Distal urethral carcinoma: Contemporary management with phallus preserving techniques

AbstractBackgroundPrimary urethral carcinoma (PUC) is rare and accounts for < 1% of all genito-urinary cancers. There is a male predominance of 3:1 and a peak incidence in the 7th and 8th decades. The aetiology of this cancer is similar to penile cancer, and the human papilloma virus (HPV) is thought to be an essential factor in tumorigenesis. Urethral cancer should be diagnosed and staged with a combination of tumour biopsy, MRI, and CT with treatment involving a multimodal approach. Contemporary management emphasises phallus-preserving surgery where feasible.Case presentationHere, we describe a case of distal urethral carcinoma, which presented as a metastatic groin mass and identifying the primary lesion proved challenging. Diagnostic flexible cystoscopy identified a tiny lesion in the navicular fossa, which was biopsied and confirmed to be a squamous cell carcinoma. The patient then underwent phallus preserving surgery, including distal urethrectomy with bilateral inguinal lymph node dissections. The final stage was pT1N1M0, and adjuvant chemotherapy was started. The distal urethrectomy involved the surgical creation of a hypospadic meatus in the midshaft of the penis. Normal voiding and sexual function were preserved.ConclusionsUrethral cancer is a rare malignancy and clinicians should bear in mind that early diagnosis of this disease can be very difficult depending on the anatomical location of the tumour. Treatment currently favours penis-preserving surgery.

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Creativity Models And Their Implementation In Contemporary Management Practice

10.15405/epsbs.2019.03.76 ◽

2019 ◽

Author(s):

O.V. Narimanova

Keyword(s):

Management Practice ◽

Contemporary Management

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Management and outcomes of isolated interhemispheric subdural hematomas associated with falx syndrome

Journal of Neurosurgery ◽

10.3171/2018.8.jns181812 ◽

2019 ◽

Vol 131 (6) ◽

pp. 1920-1925

Author(s):

Daniel A. Tonetti ◽

William J. Ares ◽

David O. Okonkwo ◽

Paul A. Gardner

Keyword(s):

Neurological Deterioration ◽

Neurological Deficits ◽

Motor Deficits ◽

Study Cohort ◽

Venous Infarction ◽

Nonsurgical Management ◽

Subdural Hematomas ◽

Poor Outcomes ◽

Contemporary Management

OBJECTIVELarge interhemispheric subdural hematomas (iSDHs) causing falx syndrome are rare; therefore, a paucity of data exists regarding the outcomes of contemporary management of iSDH. There is a general consensus among neurosurgeons that large iSDHs with neurological deficits represent a particular treatment challenge with generally poor outcomes. Thus, radiological and clinical outcomes of surgical and nonsurgical management for iSDH bear further study, which is the aim of this report.METHODSA prospectively collected, single-institution trauma database was searched for patients with isolated traumatic iSDH causing falx syndrome in the period from January 2008 to January 2018. Information on demographic and radiological characteristics, serial neurological examinations, clinical and radiological outcomes, and posttreatment complications was collected and tallied. The authors subsequently dichotomized patients by management strategy to evaluate clinical outcome and 30-day survival.RESULTSTwenty-five patients (0.4% of those with intracranial injuries, 0.05% of those with trauma) with iSDH and falx syndrome represented the study cohort. The average age was 73.4 years, and most patients (23 [92%] of 25) were taking anticoagulants or antiplatelet medications. Six patients were managed nonoperatively, and 19 patients underwent craniotomy for iSDH evacuation; of the latter patients, 17 (89.5%) had improvement in or resolution of motor deficits postoperatively. There were no instances of venous infarction, reaccumulation, or infection after evacuation. In total, 9 (36%) of the 25 patients died within 30 days, including 6 (32%) of the 19 who had undergone craniotomy and 3 (50%) of the 6 who had been managed nonoperatively. Patients who died within 30 days were significantly more likely to experience in-hospital neurological deterioration prior to surgery (83% vs 15%, p = 0.0095) and to be comatose prior to surgery (100% vs 23%, p = 0.0031). The median modified Rankin Scale score of surgical patients who survived hospitalization (13 patients) was 1 at a mean follow-up of 22.1 months.CONCLUSIONSiSDHs associated with falx syndrome can be evacuated safely and effectively, and prompt surgical evacuation prior to neurological deterioration can improve outcomes. In this study, craniotomy for iSDH evacuation proved to be a low-risk strategy that was associated with generally good outcomes, though appropriately selected patients may fare well without evacuation.

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Journal of Contemporary Management

10.35683/jcm ◽

2021 ◽

Keyword(s):

Contemporary Management

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Review of Prelabor Rupture of the Membranes: Pathophysiologic Concepts and Novel Therapeutic Strategies

Current Women s Health Reviews ◽

10.2174/1573404816999201026223954 ◽

2020 ◽

Vol 16 ◽

Author(s):

Saadia Ghafoor

Keyword(s):

