Pub Date : 2024-02-14DOI: 10.3389/fruro.2024.1309532
Chamodi Pillippu Hewa, Stephen Della-Fiorentina, Kayvan Haghighi, Wei Chua, P. Kok
Induction intravesical Bacillus Calmette-Guerin (BCG) followed by maintenance after transurethral resection of bladder tumor, is the standard adjuvant therapy for high-risk non-muscle invasive bladder cancer (NMIBC). There is sparse evidence on the practice of intravesical BCG in Australia. Our aim was to determine the outcomes of intravesical BCG therapy in NMIBC in Southwestern Sydney.This was a multi-center retrospective audit of NMIBC patients who received intravesical BCG between January 2008 and June 2020. Data was collected across six tertiary hospitals in South Western Sydney. Primary outcome was disease-free survival (DFS). Secondary outcomes were overall survival (OS), BCG induction and maintenance rates.Of the 200 eligible patients over 12.5 years, median age was 77 years and 83% were male. Of these, 55%, 4.5%, 35% and 5% were Tis, Ta, T1 and unknown stage, respectively. All patients received induction BCG and 56% received maintenance BCG (range 3-36 months). Completion rate of induction BCG was 91%. Only 9% ceased treatment due to intolerance. The median duration of cystoscopy follow-up was 17 months. After a median follow-up time of 37 months, 55% developed recurrence (29% non-muscle invasive, 32% muscle-invasive disease, 8% distant metastasis). The 1-year and 5-year DFS rates were 72% and 41% (median DFS: 39 months). The 1-year and 5-year OS rates were 98% and 87% (median OS: not reached).The DFS and OS rates were comparable to previous literature. This provides real-world data to assist future clinical trials in NMIBC.
{"title":"Outcomes of intravesical Bacillus Calmette-Guerin in patients with non-muscle invasive bladder cancer: a retrospective study in Australia","authors":"Chamodi Pillippu Hewa, Stephen Della-Fiorentina, Kayvan Haghighi, Wei Chua, P. Kok","doi":"10.3389/fruro.2024.1309532","DOIUrl":"https://doi.org/10.3389/fruro.2024.1309532","url":null,"abstract":"Induction intravesical Bacillus Calmette-Guerin (BCG) followed by maintenance after transurethral resection of bladder tumor, is the standard adjuvant therapy for high-risk non-muscle invasive bladder cancer (NMIBC). There is sparse evidence on the practice of intravesical BCG in Australia. Our aim was to determine the outcomes of intravesical BCG therapy in NMIBC in Southwestern Sydney.This was a multi-center retrospective audit of NMIBC patients who received intravesical BCG between January 2008 and June 2020. Data was collected across six tertiary hospitals in South Western Sydney. Primary outcome was disease-free survival (DFS). Secondary outcomes were overall survival (OS), BCG induction and maintenance rates.Of the 200 eligible patients over 12.5 years, median age was 77 years and 83% were male. Of these, 55%, 4.5%, 35% and 5% were Tis, Ta, T1 and unknown stage, respectively. All patients received induction BCG and 56% received maintenance BCG (range 3-36 months). Completion rate of induction BCG was 91%. Only 9% ceased treatment due to intolerance. The median duration of cystoscopy follow-up was 17 months. After a median follow-up time of 37 months, 55% developed recurrence (29% non-muscle invasive, 32% muscle-invasive disease, 8% distant metastasis). The 1-year and 5-year DFS rates were 72% and 41% (median DFS: 39 months). The 1-year and 5-year OS rates were 98% and 87% (median OS: not reached).The DFS and OS rates were comparable to previous literature. This provides real-world data to assist future clinical trials in NMIBC.","PeriodicalId":73113,"journal":{"name":"Frontiers in urology","volume":"62 39","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139778717","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-02-13DOI: 10.3389/fruro.2024.1348002
Zachary C. Danziger, Daniel Jaskowak
Animal cystometry, a process of infusing fluid into the urinary bladder to evoke reflex contractions, is a common way to study the effects of pathology, injury, or experimental therapy on lower urinary tract (LUT) dynamics. By monitoring fluid movement during the cystometric micturition cycle, one can compute important quantities that indicate the health and function of the LUT, such as bladder capacity and voiding efficiency. Unfortunately, volume measurements in these difficult studies are often unpreventably corrupted by noise, leading to uncertainty when estimating key cystometric parameters.This work proposes a criterion, based on measurable quantities, that flags micturition cycles in cystometry studies that are likely to contain large measurement errors, potentially allowing experimenters to remove them from analysis to obtain a more accurate summary of LUT dynamics.We describe the criterion, validate it against experimental data, and use computer simulations to demonstrate its utility.
