Anesthetic considerations in robotic surgery: a comprehensive review.

Recent advancements have led to a rise, in the demand for surgical methods with robot-assisted procedures becoming increasingly popular for addressing the limitations of traditional laparoscopy. However, incorporating surgery involves making changes in the way patients are positioned and logistical planning, which can challenge conventional approaches to providing anesthesia care. Despite these obstacles robotic technology shows potential for bringing about improvements in therapy. Anesthesiologists play a role in ensuring safety and delivering high quality anesthesia care during robotic surgery. Having an understanding of the elements of robotic surgical systems is essential for adjusting anesthesia practices effectively. Keeping up to date with the developments in surgery is key to achieving optimal outcomes for patients. Effective collaboration between teams and anesthesiologists is essential for managing the complexities of anesthesia during surgery. By promoting communication and cooperation across disciplines healthcare professionals can enhance safety and results. In summary while the introduction of surgery presents challenges in anesthesia care it also offers opportunities for innovation and advancement. Anesthesiologists need to embrace these advancements adapt their practices accordingly and engage in education and collaboration to ensure the safe and successful integration of robotic technology, into surgical procedures ultimately improving patient care.

Diagnostic and Prognostic Value of miR-93 in Prostate Cancer: A Meta-Analysis and Bioinformatics Analysis.

Background: Accurate and non-invasive diagnostic and prognostic markers are necessary to improve patient outcomes. MicroRNAs have been proposed as relatively non-invasive and pertinent biomarkers. miR-93 has been studied for its potential as a diagnostic and prognostic marker in prostate cancer (PCa), but findings from individual studies are inconsistent. We conducted a meta-analysis of its overall differential expression in 13 PCa studies and a bioinformatics analysis to provide a comprehensive appraisal of its diagnostic and prognostic role. Methods: We searched all published papers on miR-93 expression in PCa up to Nov 30, 2022 using PubMed, Science Direct, Web of Science, Cochrane Central Register of Controlled Trials databases. We used RevMan software to Meta-analyze the included literature. A bioinformatics analysis of genes and pathways that might be target to the effect of the mature miR-93-5p was carried out. Results: The pooled standardized mean difference (SMD) of miR-93 expression in PCa, its area under the curve (AUC) and hazard ratio (HR) were 1.26, 95% CI [-0.34-2.86], 0.84, 95% CI [0.76 -0.93] and 1.67, 95% CI [0.98, 2.84] respectively. Bioinformatics analysis revealed that mature miR-93-5p may regulate genes such as SMAD1, SMAD7 and MAPK and the PI3K-Akt signaling pathways. Conclusion: miR-93 has significant diagnostic and prognostic value in PCa. These findings highlight the potential of miR-93 as a non-invasive biomarker for PCa and may contribute to earlier detection and prognostic assessment. The target genes and signaling pathways regulated by miR-93 may provide insights into the underlying molecular mechanisms of PCa.

Association between the Estrogen receptor ß rs1256049 polymorphism and prostate cancer risk:a meta-analysis.

The Estrogen receptor ß (ESR-ß) gene is suggested to have a growth inhibitory role in prostate tissue and was proposed as a new therapeutic target for prostate cancer (PCa). Precedent studies have investigated the association between the ESR-ß rs1256049 polymorphism and PCa but findings were inconsistent. Thus, this meta-analysis was performed to assess whether the ESR-ß rs1256049 polymorphism is associated with an increased susceptibility to PCa. Eligible studies published before February 5, 2022 were systematically searched in PubMed, Web of Science, ScienceDirect and Google Scholar databases. The sample set was extracted from 11 case-control studies involving 9390 cases and 10057 controls for the association between ESR-ß rs1256049 polymorphism and PCa susceptibility. In our overall meta-analysis, no significant association between rs1256049 and PCa risk was found under all genetic models. In subgroup analysis according to ethnicity, Asians, had a significantly decreased cancer risk based on both the heterozygote genetic model (OR = 0.75, 95% CI = [0.63, 0.89] P = 0.01) and the dominant model (OR = 0.80, 95% CI [0.69, 0.94] P = 0.01). For the Caucasian group, there was a significantly increased risk observed in the allelic model (OR = 1.17, 95% CI = [1.04, 1.32] P = 0.01), heterozygote model (OR = 1.15, 95% CI = [1.01, 1.31] P = 0.03) and the dominant model (OR = 1.17, 95% CI = [1.03, 1.32] P = 0.01). Our results demonstrate that ESR-ß r1256049 polymorphism may play a possible promising effect in PCa in Caucasians and a protective factor in Asians.

