Intra-operative pubic arch interference during prostate seed brachytherapy in patients with CT-based pubic arch interference of < or =1cm.

PURPOSE: There are only a few reports on the frequency of intra-operative pubic arch interference (I-PAI) during prostate seed brachytherapy (PB). MATERIALS AND METHODS: Two hundred and forty-three patients with a CT-based pubic arch interference (PAI) of < or =1 cm and a prostate volume of < or =50-60 cc underwent PB. Those patients requiring needle repositioning by > or =0.5 cm on the template were scored as having I-PAI. The incidence of I-PAI and its impact on biochemical control were analyzed. RESULTS: Intra-operative PAI was encountered in 47 (19.3%) patients. Forty two patients (17.3%) had I-PAI in 1-2 needles, two (0.8%) had I-PAI in four needles and three patients (1.2%) had I-PAI in six needles. Overall, 1.4% of needles required repositioning due to I-PAI. BMI>27 kg/m(2) and wider (>75 mm) pubic bone separation at mid ramus (PS-ML) were associated with a lower incidence of I-PAI. At a median follow-up of 50.1 months, the 3- and 5-year bPFS was 97.3% and 95.2%, respectively. The 5-year bPFS rates for patients with and without I-PAI were 95.6% and 95%, respectively (p=0.28). CONCLUSIONS: The use of CT-based PAI of < or =1cm as a selection criterion for PB is a simple and reliable method for minimizing the incidence of I-PAI and maintaining excellent biochemical control rates.

Repair of superior mesenteric artery ligation during left nephrectomy with a native renal vein patch.

Injury to the superior mesenteric artery (SMA) during nephrectomy is a rare but potentially catastrophic complication. SMA injury during nephrectomy most commonly occurs with large tumors or bulky lymphadenopathy, with inadvertent injury or mistaken ligation of the SMA instead of the renal artery. Failure to recognize and repair an SMA injury results in ischemic bowel and death for most patients. We report a case of SMA ligation during left nephrectomy for xanthogranulomatous pyelonephritis, review the intraoperative evaluation of suspected SMA injury, and describe our vascular repair using a vein patch from the native left renal vein.