PURPOSE: Over 30,000 hip hemiarthroplasties for neck of femur fractures are performed annually in the United Kingdom (UK). The national recommendation is via the lateral approach, to reduce the risk of dislocation, with the potential expense of reduced function and mobility post-operatively. Muscle-sparing approaches, such as SPAIRE (sparing piriformis and internus repairing externus), have been invented to address the issue of dislocation. METHODS: We performed a retrospective data collection at a single center with a high annual volume of hip hemiarthroplasties over 12 months. All patients who had hip hemiarthroplasty as their primary treatment were included. Patients who passed away and were non-ambulant before their surgery were excluded from the study. Our primary outcome was the dislocation rate and secondary outcomes were the time to mobilization after surgery and the duration of surgery. Statistical analysis was performed using XLSTAT software. RESULTS: We identified 194 cases, and these were divided into 3 groups based on the surgical approach: SPAIRE (n = 43), lateral (n = 97), and posterior (n = 54). Groups had similar demographics and a minimum 3-month follow-up after surgery. There were no dislocations in the SPAIRE group, whereas the dislocation rate for the other 2 groups was 2.5% in the lateral and 9.1% in the posterior groups at 6 months post-surgery. There was an earlier return to mobility in the SPAIRE (1.4 day) compared to the 2 other groups ( 2 days and 2.6 days). Average surgical times were very similar among all 3 groups (74 min vs. 79 min vs. 71 min). CONCLUSION The SPAIRE approach seems to be safe and provides a low risk of dislocation and good post-operative function for patients undergoing hip hemiarthroplasties.
Humans ; Hemiarthroplasty/methods* ; Retrospective Studies ; Female ; Male ; Aged ; United Kingdom ; Femoral Neck Fractures/surgery* ; Middle Aged ; Treatment Outcome ; Aged, 80 and over ; Arthroplasty, Replacement, Hip/methods* ; Trauma Centers ; Hip Dislocation/prevention & control* ; Postoperative Complications/prevention & control*

This study aimed to introduce a modified Byars staged procedure and investigate its application value in patients with severe hypospadias. We retrospectively analyzed the clinical data of patients with severe hypospadias admitted to the First Affiliated Hospital of Sun Yat-sen University (Guangzhou, China) between October 2012 and October 2022. In total, 31 patients underwent the conventional Byars procedure (conventional group), and 45 patients underwent the modified Byars staged procedure (modified group). Our modified strategy was built upon the standard Byars procedure by incorporating glansplasty during the first stage and employing a Y-shaped flap in conjunction with a glandular tunnel for urethroplasty during the second stage. Notably, there were no statistically significant differences in the preoperative baseline characteristics, duration of surgery, amount of blood loss, or occurrence of postoperative complications, including urethral fistula, stricture and diverticulum, or penile curvature, between the conventional and modified groups. However, there was a significantly lower incidence of coronal sulcus fistula (0 vs 16.1%, P = 0.02) and glans dehiscence (0 vs 12.9%, P = 0.02) in the surgical group than that in the conventional group. In addition, the modified group exhibited a notably greater rate of normotopic urethral opening (100.0% vs 83.9%, P = 0.01) and a higher mean score on the Hypospadias Objective Penile Evaluation (HOPE; mean ± standard error of mean: 8.6 ± 0.2 vs 7.9 ± 0.3, P = 0.02) than did the conventional group. In conclusion, the modified Byars staged procedure significantly reduced the risks of glans dehiscence and coronal sulcus fistula. Consequently, it offers a promising approach for achieving favorable penile esthetics, thereby providing a reliable therapeutic option for severe hypospadias.
Humans ; Hypospadias/surgery* ; Male ; Retrospective Studies ; Urologic Surgical Procedures, Male/methods* ; Child, Preschool ; Child ; Postoperative Complications/etiology* ; Urethra/surgery* ; Plastic Surgery Procedures/methods* ; Surgical Flaps ; Penis/surgery* ; Treatment Outcome ; Infant

