Immune cells lacking Y chromosome show dysregulation of autosomal gene expression.

Epidemiological investigations show that mosaic loss of chromosome Y (LOY) in leukocytes is associated with earlier mortality and morbidity from many diseases in men. LOY is the most common acquired mutation and is associated with aberrant clonal expansion of cells, yet it remains unclear whether this mosaicism exerts a direct physiological effect. We studied DNA and RNA from leukocytes in sorted- and single-cells in vivo and in vitro. DNA analyses of sorted cells showed that men diagnosed with Alzheimer's disease was primarily affected with LOY in NK cells whereas prostate cancer patients more frequently displayed LOY in CD4 + T cells and granulocytes. Moreover, bulk and single-cell RNA sequencing in leukocytes allowed scoring of LOY from mRNA data and confirmed considerable variation in the rate of LOY across individuals and cell types. LOY-associated transcriptional effect (LATE) was observed in ~ 500 autosomal genes showing dysregulation in leukocytes with LOY. The fraction of LATE genes within specific cell types was substantially larger than the fraction of LATE genes shared between different subsets of leukocytes, suggesting that LOY might have pleiotropic effects. LATE genes are involved in immune functions but also encode proteins with roles in other diverse biological processes. Our findings highlight a surprisingly broad role for chromosome Y, challenging the view of it as a "genetic wasteland", and support the hypothesis that altered immune function in leukocytes could be a mechanism linking LOY to increased risk for disease.

Robot-assisted vs open radical cystectomy for bladder cancer in adults.

BACKGROUND: It has been suggested that, in comparison with open radical cystectomy (ORC), robot-assisted radical cystectomy (RARC) results in less blood loss, shorter convalescence and fewer complications, with equivalent short-term oncological and functional outcomes; however, uncertainty remains as to the magnitude of these benefits. OBJECTIVES: To assess the effects of RARC vs ORC in adults with bladder cancer. SEARCH METHODS: We conducted a comprehensive search, with no restrictions on language of publication or publication status, for randomized controlled trials (RCTs) that compared RARC with ORC. The date of the last search was 1 July 2018. Databases searched included the Cochrane Central Register of Controlled Trials, MEDLINE (1999 to July 2018), PubMed Embase (1999 to July 2018), Web of Science (1999 to July 2018), Cancer Research UK (www.cancerresearchuk.org/), and the Institute of Cancer Research (www.icr.ac.uk/). We also searched the following trial registers: ClinicalTrials.gov (clinicaltrials.gov/); BioMed Central International Standard Randomized Controlled Trials Number (ISRCTN) Registry (www.isrctn.com); and the World Health Organization International Clinical Trials Registry Platform. The review was based on a published protocol. Primary outcomes of the review were recurrence-free survival and major postoperative complications (Clavien grade III to V). Secondary outcomes were minor postoperative complications (Clavien grades I and II), transfusion requirement, length of hospital stay (days), quality of life, and positive surgical margins (%). Three review authors independently assessed relevant titles and abstracts of records identified by the literature search to determine which studies should be assessed further. Two review authors assessed risk of bias using the Cochrane risk-of-bias tool and rated the quality of evidence according to GRADE. We used Review Manager 5 to analyse the data. RESULTS: We included in the review five RCTs comprising a total of 541 participants. Total numbers of participants included in the ORC and RARC cohorts were 270 and 271, respectively. We found that RARC and ORC may result in a similar time to recurrence (hazard ratio 1.05, 95% confidence interval [CI] 0.77 to 1.43; two trials, low-certainty evidence). In absolute terms at 5 years of follow-up, this corresponds to 16 more recurrences per 1000 participants (95% CI 79 fewer to 123 more) with 431 recurrences per 1000 participants for ORC. We downgraded the certainty of evidence because of study limitations and imprecision. RARC and ORC may result in similar rates of major complications (risk ratio [RR] 1.06, 95% CI 0.76 to 1.48; five trials, low-certainty evidence). This corresponds to 11 more major complications per 1000 participants (95% CI 44 fewer to 89 more). We downgraded the certainty of evidence because of study limitations and imprecision. We were very uncertain whether RARC reduces minor complications (very-low-certainty evidence). We downgraded the certainty of evidence because of study limitations and very serious imprecision. RARC probably results in substantially fewer transfusions than ORC (RR 0.58, 95% CI 0.43 to 0.80; two trials, moderate-certainty evidence). This corresponds to 193 fewer transfusions per 1000 participants (95% CI 262 fewer to 92 fewer) based on 460 transfusion per 1000 participants for ORC. We downgraded the certainty of evidence because of study limitations. RARC may result in a slightly shorter hospital stay than ORC (mean difference -0.67, 95% CI -1.22 to -0.12; five trials, low-certainty evidence). We downgraded the certainty of evidence because of study limitations and imprecision. RARC and ORC may result in a similar quality of life (standardized mean difference 0.08, 95% CI 0.32 lower to 0.16 higher; three trials, low-certainty evidence). We downgraded the certainty of evidence because of study limitations and imprecision. RARC and ORC may result in similar positive surgical margin rates (RR 1.16, 95% CI 0.56 to 2.40; five trials, low-certainty evidence). This corresponds to eight more (95% CI 21 fewer to 67 more) positive surgical margins per 1000 participants, based on 48 positive surgical margins per 1000 participants for ORC. We downgraded the certainty of evidence because of study limitations and imprecision. CONCLUSIONS: We conclude that RARC and ORC may have similar outcomes with regard to time to recurrence, rates of major complications, quality of life, and positive surgical margin rates (all low-certainty evidence). We are very uncertain whether the robotic approach reduces rates of minor complications (very-low-certainty evidence), although it probably reduces the risk of blood transfusions substantially (moderate-certainty evidence) and may reduce hospital stay slightly (low-certainty evidence). We were unable to conduct any of the preplanned subgroup analyses to assess the impact of patient age, pathological stage, body habitus, or surgeon expertise on outcomes. This review did not address issues of cost-effectiveness.

