Pub Date : 2024-01-01Epub Date: 2024-02-17DOI: 10.1159/000537894
Levent Ozcan, Emre Can Polat, Caner Baran, Ahmet Boylu, Mustafa Erkoc, Alper Otunctemur
Introduction: The main challenge to the optimal use of neoadjuvant chemotherapy (NAC) is the difficulty in selecting patients who may or may not benefit from NAC. Our aim in this study was to investigate whether the Systemic Inflammatory Index (SII) predicts response to chemotherapy in patients who receive NAC prior to cystectomy.
Methods: We retrospectively analysed the data of patients who underwent NAC followed by cystectomy at our institution between January 2010 and September 2015 and whose 5-year follow-up was completed. All patients who underwent diagnostic biopsy with complete transurethral resection of bladder tumour at our hospital and whose pathology result was muscle-invasive transitional cell carcinoma were included in the study. At least 3 courses of gemcitabine/cisplatin NAC were given to all patients. A pathological response was defined as a reduction in cystectomy to a lower pathological stage after NAC.
Results: The SII was 320.8 ± 51 in the responders and 388.28 ± 50 in the non-responders. SII optimal cut-off of 350 was determined. The sensitivity and specificity of SII in predicting response were found to be 80% and 83%, respectively. Low SII (<350) was found to be a significant predictor of response compared with the other factors on multivariate analysis. The mean overall survival time was 55.4 months in patients with a low SII value and 40.3 months in the high SII group.
Conclusion: SII, together with known clinicopathological factors and newer genetic and molecular markers, can be used to select patients for NAC.
{"title":"Systemic Inflammatory Index: A Promising Non-Invasive Marker for the Prediction of Response to Neoadjuvant Chemotherapy prior to Cystectomy.","authors":"Levent Ozcan, Emre Can Polat, Caner Baran, Ahmet Boylu, Mustafa Erkoc, Alper Otunctemur","doi":"10.1159/000537894","DOIUrl":"10.1159/000537894","url":null,"abstract":"<p><strong>Introduction: </strong>The main challenge to the optimal use of neoadjuvant chemotherapy (NAC) is the difficulty in selecting patients who may or may not benefit from NAC. Our aim in this study was to investigate whether the Systemic Inflammatory Index (SII) predicts response to chemotherapy in patients who receive NAC prior to cystectomy.</p><p><strong>Methods: </strong>We retrospectively analysed the data of patients who underwent NAC followed by cystectomy at our institution between January 2010 and September 2015 and whose 5-year follow-up was completed. All patients who underwent diagnostic biopsy with complete transurethral resection of bladder tumour at our hospital and whose pathology result was muscle-invasive transitional cell carcinoma were included in the study. At least 3 courses of gemcitabine/cisplatin NAC were given to all patients. A pathological response was defined as a reduction in cystectomy to a lower pathological stage after NAC.</p><p><strong>Results: </strong>The SII was 320.8 ± 51 in the responders and 388.28 ± 50 in the non-responders. SII optimal cut-off of 350 was determined. The sensitivity and specificity of SII in predicting response were found to be 80% and 83%, respectively. Low SII (<350) was found to be a significant predictor of response compared with the other factors on multivariate analysis. The mean overall survival time was 55.4 months in patients with a low SII value and 40.3 months in the high SII group.</p><p><strong>Conclusion: </strong>SII, together with known clinicopathological factors and newer genetic and molecular markers, can be used to select patients for NAC.</p>","PeriodicalId":23414,"journal":{"name":"Urologia Internationalis","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139900447","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-01-01Epub Date: 2024-03-21DOI: 10.1159/000538339
Chen Sun, Zhengrong Duan
Introduction: Our study aimed to assess the independent and joint effects of leisure-time physical activity and sedentary behavior with urinary incontinence (UI).
Methods: Data were obtained from the National Health and Nutrition Examination Survey 2011-2016. The primary endpoint was the risk of different subtypes of UI, including stress UI, urgency UI, and mixed UI. The primary exposures were leisure-time physical activity and sedentary behavior. Sedentary behavior was assessed by screen time. Weighted univariate and multivariate logistic regression models were used to observe the independent and joint relationship of leisure-time physical activity and sedentary behavior with UI risk (including stress UI, urgency UI, and mixed UI).
Results: In total, 6,927 female participants were included in this analysis. 3,377 females did not have UI, 1,534 had stress UI, 836 had urgency UI, and 1,180 had mixed UI. Screen time with ≥5 h/day was associated with increased odds of urgency UI (odds ratio [OR] = 1.31, 95% confidence intervals (CI): 1.06-1.61), which indicated the relationship of sedentary behavior and urgency UI. Engaging in leisure-time physical activity with of ≥750 metabolic equivalent (MET)·min/week was found to be significantly associated with reduced likelihood of mixed UI (OR = 0.68, 95% CI: 0.55-0.85). Additionally, the interaction term of leisure-time physical activity<750 MET·min/week and screen time ≥5 h/day was observed to be linked with increased odds of urgency and mixed UI.