The Evaluation of Vascular Endothelial Growth Factor A (VEGFA) and VEGFR2 Receptor as Prognostic Biomarkers in Bladder Cancer.

Vascular endothelial growth factor (VEGF) and its receptors (VEGFR1 and VEGFR2) are the most important tissue factors involved in tumor growth and angiogenesis. The aim of this study was to evaluate the promoter mutational status of VEGFA and the expression levels of VEGFA, VEGFR1, and VEGFR2 in bladder cancer (BC) tissues and to correlate the results with the clinical-pathological parameters of BC patients. A total of 70 BC patients were recruited at the Urology Department of the Mohammed V Military Training Hospital in Rabat, Morocco. Sanger sequencing was performed to investigate the mutational status of VEGFA, and RT-QPCR was used to evaluate the expression levels of VEGFA, VEGFR1, and VEGFR2. Sequencing of the VEGFA gene promoter revealed the presence of -460T/C, -2578C/A, and -2549I/D polymorphisms, and statistical analyses showed a significant correlation between -460T/C SNP and smoking (p = 0.02). VEGFA and VEGFR2 expressions were significantly up-regulated in patients with NMIBC (p = 0.003) and MIBC (p = 0.03), respectively. Kaplan-Meier analyses showed that patients with high VEGFA expression had significantly longer disease-free survival (p = 0.014) and overall survival (p = 0.009). This study was very informative, showing the implication of VEGF alterations in BC, suggesting that VEGFA and VEGFR2 expressions could be promising biomarkers for the better management of BC.

Thrombosis of the deep dorsal vein of the penis caused by vaccine-induced thrombotic thrombocytopenia: First reported case.

The first described case of deep dorsal vein thrombosis of the penis secondary to vaccine-induced thrombotic thrombocytopenia (VITT), a complication of COVID adenoviral vector vaccines. The patient reported pain in the penis one month after vaccination. On ultrasound, a deep dorsal vein thrombosis was found and a biological workup was ordered to confirm the VITT trail. Anticoagulant therapy was immediately initiated and the patient responds well while suffering from erectile dysfunction. VITT is a potentially serious event that can be life-threatening; every practitioner should know how to deal with it.

Knotted double j ureteral stent: a case report and literature review.

Many complications due to double j (DJ) stent placement have been reported. DJ stent knotting is a rare complication, with only a few cases reported in the literature. We presented a case of DJ stent knotting and reviewed the literature regarding this complication. We reported a 20-year-old man with a history of cystinuria and ureteral stone managed with retrograde ureteroscopy and holmium laser three months ago. The patient comes for DJ stent removal. Firstly, we tried to remove the DJ stent via the cystoscopic procedure, which failed. A fluoroscopic image revealed a knotted DJ stent lodged at the ureteropelvic junction and was removed via holmium laser ureteroscopic procedure without complications. In conclusion, when cystoscopic procedure with simple traction fails to remove DJ stents, multimodality urological procedures such as holmium laser should be tried, especially in patients with urolithiasis predisposing factors.

Molecular characterization of human papillomavirus and mouse mammary tumor virus-like infections in prostate cancer tissue and relevance with tumor characteristics.

