Upper Urinary Tract Urothelial Cancer After Radical Cystectomy for Bladder Cancer: Survival Outcomes After Radical Nephroureterectomy.

BACKGROUND: Systemic and local recurrences of urothelial bladder cancer (UBC) significantly impair survival after radical cystectomy (RC), but little is known about the impact of the recurrence of urothelial cancer in the upper urinary tract (UTUC). This report describes survival outcomes and their predictors for patients who underwent RC followed by radical nephroureterectomy (RNU) for UTUC. METHODS: The Surveillance, Epidemiology, and End Results database was queried to identify patients who underwent RC for UBC and subsequent RNU for UTUC. The Kaplan-Meier method and competing-risk Cox regression (CRR) were used for the survival analysis. RESULTS: Overall, 102 patients have undergone RNU within a median of 49 months (interquartile range [IQR], 27-76 months) since RC. Muscle-invasive UTUCs were predominant at RNU (n = 58; 56.7%), but organ-confined bladder tumors were most frequent at RC (n = 42, 41.5%). After RNU, the estimated 5-year overall survival (OS) was 25.9%, the cancer-specific survival (CSS) was 35.6%, the median OS was 23 months (IQR, 11-63 months), and the CSS was 34 months (IQR, 13-132 months). In the multivariable CRR, the factors predictive for CSS after RNU included male gender (hazard ratio [HR], 2.36; 95% confidence interval [CI], 1.03-5.42; p < 0.05), muscle-invasive UTUC (HR, 2.20; 95% CI, 1.13-4.28; p < 0.05), and the presence of distant metastasis (HR,11.59; 95% CI, 5.33-25.2; p < 0.001). CONCLUSIONS: In conclusion, the patients who underwent RNU for UTUC after RC for UBC experienced poor OS and CSS. The majority of RNUs were performed for locally advanced tumors. The independent risk factors for worse OS and CSS after RNU were UTUC T stage, presence of metastasis, and male gender.

Changes in the Urinary Microbiome After Transurethral Resection of Non-muscle-Invasive Bladder Cancer: Insights from a Prospective Observational Study.

BACKGROUND: This study aimed to characterize the urinary and tumor microbiomes in patients with non-muscle-invasive bladder cancer (NMIBC) before and after transurethral resection of the bladder tumor (TURBT). METHODS: This single-center prospective study included 26 samples from 11 patients with low-grade Ta papillary NMIBC. Urine samples were collected at the index TURBT and at a 1-year follow-up cystoscopy. The metagenomic analysis of bacterial and archaeal populations was performed based on the highly variable V3-V4 region of the 16S rRNA gene. RESULTS: Phylogenetic alpha diversity of the bladder microbiome detected in urine was found to be lower at the 1-year follow-up cystoscopy compared to the time of the index TURBT (p < 0.01). Actinomyces, Candidatus cloacimonas, Sphingobacterium, Sellimonas, Fusobacterium, and Roseobacter were more differentially enriched taxa in urine at the follow-up cystoscopy than at the index TURBT. Beta diversity of urine microbiome significantly changed over time (p < 0.05). Phylogenetic alpha diversity of the microbiome was greater in tumor tissues than in paired urine samples (p<0.01). Sphingomonas, Acinetobacter, Candidatus, and Kocuria were more differentially overrepresented in tumor tissues than in urine. The enrichment of the abundance of Corynebacterium and Anaerococcus species in urine collected at TURBT was observed in patients who experienced recurrence within the follow-up period. CONCLUSIONS: In patients with low-grade NMIBC, the urine microbiome undergoes changes over time after removal of the tumor. The microbiome detected in tumor tissues is more phylogenetically diverse than in paired urine samples collected at TURBT. The interplay between bladder microbiome, tumor microbiome, and their alterations requires further studies to elucidate their predictive value and perhaps therapeutic implications.

The Role of Cocaine- and Amphetamine-Regulated Transcript (CART) in Cancer: A Systematic Review.

The functions of cocaine- and amphetamine-regulated transcript (CART) neuropeptide encoded by the CARTPT gene vary from modifying behavior and pain sensitivity to being an antioxidant. Putative CART peptide receptor GPR160 was implicated recently in the pathogenesis of cancer. However, the exact role of CART protein in the development of neoplasms remains unclear. This systematic review includes articles retrieved from the Scopus, PubMed, Web of Science and Medline Complete databases. Nineteen publications that met the inclusion criteria and describe the association of CART and cancer were analyzed. CART is expressed in various types of cancer, e.g., in breast cancer and neuroendocrine tumors (NETs). The role of CART as a potential biomarker in breast cancer, stomach adenocarcinoma, glioma and some types of NETs was suggested. In various cancer cell lines, CARTPT acts an oncogene, enhancing cellular survival by the activation of the ERK pathway, the stimulation of other pro-survival molecules, the inhibition of apoptosis or the increase in cyclin D1 levels. In breast cancer, CART was reported to protect tumor cells from tamoxifen-mediated death. Taken together, these data support the role of CART activity in the pathogenesis of cancer, thus opening new diagnostic and therapeutic approaches in neoplastic disorders.

