American journal of clinical and experimental urology最新文献

Objective: The objective of this study was to investigate the relationship between situational cues (running water, stress, cold, etc.) and overactive bladder (OAB) symptoms.

Methods: Women scheduled for urodynamic studies for clinical indications completed surveys to characterize OAB (ICIQ-OAB and OAB-V3) and responses to situational cues (validated long-form cues survey and a novel short-form cues survey). Participants were divided into two groups (Low-Bother urgency vs. High-Bother urgency), and OAB and cue survey responses were compared.

Results: A total of 47 participants were enrolled in the study with 36 meeting inclusion criteria (15 Low-Bother and 21 High-Bother) with an overall mean age of 60.0 ± 10.0 years. The High-Bother urgency group scored significantly higher on multiple cue items in the long-form (P<0.05) and only "running water" in the short-form cues survey (P<0.05). In addition, "running water" was the only cue that was scored higher in both surveys (P<0.05).

Conclusions: This study showed that patients with High-Bother urgency may have increased symptom responses to environmental, mood, and cognitive cues. These findings suggest increased sensitivity to cues, especially "running water" in participants with bothersome OAB and the potential presence of a cue-specific OAB phenotype.

Objectives: MRI-targeted biopsy (T-Bx) for which Prostate Imaging Reporting and Data System (PI-RADS) assessment categories are useful has been shown to more accurately detect clinically significant prostate cancer. However, the prognostic significance of the PI-RADS in prostate cancer patients needs further investigation. In the present study, we compared radical prostatectomy findings and postoperative oncologic outcomes in men with prostate cancer initially undergoing T-Bx for PI-RADS 3 vs. 4 vs. 5 lesions.

Methods: We assessed consecutive patients undergoing T-Bx with concurrent systematic biopsy (S-Bx), followed by radical prostatectomy. Within our Surgical Pathology database, we identified a total of 207 men where prostatic adenocarcinoma was detected on either S-Bx or T-Bx, or both.

Results: Prostate cancer was detected on S-Bx only (n = 32; 15%), T-Bx only (n = 39; 19%), or both S-Bx and T-Bx (n = 136; 66%). These patients had PI-RADS 3 (n = 42; 20%), 4 (n = 86; 42%), or 5 (n = 79; 38%) lesions, while T-Bx detected cancer in 31 (74%) of PI-RADS 3 cases, 72 (84%) of PI-RADS 4 cases, and 72 (91%) of PI-RADS 5 cases. There were no significant differences in any of the clinicopathologic features examined, including tumor grade on biopsy or prostatectomy and pT or pN stage, among the PI-RADS 3 vs. 4 vs. 5 groups, except a significantly higher rate of positive margin and significantly larger tumor volume in PI-RADS 5 cases than in PI-RADS 3 cases. Univariate and multivariable analyses revealed significantly higher risks of biochemical recurrence after prostatectomy in patients with PI-RADS 5 lesion than in those with PI-RADS 3 or 4 lesion. Additionally, compared with respective controls, detection of any grade cancer (P = 0.046) or Grade Group 2 or higher cancer (P = 0.005) on T-Bx was associated with a significantly higher risk of recurrence in patients with PI-RADS 5 lesion, but not in those with PI-RADS 3 or 4 lesion.

Conclusion: PI-RADS 5 lesions were thus found to independently predict a significantly poorer postoperative prognosis. Moreover, the failure of detection of any grade cancer or clinically significant cancer on T-Bx of PI-RADS 5 lesion may particularly indicate favorable outcomes in radical prostatectomy cases.

Objective: To investigate the effect of saline perfusion before catheter removal in patients with benign prostatic hyperplasia (BPH) treated with GreenLight laser photoselective vaporization of the prostate (PVP).

Materials and methods: Patients (n=200) with BPH treated with PVP were divided into perfusion (n=100) and control (n=100) groups. For the perfusion group, saline (200 mL or the maximum capacity tolerated) was irrigated into the bladder after standardized external urethral disinfection, and the catheter was removed. Catheter removal was routinely performed in the control group. Perioperative adverse events and clinical outcomes were compared between the groups.

Results: Patients in the perfusion group had a shorter waiting time [3 (0-4) vs. 15 (8.75-26) min; P<0.001] and a better satisfaction grade [24 (21.75-26) vs. 23 (20-25); P=0.016] for first urination than those in the control group. The perfusion group exhibited lower anxiety levels regarding first urination than the control group [1 (1-2) vs. 1.5 (1-2), respectively; P=0.012]. Urinalysis revealed that the perfusion group had significantly lower white blood cell (WBC) count than the control group on the day [25.5 (8-37.75) vs. 43.5 (24.0-64.75); P<0.001] and 2 weeks [20.5 (11-27) vs. 31.0 (20-42); P<0.001] after catheter removal. No significant differences in treatment-related adverse events were observed [perfusion (n=15), control (n=20)].

