Archive for category: Latest Articles

The role of novel minimally invasive treatments for lower urinary tract symptoms associated with benign prostatic hyperplasia

Abstract

To provide evidence‐based care, it is important for healthcare professionals to stay up to date with relevant medical literature. To overcome the barriers of high volume, time constraints and difficulty retaining information, some journals use social media (SoMe) sites, such as Twitter, to disseminate research. More recent strategies include creating visual abstracts and infographics, which combine images and text to graphically represent data (1). As the name suggests, visual abstracts summarise and simplify an article’s abstract and/or key messages.

Digital frozen section of the prostate surface during radical prostatectomy: a novel approach to evaluate surgical margins

Abstract

To provide evidence‐based care, it is important for healthcare professionals to stay up to date with relevant medical literature. To overcome the barriers of high volume, time constraints and difficulty retaining information, some journals use social media (SoMe) sites, such as Twitter, to disseminate research. More recent strategies include creating visual abstracts and infographics, which combine images and text to graphically represent data (1). As the name suggests, visual abstracts summarise and simplify an article’s abstract and/or key messages.

Primary urethral cancer: treatment patterns and associated outcomes

Objective

To evaluate the long‐term bowel‐associated quality of life (QOL) in men after radiotherapy (RT) for prostate cancer with and without the use of rectal hydrogel spacer.

Patients and Methods

The patients’ QOL was examined using the Expanded Prostate Cancer Index Composite (EPIC) and mean changes from baseline in EPIC domains were evaluated. A total of 215 patients from a randomised multi‐institutional trial of RT, with or without hydrogel spacer, with a QOL endpoint were pooled with 165 non‐randomised patients from a single institution with prospective QOL collection in patients with or without hydrogel spacer. The proportions of men with minimally important differences (MIDs) relative to pre‐treatment baseline in the bowel domain were tested using repeated measure logistic models with a pre‐specified threshold for clinically significant declines (≥5 equivalent to MIDx1 and ≥10 equivalent to MIDx2).

Results

A total of 380 men were evaluated (64% with spacer and 36% without) with QOL data being available for 199 men with >24 months of follow‐up [median (range) 39.5 (31–71.4) months]. Treatment with spacer was associated with less decline in average long‐term bowel QOL (89.4 for control and 94.7 for spacer) with differences at >24 months meeting the threshold of a MID difference between cohorts (bowel score difference from baseline: control = −5.1, spacer = 0.3, difference = −5.4; P < 0.001). When evaluated over time men without spacer were more likely to have MIDx1 (5 points) declines in bowel QOL (P = 0.01). At long‐term follow‐up MIDx1 was 36% without spacer vs 14% with spacer (P <0.001; odds ratio [OR] 3.5, 95% CI 1.7–6.9) while MIDx2 was seen in 19% vs 6% (= 0.008; OR 3.6, 95% CI 1.4–9.1). The use of spacer was associated with less urgency with bowel movements (P = 0.002) and fewer loose stools (P = 0.009), as well as less bother with urgency (P = 0.007) and frequency of bowel movements (P = 0.009).

Conclusions

In this pooled analysis of QOL after prostate RT with up to 5 years of follow‐up, use of a rectal spacer was associated with preservation of bowel QOL. This QOL benefit was preserved with long‐term follow‐up.

Two cycles of neoadjuvant chemotherapy improves survival in patients with high‐risk upper tract urothelial carcinoma

Abstract

Objectives

To assess the impact of two cycles of neoadjuvant chemotherapy (NAC) in patients who underwent nephroureterectomy for high‐risk cN0M0 upper tract urothelial carcinoma (UTUC), and to evaluate the efficacy of NAC in patients with localized disease (cT2 or lower).

Patients and Methods

We retrospectively analyzed high‐risk cN0M0 UTUC patients who received NAC followed by surgery, compared with a matched cohort who underwent initial surgery at Fujita Health University during 2005–2019. Baseline and tumor characteristics, overall survival (OS), cancer‐specific survival (CSS), and recurrence‐free survival (RFS) were compared between the cohorts. Cox proportional hazards models were used to identify predictors of survival.

