Current Urology

Fairhead, Cassandra E.L.; Hampson, Alexander; Dwyer-Hemmings, Louis; Vasdev, Nikhil

2020 Current Urology

doi: 10.1159/000499266pmid: 32398991

Background: It is estimated that between 50 and 89% of non-gonococcal urethritis is not caused by Chlamydia trachomatis. Associations between non-chlamydial non-gonococcal urethritis (NCNGU) with balanoposthitis, epididymo-orchitis and reactive arthritis have been suggested, but evidence to support these often-theoretical relationships is sparse and further investigation is called for. Concerns over increasing antimicrobial resistance has rendered the need for clarity over this question ever more pressing in recent years. A review of the current evidence on the complications of NCNGU in men is therefore urgently warranted. Objective: This systematic review summarizes and evaluates the available evidence that NCNGU, whether symptomatic or asymptomatic, causes the significant complications that are already well-recognized to be associated with non-gonococcal urethritis. These significant complications are epididymo-orchitis, balanoposthitis, and sexually-acquired reactive arthritis (Reiter's syndrome) including arthritis or conjunctivitis. Summary: We conducted a systematic review and qualitative synthesis using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis framework. Five databases (PubMed, EMBASE, Cumulative Index to Nursing and Allied Health Literature, PsycINFO, and British Nursing Index) were searched. We included studies that measured clinical outcome after diagnosis of NCNGU in men. Bias was assessed using variations of the Newcastle-Ottawa scale. Data were extracted and entered into a pre-written data abstraction proforma. Seven peer-review studies were included. This included 2 retrospective cohort studies, 1 case series, 2 case reports and 2 cross-sectional studies. The studies described and analyzed 3 types of complication: balanitis, posthitis and/or meatitis; reactive arthritis and/or conjunctivitis; and epididymitis. All studies reported one or more complications. Key Messages: This review identifies an important avenue for future research: while the available evidence suggests that NCNGU has the potential to cause significant complications in men, with the strongest evidence existing for balanitis, posthitis and/or meatitis, the nature and significance of these relationships is far from clear. The findings of this review suggest that prospective, adequately powered research into whether there is a causal link between NCNGU and significant clinical complications in men would be highly worthwhile. The findings of this review raise important questions about the utility of the term NCNGU in research and clinical practice.

Naik, Rishi; Mandal, Indrajeet; Hampson, Alexander; Casey, Rowan; Vasdev, Nikhil

2020 Current Urology

doi: 10.1159/000499265pmid: 32398992

Background: Urology is a rapidly evolving specialty, although wide variations exist between training programs in different countries. We aimed to compare the status of urology training in 5 English-speaking countries. Materials and Methods: Features compared include the training pathway structure, training requirements, competition levels and the process of moving country for international medical graduates. Results: Length of training varied considerably across countries, ranging from 5 years in the USA and Canada, to 7 years in Australia and New Zealand and 9 years in the UK. Ease of entering urology training for international medical graduates also varies, with the UK relatively easier compared to other countries. All countries encourage participation in research during training as well as completion of non-urology and urology specific surgical examinations. Conclusion: Following the Royal College of Surgeons Improving Surgical Training report, it is vital that the UK incorporates optimal elements of international programs in order to provide the best standards for trainees and world-class care in urology.

D'Agostino, Daniele; Romagnoli, Daniele; Giampaoli, Marco; Bianchi, Federico Mineo; Corsi, Paolo; Del Rosso, Alessandro; Schiavina, Riccardo; Brunocilla, Eugenio; Artibani, Walter; Porreca, Angelo