Prognostic value of T1 substaging on oncological outcomes in patients with non-muscle-invasive bladder urothelial carcinoma: a systematic literature review and meta-analysis.

PURPOSE: To evaluate the prognostic value of substaging on oncological outcomes in patients with T (or pT1) urothelial carcinoma of the bladder. METHODS: A literature search using PubMed, Scopus, Web of Science, and Cochrane Library was conducted on March 2019 to identify relevant studies according to the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) guidelines. The pooled disease recurrence (DR) and disease progression (DP) rate in T1(or pT1) patients were calculated using a fixed or random effects model. RESULTS: Overall 36 studies published between 1994 and 2018 including a total of 6781 bladder cancer patients with T1(or pT1) stage were selected for the systematic review and meta-analysis. Twenty-nine studies reported significant association between tumor infiltration depth or muscularis mucosa (MM) invasion and oncological outcomes. Totally 12 studies were included in the meta-analysis. MM invasion (T1a/b/c [or pT1a/b/c] or T1a/b [or pT1a/b] substaging system) was associated with DR (pooled HR: 1.23, 95%CI: 1.01-1.49) and DP (pooled HR: 2.61, 95%CI: 1.61-4.23). Tumor infiltration depth (T1 m/e [or pT1 m/e] substaging system) was also associated with DR (pooled HR: 1.49, 95%CI: 1.11-2.00) and DP (pooled HR: 3.29, 95%CI: 2.39-4.51). CONCLUSIONS: T1(or pT1) substaging in patients with bladder cancer is of prognostic value as it is associated with oncologic outcomes. Inclusion of this factors into the clinical decision-making process of this heterogeneous tumor may improve outcomes, while avoiding over- and under-treatment for T1(or pT1) bladder cancer.

Robotic versus open radical cystectomy for bladder cancer in adults.

