Urology Annals最新文献

Background: The risk stratification of prostate cancer using Gleason grade group (GG), serum prostate-specific antigen (PSA), and T staging has an important role for appropriate treatment. In fact, the GG of biopsy was not the same as the prostatectomy specimen. The upgrading of GG has a significant risk of delay treatment. The study aims to evaluate the concordance of GG between biopsy and prostatectomy specimens and the factors of upgrading GG.

Materials and methods: Retrospectively reviewed data from January 2010 to December 2019, 137 patients underwent prostate biopsy and followed by prostatectomy. Patients' data include pathological reports, imaging reports, serum PSA, PSA density (PSAD), and free PSA were analyzed by univariate and multivariate analysis.

Results: The concordance between the pathology was found in 54 specimens (39.4%) with the upgrading of GG in the prostatectomy was 57 specimens (41.6%). Furthermore, the downgrading was 26 specimens (18.9%). Serum PSA >10 ng/ml (P 0.003), PSAD >0.2 ng/ml/cm³ (P 0.002), free/total PSA ratio (P 0.003), margin positive for malignancy (P 0.033), and extraprostatic involvement (P 0.039) were significantly related with upgrading at the univariate analysis. Only a PSAD >0.2 (P 0.014) was found to be an independent factor that is predictive of upstaging in multivariate analysis.

Conclusions: The prevalence of upgrading of GG from prostate biopsy to radical prostatectomy is as high as the other study. The factor that related to upstaging of GG was PSAD. Therefore, additional tools for biopsy were required to enhance the accurate diagnosis and staging of prostate cancer.

Background: Transurethral resection of bladder tumors (TURBT) is the standard management for urinary bladder tumors; however, new techniques as Thulium laser en bloc resection of bladder tumors (TmLRBT) have been introduced as a substitute to TURBT.

Objectives: In this study safety, efficacy, and tumor recurrence after TmLRBT and TURBT were prospectively compared in patients with primary (<4 cm) bladder tumors.

Patients and methods: Between August 2019 and May 2021, patients with primary (<4 cm) bladder tumors were enrolled. Patients were randomized between the two procedures. All perioperative data were collected prospectively. Pathological specimen findings and recurrence rates were reported during follow-up visits.

Results: Sixty patients underwent TURBT, and another 60 had TmLRBT. No significant differences were detected in patient demographics or preoperative tumor characteristics between the two groups. Operation time was less (28.2 vs. 38.9 min, P < 0.001), and rate of bladder perforation was lower with TmLRBT compared to TURBT (3.3% vs. 15.0%, P = 0.027). In the TmLRBT group, higher rate of muscle detection (95.0% vs. 78.3%, P < 0.001) in the pathological specimen, and lower rate of tissue destruction (0.0% vs. 21.6%, P < 0.001) were obtained compared to TURBT. Recurrence rate in cases of nonmuscle invasive bladder cancer was lower with TmLRBT (6.7% vs. 33.0%, P < 0.001).

Conclusion: In this study, TmLRBT showed reduced operative time with lower perforation rates. Higher detection of detrusor muscle and less tissue destruction in the pathological specimen were obtained with TmLRBT, as well as lower rates of tumor recurrence. These findings suggest that TmLRBT is a safe and efficacious substitute to TURBT in tumors <4 cm.

Clostridioides difficile infection (CDI) is the second most common health care acquired infection (HAI) and the most common gastrointestinal HAI, with an estimated 365,200 cases reported by the center for disease control in 2017. CDI continues to remain a major cause of inpatient admission and utilization of health care resources. This study aimed to determine the true incidence, risk factors, and outcomes of CDI in patients undergoing cystectomy. We conducted an analysis of patients undergoing cystectomy between 2015 and 2017 using the American college of surgeon National Surgical Quality Improvement Program to study the incidence, risk factors, and 30 day postsurgical outcomes associated with CDI following cystectomy. Developed by the American College of Surgery, this is a nationally validated, risk adjusted, and outcomes based program designed to determine and improve the quality of surgical and postsurgical care. The incidence of CDI following cystectomy was 3.6% in our patient cohort. About 18.8% of patients developed CDI following hospital discharge. None elective surgeries and complete cystectomy procedures had a higher rate of CDI. About 48.4% of patients with CDI had a preceding postoperative infection. Postoperative organ space infections, postoperative renal failure, postoperative sepsis, and septic shock were independently associated with the development of CDI, (all P < 0.05). Patients who developed postoperative CDI during hospitalization had lengthier hospital admissions than those who did not develop a CDI and had a higher risk of deep venous thrombosis formation. A sizable number of patients experience CDIs after cystectomy procedures in the USA, and CDI development is associated with an increase in length of stay and unplanned readmissions. Interventions and initiatives are needed to reduce this burden of disease.

Introduction: Urinary incontinence (UI) is defined as the involuntary loss of urine. The condition can happen in both genders, but more frequently in women. There are multiple known risk factors for UI. For women, multiparity, previous vaginal deliveries, and menopause are known risk factors for UI. To diagnose UI, three steps should be done, including the patient history, physical examination, and laboratory tests. The options management of UI includes conservative, medical, and surgical, a trial of conservative treatment is recommended by all guidelines before medical or invasive surgical therapy. Conservative therapies include behavioral therapy, physical therapy, and timed voiding.

