Research and Reports in Urology最新文献

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.

Background: In the UK, relugolix, an oral gonadotropin-releasing hormone receptor antagonist, is indicated for advanced hormone-sensitive prostate cancer, and as neo-adjuvant and adjuvant treatment in combination with radiotherapy in patients with high-risk localised or locally advanced hormone-dependent prostate cancer. Experience with the combination of oral relugolix plus oral enzalutamide is limited.

Case presentation: A white British male (66 years old) with a history of myelodysplastic syndrome, chronic neutropenia and indeterminate colitis presented with metastatic adenocarcinoma of the prostate gland. The patient started subcutaneous leuprorelin acetate and oral enzalutamide. After 8 weeks, the oral enzalutamide dose was reduced because of fatigue. Following the second leuprorelin injection, the patient developed a subcutaneous abscess that required surgical incision and drainage. The patient switched to oral relugolix and continued with oral enzalutamide. Within 3 months of commencing leuprorelin and enzalutamide the prostate specific antigen (PSA) concentration fell from a peak of 269.00 ng/mL to 2.55 ng/mL. Following the switch to oral relugolix plus enzalutamide, the PSA remained stable until the most recent assessment 11 months later. Relugolix plus enzalutamide was well tolerated.

Conclusion: Relugolix plus enzalutamide produced a sustained reduction in PSA and the combination was well tolerated. Further research including real world data should assess relugolix in doublet and triplet combinations for prostate cancer.

Purpose: Urinary tract infections (UTIs) are among the most common bacterial infections, with uropathogenic Escherichia coli (UPEC) as the main etiologic agent of uncomplicated UTIs (uUTIs). The prevalence of uUTis caused by organisms with antimicrobial resistance (AMR) is increasing worldwide, complexifying the disease management and increasing the risk of complications. In efforts to develop new strategies for uUTI prevention, it is imperative to understand factors associated with the occurrence of new episodes.

Patients and methods: This retrospective cohort study aimed to assess the incidence of uUTIs caused by UPEC (UPEC-uUTIs) or unknown etiology (untested uUTIs) in adults aged ≥18 years receiving care in a San Francisco healthcare system.

Results: During 2014-2019, 1087 UPEC-uUTI and 4106 untested uUTI cases were documented, of which 324 (29.8%; 95% confidence interval: 27.1%-32.6%) and 1030 (25.1%; 95% confidence interval: 23.8%-26.4%) were followed by ≥1 new episode of uUTI within 12 months. In the UPEC-uUTI cohort, male gender, diagnosis of diabetes mellitus, and prior uUTI were risk factors for new episodes of uUTI. At the time of first UPEC-uUTI diagnosis, antimicrobial prescriptions were retrieved for 41.1% of cases. When tested, AMR was most frequently reported for trimethoprim/sulfamethoxazole or trimethoprim/sulfamethoxazole prescribed with other antimicrobials.

Conclusion: Our study provides important information on the incidence and risk of repeated episodes of uUTIs, as well as on AMR related to them.