BACKGROUND: It has been suggested that in comparison with open radical cystectomy, robotic-assisted radical cystectomy results in less blood loss, shorter convalescence, and fewer complications with equivalent short-term oncological and functional outcomes; however, uncertainty remains as to the magnitude of these benefits. OBJECTIVES: To assess the effects of robotic-assisted radical cystectomy versus open radical cystectomy in adults with bladder cancer. SEARCH METHODS: Review authors conducted a comprehensive search with no restrictions on language of publication or publication status for studies comparing open radical cystectomy and robotic-assisted radical cystectomy. The date of the last search was 1 July 2018 for the Cochrane Central Register of Controlled Trials, MEDLINE (1999 to July 2018), PubMed Embase (1999 to July 2018), Web of Science (1999 to July 2018), Cancer Research UK (www.cancerresearchuk.org/), and the Institute of Cancer Research (www.icr.ac.uk/). We searched the following trials registers: ClinicalTrials.gov (clinicaltrials.gov/), BioMed Central International Standard Randomized Controlled Trials Number (ISRCTN) Registry (www.isrctn.com), and the World Health Organization International Clinical Trials Registry Platform. SELECTION CRITERIA: We searched for randomised controlled trials that compared robotic-assisted radical cystectomy (RARC) with open radical cystectomy (ORC). DATA COLLECTION AND ANALYSIS: This study was based on a published protocol. Primary outcomes of the review were recurrence-free survival and major postoperative complications (class III to V). Secondary outcomes were minor postoperative complications (class I and II), transfusion requirement, length of hospital stay (days), quality of life, and positive margins (%). Three review authors independently assessed relevant titles and abstracts of records identified by the literature search to determine which studies should be assessed further. Two review authors assessed risk of bias using the Cochrane risk of bias tool and rated the quality of evidence according to GRADE. We used Review Manager 5 to analyse the data. MAIN RESULTS: We included in the review five randomised controlled trials comprising a total of 541 participants. Total numbers of participants included in the ORC and RARC cohorts were 270 and 271, respectively.Primary outomesTime-to-recurrence: Robotic cystectomy and open cystectomy may result in a similar time to recurrence (hazard ratio (HR) 1.05, 95% confidence interval (CI) 0.77 to 1.43); 2 trials; low-certainty evidence). In absolute terms at 5 years of follow-up, this corresponds to 16 more recurrences per 1000 participants (95% CI 79 fewer to 123 more) with 431 recurrences per 1000 participants for ORC. We downgraded the certainty of evidence for study limitations and imprecision.Major complications (Clavien grades 3 to 5): Robotic cystectomy and open cystectomy may result in similar rates of major complications (risk ratio (RR) 1.06, 95% CI 0.76 to 1.48); 5 trials; low-certainty evidence). This corresponds to 11 more major complications per 1000 participants (95% CI 44 fewer to 89 more). We downgraded the certainty of evidence for study limitations and imprecision.Secondary outcomesMinor complications (Clavien grades 1 and 2): We are very uncertain whether robotic cystectomy may reduce minor complications (very low-certainty evidence). We downgraded the certainty of evidence for study limitations and for very serious imprecision.Transfusion rate: Robotic cystectomy probably results in substantially fewer transfusions than open cystectomy (RR 0.58, 95% CI 0.43 to 0.80; 2 trials; moderate-certainty evidence). This corresponds to 193 fewer transfusions per 1000 participants (95% CI 262 fewer to 92 fewer) based on 460 transfusion per 1000 participants for ORC. We downgraded the certainty of evidence for study limitations.Hospital stay: Robotic cystectomy may result in a slightly shorter hospital stay than open cystectomy (mean difference (MD) -0.67, 95% CI -1.22 to -0.12); 5 trials; low-certainty evidence). We downgraded the certainty of evidence for study limitations and imprecision.Quality of life: Robotic cystectomy and open cystectomy may result in a similar quality of life (standard mean difference (SMD) 0.08, 95% CI 0.32 lower to 0.16 higher; 3 trials; low-certainty evidence). We downgraded the certainty of evidence for study limitations and imprecision.Positive margin rates: Robotic cystectomy and open cystectomy may result in similar positive margin rates (RR 1.16, 95% CI 0.56 to 2.40; 5 trials; low-certainty evidence). This corresponds to 8 more (95% CI 21 fewer to 67 more) positive margins per 1000 participants based on 48 positive margins per 1000 participants for ORC. We downgraded the certainty of evidence for study limitations and imprecision. AUTHORS' CONCLUSIONS: Robotic cystectomy and open cystectomy may have similar outcomes with regard to time to recurrence, rates of major complications, quality of life, and positive margin rates (all low-certainty evidence). We are very uncertain whether the robotic approach reduces rates of minor complications (very low-certainty evidence), although it probably reduces the risk of blood transfusions substantially (moderate-certainty evidence) and may reduce hospital stay slightly (low-certainty evidence). We were unable to conduct any of the preplanned subgroup analyses to assess the impact of patient age, pathological stage, body habitus, or surgeon expertise on outcomes. This review did not address issues of cost-effectiveness.

Assessment of knowledge concerning urology among medical students in Poland.

BACKGROUND AND OBJECTIVE: Urological diseases represent a significant health issue worldwide. Presented study aimed at assessing current urological knowledge and confidence in performing urological diagnostic and therapeutic procedures among medical students at Jagiellonian University Medical College in Poland and compare it on different stages of the undergraduate medical education. MATERIAL AND METHODS: We designed an anonymous survey distributed among Polish students from 1st to 6th year of medical studies, before and after clinical urology course. Questions concerned general urological knowledge, prostate diseases, erectile dysfunction, and self-reported practical urological skills. RESULTS: Overall, 437 respondents participated in the survey. Mean total test score in our study group was 50.08%, mean general urological knowledge score was 53.44%, mean prostate diseases knowledge score was 55.43%, mean erectile dysfunction score was 36% and mean practical skills score was 45.83%. Mean total test score increased with consecutive years of studies (R = 0.58; p <0.001). The risk of an above average total test score was significantly influenced by the urology course (OR = 7.95, 95%CI = 1.81-34.84, p = 0.006) and the year of medical studies (4th-6th vs. 1st-3rd) (OR = 5.16, 95%CI = 3.41-7.81, p <0.001). Practical skills score above average was significantly more frequent in the group after the urology course (OR = 6.75, 95%CI = 1.54-29.58, p = 0.011). CONCLUSIONS: Results of this study reveal low mean scores obtained by students, even after completing the urology course, which implies that curriculum requires further development. Urological knowledge and self-assessed practical skills increased with years of medical education. The urology course improved the score obtained in our survey, both in terms of total test score and practical skills.

Laparoendoscopic single-site donor nephrectomy (LESS-DN) versus standard laparoscopic donor nephrectomy.