Results

There were 117 and 67 patients in the study group and the control group, respectively. Significantly higher pathological downstaging (pDS) and lower lymphovascular invasion (LVI) were observed in the study group than in the control group (48% vs. 22%, p = 0.008 and 29% vs. 46%, p = 0.045, respectively). The NAC group had significantly better 5‐year OS (79% vs. 53%, p = 0.003), 5‐year CSS (84% vs. 66%, p = 0.008), and 5‐year RFS (80% vs. 61%, p = 0.001) than the control group. The OS benefit of NAC was observed even in patients with localized (cT2 or lower) disease (p = 0.019). Patients with LVI showed significantly worse CSS both in pathologically locally advanced (pT3 or higher) and in localized (pT2 or lower) tumors (p = 0.048 and p = 0.018, respectively). Multivariate analysis identified LVI, NAC, and pDS as independent predictors of OS. Male sex and post‐NAC LVI were identified as predictors of worse survival in patients who underwent NAC.

Conclusions

Two cycles of NAC improved the survival of high‐risk UTUC patients, even in patients with localized disease. Although two cycles of NAC appear to be effective in cN0M0 high‐risk UTUC including localized disease, additional larger sample‐size multicenter prospective studies comparing short‐course neoadjuvant chemotherapy regimens, followed by surgery, and surgery alone are required.

Benign Prostatic Hyperplasia‐ what do we know?

Abstract

Objectives

To assess the impact of two cycles of neoadjuvant chemotherapy (NAC) in patients who underwent nephroureterectomy for high‐risk cN0M0 upper tract urothelial carcinoma (UTUC), and to evaluate the efficacy of NAC in patients with localized disease (cT2 or lower).

Patients and Methods

We retrospectively analyzed high‐risk cN0M0 UTUC patients who received NAC followed by surgery, compared with a matched cohort who underwent initial surgery at Fujita Health University during 2005–2019. Baseline and tumor characteristics, overall survival (OS), cancer‐specific survival (CSS), and recurrence‐free survival (RFS) were compared between the cohorts. Cox proportional hazards models were used to identify predictors of survival.

Results

There were 117 and 67 patients in the study group and the control group, respectively. Significantly higher pathological downstaging (pDS) and lower lymphovascular invasion (LVI) were observed in the study group than in the control group (48% vs. 22%, p = 0.008 and 29% vs. 46%, p = 0.045, respectively). The NAC group had significantly better 5‐year OS (79% vs. 53%, p = 0.003), 5‐year CSS (84% vs. 66%, p = 0.008), and 5‐year RFS (80% vs. 61%, p = 0.001) than the control group. The OS benefit of NAC was observed even in patients with localized (cT2 or lower) disease (p = 0.019). Patients with LVI showed significantly worse CSS both in pathologically locally advanced (pT3 or higher) and in localized (pT2 or lower) tumors (p = 0.048 and p = 0.018, respectively). Multivariate analysis identified LVI, NAC, and pDS as independent predictors of OS. Male sex and post‐NAC LVI were identified as predictors of worse survival in patients who underwent NAC.

Conclusions

Two cycles of NAC improved the survival of high‐risk UTUC patients, even in patients with localized disease. Although two cycles of NAC appear to be effective in cN0M0 high‐risk UTUC including localized disease, additional larger sample‐size multicenter prospective studies comparing short‐course neoadjuvant chemotherapy regimens, followed by surgery, and surgery alone are required.

Histological comparison between predictive value of preoperative 3‐T multiparametric MRI and 68Ga‐PSMA PET/CT scan for pathological outcomes at radical prostatectomy and pelvic lymph node dissection for prostate cancer

Abstract

Objectives

To assess the impact of two cycles of neoadjuvant chemotherapy (NAC) in patients who underwent nephroureterectomy for high‐risk cN0M0 upper tract urothelial carcinoma (UTUC), and to evaluate the efficacy of NAC in patients with localized disease (cT2 or lower).