The suspected roles of human Papillomavirus (HPV) and mouse mammary tumor virus (MMTV) infections in prostate tumor development were recently reported. To detect the frequency of HPV and MMTV-like infections and clinical correlates of tumor characteristics, DNA samples from 50 men treated at Teaching Hospital of Rabat City (Morocco) between June 2017 and February 2019, were genotyped and confirmed by Sanger sequencing. Eight infections of HPV18 and two infections of MMTV-like were detected, and 50% of patients were at a Gleason score of 6. A significant association between Gleason score and HPV or MMTV-like infection was noted (P=0.0008); 90% of patients with viral infections presented with T1 and T2 pathological stage tumors. Yet, no significant differences were found between infected and noninfected men regarding other pathological parameters including prostate-specific antigen (PSA), tumor histological stage, age at diagnosis and radical prostatectomy treatment (P=0.2179, 0.4702, 0.8101, and 0.9644, respectively). The molecular evolution of HPV and MMTV in comparison with previously aligned sequences was discussed. Our findings provide a highlight on the correlations between the clinical-pathological parameters of prostate tumors and HPV and MMTV infections. Prospective studies with a wide sample size are needed for more statistical clarification of the association between viral infections with prostate tumor criteria.

AKT1 and PIK3CA activating mutations in Moroccan bladder cancer patients´ biopsies and matched urine.

Introduction: in cancer cells, activating mutations in PIK3CA and AKT1 genes, major players of PI3K-AKT-mTOR signalling pathway, are widely reported in many cancers and present attractive targets for the identification of new therapeutics and better cancer management. The present study was planned to evaluate the mutational status of PIK3CA and AKT1 genes in bladder cancer patients and to assess the association between these mutations and patients´ clinico-pathological features. Methods: in this prospective study, bladder cancer biopsies and matched urine sediments samples were collected form 70 patients. Mutations were assessed by deoxyribonucleic acid (DNA) sequencing and correlation with clinico-pathological data was performed using SPSS software. Results: AKT1 alterations were poorly detected. Only one patient with pT1 stage and high-grade tumour carried the E17K mutation. In PIK3CA exon 9, 2 point mutations, E545K and Q546E, and a SNP (E547E) were reported, whereas in exon 20, 2 point mutations (L989V and H1047R) and 2 SNPs (I1022I and T1025T) were detected. PIK3CA mutations were mainly observed in early stages and high-grade tumours. Statistical analysis showed no significant association between the studied AKT1 and PIK3CA mutations and patients´ clinico-pathological parameters (p > 0.05). Detection of these mutations in voided urine samples showed a high specificity (100%) for both genes and a moderate sensitivity: 100% for AKT1 and 66.7% for PIK3CA genes. Conclusion: this study shows clearly that mutations in AKT1 and PIK3CA are rare events and could not be considered as valuable biomarkers for bladder cancer management.

Evaluation of DNA methylation in promoter regions of hTERT, TWIST1, VIM and NID2 genes in Moroccan bladder cancer patients.

Promoter hypermethylation have been reported to play a key role in bladder cancer development and progression. The aim of this study is to evaluate the methylation status of hTERT, TWIST1, VIM and NID2 genes in bladder cancer. The methylation status was evaluated using the Methylation-Specific PCR (MSP) approach on 70 tumour biopsies from Moroccan bladder cancer patients. Overall, methylation frequencies of hTERT, TWIST1, VIM and NID2 genes, were 90%, 85.71%, 67.14% and 67.14%, respectively. Hypermethylation of all studied genes was found in all pathological grades and stages of bladder cancer. Nevertheless, statistical analysis showed no significant association between promoter methylation of hTERT, TWIST1, VIM and NID2 genes and tumours stage/grade (p value >0.05). Moreover, we have investigated the association between the methylation pattern of selected genes and the treatment outcome in a sub-group of non-muscle-invasive bladder cancer cases (52/70). Hypermethylation of hTERT, TWIST1, VIM and NID2 was detected in 83.34%; 66.67%; 83.34% and 58.34% of recurrent cases, respectively, and in 80%; 80%; 80% and 60% of progressive cases, respectively. Statistical analysis highlighted a significant association between TWIST1 hypermethylation and tumour recurrence (p = 0.041<0.05). Our results indicate that hypermethylation of hTERT, TWIST1, VIM and NID2 genes is a frequent epigenetic event in bladder cancer and could be a promising therapeutic target to prevent bladder cancer progression and metastasis.

Immune Checkpoint and Telomerase Crosstalk Is Mediated by miRNA-138 in Bladder Cancer.