BACKGROUND: Advances in minimally invasive surgery for live kidney donors have led to the development of laparoendoscopic single site donor nephrectomy (LESS-DN). At present, laparoscopic donor nephrectomy is the technique of choice for donor nephrectomy globally. Compared with open surgical approaches, laparoscopic donor nephrectomy is associated with decreased morbidity, faster recovery times and return to normal activity, and shorter hospital stays. LESS-DN differs from standard laparoscopic donor nephrectomy; LESS-DN requires a single incision through which the procedure is performed and donor kidney is removed. Previous studies have hypothesised that LESS-DN may provide additional benefits for kidney donors and stimulate increased donor rates. OBJECTIVES: This review looked at the benefits and harms of LESS-DN compared with standard laparoscopic nephrectomy for live kidney donors. SEARCH METHODS: We searched the Cochrane Kidney and Transplant's Specialised Register to 28 January 2016 through contact with the Information Specialist using search terms relevant to this review. SELECTION CRITERIA: We included randomised controlled trials (RCTs) that compared LESS-DN with laparoscopic donor nephrectomy in adults. DATA COLLECTION AND ANALYSIS: Three authors independently assessed studies for eligibility and conducted risk of bias evaluation. Summary estimates of effect were obtained using a random-effects model and results were expressed as risk ratios (RR) or risk difference (RD) and their 95% confidence intervals (CI) for dichotomous outcomes, and mean difference (MD) and 95% CI for continuous outcomes. MAIN RESULTS: We included three studies (179 participants) comparing LESS-DN with laparoscopic donor nephrectomy. There were no significant differences between LESS-DN and laparoscopic donor nephrectomy for mean operative time (2 studies, 79 participants: MD 6.36 min, 95% CI -11.85 to 24.57), intra-operative blood loss (2 studies, 79 participants: MD -8.31 mL, 95% CI -23.70 to 7.09), or complication rates (3 studies, 179 participants: RD 0.05, 95% CI -0.04 to 0.14). Pain scores at discharge were significantly less in the LESS-DN group (2 studies, 79 participants: MD -1.19, 95% CI -2.17 to -0.21). For all other outcomes (length of hospital stay; length of time to return to normal activities; blood transfusions; conversion to another form of surgery; warm ischaemia time; total analgesic requirement; graft loss) there were no significant differences observed.Although risk of bias was assessed as low overall, one study was assessed at high risk of attrition bias. AUTHORS' CONCLUSIONS: Given the small number and size of included studies it is uncertain whether LESS-DN is better than laparoscopic donor nephrectomy. Well designed and adequately powered RCTs are needed to better define the role of LESS-DN as a minimally invasive option for kidney donor surgery.

Should We Use Antibiotic Prophylaxis for Flexible Cystoscopy? A Systematic Review and Meta-Analysis.

INTRODUCTION: The role of antibiotic prophylaxis for routine flexible cystoscopy (FC) is not clear due to the varying practices of individual clinicians. There are no formal guidelines, and this may be due to a lack of formal summary of the data. METHODS: A systematic review was conducted in April 2014 including all randomised control trials on prophylactic antibiotic use for FC. The main outcome measures were confirmed bacteriuria on mid-stream urine (MSU), asymptomatic bacteriuria and symptomatic bacteriuria. A meta-analysis was conducted with difference between groups expressed as an odds ratio (OR) and control group risk. RESULTS: 5,107 patients were included, 2,173 in placebo and 2,934 in the antibiotic group. The OR for all three outcomes favoured the antibiotic group; the risk of developing symptomatic bacteriuria was 0.06 times more likely in the control group (OR 0.34), 0.054 (OR 0.40) for developing asymptomatic bacteriuria and 0.109 for confirming bacteriuria on MSU (OR 0.36). The number needed to treat (NNT) was 15 (13-19) for MSU positive bacteriuria; 32 (27-42) for symptomatic bacteriuria and 26 (23-33) for asymptomatic bacteriuria. CONCLUSIONS: Antibiotic prophylaxis did confer a reduction in cases of symptomatic and asymptomatic bacteriuria but the NNT were high. Therefore, the authors cannot advocate the use of antibiotic prophylaxis for routine FC procedures.

The assessment of bladder cancer resectability with bimanual palpation: A prospective study in laparoscopy and open cystectomy patients.

PURPOSE: To evaluate the value of examination under anesthesia (EUA) in the assessment of bladder resectability during cystectomy. MATERIALS AND METHODS: This prospective study included consecutive patients undergoing cystectomy for bladder cancer at a single center between June 2017 and October 2020. EUA was conducted before cystectomy by two urologists who assessed the bladder for limited mobility. One examiner was blinded to the imaging results. Soft tissue surgical margin status in the pathological evaluation of a cystectomy specimen served as a measure of resectability. We used multivariable logistic regression models to assess whether EUA performed by blinded or non-blinded examiners is associated with soft tissue positive surgical margins (PSMs) and to calculate the fraction of new information added by such an examination in addition to selected clinical variables. RESULTS: Among the 134 patients analyzed, limited bladder mobility was indicated by the blinded and non-blinded examiners in 23 (17.2%) and 21 (15.7%) cases, respectively. PSMs were identified in 22 (16.4%) patients, more often in patients with limited bladder mobility as assessed by the blinded (odds ratio [OR] 6.7; 95% confidence interval [CI], 1.9-24.2) and non-blinded examiners (OR 12.9; 95% CI, 2.9-57.5). The fraction of new information added by the blinded and non-blinded examiners was 48.6% and 57.7%, respectively. The enrichment of patients who underwent pure laparoscopic cystectomy (n = 102; 76%) and the inclusion of patients for emergent surgery may limit the generalizability of our findings. CONCLUSIONS: The identification of limited bladder mobility during preoperative EUA yielded prognostic information on surgical margin status. Our findings suggest that EUA has the potential to provide valuable insights in the assessment of bladder resectability. However, further research in a larger cohort of patients is warranted to validate and expand on these findings.