{"title":"On variability and detecting unreliable measurements in animal cystometry","authors":"Zachary C. Danziger, Daniel Jaskowak","doi":"10.3389/fruro.2024.1348002","DOIUrl":"https://doi.org/10.3389/fruro.2024.1348002","url":null,"abstract":"Animal cystometry, a process of infusing fluid into the urinary bladder to evoke reflex contractions, is a common way to study the effects of pathology, injury, or experimental therapy on lower urinary tract (LUT) dynamics. By monitoring fluid movement during the cystometric micturition cycle, one can compute important quantities that indicate the health and function of the LUT, such as bladder capacity and voiding efficiency. Unfortunately, volume measurements in these difficult studies are often unpreventably corrupted by noise, leading to uncertainty when estimating key cystometric parameters.This work proposes a criterion, based on measurable quantities, that flags micturition cycles in cystometry studies that are likely to contain large measurement errors, potentially allowing experimenters to remove them from analysis to obtain a more accurate summary of LUT dynamics.We describe the criterion, validate it against experimental data, and use computer simulations to demonstrate its utility.","PeriodicalId":73113,"journal":{"name":"Frontiers in urology","volume":"64 12","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139781543","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-02-13DOI: 10.3389/fruro.2024.1348002
Zachary C. Danziger, Daniel Jaskowak
Animal cystometry, a process of infusing fluid into the urinary bladder to evoke reflex contractions, is a common way to study the effects of pathology, injury, or experimental therapy on lower urinary tract (LUT) dynamics. By monitoring fluid movement during the cystometric micturition cycle, one can compute important quantities that indicate the health and function of the LUT, such as bladder capacity and voiding efficiency. Unfortunately, volume measurements in these difficult studies are often unpreventably corrupted by noise, leading to uncertainty when estimating key cystometric parameters.This work proposes a criterion, based on measurable quantities, that flags micturition cycles in cystometry studies that are likely to contain large measurement errors, potentially allowing experimenters to remove them from analysis to obtain a more accurate summary of LUT dynamics.We describe the criterion, validate it against experimental data, and use computer simulations to demonstrate its utility.
{"title":"On variability and detecting unreliable measurements in animal cystometry","authors":"Zachary C. Danziger, Daniel Jaskowak","doi":"10.3389/fruro.2024.1348002","DOIUrl":"https://doi.org/10.3389/fruro.2024.1348002","url":null,"abstract":"Animal cystometry, a process of infusing fluid into the urinary bladder to evoke reflex contractions, is a common way to study the effects of pathology, injury, or experimental therapy on lower urinary tract (LUT) dynamics. By monitoring fluid movement during the cystometric micturition cycle, one can compute important quantities that indicate the health and function of the LUT, such as bladder capacity and voiding efficiency. Unfortunately, volume measurements in these difficult studies are often unpreventably corrupted by noise, leading to uncertainty when estimating key cystometric parameters.This work proposes a criterion, based on measurable quantities, that flags micturition cycles in cystometry studies that are likely to contain large measurement errors, potentially allowing experimenters to remove them from analysis to obtain a more accurate summary of LUT dynamics.We describe the criterion, validate it against experimental data, and use computer simulations to demonstrate its utility.","PeriodicalId":73113,"journal":{"name":"Frontiers in urology","volume":"461 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139841460","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-01-24DOI: 10.3389/fruro.2023.1198980
D. Draeger, O. W. Hakenberg
Triple-drug cisplatin- and taxane-based chemotherapy is the standard treatment for metastatic penile squamous cell cancer (PeSCC), with a moderate response rate of 30% to 38%. Relapse after first-line chemotherapy has a poor prognosis and there is no established second-line treatment. Mitomycin C (MMC) is used as an effective chemotherapy in squamous cell carcinoma of other localities. We therefore used MMC as a single agent for the second-line treatment for patients with advanced PeSCC.Nine patients [median age 63 years (range 31 years–81 years)], who, after inguinal and pelvic lymphadenectomy and progression after first-line chemotherapy, received second-line treatment with 20 mg of MMC administered intravenously and weekly, were included in this study. The median number of cycles of MMC was 6 (range 2–12 cycles) and the median cumulative dose was 120 mg absolute (range 40 mg absolute–240 mg absolute). The patients’ toxicity and treatment responses were evaluated, with the latter evaluated using 18F-FDG-PET/CT.Common Terminology Criteria for Adverse Events (CTCAE) grades 3 or 4 thrombocytopenia and grades 2 or 3 leukopenia occurred in all patients, as did anemia. In seven patients, the application interval had to be extended due to thrombocytopenia. Stable disease was achieved in two patients, and all others progressed under treatment. Seven patients died of the disease, with most patients dying 6 months after starting MMC therapy. Of the two patients who responded with disease stabilization, one died of progressive disease 14 months after MMC treatment. The other responding patient has been stable for over 1 year and is still receiving treatment, which he tolerates well, and has a good quality of life.MMC has only moderate efficacy as a second-line treatment in patients with metastatic PeSCC. With MMC treatment, hematological toxicity is marked.
