To Drink or Not to Drink? Investigating Alcohol's Impact on Prostate Cancer Risk.

BACKGROUND/OBJECTIVES: Prostate cancer (PCa) is a significant global health issue. The relationship between alcohol consumption and PCa risk has been the subject of extensive research, yet findings remain inconsistent. This review aims to clarify the association between alcohol intake and PCa risk, its aggressiveness, and the potential metabolic pathways involved in PCa onset. METHODS: A comprehensive literature search was conducted across multiple databases, including PubMed and MEDLINE, focusing on epidemiological studies, meta-analyses, cohort studies, and case-control studies. Studies evaluating alcohol consumption, prostate-specific antigen (PSA) levels, and PCa risk were included. The review also explored the roles of alcohol dehydrogenase (ADH) and aldehyde dehydrogenase (ALDH) in alcohol metabolism. RESULTS: The analysis reveals a complex relationship between alcohol consumption and PCa. Heavy alcohol intake is associated with an increased risk of PCa, particularly more aggressive forms, and higher mortality rates. However, studies also show weak or no association between moderate alcohol consumption and PCa. The variability in findings may be attributed to differences in alcohol types, regional factors, and study methodologies. CONCLUSIONS: The link between alcohol consumption and PCa risk is multifaceted. While heavy drinking appears to increase the risk of aggressive PCa, the overall relationship remains unclear. Further research is needed to better understand these associations and inform public health recommendations and cancer prevention strategies.

Renal Actinomycosis in Humans-A Narrative Review.

Actinomycosis of the kidney is extremely rare, with only a few cases reported in the literature. This rare entity usually presents with common clinical manifestations and non-specific imaging findings, thus rendering its diagnosis extremely challenging. According to case reports published in the literature, fever was present in the majority of cases (56.25%). Several risk factors have been related to the development of renal actinomycosis, including a history of urogenital surgery, urolithiasis, or urogenital cancer. Initial diagnostic investigation consists of abdominal ultrasonography (15 patients, 46.88%) and abdominal computed tomography (23 patients, 48.15%). Regarding therapeutic approach, 5 patients (16.67%) received only antibiotic treatment, 5 patients (16.67%) underwent surgery, and 20 patients (66.67%) received both antibiotic and surgical treatment. Accurate diagnosis relies on the clinician's high index of suspicion and is ultimately confirmed through histological examination or cultures, obtained either preoperatively via biopsies or postoperatively after surgical removal of the infected kidney. To our knowledge, this is the first narrative review of the literature that collects knowledge concerning infection of UUT induced by dysbiosis of actinomycosis species. The aim of this narrative review was to systematically search the literature on primary renal actinomycosis, highlighting the diagnostic approach and treatment strategies for the management of this rare entity.

A review of urinary bladder microbiome in patients with bladder cancer and its implications in bladder pathogenesis.

PURPOSE: The recent discovery of the urinary microbiome has led to an emerging field of investigation about the potential role of microorganisms in the pathogenesis of urinary bladder cancer. Few preliminary data have been reported so far implicating urobiome as causative and prognostic factor of bladder tumorigenesis. In the present study, a review of the current evidence is presented about microbiome composition among patients with bladder cancer and healthy individuals as well as possible implications of microbiome on urothelial carcinoma of the bladder. METHODS: A literature review was conducted using PubMed/MEDLINE, Scopus, and the Cochrane library until December 2023. Search algorithm was constructed using the following terms and their associated Mesh terms and Boolean operators: "urinary microbiome" and "urinary microbiota". Studies written in English language, identifying, and comparing urinary microbiome among bladder cancer patients and healthy control group were included in the review. RESULTS: A total of 2,356 reports were identified. From this total 16 articles complied with the inclusion criteria were selected for analysis. These articles represent a total of about 486 bladder cancer patients. CONCLUSION: Recent studies revealed the colonization of the urinary tract and the bladder by micro-organisms using both enhanced culture- and molecular-based techniques for microbial characterization. However, several limitations exist in the literature decreasing the reliability of the current reports. As a result, urinary microbiome consist an ambitious era in bladder cancer research with an increasing number of evidence about its potential pathogenetic, prognostic and therapeutic role.