Laparoscopic versus open radical cystectomy for muscle-invasive bladder cancer: a single institute comparative analysis.

BACKGROUND: Open radical cystectomy (ORC) is the gold standard of treatment for muscle-invasive bladder cancer. Laparoscopic radical cystectomy (LRC) has emerged to provide an alternative. METHODS: Between 2006 and 2012, 155 patients who underwent LRC or ORC were compared (mean follow-up 53 months). RESULTS: The ORC group had shorter operative times (p < 0.0001), more blood loss (p < 0.00001), more transfusion requirement (p < 0.00001), longer postoperative length of hospital stay (p < 0.00001) and more morphine requirement (p = 0.02). No difference was found regarding lymph node yield (p = 0.07), positive margins (p = 0.11), cystectomy pathology results (p > 0.05) and positive lymph nodes (p = 0.02). The ORC group had less intraoperative complications (p = 0.03). No difference was found between the two groups regarding 5-year overall survival (p = 0.93), cancer-specific survival (p = 0.7) and recurrence-free survival (p = 0.62). CONCLUSION: LRC can be considered as an alternative to ORC with good operative and postoperative results in addition to comparable 5-year survival results.

Diagnostic accuracy of bimanual palpation in bladder cancer patients undergoing cystectomy: A prospective study.

OBJECTIVES: To prospectively assess the concordance of examination under anesthesia (EUA)-based clinical T stage with pathological T stage and diagnostic accuracy of EUA in patients with bladder cancer undergoing cystectomy. METHODS: Consecutive patients with bladder cancer undergoing cystectomy between June 2017 and October 2020 in a single academic center were included in a prospective study. Two urologists performed EUA (one blinded to imaging) before patients underwent cystectomy. We assessed the concordance between clinical T stage in bimanual palpation (index test) and pathological T stage in cystectomy specimens (reference test). Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated with 95% confidence intervals (CIs) to detect or exclude locally advanced bladder cancer (pT3b-T4b) in EUA. RESULTS: The data of 134 patients were analyzed. Given that stage pT3a cannot be palpated, for the nonblinded examiner, T staging in EUA was concordant with pT in 107 (79.9%) patients, 20 (14.9%) cases being understaged in EUA and 7 (5.2%) overstaged. For the blinded examiner, staging was correct in 106 (79.1%) patients, 20 (14.9%) cases being understaged and 8 (6%) overstaged. For the nonblinded examiner, sensitivity, specificity, PPV, and NPV of EUA were 55.9% (95% CI 39.2%-72.6%), 93% (88%-98%), 73.1% (56%-90.1%), and 86.1% (79.6%-92.6%), respectively; for the blinded examiner, they were 52.9% (36.2%-69.7%), 93% (88%-98%), 72% (54.4%-89.6%) and 85.3% (78.7%-92%), respectively. Awareness of imaging results did not have a major impact on EUA results. CONCLUSION: Bimanual palpation should still be used for clinical staging, given its specificity, NPV, and that it could correctly determine bladder cancer T stage in 80% of cases.

Laparoscopic partial nephrectomy in obese patients: a systematic review and meta-analysis.

What's known on the subject? and What does the study add? The literature yielded only four studies on the subject; however, no clear outcome can be taken from individual studies. This review adds a meta-analysis of these four studies to make the patient cohort larger and to allow for a greater understanding of the procedure in this select group of patients. • To compare the safety and efficacy of laparoscopic partial nephrectomy (LPN) in obese and non-obese patients. • We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (1966 to November 2011), EMBASE (1980 to November 2011), CINAHL, Clinicaltrials.gov, Google Scholar, reference lists of articles and abstracts from conference proceedings without language restriction for studies comparing LPN in obese and non-obese patients. • Four observational cohort studies were included for 256 obese patients compared with 403 non-obese patients who underwent LPN. • There was no difference in operative duration (mean difference [MD] 5.64, 95% confidence interval [CI]-3.80 to 15.09), warm ischaemic time (MD -1.04, 95% CI -2.68 to 0.59), estimated blood loss (MD 53.73, 95% CI 0.72-106.74) or hospital stay (MD -0.04, 95% CI -0.30 to 0.22). • There was no difference in complications in total (odds ratio [OR] 1.02, 95% CI 0.70-1.49), intraoperative complications (OR 0.68, 95% CI 0.30-1.53), or postoperative complications (OR 1.15, 95% CI 0.75-1.77). • The obese group had significantly more Clavien grade III complications (OR 3.95, 95% CI 1.36-11.42), despite the low absolute incidence, with 4.3% (11/256) in the obese group vs 1.5% (6/403) in the non-obese group. • Experienced laparoscopic surgeons can safely and efficiently perform PN for obese patients with comparable results to those of non-obese patients. • The likelihood of major (Clavien Classification ≥ III) complications is higher for the obese patient.