{"title":"Feasibility and effectiveness of second-line chemotherapy with mitomycin C in patients with advanced penile cancer","authors":"D. Draeger, O. W. Hakenberg","doi":"10.3389/fruro.2023.1198980","DOIUrl":"https://doi.org/10.3389/fruro.2023.1198980","url":null,"abstract":"Triple-drug cisplatin- and taxane-based chemotherapy is the standard treatment for metastatic penile squamous cell cancer (PeSCC), with a moderate response rate of 30% to 38%. Relapse after first-line chemotherapy has a poor prognosis and there is no established second-line treatment. Mitomycin C (MMC) is used as an effective chemotherapy in squamous cell carcinoma of other localities. We therefore used MMC as a single agent for the second-line treatment for patients with advanced PeSCC.Nine patients [median age 63 years (range 31 years–81 years)], who, after inguinal and pelvic lymphadenectomy and progression after first-line chemotherapy, received second-line treatment with 20 mg of MMC administered intravenously and weekly, were included in this study. The median number of cycles of MMC was 6 (range 2–12 cycles) and the median cumulative dose was 120 mg absolute (range 40 mg absolute–240 mg absolute). The patients’ toxicity and treatment responses were evaluated, with the latter evaluated using 18F-FDG-PET/CT.Common Terminology Criteria for Adverse Events (CTCAE) grades 3 or 4 thrombocytopenia and grades 2 or 3 leukopenia occurred in all patients, as did anemia. In seven patients, the application interval had to be extended due to thrombocytopenia. Stable disease was achieved in two patients, and all others progressed under treatment. Seven patients died of the disease, with most patients dying 6 months after starting MMC therapy. Of the two patients who responded with disease stabilization, one died of progressive disease 14 months after MMC treatment. The other responding patient has been stable for over 1 year and is still receiving treatment, which he tolerates well, and has a good quality of life.MMC has only moderate efficacy as a second-line treatment in patients with metastatic PeSCC. With MMC treatment, hematological toxicity is marked.","PeriodicalId":73113,"journal":{"name":"Frontiers in urology","volume":"44 9","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139601012","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-01-16DOI: 10.3389/fruro.2023.1335414
Pedro Amado, Shao-li Zheng, Dirk Lange, Dario Carugo, Sarah L. Waters, Dominik Obrist, Fiona Burkhard, F. Clavica
Ureteral stents are hollow tubes that are inserted into the ureter to maintain the flow of urine from the kidney to the bladder. However, the use of these indwelling stents is associated with potential complications. Biofilm, an organized consortium of bacterial species embedded within a self-producing extracellular matrix, can attach to the outer and inner surfaces of ureteral stents. Furthermore, encrustation - defined as the buildup of mineral deposits on the stent surface - can occur independently or in parallel with biofilm formation. Both phenomena can cause stent obstruction, which can lead to obstructive pyelonephritis and make stent removal difficult. Understanding the influence of flow on the development of biofilm and encrustation and the impact of small mechanical environmental changes (e.g., wall shear stress distribution) is key to improve the long-term performance of stents. Identifying the optimal stent properties to prevent early bacterial attachment and/or crystal deposition and their growth, would represent a breakthrough in reducing biofilm-/encrustation-associated complications. This review identifies the most prevalent bacterial strains and crystal types associated with ureteral stents, and the process of their association with the stent surface, which often depends on patient comorbidities, stent material, and indwelling time. Furthermore, we focus on the often-overlooked role of fluid dynamics on biofilm and encrustation development in ureteral stents, across a range of physical scales (i.e., from micro- to macro-scale) with the aim of providing a knowledge base to inform the development of safer and more effective ureteral stents.