Conclusion: Saline perfusion before catheter removal in patients with BPH treated with PVP could shorten the waiting time for first urination, improve patient anxiety and satisfaction and reduce postoperative urinary WBC levels.

Objective: To evaluate rebiopsy rates and clinicopathologic outcomes in patients after a negative MRI-guided biopsy to better inform the management of these patients.

Methods: Patients were included with a clinical suspicion of prostate cancer (PCa) referred for fusion biopsy for a PI-RADS v2.1 lesion ≥ 3 on multiparametric MRI and a negative MRI fusion biopsy. Biopsies included targeted and systematic cores. Patients with a prior cancer diagnosis were excluded. Both baseline and follow-up clinicopathological data, and long-term PSA values were examined in these patients. Statistical analyses included Wilcoxon rank-sum test and one-way tests.

Results: Of 685 total patients, 188 (27%) had a negative fusion biopsy. Of these 88 (47%), 74 (39%), and 26 (14%) had PI-RADS 3, 4, 5 lesions, respectively. Complete follow-up was available for 182/188 patients (97%), with a median of 24 months (interquartile range: 12-38). Post-biopsy PSA levels decreased the first and the second year (-0.24; and -0.84 ng/ml/yrs respectively). In follow-up, 44 patients had an MRI (24%) and 20 had a biopsy (10%). A positive PSA velocity was the only predictive variable for repeat MRI in univariate analysis. On repeat MRI, 9 (27%) patients had disappearance of the initial lesion, 21 (48%) had a lower PIRADS score and 14 (32%) higher. Only 12/182 (6.6%) were found to have PCa during follow-up, of those 7 (3.8%) were clinically significant.

Conclusion: For patients with nonmalignant biopsy findings after an initial mpMRI showing a suspicious PI-RADS lesion, the majority of patients will have their PSAs return to baseline over time. To support this, repeat MRI frequently demonstrated a disappearance or downgrading of PIRADS lesions. These data support monitoring patients with this clinical scenario.

Objective: The specific anatomic characteristics of the right internal spermatic vein (ISV) are pivotal factors in embolism failure. However, the inherent angles and configurations of the right ISV remain incompletely explored. This study aimed to address this gap by conducting a thorough investigation into the specific anatomic characteristics of the right ISV using imaging analysis in southwest China.

Methods: This retrospective study analyzed the imaging data of 1000 male patients who underwent multidetector spiral computed tomography (MCT). Anatomic characteristics of the right ISV, including position, type, distance, and angle, were also evaluated.

Results: The most common anatomic type (87.8%) of the right ISV was direct drainage into the inferior vena cava, with 90% of the angles below 25.7°. There were 22 cases (2.2%) with parallel right spermatic veins. In the axial plane, the right ISV (86.4%) was located in the third and fourth quadrants. The diameter at the entrance of the right ISV ranged from 2.7-3.8 mm. When the right ISV drained into the inferior vena cava, 83% of cases were located within 40 mm distance below the ostium of the right renal vein, while during draining into the right renal vein, the average distance from the main vein was 6.3 mm.

Conclusion: This study concluded that MCT can be used to evaluate the anatomical characteristics of the right ISV. The optimal interventional approach was through the jugular vein route to locate the ISV opening and improve the success rate of the embolization.

Cribiform and intraductal carcinoma are patterns of aggressive prostate carcinoma. This study investigated the clinical and pathological features of hereditary prostate cancer. Twenty cases of hereditary prostate cancer from 11 family lines treated at the First Affiliated Hospital of Zhejiang University School of Medicine between 2016-2022 were included to summarize the clinical and pathological features by analyzing clinical information including follow up the survival of the patients and pathological features. Of the 20 hereditary prostate cancer cases, 19 were radical prostate specimens and 1 was a biopsy specimen. The mean age at diagnosis of the patients was 67.55 years and the mean PSA was 15.44 ng/ml, of which 10 cases had PSA ≥ 10 ng/ml and 5 cases had PSA ≥ 20 ng/ml. Of the 19 radical prostate specimens, Gleason cribriform pattern (Gleason grade 4) of PCa is observed in 15 cases (78.95%), and intraductal carcinoma, usually a rare form, is seen in 9 cases (47.3%). Two cases demonstrated pelvic lymph node metastasis, and 7 cases (35%) belonged to high-risk or very high-risk PCa. One case (5.26%) showed partial deletion of expression of RB1, and 13 cases (68.42%) showed deletion of expression of PTEN. Follow-up was 4-90 months, 2 cases had biochemical recurrence and 1 case died from prostate cancer. The mean age at diagnosis of this group of patients with hereditary prostate cancer was 67.55 years, the mean preoperative PSA was 15.44 ng/ml, and their histomorphology was characterized by a high percentage of intraductal carcinoma and cribriform pattern of the prostate.

