OBJECTIVE

The study aimed to examine the clinical profile, surgical management, and outcomes of patients admitted for ectopic pregnancy.

METHODS

A five-year retrospective study of ectopic pregnancies admitted in a tertiary training hospital in the Philippines was performed. Data from admission and operating room records were used to obtain the annual cumulative incidence of ectopic pregnancy. Subjects were divided into laparotomy versus laparoscopy groups, and salpingostomy versus salpingectomy groups; differences in the means/medians/mean-ranks and proportions of the different clinical and outcome variables of interest were compared by Student t test/Mann-Whitney U test and chisquare/Fisher exact test of homogeneity, respectively.

RESULTS

The cumulative incidence of ectopic pregnancy ranged from 2.30% to 4.01% from 2017 to 2021. A total of 128 patients were included in the final analysis with a mean age of 27.8 ± 5.73 years. The most common identified risk factors were smoking (17.97%), previous ectopic pregnancy (17.19%), and previous tubal surgery (15.62%). The ampulla was the most common site of tubal involvement. Of the 128 patients, 45.31% underwent laparotomy while 54.69% underwent laparoscopy. Salpingectomy was performed in 76.56% of patients. Tubal rupture was noted in 42.97% of cases. Patients with abdominal pain, back pain, shoulder pain, and dizziness were more likely to undergo laparotomy than laparoscopy (p < 0.05). A lower β-hCG value was noted in patients who underwent salpingostomy compared to salpingectomy (5,569.80 mIU/mL vs 10,555.47, p < 0.05). Salpingostomy was more likely to be performed on patients with previous ectopic pregnancy (p < 0.05) and previous tubal surgery (p < 0.05) than salpingectomy.

CONCLUSION

The cumulative incidence of ectopic pregnancy in our institution was higher than global estimates. Risk factors and anatomic site of tubal involvement were similar to those reported in literature. Laparoscopy seemed to be underutilized for cases of ruptured ectopic pregnancy. Training on minimally invasive procedures should be provided to point-ofcare trainees or residents for patients to be afforded the benefits of laparoscopy.

Human ; Pregnancy, Ectopic ; Salpingectomy ; Salpingostomy

A unicornuate uterus with a non-communicating rudimentary horn is a rare Müllerian duct anomaly that is frequently underdiagnosed because of its variable clinical presentation and the limitations of conventional imaging modalities. Although not considered a direct cause of infertility, it may coexist with other reproductive pathologies and contribute to adverse reproductive outcomes. Presented here is a case series of three infertile women aged 30–36 years who were diagnosed with a unicornuate uterus and non-communicating rudimentary horn during fertility evaluation. Patient A presented with primary infertility, cyclic pelvic pain, endometriosis, and bilateral tubal disease; Patient B had a seven-year history of primary infertility and was initially suspected to have unilateral tubal obstruction; and Patient C was referred with a presumed diagnosis of uterine didelphys and was subsequently found to have a unicornuate uterus with a non-communicating rudimentary horn and ipsilateral renal agenesis. In all three cases, preoperative imaging failed to establish the definitive diagnosis, which was confirmed intraoperatively through laparoscopy, chromotubation, and hysteroscopy. Patients A and B underwent laparoscopic excision of the rudimentary horn with ipsilateral salpingectomy, while Patient C underwent only ipsilateral salpingectomy. Hysteroscopic transillumination was utilized in one case to facilitate safe laparoscopic dissection and delineation of the hemiuterine anatomy. All patients had uneventful postoperative recovery and were subsequently counseled regarding fertility options. This case series highlights the diagnostic challenges posed by unicornuate uterus with a non-communicating rudimentary horn, emphasizes the importance of a high index of suspicion during infertility work-up, and demonstrates the value of minimally invasive surgical management and hysteroscopic transillumination in selected cases. Early recognition and individualized treatment may help reduce reproductive complications and improve fertility counseling and management.

Human ; Female ; Adult: 25-44 Yrs Old ; Infertility, Female ; Laparoscopy ; Salpingectomy ; Hysteroscopy ; Pathology ; Endometriosis ; Fallopian Tube Diseases ; Transillumination ; Uterine Didelphys

