Publications by authors named "Michaël M E L Henderickx"

15 Publications

  • Page 1 of 1

Can operator-controlled imaging reduce fluoroscopy time during flexible ureterorenoscopy?

Cent European J Urol 2022 29;75(1):90-95. Epub 2022 Jan 29.

Department of Urology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.

Introduction: Fluoroscopy is routinely used during ureterorenoscopy. According to the 'As Low As Reasonably Achievable' (ALARA) principle, radiation exposure should be kept as low as reasonably achievable to decrease the risk of negative long-term effects of radiation for patients and medical staff. This study aims to assess if operator-controlled imaging during flexible ureterorenoscopy for nephrolithiasis could reduce fluoroscopy time when compared to radiographer-controlled imaging.

Material And Methods: This study was a bicentric, retrospective comparison between patients treated for nephrolithiasis with flexible ureterorenoscopy with either operator-controlled imaging or radiographer-controlled imaging. A total of 100 patients were included, 50 were treated with operator-controlled imaging and 50 with radiographer-controlled imaging. Patients undergoing flexible ureterorenoscopy with a total stone burden <20 mm and data on radiation exposure were included. Patient characteristics, stone characteristics, surgical details and fluoroscopy time were recorded for each patient and both groups were compared. Patient data were expressed as median. A 2-sided p-value <0.005 was considered statistically significant.

Results: This study found no significant differences between both groups regarding the patient and stone characteristics. However, it found a significant shorter fluoroscopy time in the operator-controlled imaging group of 33.5 seconds (IQR 16.0-70.0) compared to 57.0 seconds (IQR 36.8-95.3) in the radiographer-controlled imaging group (p = 0.001).

Conclusions: This study shows that operator-controlled imaging in flexible ureterorenoscopy could reduce fluoroscopy time when compared to radiographer-controlled imaging. Operator-controlled imaging might therefore allow urologists to perform ureterorenoscopy with greater independence while additionally reducing fluoroscopy time and its consequent negative effects for medical staff and patients.
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http://dx.doi.org/10.5173/ceju.2022.0210DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9074056PMC
January 2022

Surgical margins after partial nephrectomy as prognostic factor for the risk of local recurrence in pT1 RCC: a systematic review and narrative synthesis.

World J Urol 2022 May 3. Epub 2022 May 3.

Department of Urology, Amsterdam UMC location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands.

Purpose: To systematically review the published literature on surgical margins as a risk factor for local recurrence (LR) in patients undergoing partial nephrectomy (PN) for pT1 renal cell carcinomas (RCC).

Evidence Acquisition: A systematic literature search of relevant databases (MEDLINE, Embase and the Cochrane Library) was performed according to the PRISMA criteria up to February 2022. The hypothesis was developed using the PPO method (Patients = patients with pT1 RCC undergoing PN, Prognostic factor = positive surgical margins (PSM) detected on final pathology versus negative surgical margins (NSM) and Outcome = LR diagnosed on follow-up imaging). The primary outcome was the rate of PSM and LR. The risk of bias was assessed by the QUIPS tool.

Evidence Synthesis: After assessing 1525 abstracts and 409 full-text articles, eight studies met the inclusion criteria. The percentage of PSM ranged between 0 and 34.3%. In these patients with PSM, LR varied between 0 and 9.1%, whereas only 0-1.5% of LR were found in the NSM-group. The calculated odds ratio (95% confident intervals) varied between 0.04 [0.00-0.79] and 0.27 [0.01-4.76] and was statistically significant in two studies (0.14 [0.02-0.80] and 0.04 [0.00-0.79]). The quality analysis of the included studies resulted in an overall intermediate to high risk of bias and the level of evidence was overall very low. A meta-analysis was considered unsuitable due to the high heterogeneity between the included studies.

Conclusion: PSM after PN in patients with pT1 RCC is associated with a higher risk of LR. However, the evidence has significant limitations and caution should be taken with the interpretation of this data.
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http://dx.doi.org/10.1007/s00345-022-04016-0DOI Listing
May 2022

Could the region you live in prevent or precipitate kidney stone formation due to mineral intake through tap water? An analysis of nine distribution regions in Flanders.

Acta Chir Belg 2022 Jan 17:1-8. Epub 2022 Jan 17.

Department of Urology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.

Objectives: To analyse the mineral content of tap water in Flanders and assess if the region one lives in could prevent or precipitate stone formation due to a difference in mineral content.