2020 Current Urology

doi: 10.1159/000499264pmid: 32398993

Objectives: Transrectal ultrasound-guided biopsy (TRUS-GB) is the current reference standard procedure for diagnosis of prostate cancer (PCa) but this procedure has limitations related to the low detection rate (DR) described in the literature. The aim of the study was to evaluate the DR efficiency, and complication rate in a pure “in-bore” magnetic resonance imaging-guided biopsy (MRI-GB) series according to the Prostate Imaging Reporting and Data System, version 2 (PI-RADS v2). Materials and Methods: From July 2015 to April 2018, a series of 142 consecutive patients undergoing MRI-GB were prospectively enrolled. According to the European Society of Urogenital Radiology guidelines, the presence of clinically significant PCa (csPCa) on multiparametric magnetic resonance imaging was defined as equivocal, likely, or highly likely according to a PI-RADS v2, score of 3, 4, or 5, respectively. Results: Of 142 patients, 76 (53.5%) were biopsy naive and 66 (46.5%) had ≤ 1 previous negative set of random TRUS-GB findings. The MRI-GB findings were positive in 75 of 142 patients with a DR of 52.8%. Of the 76 patients with ≤ 1 previous set of TRUS-GB, 43 had PCa found by MRI-GB, with a DR of 57.3%. The DR in the 66 biopsy-naive patients was 48% (32/66). Of the 75 patients with positive biopsy findings, 54 (80.5%) were found to have csPCa on histological examination. Of these 54 patients, 28 had an International Society of Urological Pathology grade 2; 5 had grade 3, 19 had grade 4, and 2 had grade 5. Considering the anatomic distribution of the index lesions using the PI-RADS v2 scheme, the probability of PCa was greater for lesions located in the peripheral zone (55 of 75, 73.3%) than for those in the central zone (20 of 75, 26.7%). Conclusions: Our study conducted on 142 patients confirmed the greater DR of csPCa by MRI-GB, with a very low number of cores needed and a negligible incidence of complications, especially in patients with a previous negative biopsy. MRI-GB is optimal for the diagnosis of anterior and central lesions.

Voskamp, Maarten J.H.; Vermeer, Marloes; Molijn, Gerd-Jan; Cornel, Erik B.

2020 Current Urology

doi: 10.1159/000499263pmid: 32398994

Background: Radical cystectomy is still the gold standard for muscle-invasive bladder carcinoma (MIBC) treatment. In order to reduce postoperative complications, multimodality bladder-sparing therapies could be a good alternative. Studies in various malignancies have shown that the modified Frailty Index (mFI) may be more useful for identifying high-risk patients. Objectives: We investigated the possible correlation between the mFI in cystectomy patients with MIBC and serious complications 30 and 90 days postoperatively. Methods: Analysis of a prospective database of 109 consecutive MIBC patients who underwent a cystectomy between January 2012 and August 2017 was performed. The mFI was added retrospectively. Differences between groups were tested with independent t-tests, Mann-Whitney U tests, ANOVA, Kruskal-Wallis test, or Chi square tests as appropriate. Univariate and multivariate logistic regression analysis were performed to analyse the relation between the mFI and complications. Results: Patients with Clavien-Dindo ≥ 3 at 30 and 90 days postoperatively had a significantly higher mFI compared to patients with Clavien-Dindo < 3: the odds ratio of the mFI for serious complications within 30 days was 1.5 (95% confidence interval 1.1-2.1, p = 0.010) and for 90 days was 1.5 (95% confidence interval 1.1-2.1, p = 0.008). Conclusions: We found an association between a high mFI and postoperative complications and mortality. The mFI is therefore useful when discussing treatment options with MIBC patients.

Aquil, Shahid; Olvera-Posada, Daniel; Navaratnam, Roshan; Mikhail, David; Levine, Max A.; Luke, Patrick P.; Sener, Alp