Conclusion: Participants experiencing a lower level of leisure-time physical activity and a higher level of sedentary behavior together might enhance the urgency and mixed UI risk.
{"title":"Joint Effect of Physical Activity and Sedentary Behavior with the Female Urinary Incontinence: An Analysis of NHANES 2011-2016.","authors":"Chen Sun, Zhengrong Duan","doi":"10.1159/000538339","DOIUrl":"10.1159/000538339","url":null,"abstract":"<p><strong>Introduction: </strong>Our study aimed to assess the independent and joint effects of leisure-time physical activity and sedentary behavior with urinary incontinence (UI).</p><p><strong>Methods: </strong>Data were obtained from the National Health and Nutrition Examination Survey 2011-2016. The primary endpoint was the risk of different subtypes of UI, including stress UI, urgency UI, and mixed UI. The primary exposures were leisure-time physical activity and sedentary behavior. Sedentary behavior was assessed by screen time. Weighted univariate and multivariate logistic regression models were used to observe the independent and joint relationship of leisure-time physical activity and sedentary behavior with UI risk (including stress UI, urgency UI, and mixed UI).</p><p><strong>Results: </strong>In total, 6,927 female participants were included in this analysis. 3,377 females did not have UI, 1,534 had stress UI, 836 had urgency UI, and 1,180 had mixed UI. Screen time with ≥5 h/day was associated with increased odds of urgency UI (odds ratio [OR] = 1.31, 95% confidence intervals (CI): 1.06-1.61), which indicated the relationship of sedentary behavior and urgency UI. Engaging in leisure-time physical activity with of ≥750 metabolic equivalent (MET)·min/week was found to be significantly associated with reduced likelihood of mixed UI (OR = 0.68, 95% CI: 0.55-0.85). Additionally, the interaction term of leisure-time physical activity<750 MET·min/week and screen time ≥5 h/day was observed to be linked with increased odds of urgency and mixed UI.</p><p><strong>Conclusion: </strong>Participants experiencing a lower level of leisure-time physical activity and a higher level of sedentary behavior together might enhance the urgency and mixed UI risk.</p>","PeriodicalId":23414,"journal":{"name":"Urologia Internationalis","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11305517/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140185700","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-01-01Epub Date: 2023-12-18DOI: 10.1159/000535870
Maciej Orzechowski, Paweł Kowal, Krzysztof Ratajczyk, Michal Borucki, Katarzyna Blaszczyszyn
Introduction: Plasmacytoma is a rare plasma-cell neoplasm, which includes bone and extramedullary types. While most cases occur in the head and neck, our report presents an unusual case of extramedullary plasmacytoma (EMP) in the penis, emphasizing the diverse locations of this condition.
Case presentation: An 88-year-old man, post-hydrocelectomy, presented with a palpable penile mass causing urinary symptoms. CT scans revealed a tumor with extracapsular spread and potential urethral involvement. Biopsy confirmed lymphoma, later identified as extramedullary plasmacytoma. A follow-up whole-body CT scan was performed, revealing multiple areas of bone rarefaction of the dens of the axis. His diagnosis has been further specified as multiple myeloma. Treatment with lenalidomide, bortezomib, and dexamethasone led to significant penile tumor reduction and improved voiding symptoms after three cycles.
Conclusion: A rare case of primary EMP in the penis is reported, with only two documented cases of EMP in this location. The etiology of EMP remains unclear, possibly linked to chronic infection, irritation, or inflammation. EMP typically occurs in soft tissues, commonly in the head and neck, presenting as submucosal masses with symptoms in individuals aged 50-70. Diagnosis requires demonstrating monoclonal plasma cell infiltration and excluding multiple myeloma. While EMPs are often treated with radiotherapy, a patient with bone rarefaction suggestive of multiple myeloma requires first-line chemotherapy. This case highlights the importance of recognizing myeloma-defining events for appropriate treatment.