{"title":"The interplay between bacterial biofilms, encrustation, and wall shear stress in ureteral stents: a review across scales","authors":"Pedro Amado, Shao-li Zheng, Dirk Lange, Dario Carugo, Sarah L. Waters, Dominik Obrist, Fiona Burkhard, F. Clavica","doi":"10.3389/fruro.2023.1335414","DOIUrl":"https://doi.org/10.3389/fruro.2023.1335414","url":null,"abstract":"Ureteral stents are hollow tubes that are inserted into the ureter to maintain the flow of urine from the kidney to the bladder. However, the use of these indwelling stents is associated with potential complications. Biofilm, an organized consortium of bacterial species embedded within a self-producing extracellular matrix, can attach to the outer and inner surfaces of ureteral stents. Furthermore, encrustation - defined as the buildup of mineral deposits on the stent surface - can occur independently or in parallel with biofilm formation. Both phenomena can cause stent obstruction, which can lead to obstructive pyelonephritis and make stent removal difficult. Understanding the influence of flow on the development of biofilm and encrustation and the impact of small mechanical environmental changes (e.g., wall shear stress distribution) is key to improve the long-term performance of stents. Identifying the optimal stent properties to prevent early bacterial attachment and/or crystal deposition and their growth, would represent a breakthrough in reducing biofilm-/encrustation-associated complications. This review identifies the most prevalent bacterial strains and crystal types associated with ureteral stents, and the process of their association with the stent surface, which often depends on patient comorbidities, stent material, and indwelling time. Furthermore, we focus on the often-overlooked role of fluid dynamics on biofilm and encrustation development in ureteral stents, across a range of physical scales (i.e., from micro- to macro-scale) with the aim of providing a knowledge base to inform the development of safer and more effective ureteral stents.","PeriodicalId":73113,"journal":{"name":"Frontiers in urology","volume":" 90","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139618862","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-01-08DOI: 10.3389/fruro.2023.1270509
Genevieve Baddoo, Adriana Ene, Zubia Merchant, Swarnali Banerjee, Alan J. Wolfe, C. Putonti
Continued efforts to isolate and sequence bacteria of the urinary tract has increased representation of these species in publicly available databases. This in turn has improved taxonomic classifications of the urinary microbiome (urobiome). Short-read sequencing targeting a variable region(s) of the 16S rRNA gene sequence has been fundamental in characterizing the urobiomes of males and females with and without lower urinary tract symptoms, as well as cancers of the urinary tract. Here, we have compiled a data set of full-length or near-full-length 16S rRNA gene sequences for the urobiome. To generate this data set, we first plated 203 isolates from the bladder on differential media and sequenced their full-length 16S rRNA gene sequence. We combined this data set with publicly available genomes from primarily the female urinary tract. The final data set includes 399 sequences representative of 160 different species from 73 genera. We assessed the ability of publicly available databases to correctly predict these sequences based on the V1-V3, V4, and V4-V6 variable regions. As expected, species designations based upon these variable regions is often not possible or incorrect. We also detected incorrect genus-level classifications. This data set can be used to supplement existing databases, by increasing urobiome species variation, and thus improve future studies characterizing urobiomes.