Methods: Data from six water companies providing tap water to nine regions in Flanders regarding calcium, magnesium, potassium, sodium and sulphate content in tap water was retrieved. Minimum and maximum values were collected and compared between the different geographical regions.

Results: The highest calcium level was found in region 9 with a value of 157.0 mg/L, which is almost 10 times the value found in region 8 (16.1 mg/L). Region 6 had the highest magnesium (31.8 mg/L), potassium (30.5 mg/L), sodium (126.6 mg/L) and sulphate (218.5 mg/L) levels. The lowest level of magnesium (2.7 mg/L) was found in region 1, which was almost 12 times lower as in Region 6. Region 9 had the lowest level of potassium (1.5 mg/L), which is a factor 20 lower than Region 6. The lowest sodium and sulphate levels were found in region 8 (6.8 mg/L and 3.0 mg/L), respectively. The difference between the highest and lowest level of sulphate was a factor 70.

Conclusion: There is a broad range in the minerals found in tap water between the different production sites in the nine distribution regions in Flanders. However, due to the high standards tap water has to meet in Flanders, the region one lives in will not lead to a higher or lower risk of kidney stone formation if the advised 2 to 3 L per day are consumed.
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http://dx.doi.org/10.1080/00015458.2022.2025722DOI Listing
January 2022

How to evaluate a flexible ureterorenoscope? Systematic mapping of existing evaluation methods.

BJU Int 2021 10 3;128(4):408-423. Epub 2021 Aug 3.

Department of Urology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.

Objectives: The objective of this study was to identify, map and review scope-related and user-related parameters used to evaluate the quality of flexible ureterorenoscopes. Thereby identifying key items and variability in grading systems.

Methods: A literature search of four databases (MEDLINE [Ovid], EMBASE [Ovid], Web of Science, Google scholar and the Cochrane Library) was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines encompassing articles published up to August 2020. A total of 2386 articles were screened.

Results: A total of 48 articles were included in this systematic scoping review. All studies had a prospective design. Five key items in the assessment of flexible ureterorenoscopy were distinguished: 'Manoeuvrability' (87.5%), 'Optics' (64.6%), 'Irrigation' (56.3%), 'Handling' (39.6%) and 'Durability' (35.4%). After regrouping, every key item could be divided into specific subcategories. However, the quality assessment showed a wide variation in denomination, method of measurement, circumstances of measurement, tools used during measurements, number of measurements performed, number of observers, and units of outcomes.

Conclusion: The research field regarding quality assessment of ureterorenoscopes is heterogeneous. In this systematic scoping review we identified five key parameters: Manoeuvrability, Optics, Irrigation, Handling and Durability, used to grade flexible ureterorenoscopes. However, within these categories we found a wide variety in terms of method of measurements. A standardised, uniform grading tool is required to assess and compare the quality of flexible ureterorenoscopes in the future.
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http://dx.doi.org/10.1111/bju.15544DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8519042PMC
October 2021

Introduction of a Standardized Approach of Electronic Urinary pH Monitoring to Assist Alkalization Therapy: A Uric Acid Urolithiasis Patient's Perspective.

J Endourol 2021 10 1;35(10):1563-1570. Epub 2021 Sep 1.

Department of Urology and Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.

This study evaluates the introduction of an electronic pH meter to measure the urinary pH in patients with uric acid (UA) urolithiasis and assess patient's perspective. Patients known with UA urolithiasis were included in this single-center, nonrandomized, prospective feasibility study, IDEAL stage 2a. Their experience with urolithiasis and satisfaction with the method of urinary pH monitoring before inclusion was evaluated. All patients received an electronic pH meter and standardized instructions. After a period of 6-12 weeks their experience and satisfaction with this pH meter and new regimen was assessed. Patient satisfaction was scored on a Likert scale 1-5. Eighteen patients were included. Median age was 63 years and median body mass index was 30 kg/m. The cohort consisted of 67% men and 33% women. In their medical history, 55% had unilateral stones, whereas 45% had bilateral stones. The median estimated glomerular filtration rate was 58 mL/minute/1.73 m. Eighty-nine percent took medication to alkalize their urine, median 3.5 years. Fifteen patients used paper reagent strips and three used an electronic pH meter to assess urinary pH before this study. Satisfaction with the method of urinary pH measurement at inclusion was reasonable (median score 3; interquartile range [IQR] 1-4). Satisfaction with the new electronic pH meter was good (median score 4; IQR 3-5), as was the overall satisfaction (median score 4; IQR 3-5). The new electronic pH meter was slightly easier to use (median 3.5; IQR 1.75-5), as easy in maintenance (median 3; IQR 2-4), and significantly easier to read (median 5; IQR 4-5). The new electronic pH meter was better (median score 4; IQR 2.75-5) than their previous method. The introduction of a standardized approach of urinary pH monitoring for UA urolithiasis patients with an electronic pH meter leads to an easier interpretable outcome and higher patient satisfaction.
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http://dx.doi.org/10.1089/end.2020.0621DOI Listing
October 2021

Global Variations in the Mineral Content of Bottled Still and Sparkling Water and a Description of the Possible Impact on Nephrological and Urological Diseases.