{"title":"Extramedullary Plasmacytoma of the Penis as a First Manifestation of Multiple Myeloma: A Case Report.","authors":"Maciej Orzechowski, Paweł Kowal, Krzysztof Ratajczyk, Michal Borucki, Katarzyna Blaszczyszyn","doi":"10.1159/000535870","DOIUrl":"10.1159/000535870","url":null,"abstract":"<p><strong>Introduction: </strong>Plasmacytoma is a rare plasma-cell neoplasm, which includes bone and extramedullary types. While most cases occur in the head and neck, our report presents an unusual case of extramedullary plasmacytoma (EMP) in the penis, emphasizing the diverse locations of this condition.</p><p><strong>Case presentation: </strong>An 88-year-old man, post-hydrocelectomy, presented with a palpable penile mass causing urinary symptoms. CT scans revealed a tumor with extracapsular spread and potential urethral involvement. Biopsy confirmed lymphoma, later identified as extramedullary plasmacytoma. A follow-up whole-body CT scan was performed, revealing multiple areas of bone rarefaction of the dens of the axis. His diagnosis has been further specified as multiple myeloma. Treatment with lenalidomide, bortezomib, and dexamethasone led to significant penile tumor reduction and improved voiding symptoms after three cycles.</p><p><strong>Conclusion: </strong>A rare case of primary EMP in the penis is reported, with only two documented cases of EMP in this location. The etiology of EMP remains unclear, possibly linked to chronic infection, irritation, or inflammation. EMP typically occurs in soft tissues, commonly in the head and neck, presenting as submucosal masses with symptoms in individuals aged 50-70. Diagnosis requires demonstrating monoclonal plasma cell infiltration and excluding multiple myeloma. While EMPs are often treated with radiotherapy, a patient with bone rarefaction suggestive of multiple myeloma requires first-line chemotherapy. This case highlights the importance of recognizing myeloma-defining events for appropriate treatment.</p>","PeriodicalId":23414,"journal":{"name":"Urologia Internationalis","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138809324","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-01-01Epub Date: 2024-01-31DOI: 10.1159/000536565
Phillip Marks, Roland Dahlem, Peer Daniels, Jakob Klemm, Lennart Kühnke, Benedikt Kranzbühler, Frederik König, Liucheng Ding, Oliver Engel, Armin Soave, Margit Fisch, Malte W Vetterlein
Introduction: Urethral strictures, particularly those refractory to endoscopic interventions, are commonly treated through open urethroplasty. However, predicting recurrence in homogeneous patient populations remains challenging.
Methods: To address this, we developed an intraoperative urethral stricture assessment tool aiming to identify comprehensive risk predictors. The assessment includes detailed parameters on stricture location, length, urethral bed width, spongiosum thickness, obliteration grade, and spongiofibrosis extension. The tool was prospectively implemented in 106 men with anterior one-stage augmentation urethroplasty from April 2020 to October 2021.
Results: An intraoperative granular assessment of intricate stricture characteristics is feasible. Comparative analyses revealed significant differences between bulbar and penile strictures. Bulbar strictures exhibited wider urethral beds and thicker spongiosum compared to penile strictures (all p < 0.001). The assessment showed marked variations in the degree of obliteration and spongiofibrosis extension.
Conclusion: Our tool aligns with efforts to standardize urethral surgery, providing insights into subtle disease intricacies and enabling comparisons between institutions. Notably, intraoperative assessment may surpass the limitations of preoperative imaging, emphasizing the necessity of intraoperative evaluation. While limitations include a single-institution study and limited sample size, future research aims to refine this tool and determine its impact on treatment strategies, potentially improving long-term outcomes for urethral strictures.
{"title":"Advancing Intraoperative Assessment of Urethral Stricture Anatomic Variation: A Prospective Proof-of-Concept Study.","authors":"Phillip Marks, Roland Dahlem, Peer Daniels, Jakob Klemm, Lennart Kühnke, Benedikt Kranzbühler, Frederik König, Liucheng Ding, Oliver Engel, Armin Soave, Margit Fisch, Malte W Vetterlein","doi":"10.1159/000536565","DOIUrl":"10.1159/000536565","url":null,"abstract":"<p><strong>Introduction: </strong>Urethral strictures, particularly those refractory to endoscopic interventions, are commonly treated through open urethroplasty. However, predicting recurrence in homogeneous patient populations remains challenging.</p><p><strong>Methods: </strong>To address this, we developed an intraoperative urethral stricture assessment tool aiming to identify comprehensive risk predictors. The assessment includes detailed parameters on stricture location, length, urethral bed width, spongiosum thickness, obliteration grade, and spongiofibrosis extension. The tool was prospectively implemented in 106 men with anterior one-stage augmentation urethroplasty from April 2020 to October 2021.</p><p><strong>Results: </strong>An intraoperative granular assessment of intricate stricture characteristics is feasible. Comparative analyses revealed significant differences between bulbar and penile strictures. Bulbar strictures exhibited wider urethral beds and thicker spongiosum compared to penile strictures (all p < 0.001). The assessment showed marked variations in the degree of obliteration and spongiofibrosis extension.</p><p><strong>Conclusion: </strong>Our tool aligns with efforts to standardize urethral surgery, providing insights into subtle disease intricacies and enabling comparisons between institutions. Notably, intraoperative assessment may surpass the limitations of preoperative imaging, emphasizing the necessity of intraoperative evaluation. While limitations include a single-institution study and limited sample size, future research aims to refine this tool and determine its impact on treatment strategies, potentially improving long-term outcomes for urethral strictures.</p>","PeriodicalId":23414,"journal":{"name":"Urologia Internationalis","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139724193","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-01-01Epub Date: 2024-05-07DOI: 10.1159/000539181
Nikolaos Pyrgidis, Gerald B Schulz, Yannic Volz, Benedikt Ebner, Severin Rodler, Thilo Westhofen, Lennert Eismann, Julian Marcon, Christian G Stief, Friedrich Jokisch
Introduction: Studies assessing the impact of preoperative and first-day postoperative values of leukocytes, thrombocytes, and platelet/leukocyte ratio (PLR) after radical cystectomy (RC) are sparse. We aimed to assess the impact of these factors on long-term survival after RC.