Percutaneous Microwave Ablation Versus Robot-Assisted Partial Nephrectomy for Stage I Renal Cell Carcinoma: A Propensity-Matched Cohort Study Focusing Upon Long-Term Follow-Up of Oncologic Outcomes.

PURPOSE: To retrospectively compare long-term oncologic outcomes of percutaneous computed tomography-guided microwave ablation (MWA) and robot-assisted partial nephrectomy (RAPN) for the treatment of stage 1 (T1a and T1b) renal cell carcinoma (RCC) patients. MATERIALS AND METHODS: Institutional database research identified all T1 RCC patients who underwent either MWA or RAPN. Models were adjusted with propensity score matching. Kaplan-Meier log-rank test analyses and Cox proportional hazard regression models were used to compare the oncologic outcomes. Patient and tumor characteristics, technical success as well as oncologic outcomes were evaluated and compared between the 2 groups. RESULTS: After propensity score matching, a total of 71 patients underwent percutaneous MWA (mean age 70 ± 10 years) and 71 underwent RAPN (mean age 60 ± 9 years). At 8-year follow-up, the estimated survival rates for MWA cohort were 98% (95% confidence interval [CI] 95-100%) for overall survival, 97% (95% CI 93-100%) for recurrence-free survival, and 97% (95% CI 93-100%) for metastasis-free survival. The matched cohort that underwent RAPN exhibited survival rates of 100% (95% CI 100-100%) for overall survival, 98% (95% CI 94-100%) for recurrence-free survival, and 98% (95% CI 94-100%) for metastasis-free survival. After performing log-rank testing, these rates were not significantly different (p values of 0.44, 0.67, and 0.67, respectively). CONCLUSION: The results of the present study suggest that both MWA and RAPN are equally effective in terms of oncologic outcome for the treatment of T1 RCC.

Evaluating the Impact of Benign Prostatic Hyperplasia Surgical Treatments on Sexual Health.

Benign prostatic hyperplasia (BPH), a prevalent condition in older men, is often managed through various surgical interventions. This narrative review aims to explore the impact of these surgical treatments on sexual function, a critical aspect of patient quality of life often overlooked in BPH management. The methodology encompassed a thorough review of contemporary surgical techniques for BPH, including prostate resection, enucleation, vaporization, and minimally invasive therapies such as UroLift, Rezum, and Aquablation. Additionally, the focus was on patient-centered outcomes, with a special emphasis on sexual health following surgery. Findings reveal that, while surgical interventions effectively alleviate BPH symptoms, they often have significant repercussions in sexual function, including erectile and ejaculatory dysfunction. However, emerging techniques demonstrate potential in preserving sexual function, underscoring the need for patient-centric treatment approaches. The study highlights the complex interplay between BPH surgery and sexual health, with minimally invasive treatments showing promise in balancing symptom relief and sexual function preservation. In conclusion, the study advocates for an integrated, interdisciplinary approach to BPH treatment, emphasizing the importance of considering sexual health in therapeutic decision-making. This narrative review suggests a paradigm shift towards minimally invasive techniques could optimize patient outcomes, marrying symptom relief with quality-of-life considerations. The need for further research in this domain is evident, particularly in understanding long-term sexual health outcomes following different surgical interventions for BPH.

A Giant Oncocytoma in an Elderly Female Patient: A Case Report.

Renal oncocytomas are rare, benign tumors that can be difficult to distinguish from malignant renal cell carcinomas. This case report presents an 84-year-old woman with a sizeable renal oncocytoma and discusses this rare entity's diagnostic challenges and management.

Paraganglioma of the Urinary Bladder: A Case Report on a Rare and Unexpected Tumor Location.

