The latest medical research on Urology

Lymph node (LN) metastasis is a poor prognostic factor in patients with prostate cancer. Elucidating the mechanisms underlying cancer progression in the metastatic microenvironment of LNs is crucial to establishing novel therapies. Adipocytes interact with cancer cells and regulate cancer progression. In this study, we aimed to clarify the clinicopathological significance of extranodal adipose tissue invasion in metastatic LNs and preoperative adipokine concentration in patients with prostate cancer exhibiting metastatic LNs.

We examined the pathological findings of primary and metastatic nodes and clinical information of 66 specimens from 46 patients with prostate cancer. A sub-analysis was performed to assess the relationship between preoperative adiponectin/leptin concentrations and clinical/pathological findings in the blood samples of 56 patients with prostate cancer who either did or did not show LN metastasis.

The number of metastatic LNs in patients correlated with the involvement of adipose tissue and lymphovascular invasion (p = 0.039 and < 0.001, respectively). Preoperative adiponectin concentration was lower in patients with resected margin-positive and extraprostatic extension-positive primary cancers (p = 0.0071 and 0.02, respectively). Preoperative adiponectin concentrations were significantly lower in patients with metastatic LNs than in patients without LN metastasis (p < 0.001). Moreover, leptin concentrations were significantly higher in patients with metastatic LNs than in patients without LN metastasis (p < 0.001). In patients with metastatic LNs, preoperative adiponectin concentrations were significantly lower in patients with biochemical recurrence than in patients without biochemical recurrence (p = 0.031). There was no correlation between biochemical recurrence and pathological findings.

This is the first report on the detailed histopathological characteristics of prostate cancer with LN metastases and the significance of preoperative adiponectin concentration in predicting the pathological features of primary cancers. Also, adipokines are a significant prediction factor of LN metastases for prostate cancer patients. Adipose tissue and adipose-secreting factors may be involved in the progression of metastatic and primary prostate cancer.

To evaluate long-term outcomes of primary chemoablation using a mitomycin reverse thermal gel (UGN-101) in patients with low-grade upper tract urothelial carcinoma.

Patients who participated in the OLYMPUS trial (TC-UT-03, NCT02793128) and achieved a complete response after 6 weekly doses of UGN-101 were followed up to 12 months after initial complete response. Those with complete response at study completion were eligible for long-term follow-up for up to 5 years or until disease recurrence, progression, or death.

Of the 71 patients enrolled in the OLYMPUS trial, 42 patients achieved complete response 4-6 weeks after completing ≥1 instillation of UGN-101. Amongst the 41 patients followed after initial complete response, median follow-up was 28.1 months (95% CI 13.1, 57.5), and median duration of response was 47.8 months (95% CI 13.0, not estimable).Twenty patients (49%) had long-term follow-up (median 53.3 months [95% CI 27.9, 65.3]). Seventy-five percent of patients had no evidence of recurrence at last follow-up, with median duration of response not estimable (95% CI 43.5, not estimable) due to a low event rate.

Primary intracavitary chemoablation with UGN-101 for low-grade upper tract urothelial carcinoma is associated with favorable long-term durability.

The aim of our study was to investigate the impact of the time interval between prostate biopsy and radical prostatectomy (RP) on postoperative urinary continence (UC)/erectile function (EF). From a clinical point of view, an interval of several weeks seems to facilitate surgical preparation.

We retrospectively analyzed patients who underwent RP for localized prostate cancer (PCa) in a tertiary care center between 2011 and 2020. We evaluated the influence of the following variables on UC and EF 1 year after RP: time from biopsy to RP, age, BMI, pathological T-stage, EF and intraoperative nerve sparing (unilateral vs. bilateral). For this purpose, we performed linear regression analyses as well as manual grouping and cluster analyses to identify possible temporal cutoff ranges. The EPIC-26 and the IIEF questionnaires were used for the assessment of UC and EF.

We identified 6202 consecutive patients who underwent RP. Neither manual grouping nor cluster analyses showed a significant difference in continence or potency after RP. According to linear regression models, only age was an independent predictor of incontinence (95%-CI 0.006-0.01), and EF before RP (95%-CI 0.22-0.26), age (95%-CI - 0.68 to - 0.5), BMI (95%-CI - 0.66 to - 0.29) and bilateral NS (95%-CI 5.5-2.1) had significant impacts on postoperative EF (all p < 0.001).

In the selected patient population, the time interval between prostate biopsy and RP did not seem to have an effect on postoperative functional outcomes (UC and EF).

To determine the success rate of oncological microdissection testicular sperm extraction (onco-microTESE) in patients with testicular cancer (TC) with azoospermia and severe oligoasthenoteratozoospermia (OAT; <1 million/mL sperm) and to explore any factors that may predict success.

Case series of outcomes from all consecutive patients (42 testes in 38 patients) that presented or were referred to a single specialist tertiary referral centre for fertility management in the context of TC with severe OAT or azoospermia between August 2015 and August 2022. Biochemical, radiological, and histological parameters were collected for all patients. All patients underwent onco-microTESE (simultaneous radical inguinal orchidectomy with ex vivo microTESE of the affected testis). Those with unsuccessful surgical sperm retrieval (SSR) from the affected testis underwent contemporaneous contralateral microTESE, if no contraindication was present. The primary outcome was successful SSR from the affected testicle sufficient for assisted reproductive techniques. Secondary outcomes included contralateral microTESE success, the time from referral to procedure, and the total successful fertility preservation rate.

Initial onco-microTESE was successful in 19 of 31 patients (61%) with azoospermia. Contralateral microTESE was successful in a further two of eight patients with azoospermia with failed onco-microTESE. Overall, 22/31 patients with azoospermia (71%) had successful fertility preservation in this series. In addition, six of seven patients with severe OAT had further sperm harvested by onco-microTESE to maximise their fertility preservation. All surgery was performed within median (interquartile range) of 7 (5-13) days from presentation.

Onco-microTESE represents an effective method of fertility preservation for sub-fertile patients with TC without delaying oncological treatment. Knowledge of the fertility status at first presentation is essential to allow for such additional options for optimal fertility preservation in TC.