American journal of clinical and experimental urology最新文献

This case study emphasizes the critical role of accurate diagnosis and tailored management strategies in successfully treating bladder injuries, particularly in complex cases. We present a patient with trigonal involvement and a Grade V injury that did not respond to conservative treatment, underscoring the need for precise surgical management. However, considering the patient's condition and the variability in surgical approaches, a less invasive intervention was chosen, leading to successful management using an external catheter to allow the bladder to heal without direct contact with urine. This innovative approach resulted in complete recovery without surgery, demonstrating the potential for positive outcomes even in complex cases. The study reiterates the importance of prompt recognition and appropriate management to prevent adverse outcomes associated with bladder trauma, underscoring the significance of close clinical monitoring and individualized treatment strategies for successful outcomes.

Background: Genetic factors are thought to play a major role in erectile dysfunction (ED), but the search for specific ED-related genes remains a mysterious area characterised by limited and inconclusive research.

Methods: Whole blood expression quantitative trait loci (eQTLs) and the GWAS data related to the genetics of ED are derived from a Finnish database, Finngen, which contains a dataset of 1154 cases and 94024 controls, culminating in a total of 95178 individuals under scrutiny. Based on these pooled data, a Mendelian randomisation (MR) analysis of ED was performed. Subsequent analyses of PPI and single cell type expression help identify potential pathogenic genes, revealing the function of genes and their association with phenotypes.

Results: After SMR analysis, 110 ED-associated genes were screened, of which MDM4 Degree had the highest value with an OR of 1.8453076, was displaced on chromosome 1, and had a risk of promoting ED. Single-cell sequencing analysis results demonstrate the expression of the MDM4 gene in six cell types, further confirming the role of the MDM4 gene in ED.

Conclusions: Our study showed that among the 110 genes associated with ED, MDM4 was highly associated with an increased risk of ED. These findings strongly support personalised treatment strategies decision-making for ED patients.

Emphysematous pyelonephritis (EPN) is a rare infectious disease affecting the renal and perirenal tissues, wherein gas formation occurs in the renal parenchyma, perinephric tissues, or collecting systems. It can be life threatening with mortality rates upto 60%. Here, we report a case series of EPN during the COVID pandemic with COVID test-positive patients who were diagnosed based on clinical signs, symptoms, and CT scans. One patient was conservatively managed, one underwent nephrectomy, and the others were treated with percutaneous drainage and pigtailing. Despite being critically ill, all the patients recovered uneventfully. Owning to the rarity of the lesion and variations in the clinical spectrum, the diagnosis of EPN is challenging. EPN requires early diagnosis and prompt management. The interventional technique depends on the clinical status of the patient and the severity of the lesion. Although the threshold of intervention is low in normal clinical practice, in covid patients, we tried to manage patients conservatively and intervened only when unavoidable.

Histopathology, which is the gold-standard for prostate cancer diagnosis, faces significant challenges. With prostate cancer ranking among the most common cancers in the United States and worldwide, pathologists experience an increased number for prostate biopsies. At the same time, precise pathological assessment and classification are necessary for risk stratification and treatment decisions in prostate cancer care, adding to the challenge to pathologists. Recent advancement in digital pathology makes artificial intelligence and learning tools adopted in histopathology feasible. In this review, we introduce the concept of AI and its various techniques in the field of histopathology. We summarize the clinical applications of AI pathology for prostate cancer, including pathological diagnosis, grading, prognosis evaluation, and treatment options. We also discuss how AI applications can be integrated into the routine pathology workflow. With these rapid advancements, it is evident that AI applications in prostate cancer go beyond the initial goal of being tools for diagnosis and grading. Instead, pathologists can provide additional information to improve long-term patient outcomes by assessing detailed histopathologic features at pixel level using digital pathology and AI. Our review not only provides a comprehensive summary of the existing research but also offers insights for future advancements.

Background: Bladder cancer (BC) is very common among cancers of urinary system. It was usually categorized into two types: non-muscle invasive bladder cancer (NMIBC) and muscle invasive bladder cancer (MIBC). NMIBC and MIBC groupings are heterogeneous and have different characteristics.

Objectives: The study was aimed to find some hub genes and related signal pathways which might be engaged in the progression of BC and to investigate the relationship with clinical stages and its prognostic significance.

