The latest medical research on Urology

The research magnet gathers the latest research from around the web, based on your specialty area. Below you will find a sample of some of the most recent articles from reputable medical journals about urology gathered by our medical AI research bot.

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Effective targeting of RNA polymerase I in treatment-resistant prostate cancer.

Prostate

Advanced prostate cancers depend on protein synthesis for continued survival and accelerated rates of metabolism for growth. RNA polymerase I (Pol I) is the enzyme responsible for ribosomal RNA (rRNA) transcription and a rate-limiting step for ribosome biogenesis. We have shown using a specific and sensitive RNA probe for the 45S rRNA precursor that rRNA synthesis is increased in prostate adenocarcinoma compared to nonmalignant epithelium. We have introduced a first-in-class Pol I inhibitor, BMH-21, that targets cancer cells of multiple origins, and holds potential for clinical translation.

The effect of BMH-21 was tested in prostate cancer cell lines and in prostate cancer xenograft and mouse genetic models.

We show that BMH-21 inhibits Pol I transcription in metastatic, castration-resistant, and enzalutamide treatment-resistant prostate cancer cell lines. The genetic abrogation of Pol I effectively blocks the growth of prostate cancer cells. Silencing of p53, a pathway activated downstream of Pol I, does not diminish this effect. We find that BMH-21 significantly inhibited tumor growth and reduced the Ki67 proliferation index in an enzalutamide-resistant xenograft tumor model. A decrease in 45S rRNA synthesis demonstrated on-target activity. Furthermore, the Pol I inhibitor significantly inhibited tumor growth and pathology in an aggressive genetically modified Hoxb13-MYC|Hoxb13-Cre|Ptenfl/fl (BMPC) mouse prostate cancer model.

Taken together, BMH-21 is a novel promising molecule for the treatment of castration-resistant prostate cancer.

Validating the European randomised study for screening of prostate cancer (ERSPC) risk calculator in a contemporary South African cohort.

World Journal of Diabetes

Numerous prostate cancer predictive tools have been developed to help with decision-making in men needing prostate biopsy. However, they have been modelled and validated almost exclusively in Caucasian cohorts, hence limiting their use in other population groups. The aim of this study was to assess the validity of the ERSPC risk calculator in a South African cohort.

Patients who have had a transrectal ultrasound (TRUS)-guided prostate biopsy at Groote Schuur Hospital from January 2008 to August 2017 were reviewed. Predictor variables were entered into the ERSPC risk calculator and results were compared with prostate biopsy pathology results. Predictive accuracy of the ERSPC risk calculator for these patients was derived using receiver operator characteristics (ROC) Area under the curve and is expressed as a percentage.

516 prostate biopsy sessions in 475 different men were analysed. The predictive accuracy of the ERSPC risk calculator was better than a PSA/DRE strategy for the presence of cancer-0.738 (95% CI 0.695-0.781) vs 0.686 (95% CI 0.639-0.732), and for significant PCa-0.833 (95% CI 0.789-0.876) vs 0.793 (95% CI 0.741-0.846). This translated into 50 less biopsies when compared to a PSA > 4/abnormal DRE strategy. Use of the ERSPC RC would have missed eight non-significant cancers [Significant cancer being defined as having a tumour stage T2b (> 1/2 lobe involved with prostate cancer) and/or a Gleason Score equal to or greater than 7].

Our results confirm the validity of the ERSPC RC in a South African cohort. Application of this calculator to the wider South African population would allow better selection of patients for prostate biopsy and spare a significant number its adverse consequences.

Novices in MRI-targeted prostate biopsy benefit from structured reporting of MRI findings.

World Journal of Diabetes

The aim of this study was to investigate whether structured reports (SRs) of prostate MRI results are more suitable than non-structured reports (NSRs) for promoting the more accurate assessment of the location of a single prostate cancer lesion by novices in MRI-targeted biopsy.

