Indian Journal of Urology最新文献

Introduction: Recently, the Prostate Imaging Reporting and Data System - 3 lesions (PI-RADS 3) have been sub classified into "3a" - lesions with a volume of <0.5 mL and "3b" - lesions exceeding 0.5 mL, whereas the prostate-specific antigen density (PSAD) is an established adjunct tool for predicting clinically significant prostate cancer (csPCa). The objective of this study was to evaluate the association between the volume of PI-RADS 3 lesions and PSAD in diagnosing csPCa and to assess the sensitivity, specificity, negative predictive value (NPV), and positive predictive value (PPV) when PSAD is combined with the lesion volume.

Methods: This retrospective single-center study reviewed the data of transperineal prostate biopsies performed under transrectal ultrasound guidance from January 2018 to December 2023. csPCa was defined as a Gleason score ≥3 + 4. Patients were divided into two groups based on the PIRADS-3 subclassification and PSAD.

Results: Out of the 108 PIRADS-3 lesions, 17 patients had csPCa. All the patients with PIRADS-3a (n = 37) had clinically insignificant tumors or benign conditions. Receiver operating characteristic curve analysis for predicting csPCa showed that the (Area under the curve) AUC values of PSAD, prostate volume, and prostate-specific antigen were 0.899, 0.746, and 0.381, respectively. 16 csPCa patients in PIRADS-3b category had PSAD ≥0.29 ng/ml², whereas 1 patient had PSAD <0.29 ng/ml². Sensitivity, specificity, PPV, and NPV of PIRADS-3b lesions were 100%, 40.66%, 23.94%, and 100%, respectively, and it became 94.12%, 74.07%, 53.33%, and 97.56%, respectively, when PSAD was added to PIRADS-3b lesions.

Conclusion: The combination of lesion volume of the PI-RADS 3 lesion and PSAD improved the PPV and specificity of detecting csPCa.

This video explores the technique of robot-assisted pyeloplasty using the Da-Vinci Single-Port robot through the supine anterior retroperitoneal access in a 28-year-old male with a right-sided ureteropelvic junction obstruction. The patient was placed in a supine position, with a 10°-20° elevation of the ipsilateral flank. Retroperitoneal access was obtained at the McBurney's point for the placement of the port. The standardized steps of the Anderson-Hynes pyeloplasty technique were executed. Operative time was 120 min with 10 mL of blood loss. The patient was discharged on the same day without complications. At 4-months follow-up, on the renal scan, the right kidney showed stable function with improved drainage.

Purpose: This study aims to assess the impact of unclassified renal cell carcinoma (uRCC) on clinical, pathological, and oncological outcomes compared with clear cell renal cell carcinoma (ccRCC).

Materials and methods: We analyzed the data of 48 uRCC and 688 ccRCC cases, collected from a histopathological database at a single center from July 2011 to August 2019. uRCC cases were confirmed according to the 2016 World Health Organization classification. Baseline characteristics, clinical findings, and oncological outcomes were compared between the groups.

Results: Patients with uRCC exhibited the same clinical symptoms as ccRCC patients, a higher prevalence of lymphadenopathy (31.2% vs. 15.8%, P < 0.01), and greater sarcomatoid/rhabdoid differentiation on histology (12.5% vs. 5%, P = 0.03) compared to ccRCC patients. Although there was no difference regarding overall metastasis at initial diagnosis, distant lymphadenopathy (16.7% vs. 7.8%, P = 0.04) and liver metastasis (8.9% vs. 2.8%, P = 0.04) were more common in the uRCC group. The two groups had similar high-grade (HG) frequency on histology (62.5% for uRCC vs. 53.7% for ccRCC, P = 0.23). The estimated recurrence-free survival at 48 months was 94.3% for uRCC, 92.5% for low-grade (LG) ccRCC (P = 0.91), and 66.5% for HG ccRCC (P < 0.01). The estimated overall survival at 48 months was 66.1% for uRCC, 87.4% for LG ccRCC (P = 0.75), and 63.4% for HG ccRCC (P < 0.01).

Conclusion: Our study demonstrates that uRCC has significantly higher rates of lymphadenopathy, sarcomatoid differentiation, and liver metastasis compared to ccRCC. Despite these differences, uRCC presents with similar clinical symptoms and histological grade as ccRCC. Furthermore, uRCC exhibits a recurrence rate comparable to LG ccRCC and an overall survival rate similar to HG ccRCC.

Introduction: Despite level 1 evidence supporting neoadjuvant chemotherapy (NACT) followed by radical cystectomy (RC) for muscle-invasive bladder cancer (MIBC), its adoption is hindered by concerns about toxicity and detrimental impact on post-RC complications. We retrospectively reviewed post-RC complications at a tertiary care hospital, particularly assessing impact of NACT.

Methods: Data from the institutional bladder cancer database were retrieved for patients aged ≥18 with MIBC (≥American Joint Committee on Cancer Clinical Stage T2), treated with RC between May 2013 and July 2023. Exclusions were nonurothelial histology, salvage cystectomy, and palliative intent. Data abstracted included patient characteristics, NACT administration, surgery, and outcomes. Patients were divided into two groups based on NACT and compared. Complications were categorized as early (≤30 days) or late (31-90 days) and graded. Statistical analysis set significance at P < 0.05.

