Prediction models of incontinence and sexual function one year after radical prostatectomy based on data from 20 164 prostate cancer patients.

BACKGROUND: Incontinence and sexual dysfunction are long-lasting side effects after surgical treatment (radical prostatectomy, RP) of prostate cancer (PC). For an informed treatment decision, physicians and patients should discuss expected impairments. Therefore, this paper firstly aims to develop and validate prognostic models that predict incontinence and sexual function of PC patients one year after RP and secondly to provide an online decision making tool. METHODS: Observational cohorts of PC patients treated between July 2016 and March 2021 in Germany were used. Models to predict functional outcomes one year after RP measured by the EPIC-26 questionnaire were developed using lasso regression, 80-20 splitting of the data set and 10-fold cross validation. To assess performance, R2, RMSE, analysis of residuals and calibration-in-the-large were applied. Final models were externally temporally validated. Additionally, percentages of functional impairment (pad use for incontinence and firmness of erection for sexual score) per score decile were calculated to be used together with the prediction models. RESULTS: For model development and internal as well as external validation, samples of 11 355 and 8 809 patients were analysed. Results from the internal validation (incontinence: R2 = 0.12, RMSE = 25.40, sexual function: R2 = 0.23, RMSE = 21.44) were comparable with those of the external validation. Residual analysis and calibration-in-the-large showed good results. The prediction tool is freely accessible: https://nora-tabea.shinyapps.io/EPIC-26-Prediction/. CONCLUSION: The final models showed appropriate predictive properties and can be used together with the calculated risks for specific functional impairments. Main strengths are the large study sample (> 20 000) and the inclusion of an external validation. The models incorporate meaningful and clinically available predictors ensuring an easy implementation. All predictions are displayed together with risks of frequent impairments such as pad use or erectile dysfunction such that the developed online tool provides a detailed and informative overview for clinicians as well as patients.

[Primary pigmented malignant melanoma of the bladder treated with radical urethrocystectomy and adjuvant therapy]. / Primär pigmentiertes malignes Melanom in der Harnblase therapiert mit radikaler Urethrozystektomie und adjuvanter Therapie.

Primary malignant melanoma of the urinary tract is a rare entity with less than 50 cases reported worldwide. The following case concerns a 64-year-old woman whom we first saw in our emergency room due to gross haematuria. As part of the subsequent diagnostic investigation, we detected a primary malignant melanoma of the bladder and the urethra. The patient was treated with radical urethrocystectomy including pelvic lymphadenectomy and an ileum conduit. This was followed by a year of adjuvant therapy using checkpoint inhibitors.

[The impact of using intraoperative photodynamic diagnosis on the prognosis of bladder cancer]. / Analyse der Anwendung der intraoperativen photodynamischen Diagnostik beim Harnblasenkarzinom.

BACKGROUND: Photodynamic Diagnosis (PDD) is widely used today for the diagnosis and treatment of superficial bladder cancer. This study aimed to analyse the impact of using this technique on recurrence rate, residual tumour rate and progression-free survival. MATERIALS AND METHODS: We conducted this study retrospectively in our unit between 10/2014 and 02/2018. We divided our patients into 2 groups: white light group, 49 patients who underwent primary bladder tumour resection with white light transurethral resection of bladder tumour (WL-TURB), and blue light group, 49 patients treated with blue light transurethral resection of bladder tumour (BL-TURB) with PDD. Patients in both groups were followed up for one year. We collected data for tumour recurrence for the first year, 3-month and 1-year relapse-free survival and 1-year progression-free assessment pursuant to the EORTC risk classification by Sylvester 2006. Furthermore, the residual tumour rate was determined by re-TURB. RESULTS: The following results were found independent of age, gender and histological findings: Residual tumour rate: blue light group 13.95 % vs. white light group 32.6 %, (p 0.02, OR 3.8, CI 95 % [1.17 - 12.85]).; 3-month relapse-free survival: blue light group 87.7 % vs. white light group 67.4 % (p 0.02, HR 3.18, CI 95 % [1.20 - 8.42]); 1-year relapse-free survival: blue light group 77.6 % vs. white light group 55.1 % (p 0.015, HR 2.56, CI 95 % [1.20 - 5.45]); 1-year progression-free survival: blue light group 95.9 % vs. white light group 79.6 %, p 0.03, HR 5.23, CI 95 % [1.11 - 24.53]) CONCLUSION: The use of hexaminolevulinate significantly reduces the risk of residual tumours compared with conventional TURB. The PDD technique significantly improved 3- and 12-month recurrence-free survival, especially in low and medium-risk tumours, and 1-year progression-free survival, especially in high-risk tumours.

[From stone treatment to coiling of aneurysm]. / Von der Steintherapie zum Aneurysmacoiling.

The following is a case report of a 54-year-old female who presented with persistent macrohaematuria with bladder tamponade three weeks after percutaneous nephrolithotomy. Angiography revealed an intrarenal aneurysm, which was closed by coiling, resulting in complete cessation of bleeding.

[Infected urachal cyst in an adult manifests as urosepsis]. / Infizierte Urachuszyste beim Erwachsenen, Manifestation als Urosepsis.

The following is a case of an 81-year-old male adult who presented to our emergency department with signs of urosepsis. The patient came with an indwelling urinary catheter due to benign prostatic hyperplasia. Extended diagnostic investigation demonstrated an infected urachal cyst as the cause of infection, which was surgically treated.