The Sensitivity and Specificity of Multiparametric Magnetic Resonance Imaging and Prostate-Specific Membrane Antigen Positron Emission Tomography/Computed Tomography for Predicting Seminal Vesicle Invasion in Clinically Significant Prostate Cancer: A Multicenter Retrospective Study.

Background/Objectives: The presence of seminal vesicle invasion (SVI) in prostate cancer (PCa) is associated with poorer postoperative outcomes. This study evaluates the predictive value of magnetic resonance imaging (MRI) and prostate-specific membrane antigen positron emission tomography/computed tomography (PSMA PET/CT) for SVI in PCa. Methods: This cohort study included consecutive robotic prostatectomy patients for PCa at three Australian tertiary referral centres between April 2016 and September 2022. MRI and PSMA PET/CT results, clinicopathological variables, including age, BMI, prostate-specific antigen (PSA), PSA density, DRE, Biopsy Gleason score, Positive biopsy cores, PIRADS v2.1 score, MRI volume and MRI lesion size were extracted. The sensitivity, specificity, and accuracy of MRI and PSMA PET/CT for predicting SVI were compared with the histopathological results by receiver operating characteristic (ROC) analysis. Subgroup univariate and multivariate analysis was performed. Results: Of the 528 patients identified, 86 had SVI on final pathology. MRI had a low sensitivity of 0.162 (95% CI: 0.088-0.261) and a high specificity of 0.963 (95% CI: 0.940-0.979). The PSMA PET/CT had a low sensitivity of 0.439 (95% CI: 0.294-0591) and a high specificity of 0.933 (95% CI: 0.849-0.969). When MRI and PSMA PET/CT were used in combination, the sensitivity and specificity improved to 0.514 (95%CI: 0.356-0.670) and 0.880 (95% CI: 0.813-0.931). The multivariate regression showed a higher biopsy Gleason score (p = 0.033), higher PSA (p < 0.001), older age (p = 0.001), and right base lesions (p = 0.003) to be predictors of SVI. Conclusions: MRI and PSMA PET/CT independently underpredicted SVI. The sensitivity and AUC improved when they were used in combination. Multiple clinicopathological factors were associated with SVI on multivariate regression and predictive models incorporating this information may improve oncological outcomes.

The Urological Tribulations of Michel de Montaigne: How the Essayist's Stones Influenced His Writings.

OBJECTIVE: To explore how Michel de Montaigne's battle with urolithiasis influenced his writings and philosophical outlook during the Renaissance period. MATERIALS AND METHODS: The study examines historical texts, Montaigne's personal essays, and contemporary medical literature from the Renaissance era. A comprehensive review of Montaigne's extensive travels across Europe, interactions with prominent physicians, and the various treatments he sought for urolithiasis is conducted. The analysis focuses on how these experiences shaped his literary work and philosophical reflections. RESULTS: Montaigne's struggle with urolithiasis began at the age of 45, profoundly impacting his life and writings. His journey through France, Germany, Switzerland, Austria, and Italy in search of relief, along with consultations with renowned physicians such as Félix Platter and Girolamo Borro, significantly influenced his philosophical inquiries into human suffering and mortality. Montaigne's detailed accounts of his condition, describing 19 episodes of renal colic, offered early patient-centered perspectives in medical literature, highlighting the importance of understanding the psychological and emotional dimensions of illness. His therapeutic use of thermal baths and other non-invasive treatments reflected the medical practices of the time. CONCLUSION: Montaigne's experience with urolithiasis not only shaped his philosophical essays but also underscored the importance of empathetic and holistic patient care. His writings emphasize the need for integrating patient narratives into medical practice, a concept that remains crucial in contemporary health care. Montaigne's legacy continues to inspire a compassionate approach to urological care, emphasizing the interconnected nature of physical and emotional well-being, and advocating for a more patient-centered perspective in medical treatments.

A rare case of fatal rectal perforation and sepsis following traumatic urinary catheterization.

This case report details a fatal rectal perforation and sepsis in a comorbid 96-year-old male after traumatic urinary catheterization, highlighting the risks of IDC management in elderly patients with complex health backgrounds. Despite maximal medical therapy, including escalated antibiotics and ICU care, the patient died from septic shock linked to improper catheter insertion by a non-specialist nurse in the community. This case emphasizes the urgent need for better catheterization practices, specialized nursing education, and clear guidelines to prevent such outcomes.

Optilume® drug-coated balloon dilation for the treatment of refractory post-TURP bladder neck contracture.

This case report presents the first use of Optilume® drug-coated balloon (DCB) technology for the management of post-transurethral resection of the prostate bladder neck contracture (BNC), a condition often resistant to traditional treatments. A 62-year-old male with recurrent BNC, unresponsive to multiple operative interventions, underwent treatment with the Optilume® DCB, resulting in significant symptom resolution without further invasive procedures. This novel application of DCB technology, delivering paclitaxel directly to the affected tissue, offers a promising alternative by targeting the underlying pathophysiology of BNC.

Novel presentation of Raoultella planticola-induced epididymo-orchitis post gastroenteritis.

This report documents the first case of Raoultella planticola epididymo-orchitis following campylobacter gastroenteritis in a 76-year-old male. Highlighting R. planticola's expanded pathogenic potential beyond common urinary tract infections, this case emphasizes its clinical significance in atypical genitourinary presentations, particularly in individuals with pre-existing conditions like diabetes mellitus and renal failure. Despite intrinsic ampicillin resistance, targeted ciprofloxacin treatment proved effective. This case underscores the necessity for broad diagnostic considerations and tailored antibiotic therapy in managing complex infections, advocating for increased awareness of emerging resistant uropathogens in clinical practice.