Corynebacterium coyleae as potential urinary tract pathogen.

Corynebacterium coyleae is part of the commensal microflora of the skin, urethra, mucous membranes, and genital tract. Isolates from patients with urinary tract infection (UTI) were reported, but the pathogenic potential of this species has not been defined yet. The aim of the study is to determine whether C. coyleae could be the etiological agent of UTI and to analyze its antibiotic susceptibility. Urine samples were cultured quantitatively according to accepted laboratory procedures. The identification of bacterial isolates was carried out using the Vitek MS (bioMérieux) and antibiotic susceptibility was tested using disc diffusion according to EUCAST guidelines. Between 1 January 2017 and 30 October 2018, a total of 39 C. coyleae strains were isolated. This represented 0.32% of all urine samples cultured in the laboratory during the collection period. The strains were isolated from samples obtained from 35 women and 3 men (age median for all-64 years). One female patient presented with C. coyleae in her urine twice at an interval of 21 months. In six cases of UTI, C. coyleae was isolated in monoculture. The isolates had the same resistance pattern. A total of 11 strains were obtained from cases with a clinical diagnosis of UTI. In 13 cases, the strain was cultured in a monoculture and in 28 cases with accompanying species. All strains were susceptible to vancomycin. However, resistance to ciprofloxacin was observed for 58.4% of the strains. Urine isolates of C. coyleae must be considered as contamination or normal flora in most cases (28/39, 72%). In the remaining cases, it can be considered as potential etiologic agents, mostly in women and especially in the 6 UTI cases where C. coyleae was found as the single culture-positive species. Several of these isolates demonstrate resistance to antibiotics commonly used in empiric treatment of urinary tract infections.

[Infectious complications of prostate biopsy].

Prostate cancer is the second most common malignancy in men in Poland. Prostate biopsy remains the gold standard for diagnosis. Every year, the number of procedures is increasing, so knowledge of possible complications is becoming crucial. Over time, a continuous increase in infectious complications of prostate biopsy is observed, so it is important to identify risk factors and preventive methods. Antibiotic prophylaxis is mandatory for prostate biopsy. Simultaneously, complications after prostate biopsy affect as many as 90% of patients, including up to 17% of infective complications. In some patients, complications are severe and require urgent medical intervention. The risk of death from septic complications is approximately 0.1%. Significant risk factors are diabetes, older age, enlarged prostate gland and recent antibiotic exposure. Transperineal or MRI guided biopsy is associated with a significantly lower incidence of severe infectious complications.

(A)voiding misdiagnosis: prediction of detrusor underactivity vs. bladder outlet obstruction using pre-urodynamic nomogram in male patients with LUTS.

PURPOSE: Our study aimed to develop a noninvasive model using a combination of the set of clinical data and uroflowmetry (UFL) to differentiate between detrusor underactivity (DU) and bladder outlet obstruction (BOO) in non-neurogenic male patients with lower urinary tract symptoms (LUTS). METHODS: Data from 229 men with LUTS, diagnosed with DU or BOO on a pressure-flow study (PFS), were retrospectively analyzed, including medical history, Core Lower Urinary Tract Symptoms score (CLSS) questionnaire, UFL and PFS. Uni- and multivariate logistic regression were utilized for the prediction analyses. RESULTS: Of the cohort, 128 (55.9%) patients were diagnosed with DU. A multivariate logistic regression analysis identified less prevalent nocturia (OR 0.27, p < 0.002), more prevalent intermittency (OR 2.33, p = 0.03), less prevalent weak stream (OR 0.14, p = 0.0004), lower straining points in CLSS (OR 0.67, p = 0.02), higher slow stream points in CLSS (OR 1.81, p = 0.002), higher incomplete emptying points in CLSS (OR 1.31, p < 0.02), lower PVR ratio (OR 0.20, p = 0.03), and present features of fluctuating (OR 2.00, p = 0.05), fluctuating-intermittent (OR 3.09, p < 0.006), and intermittent (OR 8.11, p = 0.076) UFL curve shapes as independent predictors of DU. The above prediction model demonstrated satisfactory accuracy (c-index of 0.783). CONCLUSION: Our 10-factor model provides a noninvasive approach to differentiate DU from BOO in male patients with non-neurogenic LUTS, offering a valuable alternative to invasive PFS.