J Clin Med 2021 Jun 27;10(13). Epub 2021 Jun 27.

Department of Urology, University Hospital Southampton NHS Trust, Southampton SO16 6YD, UK.

Kidney stone disease (KSD) is a complex disease. Besides the high risk of recurrence, its association with systemic disorders contributes to the burden of disease. Sufficient water intake is crucial for prevention of KSD, however, the mineral content of water might influence stone formation, bone health and cardiovascular (CVD) risk. This study aims to analyse the variations in mineral content of bottled drinking water worldwide to evaluate the differences and describes the possible impact on nephrological and urological diseases. The information regarding mineral composition (mg/L) on calcium, bicarbonate, magnesium, sodium and sulphates was read from the ingredients label on water bottles by visiting the supermarket or consulting the online shop. The bottled waters in two main supermarkets in 21 countries were included. The evaluation shows that on a global level the mineral composition of bottled drinkable water varies enormously. Median bicarbonate levels varied by factors of 12.6 and 57.3 for still and sparkling water, respectively. Median calcium levels varied by factors of 18.7 and 7.4 for still and sparkling water, respectively. As the mineral content of bottled drinking water varies enormously worldwide and mineral intake through water might influence stone formation, bone health and CVD risk, urologists and nephrologists should counsel their patients on an individual level regarding water intake.
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http://dx.doi.org/10.3390/jcm10132807DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8267898PMC
June 2021

Laparoscopic cryoablation for small renal masses: Oncological outcomes at 5-year follow-up.

Arab J Urol 2020 Dec 17;19(2):159-165. Epub 2020 Dec 17.

Department of Urology, Onze Lieve Vrouwe Gasthuis (OLVG), Amsterdam, The Netherlands.

: To evaluate the oncological outcome at 5-year follow-up after laparoscopic cryoablation (LCA) for small renal masses (SRMs), as there is an increasing interest in ablative therapy for cT1a renal tumours due to the rising incidence of SRMs, the trend towards minimally invasive nephron-sparing treatments, and the ageing population. : Between 2004 and 2015, 233 consecutive LCA were performed in 219 patients for SRMs at two referral centres. We only included those patients with ≥5 years of follow-up ( = 165) in a prospectively maintained database. A descriptive analysis was conducted for pre-, peri- and postoperative characteristics. A Kaplan-Meier analysis assessed overall (OS), disease-specific (DSS), and recurrence-free survival (RFS). : The median (interquartile range [IQR]) age of our patient cohort was 68 (60.5-76) years. The median (IQR) body mass index was 26.2 (23.8-29) kg/m, and the median (IQR) Charlson Comorbidity Index score corrected for age was 4 (2.5-6). The median (IQR) tumour diameter was 28 (21-33) mm. In all, 15% developed a complication in the first 30 days after LCA, of which 1% had a major complication (Clavien-Dindo Grade ≥III). The median (IQR) preoperative estimated glomerular filtration rate (eGFR) was 82.5 (65-93.75) mL/min/1.73 m. The median eGFR decreased by 16.4% and 15.2% at the 3-month and 5-year follow-up, respectively. Persistence was found in 1%, local recurrence in 2%, and systemic progression in 4%. The OS, DSS, and RFS were 74%, 96.9% and 95.4%, respectively. : LCA is a safe and effective treatment for SRMs in selected cases and shows good oncological outcomes after 5 years of follow-up, with only 1% developing a major complication.
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http://dx.doi.org/10.1080/2090598X.2020.1863308DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8158258PMC
December 2020

Donor kidney lithiasis and back-table endoscopy: a successful combination.

Acta Chir Belg 2021 May 31:1-4. Epub 2021 May 31.

Department of Urology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.

Introduction: Urolithiasis in renal allografts is relatively rare with an incidence of 0.17-4.40%. It is nonetheless an important issue, as there is a risk of obstruction, sepsis and even loss of the renal allograft. The management of stones in renal allografts remains challenging because of the anatomy, the renal denervation and the use of immunosuppressive medication.