Urinary incontinence is a common complication following robot-assisted radical prostatectomy (RARP). Urethral length has been identified as a factor affecting postoperative continence recovery. In this meta-analysis, we examined the association between use of the maximal urethral length preservation (MULP) technique and postoperative urinary continence in patients undergoing RARP. We conducted a comprehensive search of PubMed, Web of Science, Embase, and the Cochrane Library up to December 31, 2023. The quality of the literature was assessed using the Newcastle-Ottawa Scale. A random-effects meta-analysis was performed to synthesize data and calculate the odds ratio (OR) from eligible studies on continence and MULP. Six studies involving 1869 patients met the eligibility criteria. MULP was positively associated with both early continence (1 month after RARP; Z = 3.62, P = 0.003, OR = 3.10, 95% confidence interval [CI]: 1.68-5.73) and late continence (12 months after RARP; Z = 2.34, P = 0.019, OR = 2.10, 95% CI: 1.13-3.90). Oncological outcomes indicated that MULP did not increase the overall positive surgical margin rate or the positive surgical margin status at the prostate apex (both P > 0.05). In conclusion, the use of the MULP technique in RARP significantly improved both early and late postoperative continence outcomes without compromising oncological outcomes.
Humans ; Prostatectomy/adverse effects* ; Robotic Surgical Procedures/methods* ; Male ; Urethra/surgery* ; Urinary Incontinence/prevention & control* ; Postoperative Complications/etiology* ; Prostatic Neoplasms/surgery* ; Organ Sparing Treatments/methods*

Isolated male epispadias typically presents with preputial defects and dorsal urethral dehiscence. A less common subtype, known as concealed epispadias, is distinguished by an intact prepuce. Despite its clinical relevance, there is limited literature on this variant. In this study, we retrospectively analyzed the clinical data of 86 pediatric patients with isolated male epispadias treated in Beijing Children's Hospital (Beijing, China) from May 2004 to July 2023, including 19 cases of concealed epispadias and 67 of nonconcealed epispadias. We compared clinical characteristics, preoperative diagnostics, surgical techniques, postoperative outcomes, and sexual function during follow-up between the concealed and nonconcealed groups. No significant differences were observed between the two groups regarding surgical methods, postoperative complications, or rates of urinary incontinence. However, notable distinctions were found in the age at initial diagnosis, timing of surgery, frequency of incontinence, location of the urethral meatus, and postoperative urinary incontinence scores (all P < 0.05). Given the absence of penopubic epispadias in concealed cases, we categorized glans and penile epispadias within nonconcealed epispadias as distal epispadias ( n = 40) and subsequently compared them with concealed epispadias cases. The postoperative urinary incontinence scores did not differ significantly between the concealed and distal epispadias groups. These findings suggest that concealed epispadias represents a relatively milder form of the condition, characterized by the absence of penopubic involvement, lower rates of urinary incontinence, and favorable surgical outcomes. However, the intact prepuce in concealed cases underscores the need for careful identification and early diagnosis.
Humans ; Male ; Retrospective Studies ; Epispadias/classification* ; China ; Tertiary Care Centers ; Child, Preschool ; Child ; Postoperative Complications/epidemiology* ; Urinary Incontinence/epidemiology* ; Urethra/surgery* ; Infant ; Penis/surgery* ; Adolescent ; Urologic Surgical Procedures, Male/methods* ; East Asian People

Penile fracture is a rare urological emergency that may cause erectile dysfunction (ED). We analyzed the factors affecting erectile function in patients who underwent surgical repair for the management of penile fractures. Eighty-two patients who underwent penile fracture surgery in the Department of Urology, University of Gaziantep (Gaziantep, Türkiye) between January 2012 and January 2023 were evaluated. Age, body mass index, time elapsed from the incident of penile fracture to surgery, size, laterality, level of the defect, causes of fracture, presenting signs and symptoms, and relevant complications were recorded. Erectile function of the patients was evaluated preoperatively and at postoperative 3 rd and 6 th months according to the International Index of Erectile Function-5 (IIEF-5) scoring system. The factors decreasing the erection quality of the patients after surgical repair of penile fractures were investigated using IIEF-5 scoring system. Only age, defect size, and time elapsed from fracture onset to surgery were found to be effective on the occurrence of ED ( P = 0.005, P < 0.001, and P < 0.001, respectively). In the receiver operating characteristic (ROC) analysis, the cut-off values were 12.5 mm for defect size ( P < 0.001), 8.5 h for the time elapsed from fracture onset to surgery ( P = 0.036), and 40.5 years for the age of the patients ( P = 0.005). Delayed surgery, defect size, and advanced age had significant and negative effects on erectile function in cases of penile fracture. Before repair of the defect, patients should be given appropriate counseling about the possibility of ED, and early penile rehabilitation should be initiated.
Humans ; Male ; Erectile Dysfunction/epidemiology* ; Penis/surgery* ; Adult ; Middle Aged ; Risk Factors ; Postoperative Complications/etiology* ; Young Adult ; Rupture/surgery* ; Age Factors ; Aged ; Penile Erection ; Retrospective Studies

