RESUMEN
OBJECTIVE: To review the literature reporting the technique of percutaneous nephrolithotomy (PCNL) and outcomes for prone and supine PCNL, as PCNL is an established treatment for renal calculi and both prone and supine PCNL have been described, but there has been much debate as to the optimal position for renal access in PCNL. METHODS: A review of the medical literature was conducted using the PubMed database to identify relevant studies reporting on prone and supine PCNL published up until July 2015. Only publications in English were considered. Search terms included 'supine', 'prone', 'percutaneous nephrolithotomy', 'PCNL' and 'randomised controlled trial'. Articles relevant to the particular aspect of PCNL discussed were selected. RESULTS: In all, 30 articles were included in the literature review. Nine of these articles were of Level 1 Evidence as graded by the Oxford System of Evidence-based Medicine. CONCLUSION: The present systematic review highlights the benefits and disadvantages of supine and prone PCNL. The published data on supine and prone PCNL have shown no significant superiority of either approach. Whether prone or supine PCNL is optimal, remains a debatable topic.
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OBJECTIVE: To evaluate the introduction of dynamic lymphoscintigraphy and sentinel lymph-node (SLN) biopsy (used to detect occult lymph node metastases in patients with penile cancer and clinically impalpable inguinal lymph nodes at presentation) at a UK tertiary referral centre for penile cancer. PATIENTS AND METHODS: In all, 75 patients with penile squamous cell carcinoma of stage T1, grade > or = 2, and unilateral or bilateral impalpable groin nodes, were prospectively enrolled over a 2-year period. Patients underwent lymphoscintigraphy with (99m)technetium-labelled nanocolloid which was injected intradermally around the tumour or into the distal penile shaft skin. Four hours later, the SLN(s) were identified during surgery using a hand-held gamma-probe and intradermal injections with blue dye. Completion lymph node dissection was subsequently used in patients with tumour-positive SLNs. RESULTS: In all, 255 SLNs were removed from 143 groins; all excised nodes had taken up the radioactive marker, and the blue dye was evident in 87%. Eighteen of 75 (24%) patients and 21 of 143 groins (15%) had a tumour-positive SLN. All but one patient went on to completion lymph node dissection. Three of these 18 (17%) had further disease in other than SLNs. Six of 143 (4%) groins developed minor complications. One false-negative result was reported at a median (range) follow-up of 11 (2-24) months. CONCLUSION: This technique is feasible for managing penile cancer in a UK tertiary referral centre. The initial results suggest that it can accurately identify the SLN(s), which can then be removed for pathological review with minimal morbidity.
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Carcinoma de Células Escamosas/secundario , Escisión del Ganglio Linfático/métodos , Ganglios Linfáticos/patología , Neoplasias del Pene/patología , Biopsia del Ganglio Linfático Centinela/normas , Adulto , Anciano , Anciano de 80 o más Años , Carcinoma de Células Escamosas/diagnóstico por imagen , Carcinoma de Células Escamosas/cirugía , Estudios de Factibilidad , Estudios de Seguimiento , Humanos , Ganglios Linfáticos/diagnóstico por imagen , Ganglios Linfáticos/cirugía , Metástasis Linfática/diagnóstico por imagen , Metástasis Linfática/patología , Masculino , Persona de Mediana Edad , Neoplasias del Pene/diagnóstico por imagen , Neoplasias del Pene/cirugía , Estudios Prospectivos , Cintigrafía , Biopsia del Ganglio Linfático Centinela/métodos , Resultado del TratamientoRESUMEN
OBJECTIVE: To evaluate medium-term outcome data from patients with distal urethral cancers treated with penile-preserving surgery. PATIENTS AND METHODS: We analysed prospectively 18 consecutive men referred for the management of urethral carcinoma. All had a specialist review in a supra-regional multidisciplinary team meeting, where the histology findings were reviewed by one pathology consultant. Tumours were staged according to the Tumour-Node-Metastasis classification and the patients offered penile-preserving surgery when tumours were limited to the glanular or penile urethra. RESULTS: All 18 patients were suitable for penile-preserving surgery; the procedures were: three hypospadias formation with or without topical chemotherapy; four buccal mucosa urethroplasty; three glansectomy and reconstruction; six glansectomy, distal corporectomy, reconstruction and hypospadias formation; two urethrectomy with or with no excision of adjacent tunica albuginea. The mean (median, range) follow-up was 26 (20.5, 9-58) months. There were no local recurrences; four patients with regional nodal disease progressed and of these, two died from metastatic disease, and one died from an unrelated condition. CONCLUSION: Medium-term data show that penile-preserving surgery is a feasible treatment for men with distal urethral carcinoma, providing excellent local control without prejudicing survival; a longer follow-up is needed.
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Carcinoma de Células Escamosas/cirugía , Pene/cirugía , Neoplasias Uretrales/cirugía , Procedimientos Quirúrgicos Urológicos Masculinos/normas , Adulto , Anciano , Anciano de 80 o más Años , Antineoplásicos/uso terapéutico , Carcinoma de Células Escamosas/tratamiento farmacológico , Terapia Combinada , Estudios de Factibilidad , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Resultado del Tratamiento , Neoplasias Uretrales/tratamiento farmacológico , Procedimientos Quirúrgicos Urológicos Masculinos/métodosRESUMEN
OBJECTIVES: We present medium-term outcome data for patients with invasive penile cancer treated with glansectomy and reconstruction with a split-thickness skin graft. METHODS: A series of consecutive patients referred with penile malignancies over a 6-yr period were analyzed prospectively. A dedicated histopathologist reviewed all the specimens. After clinical staging, patients with tumours confined to the glans were offered glansectomy. RESULTS: A total of 72 patients (32% of patients, 31% of procedures) underwent glansectomy for penile carcinoma. Of these, 65 patients were new diagnoses and seven were recurrences after radiotherapy. The mean follow-up period was 27 mo (range: 4-68 mo). There have been three late local recurrences (4%). CONCLUSION: Glansectomy appears to be an oncologically safe and effective procedure for patients with glans-confined squamous cell tumours. It preserves maximum phallic length and results in a very satisfactory cosmetic penile appearance after reconstruction.