Forty-three patients with nonmetastatic inflammatory breast carcinoma have been treated by initial doxo-rubicin, 5-fluorouracil, and cyclophosphamide (FAC) combination chemotherapy. After three chemotherapy cycles, responding patients underwent surgery. Chemotherapy was then completed for nine cycles of FAC followed by locoregional radiation therapy. All patients received tamoxifen 40 mg/day for 1 year from the time of diagnosis. Thirty-eight patients (88%) had a clinical response to chemotherapy and underwent surgery. On histologic examination 17 patients had a residual tumor mass less than 1 cm diameter or a complete tumor disappearance; lymph nodes dissection was negative in 15 patients. With a median follow-up of 48 months, the predicted 5-year disease-free survival (DFS) is 48% (median DFS, 46 months). Analysis of prognosis factors shows that age, menopausal status, and histologic grade have no predictive value. The DFS and overall survival were significantly improved by the presence of hormonal receptors and a low number of positive lymph nodes (<4) at surgery. The most significant prognosis factor was the residual tumor mass after initial chemotherapy with an 80% predicted 5-year DFS for the responding patients versus 30% for the no responding patients (P < 0.001). Cancer 65:851-855, 1990. ETWEEN 2% and 5% of breast cancers are inflam-B matory carcinomas. Their prognosis is especially poor. Clinical signs of inflammatory breast carcinoma include elevation of skin temperature, pain, erythema, and edema with dimpling. An tumor mass is rarely palpable. In the PEV2 type, acute inflammatory carcinoma involves more than one third of the breast, whereas in PEV3 type the acute process involves the whole breast. Subcutaneous lymphatic vessels are often invaded by the tumor as demonstrated at skin biopsy,2 but histopatho-logic changes of the skin are not pathogn~monic.~ Prognosis is a major concern. Most cases experience early metastatic dissemination in the first 2 years after Disease-free survival (DFS) rates after 5 years are below lo%, after surgery, radiation therapy, or both.'-' I Initial multiple drug regimens have increased DFS and 5-year survival rates to about 40%."-ls This study reports the results of a treatment strategy for inflammatory breast cancer. Initial chemotherapy in

We evaluated the role of prostate health index (PHI) in predicting Gleason score (GS) upgrading in International Society of Urological Pathology Grade Group (ISUP GG) 1 & 2 prostate cancer (PCa) or adverse pathologic outcomes at radical prostatectomy (RP). A total of 300 patients with prostate specific antigen ≥ 3 ng/mL, PHI and prostate biopsy (71 patients with RP included) were retrospectively included in the study. The primary study outcomes are PCa and clinically significant PCa (csPCa, defined as ISUP GG ≥ 2) diagnostic rate of PHI, and GS upgrading rate at RP specimen. The secondary outcomes are the comparison between GS upgrading and non-upgrading group, GS upgrading and high-risk PCa (ISUP GG ≥ 3 or ≥ pT3a) predictability of preoperative clinical factors. Overall, 139 (46.3%) and 92 (30.7%) were diagnosed with PCa and csPCa, respectively. GS upgrading rate was 34.3% in all patients with RP. Significant differences were shown in the total prostate volume (p = 0.047), the distribution of ISUP GG at biopsy (p = 0.001) and RP (p = 0.032), respectively. PHI values ≥ 55 [Odds ratio (OR): 3.64 (95% confidence interval (CI) = 1.05–12.68, p = 0.042] and presence of PI-RADS lesion ≥ 4 (OR: 7.03, 95% CI = 1.68–29.51, p = 0.018) were the significant predictors of GS upgrading in RP specimens (AUC = 0.737). PHI values ≥ 55 (OR: 9.05, 5% CI = 1.04–78.52, p = 0.046) is a significant factor for predicting adverse pathologic features in RP specimens (AUC = 0.781). PHI could predict GS upgrading in combination with PIRADS lesions ≥ 4 in ISUP GG 1 & 2. PHI alone could evaluate the possibility of high-risk PCa after surgery as well.