Laparoscopic radical cystectomy: a 5-year review of a single institute's operative data and complications and a systematic review of the literature.

OBJECTIVE: We aim to evaluate our experience and results with laparoscopic radical cystectomy and conduct a systematic review of studies reporting on 50 or more procedures. MATERIALS AND METHODS: Between February 2006 and March 2011, a prospective study in a single institute on patients with bladder cancer who underwent laparoscopic radical cystectomy was conducted. A search of the Cochrane Library, PubMed, Medline, and Scopus databases was conducted for studies reporting on 50 or more laparoscopic radical cystectomy procedures to compare with our results. RESULTS: Sixty men and five women underwent laparoscopic radical cystectomy during the 5-year study period. Thirty-nine patients were submitted to ileal conduits, 24 to neobladders, and two patients to ureterocutaneostomies. The mean operative time was 294 ± 27 minutes, the mean blood loss was 249.69 ± 95.59 millilitres, the mean length of hospital stay was 9.42 ± 2 days, the mean morphine requirement was 3.69 ± 0.8 days. The overall complication rate was 44.6% (29/65). However, the majority of the patients with complications (90% (26/29)) had minor complications treated conservatively with no further surgical intervention needed. The literature search found seven studies, which reported on their institutions' laparoscopic radical cystectomy results of 50 or more patients. Generally, our results were similar to other reported studies of the same calibre. CONCLUSION: Laparoscopic radical cystectomy is a safe and efficient modality of treatment of bladder cancer. However, it comes with a steep learning curve, once overcome, can provide an alternative to open radical cystectomy.

Artificial urinary sphincter implantation with periprostatic cuff placement for urinary incontinence in men.

Introduction: Artificial urinary sphincter (AUS) implantation is the treatment of choice for male urinary incontinence (UI). The aim of the present study was to evaluate treatment outcomes of UI in men using an AUS with a cuff placed around the prostatic urethra. Material and methods: Forty-three men with preserved prostatic urethra were selected for AUS implantation due to UI. Twenty patients had the cuff implanted around the prostate using the retropubic approach (Group 1), and 23 had the cuff placed around the bulbous urethra (Group 2). Both groups were compared in terms of continence quality as well as intra- and postoperative complications. Results: The groups were comparable with respect to age and duration of follow-up. Median time to complications was 90.3 and 10.7 months in Group 1 and Group 2, respectively (p = 0.007). The complication rate was 40% and 58.3% in Group 1 and 2, respectively (p = 0.001). Complete continence was obtained in 80% of patients from Group 1 and 33.3% of men from Group 2A (p = 0.001). Conclusions: The analysis indicates that cuff placement around the prostatic urethra results in better continence and is characterised by fewer complications. This method is dedicated for patients who have not had the prostate gland removed. Due to the retrospective nature of this analysis and small groups of patients, it is not possible to formulate ultimate recommendations.

Extraperitoneal laparoscopic Millin prostatectomy using finger enucleation.

PURPOSE: We evaluated the feasibilty, safety and results of extraperitoneal laparoscopic Millin prostatectomy using finger enucleation through an additional 1 cm suprapubic incision. MATERIALS AND METHODS: A total of 66 consecutive laparoscopic simple prostatectomies were performed with this technique in men with symptomatic bladder outflow obstruction and a prostate gland larger than 70 cc on transrectal ultrasound. Data such as operating time, intraoperative blood loss, transfusion rate, complications, catheterization period, hospitalization time and surgical specimen weight were prospectively collected and evaluated. Preoperative and 3-month postoperative International Prostate Symptom Score and urinary flow rates were used to assess the surgical outcome. RESULTS: Average operating time was 55 minutes with a mean estimated blood loss of 200 ml. No blood transfusion was necessary, and no conversion, complications or mortality was present. The mean postoperative catheterization period was 7.3 days with a mean hospital stay of 5.2 days. Mean enucleated tissue weight was 85.5 gm. At 3 months postoperatively the International Prostate Symptom Score improved to a mean of 5.8 (from a mean preoperative score of 29.5) while maximum urine flow improved to a mean of 18.5 ml per second (from a mean preoperative rate of 5.8 ml per second). CONCLUSIONS: This procedure is safe and fast with excellent functional outcomes. However, prolonged catheterization and hospitalization are still required.

Investigation of Chromosome 1 Aberrations in the Lymphocytes of Prostate Cancer and Benign Prostatic Hyperplasia Patients by Fluorescence in situ Hybridization.

