Central European Journal of Urology最新文献

Introduction: Olaparib, rucaparib, niraparib, and talazoparib are poly (ADP-ribose) polymerase (PARP) inhibitors (PARPi) targeted at recombination. To gain a comprehensive understanding of the mechanism of action of PARPi, scientists conducted research involving numerous studies that provided evidence regarding their efficacy and safety.

Material and methods: A literature review was performed using the PubMed^® and Google Scholar databases. Articles were reviewed and categorized based on the most crucial and current information regarding the pharmacological properties and use of PARPi in treating metastatic castration-resistant prostate cancer (mCRPC), while also indicating the future therapeutic direction toward which these pharmaceuticals are progressing. Data were extracted, analyzed and summarized.

Results: PARP inhibitors like olaparib, rucaparib, niraparib, and talazoparib show promise in mCRPC, particularly for patients with specific genetic mutations (BRCA1/2, ATM). While they extend PFS and sometimes OS, side effects - especially anemia - are prevalent and impact treatment continuation.

Conclusions: Despite PARPi already being recognized as the standard treatment for mCRPC, further research is crucial to optimize their efficacy and safety, particularly in the context of combination therapies and use in the early stages of the disease.

Introduction: Nitroxoline is an old antimicrobial agent with a broad spectrum of pharmacological applications and a unique mechanism of action. However, its use in the treatment and prevention of urinary tract infections (UTIs) has not been popular in the recent past. Recently, nitroxoline is gaining interest, due to frequent drug-resistance in uropathogens. Unfortunately, there are few modern clinical trials assessing this antibiotic. Also, older researchers often do not meet current scientific standards. This review seeks to provide a comprehensive overview of nitroxoline as a viable option in treating uncomplicated lower UTIs.

Material and methods: A comprehensive literature search regarding the use of nitroxoline in UTIs was conducted using Pubmed, Cochrane Library and Embase databases. A cross-reference search was also performed. Case reports, editorials and non-peer-reviewed literature were excluded from further analysis. As a result, 21 publications were included in this review.

Results: The available literature on nitroxoline's mechanism of action, pharmacokinetics, minimum inhibitory concentrations, in vitro activity and resistance rates strongly suggests that nitroxoline is a potent broad-spectrum antimicrobial agent. Moreover, clinical efficacy of the drug was analyzed - 2 articles proved high eradication rates in women with uncomplicated lower UTIs and 1 reported unsuccessful treatment in geriatric patients with lower complicated and uncomplicated UTIs. Finally, the present data on adverse effects indicate that nitroxoline is well-tolerated.

Conclusions: Nitroxoline is an obscure, yet potentially effective and safe antimicrobial agent in uncomplicated lower UTIs. Unfortunately, it is available only in a few countries. Nonetheless, nitroxoline can be useful in urological practice.

Introduction: It is still uncertain whether detrusor underactivity (DUA) influences the outcomes of women undergoing surgery for stress urinary incontinence (SUI). Even less evidence is available about women with complicated stress urinary incontinence (C-SUI). The aim of the study was to assess outcomes of middle urethral sling (MUS) placement according to the type of SUI, and the impact of DUA on uncomplicated SUI (U-SUI) and C-SUI functional and surgical results.

Material and methods: The study was conducted among patients undergoing MUS. The population was divided into 4 groups: 1: C-SUI with DUA; 2: C-SUI without DUA; 3: U-SUI with DUA; and 4: U-SUI without DUA. Women were qualified for the DUA group if they met one of the Jeong, Abarbanel and Marcus, BVE, and PIP1 Griffiths criteria. Post-operative functional outcomes and differences in POUR rate, de novo overactive bladder syndrome (OAB), and SUI recurrence were examined.

