Current Urology

Baladakis, John; Perera, Marlon; Bolton, Damien; Lawrentschuk, Nathan; Adam, Ahmed

2019 Current Urology

doi: 10.1159/000499309pmid: 31602182

Aims: We aimed to compare the outcome of curative treatment options in localised Prostate Cancer (PCa) amongst HIV positive (HIV+) men. Methods: A systematic search of the Cochrane Library of Systematic Reviews, the Scopus and PubMed databases was performed (January 1995 to November 2015) using pre-determined search terms. Outcome measures for comparison included the rate of biochemical failure (BCF), survival benefit and complications. Results: A total of 14 eligible articles were identified for inclusion, representing a total of 202 HIV+ men with PCa. Radical Prostatectomy was performed in 40/153 compared to 109/153 patients undergoing alternative (non-surgical) treatments options. Only 3 studies compared outcomes within their respective study cohort. One study (n = 10) reported BCF results with 1/2 BCF patient in the surgical arm vs. 1/8 BCF positive patients in the non-surgical arm (mean 46 months follow-up), while two other studies reported no occurrences of BCF within both arms of their studies. Conclusion: Due to paucity in the literature, there is insufficient evidence to support a certain treatment modality arm specifically for HIV+ men with localized PCa. An individualized management algorithm seems feasible within this cohort, until more definitive studies are performed.

Jazayeri, Seyed B.; Liu, Jennifer S.; Weissman, Brittany; Lester, Janice; Samadi, David B.; Feuerstein, Michael A.

2019 Current Urology

doi: 10.1159/000499308pmid: 31602183

Introduction: Principles of management for upper tract urothelial carcinoma (UTUC) are mostly derived from knowledge of lower tract urothelial carcinoma (LTUC), however recent research indicates that these may be disparate diseases. In this review, we sought to compare the responsiveness of these tumors to similar treatment, platinum-based chemotherapy used in the adjuvant setting. Materials and Methods: PubMed, EMBASE, and Web of Science were searched using a systematic search strategy. Disease-free survival (DFS), cancer-specific survival (CSS) and overall survival (OS) in patients with LTUC and UTUC treated with adjuvant chemotherapy were compared. Review Manager V 5.3 was used for meta-analyses. Results: Adjuvant chemotherapy was associated with improved DFS (HR 0.41, 95%CI 0.31-0.54), CSS (HR 0.29, 95%CI 0.17-0.50) and OS (HR 0.51, 95%CI 0.38-0.70) rates in LTUC. The effectiveness of adjuvant chemotherapy in UTUC was less pronounced with respect to DFS (HR 0.61, 95%CI 0.1-0.93) and CSS (HR 0.70, 95%CI 0.56-0.90) rates, and there was no effect on OS (HR 0.87, 95%CI 0.69-1.10). Differences in CSS and OS were significant (p < 0.0001) in favor of adjuvant chemotherapy for LTUC versus UTUC Conclusion: Despite similar histology, we found significant differences in responsiveness to adjuvant chemotherapy between LTUC and UTUC. This may add to the already growing knowledge that these are disparate diseases. Newer systemic treatments for urothelial carcinoma may prove more effective than platinum-based chemotherapy in the adjuvant setting for UTUC.

de Oliveira, Pedro Simoes; Reis, José Palma; de Oliveira, Tiago Ribeiro; Martinho, David; e Silva, Ricardo Pereira; Marcelino, Joao; Gaspar, Sandro; Martins, Francisco; Lopes, Tome

2019 Current Urology

doi: 10.1159/000499307pmid: 31602184

Background/Aims: Sacral neuromodulation (SNM) is a well-established treatment in several urinary and bowel dysfunctions, nevertheless its role on sexual dysfunction remains unclear. We evaluate the impact of SNM on sexual function and its association with age at SNM, functional diagnosis and post-void residual urine (PVR) before SNM. Methods: Patients who had SNM were retrospectively analyzed. Sexual function was assessed before and after treatment with the International Index of Erectile Function (IIEF-5) for men and the Female Sexual Function Index (FSFI) for women. IIEF-5 and FSFI were also associated with age at SNM, functional diagnosis, and PVR. Results: Fifteen females and 9 males, with a median age of 41 years (26-72 years), median follow-up 20.7 months (2-53 months) were enrolled. IIEF-5 improved in 4 patients (p = 0.06), and FSFI total score in 5 (p = 0.2). There was significant association between functional diagnosis and FSFI total score (p = 0.05), and FSFI specific domains of arousal (p = 0.03), lubrication (p = 0.04), and satisfaction (p = 0.03), with significant improvement showed in patients with detrusor overactivity with impaired contractility. Conclusion: Although gains observed in IIEF-5 and FSFI were modest, our preliminary results show that SNM may have favorable impact on sexual function.

KatafigiotisItay, Ioannis; Sabler, Itay M.; Heifetz, Eliyahu M.; Isid, Ayman; Sfoungaristos, Stavros; Lorber, Amitay; Yutkin, Vladimir; Hidas, Guy; Latke, Arie; Landau, Ezekiel H.; Pode, Dov; Gofrit, Ofer N.; Duvdevani, Mordechai

2019 Current Urology

doi: 10.1159/000499306pmid: 31602185

Backgrounds/Aims: Operation room (OR) time is of great value affecting surgical outcome, complications and the daily surgical program with financial implications. Methods: We retrospectively evaluated 570 consecutive patients submitted to ureteroscopy or ureterorenoscopy for the treatment of ureteral or renal stones. Demographic parameters, patient's stones characteristics, type of ureteroscope, surgeon experience and surgical theater characteristics were analyzed. OR time was calculated from the initiation of anesthesia to patient extubation. Multivariate analysis was conducted using a linear regression test with multiple parameters to identify predictors of OR time. Results: Eight factors were identified as significant. These include total stones volume, ureteroscope used, stone number, nurses experience, radio-opacity of the stone on kidney-ureter-bladder X-ray, main surgeon experience, operating room type, and having a nephrostomy tube prior to surgery. Conclusions: The surgical team experience and familiarity with endourological procedure, and the surgical room characteristics has a crucial impact on OR time and effectiveness.