Patients and Methods

We retrospectively analyzed high‐risk cN0M0 UTUC patients who received NAC followed by surgery, compared with a matched cohort who underwent initial surgery at Fujita Health University during 2005–2019. Baseline and tumor characteristics, overall survival (OS), cancer‐specific survival (CSS), and recurrence‐free survival (RFS) were compared between the cohorts. Cox proportional hazards models were used to identify predictors of survival.

Results

There were 117 and 67 patients in the study group and the control group, respectively. Significantly higher pathological downstaging (pDS) and lower lymphovascular invasion (LVI) were observed in the study group than in the control group (48% vs. 22%, p = 0.008 and 29% vs. 46%, p = 0.045, respectively). The NAC group had significantly better 5‐year OS (79% vs. 53%, p = 0.003), 5‐year CSS (84% vs. 66%, p = 0.008), and 5‐year RFS (80% vs. 61%, p = 0.001) than the control group. The OS benefit of NAC was observed even in patients with localized (cT2 or lower) disease (p = 0.019). Patients with LVI showed significantly worse CSS both in pathologically locally advanced (pT3 or higher) and in localized (pT2 or lower) tumors (p = 0.048 and p = 0.018, respectively). Multivariate analysis identified LVI, NAC, and pDS as independent predictors of OS. Male sex and post‐NAC LVI were identified as predictors of worse survival in patients who underwent NAC.

Conclusions

Two cycles of NAC improved the survival of high‐risk UTUC patients, even in patients with localized disease. Although two cycles of NAC appear to be effective in cN0M0 high‐risk UTUC including localized disease, additional larger sample‐size multicenter prospective studies comparing short‐course neoadjuvant chemotherapy regimens, followed by surgery, and surgery alone are required.

Non‐invasive and surgical penile enhancement interventions for aesthetic or therapeutic purposes: a systematic review

Objective

To systematically review the literature in order to investigate the efficacy and safety of surgical and non‐invasive penile enhancement procedures for aesthetic and therapeutic purposes.

Methods

A systematic search for papers investigating penile enhancement procedures was performed using the MEDLINE database. Articles published from January 2010 to December 2019, written in English, including >10 cases, and reporting objective length and/or girth outcomes, were included. Studies without primary data and conference abstracts were excluded. The main outcome measure was objective length and/or girth improvement. The review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) statement.

Results

Out of 220 unique records, a total of 57 were reviewed. Eighteen studies assessed interventions for penile enhancement in 1764 healthy men complaining of small penis. Thirty‐nine studies investigated 2587 men with concomitant pathologies consisting mostly of Peyronie’s disease and erectile dysfunction. Twenty‐five studies evaluated non‐invasive interventions and 32 studies assessed surgical interventions, for a total of 2192 and 2159 men, respectively. Non‐invasive interventions, including traction therapies and injection of fillers, were safe and mostly efficacious, whereas surgical interventions were associated with minor complications and mostly increased penile dimensions and/or corrected penile curvature. Overall, the quality of studies was low, and standardized criteria to evaluate and report efficacy and safety of procedures, as well as patient satisfaction, were missing.

Conclusion

The quality of the studies on penile enhancement procedures published in the last decade is still low. This prevents us from establishing recommendations based on scientific evidence regarding the efficacy and safety of interventions that are performed to increase the penis size for aesthetic or therapeutic indications.

Randomised comparison of techniques for control of the dorsal venous complex during robot‐assisted laparoscopic radical prostatectomy

Objective

To systematically review the literature in order to investigate the efficacy and safety of surgical and non‐invasive penile enhancement procedures for aesthetic and therapeutic purposes.

Methods

A systematic search for papers investigating penile enhancement procedures was performed using the MEDLINE database. Articles published from January 2010 to December 2019, written in English, including >10 cases, and reporting objective length and/or girth outcomes, were included. Studies without primary data and conference abstracts were excluded. The main outcome measure was objective length and/or girth improvement. The review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) statement.