PURPOSE: Radiotherapy is one of the most common treatments for prostate cancer. Finding a useful predictor of the therapeutic outcome is crucial as it increases the efficacy of treatment planning. This study investigated the individual susceptibility to radiation based on chromosome 1 aberration frequency measured by the FISH (fluorescence in situ hybridization) method. PATIENTS AND METHODS: Whole blood samples were collected from 27 prostate cancer (PCa) patients and 32 subjects with benign prostatic hyperplasia (BPH), who were considered as a control group. Samples were irradiated with 2 Gy of x-rays, cultured, harvested, and used in the FISH procedure. RESULTS: After irradiation, significantly higher levels of all studied chromosome 1 aberrations (except for deletions) in the group of PCa patients were revealed. Furthermore, in the lymphocytes of cancer patients, nearly five-fold higher frequencies of acentric fragments were observed compared to the BPH group. The highest individual radiosensitivities for all estimated biomarkers were seen in PCa patient cells who reported cancer incidence in the immediate family (CIF+). CONCLUSION: The differences in chromosome 1 aberrations between PCa and BPH demonstrate that lymphocytes taken from patients with prostate cancer have higher radiosensitivity which might be related to hereditary or familiar inclinations. Therefore, this technique may find future application in searching biomarkers of the cellular radiotherapy response in prostate cancer patients.

Changing patterns of urologic emergency visits and admissions during the COVID-19 pandemic: a retrospective, multicenter, nationwide study.

INTRODUCTION: We aimed to examine the change in the number and severity of visits to the emergency departments (EDs) and subsequent admissions for urgent urologic conditions in the early stage of the coronavirus disease 2019 (COVID-19) pandemic in Poland. MATERIAL AND METHODS: We evaluated data from 13 urologic centers in Poland and compared the number of visits to the EDs and subsequent admissions before and after the advent of COVID-19 in 2020, and before and after the escalating national restrictions. Furthermore, data on types of urologic complaints, crucial laboratory parameters, and post-admission procedures were analyzed. RESULTS: In total 1,696 and 2,187 urologic visits (22.45% decrease) and 387 and 439 urologic urgent admissions (11.85% decrease) were reported in given periods in 2020 and 2019, respectively. The year-over-year difference in daily mean visits was clear (36.1 vs. 46.5; p < 0.001). Declines were seen in all complaints but device malfunction. In 2020 daily mean visits and admissions decreased from 40.9 and 9.6 before lockdowns to 30.9 (p < 0.001) and 6.9 (p = 0.001) after severe restrictions, respectively. There was a trend towards more negative laboratory parameter profiles in 2020, with patients who visited the EDs after severe restrictions having twice as high median levels of C-reactive protein (15.39 vs. 7.84, p = 0.03). CONCLUSIONS: The observed declines in ED visits and admissions were apparent with the significant effect of national lockdowns. Our results indicate that some of the patients requiring urgent medical help did not appear at the ED or came later than they would have done before the pandemic, presenting with more severe complaints.

How has the COVID-19 pandemic impacted Polish urologists? Results from a national survey.

INTRODUCTION: Poland was initially less affected by the coronavirus disease 2019 (COVID-19) pandemic, however, severe restrictions, and health care restructuration have impacted all areas of medicine, including urology. Therefore, we aimed, via an online survey, to examine the impact of the COVID-19 pandemic on Polish urologists and urology residents. MATERIAL AND METHODS: Between May 15 and June 6, 2020, 229 (28.63% response rate) urologists and urology residents responded to a 28-question online survey. The questionnaire analyzed basic demographic and professional characteristics, and the impact of the COVID-19 pandemic on physicians' everyday work, mental status as well as private life. We further compared the differences between the selected subgroups. RESULTS: Nearly all (96.5%) responders claimed that the pandemic had a moderate to high impact on their everyday clinical practice with the majority of the residents (62.0%) believing that the COVID-19 pandemic will harm their training. Most responders (86.9%) reported over 25% declines in outpatient clinic consultations and 55.9% claimed that their income dropped over 25%. Only 38.9% wanted telemedicine to permanently replace some of the consultations after the pandemic, with residents being significantly more positive about this modality (51.4% vs. 33.1%; p = 0.01). Interestingly, 79.9% noticed the negative psychological effect of the pandemic on their colleagues, and 57.6% felt increased anxiety, sadness, or stress. CONCLUSIONS: This study revealed the complaints and needs of Polish urologists and urology residents after the first wave of the COVID-19 pandemic. There was a significantly negative impact on their work, mental health, and private life.

The Prognostic Value of Tumor Regression Grades Combined With TNM Classification in Patients With Muscle-Invasive Bladder Cancer Who Underwent Neoadjuvant Chemotherapy Followed by Radical Cystectomy.