Methods: An analysis of patients undergoing open RC from 2004 to 2023 at our center was performed. Leukocytosis was defined as ≥8,000 leukocytes/μL and thrombocytosis as ≥400,000 thrombocytes/μL. Similarly, the cutoff for PLR was set at 28. A multivariable Cox regression analysis was performed to assess the role of leukocytosis, thrombocytosis, and PLR on long-term survival after RC. For all analyses, hazard ratios (HRs) with the corresponding 95% confidence intervals (CIs) were estimated.
Results: A total of 1,817 patients with a median age of 70 years (interquartile range [IQR]: 62-77) were included. Overall, 804 (44%), 175 (10%), and 1,296 (71%) patients presented with leukocytosis, thrombocytosis, and PLR ≥28 preoperatively. Accordingly, 1,414 (78%), 37 (2%), and 249 (14%) patients presented with leukocytosis, thrombocytosis, and PLR ≥28 on the first day after RC. At a median follow-up of 26 months (IQR: 8-68) after RC, 896 (49%) patients died. In the multivariate Cox regression analysis after adjusting for major perioperative risk factors, only preoperative leukocytosis (HR: 1.3, 95% CI: 1.1-1.6, p = 0.01), as well as both preoperative and first-day thrombocytosis (HR: 2.1, 95% CI: 1.5-2.9, and HR: 2.8, 95% CI: 1.6-5.1, p < 0.001, accordingly) were associated with worse overall survival.
Conclusion: PLR should not be used as a prognostic marker for survival after RC. On the contrary, preoperative leukocytosis, as well as preoperative and first-day thrombocytosis should raise awareness among clinicians performing RC since they were independently associated with worse survival after RC.
{"title":"The Prognostic Value of Perioperative Platelet and Leukocyte Values in Patients Undergoing Radical Cystectomy: A Prospective Long-Term Cohort Study.","authors":"Nikolaos Pyrgidis, Gerald B Schulz, Yannic Volz, Benedikt Ebner, Severin Rodler, Thilo Westhofen, Lennert Eismann, Julian Marcon, Christian G Stief, Friedrich Jokisch","doi":"10.1159/000539181","DOIUrl":"10.1159/000539181","url":null,"abstract":"<p><strong>Introduction: </strong>Studies assessing the impact of preoperative and first-day postoperative values of leukocytes, thrombocytes, and platelet/leukocyte ratio (PLR) after radical cystectomy (RC) are sparse. We aimed to assess the impact of these factors on long-term survival after RC.</p><p><strong>Methods: </strong>An analysis of patients undergoing open RC from 2004 to 2023 at our center was performed. Leukocytosis was defined as ≥8,000 leukocytes/μL and thrombocytosis as ≥400,000 thrombocytes/μL. Similarly, the cutoff for PLR was set at 28. A multivariable Cox regression analysis was performed to assess the role of leukocytosis, thrombocytosis, and PLR on long-term survival after RC. For all analyses, hazard ratios (HRs) with the corresponding 95% confidence intervals (CIs) were estimated.</p><p><strong>Results: </strong>A total of 1,817 patients with a median age of 70 years (interquartile range [IQR]: 62-77) were included. Overall, 804 (44%), 175 (10%), and 1,296 (71%) patients presented with leukocytosis, thrombocytosis, and PLR ≥28 preoperatively. Accordingly, 1,414 (78%), 37 (2%), and 249 (14%) patients presented with leukocytosis, thrombocytosis, and PLR ≥28 on the first day after RC. At a median follow-up of 26 months (IQR: 8-68) after RC, 896 (49%) patients died. In the multivariate Cox regression analysis after adjusting for major perioperative risk factors, only preoperative leukocytosis (HR: 1.3, 95% CI: 1.1-1.6, p = 0.01), as well as both preoperative and first-day thrombocytosis (HR: 2.1, 95% CI: 1.5-2.9, and HR: 2.8, 95% CI: 1.6-5.1, p < 0.001, accordingly) were associated with worse overall survival.</p><p><strong>Conclusion: </strong>PLR should not be used as a prognostic marker for survival after RC. On the contrary, preoperative leukocytosis, as well as preoperative and first-day thrombocytosis should raise awareness among clinicians performing RC since they were independently associated with worse survival after RC.</p>","PeriodicalId":23414,"journal":{"name":"Urologia Internationalis","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140877449","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-01-01Epub Date: 2024-02-05DOI: 10.1159/000536317
Mahmoud Farzat, Florian M Wagenlehner
Introduction: Symptomatic lymphocele remains a relevant complication after pelvic tumor surgery. This study aims to investigate how the number of lymph nodes removed may influence postoperative outcomes and if it increases the probability of detecting lymph node metastasis.