{"title":"Cataloging variation in 16S rRNA gene sequences of female urobiome bacteria","authors":"Genevieve Baddoo, Adriana Ene, Zubia Merchant, Swarnali Banerjee, Alan J. Wolfe, C. Putonti","doi":"10.3389/fruro.2023.1270509","DOIUrl":"https://doi.org/10.3389/fruro.2023.1270509","url":null,"abstract":"Continued efforts to isolate and sequence bacteria of the urinary tract has increased representation of these species in publicly available databases. This in turn has improved taxonomic classifications of the urinary microbiome (urobiome). Short-read sequencing targeting a variable region(s) of the 16S rRNA gene sequence has been fundamental in characterizing the urobiomes of males and females with and without lower urinary tract symptoms, as well as cancers of the urinary tract. Here, we have compiled a data set of full-length or near-full-length 16S rRNA gene sequences for the urobiome. To generate this data set, we first plated 203 isolates from the bladder on differential media and sequenced their full-length 16S rRNA gene sequence. We combined this data set with publicly available genomes from primarily the female urinary tract. The final data set includes 399 sequences representative of 160 different species from 73 genera. We assessed the ability of publicly available databases to correctly predict these sequences based on the V1-V3, V4, and V4-V6 variable regions. As expected, species designations based upon these variable regions is often not possible or incorrect. We also detected incorrect genus-level classifications. This data set can be used to supplement existing databases, by increasing urobiome species variation, and thus improve future studies characterizing urobiomes.","PeriodicalId":73113,"journal":{"name":"Frontiers in urology","volume":"47 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139444933","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-01-01Epub Date: 2025-01-14DOI: 10.3389/fruro.2024.1487873
William L Harryman, James P Hinton, Rafael Sainz, Jaime M C Gard, John M Ryniawec, Gregory C Rogers, Noel A Warfel, Beatrice S Knudsen, Raymond B Nagle, Juan J Chipollini, Benjamin R Lee, Belinda L Sun, Anne E Cress
In 2024, prostate cancer (PCa) remains the most common non-skin cancer in males within the United States, with an estimated 299,010 new cases, the highest increase incident trend rate (3.8%) of all cancers, and one of the eight deadliest. PCa cases are projected to double from 1.8 million to 2.9 million per year between 2020 and 2040. According to the National Comprehensive Cancer Network (NCCN) treatment guidelines, most cases (65%) are intermediate risk (Gleason sum score <7 [3 + 4, 4 + 3], prostate organ-confined, and PSA < 20) with treatment options limited to active surveillance, external beam radiation, and/or surgery to prevent metastasis in the long term (>10 years). It is increasingly recognized that the two most common subtypes of intermediate risk PCa are cribriform architecture (CA) and intraductal carcinoma of the prostate (IDC-P), which can occur together, and both are associated with increased metastatic risk, biochemical recurrence, and disease-specific mortality. Both subtypes display hypoxia, genomic instability, and are identified as Gleason 4 in pathology reports. However, since false negatives are common (up to 50%) in these subtypes on biopsy, more research is needed to reliably detect these subtypes that have an increased risk for invasive disease. We note that even with mpMRI-guided biopsies, the sensitivity is 54% for cribriform architecture and only 37% for IDC-P. The presence of these PCa subtypes in biopsy or radical prostatectomy (RP) tissue can exclude patients from active surveillance and from designation as intermediate risk disease, further underscoring the need for increased molecular understanding of these subtypes for diagnostic purposes. Understanding the heterogeneity of intermediate risk primary PCa phenotypes, using computational pathology approaches to evaluate the fixed biopsy specimen, or video microscopy of the surgical specimen with AI-driven analysis is now achievable. New research associating the resulting phenotypes with the different therapeutic choices and vulnerabilities will likely prevent extracapsular extension, the definition of high-risk disease, and upstaging of the final pathologic stage.