Results

Out of 220 unique records, a total of 57 were reviewed. Eighteen studies assessed interventions for penile enhancement in 1764 healthy men complaining of small penis. Thirty‐nine studies investigated 2587 men with concomitant pathologies consisting mostly of Peyronie’s disease and erectile dysfunction. Twenty‐five studies evaluated non‐invasive interventions and 32 studies assessed surgical interventions, for a total of 2192 and 2159 men, respectively. Non‐invasive interventions, including traction therapies and injection of fillers, were safe and mostly efficacious, whereas surgical interventions were associated with minor complications and mostly increased penile dimensions and/or corrected penile curvature. Overall, the quality of studies was low, and standardized criteria to evaluate and report efficacy and safety of procedures, as well as patient satisfaction, were missing.

Conclusion

The quality of the studies on penile enhancement procedures published in the last decade is still low. This prevents us from establishing recommendations based on scientific evidence regarding the efficacy and safety of interventions that are performed to increase the penis size for aesthetic or therapeutic indications.

Emphysematous Pyelonephritis Prognostic Scoring System and Risk Stratification ‐ an Eleven‐Year Prospective Study at a Tertiary Referral Centre

Abstract

Objectives

To define pre‐morbid, clinical, laboratory, and imaging features and identify prognostic factors associated with morbidity and mortality in patients with Emphysematous pyelonephritis (EPN) and develop a prognostic scoring system for improving management outcomes.

Patients and Methods

From Jan 2009 to Dec 2019, we performed a prospective study of all patients with a suspected diagnosis of EPN referred to a specialist tertiary centre in South India. All patients who underwent non‐contrast Computed tomography (CT) of the abdomen and those diagnosed with EPN were included in this study. Demographic parameters, imaging, haematological and microbiology results were recorded. Patients were divided into three groups: Group 1 ‐ patients who survived without any intervention; Group 2 ‐ those who survived with surgical intervention, and group 3 ‐ those who died with or without intervention. A prognostic scoring system was developed from 18 different parameters and risk stratification was developed. The scores were correlated with overall prognosis. Data analysis was performed using IBM SPSS version 20 and STATA 14, p‐value <0.05 was considered significant.

Results

Data from 131 patients with EPN enrolled in the study were analysed: Group 1 (n=22); Group 2 (n=102); Group 3 (n=7). By using univariate analysis, 10 factors were identified to be significantly associated with prognosis. Diabetes mellitus was the most common co‐morbidity. Shock at initial admission indicated a poor prognosis and warranted immediate attention (p <0.001).

Conclusions

A multi‐disciplinary approach, a high index of clinical suspicion, an early diagnosis and administration of culture‐specific antibiotics with identification of prognostic indicators and risk stratification allows prompt and appropriate medical and surgical treatments that could improve EPN management outcomes.

Percutaneous microwave ablation of renal masses in a UK cohort

Abstract

Objectives

To define pre‐morbid, clinical, laboratory, and imaging features and identify prognostic factors associated with morbidity and mortality in patients with Emphysematous pyelonephritis (EPN) and develop a prognostic scoring system for improving management outcomes.

Patients and Methods

From Jan 2009 to Dec 2019, we performed a prospective study of all patients with a suspected diagnosis of EPN referred to a specialist tertiary centre in South India. All patients who underwent non‐contrast Computed tomography (CT) of the abdomen and those diagnosed with EPN were included in this study. Demographic parameters, imaging, haematological and microbiology results were recorded. Patients were divided into three groups: Group 1 ‐ patients who survived without any intervention; Group 2 ‐ those who survived with surgical intervention, and group 3 ‐ those who died with or without intervention. A prognostic scoring system was developed from 18 different parameters and risk stratification was developed. The scores were correlated with overall prognosis. Data analysis was performed using IBM SPSS version 20 and STATA 14, p‐value <0.05 was considered significant.

Results

Data from 131 patients with EPN enrolled in the study were analysed: Group 1 (n=22); Group 2 (n=102); Group 3 (n=7). By using univariate analysis, 10 factors were identified to be significantly associated with prognosis. Diabetes mellitus was the most common co‐morbidity. Shock at initial admission indicated a poor prognosis and warranted immediate attention (p <0.001).

Conclusions

A multi‐disciplinary approach, a high index of clinical suspicion, an early diagnosis and administration of culture‐specific antibiotics with identification of prognostic indicators and risk stratification allows prompt and appropriate medical and surgical treatments that could improve EPN management outcomes.

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