50 NSRs and 50 SRs describing a single prostatic lesion were presented to 5 novices in MRI-targeted biopsy. The participants were asked to plot the tumor location in a two-dimensional prostate diagram and to answer a questionnaire on the quality of the reports. The accuracy of the plotted tumor position was evaluated with a validated 30-point scoring system that distinguished between "major" and "minor" mistakes.

The overall mean score for the accuracy of the tumor plotting was significantly higher for SRs than for NSRs (26.4 vs. 20.7, p < 0.01). The mean numbers of major (1.4 vs. 0.48, p < 0.01) and minor (3.05 vs. 1.15, p < 0.01) mistakes were significantly higher for NSRs than for SRs. Compared with NSRs, SRs received significantly higher ratings for the perceived quality of the summary (4.0 vs. 2.4, p < 0.01) as well as for the overall satisfaction with the report (4.1 vs. 2.1, p < 0.01).

Novices in MRI-targeted biopsy prefer structured reporting of prostate MRI as an information tool. SRs allow for a more accurate assessment of the location of single prostate cancer lesions. Therefore, structured reporting of prostate MRI may help to foster the learning process of novices in MRI-targeted biopsy.

Day-surgery percutaneous nephrolithotomy: a high-volume center retrospective experience.

World Journal of Diabetes

Percutaneous nephrolithotomy (PCNL) is traditionally performed on an inpatient basis. We determine the safety and outcome of day-surgery PCNL by experienced surgeon hands.

A protocol for day-surgery PCNL was undertaken. A retrospective analysis of all 86 cases of planned day-surgery PCNL accomplished by an experienced surgeon who followed this protocol between May 2017 and March 2019 was performed. Patient demographics, operative data, complications, and readmission rates were recorded. Day-surgery PCNL was defined as discharge of patients either the same day or within 24 h after surgery.

The average stone burden was 361.1 mm2 and 70 (81.4%) of patients had multiple stones or staghorn stones. 82 (95.4%) patients achieved same-day discharge or received overnight observation prior to discharge, and 4 patients (4.6%) required full admission (longer than 24 h). The readmission rate was 2.3% (2 patients). The postoperative complications occurred in 10 (11.6%) patients, including 7, 2, 2 of grade I, II, III complications. The average operation time was 64 min and the hemoglobin drop was 15.7 ± 16.9 g/L. The established tracts size ranged from 16 to 22Fr. The stone clearance rate was 90.7%. The tubeless without nephrostomy tube was performed in 60.5%. Eight cases were performed by multiple-tracts PCNL with 2-4 tracts, with only two case required full admission.

Experienced surgeons who performed day-surgery PCNL experience excellent patient outcomes in appropriately selected patients. Most complications can be treated conservatively and only a few required intervention or readmission.

Observational analysis of mesh related complications in urogynecologic procedures.

Journal of Robotic Surgery

Since the 1990s, the use of mesh has expanded in gynecologic surgeries in the aim of correcting pelvic organ prolapse. Because there has been a lot...

Transition effects from laparocscopic to robotic surgery skills in small cavities.

Journal of Robotic Surgery

Conventional laparoscopic surgery (LS) is being challenged by the ever-increasing use of robotic surgery (RS) to perform reconstructive procedures....

Two-year clinical outcomes associated with robotic-assisted subthalamic lead implantation in patients with Parkinson's disease.

Journal of Robotic Surgery

Few centers have routinely implemented robotic stereotactic systems for deep brain stimulator (DBS) placement. The present study compares clinical ...

Evaluation of the prognostic role of co-morbidities on disease outcome in renal cell carcinoma patients.

World Journal of Diabetes

Co-morbidities may induce local and systemic tumor progression of renal cell carcinoma (RCC); however, the prognostic impact of co-morbidities has not yet been well characterized.

RCC patients (n = 2206) surgically treated at three academic institutions in the US and Europe were included in the analysis. Presence of diabetes mellitus, hypertension, chronic kidney disease, chronic obstructive pulmonary disease, coronary heart disease, and hypothyroidism were investigated for their association with clinicopathological features and cancer-specific survival.