2024年，前列腺癌（PCa）仍然是美国男性中最常见的非皮肤癌，估计有299,010例新病例，是所有癌症中发病率增长趋势最高的（3.8%），也是八种最致命的癌症之一。预计在2020年至2040年间，前列腺癌病例将从每年180万例增加一倍至290万例。根据国家综合癌症网络（NCCN）治疗指南，大多数病例（65%）为中等风险（Gleason sum score 10年）。人们越来越认识到，中危性前列腺癌的两种最常见亚型是筛状结构癌（CA）和前列腺导管内癌（IDC-P），它们可以同时发生，并且两者都与转移风险增加、生化复发和疾病特异性死亡率相关。两种亚型均表现为缺氧、基因组不稳定，在病理报告中被鉴定为Gleason 4。然而，由于活组织检查中这些亚型的假阴性很常见（高达50%），因此需要更多的研究来可靠地检测这些具有增加侵袭性疾病风险的亚型。我们注意到，即使采用mpmri引导下的活检，筛状结构的敏感性为54%，而IDC-P的敏感性仅为37%。活检或根治性前列腺切除术（RP）组织中这些PCa亚型的存在可以将患者排除在主动监测之外，也可以将患者排除在中间风险疾病之外，这进一步强调了对这些亚型的分子理解以用于诊断的必要性。了解中级风险原发性PCa表型的异质性，使用计算病理学方法评估固定活检标本，或手术标本的视频显微镜与人工智能驱动的分析现在是可以实现的。新的研究将所产生的表型与不同的治疗选择和脆弱性联系起来，这可能会阻止囊外延伸、高风险疾病的定义和最终病理阶段的提前。
{"title":"Intermediate risk prostate tumors contain lethal subtypes.","authors":"William L Harryman, James P Hinton, Rafael Sainz, Jaime M C Gard, John M Ryniawec, Gregory C Rogers, Noel A Warfel, Beatrice S Knudsen, Raymond B Nagle, Juan J Chipollini, Benjamin R Lee, Belinda L Sun, Anne E Cress","doi":"10.3389/fruro.2024.1487873","DOIUrl":"10.3389/fruro.2024.1487873","url":null,"abstract":"<p><p>In 2024, prostate cancer (PCa) remains the most common non-skin cancer in males within the United States, with an estimated 299,010 new cases, the highest increase incident trend rate (3.8%) of all cancers, and one of the eight deadliest. PCa cases are projected to double from 1.8 million to 2.9 million per year between 2020 and 2040. According to the National Comprehensive Cancer Network (NCCN) treatment guidelines, most cases (65%) are intermediate risk (Gleason sum score <7 [3 + 4, 4 + 3], prostate organ-confined, and PSA < 20) with treatment options limited to active surveillance, external beam radiation, and/or surgery to prevent metastasis in the long term (>10 years). It is increasingly recognized that the two most common subtypes of intermediate risk PCa are cribriform architecture (CA) and intraductal carcinoma of the prostate (IDC-P), which can occur together, and both are associated with increased metastatic risk, biochemical recurrence, and disease-specific mortality. Both subtypes display hypoxia, genomic instability, and are identified as Gleason 4 in pathology reports. However, since false negatives are common (up to 50%) in these subtypes on biopsy, more research is needed to reliably detect these subtypes that have an increased risk for invasive disease. We note that even with mpMRI-guided biopsies, the sensitivity is 54% for cribriform architecture and only 37% for IDC-P. The presence of these PCa subtypes in biopsy or radical prostatectomy (RP) tissue can exclude patients from active surveillance and from designation as intermediate risk disease, further underscoring the need for increased molecular understanding of these subtypes for diagnostic purposes. Understanding the heterogeneity of intermediate risk primary PCa phenotypes, using computational pathology approaches to evaluate the fixed biopsy specimen, or video microscopy of the surgical specimen with AI-driven analysis is now achievable. New research associating the resulting phenotypes with the different therapeutic choices and vulnerabilities will likely prevent extracapsular extension, the definition of high-risk disease, and upstaging of the final pathologic stage.</p>","PeriodicalId":73113,"journal":{"name":"Frontiers in urology","volume":"4 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11932713/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143702436","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-12-18DOI: 10.3389/fruro.2023.1323444
Natalija Kovacevic, Larry Sirls, J. Gilleran, Kenneth Peters
Chronic pelvic pain conditions such as pudendal neuralgia pose significant treatment difficulty due to their elusive etiology and diverse symptomatology. Initially approved as a third or fourth-line treatment of non-obstructive urinary retention and fecal incontinence, neuromodulation has also proven effective for pelvic pain associated with urinary dysfunction. Recently, sacral and pudendal neuromodulation has demonstrated efficacy in managing a spectrum of chronic pelvic conditions including refractory pudendal neuralgia. The individualized approach of peripheral neuromodulation has opened new avenues for tailored medical interventions, extending its application to conditions such as pudendal neuralgia, post sling pain, and vulvodynia. New technologies leading to miniaturized neuromodulation devices such as Freedom® stimulators (Curonix), allows us to implant leads and modulate nerves at precise pain targets. Further experience and research is needed to assess the impact of targeted neuromodulation on managing complex pelvic pain conditions.