Introduction: Steroid cell tumors are rare sex cord-stromal tumors, accounting for <0.1% of ovarian neoplasms. Extraovarian steroid cell tumors are exceptionally rare, often androgensecreting, and pose significant diagnostic challenges. Early recognition is essential to prevent prolonged morbidity from hyperandrogenism. Case: A 60-year-old female, 15 years after total hysterectomy and bilateral salpingo-oophorectomy for a large ovarian mass with massive ascites, presented with deranged liver function tests on routine follow-up. Ultrasonography and computed tomography imaging revealed multiple hypervascular lesions in the liver, retroperitoneum, and peritoneum, suggestive of metastatic disease, with normal-appearing adrenal glands. Biopsy of a liver lesion demonstrated a metastatic neoplasm with morphology and immunoprofile favoring a steroid cell tumor. However, metastasis from the adrenal cortex or an ovarian primary could not be excluded. Given the prior bilateral oophorectomy, metastatic adrenocortical carcinoma was initially suspected, prompting endocrine evaluation. Further history revealed a 1-year history of progressive virilization, including increased facial hair and frontal balding. Hormonal studies demonstrated elevated testosterone (12.2 mmol/L and reference range 0.1–1.42) and dehydroepiandrosterone sulfate (15.9 µmol/L and reference range 0.510–5.560) and the adrenocorticotropic hormone level of 11.7 pmol/L (reference range 1.60–13.9) with suppressed gonadotrophins. Additional workup for catecholamine, cortisol, and aldosterone excess was unremarkable. The discordance between androgen excess and normal adrenal imaging, despite absent ovarian tissue, suggested an extraadrenal androgen-secreting steroid cell tumor. A second histopathology review and multidisciplinary discussion with radiology, gynecologic oncology, and pathology teams were undertaken. As the disease was deemed inoperable, repeat retroperitoneal lesion biopsy confirmed metastatic steroid cell tumor and guided palliative chemotherapy. She was subsequently referred to gynecologic oncology for systemic chemotherapy. Conclusion Extra-adrenal steroid cell tumors, though rare, should be considered in patients with hyperandrogenism long after bilateral oophorectomy, especially when adrenal imaging is normal. Multidisciplinary evaluation and repeat biopsy are often crucial for establishing the diagnosis and guiding treatment.
Hyperandrogenism ; Ovariectomy ; Steroids ; Neoplasms

INTRODUCTION AND OBJECTIVE

The increasing demand for cost-effective surgical techniques has driven innovations in robotic-assisted radical prostatectomy (RARP). While single-port robotic surgery reduces invasiveness and improves cosmesis, its widespread use is limited by high costs and technical constraints. This study evaluates the safety, feasibility and cost-effectiveness of extraperitoneal single-port robotic-assisted radical prostatectomy (espRARP) using a modified Da Vinci Si HD system, employing a wound protector and surgical glove as a low-cost multi-channel laparoscopic port.

METHODS

Ten patients with localized prostate cancer underwent espRARP using a three-arm Da Vinci Si system and side docking to enhance instrument access. A homemade multi-channel port was constructed using an Alexis® wound protector and surgical gloves. Perioperative outcomes—including operative time, blood loss, complications and oncologic results were analyzed descriptively.

RESULTS

All cases were completed without conversion to open surgery. The mean operative time was 215.8 minutes with an estimated blood loss of 200 mL. No positive surgical margins were recorded, and 20% of patients exhibited pathological upgrading. The average hospital stay was 3.4 days. One patient developed a Clavien–Dindo II complication; no major complications occurred

LIMITATIONS

This pilot study is limited by its small sample size (n = 10), single-surgeon, single institution design, short follow-up period, and absence of functional outcome assessment. Only descriptive analysis was performed without statistical comparison.

CONCLUSION

The modified espRARP technique using a low-cost glove-port and three-arm Da Vinci Si system is safe, feasible and cost-efficient. Comparable perioperative and oncologic outcomes to conventional multi-port and proprietary single-port systems were achieved at a fraction of the cost. This approach provides a practical and accessible alternative for robotic prostatectomy in resource-limited healthcare settings.

Human ; Prostatectomy ; General Surgery ; Prostatic Neoplasms

Synovial sarcoma is an extremely rare soft tissue cancer that predominantly affects young adults, typically occurring at the para-articular region of the extremities. Primary synovial sarcoma of the prostate is exceptionally uncommon in clinical practice.

Presented here is a case of a 29-year-old male with prostatic synovial sarcoma. He experienced lower urinary tract symptoms and eventually had urine retention. The imaging findings, treatment plan, and differential diagnosis, were also discussed.

The patient experienced urinary frequency, dysuria, and acute urinary retention, which led to the insertion of a Foley catheter. Subsequent ultrasound scans revealed a large lobulated solid prostate gland. A prostate biopsy confirmed the presence of a malignant spindle cell neoplasm, indicating a prostatic stromal sarcoma. Immunohistomorphologic findings (TLE-1+, STAT6-, S100-, CD34-, ER-, PR-) were consistent with a diagnosis of Monophasic Synovial Sarcoma. The patient underwent six cycles of neoadjuvant chemotherapy before a Radical Prostatectomy was performed. The postoperative course was uneventful, and the patient was discharged in a significantly improved condition.

Given the rarity of this condition, the authors report a case of prostatic synovial sarcoma and how they managed it. They performed a radical prostatectomy with neoadjuvant chemotherapy, which had a positive effect. Subsequent postoperative monitoring and imaging showed no further symptoms.