Hypertension was associated with less advanced T stages (p = 0.025), a lower risk of lymph-node (p = 0.026) and distant metastases (p = 0.001), and improved cancer specific survival in univariable analysis (HR 0.81 95% CI 0.69-0.96, p = 0.013). However, hypertension was not an independent prognostic factor after adjustment for TNM stages, grading, and ECOG performance status (HR 0.95, 95% CI 0.80-1.12; p = 0.530). A correlation between the use of concomitant anti-hypertensive medications and improved survival outcome was not identified. All other investigated co-morbidities did not show significant associations with clinicopathological features or cancer-specific survival.

Although the investigated co-morbidities are capable or inducing pathophysiological changes that are predisposing factors for tumor progression, none is an independent prognostic factor in patients with RCC.

Feasibility of adopting retroperitoneal robotic partial nephrectomy after extensive transperitoneal experience.

World Journal of Diabetes

Adoption of robotic retroperitoneal surgery has lagged behind robotic surgery adoption in general due to unique challenges of access and anatomy. We evaluated our initial results with robotic retroperitoneal robotic partial nephrectomy (RRPN) after transitioning from exclusively transperitoneal robotic partial nephrectomy (TRPN) to evaluate safety and any identifiable learning curve.

We evaluated our single-surgeon (RA) prospective partial nephrectomy database since adopting RRPN routinely for posterior tumors in 2017. The surgeon had previously performed 410 partial nephrectomies by this time. Outcomes were compared after the initial 30 RRPN.

Of 137 patients since adopting RRPN, two attempted RRPN were converted to TRPN without complications due to morbid obesity affecting access, and 30 RRPN were completed (107 TRPN). There were no statistically significant differences in demographics, mean tumor size, or RENAL score between groups. Mean blood loss was lower in RRPN (53 mL vs 99 mL, P < 0.05), but there were no transfusions in either group. There was no difference in mean operative (127.8 min vs 141.2 min, P = 0.06) or ischemia time (11.1 min vs 10.8 min, P = 0.98). There were no positive margins in either group. Mean length of stay was lower in RRPN due to more same-day discharges (0.7 vs 0.9 days). There were no 90-day Clavien III-V complications. One RRPN patient was readmitted POD#8 overnight for hypoxia, and one visited the emergency room POD#7 for persistent pain. All three TRPN complications were managed as outpatients.

Successful adoption of RRPN can be achieved readily after experience with TRPN. Outcomes were immediately comparable without any identifiable learning curve.

Effect of optical fiber diameter and laser emission mode (cw vs pulse) on tissue damage profile using 1.94 µm Tm:fiber lasers in a porcine kidney model.

World Journal of Diabetes

To evaluate the ablation capacity using two Thulium fiber lasers (TFL) in a porcine kidney model.

All tissue samples were mounted on a motorized stage for a precise speed of cutting. A continuous wave (cw) TFL and a super pulsed (SP) TFL were used at power settings of 60 and 120 W with 200 and 600 µm laser fibers. After lactate dehydrogenase staining, histological evaluation was performed to measure the vaporization volume (VV), ablation depth (AD), thermo-mechanical damage zones (TMZ), coagulation zones (CZ) and the carbonization grade (CG).

At 120 W, no significant differences were seen between 200 and 600 µm fibers utilizing the cw TFL regarding VV (24.6 vs. 28.2 mm3/s), AD (5.6 vs. 5.7 mm), TMZ (0 vs. 0 mm2) and CZ (18.1 vs. 12.3 mm2). Using the SP TFL, no significant differences between both fiber diameters with regard to VV (4 vs. 6.2 mm3/s), AD (2.7 vs. 3.4 mm), TMZ (1 vs. 2.6 mm2) and CZ (3.1 vs. 2.2 mm2) at 120 W were found, respectively. However, the VV of the cw TFL at 60 W was significantly less compared to 120 W using 200 and 600 µm fibers, respectively, whereas the SP TFL did not show significant differences between 60 and 120 W with regard to VV. SP TFL showed a consistently lower CG compared to cw TFL.

