Background: Bulbourethral syringocele is an uncommon and under-diagnosed condition most commonly seen in the paediatric population, although there is increasing recognition in adults. Due to the difficulty in diagnosis, we report our experience of urethral syringocele in a quaternary paediatric hospital, with differing presentations, diagnosis and treatment. Methods: This is a retrospective review of seven cases of children over a period of 14 years, including their presentations, diagnosis, treatment and follow-up. A review of the current literature is presented. Results: The median age of these seven cases at presentation was 11 years (6 days to 16 years). Clinical features varied with age, with obstructive uropathy in a neonate, urinary tract infection in an infant, scrotal abscess in two children and lower urinary tract obstructive symptoms in three teenagers. Diagnostic voiding cystogram diagnosed the majority of syringoceles and two were seen on magnetic resonance imaging. Five boys underwent endoscopic transurethral deroofing and two children required transperineal marsupialization. Long-term follow-up showed all had complete resolution of symptoms. Conclusion: Urethral syringocele presents from the neonatal period to late adolescence, with the presenting features reflective of age. Surgical management can be performed endoscopically or by open approach. Awareness of this condition and inclusion in the differential diagnosis, particularly in the setting of an atypical or recurrent scrotal abscess, could avoid a prolonged therapeutic course.
Prediction of the presence of extracapsular extension (ECE) of prostate cancer (PCa) before surgery is of paramount importance to tailor the amount of nervesparing during radical prostatectomy (RP). A novel nomogram to predict ECE has been recently developed with the integration of a multiparametric magnetic resonance imaging (mpMRI) derived variable (Martini et al, BJUI 2018, 1-9). Authors defined the "presence of ECE" as the loss or irregularity of the capsule, whereas contact, bulge or abutment are considered as negative for ECE.We aimed to externally validate this nomogram on 137 prostatic lobes from 106 patients undergoing mpMRI-targeted biopsy plus saturation sampling.METHODS: We applied the model from Martini to the most recent cases of PCa patients (n[106) with a positive mpMRI submitted to RP. PCa was diagnosed in all cases by mpMRI-targeted plus systematic saturation biopsy. According to Martini 0 s model, we considered only lobes with a positive biopsy (137). The primary endpoint was to perform an EV; the secondary endpoint was to explore the incremental role of the mpMRI-variable added to conventional clinical-pathological ones.AUC was used to assess the nomogram 0 s discriminative performance. The comparison between AUCs of two-nested models was performed using the test of Heller.RESULTS: The AUC at EV was 67.6% (95%CI:57.4%-77.8%). Sensitivity and specificity at the 20% cutoff suggested by Authors were 53.6% (95%CI:33.9%-72.5%) and 77.1% (95%CI:68%-84.6%), respectively. The model showed a poor calibration with tendency towards underestimation. As far as the secondary endpoint, the tool without mpMRI-variable showed a discrimination of 66.5% (95% CI:56.5%-76.7%) and the difference between the two AUCs was not statistically significant (p[0.113).CONCLUSIONS: On External validation, the predictive performance of Martini 0 s model seems to be suboptimal. A possible explanation could be the subjective approach of ECE depiction at mpMRI used by Authors; actually, the ideal variable predicting ECE from imaging is far to be defined.Further EV studies on larger sample size are required to definitely assess the generalizability of this nomogram.
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