Methods: GSE37317 datasets were acquired from Gene Expression Omnibus (GEO) database. GEO2R on-line tool was selected to screen the differentially expressed genes (DEGs) of the two different types of BC. Then, Gene Ontology (GO) enrichment and KOBAS-Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway analysis of these DEGs were conducted. A protein-protein interaction (PPI) network was employed to help us screen hub genes and find significant modules. Finally, we made analysis of gene expression and survival curve by GEPIA and Kaplan-Meier plotter database.

Results: 224 DEGs were screened in total, with 110 showing increased expression and 114 demonstrating decreased expression. GO and KEGG pathway enrichment analysis showed that DEGs were mostly involved in collagen fibril organization, extracellular matrix (ECM) structural constituent, bHLH transcription factor binding, AGE-RAGE signaling pathway and TGF-beta signaling pathway. Only 3 hub genes (DCN, JUN, THBS1) displayed significantly higher expression compared to those in the healthy controls. These hub genes were also strongly related to clinical stages as well as overall survival (OS) of BC patients.

Conclusions: Taken together, most of hub genes involved in the progression of BC were related to ECM and EMT. In addition, 3 hub genes (DCN, JUN, THBS1) were strongly related with clinical stages and OS of BC patients. This study can enhance our comprehension of the progression of NMIBC and identify novel potential targets for MIBC.

Objectives: Prostate inflammation is linked to lower urinary tract dysfunction and is a key factor in chronic prostatitis/chronic pelvic pain syndrome. Autoimmunity was recently identified as a driver of prostate inflammation. Agonists of the aryl hydrocarbon receptor (AHR), a ligand-activated transcription factor, have been used to suppress autoimmunity in mouse models of colitis, rhinitis, and dermatitis, but whether AHR agonists suppress prostate autoimmunity has not been examined. Here, we test whether ITE (2-(1'H-indole-3'-carbonyl)-thiazole-4-carboxylic acid methyl ester), an AHR agonist, suppresses inflammation, allodynia, and urinary dysfunction in a mouse model of experimental autoimmune prostatitis (EAP).

Methods: C57BL/6J adult male mice were immunized with rat prostate antigen to induce EAP or TiterMax Gold® adjuvant (uninflamed control). Mice were also treated with ITE (10 mg/kg/day IP) or DMSO (vehicle, 5 mg/kg/day IP) for 6 days. Using the Nanostring nCounter Inflammation Panel, we evaluated the impact of EAP and ITE on prostatic RNA abundance. We validated EAP and ITE-mediated changes in a subset of RNAs by RT-PCR and RNAScope in situ RNA detection.

Results: EAP appeared to heighten histological inflammation in the dorsal prostate, induced tactile allodynia, and appeared to increase the frequency of non-voiding bladder contractions. ITE mitigated some actions of EAP. EAP changed abundance of 40 inflammation-related RNAs, while ITE changed abundance of 28 inflammation-related RNAs. We identified a cluster of RNAs for which ITE protected against EAP-induced changes in the abundance of H2-Ab1, S100a8, and S100a9. ITE also increased the abundance of the AHR-responsive Cyp1a1 RNA.

Conclusions: These findings support the hypothesis that ITE activates the AHR in the prostate and reduces autoimmune-mediated prostatitis in mice.

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.

Background: Testicular torsion is the major urologic emergency. If not treated promptly, this condition can result in testicular necrosis or long-term functional impairment. At present, there are few paper about long time follow-up of these patients. The primary objective of our study is to report the long-term clinical-instrumental data (mean follow-up 12 years) of patients treated for testicular torsion.

Methods: We considered patients treated for testicular torsion during the period between 1997 and 2017. Inclusion and exclusion criteria were created. Patients were contacted by phone between December 2021 and January 2022. Each patient underwent clinical and ultrasonographic evaluation, and in addition, some subjects were offered additional tests (hormonal assays and semen analysis).

Results: During the study period, 22 patients were treated for testicular torsion. From the ultrasonographic study, it was found that the volume of the affected testis is reduced and it is associated with microcalcifications and heterogeneous echogenicity. Morphovolumetric recovery seems to be more related to age of onset than to the degree of torsion.

Conclusions: Based on our results we can state that affected testes, if preserved, grow less and have altered ultrasonographic morphology. Clinically, the age of onset of torsion seems more important than the degree of torsion.

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.