Paraganglioma of the urinary bladder is an exceptionally rare tumor. It originates from chromaffin cells, which are responsible for producing catecholamines. We report a unique case of a 74-year-old woman diagnosed with nonfunctional bladder paraganglioma, who presented with macroscopic hematuria and right-sided renal colic but lacked the usual symptoms associated with catecholamine excess. This case highlights the diagnostic challenges of nonfunctional variants of paraganglioma due to their histological similarity to urothelial carcinomas. It underscores the importance of a thorough histological examination and the need for a multidisciplinary approach to establish a diagnosis and determine the optimal treatment strategy. Our case contributes to the sparse literature on this rare condition, and it aims to enhance clinicians' awareness and understanding of urinary bladder paragangliomas.

Diagnostic Challenges and Management of Acquired Hemophilia A Presenting as Gross Hematuria: A Case Report.

Acquired hemophilia A (AHA) is a rare autoimmune disorder marked by autoantibodies against coagulation factor VIII, leading to bleeding complications. This case report explores a unique presentation of AHA, initially manifested as gross hematuria, a symptom often encountered in healthcare settings with a broad range of differential diagnoses. The background of this study highlights the rarity of AHA and its diverse clinical presentations. The case involves a 62-year-old man with no history of bleeding disorders, presenting with gross hematuria and later developing severe anemia and ecchymoses. Methods employed in the evaluation included urological assessments such as cystoscopy and computed tomography, alongside hematological investigations, which later revealed a prolonged activated partial thromboplastin time (aPTT) and a critically low factor VIII level, indicative of AHA. Results showed a lack of early recognition of coagulation abnormalities, underscoring the need for comprehensive initial assessments in cases of unexplained hematuria. The patient's management at a specialized Hemophilia Center involved inhibitor eradication therapy and management of acute bleeding episodes, resulting in significant clinical improvement. The conclusions drawn from this case emphasize the importance of considering rare conditions like AHA in the differential diagnosis of hematuria and the necessity for a broad diagnostic approach. It advocates for heightened awareness and early coagulation studies in unexplained cases of hematuria to prevent delayed diagnoses and improve patient outcomes. This case contributes to the understanding of AHA's clinical variability and the critical nature of early and comprehensive diagnostic approaches in hematuria evaluation.

Emerging Role of YAP and the Hippo Pathway in Prostate Cancer.

The Hippo pathway regulates and contributes to several hallmarks of prostate cancer (PCa). Although the elucidation of YAP function in PCa is in its infancy, emerging studies have shed light on the role of aberrant Hippo pathway signaling in PCa development and progression. YAP overexpression and nuclear localization has been linked to poor prognosis and resistance to treatment, highlighting a therapeutic potential that may suggest innovative strategies to treat cancer. This review aimed to summarize available data on the biological function of the dysregulated Hippo pathway in PCa and identify knowledge gaps that need to be addressed for optimizing the development of YAP-targeted treatment strategies in patients likely to benefit.

Experimental isolation and preservation of solid organs before transplantation: effects of pretreatment using four different molecules.

OBJECTIVES: In transplantation surgery, the ischaemic organ and reperfusion impairment after cold storage remains a considerable risk factor for impaired function and potential failure of the grafted organ. Substantial logistical efforts have been undertaken to reduce the cold ischaemic time because the demand for available transplant organs and the periods of cold ischaemia are increasing. METHODS: Four molecules were investigated (erythropoietin, sildenafil, lazaroid [U74389G], octreotide) in individual intravenous infusions 1 hour before the organ was harvested. This study was performed in 30 healthy landrace/large-white pigs (male; >10 weeks old; average weight, 22 ± 2 kg) in groups of six. The organs were studied at harvest, and at 8 and 24 hours post-harvest. RESULTS: The lazaroid molecule increased malondialdehyde (MDA) levels in the liver and pancreas at 8 hours. Hepatic lazaroid molecules improved liver histology at 8 and 24 hours. For kidneys, erythropoietin had a positive effect at 24 hours post-harvest. For the pancreas, octreotide showed better performance. In the lungs, there was less interstitial oedema with erythropoietin and lazaroid compared with the control group at 8 hours post-harvest. CONCLUSION: All molecules had a positive effect and decreased ischaemia/reperfusion graft injury. Thus, pretreatment before organ harvest has a beneficial role.