Inamoto, Teruo; Sassa, Naoto; Hattori, Ryohei; Ibuki, Naokazu; Komura, Kazumasa; Minami, Koichiro; Takai, Tomoaki; Uchimoto, Taizo; Saito, Kenkichi; Tanda, Naoki; Tsujino, Takuya; Sano, Tomoyasu; Kato, Masashi; Tsuzuki, Toyonori; Gotoh, Momokazu; Azuma, Haruhito

2019 Current Urology

doi: 10.1159/000499305pmid: 31602186

Objective: To examine the association between the body mass index (BMI) and the risk of survival, and to evaluate whether tumor characteristics differ by BMI in patients with upper tract urothelial carcinoma (UTUC) managed by surgery. Methods: A clinical series on 876 patients with localized UTUC following nephroureterectomy with a bladder cuff, with data from Osaka Medical College registry (discovery cohort) and the Nagoya group (validation cohort) was examined. In addition to analyzing the overall survival and cancer-specific survival (CSS), the survival impact adjusted by pathological variables was also assessed by the BMI group. Results: The percentage of high risk features including positive lymphovascular invasion was doubled in the discovery cohort compared to the validation cohort. The group of BMI ≥ 25 kg/m² was associated with improved CSS in the discovery cohort (p = 0.004), and this tendency was verified in the validation cohort (p = 0.006). Nonproportional hazards existed for the group of BMI ≥ 25 kg/m² and the BMI 18.5-25 kg/m² relative to the group of BMI < 18.5 kg/m², with a change in the CSS hazard. In multivariable Cox models, the BMI group had a superior predictive value compared with other pre-clinical factors both in the discovery cohort (HR = 3.85, p = 0.01; 95%CI: 0.09-0.73) and the validation cohort (HR = 1.56, p = 0.01; 95%CI: 0.45-0.91). When adjusted by lymphovascular invasion, the concordance of the model proposed by the discovery cohort (0.52) challenged in the validation cohort was 0.59. Conclusions: We found a clinically relevant signature for high risk patients with BMI grouping. Further research is necessary on whether tailoring recommendations for weight and nutrition management to tumor characteristics will improve outcomes.

Vande Lune, Patrick L.; Thayer, David; Mani, Naganathan; Warren, Andrew; Desai, Alana C.; Picus, Daniel J.; Gunn, Andrew J.

2019 Current Urology

doi: 10.1159/000499304pmid: 31602187

Introduction: We present our experience in image-guided percutaneous nephrolithotomy (PCNL) access in 591 patients. Materials and Methods: An IRB-approved review of all adult PCNL cases from 2009 to 2014 was performed. Patient data, information regarding stone size and location, procedural details, clinical success, complications by access site (upper pole versus middle or lower pole) and puncture location (supracostal versus infracostal) were recorded. Results: In this study, 591 patients (314 males, 278 females, mean stone size: 23 mm, range: 4-100 mm) were included. Stone clearance was achieved in 66% of patients. There were 174 total complications (29.3%). Upper pole access was less likely to require a secondary access to achieve stone clearance (p = 0.02) and was preferentially used for both larger stones (p = 0.006) and staghorn calculi (p = 0.001). If a supracostal approach to the upper pole was used, there were significantly more complications compared to an infracostal approach (p = 0.002). Conclusion: Upper pole access for PCNL provides anatomic advantages for stone clearance but significantly increases the risk for complications when a supracostal puncture is required.

Porcaro, Antonio B.; Tafuri, Alessandro; Sebben, Marco; Corsi, Paolo; Processali, Tania; Pirozzi, Marco; De Marchi, Davide; Inverardi, Davide; Cerruto, Maria A.; Amigoni, Nelia; Rizzetto, Riccardo; Brunelli, Matteo; Iacovelli, Roberto; Siracusano, Salvatore; Artibani, Walter

2019 Current Urology

doi: 10.1159/000499303pmid: 31602188

Introduction: Prostate cancer (PCa) patients who are classified into the intermediate risk category represent a heterogeneous population needing further preoperative risk assessment. Objectives: To evaluate clinical total testosterone (TT) associations with lymph node invasion (LNI) in intermediate risk PCa. Material and Methods: Between November 2014 and July 2016, intermediate risk PCa was assessed in 154 patients who underwent extended pelvic lymph node dissection if the risk of LNI was higher than 5%. Clinical factors associated with the risk LNI were investigated by the multinomial logistic regression model. Results: The risk of LNI was assessed higher than 5% in 40.9% of cases of whom 15.5% had LNI. In the multivariate model, the risk of LNI was independently increased by prostate specific antigen (OR = 1.185; p = 0.021) and TT (OR = 1.004; p = 0.036). As a result, TT was an independent factor that associated with LNI because it increased the risk of LNI by 4% for each increment unit of TT. Conclusion: Preoperative TT independently increased the risk of LNI in the intermediate risk class of PCa patients elected to radical prostatectomy and extended pelvic lymph node dissection. TT might be a useful preoperative factor for stratifying intermediate risk patients because of the positive association of TT with high grade tumors.

2019 Current Urology

doi: 10.1159/000502219