Methods: The study included 500 patients who underwent RARP including lymphadenectomy performed by a single surgeon. Patients were divided into two groups: group 1 consisted of 308 patients with 20 or fewer lymph nodes removed (mean 15), while group 2 had 192 patients with over 20 nodes removed (mean 27). Perioperative data were analyzed, and postoperative outcomes were compared between groups.
Results: Overall, lymph node metastasis was detected in 17.8% of men. In detail, out of 19.6 lymph nodes removed, an average of 3.14 lymph nodes per patient showed metastasis, with a slightly higher incidence of 19.7% in group 2 compared to 16.5% in group 1, though not statistically significant (p = 0.175). The number of lymph node metastases was significantly higher in group 2 patients (3.47) versus group 1 (2.37) (p = 0.048). All complications except symptomatic lymphoceles (p = 0.004) were not significantly different between groups. Univariate linear regression analysis revealed no correlation between the number of removed lymph nodes and symptomatic lymphocele. However, it did correlate with catheter days and readmissions.
Conclusion: A correlation may exist between the number of lymph nodes removed during RARP and an increased incidence of complications, particularly symptomatic lymphocele. A more extensive PLND may result in prolonged catheter days and increased readmissions. With the increased extent of pelvic lymphadenectomy, the probability of detecting lymphogenic metastasis rises. The diagnostic value of PLND is well established. Further randomized trials are needed to weigh its necessity and extent.
{"title":"How Might the Number of Lymph Nodes Removed during RARP Impact the Postoperative Outcomes?","authors":"Mahmoud Farzat, Florian M Wagenlehner","doi":"10.1159/000536317","DOIUrl":"10.1159/000536317","url":null,"abstract":"<p><strong>Introduction: </strong>Symptomatic lymphocele remains a relevant complication after pelvic tumor surgery. This study aims to investigate how the number of lymph nodes removed may influence postoperative outcomes and if it increases the probability of detecting lymph node metastasis.</p><p><strong>Methods: </strong>The study included 500 patients who underwent RARP including lymphadenectomy performed by a single surgeon. Patients were divided into two groups: group 1 consisted of 308 patients with 20 or fewer lymph nodes removed (mean 15), while group 2 had 192 patients with over 20 nodes removed (mean 27). Perioperative data were analyzed, and postoperative outcomes were compared between groups.</p><p><strong>Results: </strong>Overall, lymph node metastasis was detected in 17.8% of men. In detail, out of 19.6 lymph nodes removed, an average of 3.14 lymph nodes per patient showed metastasis, with a slightly higher incidence of 19.7% in group 2 compared to 16.5% in group 1, though not statistically significant (p = 0.175). The number of lymph node metastases was significantly higher in group 2 patients (3.47) versus group 1 (2.37) (p = 0.048). All complications except symptomatic lymphoceles (p = 0.004) were not significantly different between groups. Univariate linear regression analysis revealed no correlation between the number of removed lymph nodes and symptomatic lymphocele. However, it did correlate with catheter days and readmissions.</p><p><strong>Conclusion: </strong>A correlation may exist between the number of lymph nodes removed during RARP and an increased incidence of complications, particularly symptomatic lymphocele. A more extensive PLND may result in prolonged catheter days and increased readmissions. With the increased extent of pelvic lymphadenectomy, the probability of detecting lymphogenic metastasis rises. The diagnostic value of PLND is well established. Further randomized trials are needed to weigh its necessity and extent.</p>","PeriodicalId":23414,"journal":{"name":"Urologia Internationalis","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11151957/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139693063","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-01-01Epub Date: 2023-11-28DOI: 10.1159/000535466
Süleyman Çankaya, Ahmet Ender Caylan, Funda Aydin, Murat Uçar, Ömer Kutlu
Introduction: The purpose of our study was to evaluate reliability of 68Ga-labeled prostate-specific membrane antigen positron emission tomography (68Ga-PSMA PET/CT) and identify appropriate SUVmax cutoff values in order to use for diagnosis, especially in patients remained clinically suspicious for prostate cancer (PCa).