Clinical Outcome and Prognostic Factors of Sepsis, Septic Shock and Prolonged Hospitalization, of Patients Presented with Acute Obstructive Pyelonephritis.

Objective: To investigate prognostic factors of outcome of acute obstructive pyelonephritis (AOP). Materials and Methods: Patients with AOP were prospectively evaluated and logistic regression analysis was applied to identify factors associated with the duration of hospital stay and occurrence of sepsis and septic shock. Results: Based on CT scan findings, 62 patients were found to have AOP and subjected to emergency drainage. The main etiology of obstruction was lithiasis (70.9%). Double-J stent and percutaneous nephrostomy were introduced in 48 and 14 patients, respectively. Urosepsis and septic shock were diagnosed in 20 (32%) and 6 (9.7%) patients, respectively. None of the patients died of sepsis. In univariative analysis, older age, high neutrophils, increased serum creatinine, higher Charlson comorbidity index (CCI) score, any CCI score ≥1, diabetes mellitus (DM) longer operation time (OT), and multiresistant stains were risk factors of sepsis. Gender, type of drainage, laterality, white blood cell count, neutrophils rate >80%, C-reactive protein, and the presence of malignancy or lithiasis were not. Age, DM, and CCI score ≥1 were associated with prolonged hospitalization. None of the factors was associated with shock. In multivariative models, age (odds ratio [OR]: 1.09, 95% confidence interval [CI]: 1.02-1.16, p = 0.010), multiresistant strains (OR: 16.36, 95% CI: 1.97-135.71, p = 0.006), OT >20 minutes (OR: 1.03, 95% CI: 1.00-1.07, p = 0.048), and elevated creatinine (OR: 1.68, 95% CI: 1.001-2.84, p = 0.049) were independent prognostic factors of sepsis, and DM (OR: 30.8%, CI: 8.86%-52.8%, p = 0.007) was a prognostic factor of longer hospitalization. Conclusions: One-third of AOP patients will develop sepsis. Older age, elevated serum creatinine, longer OT presence of multiresistant strains, and DM are independent factors of worse outcome.

Malignant solitary fibrous tumor of urinary bladder: A rare clinical entity.

Solitary Fibrous Tumors (SFTs) are mesenchymal tumors occurring in several sites. Urinary bladder SFTs are quite rare. Eighteen cases are described in the literature and only two of them had malignant features. SFTs comprise a histologic spectrum of mesenchymal neoplasms that show fibroblastic differentiation. The signs and symptoms are non specific. Immunohistochemistry plays a pivotal role in the diagnosis, differentiating SFTs from other spindle cell mesenchymal tumors. Malignant criteria are considered the large size, increased mitotic activity, focal necrosis or hemorrhage, nuclear atypia, hypercellularity and infiltrative margins. Clinical and biological behavior of bladder SFTs is usually not aggressive but cannot be safely predicted based on the pathologic features. Complete surgical resection is the cornerstone of treatment. We present the third bladder SFT case with malignant features and a mini literature review.

How Effective Is Retrograde Semirigid and Flexible Ureteroscopic Lithotripsy for the Treatment of Large Ureteral Stones Equal of or Greater than 15 mm? Results from a Single Center.

PURPOSE: To present the results and complications of retrograde ureteroscopic lithotripsy for treatment of large ureteral stones. METHODS: Nineteen patients were treated for ureteral stones ≥15 mm detected in CT or plain KUB film. Endoscopy was performed with either a semirigid or flexible ureteroscope. Stone fragmentation was performed using a 30 W Holmium laser. RESULTS: The mean stone size was 20.7 mm (range 15-30). The mean duration of the operation was 82 min (45-140). Measures to prevent retropulsion of fragments into the kidney were not routinely applied. A subsequent RIRS during the same session was necessary in 2 cases. After a single procedure a stone free state was achieved in 15 cases (78.9%), while 4 others required a second session (ESWL or second ureterolithotripsy, 2 cases each). In only 1 patient, the stone-free state was not achieved after a 1.2 procedure per patient (overall success rate 94.7%). The mean duration of hospitalization was 1.9 days (range 1-5). Three patients experienced postoperative pyelonephritis and 2 others prolonged hematuria. CONCLUSION: Endoscopic lithotripsy is safe and effective in treating large ureteral stones. After a single endoscopic procedure, approximately 4 out of 5 patients are expected to become stone free. This rate increases to 95% with a second session of lithotripsy.

