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MP-14.06: Evaluation of pelvic floor reconstructive surgery using tridimensional helical CT
MODERATED POSTER SESSIONS
used to detect prostate cancer as a relatively non-invasive modality based on the tissue strain value. Patients & Methods: Seventeen patients underwent RTE in conjunction with digital rectal examination (DRE), conventional gray-scale transrectal ultrasonography (TRUS), color Doppler ultrasonography (CDUS), and magnetic resonance imaging (MRI)(T2-weighted image (T2WI), dynamic contrast enhanced image (DCEI)) prior to radical prostatectomy. An EUB 8500 ultrasound system (HITACHI, Japan) with a 7.5 MHz end-fire transrectal probe was used for this study. The elastogram was compared to findings of conventional modalities and pathological findings of prostatectomy specimens. To obtain the elastogram, compression of the prostate was performed along with a visual indicator on a video screen. Results: Prostate cancer was clearly visualized on real-time elastography as blue areas of harder tissue with a so-called halo effect at the border between the cancerous tissue and surrounding tissue (figure 1). Twenty of 27 pathologically confirmed tumors were detected with RTE. The cancer detection rate with RTE (74%) was superior to the rates of other modalities (DRE 33%, TRUS 48%, CDUS 56%, T2WI 42%, DCEI 47%). RTE detected 14 of 19 posterior tumors (73.7%), and the detection rate for anterior tumors (6 of 8 tumors, 75%) was nearly equal to that of the posterior tumor with the least dependency on tumor volume. All the tumors with a volume greater than 5 mL were detected with RTE. Even in tumors with a volume less than 1 mL, RTE showed a 73% detection rate, which was much higher than the rates for other imaging modalities (DRE 36%, TRUS 27%, CDUS 45%, T2WI 33%, DCEI 33%). RTE was the only method capable of depicting all of the tumors with a Gleason score of 8 or 9. Conclusion: In our preliminary study, RTE is a non-invasive and cost-effective modality to detect prostate cancer with the least interobserver variability.
tal sonography are benign, their clinical significance can be difficult to resolve. The purpose of this study was to determine the incidence of benign and malignant etiologies of solid epididymal masses studied with sonography. In addition, we explored sonographic features that may allow for a prospective diagnosis of benign or malignant. Finally, we reviewed sonographic and historical factors that may have played a role in the decision to pursue surgical or conservative management at our institution. Methods: We retrospectively reviewed all patients at Mayo Clinic - Rochester with solid epididymal masses evaluated by scrotal sonography between 1996 and 2004. Multiple clinical and sonographic variables were evaluated, including mass size, location, echogenicity, Doppler flow, calcifications, pain, history of vasectomy, and whether surgical consultation was recommended by the radiologist. Patients with malignant disease were compared to those with benign disease; patients undergoing surgery were compared to those receiving conservative management. Results: Of the 90 patients included in our study, 27 underwent surgical intervention (30%), and 5 had malignant disease (5.6%). Increased size, increased Doppler flow, and clinical concern of a radiologist were statistically significant markers for malignancy (p⬍0.05). Using the significant object criteria (Doppler flow present in mass, volume ⬎2cm3) as a test for malignancy yielded a sensitivity of 100%, specificity of 85%, positive predictive value of 29%, and negative predictive value of 100%. Circumscribed masses, masses with increased size, increased Doppler flow, and those subjectively worrisome for malignancy by the radiologist, were significantly more likely to undergo surgical management than observation (p⬍0.05). Conclusion: The vast majority of solid epididymal masses are benign (94.4%). Sonographic features can help identify lesions that are worrisome for malignancy and may require surgical evaluation.
MP-14.05 A retrospective review of solid epididymal masses evaluated by scrotal sonography with pathologic and clinical correlation Alleman W, King BF, Larson DL, Cheville JC, Nehra A Mayo Clinic College of Medicine, Rochester, MN, USA
MP-14.06 Evaluation of pelvic floor reconstructive surgery using tridimensional helical CT Palma P, Riccetto C, Fraga R, Maia R, Netto, Jr N University Of Campinas-UNICAMP, Sao Paulo, Brazil
Introduction: Although the majority of solid epididymal masses analyzed by scro-
112
Objective: To evaluate and further understanding the use of meshes in the anterior, medium and posterior compart-
Image 1. MP-14.06
ments after pelvic floor reconstruction, using a special polypropylene mesh which received barium as a contrast material. Methods: A total of fifteen female patients patients with stress urinary incontinence (SUI), anterior (AVP) and posterior (PVP) vaginal wall prolapses or a combination of those underwent surgical repair using radiopaque meshes, after informed consent. Patients with SUI underwent obturator procedure and those with severe type III SUI underwent obturator crossover slings. Patients with AVP underwent a combined prepubic and obturator mesh and those with PVP underwent a infracoccigeal sacropexy. Tridimentional reconstruction using helical CT was done four weeks post operatively along with cistografy or enema depending upon the previous surgery. Results: In all cases the device was well demonstrated. Transobturator slings were shown at the midurethra and the anchoring tails perforated the obturator foramen at the safety region. Obturator crossover assumed a helical shape around the urethra ina loose manner. Regarding AVP both pre-pubic armpit and obturator ones were clearly seen and the mesh in the proper position supporting the bladder base occluding the distal part of the urogenital hiatus (fig1). Infracoccigeal sacropexy along woth the enema disclosed indirectly a well supported “neo rectovaginal fascia” and the anchoring tails parallel to the sacrum. Conclusion: Tridimentional reconstruction helical CT using radiopaque meshes allows for better understanding live anatomy, the way neoligaments are created and seems to be a promising investigative method in pelvic reconstructive surgery.