Human ; Male ; Adult: 25-44 Yrs Old ; Prostate Synovial Sarcoma ; Prostate Cancer ; Prostatectomy ; Sarcoma, Synovial ; Lower Urinary Tract Symptoms

Osteoporosis is a prevalent skeletal condition characterized by reduced bone mass and strength, leading to increased fragility. Buqi-Tongluo (BQTL) decoction, a traditional Chinese medicine (TCM) prescription, has yet to be fully evaluated for its potential in treating bone diseases such as osteoporosis. To investigate the mechanism by which BQTL decoction inhibits osteoclast differentiation in vitro and validate these findings through in vivo experiments. We employed MTS assays to assess the potential proliferative or toxic effects of BQTL on bone marrow macrophages (BMMs) at various concentrations. TRAcP experiments were conducted to examine BQTL's impact on osteoclast differentiation. RT-PCR and Western blot analyses were utilized to evaluate the relative expression levels of osteoclast-specific genes and proteins under BQTL stimulation. Finally, in vivo experiments were performed using an osteoporosis model to further validate the in vitro findings. This study revealed that BQTL suppressed receptor activator of NF-κB ligand (RANKL)-induced osteoclastogenesis and osteoclast resorption activity in vitro in a dose-dependent manner without observable cytotoxicity. The inhibitory effects of BQTL on osteoclast formation and function were attributed to the downregulation of NFATc1 and c-fos activity, primarily through attenuation of the MAPK, NF-κB, and Calcineurin signaling pathways. BQTL's inhibitory capacity was further examined in vivo using an ovariectomized (OVX) rat model, demonstrating a strong protective effect against bone loss. BQTL may serve as an effective therapeutic TCM for the treatment of postmenopausal osteoporosis and the alleviation of bone loss induced by estrogen deficiency and related conditions.
Animals ; NFATC Transcription Factors/genetics* ; Drugs, Chinese Herbal/pharmacology* ; Ovariectomy ; Osteoclasts/metabolism* ; Female ; Osteogenesis/drug effects* ; Rats, Sprague-Dawley ; Rats ; NF-kappa B/genetics* ; Osteoporosis/genetics* ; Signal Transduction/drug effects* ; Bone Resorption/genetics* ; Cell Differentiation/drug effects* ; Humans ; RANK Ligand/metabolism* ; Mitogen-Activated Protein Kinases/genetics* ; Transcription Factors

Various techniques have been described for reconstructing the skin of the penile shaft; however, no universally accepted standard exists for correcting buried penis in adults. We aimed to describe a new technique for correcting an adult-acquired buried penis through a diamond-shaped incision at the penopubic junction. We retrospectively analyzed data from patients treated with our technique between March 2019 and June 2023 in the Department of Andrology, Nanjing Drum Tower Hospital (Nanjing, China). Forty-two adult males with buried penises, with a mean (±standard deviation [s.d.]) age of 26.6 (±6.6) years, underwent surgery. All patients were obese, with an average (±s.d.) body mass index of 35.56 (±3.23) kg m -2 . In addition to phalloplasty, 32 patients concurrently underwent circumcision, and 28 underwent suprapubic liposuction. The mean (±s.d.) duration of the operation was 98.02 (±13.28) min. The mean (±s.d.) duration of follow-up was 6.71 (±3.43) months. The length in the flaccid unstretched state postoperatively was significantly greater than that preoperatively (mean ± s.d: 5.55±1.19 cm vs 1.94±0.59 cm, P < 0.01). Only minor complications, such as wound disruption (7.1%) and infection (4.8%), were observed. The mean (±s.d.) score of patient satisfaction was 4.02 (±0.84) on a scale of 5. This technique provides excellent cosmetic and functional outcomes with a minimal risk of complications. However, additional clinical studies are needed to evaluate the long-term effects of this procedure.
Humans ; Male ; Patient Satisfaction ; Adult ; Lipectomy/methods* ; Penis/surgery* ; Retrospective Studies ; Treatment Outcome ; Plastic Surgery Procedures/methods* ; Young Adult ; Penile Diseases/surgery* ; Urologic Surgical Procedures, Male/methods*

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*

Androgens play an important role in prostate cancer development and progression. Androgen action is mediated through the androgen receptor (AR), a ligand-dependent DNA-binding transcription factor. AR is arguably the most important target for prostate cancer treatment. Current USA Food and Drug Administration (FDA)-approved AR inhibitors target the ligand-binding domain (LBD) and have exhibited efficacy in prostate cancer patients, particularly when used in combination with androgen deprivation therapy. Unfortunately, patients treated with the currently approved AR-targeting agents develop resistance and relapse with castration-resistant prostate cancer (CRPC). The major mechanism leading to CRPC involves reactivation of AR signaling mainly through AR gene amplification, mutation, and/or splice variants. To effectively inhibit the reactivated AR signaling, new approaches to target AR are being actively explored. These new approaches include novel small molecule inhibitors targeting various domains of AR and agents that can degrade AR. The present review provides a summary of the existing FDA-approved AR antagonists and the current development of some of the AR targeting agents.
Humans ; Male ; Androgen Receptor Antagonists/therapeutic use* ; Receptors, Androgen/metabolism* ; Prostatic Neoplasms/drug therapy* ; Prostatic Neoplasms, Castration-Resistant/drug therapy* ; Signal Transduction/drug effects*