A case of an elderly patient with severe aortic insufficiency who carried high risks for surgical valve replacement. After a detailed preoperative evaluation, the patient successfully received transapical transcatheter aortic valve replacement. Postoperatively, complete left bundle branch block developed, resulting in impaired left ventricular function. Despite guideline-directed medical therapy for heart failure, cardiac function showed no significant recovery. At 4.5 months post-surgery, left bundle branch pacing was performed, leading to a marked improvement in cardiac function.
Aged ; Humans ; Male ; Aortic Valve Insufficiency/surgery* ; Bundle-Branch Block/etiology* ; Cardiac Pacing, Artificial ; Postoperative Complications/therapy* ; Transcatheter Aortic Valve Replacement/adverse effects*

With the clinical generalization and popularization of transcatheter aortic valve replacement (TAVR), cerebrovascular events related to TAVR occur more frequently, which significantly impairs neurocognitive function, increases mortality, and seriously affects prognosis and quality of life in these patients. However, the reported incidence rates of TAVR-related stroke differ in literature due to inconsistent diagnostic criteria. According to the onset time, TAVR-related stroke can be divided into acute (≤24 h), subacute (24 h-30 d), early (31 d-1 year) and late (>1 year) types, and the cause of stroke generally varies according to the onset time. Both surgical (balloon aortic valvuloplasty, types of transcatheter heart valve, alternative access) and non-surgical (valvular calcium burden, bicuspid aortic valve, subclinical leaflet thrombosis, postoperative new-onset atrial fibrillation) can be related to the occurrence of TAVR-related stroke. Postprocedural monitoring, postprocedural antithrombotic therapy, and cerebral embolic protection devices are important for the prevention of TAVR-related stoke. This article reviews the research progress on TAVR-related stroke, focusing on its epidemiology, risk factors and preventive measures, aiming to provide reference for the clinical management of stroke in TAVR.
Humans ; Transcatheter Aortic Valve Replacement/adverse effects* ; Stroke/epidemiology* ; Postoperative Complications/etiology* ; Aortic Valve Stenosis/surgery* ; Risk Factors

Transcatheter aortic valve replacement (TAVR) has emerged as the first-line treatment for aortic valve stenosis. Coronary obstruction is a severe complication of TAVR, with mortality rates exceeding 30%. Coronary obstruction can be classified as acute or delayed based on the timing of the onset, and as direct or indirect obstruction according to the underlying mechanism. Risk factors for predicting coronary obstruction include a small sinus of Valsalva diameter, excessively long native leaflets, low coronary height, and small sinotubular junction height and diameter. Accurate preoperative assessment of these anatomical parameters using CT is crucial for selecting the appropriate valve type, size, and implantation depth. Preventive technical strategies for coronary obstruction include intraoperative interventional treatments (such as the "Chimney" stenting technique), leaflet modification (such as the BASILICA technique), and alignment of the annulus and coronaries. These techniques have demonstrated significant efficacy in reducing the incidence of coronary obstruction and associated mortality. This paper reviews the epidemiology, classification, and mechanisms of coronary obstruction, with a particular focus on the identification, prevention, and treatment of high-risk patients. The aim is to highlight the importance of recognizing and managing coronary risks during TAVR and to provide actionable recommendations for the prevention and treatment of coronary obstruction in clinical practice.
Humans ; Transcatheter Aortic Valve Replacement/methods* ; Risk Factors ; Aortic Valve Stenosis/surgery* ; Postoperative Complications/prevention & control* ; Coronary Occlusion/etiology*