Results: 142 women took part in the study, of whom 97 completed the 2-year follow-up. DUA was found in 54.6% (53/97) of patients. C-SUI was prevalent also in the no-DUA group (59.1%). Post-operative ICIQ-FLUTS improved more in the no-DUA patients compared to the DUA women. Post-operative Qmax was statistically significant higher the in no-DUA than in the DUA population. After surgery, neither the PVR nor the PVR ratio differed in the DUA and the no-DUA patients. C-SUI and U-SUI patients showed a POUR rate of 15.6%-12.1%, de novo OAB 12.5%-3%, tape incision 3.1%-3%, and SUI recurrence 4.6%-3%, respectively.

Conclusions: The impact of pre-operative DUA on the outcomes of patients undergoing MUS was negligible, even in C-SUI cases. DUA women with SUI, even if complicated, should not be excluded from this kind of surgery.

Introduction: Prostate cancer is the second most common male cancer worldwide. Its rising incidence and high overtreatment rate drive the search for new prognostic factors. Histopathological variants, such as cribriform pattern (CP), are associated with poorer oncologic outcome. The aim of this study was to assess the correlation between CP in prostate biopsy and radical prostatectomy (RP) and postoperative pathological features.

Material and methods: In this retrospective, single-centre study we analysed the reviewed medical records of 100 men who underwent minimally invasive RP in the years 2017-2019. RP histopathological examination was performed by a single expert pathologist, and preoperative biopsies were assessed by various professionals from different referral centres.

Results: 48% of men underwent endoscopic RP with limited lymphadenectomy, whereas 52% underwent laparoscopic RP with extended lymphadenectomy. CP in biopsy was present in 6 patients: 3 in each of both groups (6.3% and 5.8%, respectively). Lymph node metastases were present in 50% and 10% of patients with and without CP in biopsy, respectively (p = 0.028). Postoperative histopathological examination revealed CP in 65%. CP in RP was associated with higher International Society of Urological Pathology (ISUP) (p < 0.001), extraprostatic extension (EPE) (p = 0.001), seminal vesicle invasion (SVI) (p = 0.001), and positive surgical margin (PSM) (p = 0.004). Thirteen (20%) of the patients with CP in the RP specimen had lymph node metastasis, and none of the patients without CP in the RP specimen had regional LN metastasis.

Conclusions: The presence of CP in a biopsy specimen and RP is associated with negative postoperative features. Therefore, efforts should be made to increase CP reporting in biopsies because its identification could trigger a more radical surgical approach with extended lymphadenectomy.

Introduction: Enuresis (NE) is a socially stigmatising and stressful condition affecting children's and parent's quality of life. The aim of this review was to evaluate and summarize the current knowledge about the pharmacological and non-pharmacological traditional and innovative treatments in children with NE.

Material and methods: We examined the following bibliographic electronic databases: PubMed and the Cochrane Library, from January 2000 until July 2023. The search was guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) (8) and was limited to English-language papers that focused on enuresis in patients under 18 years old. Each paper that met the eligibility criteria was reviewed and analyzed in full text by three authors and any discrepancies among them were solved by debate. Due to the heterogeneity of the articles examined, we focused on a qualitative analysis.

Results: Overall, we identified 560 records through database searching. As first step, we excluded 46 articles in non-English language, 6 records whose related articles were not available, 8 articles concerning ongoing trials and 210 duplicated papers. As second step, we eliminated 215 records by evaluating only title and abstract because they did not match the inclusive criteria we mentioned before. Of the remaining 75 studies, we excluded 34 through a further discussion among authors upon the reliability of data. Thus, 41 selected articles were included in the review.

Conclusions: Multiple treatment approaches, both pharmacological and non pharmacological, have been established and validated to reduce signs and symptoms of NE and improve quality of life and the social and emotional discomfort experienced by children. The aim of pediatrician is to identify the right therapy protocol for very single child, evaluating the best approach for him and the family.

