The prognostic significance of capsular incision into tumor during radical prostatectomy.

BACKGROUND: The prognostic significance of capsular incision (CapI) into tumor during radical prostatectomy (RP) with otherwise organ-confined disease remains uncertain. OBJECTIVE: To evaluate the impact of CapI into tumor on oncologic outcome. DESIGN, SETTING, AND PARTICIPANTS: A retrospective review of 8110 consecutive patients with prostate cancer treated at Ottawa Hospital and at Memorial Sloan-Kettering Cancer Center, both tertiary academic centers, between 1985 and 2008. INTERVENTION: All patients underwent an open, laparoscopic or robotic RP. MEASUREMENTS: Patients were divided into four pathologic categories: group 1 (CapI group), positive surgical margins (PSMs) without extraprostatic extension (EPE); group 2, negative surgical margins (NSMs) without EPE; group 3, NSM with EPE; group 4, PSMs with EPE. Estimates of recurrence-free survival were generated with the Kaplan-Meier method. Recurrence was defined as a prostate-specific antigen (PSA) >0.2 ng/ml and rising. Cox proportional hazards regression was used to estimate the hazard ratio (HR) for recurrence controlling for pretreatment PSA, RP date, RP Gleason sum, seminal vesicle invasion, and lymph node involvement. Pathologic categories were defined in the model by including the variables EPE and surgical margins (SMs) as well as their interaction. RESULTS AND LIMITATIONS: Median follow-up was 37.3 mo. The 5-yr recurrence-free probability after RP for the CapI group was 77% (95% confidence interval [CI], 72-83). This was not only inferior to patients with NSMs and no EPE (log rank p<0.0001) but also to those with NSMs and EPE (log rank p=0.0002). In multivariate analysis the interaction between EPE and SM was not significant (p=0.26). In the adjusted model excluding the interaction term, patients with EPE had an increased risk for recurrence (HR: 1.80; 95% CI, 1.49-2.17; p<0.0001) as did those with positive margins (HR: 1.81; 95% CI, 1.51-2.15; p<0.0001). This was a retrospective study. CONCLUSIONS: CapI into tumor has a significant impact on patient outcome following RP. Patients, who otherwise would have organ-confined disease, will now have a higher probability of recurrence than those with completely resected extraprostatic disease.

Single-site laparoscopic orchidopexy in an infant.

We describe a laparoscopic orchidopexy performed on an 18-month-old child through a single infraumbilical site.

Endoscopic stone management in children.

PURPOSE OF REVIEW: The management of urolithiasis in children has significantly changed over the past 20 years. Extracorporeal shockwave lithotripsy (SWL) was initially the preferred modality of treatment. More recently, ureteroscopy and percutaneous nephrolithotomy (PCNL) are being used at an increasing frequency in the management of pediatric stone disease. RECENT FINDINGS: Development has been made in various aspects of pediatric endoscopic stone management. Ureteroscopy and PCNL have been applied at an increasing frequency to treat pediatric stone disease, which has guided modifications to improve the procedures. Increased endoscopic experience with managing urolithiasis has broadened the indications wherein these methods are utilized. Technology is continually advancing to meet the needs of this population. Ureteroscopes have been modified to accommodate the pediatric ureter, optics advanced, and access sheaths are used to improve results. In addition, technique is constantly being refined. SUMMARY: Further experience will direct surgeons as to when ureteroscopy and PCNL are appropriate. The incidence of urolithiasis is on the rise in developing nations; there is a need to address the most efficient method of treatment that minimizes the morbidity to the child.