{"title":"Peripheral nerve stimulation for pudendal neuralgia and other pelvic pain disorders: current advances","authors":"Natalija Kovacevic, Larry Sirls, J. Gilleran, Kenneth Peters","doi":"10.3389/fruro.2023.1323444","DOIUrl":"https://doi.org/10.3389/fruro.2023.1323444","url":null,"abstract":"Chronic pelvic pain conditions such as pudendal neuralgia pose significant treatment difficulty due to their elusive etiology and diverse symptomatology. Initially approved as a third or fourth-line treatment of non-obstructive urinary retention and fecal incontinence, neuromodulation has also proven effective for pelvic pain associated with urinary dysfunction. Recently, sacral and pudendal neuromodulation has demonstrated efficacy in managing a spectrum of chronic pelvic conditions including refractory pudendal neuralgia. The individualized approach of peripheral neuromodulation has opened new avenues for tailored medical interventions, extending its application to conditions such as pudendal neuralgia, post sling pain, and vulvodynia. New technologies leading to miniaturized neuromodulation devices such as Freedom® stimulators (Curonix), allows us to implant leads and modulate nerves at precise pain targets. Further experience and research is needed to assess the impact of targeted neuromodulation on managing complex pelvic pain conditions.","PeriodicalId":73113,"journal":{"name":"Frontiers in urology","volume":" 25","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138995272","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-12-12DOI: 10.3389/fruro.2023.1275334
Sara B. Papp, Philippe E. Zimmern
Type 2 diabetes mellitus is considered a risk factor for developing recurrent urinary tract infections. This review examined current knowledge on the incidence rates, bacterial strains, risk factors, treatments, and outcomes of recurrent urinary tract infections in type 2 diabetes, predominantly in women.A systematic review was conducted for all English language articles from inception to June 2022 utilizing the Cochrane and Preferred Reporting Items for Systematic Reviews and Meta-Analyses standards in the databases PubMed, OVID Embase, and Cochrane Library. References were cross-examined for further articles. Data collected described the prevalence, characteristics, and management of recurrent urinary tract infections. Risk of bias assessments were performed for all studies.From 3342 identified articles, 597 met initial study criteria. Fifteen studies from 10 countries were included after full-text reviews. Four studies found higher recurrent urinary tract infection rates in diabetics versus non-diabetics meanwhile others reported recurrence rates from 23.4% to 37%. Four of five studies found diabetes to be a risk factor for recurrent urinary tract infection. E. coli was the most frequent causative pathogen. Antibiotic prescription results varied; however, multiple studies determined that longer treatment (≥ 5 days) did not correlate with lower recurrence rates. Risk of bias assessments found the most frequent study weakness to be identification of confounding variables.This review covered multiple subtopics, with few comprehensive or generalizable results, suggesting a need for more research on how recurrent urinary tract infections can be better evaluated and managed in women with type 2 diabetes.
{"title":"Recurrent Urinary tract infections and type 2 diabetes mellitus: a systematic review predominantly in women","authors":"Sara B. Papp, Philippe E. Zimmern","doi":"10.3389/fruro.2023.1275334","DOIUrl":"https://doi.org/10.3389/fruro.2023.1275334","url":null,"abstract":"Type 2 diabetes mellitus is considered a risk factor for developing recurrent urinary tract infections. This review examined current knowledge on the incidence rates, bacterial strains, risk factors, treatments, and outcomes of recurrent urinary tract infections in type 2 diabetes, predominantly in women.A systematic review was conducted for all English language articles from inception to June 2022 utilizing the Cochrane and Preferred Reporting Items for Systematic Reviews and Meta-Analyses standards in the databases PubMed, OVID Embase, and Cochrane Library. References were cross-examined for further articles. Data collected described the prevalence, characteristics, and management of recurrent urinary tract infections. Risk of bias assessments were performed for all studies.From 3342 identified articles, 597 met initial study criteria. Fifteen studies from 10 countries were included after full-text reviews. Four studies found higher recurrent urinary tract infection rates in diabetics versus non-diabetics meanwhile others reported recurrence rates from 23.4% to 37%. Four of five studies found diabetes to be a risk factor for recurrent urinary tract infection. E. coli was the most frequent causative pathogen. Antibiotic