Methods: Eighty-four patients applied 68Ga-PSMA PET/CT subsequent to transrectal ultrasound-guided prostate biopsy (TRUS-bx) involved in this study retrospectively. 68Ga-PSMA PET/CT imagings were analyzed by a nuclear medicine physician, and region of interests were drawn manually in prostate diagrams including 6 segments for each patient. These marked diagrams were analyzed with histopathology reports TRUS-bx. 504 segments were grouped with Gleason scoring system, and all groups were compared with mean SUVmax values.
Results: Mean SUVmax value of Gleason grade group 1 (GG1, n: 352 segments) was 6.6 (±4.6) and significantly lower than the other groups (p < 0.001). No significant difference was detected within GG2-5 groups (p > 0.05). According to receiver operating characteristic curve analysis, SUVmax cutoff values were 1.0 (AUC: 0.961) for tumor detection, yielding a sensitivity, specificity, positive predictive value, negative predictive value of 99.4%, 92.1%, 96.5%, 98%, respectively, and 4.2 (AUC: 0.853) for detection of clinically significant PCa with 88.8%, 62.4%, 84.5%, and 71%, respectively. Although tumor percentage of biopsy core and Gleason group were correlated with SUVmax uptake, but patient age was not.
Conclusion: 68Ga-PSMA PET appears to be a reliable option for diagnosis and disease management in PCa and can be considered especially in discrimination of csPCa, and patients remained suspicious for disease.
{"title":"Correlation between Prostate Cancer Positive Cores and 68Ga-PSMA Distribution in Prostate Gland.","authors":"Süleyman Çankaya, Ahmet Ender Caylan, Funda Aydin, Murat Uçar, Ömer Kutlu","doi":"10.1159/000535466","DOIUrl":"10.1159/000535466","url":null,"abstract":"<p><strong>Introduction: </strong>The purpose of our study was to evaluate reliability of 68Ga-labeled prostate-specific membrane antigen positron emission tomography (68Ga-PSMA PET/CT) and identify appropriate SUVmax cutoff values in order to use for diagnosis, especially in patients remained clinically suspicious for prostate cancer (PCa).</p><p><strong>Methods: </strong>Eighty-four patients applied 68Ga-PSMA PET/CT subsequent to transrectal ultrasound-guided prostate biopsy (TRUS-bx) involved in this study retrospectively. 68Ga-PSMA PET/CT imagings were analyzed by a nuclear medicine physician, and region of interests were drawn manually in prostate diagrams including 6 segments for each patient. These marked diagrams were analyzed with histopathology reports TRUS-bx. 504 segments were grouped with Gleason scoring system, and all groups were compared with mean SUVmax values.</p><p><strong>Results: </strong>Mean SUVmax value of Gleason grade group 1 (GG1, n: 352 segments) was 6.6 (±4.6) and significantly lower than the other groups (p < 0.001). No significant difference was detected within GG2-5 groups (p > 0.05). According to receiver operating characteristic curve analysis, SUVmax cutoff values were 1.0 (AUC: 0.961) for tumor detection, yielding a sensitivity, specificity, positive predictive value, negative predictive value of 99.4%, 92.1%, 96.5%, 98%, respectively, and 4.2 (AUC: 0.853) for detection of clinically significant PCa with 88.8%, 62.4%, 84.5%, and 71%, respectively. Although tumor percentage of biopsy core and Gleason group were correlated with SUVmax uptake, but patient age was not.</p><p><strong>Conclusion: </strong>68Ga-PSMA PET appears to be a reliable option for diagnosis and disease management in PCa and can be considered especially in discrimination of csPCa, and patients remained suspicious for disease.</p>","PeriodicalId":23414,"journal":{"name":"Urologia Internationalis","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138452583","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: There is limited research into the efficacy and safety of tadalafil combined with tamsulosin for the treatment of lower urinary tract symptoms (LUTS) caused by benign prostatic hyperplasia (BPH), with or without erectile dysfunction (ED). Therefore, we aimed to investigate the efficacy and safety of combination therapy compared to that of monotherapy.
Methods: We searched PubMed, Embase, Cochrane Library, Web of Science, SinoMed, CNKI, WanFang Data Service Platform, and ClinicalTrials.gov to identify eligible studies. A total of 639 articles were retrieved, of which 12 were randomized controlled trials (RCTs) published as of February 2023 and included in this meta-analysis.
Results: After screening 639 articles, 12 RCTs including 1,531 subjects were considered eligible for the meta-analysis. The results showed that the total International Prostate System Score (total IPSS), maximum flow rate (Qmax), and quality of life (QoL) in tadalafil combined with tamsulosin were significantly better than those in monotherapy. Compared with tadalafil monotherapy, combination therapy mainly improved IPSS voiding. As for postvoid residual urine (PVR), the combination therapy did not improve PVR compared to the tadalafil group, but significantly improved PVR compared to the tamsulosin group. For the International Index of Erectile Function (IIEF), the curative effect of the combined group was better than that of the tamsulosin group but not better than that of the tadalafil group. In terms of safety, the adverse reactions (AEs) in the combined treatment group were significantly higher than those in the monotherapy group. None of the 12 RCTs reported serious adverse events.
