Research and Reports in Urology最新文献

Introduction: Prostate cancer (CaP) is the most common malignancy and the second leading cause of cancer-related deaths among men in Botswana. Currently, diagnosing CaP relies on examining prostate biopsy samples, which can be challenging due to benign mimics. This study aims to evaluate the potential of Alpha-methyl acyl-CoA racemase (AMACR/p504s) and p63, as diagnostic markers for CaP. This may potentially validate the use of immunohistochemistry for detecting CaP in Botswana, where it is not routinely utilized.

Methods: The study included 69 samples, comprising 5 prostatic chip specimens, 50 core biopsies, and 14 radical prostatectomy specimens. These cases were reviewed and categorized into CaP (49 cases) and benign prostatic hyperplasia (BPH) (20 cases). Immunohistochemistry was performed using AMACR/p504s and p63 immunohistochemical stains.

Results: The study found that AMACR/p504s had a sensitivity of 96% and a specificity of 95%, while p63 had a sensitivity and specificity of 100%. PSA levels showed significant positive correlation with AMACR/p504s expression (P < 0.00001).

Discussion: In this study, we have demonstrated the diagnostic utility of AMACR/p504s and p63 due to their high sensitivity and specificity in detecting CaP in Botswana, where these biomarkers are not yet widely used. Furthermore, utilizing these markers in conjunction with other diagnostic tools, such as PSA levels and morphological evaluation, could improve the diagnostic accuracy, especially in challenging cases where histopathological examination alone may be inconclusive.

Purpose: The objective of our study was to examine the knowledge of male infertility and the acceptance of assisted reproductive technology (ART) methods.

Patients and methods: We conducted a descriptive, comparative, cross-sectional study from April 2023 to August 2023 in a center in Dakar. Included in the study were male patients aged 18 and older followed for male infertility (group 1) and fertile patients of the same age as those in group 1 (group 2). We designed a questionnaire assessing the sociodemographic characteristics of the respondents, their knowledge of male infertility, knowledge of ART, its acceptability, and the source of information about male infertility.

Results: Our sample size consisted of 119 respondents for each group. The average age of respondents in both groups was 41.24 ± 8.42 years. Fifty-eight percent of respondents in group 1 were referred by their wife's gynecologist. Fifty-four percent of respondents in group 1 had a good knowledge of male infertility, and 42.86% had average knowledge of male infertility. The majority of respondents in group 1 (42.9%) and group 2 (40.3%) did not know the duration that defines infertility. Fifty-seven percent of respondents in Group 1 and 81.5% of respondents in Group 2 did not know what assisted reproductive technology meant. Eighty-six percent of respondents in Group 1 agreed to use ART for procreation. The majority of respondents in Group 1 (54.6%) and Group 2 (58.8%) attributed a success rate of between 35% and 75% to ART.

Conclusion: Infertile men had better knowledge of male fertility than fertile men. Respondents in both groups, as well as the advanced age of men did not know the duration defining infertility. Poor knowledge of ART was also observed among respondents in both groups, and a better acceptance of ART methods was noted among infertile men.

A 44-year-old healthy Caucasian gentleman presented with fevers and right lower quadrant pain. He had mildly elevated inflammatory markers and computed tomography demonstrated cystic enlargement of the right seminal vesicle concerning for seminal vesicle abscess (SVA). SVA is a rare diagnosis and generally requires drainage for adequate source control. The patient was commenced on intravenous antibiotics and underwent uncomplicated transperineal drainage of seminal vesicle abscess under local anaesthetic. Urine culture confirmed infection with Citrobacter koseri and the patient was discharged on the first post-operative day with a 14-day course of oral co-trimoxazole. Six-week follow-up with multiparametric magnetic resonance imaging of the prostate shows no evidence of any prostatic lesions, prostatitis or recurrence of abscess.

Current diagnosis of urinary tract infections (UTIs) in the UK initially relies on self-reported patient symptoms with no point-of-care test robust enough to accurately identify the causative pathogen and inform on antibiotic susceptibility. In serious UTI cases, standard urine culture is regarded as the gold standard for diagnosis and involves direct isolation, culture and antibiotic susceptibility testing of pathogens. These methods are not suitable in initial UTI diagnosis and treatment because of the time taken to conduct these analyses (≥3 days). Inaccurate and slow diagnostics can lead to unnecessary or incorrect antibiotic prescribing, which can lead to increased antimicrobial resistance and poorer patient outcomes. Novel point-of-care testing devices are urgently needed to improve the diagnostics of UTIs. In this article, we highlight novel point-of-care tests which are in development that can detect UTI-causing pathogens rapidly and accurately. These devices require additional studies to prove their clinical utilities. Adoption of these technologies can empower general practitioners (GPs) and pharmacists in prescribing decisions and improve antimicrobial stewardship.