prescription results varied; however, multiple studies determined that longer treatment (≥ 5 days) did not correlate with lower recurrence rates. Risk of bias assessments found the most frequent study weakness to be identification of confounding variables.This review covered multiple subtopics, with few comprehensive or generalizable results, suggesting a need for more research on how recurrent urinary tract infections can be better evaluated and managed in women with type 2 diabetes.","PeriodicalId":73113,"journal":{"name":"Frontiers in urology","volume":"7 6","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139009686","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-12-08DOI: 10.3389/fruro.2023.1324696
Alireza Ghasemzadeh, Eric T. Wendt, Brendan Dolan, Juliana Craig, G. Allen, E. J. Abel, D. D. Shapiro
To describe the treatment and outcomes of patients who are medically immunosuppressed due to prior organ transplantation or autoimmune disease with clinical T1 renal cell carcinoma (cT1).An institutional database of patients treated for RCC was queried for patients with cT1 RCC and on chronic medical immunosuppression at the time of RCC diagnosis. The outcomes for patients undergoing (1) surgery, (2) ablation, or 3) active surveillance (AS) are described.Between 2010 and 2022, 74 medically immunosuppressed patients with RCC were identified and treated using surgery (n = 29), ablation (n = 33), or AS (n = 12). Seven (58%) AS patients underwent deferred treatment (six ablations and one nephrectomy) due to tumor growth. For surgery patients and ablation patients, the 30-day readmission rates [17% and 9%, respectively (p = 0.7)], and 90-day complication rates [24% and 21%, respectively (p = 0.9)] were similar. One (3%) surgical patient and two (6%) ablation patients recurred locally. Despite being immunosuppressed, only one (3%) surgical patient, one (3%) ablation patient, and no AS patients progressed to metastatic disease. No significant differences were noted for the local recurrence-free rates, metastasis-free rates, and overall survival for the three cohorts (p > 0.05 for all).Patients with stage one RCC with medical immunosuppression can be safely managed through surgery, thermal ablation, or active surveillance, with similar outcomes to historical series of non-immunosuppressed patients. Future prospective studies should investigate shared decision making in this patient cohort and include discussion of less aggressive options that minimize morbidity but preserve oncologic control.
{"title":"Management of stage 1 renal cell cancer in patients immunosuppressed for organ transplantation or autoimmune disease","authors":"Alireza Ghasemzadeh, Eric T. Wendt, Brendan Dolan, Juliana Craig, G. Allen, E. J. Abel, D. D. Shapiro","doi":"10.3389/fruro.2023.1324696","DOIUrl":"https://doi.org/10.3389/fruro.2023.1324696","url":null,"abstract":"To describe the treatment and outcomes of patients who are medically immunosuppressed due to prior organ transplantation or autoimmune disease with clinical T1 renal cell carcinoma (cT1).An institutional database of patients treated for RCC was queried for patients with cT1 RCC and on chronic medical immunosuppression at the time of RCC diagnosis. The outcomes for patients undergoing (1) surgery, (2) ablation, or 3) active surveillance (AS) are described.Between 2010 and 2022, 74 medically immunosuppressed patients with RCC were identified and treated using surgery (n = 29), ablation (n = 33), or AS (n = 12). Seven (58%) AS patients underwent deferred treatment (six ablations and one nephrectomy) due to tumor growth. For surgery patients and ablation patients, the 30-day readmission rates [17% and 9%, respectively (p = 0.7)], and 90-day complication rates [24% and 21%, respectively (p = 0.9)] were similar. One (3%) surgical patient and two (6%) ablation patients recurred locally. Despite being immunosuppressed, only one (3%) surgical patient, one (3%) ablation patient, and no AS patients progressed to metastatic disease. No significant differences were noted for the local recurrence-free rates, metastasis-free rates, and overall survival for the three cohorts (p > 0.05 for all).Patients with stage one RCC with medical immunosuppression can be safely managed through surgery, thermal ablation, or active surveillance, with similar outcomes to historical series of non-immunosuppressed patients. Future prospective studies should investigate shared decision making in this patient cohort and include discussion of less aggressive options that minimize morbidity but preserve oncologic control.","PeriodicalId":73113,"journal":{"name":"Frontiers in urology","volume":"78 9","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138586742","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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