Upper urinary tract adenocarcinoma is a rare malignancy with a challenging diagnosis and limited treatment options. This paper presents a rare case of primary ureteral adenocarcinoma, an exceptionally uncommon malignancy typically associated with genitourinary or extra-genitourinary tumors. The 53-year-old patient, with a history of gastric adenocarcinoma and prior chemotherapy, developed left flank pain. Imaging revealed a tumor in the distal ureter, leading to a left radical nephroureterectomy. Histopathology confirmed an intestinal-type adenocarcinoma of the upper urinary tract. Unique to this case, the adenocarcinoma originated separately from the stomach. Despite planning adjuvant chemotherapy, the patient's deteriorating condition led to palliative care, and he passed away three months post-diagnosis. The paper underscores the challenges in diagnosing and treating such rare malignancies, emphasizing the need for further research to understand their etiology and optimal management.

Objective: In this study we aimed to determine the impact of human urine derived stem cells (USC) and genetically modified USC that were designed to overexpress myogenic growth factor IGF1 (USC^IGF), on the regenerative capacity of cardiotoxin (CTX)-injured murine skeletal muscle.

Methods: We overexpressed IGF1 in USC and investigated the alterations in myogenic capacity and regenerative function in cardiotoxin-injured muscle tissues.

Results: Compared with USC alone, USC^IGF1 activated the IGF1-Akt-mTOR signaling pathway, significantly improved myogenic differentiation capacity in vitro, and enhanced the secretion of myogenic growth factors and cytokines. In addition, IGF1 overexpression increased the ability of USC to fuse with skeletal myocytes to form myotubes, regulated the pro-regenerative immune response and inflammatory cytokines, and increased myogenesis in an in vivo model of skeletal muscle injury.

Conclusion: Overall, USC genetically modified to overexpress IGF1 significantly enhanced skeletal muscle regeneration by regulating myogenic differentiation, paracrine effects, and cell fusion, as well as by modulating immune responses in injured skeletal muscles in vivo. This study provides a novel perspective for evaluating the myogenic function of USC as a nonmyogenic cell source in skeletal myogenesis. The combination of USC and IGF1 expression has the potential to provide a novel efficient therapy for skeletal muscle injury and associated muscular defects in patients with urinary incontinence.

Chronic prostatitis/chronic pelvic pain syndrome (CP/CPSS) is a debilitating condition characterized by prostate inflammation, pain and urinary symptoms. The immune system's response to self-antigens is a contributing factor to CP/CPSS. In this review, we examine the use of experimental autoimmune prostatitis (EAP) in rodents to model salient features of autoimmune mediated CP/CPSS. By exploring etiological factors, immunological mechanisms, and emerging therapeutic strategies, our aim is to enhance our understanding of CP/CPSS pathogenesis and promote the development of strategies to test innovative interventions using the EAP pre-clinical model.

Sex-determining region Y-box 2 (SOX2) is a transcription factor with a central role in embryologic development. SOX2 is also an oncogene in several cancer types. Prior work by our group has shown SOX2 activity associates with cell cycle dysregulation in early-stage bladder cancer. The present study was thus undertaken to broadly investigate SOX2 in bladder cancer, with emphasis on associations with tumor stage, clinical outcomes, and tumorigenicity. Gene expression was quantified by immunohistochemistry in an established tissue microarray (n=303 cystectomy specimens, all stages) and whole tissue sections of noninvasive papillary urothelial carcinoma (n=25). Gene expression by RNA sequencing was evaluated in non-muscle invasive and muscle-invasive cohorts from publicly available repositories. By immunohistochemistry, SOX2 was expressed in 40% of whole tissue sections of noninvasive papillary carcinoma, which correlated with SOX2 expression by RNA sequencing (r=0.6, P=0.001, Spearman correlation). Expression tended to be focal (median H-score =6). SOX2 was expressed in only 9% of TMA cases, consistent with focal expression. SOX2 expression was substantially higher in muscle-invasive compared with noninvasive papillary urothelial carcinoma by RNA sequencing (P<0.001, Wilcoxon rank sum test). SOX2 expression associated with stage progression in lamina-propria invasive cancers (hazard ratio =2, P=0.05, Cox model, binary, RNA sequencing) but not noninvasive papillary cancers (P=0.5, Cox model, binary, RNA sequencing). SOX2 expression did not associate with overall survival in muscle-invasive carcinoma. Activity of SOX2 in bladder cancer was tested in vivo using murine allografts created with MB49 cells that express human SOX2 (MB49-SOX). MB49-SOX allografts expressed this protein focally by immunohistochemistry, much like human tumors. Compared with controls, MB49 allografts demonstrated larger tumor size (P=0.03, Wilcoxon rank sum test) and higher tumor burden in mesenteric metastases (P=0.009, Wilcoxon rank sum test). Though SOX2 expression is focal within tumors, it may drive tumorigenesis, increase growth rate, and promote aggressive features of bladder cancer, particularly stage progression of early-stage disease.