Case Presentation: This report discusses the treatment of asymptomatic nephrolithiasis in a living donor kidney allograft. A CT abdomen revealed a lower pole stone (5.9 × 5.5 × 5.0 mm; 920 HU) in the right kidney of the potential donor. After multidisciplinary discussion, it was decided to procure the right kidney despite the presence of a documented nephrolithiasis. After discussion with both donor and recipient, an flexible ureterorenoscopy for stone removal on the back table just before implantation of the allograft was planned. The stone was found in the lower pole covered by a thin film of the urothelium. The thin film of urothelium was opened with a laser and the stone fragments were retrieved with a basket. CT after one month showed no residual stones in the transplanted kidney.

Conclusion: Back-table endoscopy in a renal allograft is a feasible technique and should be discussed as an option in case of urolithiasis in a kidney that is considered for transplantation. Furthermore, the appropriate treatment of donor kidney lithiasis is another, although rare, method to expand the living donor renal allograft pool.
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http://dx.doi.org/10.1080/00015458.2021.1934333DOI Listing
May 2021

Variations in the mineral content of bottled 'carbonated or sparkling' water across Europe: a comparison of 126 brands across 10 countries.

Cent European J Urol 2021 19;74(1):71-75. Epub 2021 Feb 19.

University Hospital Southampton NHS Trust, Department of Urology, Southampton, United Kingdom.

Introduction: Kidney stone disease is a common disease with high recurrence rates. Sufficient intake of water is the cornerstone in primary prevention of stone disease. However, the mineral composition of water can affect urinary minerals and influence stone formation. The aim of this study is to assess the variation in the mineral composition of bottled sparkling or carbonated drinking water across Europe.

Material And Methods: The two largest supermarket chains in each participating country were visited to obtain data on mineral composition regarding bicarbonate, calcium, magnesium, potassium, sodium and sulphates of sparkling or carbonated waters by reading the ingredient labels on the bottles supplied by the manufacturers. Alternatively, the web-shops of these supermarkets were consulted.

Results: In total, 126 sparkling water brands across ten European countries were analysed regarding mineral composition. The median concentrations per mineral varied greatly. The greatest variation in median mineral content was found for sodium and sulphates with levels ranging from 3.1 mg/l to 63.0 mg/l and 6.0 mg/l to 263.0 mg/l respectively. A wide distribution of calcium content was found in Switzerland, with calcium levels reaching up to 581.6 mg/l.

Conclusions: This study confirms that the mineral composition of sparkling or carbonated water varies greatly across Europe. Patients with kidney stone disease should be aware that the mineral content of water may influence stone formation and be mindful of the great variation that exists between different water brands. Mineral water can be a source of potential promotors or inhibitors of stone formation and patients and urologists need to be mindful of this.
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http://dx.doi.org/10.5173/ceju.2021.0331.R1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8097654PMC
February 2021

Variations in the Mineral Content of Bottled "Still" Water Across Europe: Comparison of 182 Brands Across 10 Countries.

J Endourol 2021 02 11;35(2):206-214. Epub 2020 Sep 11.

Department of Urology, University Hospital Southampton NHS Trust, Southampton, United Kingdom.

Kidney stone disease (KSD) is a highly prevalent disease worldwide. As water intake and its mineral content influence stone formation and recurrence, patients and physicians must be aware of the mineral content of drinkable water. We analyzed commercial bottled still water within Europe to assess the variation in its mineral composition across different manufacturers and countries. Data on the mineral composition of bottled still water regarding bicarbonate, calcium, magnesium, potassium, sodium, and sulfate concentration (mg/L) were collected from ten European countries. To collect the data, the two main supermarket chains in each participating country were either visited to check for the ingredient label on bottles or the online shop was consulted through the website of the supermarket in question. Descriptive statistics such as simple boxplots were used to illustrate the variation in mineral content. One hundred eighty-two different commercial water brands were analyzed. Up to a fivefold variation in average concentrations per mineral between countries was observed. For calcium, a wide distribution was found in France and Switzerland compared with other countries with calcium levels ranging from 10.5 to 565 mg/L and 8.4 to 579 mg/L, respectively. By consuming 2 L of water with such high calcium levels, the daily reference intake for calcium is already achieved. The mineral content of bottled still water across Europe varies greatly. For patients with KSD it is important to be aware of the mineral content of the water they drink, as it might influence stone recurrence rates and necessitate alterations of their diet.
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http://dx.doi.org/10.1089/end.2020.0677DOI Listing
February 2021

Renal biopsies performed before versus during ablation of T1 renal tumors: implications for prevention of overtreatment and follow-up.