Results: Of 154 patients who underwent RC, 33 were excluded due to non-MIBC, nonurothelial histology, or salvage cystectomy. The 121 patients analyzed had a mean age of 64 years and a Charlson Comorbidity Index (CCI) of 4.9. Among them, 61 received NACT and 60 did not. There was no significant difference between the NACT+RC and RC-only groups in overall complication rates (85.3% vs. 75.0%, P = 0.16) or in major complications (50.8% vs. 58.3%, P = 0.41). CCI >5 predicted major complications, while NACT did not.

Conclusion: In our study of MIBC patients managed at a tertiary care institute in India, NACT administration did not increase postoperative complications.

Background and objective: Primary hyperoxaluria (PH), a rare autosomal recessive disorder, results in defective metabolism of oxalate, leading to increased oxalate levels. Oxalobacter formigenes (O. formigenes) is a nonpathological anaerobic bacterium that uses oxalate for its survival and thus decreases the plasma oxalate levels. We aimed to use randomized controlled trials (RCTs) to evaluate the efficacy of O. formigenes in treating PH.

Methods: A literature review was conducted for synthesizing the evidence from RCTs on Scopus, Web of Science, Embase, PubMed, and CENTRAL until January 2023. The outcomes were pooled using mean difference (MD) for continuous data and odds ratios (OR) for dichotomous data along with confidence interval (CI). The systematic review is registered with Prospero ID CRD42023404421.

Results: We included five RCTs with 208 patients. The pooled analysis did not favor O. formigenes over placebo in reducing the plasma oxalate levels (MD: -0.00 mmol/day; 95% CI: [ - 0.01-0.00]; P = 0.06). Similar results were observed for urinary oxalate levels (MD: -0.01 mmol/day; 95% CI: [ - 0.12-0.10]; P = 0.86). There were no significant adverse events (OR: 0.44; 95% CI: [0.14-1.39]; P = 0.16) or serious adverse events (OR: 0.80; 95% CI: [0.29-2.25]; P = 0.67).

Conclusion: O. formigenes was ineffective in reducing the serum and urine oxalate levels in patients with PH but has an acceptable safety profile. As PH is a relatively rare disease and few patients consent for the trials, stringent protocols are required in the future to achieve data accuracy pertinent for making conclusive recommendations on the efficacy of O. formigenes in patients with PH.

Introduction: Neoadjuvant chemotherapy (NAC) in the management of muscle-invasive bladder carcinoma has not been adopted universally. We studied the oncological outcomes and complications in patients who underwent radical cystectomy (RC) with or without NAC.

Methods: A retrospective review of patients who underwent RC with or without NAC from June 2009 to June 2020 was conducted. Oncological outcomes, overall survival (OS) and recurrence-free survival (RFS), complications, and prognostic factors were analyzed.

Results: Of the 314 patients who underwent RC, 83 patients received NAC (Group A), and 231 underwent RC alone (Group B). The median age was 58 years. The median follow-up duration was 22 (3-64) and 24 (3-62) months, respectively. The median OS in Group A was significantly higher than Group B (38 months [confidence interval (CI): 34-42] and 32 [CI: 29-35], respectively, [P = 0.033]). The RFS in Groups A and B was 34 (CI: 30-39) and 31 (CI: 28-34) months, respectively (P = 0.47). Higher pathological T stage (T3/4), node positivity and lymphovascular invasion (LVI) were predictors of poor OS and RFS (P < 0.0001). Clavien grades 3/4 complications were comparable (8% vs. 15%; P = 0.19). Glomerular filtration rate (GFR) <60 mL/min/1.73 m² was associated with higher postoperative complications in both groups (P = 0.012).

Conclusion: The OS with NAC was superior to upfront RC. RFS was, however, comparable. NAC was safe and well-tolerated. Pathologically, higher T stage, node positivity, and LVI were associated with poorer OS and RFS. Low GFR negatively influenced postoperative complications.

Introduction: Gallium-68 prostate-specific membrane antigen positron emission tomography (⁶⁸Ga-PSMA PET) is being increasingly used in patients with prostate cancer (PCa) for the staging and detection of lymph node (LN) metastases, despite a lack of prospective, validated evidence. We aimed to investigate the relationship between the PSMA PET findings (maximum standardized uptake [SUV_max] value) and the final histopathology results (Gleason Grade [GG], and LN positivity) in patients undergoing radical prostatectomy.

Methods: This is a single centre, prospective, observational study of 63 consecutive eligible patients treated at a tertiary care centre in India. Patients underwent ⁶⁸Ga-PSMA PET computed tomography with fusion magnetic resonance imaging for staging, followed by a Transrectal ultrasound guided prostate biopsy. All patients underwent robotic-assisted radical prostatectomy with extended pelvic LN dissection as per the standard protocol. Clinical parameters and SUV_max values were collected and analysed.

Results: The median preoperative prostate specific antigen (PSA) was 15.0 ng/ml (interquartile range: 9.4-28.0). A statistically significant correlation was observed between the PSA values and the SUV_max uptake (P < 0.001). Additionally, there was a statistically significant correlation between the SUV_max of the prostatic lesion and the GG on the radical prostatectomy specimens (P = 0.025), and SUV_max of LN and LN involvement (P < 0.001). The sensitivity and specificity of the ⁶⁸Ga-PSMA PET scan were 77.8% and 88.7%, respectively.

Conclusions: SUVmax of the PCa lesion and the GG Group on the final histopathology correlates significantly. There is an increased SUV uptake in Gleason's Score (GS) 8, 9 tumours as compared to GS 6 and 7.