Treatment of Ureteral Stent-Related Symptoms.

BACKGROUND: The aim of the study was to assess the effectiveness of the main classes of drugs used at reducing morbidity related to ureteric stents. SUMMARY: After establishing a priori protocol, a systematic electronic literature search was conducted in July 2019. The randomized clinical trials (RCTs) selection proceeded in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines and was registered (PROSPERO ID 178130). The risk of bias and the quality assessment of the included RCTs were performed. Ureteral Stent Symptom Questionnaire (USSQ), International Prostate Symptom Score (IPSS), and quality of life (QoL) were pooled for meta-analysis. Mean difference and risk difference were calculated as appropriate for each outcome to determine the cumulative effect size. Fourteen RCTs were included in the analysis accounting for 2,842 patients. Alpha antagonist, antimuscarinic, and phosphodiesterase (PDE) inhibitors significatively reduced all indexes of the USSQ, the IPSS and QoL scores relative to placebo. Conversely, combination therapy (alpha antagonist plus antimuscarinic) showed in all indexes of the USSQ, IPSS, and QoL over alpha antagonist or antimuscarinic alone. On comparison with alpha blockers, PDE inhibitors were found to be equally effective for urinary symptoms, general health, and body pain parameters, but sexual health parameters improved significantly with PDE inhibitors. Finally, antimuscarinic resulted in higher decrease in all indexes of the USSQ, the IPSS, and QoL relative to alpha antagonist. KEY MESSAGE: Relative to placebo, alpha antagonist alone, antimuscarinics alone, and PDE inhibitors alone have beneficial effect in reducing stent-related symptoms. Furthermore, there are significant advantages of combination therapy compared with monotherapy. Finally, PDE inhibitors are comparable to alpha antagonist, and antimuscarinic seems to be more effective than alpha antagonist alone.

Prospective evaluation of urinary steroids and prostate carcinoma-induced deviation: preliminary results.

BACKGROUND: The serum prostate-specific antigen is the most widespread biomarker for prostate disease. Its low specificity for prostatic malignancies is a matter of concern and the reason why new biomarkers for screening purposes are needed. The correlation between altered production of the main steroids and prostate carcinoma (PCa) occurrence is historically known. The purpose of this study is to evaluate the modifications of a comprehensive urinary endogenous steroidal profile (USP) induced by PCa, by multivariate statistical methods. METHODS: A total of 283 Italian subjects were included in the study, 139 controls and 144 PCa-affected patients. The USP, including 17 steroids and five urinary steroidal ratios, was quantitatively evaluated using gas chromatography coupled with single quadrupole mass spectrometry (GC-MS). The data were interpreted using a chemometric, multivariate approach (intrinsically more sensible to alterations with respect to traditional statistics) and a model for the discrimination of cancer-affected profiles was built. RESULTS: Two multivariate classification models were calculated, the former including three steroids with the highest statistical significance (e.g. testosterone, etiocholanolone and 7ß-OH-DHEA) and PSA values, the latter considering the three steroids' levels only. Both models yielded high sensitivity and specificity scores near to 70%, resulting significantly higher than PSA alone. CONCLUSIONS: Three USP steroids resulted significantly altered in our PCa population. These preliminary results, combined with the simplicity and low-cost of the analysis, open to further investigation of the potential role of this restricted USP in PCa diagnosis.

All you need to know about "Aquablation" procedure for treatment of benign prostatic obstruction.

INTRODUCTION: In recent years, technological advances and new approaches have been developed for the treatment of benign prostatic obstruction (BPO) in order to reduce complications like bleeding, retrograde ejaculation and risk of infection while obtaining an adequate disobstruction. The most recent surgical approach introduced is the Aquablation system (PROCEPT BioRobotics, Redwood Shores, CA, USA). This intervention is a robotically guided system that uses high-velocity water jets in order to ablate prostatic tissue, with real-time ultrasound guidance. The aim of this review is to summarize the current evidence on Aquablation and its results, compared to the reported outcomes of the gold standard treatment, the transurethral resection of the prostate (TURP). EVIDENCE ACQUISITION: A systematic review of the Literature was performed in June 2019 using Medline (via PubMed), Embase (via Ovid), and Cochrane databases. The studies that compared the Aquablation to the standard TURP were included. Moreover, a critical review of the single arm studies was conducted. EVIDENCE SYNTHESIS: The results of this systematic review, based on a single RCT that compared Aquablation vs. TURP in prostates 30-80 cc in size, confirmed that Aquablation has at least a similar efficacy as TURP, but has a better safety profile, allows shorter resection times, and has a lower risk of retrograde ejaculation. Moreover, in some subcategories of patients (e.g., when prostate volume is >50 cc) functional outcomes of Aquablation are better than those of TURP. Evidence from non-comparative clinical studies and from real life scenarios have confirmed that Aquablation may be used effectively for prostate volumes up to 150 cc. CONCLUSIONS: The Aquablation procedure for the treatment of BPO allows high clinical efficacy with an excellent safety profile. For prostate volume 30-80 cc, comparative studies demonstrated that this procedure offers clinical results at least comparable to those of conventional TURP. Latest evidence showed that Aquablation may be used effectively for prostate volumes up to 150 cc. The major strengths are its high-speed resection time, low complication rate, and potential for sexual function preservation.

Correlation between chronological and physiological age of males from their multivariate urinary endogenous steroid profile and prostatic carcinoma-induced deviation.

The biosynthesis of endogenous androgenic anabolic steroids (EAAS) in males varies with age. Knowledge of the general urinary EAAS profile's dependence from aging - not reported up to now - may represents a prerequisite for its exploitation in the screening and diagnostic support for several pathologies. Extended urinary EAAS profiles were obtained from healthy and pathological individuals, using a GC-MS method which was fully validated by a stepwise, analyst-independent scheme. Seventeen EAAS and five of their concentration ratios were determined and investigated using multivariate statistical methods. A regression model based on Kernel partial least squares algorithm was built to correlate the chronological age of healthy male individuals with their "physiological age" as determined from their urinary EAAS profile. Strong correlation (R2 = 0.75; slope = 0.747) and good prediction ability of the real chronological age was inferred from EAAS data. In contrast, patients with recent diagnosis (not pharmacologically treated) of prostatic carcinoma (PCa) exhibited a comprehensive EAAS profile with strong negative deviation from the model, corresponding a younger predicted age. This result is possibly related to the activation of anomalous steroid biosynthesis induced from PCa. Over a restricted 60-80 years-old population, PLS-discriminant analysis (DA) was used to distinguish healthy subjects from patients with untreated PCa. PLS-DA yielded excellent discrimination (sensitivity and specificity >90%) between healthy and pathological individuals. This proof-of-concept study provides a preliminary evaluation of multivariate DA on wide EAAS profiles as a screening method to distinguish PCa from non-pathological conditions, overcoming the potentially interfering effect of ageing.

Assessing problematic States in patients' narratives: the grid of problematic States.

The authors present the theoretical background, development, and validation of a new psychotherapy process rating tool: Grid of Problematic States (GPS). The GPS is based on Horowitz's states of mind theory, which describes recurrent patterns of experience and behavior. Meaningful changes in the observed states indicate therapeutic change. The GPS is designed for use with transcripts from psychotherapy sessions and focuses on narrative episodes within the patient dialogue. The GPS was applied to a completely transcribed cognitive psychotherapy with a patient diagnosed as mild major depressive. The authors demonstrated that the GPS could reliably assess disorganization and the development of stable construct clusters of thought themes, emotions, and somatic sensations. The interpretation of results is consistent with the patient's clinical assessment.