Abdom Radiol (NY) 2021 01 20;46(1):373-379. Epub 2020 Jun 20.

Department of Urology, OLVG, Oosterpark 9, 1091 AC, Amsterdam, The Netherlands.

Purpose: To assess the difference between renal mass biopsy (RMB) performed either before or during the ablation procedure.

Methods: A retrospective multicenter study was performed in patients with a cT1 renal mass treated with ablation between January 2007 and July 2019, including a search in the national pathology database for patients with a RMB planned for ablation. Patient and tumor characteristics and information on malignant, benign, and non-diagnostic biopsy results were collected to establish rates of overtreatment and number of ablations avoided in case of benign or non-diagnostic histology.

Results: RMB was performed in 714 patients, of which 231 patients received biopsy before planned ablation, and 483 patients at the time of ablation. Pathology results before ablation were malignant in 63% (145/231), benign in 20% (46/231) and non-diagnostic in 17% (40/231). Pathology results at the time of ablation were malignant in 67.5% (326/483), benign in 16.8% (81/483) and non-diagnostic in 15.7% (76/483), leading to a total of 32.5% of ablation of benign or non-diagnostic lesions. Of the patients with a benign biopsy obtained before ablation, 80.4% (37/46) chose not to undergo ablation. Patients with inconclusive biopsy before planned ablation chose an informed individualized approach including ablation, repeated biopsy, or no intervention in 56%, 34% and 10%.

Conclusion: This study emphasizes the importance of obtaining a biopsy prior to the ablation procedure in a separate session to lower the rate of potentially unnecessary ablations.
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http://dx.doi.org/10.1007/s00261-020-02613-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7864836PMC
January 2021

Fluoroscopy-use during ureterorenoscopy: are urologists concerned about radiation exposure? A nationwide survey in Belgium and The Netherlands.

Acta Chir Belg 2021 Jun 21;121(3):170-177. Epub 2019 Nov 21.

Department of Urology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.

Introduction: To evaluate the use and awareness of radiation during URS among Belgian and Dutch urologists.

Material And Methods: An online questionnaire was send to all members of the Belgian and Dutch Association of Urology.

Results: 170 urologists finished the complete questionnaire. 10% of the respondents are not familiar with the ALARA-principle. 29% starts with a KUB and 48% makes an XRPG at the beginning of the procedure. 85% uses fluoroscopy to place a wire or ureteral access sheet, 18% during stone treatment, 59% to screen for missed stones or calyces, 90% to place a JJ-stent or ureter-catheter and 23% to check for extravasation. 82% do not document radiation data. 51% does not wear a dosimeter during fluoroscopy. Almost all wear a lead apron during fluoroscopy, 47% uses additional thyroid shields and only 4% uses lead glasses. 88% intentionally reduces fluoroscopy time, 75% reduces the exposed area with a diaphragm, 72% brings the radiation source close to the patient and 44% uses pulsed fluoroscopy.

Conclusion: There is a wide variety in the use and awareness of radiation during URS. To further reduce radiation and its negative effect for patients and medical staff, awareness about radiation safety should increase among urologists.
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http://dx.doi.org/10.1080/00015458.2019.1693150DOI Listing
June 2021

Effects of a six-month supervised physical exercise program on physical and cardio-metabolic profile and quality of life in patients with prostate cancer on androgen deprivation therapy: a pilot and feasibility study.

Cent European J Urol 2018 12;71(2):234-241. Epub 2018 Jun 12.

Department of Urology, Antwerp University Hospital, Edegem, Belgium.

Introduction: To evaluate the effect of a six-month supervised physical exercise program on the physical and cardio-metabolic profile and quality of life in patients with prostate cancer on androgen deprivation therapy.

Material And Methods: Twenty-seven patients with prostate cancer on androgen deprivation therapy were included in a physical exercise program. The program consisted of supervised physical exercises during a six-month period (two hours, twice a week). The exercise program contained moderate to high intensity aerobic and resistance exercises: cycling, walking or jogging for 45 minutes at an intensity of ±80% of the individual maximum heart rate, followed by resistance exercises targeting the major lower and upper body muscles. All patients were assessed prior to the exercise program, including anthropometrical parameters, blood analysis, quality of life and physical fitness. Blood analysis was repeated at a three-month follow-up. Anthropometrical parameters, physical fitness and quality of life were recorded at a three-, six- and nine-month follow-up.

