Urological outcomes following pelvic exenteration for non-urological malignancies.

Background: Pelvic exenteration (PE) is a major surgical procedure used as a salvage therapy for patients with locally advanced or recurrent pelvic malignancies. Urinary reconstruction is a major part of PE and is often associated with high rates of post-operative complications. In the current study we evaluate the short and long-term urological outcomes following PE for Colo-Rectal (CR) and gyneco-oncological (GO) malignancies. Methods: Study included 22 patients who underwent PE for recurrent or locally advanced CR and GO malignancies in our institution between the years 2010-2018. The endpoint was post-operative freedom from urological complications. Results: Of 22 patients included, 13 (59 %) and 9 (41 %) underwent PE for CR and GO malignancies respectively. The mean age of the patients was 54 years. The median follow-up was 19 months. Seven (78 %) patients with GO malignancy and 11 (85 %) with CR malignancy underwent PE for local recurrence. Hydronephrosis prior to surgery existed in 8 (36.3 %) patients, of which, 5 patients required kidney drainage via nephrostomy tube. Two patients underwent posterior pelvic exenteration (PPE) with bladder preservation whereas the remaining 20 underwent cystectomy with urinary diversion by ileal conduit. Hydronephrosis post PE developed in 13 patients (59 %). eight (36 %) patients needed kidney drainage by nephrostomy tubes post PE, of these, 6 (75 %) had disease recurrence. The 2 years freedom from kidney drainage was 68 %, however the median time for kidney drainage was 0.5 months. The median overall survival was 12.5 months. Conclusion: The rate of urological complications following PE is relatively high and associated with disease recurrence.

Appropriate responses by elders to oral symptoms: dentists' recommendations.

This paper reports the results of a study of dentists' recommendations regarding the appropriate health action of elders in response to certain oral common symptoms and problems. Previous studies have found that elders most commonly respond to oral symptoms by using nonprofessional means. This study found that, without exception, the recommendation to consult a dentist was the primary mode of response favored by dentists, even in response to symptoms and problems that are most often trivial and rarely indicative of serious health problems. The results of this pilot study suggest that the need exists for dentists to reach a more realistic consensus regarding alternatives to professional consultation in response to some symptoms and problems.