INTRODUCTION: Tumor regression grades (TRGs) quantify the pathologic response to neoadjuvant chemotherapy (NAC). The aim of the study was to investigate the prognostic value of TRGs in combination with the TNM classification in an independent cohort of patients with muscle-invasive bladder cancer (MIBC) treated with NAC followed by radical cystectomy (RC) in a retrospective setting. PATIENTS AND METHODS: Patients treated with a complete course of NAC followed by RC for MIBC between December 2012 and December 2017 were enrolled in the study. TRGs were determined in RC specimens. Data were collected preoperatively, and the follow-up was continued up to August 2018. Kaplan-Meier curves and the Cox proportional hazards model were used to compare survival probabilities between major responders (no MIBC, < ypT2 and ypN0), partial responders (≥ ypT2 or ypN+ and TRG2), and non-responders (≥ ypT2 or ypN+ and TRG3). RESULTS: A group of 70 patients with a median age of 64 years (interquartile range, 58-67 years) was analyzed. There were 36 major responders, 21 partial responders, and 13 non-responders. In comparison with a major response, a partial response was associated with a hazard ratio of 9.44 (95% confidence interval, 1.10-80.89; P = .04) and non- responders showed a hazard ratio of 17.85 (95% confidence interval, 2.18-145.85; P = .007) for death. CONCLUSIONS: The study confirms the prognostic value of the pathologic response to NAC. Determination of TRGs is straightforward, provides valuable information, and could be easily included in the standard pathologic examination of RC surgical specimen. Prospective studies are needed to establish the role of TRG in routine clinical practice.

Identification of potential prognostic factors for absence of residual disease in the second resection of T1 bladder cancer.

INTRODUCTION: The aim of this single centre retrospective study was to analyse the results of second resection (repeat transurethral resection of bladder tumour - reTURBT) after a macroscopically complete resection of T1 urothelial bladder tumour and to identify prognostic factors for absence of residual disease (T0) in the second resection of T1 bladder cancer. MATERIAL AND METHODS: Patients with T1 bladder cancer diagnosed in a macroscopically complete initial resection who underwent second resection within 12 weeks were included into the retrospective analysis. Based on the presence or absence of residual disease, patients were grouped for further analysis. Univariate and multivariable logistic regressions were performed to identify potential prognostic factors. RESULTS: Among the 139 patients who met the inclusion criteria, 96 (69.1%) had no residual disease (T0) and 43 (30.9%) had residual disease in the second resection (including muscle invasive bladder cancer in 2.2%). Adjusted odds ratios (OR) of T0 status obtained from the final model were as follows: detrusor muscle presence in the first resection (OR 3.05; 95% CI 1.12-8.35, p = 0.03), immediate post-operative intravesical mitomycin C administration after the first TURBT (OR 2.52, 95% CI 1.12-5.68; p = 0.03) and primary bladder cancer setting (OR 2.45, 95% CI 1.10-5.47; p = 0.03). CONCLUSIONS: Our results add evidence regarding the importance of detrusor muscle presence in the first TURBT. Identification of predictors of T0 status at second resection could help design prospective studies assessing the possibility to avoid re-resection in selected patients with T1 bladder cancer without compromising oncological outcomes.

Neurotic personality and lower urinary tract symptoms in day hospital patients diagnosed at pretreatment between 2004 and 2014. / Osobowosc nerwicowa a objawy z dolnego odcinka ukladu moczowego u pacjentów kwalifikowanych do leczenia psychoterapia na oddziale dziennym w latach 2004­2014.

OBJECTIVES: Evaluation of the association between the occurrence of lower urinary tract symptoms in patients qualified for psychotherapy and the severity and profile of their neurotic personality disorders. MATERIAL AND METHODS: Retrospective analysis of questionnaires included in the medical records of 2,450 patients qualified for psychotherapy in 2004-2014 in terms of correlations between the symptoms of pollakiuria and unconscious urinary incontinence, and the global severity of neurotic symptoms (OWK), global severity of neurotic personality disorders (XKON) and abnormal values of 24 scales of the KON-2006 questionnaire. Correlations in the form of OR coefficients with 95% confidence intervals were estimated using logistic regression analyzes. RESULTS: Lower urinary tract symptoms are associated with a significantly greater severity of neuroticism, both described by the global severity of symptoms (OWK) as well as by the global neurotic personality disorder index (XKON) and abnormal values of the KON-2006 questionnaire scales. The occurrence of both symptoms was associated with the following scales: 'Negative self-esteem' and 'Envy', the occurrence of pollakiuria - with the scales 'Feeling of being dependent on others', 'Demobilization', 'Conviction of life helplessness' and 'Feeling of lack of influence', the occurrence of unconscious urinary incontinence - with the scales 'Feeling of being alienated' and 'Exaltation' for both genders, and only in men 'Risk avoidance' (low 'Risk tendencies'), 'Conviction of life helplessness', 'Difficulties in interpersonal relations'. Extreme severity of pollakiuria was more strongly associated with many of the mentioned scales, and also slightly differently with other scales, e.g., in men - with the 'Sense of overload' and 'Imagination, fantasizing'. CONCLUSIONS: Neurotic personality traits described by abnormal values of the KON-2006 questionnaire scales are associated with the presence (and also to some extent with the severity) of psychogenic lower urinary tract symptoms. Connections may be bi-directional - in some cases experiencing and self-description of personality traits may be secondary to suffering associated with pollakiuria and incontinence.