Herein, we describe an unusual case of cystoscope damage during a planned laser cystolithotripsy in a 65-year-old male with a previous history of radical prostatectomy for prostate cancer and subsequent serial urethral dilations for bladder neck contracture. Upon crossing the penile urethra without exerting significant pressure, we noticed the cystoscope's distal metallic tip detachment. Therefore, we re-introduced another 22Fr cystoscope and removed the broken part with alligator forceps. Fortunately, no urethral injury or associated complications were noticed on gently re-entering the bladder. Hence, we managed to complete the endoscopic laser cystolithotripsy shortly thereafter. Review of the relevant literature revealed three similar cases. All related to the same manufacturer. Urologists should not lose sight of the fact that such an unexpected instance may tremendously impact the procedure's success, requiring vigilance and adherence to safety protocols.

Azoospermia is recognised in 10-15% of men diagnosed due to infertility. Obstructive azoospermia occurs in 20-40% in this group of patients and it is characterised by normal FSH values, testes of normal size, and epididymal enlargement. Obstructive azoospermia is a common cause of male infertility. Several imaging techniques are used to assess the patency of the seminal tract, including the following: scrotal ultrasound, transrectal ultrasound (TRUS), and scrotal magnetic resonance imaging (MRI), with vasography being considered a gold standard. However, each of these methods has its limitations, and no single test can provide a comprehensive diagnosis. This article describes an attempt to combine high-resolution multiplanar MRI with functional evaluation of the patency of the seminal tract of classical vasography. A detailed description of the level of spermatic duct obstruction may help decide whether the condition qualifies for surgical treatment.

Introduction: In the literature on cancer treatment, there is growing interest in quality of life (QoL). Improvement in QoL is coming to be regarded as a key consideration in maintaining standards of care. The choice of medical intervention should be based not only on a patient's physical health, test results, and the stage of the disease, but also on their emotional and psychosocial condition.

Material and methods: The study included a group of 72 men with prostate cancer scheduled for radical prostatectomy (RP). QoL was assessed using standardised and validated questionnaires. The survey was conducted before surgery and then after 3, 6, 9, and 12 months.

Results: Analysis of changes in QoL 3 months after surgery showed a significant decrease in all symptomatic and functional domains, the largest decrease being observed in social functioning. One year after surgery, most scores had returned to their preoperative level, with the exception of those for social functioning, symptoms of pain, insomnia, and financial difficulties. It was noted that preoperative urinary symptom scale scores were significantly lower than those obtained one year after RP, the largest difference being apparent in the first months after surgery. It was also found that the number of people using incontinence precautions significantly increased 3 months after surgery and continued to do so.

Conclusions: The greatest deterioration of QoL occurs in the first months after surgery and mainly affects social, emotional, and sexual functioning, as well as symptoms related to incontinence and fatigue.

Introduction: The aim of this study was to investigate the expression of fibrosis-related genes in obstructed ureteral tissue and determine its relationship with biomarkers of renal damage and preoperative renal scan findings.

Material and methods: In all cases, bladder urine and blood samples were collected preoperatively. They were analysed for serum cystatin C, urinary albumin, urinary beta 2 microglobulin, and urinary neutrophil gelatinase-associated lipocalin concentrations, as well as their concentrations standardised by urine creatinine. Pyeloureteral junction obstruction tissue specimens were frozen in liquid nitrogen upon harvesting. RNA was extracted from the samples using TRIzol reagent. qPCR was performed, and the relative expressions of TGFβ1, MMP1, TIMP1, PAI1, CTGF, and VEGFA in stenotic ureteral tissue were calculated. Spearman's rank correlation test was used to calculate the correlation between the relative expression of investigated genes, urine, and blood biomarkers of renal damage and preoperative renal scan findings.

Results: A total of 20 pyeloureteral junctions of 20 patients were harvested at the time of dismembered pyeloplasty. The median age of the patients at the time of the operation was 15.2 [9.07, 66.2] months. There was a significant negative correlation between urinary albumin concentration and relative TGFβ1 expression in pyeloureteral junction tissue (rho = -0.45, p = 0.047), as well as between uAlb and relative VEGFA expression (rho = -0.575, p = 0.008). No correlation with other urine biomarkers of renal damage or renal scan findings was found.

Conclusions: Expression of fibrosis-related genes in the obstructive tissue of the pyeloureteral junction have no direct correlation with biomarkers of renal damage.