Conclusions: Tadalafil combined with tamsulosin was more effective in the treatment of male LUTS/BPH, with or without ED, on the improvement of total IPSS, QoL, and Qmax. However, the benefits of combination therapy for ED remain unclear. However, combination therapy seemed to have a higher incidence of adverse reactions.
背景:关于他达拉非联合坦索罗辛治疗由良性前列腺增生症(BPH)引起的下尿路症状(LUTS)、伴有或不伴有勃起功能障碍(ED)的疗效和安全性的研究十分有限。因此,我们旨在研究联合疗法与单一疗法相比的疗效和安全性:我们检索了 PubMed、Embase、Cochrane Library、Web of Science、SinoMed、CNKI、万方数据服务平台和 ClinicalTrials.gov,以确定符合条件的研究。共检索到639篇文章,其中12篇为截至2023年2月发表的随机对照试验(RCT),并纳入本次荟萃分析:在筛选了 639 篇文章后,12 项随机对照试验(包括 1531 名受试者)被认为符合荟萃分析的条件。结果显示,他达拉非联合坦索罗辛治疗的国际前列腺系统总评分(total IPSS)、最大流量(Qmax)和生活质量(Qol)明显优于单药治疗。与他达拉非单药治疗相比,联合治疗主要改善了IPSS排尿情况。至于排尿后残余尿(PVR),与他达拉非组相比,联合疗法并未改善PVR,但与坦索罗辛组相比,联合疗法明显改善了PVR。在国际勃起功能指数(IIEF)方面,联合治疗组的疗效优于坦索罗辛组,但不优于他达拉非组。在安全性方面,联合治疗组的不良反应(AEs)明显高于单一治疗组。12项研究均未报告严重不良事件:结论:他达拉非联合坦索罗辛治疗男性LUTS/BPH(伴有或不伴有ED)对改善总IPSS、Qol和Qmax更有效。然而,联合疗法对治疗 ED 的益处仍不明确。不过,联合疗法的不良反应发生率似乎更高。
{"title":"Comparison of Monotherapies and Combination Therapy of Tamsulosin and Tadalafil for Treating Lower Urinary Tract Symptoms Caused by Benign Prostatic Hyperplasia with or without Erectile Dysfunction: A Meta-Analysis.","authors":"Jianping Liu, Weijian Zhou, Peng Zhang, Wei Zhang, Congwang Chang, Guanghua Fu","doi":"10.1159/000535606","DOIUrl":"10.1159/000535606","url":null,"abstract":"<p><strong>Background: </strong>There is limited research into the efficacy and safety of tadalafil combined with tamsulosin for the treatment of lower urinary tract symptoms (LUTS) caused by benign prostatic hyperplasia (BPH), with or without erectile dysfunction (ED). Therefore, we aimed to investigate the efficacy and safety of combination therapy compared to that of monotherapy.</p><p><strong>Methods: </strong>We searched PubMed, Embase, Cochrane Library, Web of Science, SinoMed, CNKI, WanFang Data Service Platform, and <ext-link ext-link-type=\"uri\" xlink:href=\"http://ClinicalTrials.gov\" xmlns:xlink=\"http://www.w3.org/1999/xlink\">ClinicalTrials.gov</ext-link> to identify eligible studies. A total of 639 articles were retrieved, of which 12 were randomized controlled trials (RCTs) published as of February 2023 and included in this meta-analysis.</p><p><strong>Results: </strong>After screening 639 articles, 12 RCTs including 1,531 subjects were considered eligible for the meta-analysis. The results showed that the total International Prostate System Score (total IPSS), maximum flow rate (Qmax), and quality of life (QoL) in tadalafil combined with tamsulosin were significantly better than those in monotherapy. Compared with tadalafil monotherapy, combination therapy mainly improved IPSS voiding. As for postvoid residual urine (PVR), the combination therapy did not improve PVR compared to the tadalafil group, but significantly improved PVR compared to the tamsulosin group. For the International Index of Erectile Function (IIEF), the curative effect of the combined group was better than that of the tamsulosin group but not better than that of the tadalafil group. In terms of safety, the adverse reactions (AEs) in the combined treatment group were significantly higher than those in the monotherapy group. None of the 12 RCTs reported serious adverse events.</p><p><strong>Conclusions: </strong>Tadalafil combined with tamsulosin was more effective in the treatment of male LUTS/BPH, with or without ED, on the improvement of total IPSS, QoL, and Qmax. However, the benefits of combination therapy for ED remain unclear. However, combination therapy seemed to have a higher incidence of adverse reactions.</p>","PeriodicalId":23414,"journal":{"name":"Urologia Internationalis","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138809320","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-01-01Epub Date: 2024-03-08DOI: 10.1159/000538237
Séverine Banek, Mike Wenzel, Benedikt Lauer, Quynh Chi Le, Benedikt Hoeh, Florestan Koll, Cristina Cano Garcia, Clara Humke, Jens Köllermann, Felix K H Chun, Marina Kosiba, Luis A Kluth
Introduction: Despite the prospective randomized controlled JAVELIN Bladder 100 trial, no real-world evidence exists regarding tumor characteristics, adverse events (AEs), and survival of avelumab maintenance (AVM)-treated patients with partial/complete response or stable disease after previous platinum-based chemotherapy for advanced/metastatic urothelial carcinoma (mUC).