BACKGROUND: Tumor recurrence and progression in non-muscle invasive bladder cancer (NMIBC), therapy failure, and severe side effects in muscle invasive bladder cancer (MIBC) are the major challenges in the clinical management of bladder cancer (BC). Here, we identify new molecular targetable signatures to improve BC patients' stratification and the outcome of current immunotherapies. MATERIAL AND METHODS: In a prospective cohort of 70 BC patients, we assessed the genetic and molecular regulation of TERT in maintaining telomere length in parallel to immune checkpoint and microRNA expression. RESULTS: TERT was undetectable in healthy bladder tissues but upregulated in invasive BC stages and high tumor grade. Its expression was linked with the combined effect of the C250T mutation and THOR hypermethylation, associated with progressing tumors and maintaining of telomere length. In the same cohort, PD-L1 scored highest in NMIBC, while PD-L2 was upregulated in MIBC. We also show that miR-100-5p and 138-5p were highly expressed in healthy bladder specimens and cell line, while expression decreased in the BC tissues and BC cell lines. In line with the binding prediction for these miRNAs on target genes, miRs 100-5p and 138-5p expression strongly inverse correlated with TERT, PD-L1, and PD-L2 expression, but not PD1. CONCLUSION: We identify a loop involving TERT, PD1-ligands, and miR-138-5p in BC, that might represent not only a useful biomarker for improved diagnosis and patients' stratification but also as a promising axis that might be therapeutically targeted in situ.

Three simultaneous primary urologic malignancies iA single patient: A case report and review of the literature.

INTRODUCTION: The simultaneous appearance of several primary cancers is rare. PRESENTATION: We report the case of a 77-year-old man admitted to the Mohammed V military hospital in Rabat (university hospital) and presenting severe dysuria on the PSA test which was 10.83 ng / ml. The prostate MRI performed revealed a suspected lesion. He had left renal colic associated with hematuria two weeks later. A CT scan of the abdomen and pelvis performed revealed a 14 × 12 mm middle and lower calyx excretory tract tumor on the left and a 27.6 × 26.4 lower right polar kidney tumor enhanced after injection of product from contrast. The prostate biopsy confirmed an adenocarcinoma of the prostate. He first underwent a left nephroureterectomy for the tumor of the excretory tract, followed by radiotherapy combined with hormone therapy for his adenocarcinoma. It was decided to monitor the tumor of the right kidney. DISCUSSION: The literature contains only a few case reports and reviews of patients with three or more synchronous malignancies. We report the case of a man in whom three different cancers were found over a period of three months. The patient had no significant medical history, such as a family history of cancer or chemotherapy other than old age and chronic smoking. Therefore, we suggest that these factors may favor the occurrence of several synchronous primary cancers. CONCLUSION: There is no consensus on the treatment of multiple malignant tumors. Patient care is individual, by a multidisciplinary team, accounting for the type and the stage of each tumor with a more conservative approach.

Bladder lipoma: Moroccan case report.

Lipomas are encapsulated benign tumors typically found in the integument, central nervous system or gastrointestinal tract and represent the most common benign mesenchymal neoplasm in adults. Bladder lipoma is a rare tumor that has been reported in a handful of cases in medical literature. A literature review from PubMed, MEDLINE, EMBASE and Cochrane databases of bladder lipoma yielded less than 20 cases. We report a case of a 69 year-old Moroccan male patient with hematuria as a chief symptom. The diagnosis of bladder lipoma was suspected by flexible fibroscopy and assessed by transurethral resection. Macroscopic and histological examination revealed a lipomatous tumour with no sign of malignancy. There was no recurrence after one year of follow-up. Although bladder lipomas are rare entities, they must be considered in the differential diagnosis of bladder tumor. However, we should always keep in mind that any bladder tumor is malignant until proven otherwise.

Evaluation of glutathione S-transferase pi 1 expression and gene promoter methylation in Moroccan patients with urothelial bladder cancer.