Management Strategies ◽

Signs And Symptoms ◽

Cochrane Library ◽

Main Body ◽

Scientific Publications ◽

Timely Diagnosis ◽

Narrative Literature Review ◽

Contemporary Management ◽

Online Library ◽

Novel Therapeutic Strategies

Background:: Prelabor rupture of membrane (PROM) refers to the breakage of fetal membranes before the onset of labor, resulting in the leakage of amniotic fluid. PROM affects approximately 3% and 8% of preterm and term pregnancies. Because of associated high maternal and perinatal mortality, correct and timely diagnosis together with effective management is highly recommended to prevent adverse fetal and maternal outcomes. Objective:: To provide an overview of the novel concepts in the understanding of PROM including etiology, pathophysiology, risk factors, complications, assessment, diagnostic modalities, and contemporary management strategies for PROM at preterm and term. Methodology:: This narrative literature review was conducted through a literature search using the Cochrane library and electronic databases including PubMed, Web of Science, Medline, Scopus, Crossref, Google Scholar, Wiley online library, ScienceDirect with specific search terms in scientific publications published from March 1980 to March 2020. Main Body:: Preterm PROM has the potential to cause prenatal morbidity and mortality. It is imperative to monitor the signs and symptoms of an impending infection due to the risk of infectious morbidity with PROM at preterm and preterm. PROM at preterm and term requires prompt diagnosis followed by an appropriate management strategy. Conclusion:: The correct and timely diagnosis of PROM is essential for efficacious management. Furthermore, it can reduce avoidable emergent health care visits and related costs in a clinical setting subjected to pregnancy with suspected PROM. Further studies are needed to fill the gaps in identifying better diagnostic predictive tools in high- risk pregnancies.

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Contemporary management of locoregionally advanced melanoma in Australia and New Zealand and the role of adjuvant systemic therapy

ANZ Journal of Surgery ◽

10.1111/ans.17051 ◽

2021 ◽

Vol 91 (S2) ◽

pp. 3-13

Author(s):

B. Mark Smithers ◽

Robyn P. M. Saw ◽

David E. Gyorki ◽

Richard C. W. Martin ◽

Victoria Atkinson ◽

...

Keyword(s):

New Zealand ◽

Systemic Therapy ◽

Advanced Melanoma ◽

Adjuvant Systemic Therapy ◽

Contemporary Management

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Primary tumor surgery improves survival in non-metastatic primary urethral carcinoma patients: a large population-based investigation

BMC Cancer ◽

10.1186/s12885-021-08603-z ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Jie Wu ◽

Yu-Chen Wang ◽

Wen-Jie Luo ◽

Bo-Dai ◽

Ding-Wei Ye ◽

...

Keyword(s):

Regression Model ◽

Competing Risks ◽

Primary Tumor ◽

Cox Regression ◽

Radical Surgery ◽

Large Population ◽

Local Therapy ◽

Primary Site ◽

Urethral Carcinoma ◽

The Impact

Abstract Background Primary urethral carcinoma (PUC) is a rare genitourinary malignancy with a relatively poor prognosis. The aim of this study was to examine the impact of surgery on survival of patients diagnosed with PUC. Methods A total of 1544 PUC patients diagnosed between 2004 and 2016 were identified based on the SEER database. The Kaplan-Meier estimate and the Fine and Gray competing risks analysis were performed to assess overall survival (OS) and cancer-specific mortality (CSM). The multivariate Cox regression model and competing risks regression model were used to identify independent risk factors of OS and cancer-specific survival (CSS). Results The 5-yr OS was significantly better in patients who received either local therapy (39.8%) or radical surgery (44.7%) compared to patients receiving no surgery of the primary site (21.5%) (p < 0.001). Both local therapy and radical surgery were each independently associated with decreased CSM, with predicted 5-yr cumulative incidence of 45.4 and 43.3%, respectively, compared to 64.7% for patients receiving no surgery of the primary site (p < 0.001). Multivariate analyses demonstrated that primary site surgery was independently associated with better OS (local therapy, p = 0.037; radical surgery, p < 0.001) and decreased CSM (p = 0.003). Similar results were noted regardless of age, sex, T stage, N stage, and AJCC prognostic groups based on subgroup analysis. However, patients with M1 disease who underwent primary site surgery did not exhibit any survival benefit. Conclusion Surgery for the primary tumor conferred a survival advantage in non-metastatic PUC patients.

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Gender Stereotypes and Their Impact on Women’s Career Progressions from a Managerial Perspective

IIM Kozhikode Society & Management Review ◽

10.1177/2277975220975513 ◽

2021 ◽

pp. 227797522097551

Author(s):

Naznin Tabassum ◽

Bhabani Shankar Nayak

Keyword(s):

Gender Studies ◽

Gender Stereotypes ◽

Theoretical Understanding ◽

Management Culture ◽

Women In Management ◽

Critical Theories ◽

The Social ◽

Prejudice And Discrimination ◽

Contemporary Management ◽

Managerial Perspective

Gender stereotypes continue to exist and are transmitted through media, and through social, educational and recreational socialization, which promote gender prejudice and discrimination. This paper argues that contemporary management culture does not critically engage with the social theories of gender studies, which could help in developing gender-neutral affirmative action-oriented managerial perspectives. The paper outlines different aspects of gender stereotyping and their impact on women’s career progressions from a managerial perspective, which engages with the critical theories of gender studies. The paper contributes to existing literature by identifying the antecedents of gender stereotypes and their impacts on the career progressions of women in management. It advances theoretical understanding of three clear conceptual shifts, that is, (a) Women in Management, (b) Women and Management and (c) Gender and Management. The theoretical transition from Women in Management to Women and Management led to progressive conceptual shifts in management literature but gender stereotypes continue to exist in society.

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