This experiment suggests that there is no significant difference using 200 or 600 µm laser fibers in cw or SP TFLs. However, the cw TFL produces a coagulation zone three to five times larger than the SP TFL regardless of the fiber diameter.

Urodynamic Outcomes in Children after Single and Multiple Injections in Overactive and Low Compliance Neurogenic Bladder Treated with AboBotulinum Toxin-A.

J Urol

Intradetrusor botulinum toxin is an established part of the treatment pathway for paediatric patients with neurogenic bladder. Aim is1 to determine the urodynamic effect of single and multiple administrations of Abobotulinumtoxin-A (ABTA) in paediatric patients with neurogenic bladder;2 to determine the urodynamic efficacy of ABTA in low compliance vs. overactive bladders.

Single-centre retrospective review of all paediatric patients with neurogenic bladder treated with ABTA. Videourodynamic (VUD) data on cystometric capacity (CC), maximum neurogenic detrusor overactivity pressure (Max NDO) and compliance was gathered pre- and post first ABTA administration and after last administration. Patients were divided into low compliance and overactive bladder groups depending on their initial VUD findings. Paired t test was used to compare VUD outcomes pre- and post- ABTA. Mann-Whitney U test was used to compare bladder groups.

Thirty patients were included. Fifteen patients (50%) had multiple ABTA injections. Sixteen patients (53%) had overactive bladders. ABTA administration significantly improved CC (P<0.0001) and Max NDO (p=0.0001). Overall, compliance did not significantly change (p=0.25). There was no significant difference in urodynamic parameters between first and last ABTA injections. Improvement in CC (p=0.05) and Max NDO (p=0.25) was similar between low compliance and overactive bladder groups. Compliance significantly improved in the low compliance group versus overactive bladder group (p=0.016).

Intradetrusor ABTA improves CC and Max NDO in paediatric patients with neurogenic bladder. This effect is maintained over multiple injections. Compliance is significantly improved in patients with low compliance bladder compared with overactive bladder.

Decision Regret after Radical Prostatectomy Does Not Depend upon Surgical Approach: 6-Year Follow-Up of a Large German Cohort Undergoing Routine Care.

J Urol

Numerous studies have compared outcomes of open (ORP) and robotic-assisted radical prostatectomy (RARP), but only one study focused on patient satisfaction and regret. Our study aimed to evaluate intermediate-term decision regret after ORP and RARP.

The "HAROW" study analyzed localized prostate cancer patient treatments (≤T2c N0 M0) in Germany from 2008 to 2013. For 1260 patients after retropubic ORP or RARP, we collected a intermediate-term follow-up.

The response rate was 76.8% (936/1218). Four hundred four patients underwent RARP, and 532 underwent ORP. RARP patients showed more self-determined behavior; they reported an active role in surgical decision making (RARP 39% vs. 24% ORP, p<0.001) and surgical approach (RARP 52% vs. 18% ORP, p<0.001). RARP patients actively participated treating hospital selection (RARP 25% vs. 11% ORP, p<0.001) used the internet often (RARP 87% vs. 72% ORP, p<0.001), and traveled increased distances (RARP 65 km vs. 40 km ORP, p<0.001). Overall, decision regret was low, with a mean score of 14 ± 19 (0 = no regret; 100 = high regret). Multivariate analysis showed that erectile function (OR 3.2), urinary continence (OR 1.8), freedom of recurrence (OR 1.6), an active role in decision making (OR 2.2), and shorter follow-up time (OR 0.9 per year) were predictive of low decision regret (score<15).

Intermediate-term functional and oncologic outcomes as well as autonomous decision making and follow-up time influenced decision regret after radical prostatectomy. The surgical approach was not associated with intermediate-term decision regret.