Results: A positive effect on physical performance, muscular strength and quality of life was seen. The applied physical exercise program was well tolerated and characterized by a high satisfaction rate. An alarming issue of remarkably unfavorable baseline cardio-metabolic profile was revealed within our study population.

Conclusions: Our data indicates that a six-month supervised physical exercise program can be beneficial in preventing androgen deprivation therapy-related side effects in patients with prostate cancer. We emphasize the importance of screening for cardio-metabolic risk factors in patients who are treated with androgen deprivation therapy.
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http://dx.doi.org/10.5173/ceju.2018.1652DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6051362PMC
June 2018

Localized prostate cancer and robot-assisted laparoscopic radical prostatectomy: a retrospective, comparative study between pre- and post-operative Gleason scores.

Acta Chir Belg 2018 Feb 18;118(1):15-20. Epub 2017 Jul 18.

a Department of Urology , GZA Sint-Augustinus , Wilrijk , Belgium.

Introduction: To compare the pre- and post-operative Gleason scores (GS) in patients with localized prostate cancer treated with robot-assisted laparoscopic radical prostatectomy.

Materials And Methods: A single center, retrospective comparison between pre- and post-operative GS. Age, prostate volume, PSA, number of biopsies, number of positive cores, biopsy GS, cTNM, final pathology GS and pTNM of 286 patients were retrieved. They were divided into risk groups.

Results: A total of 286 patients with a mean age at surgery of 64.64 ± 7.81 y and mean PSA-value of 9.35 ± 8.38 ng/mL. Mean prostate volume was 55.09 ± 24.93 mL, mean number of biopsies was 11.90 ± 4.63. Mean percentage of positive cores was 36.90 ± 22.42%. A GS of <7 was seen in 23.4%, 66.8% had a GS of 7 and 9.7% of >7 in final pathology. Of the total, 38.1% were pre-operative low risk, 58.7% of them had an upgrade in GS on final pathology, 45.1% were in the intermediate risk group, 5.4% showed a downgrade, 64.3% remained stable and 30.2% had an upgrade in GS. Also, 16.8% were high risk patients of which 35.4% had a downgrade, 39.6% remained stable and 25% showed an upgrade of the GS.

Conclusions: We found a substantial underestimation of the GS in the pre-operative setting when compared to the GS in final pathology.
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http://dx.doi.org/10.1080/00015458.2017.1353234DOI Listing
February 2018

Renal papillary necrosis in patients with sickle cell disease: How to recognize this 'forgotten' diagnosis.

J Pediatr Urol 2017 Jun 7;13(3):250-256. Epub 2017 Mar 7.

Department of Urology, University Hospital Antwerp, Edegem, Belgium.

Introduction: Renal papillary necrosis is not commonly seen in daily practice, but can have severe consequences when it is not diagnosed in time. It is known to be associated with sickle cell hemoglobinopathies; however a wide range of etiologies are possible, and it is therefore not the first diagnosis clinicians consider in patients with sickle cell disease who present with hematuria.

Methods: A literature search was performed to summarize the current knowledge about renal papillary necrosis associated with sickle cell disease. These findings are illustrated with a case of a 9-year old girl with sickle cell disease who was referred with painless gross hematuria.

Results: Typical radiologic signs for renal papillary necrosis are necrotic cavities that fill with contrast, small collections of contrast peripheral to the calyces in the papillary region (ball-on-tee sign), calcification of the papillary defect, filling defects, hydronephrosis, blunted papillary tip, clefts in the renal medulla filled with contrast, hyperattenuated medullary calcifications, non-enhanced lesions surrounded by rings of excreted contrast, and clubbed calyces.

Discussion: This study focuses on the pathophysiology of renal papillary necrosis associated with sickle cell disease, the possible symptoms, as well as the diagnostic steps, with a special interest in particular presentation on old (retrograde pyelography) and new (computed tomography) gold standard in radiologic imaging, and the management for this pathology.

Conclusion: This study aims to remind clinicians of this "forgotten" diagnosis and what signs to look for in pediatric patients with sickle cell disease who present with hematuria. In pediatric cases radiation protection is important, therefore knowing what radiologic signs can be found on retrograde pyelography can lead to early identification of this pathology without having to proceed to computed tomography.
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http://dx.doi.org/10.1016/j.jpurol.2017.01.020DOI Listing
June 2017
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