0.006). At 12-month postoperative period, 4 (9.8 %) and 14 (35.0 %) patients in ileal conduit and ileal neobladder groups were able to achieve erections hard enough for vaginal penetration and maintained their erection to completion of intercourse, respectively (P = 0.006). Among patients in the ileal conduit and ileal neobladder groups, additional 4 (9.8 %) and 7 (17.1 %) patients were able to get some erection, but were unable to maintain their erection to completion of intercourse (P = 0.02). At 12-month follow up period 24.4 % of the ileal conduit and 45.0 % of the ileal neobladder patients rated their sexual desire very high or high (P = 0.01). CONCLUSION: When performed properly, orthotopic ileal neobladder substitution after RCP offers better long-term results in terms of EF and SD.

Sexual Function after Non-Nerve-Sparing Radical Cystoprostatectomy: A Comparison between Ileal Conduit Urinary Diversion and Orthotopic Ileal Neobladder Substitution

Objective To compare the erectile function (EF) and sexual desire (SD) in men after radical cystoprostatectomy (RCP) who had either an ileal conduit urinary diversion or orthotropic ileal neobladder substitution. Materials and Methods Eighty one sexually active men with bladder cancer were enrolled in this prospective study. After RCP according to patients' preferences they underwent either ileal conduit urinary diversion (n = 41) or orthotropic ileal neobladder substitution (n = 40). EF and SD were assessed using International Index of Erectile Function (IIEF) questionnaire. Patients were assessed at 4-week before surgery and were followed up at 1, 6, and 12-month postoperatively using the same questionnaire. Results Postoperatively the EF and SD domains deteriorated significantly in both groups, but in a small proportion of the patients submitted to ileal neobladder they gradually improved with time (P = 0.006). At 12-month postoperative period, 4 (9.8%) and 14 (35.0%) patients in ileal conduit and ileal neobladder groups were able to achieve erections hard enough for vaginal penetration and maintained their erection to completion of intercourse, respectively (P = 0.006). Among patients in the ileal conduit and ileal neobladder groups, additional 4 (9.8%) and 7 (17.1%) patients were able to get some erection, but were unable to maintain their erection to completion of intercourse (P = 0.02). At 12-month follow up period 24.4% of the ileal conduit and 45.0% of the ileal neobladder patients rated their sexual desire very high or high (P = 0.01). Conclusion When performed properly, orthotopic ileal neobladder substitution after RCP offers better long-term results in terms of EF and SD. .

The distance of the sigmoid sinus and the middle fossa dura from the external auditory canal in chronic otitis media.

PURPOSE: Mastoid pneumatization is reduced in most patients suffering from chronic otitis media (COM). In most studies, the relationship between the degree of pneumatization and the distance of the sigmoid sinus from the external auditory canal has been examined, yielding different results. This study addresses the relationship between COM and the distance of the sigmoid sinus and also middle fossa dura from the external auditory canal. METHODS: This was a case-control study on 15 adult COM patients, 12 traumatic facial palsy patients, and 15 cadaver temporal bones. After mastoidectomy, the distance between the spine of Henle and both the middle fossa dura and sigmoid sinus were measured, and the findings in each group was analyzed using Tukey's and ANOVA tests. RESULTS: The average distance of the external auditory canal and the sigmoid sinus was 15.27 ± 3.3 mm in the COM group, 16.92 ± 3.23 mm in the traumatic facial palsy group, and 14.53 ± 2.92 mm in the cadaver temporal bones. There was no significant difference between the groups (p = 0.115). The average distance of the spine of Henle from the middle fossa dura was 6.73 ± 1.62 mm in the COM group, 11.4 ± 2.05 mm in the traumatic facial palsy group, and 8.93 ± 1.94 in the cadaver temporal bones. There was a significant difference between the groups (p < 0.001). CONCLUSION: The distance of both the sigmoid sinus and the middle fossa dura from the external auditory canal (which indicates mastoid pneumatization) is reduced in COM patients.

Glutathione-S-transferase (GST) polymorphisms are associated with relapse after radical prostatectomy.

BACKGROUND: Organ confined prostate cancer (PCa) can be cured by radical retropubic prostatectomy (RRP); however, some tumors will still recur. Current tools fail to identify patients at risk of recurrence. Glutathione-S-transferases (GSTs) are involved in the metabolism of carcinogens, hormones and drugs. Thus, genetic polymorphisms that modify the GST activities may modify the risk of PCa recurrence. METHODS: We retrospectively recruited Argentine PCa patients treated with RRP to study the association between GST polymorphisms and PCa biochemical relapse after RRP. We genotyped germline DNA in 105 patients for: GSTP1 c.313A>G (p.105 Ile>Val, rs1695) by PCR-RFLP; and GSTT1 null and GSTM1 null polymorphisms by multiplex PCR. Kaplan-Meier curves and Cox proportional hazard models were used to evaluate these associations. RESULTS: Patients with GSTP1 c.313GG genotype showed shorter biochemical relapse-free survival (BRFS) (P = 0.003) and higher risk for recurrence in unadjusted (Hazard ratio (HR) = 3.16, 95% confidence interval (95% CI) = 1.41-7.06, P = 0.005) and multivariate models (HR = 3.01, 95% CI = 1.13-8.02, P = 0.028). We did not find significant associations for GSTT1 and GSTM1 genotypes. In addition, we found shorter BRFS (P = 0.010) and increased risk for recurrence for patients having two or more risk alleles when we combined the genotypes of the three GSTs in multivariate models (HR = 3.06, 95% CI = 1.20-7.80, P = 0.019). CONCLUSIONS: Our results give support to the implementation of GSTs genotyping for personalized therapies as a novel alternative for PCa management for patients who undergo RRP. To the best of our knowledge, this is the first study that examined GST polymorphisms in PCa progression in Argentine men. Replication of our findings in larger cohort is warranted.

Perception of teaching competencies by medical educators.

The purpose of this study was to determine the effect of an introductory educational planning workshop on perception of teaching competencies by medical educators. A questionnaire containing twenty-seven teaching competencies (TC) was administered before and after the workshop. The twenty-five participants, from four different countries, were asked to rate each TC regarding its importance for teachers and whether they possessed them or needed further training. The results showed that this workshop created more awareness regarding the importance of these TCs and also created a need for further training for specific TCs in order to put educational principles into practice.

Students' Reactions to a Problem-based Student-centred Course.

An eight-week course based on a non-traditional instructional format was offered to 136 first-year medical and dental students. The course was problem-based, student-centred and took place in a small tutorial setting. During and at the end of the course students evaluated their own performance, as well as the course itself. Analysis of the results showed that students reacted favourably to this mode of instruction and requested that more courses should be offered utilizing this approach. The performance of students surpassed the expectation of members of the faculty.

A process model for curriculum deveopment.

An operational model of the processes of decision making in the development of curriculum was porposed. Attempts were made to present a conceptual framework from which the model was elaborated. In addition, examples of field experience related to the application of educational planning theory into practive were presented.