Phase I study of a new tablet-based image guided surgical system in robot-assisted radical prostatectomy.

Robot-assisted radical prostatectomy is, currently, the most commonly utilized procedure for the treatment of localized prostate cancer. Image-guided surgical systems have been proposed in the literature as a valuable tool for the better utilization of the preoperative data in theatre. In this Phase 1 trial, we tested the feasibility and safety of a new, cutting-edge tablet-based surgical imaging system designed for robot-assisted radical prostatectomy (RARP). It utilizes the preoperative MRI images of the prostate, mapping them intra-operatively, real time to the patient by magnetic tracking to fixed points of the pelvis. The system is comprised of a tablet computer with a touch screen display; a tracking system housed in a portable cart, a magnetic field generator and position sensors. It updates image data over 20 times per second to compensate with anatomical alterations during the operation. Four patients diagnosed with prostate adenocarcinoma were enrolled in this study. All four had negative surgical margins along with satisfactory functional recovery regarding continence and potency. The navigational accuracy and the real time information provided by the imaging system was mainly utilized in the more challenging parts of the operation including the apical dissection, the nerve sparing procedure and the bladder neck dissection. The system proved to be safe and its clinical efficacy is due to be assessed with a Phase II clinical study.

Optimal bladder diary duration for patients with suprapontine neurogenic lower urinary tract dysfunction

ABSTRACT Purpose: To identify the minimum bladder diary's length required to furnish reliable documentation of LUTS in a specific cohort of patients suffering from neurogenic urinary dysfunction secondary to suprapontine pathology. Materials and Methods: From January 2008 to January 2014, patients suffering from suprapontine pathology and LUTS were requested to prospectively complete a bladder diary form for 7 consecutive days. Micturitions per day, excreta per micturition, urgency and incontinence episodes and voided volume per day were evaluated from the completed diaries. We compared the averaged records of consecutive days (2-6 days) to the total 7 days records for each patient's diary, seeking the minimum diary's length that could provide records comparable to the 7 days average, the reference point in terms of reliability. Results: From 285 subjects, 94 male and 69 female patients enrolled in the study. The records of day 1 were significantly different from the average of the 7 days records in every parameter, showing relatively small correlation and providing insufficient documentation. Correlations gradually increased along the increase in diary's duration. According to our results a 3-day duration bladder diary is efficient and can provide results comparable to a 7 day length for four of our evaluated parameters. Regarding incontinence episodes, 3 days seems inadequate to furnish comparable results, showing a borderline difference. Conclusions: A 3-day diary can be used, as its reliability is efficient regarding number of micturition per day, excreta per micturition, episodes of urgency and voided volume per day.

Dynamic penile peak systolic velocity predicts major adverse cardiovascular events in hypertensive patients with erectile dysfunction.