BACKGROUND: Video-assisted thoracoscopic surgery (VATS) lobectomy is the primary surgical treatment for lung cancer. A significant factor affecting postoperative recovery is prolonged air leak (PAL). Despite numerous clinical strategies could prevent and manage postoperative PAL, its incidence remains high. Phrenic nerve cryotherapy (PNC) temporarily inhibits phrenic nerve function, causing diaphragm elevation, which reduces thoracic cavity volume, enhances pleural apposition, and mitigates air leakage. This study investigates the efficacy of PNC in preventing postoperative PAL during VATS lobectomy. METHODS: A total of 108 eligible lung cancer patients who underwent surgery at the Department of Thoracic Surgery, The Affiliated Hospital of Inner Mongolia Medical University, from June 2023 to January 2025, were enrolled and randomly assigned to the control group (n=54) and the experimental group (n=54). The patients in both the two groups received VATS lobectomy and systematic lymph node dissection, with the experimental group also undergoing PNC during the operation. The baseline characteristics, intraoperative, postoperative indicators and dynamic changes in air leakage between the two groups were compared. RESULTS: The baseline clinical characteristics were comparable between the two groups (P>0.05). The incidence of pulmonary air leakage at 24 h after surgery (31.5% vs 29.6%) and the incidence of postoperative PAL (20.4% vs 14.8%) showed no significant differences between the two groups (P>0.05). The intraoperative air leak test to 24 hours after surgery revealed that air leakage ceased in 8 cases (32.0%) in the control group, compared to 14 cases (46.7%) in the experimental group. Moreover, during the progression from air leakage at 24 hours post-surgery to postoperative PAL, air leakage ceased in 6 cases (35.3%) in the control group and 8 cases (50.0%) in the experimental group, with a statistically significant difference (P<0.001). Compared to the control group, the patients in the experimental group exhibited more pronounced postoperative diaphragmatic elevation that recovered to a slightly higher than preoperative level by 3 mon after surgery. CONCLUSIONS The combination of PNC and active lung repair can serve as an important intervention for patients at high risk of intraoperative air leakage, reducing the occurrence of postoperative PAL.
Humans ; Thoracic Surgery, Video-Assisted/adverse effects* ; Male ; Female ; Middle Aged ; Lung Neoplasms/surgery* ; Aged ; Phrenic Nerve/physiopathology* ; Cryotherapy ; Pneumonectomy/adverse effects* ; Postoperative Complications/etiology* ; Adult

BACKGROUND: Lung cancer has the highest mortality rate among all malignant tumors, and non-small cell lung cancer (NSCLC) accounts for about 80%-85% of all lung cancers. Lobectomy and lymph node dissection are one of the most important treatment methods, and lymph node dissection, as an important part, has attracted much attention. And its mode and scope of dissection may affect postoperative complications, particularly the occurrence of chronic cough. The aim of this study is to investigate the effect of lymph node dissection on postoperative chronic cough in patients with NSCLC undergoing lobectomy, and to provide clinical evidence for optimizing surgical strategy and reducing postoperative chronic cough. METHODS: A retrospective analysis was conducted on the clinical data of 365 NSCLC patients who underwent lobectomy at the First Affiliated Hospital of University of Science and Technology of China from December 2020 to December 2023. The relationship between clinical characteristics and postoperative chronic cough was analyzed. The Chinese version of the Leicester Cough Questionnaire (LCQ-MC) scores were collected from the patients at 2 time points: 1 day before surgery and 8 weeks after surgery. Patients were divided according to lymph node dissection methods, to explore the relationship between lymph node dissection and chronic cough after lobectomy. Additionally, patients were divided into chronic cough and non-chronic cough groups based on the presence of postoperative chronic cough, to investigate whether perioperative data, lymph node dissection methods, and lymph node dissection regions were influencing factors. RESULTS: Patients undergoing lobectomy were more likely to have chronic cough after surgery in the systematic lymph node dissection group than in the lymph node sampling group (P<0.05). LCQ-MC scale evaluation showed that the psychological, physiological, social and total score of the patients in systematic lymph node dissection group were significantly lower than those in lymph node sampling group (P<0.05). Multivariate analysis showed that anesthesia time, operation site, lymph node dissection method, whether to perform upper mediastinal lymph node dissection, number of upper mediastinal lymph node dissection, whether to perform lower mediastinal lymph node dissection and total number of lymph node dissection were independent risk factors for postoperative chronic cough in NSCLC patients (P<0.05). CONCLUSIONS When NSCLC patients underwent lobectomy, lymph node sampling was associated with a significantly lower risk of chronic cough than systematic lymph node dissection. Dissecting lymph nodes in the upper and lower mediastinal regions and the number of lymph nodes dissected may increase the risk of postoperative cough and reduce the quality of life of patients after surgery.
Humans ; Carcinoma, Non-Small-Cell Lung/surgery* ; Male ; Female ; Lung Neoplasms/surgery* ; Middle Aged ; Cough/etiology* ; Retrospective Studies ; Lymph Node Excision/methods* ; Aged ; Chronic Disease ; Postoperative Complications/etiology* ; Adult ; Lymph Nodes/surgery* ; Pneumonectomy/adverse effects* ; Chronic Cough