2020 Current Urology

doi: 10.1159/000499262pmid: 32398995

Objectives: To evaluate a case-matched study comparing postoperative renal function using two surgical techniques: an off-clamp partial nephrectomy (PN) with the aid of the Altrus® device and a standard on-clamp laparoscopic PN. Material and Methods: A total of 36 patients underwent PN. Eighteen had the off-clamp technique and 18 had the standard laparoscopic on-clamp PN. Demographic, clinical, radiological, and perioperative data were collected for analysis. An emphasis on renal function was made by analyzing both the perioperative and follow-up with estimated glomerular filtration rate and MAG3. Results: The median values did not signifcantly differ for age, Charlson Comorbidity Index, and hospital stay in the off-clamp versus on-clamp PN [62.5 (interquartile range, IQR 11) vs. 60 (IQR 16) years, 4 (IQR 2) vs. 5 (IQR 2) and 5 (IQR 1) vs. 4 (IQR 2) days], respectively. The median diameter of the tumors was 33 (IQR 23) versus 41 (IQR 28) mm (p = 0.63), with median R.E.N.A.L. nephrometry scores of 7 (IQR 2) versus 7 (IQR 2) (p = 0.33). There was greater blood loss in the Altrus® (375 vs. 200 ml, p = 0.037). The clamp time in the on-clamp group was 30 (IQR 6) minutes (range 22-68 minutes) compared to 0 minutes in the off-clamp group. There was no difference in hemoglobin or creatinine levels between the groups. However, the on-clamp group had a significant loss in ipsilateral renal function on the MAG3 scan (49 vs. 42%, p = 0.0001), whereas the off-clamp group had no difference (48 vs. 46%, p = 0.72). Conclusions: The off-clamp method for PN is a feasible and safe option with better preservation of ipsilateral renal function when compared with on-clamp PN in the treatment of small renal masses.

Saleh, Saleh A.K.; Adly, Heba M.; Abdelkhaliq, Altaf A.; Nassir, Anmar M.

2020 Current Urology

doi: 10.1159/000499261pmid: 32398996

Backgrounds: Variations of trace element contents may be associated with several diseases including metabolic disorders, cellular growth disturbance, mutation and tumorigenesis. Prostate cancer is the second most common male cancer worldwide and stand fifth most common male cancer in Saudi Arabia. Objective: In the present study, Serum levels of selenium, zinc, copper, manganese, and iron were measured in patients with BPH and prostate cancer aiming to explore the association between these elements and prostate cancer. Patients and Methods: The study included 40 newly diagnosed prostate cancer patients, 22 patients with BPH and 30 healthy male subjects. All participant groups had similar socio-economic levels. Fasting blood samples were collected from all subjects and before any intervention for the patients. Serum PSA concentrations were analyzed by ELIZA and trace elements Se, Zn, Cu, Mn and Fe were measured by ICP-MS. Results: Serum Se, Zn, and Mn levels of prostate cancer patients were significantly decreased compared to control groups. The levels of serum Cu and Fe were significantly higher in prostate cancer patients than in control groups. Conclusion: In the present study, an association was noticed between serum trace elements disturbance and prostate cancer. The decreased levels of Se, Zn, and Mn, and increased Cu and Fe levels may play significant roles in the initiation of prostate cancer. However, future prospective studies on the causes of trace elements alteration in prostate cancer patients are needed as well as to illustrate the relation between different prostate cancer stages and trace elements concentrations.

Patel, Sagar; Abimbola, Obafunbi; Roy, Ornob P.

2020 Current Urology

doi: 10.1159/000499260pmid: 32398997

Duplex collecting system of the kidney is a common congenital anomaly of the urinary tract and is less reported in the adult population. Rarely, this anomaly can result in ureterovesical junction compression. Herein, we present a case of ureterovesical junction compression occurring in an adult patient with a duplex collecting system and describe the surgical management.

Oberle, Anthony D.; Brown, James A.

2020 Current Urology

doi: 10.1159/000499259pmid: 32398998

Interest in surveillance for small renal masses has expanded exponentially due to incidental detection with increased imaging. However, some of these small renal masses behave aggressively. Sarcomatoid pathology is associated with a worse prognosis. Traditionally, it has been thought of as a common pathway of dedifferentiation once a renal malignancy of any histology reaches a threshold size of approximately 3 cm. We report a case of a 65-year-old male with a 2 cm sarcomatoid renal cell carcinoma. To our knowledge, this is the smallest tumor with sarcomatoid differentiation reported in the literature.