One of the most challenging aspects of urology is restoring patency to ureters with long defects. In certain cases, it may not be feasible to perform plastic surgery on the ureter with its own tissue or bladder. In such instances, alternative solution like appendicular ureteroplasty may be promising solution. Ureteral injuries have several etiologies, some of them are secondary to unintentional ureteral trauma during surgery. More than half of these injuries are unrecognized during the first laparotomy. Extensive ureteral injuries are difficult to repair, even with application of several types of surgical techniques. The advantage of appendicular ureteroplasty is the simplicity of the ureteral replacement technique without compromising other substitution options in case of failure. This is a case report of a young adult with abdominal gunshot injuries, with significant loss of tissues located to distal third of the right ureter. The appendicular urethroplasty was successfully performed. The patient remained stable after one year of out follow-up as an outpatient.

Background: Serum prostate-specific antigen (PSA) is a widely used maker for prostate cancer (PCa) screening. However, its correlation with PCa varies, partly due to ethnic differences. This study investigated the correlation between PSA and PCa diagnosis as well as the burden of the disease in the Tanzanian community.

Methods: This community-based PCa screening took place in Northern Tanzania from May 2022 to September 2022, where men aged ≥40 years were involved. Each participant provided 5 milliliters of venous blood for PSA determination. Those with PSA levels >4 ng/mL underwent prostate biopsy. Two pathologists independently evaluated the biopsies. The correlation between PSA and biopsy results was assessed using STATA version 17.0.

Results: The study included 6164 African men with a mean age of 60±11 years. Of these, 912 (14.8%) had PSA >4 ng/mL, and hence 581 (63.7%) underwent prostate biopsy. A total of 179 men (30.8%) were histologically diagnosed with prostatic adenocarcinoma, whereby 46 (25.7%) had Gleason scores 8-9. Among participants with PSA >20 ng/mL, over 2/3 (64.7%) had PCa, rising to nearly 100% at PSA >100 ng/mL. A positive correlation between PSA levels and PCa/aggressive disease was observed. PSA sensitivity decreased with rising levels, hitting 78.2% at >10ng/mL and 24.6% at >100ng/mL, while specificity increased, peaking at 99.8% for >100ng/mL from 73.9% at >10ng/mL. The optimal PSA cut point was >10ng/mL. PSA demonstrated an 84% overall ability to predict PCa and a 71% ability to predict aggressive disease.

Conclusion: This study found a notable presence of intermediate-high grade PCa within the community, suggesting the need for regular screening and management. Moreover, PSA demonstrated clinically useful ability in predicting PCa among African men aged 40 years and older.

BCG is the standard of care for non-muscle invasive high-risk bladder cancer. Notwithstanding the high rate of cure, cancer may recur. A non-muscle invasive high-risk recurrence may be defined as BCG refractory or naïve. BCG refractory patients have been further divided into BCG unresponsive and BCG exposed. A recurrent high-risk bladder cancer within 1 year after BCG induction plus maintenance or two courses of BCG induction defines an unresponsive disease. Any recurrence after 24 months since induction and maintenance should be considered as BCG naïve. The remaining cases are BCG exposed. The standard of care for BCG exposed and naïve patients is another cycle of BCG in the first place, while radical cystectomy should be discussed as alternative with the patient. The preferred therapy for BCG unresponsive patients is radical cystectomy according to AUA or EAU guidelines. However, systemic immunotherapy with pembrolizumab or gene therapy with intravesical nadofaragene firadenovec may be administered for patients unfit or unwilling to undergo radical cystectomy with outcomes superior to intravesical docetaxel, gemcitabine or valrubicin. Our narrative review tries to elucidate BCG refractory definition and treatment specifically regarding alternative therapies to radical cystectomy yet approved or under investigation. The last years have been exciting regarding new developments in this field after a long period of stagnation. Unfortunately, data available on some alternative therapies are mainly limited mainly to Phase I or II studies with a lack of robust evidence, but a clear trend in future treatments has just been drawn.