BACKGROUND: Glutathione S-transferase pi 1 (GSTP1) is a cytosolic detoxifying enzyme that protects cells against deleterious effects of oxidative stress. Deregulated expression of GSTP1 protein and aberrant promoter methylation of GSTP1 gene were reported in various human tumors and were shown to be involved in the molecular pathway for cancer development. AIMS AND METHODS: In this study, we aimed to determine the expression status of GSTP1 in relation to its gene promoter methylation in Moroccan population of 30 bladder cancer (BC) patients and in two noncancerous bladder tissues used as controls. GSTP1 expression was assessed by immunohistochemistry and GSTP1 gene promoter methylation status was studied by methylation-specific PCR (MS-PCR). RESULTS: Glutathione S-transferase pi 1 was expressed in the two normal tissues. In BC cases, GSTP1 expression was strong in 23.33% (7/30), moderate in 60% (18/30), and weak in 13.33% (4/30) of cases, while GSTP1 was not expressed in one cancer case (3.33%). Variability of GSTP1 expression does not correlate with high-grade cancer or invasive-stage (p > 0.05). No GSTP1 gene promoter methylation was detected in all control and cancer cases. CONCLUSION: Our data suggest that GSTP1 expression is not associated with BC development, limiting its use as a biomarker for BC management in Morocco. Moreover, difference in GSTP1 expression among BC cases is not due to GSTP1 promoter methylation.

[Bellini duct carcinoma: a new case study and literature review]. / Carcinome du tube collecteur de Bellini: une nouvelle observation avec revue de la littérature.

Bellini duct carcinoma is a very rare type of renal cell carcinoma (RCC), accounting for less than 1%. It arises from the distal nephron, more specifically from the collecting duct. Its morphological features are extremely variable, making its diagnosis difficult. We report the case of a 62-year old patient admitted with a painless progressive left flank swelling. CT scan showed a huge mass occupying the upper portion of the left kidney. The patient underwent radical nephrectomy. Anatomopathological examination showed collecting duct carcinoma of the kidney. Patient's evolution was exceptionally favorable: no recurrence, no locoregional metastasis and no distant metastasis.

Large prostatic stones with staghorn renal calculus in a 61-year-old man: an unusual presentation of uncommon disease.

Prostatic parenchymal calculi are common in ageing men who are evaluated for benign prostatic hyperplasia or prostate cancer. Giant prostatic calculi are very rare, usually associated with local predisposing factors for urinary stasis and infections, and traditionally managed by open surgery. We present the first case of its kind to be associated with a concurrent staghorn nephrolithiasis, and removed successfully by endoscopic approach using an access sheath through the urethra.

Expression of human epidermal growth factor receptor 2 in bladder urothelial carcinoma.

BACKGROUND: Urothelial bladder carcinoma (UBC) is one of the most prevalent cancers in men worldwide. Human epidermal growth factor receptor 2 (HER2) expression has been detected in a wide range of urothelial carcinoma. Despite many reports in the literature, the prognostic significance of this overexpression remains unclear. The aim of this study was to assess the expression of HER2 in urothelial bladder carcinomas and its association with clinical and pathological parameters. METHODS: 103 cases of UBC were diagnosed in our department between January 2014 and December 2015. The tumor specimens obtained by transurethral resection or cystectomy were evaluated by immunohistochemistry using HER2 antibody. RESULTS: HER2 protein overexpression was present in 11.7% of cases and associated with tumor grade (p = 0.003) and pathological stage (p = 0.015). In multivariate analysis, HER2 overexpression was associated only with tumor grade (P = 0.04). CONCLUSION: HER2 protein overexpression is noted in patients with high grade cancer. This expression may select patients for anti HER2 targeted therapy. Future larger and prospective studies will verify the frequency of HER2 alteration and the role of HER2 in the aggressive behavior.

Upper urinary tract lipoma: A case report.

Upper urinary tract (UUT) benign tumours are rare. We present a case of UUT lipoma in a 41-year-old man with left flank pain. A computed tomographic urography scan revealed an irregular thickening of the left renal collecting system wall extending from the upper calices to the renal pelvis. The diagnosis of UUT was made and the patient underwent a nephroureterectomy with bladder cuff excision, as standard treatment. However, macroscopic and histological examination revealed a lipomatous tumour with no sign of malignancy. To our knowledge this is the first reported case of its kind of a UUT managed first with a minimally invasive approach.