Methods: We relied on our institutional database to identify mUC patients who received AVM between January, 2021 and December, 2023. The main outcomes consisted of overall survival (OS) and progression-free survival (PFS) and were computed by Kaplan-Meier estimates. Stratification was performed according to programmed death ligand 1 (PD-L1) status.
Results: Overall, 24 AVM patients were identified at a median age of 71 (interquartile range [IQR]: 67-76) years, of which 67% were males. Of these, 63%, 21%, and 17% received AVM therapy for bladder cancer and upper tract urothelial carcinoma or both, respectively. PD-L1 status was positive in 45% of patients. During AVM treatment, AEs were observed in 33% of patients; however, they were limited to ≤2 grade AEs. At a median follow-up of eight (IQR 4-20) months, 71% of patients had progressed under AVM with median PFS of 6.2 months (confidence interval [CI]: 3.2-18.2). Median OS was 13.4 (CI: 6.9 - not reached [NR]) months. One-year OS after AVM was 52%. In PD-L1-positive patients, median PFS and OS were 6.4 (CI: 2.7 - NR) months and 13.4 (CI: 7.7 months - NR), respectively.
Conclusion: AVM is associated with moderate AE rates. Despite similarities in baseline characteristics compared to trial-selected JAVELIN Bladder 100 mUC patients, AVM resulted in longer/similar PFS but significantly shorter OS in real-world setting.
{"title":"Real-World Evidence of Tumor and Patient Characteristics and Survival with Avelumab Maintenance after Chemotherapy for Advanced and Metastatic Urothelial Carcinoma.","authors":"Séverine Banek, Mike Wenzel, Benedikt Lauer, Quynh Chi Le, Benedikt Hoeh, Florestan Koll, Cristina Cano Garcia, Clara Humke, Jens Köllermann, Felix K H Chun, Marina Kosiba, Luis A Kluth","doi":"10.1159/000538237","DOIUrl":"10.1159/000538237","url":null,"abstract":"<p><strong>Introduction: </strong>Despite the prospective randomized controlled JAVELIN Bladder 100 trial, no real-world evidence exists regarding tumor characteristics, adverse events (AEs), and survival of avelumab maintenance (AVM)-treated patients with partial/complete response or stable disease after previous platinum-based chemotherapy for advanced/metastatic urothelial carcinoma (mUC).</p><p><strong>Methods: </strong>We relied on our institutional database to identify mUC patients who received AVM between January, 2021 and December, 2023. The main outcomes consisted of overall survival (OS) and progression-free survival (PFS) and were computed by Kaplan-Meier estimates. Stratification was performed according to programmed death ligand 1 (PD-L1) status.</p><p><strong>Results: </strong>Overall, 24 AVM patients were identified at a median age of 71 (interquartile range [IQR]: 67-76) years, of which 67% were males. Of these, 63%, 21%, and 17% received AVM therapy for bladder cancer and upper tract urothelial carcinoma or both, respectively. PD-L1 status was positive in 45% of patients. During AVM treatment, AEs were observed in 33% of patients; however, they were limited to ≤2 grade AEs. At a median follow-up of eight (IQR 4-20) months, 71% of patients had progressed under AVM with median PFS of 6.2 months (confidence interval [CI]: 3.2-18.2). Median OS was 13.4 (CI: 6.9 - not reached [NR]) months. One-year OS after AVM was 52%. In PD-L1-positive patients, median PFS and OS were 6.4 (CI: 2.7 - NR) months and 13.4 (CI: 7.7 months - NR), respectively.</p><p><strong>Conclusion: </strong>AVM is associated with moderate AE rates. Despite similarities in baseline characteristics compared to trial-selected JAVELIN Bladder 100 mUC patients, AVM resulted in longer/similar PFS but significantly shorter OS in real-world setting.</p>","PeriodicalId":23414,"journal":{"name":"Urologia Internationalis","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11305518/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140050398","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}