Purpose: Benign prostatic hyperplasia (BPH) is a major urological health issue for men globally. Fucoidan, a sulfated polysaccharide, displays diverse bioactivities such as anti-inflammatory, anti-tumor, antioxidant, and immunoregulatory effects. This 28-day study examined the effects of Undaria pinnatifida fucoidan on testosterone-induced BPH in rats.

Methods: Forty-eight Sprague Dawley (SD) rats were randomly divided into six groups; G1- vehicle control, G2- testosterone alone BPH control group (3 mg/kg), G3- finasteride (10 mg/kg) + testosterone, G4- fucoidan (40 mg/kg) + testosterone, G5- fucoidan (400 mg/kg) + testosterone, and G6- fucoidan alone (400 mg/kg). The animals were observed for clinical signs, body weight, feed consumption, prostate weight, prostate index, and biochemical markers such as tumor necrosis factor-alpha (TNF-α), interleukin- 1β (IL-1β), prostate-specific antigen (PSA) and messenger ribonucleic acid (mRNA) expression of BCL-2-associated X protein (BAX) and B-cell lymphoma-2 (BCL-2) in serum. Testosterone and dihydrotestosterone (DHT) levels were evaluated in both serum and prostate.

Results: Fucoidan significantly prevented an increase in prostate weight and prostate index induced by testosterone. DHT levels in the prostate of the intervention groups were significantly lower than in the BPH control group (p <0.05); however, no significant difference was observed in serum levels. Similarly, a significant reduction was observed in serum and prostate testosterone levels in the intervention groups compared to the BPH control group (p <0.05). Biochemical analyses showed PSA levels were significantly lower in the fucoidan groups compared to the BPH control group (p<0.05). Although not statistically significant, fucoidan groups showed a trend of reducing IL-1β and TNF-α levels. Fucoidan demonstrated pro-apoptotic potential in its ability to decrease BCL-2 and increase BAX. Histopathological evidence revealed fewer microscopic lesions in the fucoidan groups compared to the BPH control group.

Conclusion: The results suggest Undaria pinnatifida fucoidan can reduce testosterone-induced BPH symptoms in SD rats.

Bladder pain Syndrome presents a multifaceted challenge in contemporary urological practice, marked by LUTS, negative behavioural, sexual, or emotional experiences, and the potential for sexual dysfunction. We meticulously explored the existing literature of conservative, non-invasive and invasive interventions, aiming to provide clinicians with a nuanced understanding of available options for comprehensive BPS management. We delve into the effectiveness and safety profiles from behavioural approaches through lifestyle changes and physical therapy, to oral or intravesical medications, until the definitive surgical treatment. The best option evaluated is the involvement of a multidisciplinary team, including urologists, urotherapists, gynaecologists, pain specialists, primary care physicians and psychologists, educating those patients regarding the condition and its chronic course and tailoring the perfect treatment for each person. Despite this, BPS remains a challenge for urologists. Indeed, our objective is to contribute to the evolving landscape of BPS management, fostering informed decision-making and personalized care for individuals grappling with this challenging condition.

Introduction: We analyzed the time course of postvoid residual urine volume for patients with cerebrovascular diseases in the acute phase.

Materials and methods: A multidisciplinary specialized team measured postvoid residual urine volume of 65 patients (31 patients with cerebral infarction and 34 patients with cerebral hemorrhage) from September 2021 to August 2023. If a patient's postvoid residual urine volume was 100 mL or more, an indwelling urinary catheter was reinserted with or without medication, or clean intermittent catheterization was performed with or without medication. The multidisciplinary specialized team took repeated measurements of postvoid residual urine volume for a patient at every week's round until the postvoid residual urine volume was <100 mL. The cumulative incidence of the time interval between the onset of the cerebrovascular accident and the day of postvoid residual urine volume <100 mL was calculated as 1 + the Kaplan-Meier estimator.

Results: In the Kaplan-Meier estimator, the median cumulative incidence of the period between the onset of a cerebrovascular accident and the day in which postvoid residual urine volume was <100 mL was 16.5 days and 15.5 days for patients with cerebral infarction and cerebral hemorrhage, respectively. No significant difference existed between the two groups in the time interval from the onset of a cerebrovascular accident to the day in which postvoid residual urine volume was <100 mL (The P value from the Log-rank test was 0.845). The time interval between the onset of a cerebrovascular accident and the day in which postvoid residual urine volume was <100 mL was 75 days after the onset of both types of cerebrovascular accidents.

Conclusion: Postvoid residual urine volume of patients with cerebrovascular disease was expected to become <100 mL within 75 days after the onset of the cerebrovascular accident.