This study aimed to determine the urodynamic characteristics of refractory enuresis and explore whether they can be managed through differential endoscopic injection with botulinum toxin. Methods: A total of 27 patients with nonmonosymptomatic enuresis who showed no response after conservative treatment for more than 12 months were included herein. Patients then underwent videourodynamic study and received a differential endoscopic injection of botulinum toxin within the same day. Reduced capacity, detrusor overactivity, and bladder neck widening were the three major abnormal findings assessed during the filling phase, while sphincter hyperactivity was the only abnormality assessed during the emptying phase. Intravesical or intrasphincteric injection of botulinum toxin was attempted according to videourodynamic study findings. Follow-up was conducted 1, 3, 6, and 12 months after treatment. Results: The median age was 10 (7-31) years. Although 19 and 8 patients had preoperative diagnosis of overactive bladder or dysfunctional voiding, respectively, urodynamic diagnosis was different in more than half of them. Those showing detrusor overactivity benefited from intravesical botulinum toxin injection, whereas those with only sphincter hyperactivity benefited from both intravesical and intrasphincteric injections. Treatment resistance to botulinum toxin seemed to have been attributed to bladder neck widening. Time had no apparent effect on efficacy, which remained 6 months after the injection. More than 80% of the patients retained the benefits of injection after 1 year. Conclusions: Videourodynamic study was useful in identifying reasons of refractory nonmonosymptomatic enuresis and helpful in determining appropriate sites of botulinum toxin A c c e p t e d A r t i c l e 2 injection.

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Purpose This study aimed to evaluate the feasibility of the newly-developed three-dimensional (3D) printed training module for navigation during retrograde intrarenal surgery. Materials and Methods Two specialists provided orientation to all trainees. The 3D printing model consisted of eight calyces in each kidney. One navigation time started from the moment when the endoscope entered the ureter. After navigation was completed, the navigation time was recorded. The goal was to perform ten navigation times for each side, starting from the right or the left side at random. After the experiment, all trainees were asked to fill out a questionnaire. Results The average training period of all 17 trainees was 3.05±1.80 years. Eleven trainees (64.7%) had the experience of assisting surgery for <100 cases, and six trainees (35.3%) had the experience of assisting surgery for 100 to 500 cases. Nine trainees (52.9%) began training from the right, and eight trainees (47.1%) started from the left. The average navigation time of 308 trials was 153.4±92.6 seconds. The maximum and minimum navigation times were 354.3±177.2 seconds and 80.1±25.6 seconds. The mean navigation time of the first and the last trials of all trainees significantly decreased from 251.4±108.0 seconds to 93.9±33.2 seconds. The average reduction in navigation time was 201.3±133.3 seconds. Almost all trainees were satisfied with the training. Conclusions The newly-developed 3D printing navigation training module seems to be adequate to improve surgical skills of flexible ureteroscopy.

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INTRODUCTION AND OBJECTIVE: COVID-19 has caused significant disruption to the management of urological cancer, this study aims to assess 30-day postoperative outcomes for patients undergoing urological cancer surgery during the COVID-19 pandemic.METHODS: COVIDSurg study is the largest international, multicentre study of COVID-19 in surgical patients performed to date. COVIDSurg-Cancer explored the safety of performing elective cancer surgery during the pandemic. All bladder, kidney, UTUC and prostate cancer patients who underwent elective cancer surgery between March 2020 and July 2020 were included. Univariable and multivariable regression was performed to assess association of patient factors with mortality, respiratory complications and operative complications.RESULTS: A total of 1,902 patients from 36 countries were included. 658 (34.6%) patients had bladder cancer, 590 (31.0%) kidney cancer or UTUC, and 654 (34.4%) prostate cancer. These patients underwent elective curative surgery for their cancers (prostatectomies, nephrectomies, cystectomies, nephroureterectomy, TURBTs). 62% of sites were not designated "hot" COVID-19 sites (i.e. did not actively admit patients with COVID-19).A total of 42/1902 (0.2%) patients were diagnosed with COVID-19 during their inpatient stay. 21 (0.1%) mortalities were observed; of those, 8 (38.1%) were diagnosed with COVID-19. Mortalities were found to be more likely in patients with concurrent COVID-19 infection (OR 31.7, 95% CI 12.4-81.42, p<0.001), aged over 80, ASA grade 3þ and ECOG grade 1þ. 40 (0.2%) respiratory complications (acute respiratory distress syndrome or pneumonia) were observed within 30 days of surgery. Respiratory complications were more likely in patients aged with concurrent COVID-19 infection (OR 40.6, p<0.001), over 70, from an area with high community risk or with a revised cardiac risk index of 1þ. There were 84 major complications (Clavien-Dindo score !3). Patients with a concurrent COVID-19 infection (OR 7.45, p<0.001) or aged 80 or above were more likely to experience major complications.CONCLUSIONS: Elective urological cancer surgeries are safe to perform during the COVID-19 pandemic. This study highlights important risk-factors associated with worse outcomes. Our data can inform health services to safely select patients for surgery during the pandemic. Patients with concurrent COVID-19 infection have a higher risk of mortality and respiratory complications and should not undergo surgery if possible.