UROLOGY 70 (Supplment 3A), September 2007
used to detect prostate cancer as a relatively non-invasive modality based on the tissue strain value. Patients & Methods: Seventeen patients underwent RTE in conjunction with digital rectal examination (DRE), conventional gray-scale transrectal ultrasonography (TRUS), color Doppler ultrasonography (CDUS), and magnetic resonance imaging (MRI)(T2-weighted image (T2WI), dynamic contrast enhanced image (DCEI)) prior to radical prostatectomy. An EUB 8500 ultrasound system (HITACHI, Japan) with a 7.5 MHz end-fire transrectal probe was used for this study. The elastogram was compared to findings of conventional modalities and pathological findings of prostatectomy specimens. To obtain the elastogram, compression of the prostate was performed along with a visual indicator on a video screen. Results: Prostate cancer was clearly visualized on real-time elastography as blue areas of harder tissue with a so-called halo effect at the border between the cancerous tissue and surrounding tissue (figure 1). Twenty of 27 pathologically confirmed tumors were detected with RTE. The cancer detection rate with RTE (74%) was superior to the rates of other modalities (DRE 33%, TRUS 48%, CDUS 56%, T2WI 42%, DCEI 47%). RTE detected 14 of 19 posterior tumors (73.7%), and the detection rate for anterior tumors (6 of 8 tumors, 75%) was nearly equal to that of the posterior tumor with the least dependency on tumor volume. All the tumors with a volume greater than 5 mL were detected with RTE. Even in tumors with a volume less than 1 mL, RTE showed a 73% detection rate, which was much higher than the rates for other imaging modalities (DRE 36%, TRUS 27%, CDUS 45%, T2WI 33%, DCEI 33%). RTE was the only method capable of depicting all of the tumors with a Gleason score of 8 or 9. Conclusion: In our preliminary study, RTE is a non-invasive and cost-effective modality to detect prostate cancer with the least interobserver variability.
tal sonography are benign, their clinical significance can be difficult to resolve. The purpose of this study was to determine the incidence of benign and malignant etiologies of solid epididymal masses studied with sonography. In addition, we explored sonographic features that may allow for a prospective diagnosis of benign or malignant. Finally, we reviewed sonographic and historical factors that may have played a role in the decision to pursue surgical or conservative management at our institution. Methods: We retrospectively reviewed all patients at Mayo Clinic - Rochester with solid epididymal masses evaluated by scrotal sonography between 1996 and 2004. Multiple clinical and sonographic variables were evaluated, including mass size, location, echogenicity, Doppler flow, calcifications, pain, history of vasectomy, and whether surgical consultation was recommended by the radiologist. Patients with malignant disease were compared to those with benign disease; patients undergoing surgery were compared to those receiving conservative management. Results: Of the 90 patients included in our study, 27 underwent surgical intervention (30%), and 5 had malignant disease (5.6%). Increased size, increased Doppler flow, and clinical concern of a radiologist were statistically significant markers for malignancy (p⬍0.05). Using the significant object criteria (Doppler flow present in mass, volume ⬎2cm3) as a test for malignancy yielded a sensitivity of 100%, specificity of 85%, positive predictive value of 29%, and negative predictive value of 100%. Circumscribed masses, masses with increased size, increased Doppler flow, and those subjectively worrisome for malignancy by the radiologist, were significantly more likely to undergo surgical management than observation (p⬍0.05). Conclusion: The vast majority of solid epididymal masses are benign (94.4%). Sonographic features can help identify lesions that are worrisome for malignancy and may require surgical evaluation.
MP-14.05 A retrospective review of solid epididymal masses evaluated by scrotal sonography with pathologic and clinical correlation Alleman W, King BF, Larson DL, Cheville JC, Nehra A Mayo Clinic College of Medicine, Rochester, MN, USA
MP-14.06 Evaluation of pelvic floor reconstructive surgery using tridimensional helical CT Palma P, Riccetto C, Fraga R, Maia R, Netto, Jr N University Of Campinas-UNICAMP, Sao Paulo, Brazil
Introduction: Although the majority of solid epididymal masses analyzed by scro-
112
Objective: To evaluate and further understanding the use of meshes in the anterior, medium and posterior compart-
Image 1. MP-14.06
ments after pelvic floor reconstruction, using a special polypropylene mesh which received barium as a contrast material. Methods: A total of fifteen female patients patients with stress urinary incontinence (SUI), anterior (AVP) and posterior (PVP) vaginal wall prolapses or a combination of those underwent surgical repair using radiopaque meshes, after informed consent. Patients with SUI underwent obturator procedure and those with severe type III SUI underwent obturator crossover slings. Patients with AVP underwent a combined prepubic and obturator mesh and those with PVP underwent a infracoccigeal sacropexy. Tridimentional reconstruction using helical CT was done four weeks post operatively along with cistografy or enema depending upon the previous surgery. Results: In all cases the device was well demonstrated. Transobturator slings were shown at the midurethra and the anchoring tails perforated the obturator foramen at the safety region. Obturator crossover assumed a helical shape around the urethra ina loose manner. Regarding AVP both pre-pubic armpit and obturator ones were clearly seen and the mesh in the proper position supporting the bladder base occluding the distal part of the urogenital hiatus (fig1). Infracoccigeal sacropexy along woth the enema disclosed indirectly a well supported “neo rectovaginal fascia” and the anchoring tails parallel to the sacrum. Conclusion: Tridimentional reconstruction helical CT using radiopaque meshes allows for better understanding live anatomy, the way neoligaments are created and seems to be a promising investigative method in pelvic reconstructive surgery.
UROLOGY 70 (Supplment 3A), September 2007