OBJECTIVE: Hypertension is associated with an abnormal penile blood flow. Reduced dynamic penile peak systolic velocity (D-PSV) correlates with adverse cardiovascular outcomes. The aim of this study is to investigate whether abnormal penile blood flow predicts major adverse cardiovascular events (MACE) in hypertensive men. METHODS: In total, 298 hypertensive men (55 ±â€Š9 y/o) without known cardiovascular disease or diabetes were evaluated for cavernous vascular disease severity by dynamic penile Doppler ultrasound. The whole population was divided into tertiles according to D-PSV reduction (low tertile <25 cm/s; middle tertile 25-35 cm/s; and high tertile >35 cm/s). Predictive performance was evaluated with calibration, discrimination, and reclassification. RESULTS: During the mean follow-up period of 4.9 years, a total of 22 (7%) MACE occurred. D-PSV level was associated with MACE and the differences between the tertiles were significant (Mantel log-rank test: 6.54; P < 0.01). A Cox proportional hazard model showed that study participants in the lowest D-PSV tertile (<25 cm/s) had an approximately 3.5-fold higher MACE risk compared with those in the highest D-PSV tertile (>35 cm/s) after adjustment for age, systolic pressure, metabolic parameters, smoking, C-reactive protein, and testosterone levels. Low D-PSV did not significantly improve the C-statistic model (0.774 vs. 0.767; P = 0.44), whereas the calibration was satisfactory (Hosmer-Lemeshow X = 8.73, P = 0.30). When only intermediate-risk patients were evaluated, the risk reclassification beyond traditional risk factors resulted in a clinical net reclassification index of 9.2% that was marginally significant (P = 0.07). The integrated discrimination improvement index showed better performance of the model that included D-PSV compared with the reference model in identifying MACE (improvement index: 0.047, P = 0.038). CONCLUSION: Low-penile blood flow predicts MACE in hypertensive patients free of clinical atherosclerosis. This predictive ability is independent of the severity of hypertension and decreased testosterone that is often present in such patients.

A review of continuous vs intermittent androgen deprivation therapy: redefining the gold standard in the treatment of advanced prostate cancer. Myths, facts and new data on a ″perpetual dispute″.

OBJECTIVES: To review the literature and present new data of continuous androgen deprivation therapy (ADT) vs intermittent androgen deprivation (IAD) as therapies for prostate cancer in terms of survival and quality of life and clarify practical issues in the use of IAD. MATERIALS AND METHODS: We conducted a systematic search on Medline and Embase databases using ″prostatic neoplasm″ and ″intermittent androgen deprivation″ as search terms. We reviewed meta-analyses, randomised controlled trials, reviews, clinical trials and practise guidelines written in English from 2000 and onwards until 01/04/2013. Ten randomized controlled trials were identified. Seven of them published extensive data and results randomizing 4675 patients to IAD versus CAD. Data from the other three randomized trials were limited. RESULTS: Over the last years studies confirmed that IAD is an effective alternative approach to hormonal deprivation providing simultaneously several potential benefits in terms of quality of life and cost effectiveness. Thus, in patients with non metastatic, advanced prostate cancer IAD could be used as standard treatment, while in metastatic prostate cancer IAD role still remains ambiguous. CONCLUSIONS: Nowadays, revaluation of the gold standard of ADT in advanced prostate cancer appears essential. Recent data established that IAD should no longer be consi¬dered as investigational, since its effectiveness has been proven, especially in patients suffering from non-metastatic advanced prostate cancer.

A review of continuous vs intermittent androgen deprivation therapy: Redefining the gold standard in the treatment of advanced prostate cancer. Myths, facts and new data on a perpetual dispute / Editorial Comment

Objectives: To review the literature and present new data of continuous androgen deprivation therapy (ADT) vs intermittent androgen deprivation (IAD) as therapies for prostate cancer in terms of survival and quality of life and clarify practical issues in the use of IAD. Materials and Methods: We conducted a systematic search on Medline and Embase databases using “prostatic neoplasm” and “intermittent androgen deprivation” as search terms. We reviewed meta-analyses, randomised controlled trials, reviews, clinical trials and practise guidelines written in English from 2000 and onwards until 01/04/2013. Ten randomized controlled trials were identified. Seven of them published extensive data and results randomizing 4675 patients to IAD versus CAD. Data from the other three randomized trials were limited. Results: Over the last years studies confirmed that IAD is an effective alternative approach to hormonal deprivation providing simultaneously several potential benefits in terms of quality of life and cost effectiveness. Thus, in patients with non metastatic, advanced prostate cancer IAD could be used as standard treatment, while in metastatic prostate cancer IAD role still remains ambiguous. Conclusions: Nowadays, revaluation of the gold standard of ADT in advanced prostate cancer appears essential. Recent data established that IAD should no longer be considered as investigational, since its effectiveness has been proven, especially in patients suffering from non-metastatic advanced prostate cancer. .