Aim: Our aim in this study is to estimate the prevalence of UI in admitted women and the general population and to compare UI between the general population and admitted women in Al-Kharj city.

Material: A quantitative cross-sectional study of 108 women admitted to maternity and children's hospital and 435 women from the general population of Al Kharj city, Saudi Arabia, between January and March 2021, aged 18+ years. A hard copy questionnaire was distributed to admitted patients at maternity and children's hospital, and an electronic questionnaire was distributed by social media to the general population.

Result: The prevalence of UI in the general population was reported by 132 women (30%). Seventy-four out of 132 women have stress UI (56%), 45 women have urge UI (34%), and the remaining 13 women have mixed UI (10%). The prevalence in admitted women was reported by 38 out of 108 women (35%). Twenty-four out of 38 women have stress UI (63%), 10 women have urgency UI (26%), and the remaining four women have mixed UI (11%).

Conclusion: UI is a common health problem in our society. Risk factors for UI are advanced age, multi parity, chronic disease, and obesity.

Objective: This study aimed to demonstrate our management of rectal injury (RI) and rectourinary fistula (RUF) from radical prostatectomy (RP) and identify a possible factor that increased the chance of developing RUF.

Materials and methods: Between January 2011 and December 2019, a total of 14 cases of RI were retrospectively reviewed and analyzed, including preoperative, perioperative, and postoperative information.

Results: In all 14 cases of RI, the average age at RP was 66.3 years (54-77). During the study period, 8 of 14 cases of RI occurred in our hospital, and the incidence of RI was 0.42%. RI was intraoperative recognition in 8 cases and delayed diagnosis in 6 cases. For immediate recognition, 4 of 8 cases were primarily repaired without developing RUF and did not require diverting colostomy and suprapubic cystostomy. RUF occurred in 10 cases including 4 cases of intraoperative recognition and all cases of delayed diagnosis. In a subgroup analysis of RI that occurred in our hospital, the timing for diagnosis was clinically and statistically significant difference (P = 0.029). Instantly detected RI during RP and intraoperative rectal repair resulted in no postoperative complication. Among all 10 cases of RUF, 5 cases were successfully repaired by modified York-Mason procedure with dartos tissue flap interposition. No major complications were reported.

Conclusions: Incidence of RI was 0.42% and intraoperative recognition of RI was a key to prevent the development of RUF. Modified York-Mason procedure with dartos tissue flap interposition was an effective treatment for RUF.

Background: Epithelial-mesenchymal transition (EMT) plays an important role in bladder carcinoma (BC) invasiveness and metastasis. Studies have shown that muscle-invasive BC (MIBC) and non-MIBC (NMIBC) are different at the molecular level owing to different EMT-related programming. Recent studies suggest that dysregulation of specific miRNAs is linked to EMT in BC. With this background, we aimed to study the immunoexpression of EMT-markers and its correlation with miRNA-200c expression in a series of MIBCs and NMIBCs.

Materials and methods: Quantitative real-time-polymerase chain reaction for the quantification of miR-200c expression was performed on 50 cases of urinary BC obtained from transurethral resection of bladder tumor (TURBT), cystectomy specimens, and ten peritumoral bladder tissue. Immunohistochemistry for ZEB1, ZEB2, TWIST, E-cadherin, and β-catenin was performed on tumor and peritumoral bladder tissue.

Results: Thirty-five TURBT and 15 cystectomy specimens were assessed. Among MIBC, loss of expression of E-cadherin (72.3%), β-catenin (66.7%), and ZEB1, ZEB2, and TWIST2 immunoreactivity was noted in 53.3%, 86.7%, and 73.3% of cases, respectively. Among NMIBC, loss of expression of E-cadherin (22.5%), β-catenin (17.1%) and ZEB1, ZEB2, and TWIST immunoreactivity was noted in 11.5%, 51.4%, and 91.4% of cases, respectively. Upregulation of miRNA-200c was noted in cases with retained E-cadherin and negative TWIST expression. Downregulation of miRNA-200c expression was noted in all the cases showing loss of E-cadherin, β-catenin, and in cases immunoreactive for ZEB1, ZEB2, and TWIST in MIBC. Downregulation of miRNA-200c expression was also noted in cases of MIBC with retained β-catenin and those immunonegative for ZEB1 and ZEB2. A similar trend was noted in NMIBC. Median miRNA-200c expression was low in both high-grade and low-grade NMIBC compared to peritumoral bladder tissue and was not statistically significant.

Conclusion: This study for the first time explores the relation of miR200C with E-cadherin, b-catenin, and its direct transcriptional regulators, namely Zeb1, Zeb2, and Twist in the same cohort of BC. We observed that miRNA-200c is downregulated in both MIBC and NMIBC. We identified novel expression of TWIST in cases of BC showing downregulation of miR200Cs suggesting that it is one of the protein targets of altered miRNA-200c expression contributing to EMT and can serve as a promising diagnostic marker and therapeutic target. Loss of E-cadherin and ZEB1 immunoexpression in high-grade NMIBC suggests an aggressive clinical behavior. However, ZEB2 heterogeneous expression in BC limits its diagnostic and prognostic utility.