The Association between Lymph Node Dissection and Survival in Lymph Node-Negative Upper Urinary Tract Urothelial Cancer.

The benefit of lymph node dissection (LND) during radical nephroureterectomy (RNU) in lymph node (LN)-negative (cN0/pN0) UTUC remains controversial. We aimed to assess the association between LND and its extent and survival in LN-negative UTUC. The Surveillance, Epidemiology, and End Results database was searched to identify patients with non-metastatic chemotherapy-naïve cN0/pNx or pN0 UTUC who underwent RNU +/- LND between 2004 and 2019. Overall, 4649 patients with cN0/pNx or pN0 UTUC were analyzed, including 909 (19.55%) individuals who had LND. Among them, only in 368 patients (7.92%) was LND extended to at least four LNs, and the remaining 541 patients (11.64%) have had < four LNs removed. In the whole cohort, LND contributed to better cancer-specific survival (CSS) and overall survival (OS). Furthermore, a propensity score-matched analysis adjusted for confounders confirmed that improved CSS and OS was achieved only when ≥ four LNs had been removed, especially in muscle-invasive UTUC. A multivariable analysis further confirmed an association between the extent of LND and CSS. To conclude, adequate LND during RNU was associated with improved OS and CSS in LN-negative UTUC, particularly in muscle-invasive stage. This underscores that a sufficient LN yield is required to reveal a therapeutic benefit in patients undergoing RNU.

The effect of O-1602, a GPR55 agonist, on the cyclophosphamide-induced rat hemorrhagic cystitis.

The goal of our study was to determine whether GPR55 agonists, O-1602, could reverse the cyclophosphamide (CYP)-induced changes in cystometric and inflammatory parameters, indicative of the development of bladder inflammation and overactivity. If confirmed, the stimulation of novel cannabinoid receptor - GPR55, could be a reasonable strategy as a treatment of CYP-induced haemorrhagic cystitis. The experiments were conducted in female Wistar rats. Based on the methodology of our published studies on CYP-induced heamorrhagic cystitis we performed experiments after administration of CYP, O-1602 or CYP plus O-1602. These included surgical procedures, conscious cystometry, measurements of bladder oedema and urothelium thickness using the Evans Blue dye leakage technique, as well as biochemical analyses with particular ELISA kits. O-1602 ameliorated the symptoms of CYP-induced detrusor overactivity leading to an increase in voided volume (0.59 vs. 0.93 ml), and lowering the detrusor overactivity index (703 vs. 115 cm H2O/ml). Intravenous administration of the GPR55 agonist to animals that received CYP significantly decreased Evans Blue extravasation and increased urothelium thickness. O-1602 also reversed the pro-inflammatory activity of CYP by restoring concentrations of brain-derived neurotrophic factor, nerve growth factor, calcitonin gene related peptide, interleukin 1-beta, interleukin-6, tumour necrosis factor alpha, malondialdehyde, nitrotyrosine, occludin, and organic cation transporter 3. GPR55 agonist, O-1602, represents a novel class of uroprotective agents, targeting the inflammatory basis of cystitis. To our knowledge, this is the first paper proposing O-1602 agent, as a candidate for future studies in the treatment of CYP-induced cystitis.

Role of NLRP3 inflammasome in the development of bladder pain syndrome interstitial cystitis.

Although it has been proposed that NOD-like receptor protein 3 (NLRP3) inflammasome activation may have an important contribution to the onset of bladder pain syndrome/interstitial cystitis (BPS/IC), as of today there is still insufficient evidence to accept or to reject this hypothesis. However, taking into consideration that inflammasomes have been already shown as important mediators of cyclophosphamide-induced bladder inflammation and that some studies have also revealed human bladder epithelium expresses high levels of NLRP3, such a hypothesis seems to be reasonable. The purpose of this review is to discuss a scenario that NLRP3 inflammasome is a crucial player in the development of this disease. Identification of a novel mediator of bladder inflammation and pain could lead to emerging new therapeutic strategy and the first causative therapy.

Prediction of BCG responses in non-muscle-invasive bladder cancer in the era of novel immunotherapeutics.

Bacillus Calmette-Guerin (BCG) instillations are considered as a gold standard of therapy in high- and intermediate-risk non-muscle-invasive bladder cancer (NMIBC). Unfortunately, up to 40% of patients might experience treatment failure and even 15% of patients initially diagnosed with NMIBC will progress to muscle-invasive disease. Since patients, who fail to respond to BCG, are at particular risk of progression, immediate radical cystectomy (RC) is currently recommended to provide cancer control. However, immunotherapy in NMIBC management still evolves. Immune checkpoint inhibitors emerge as new immunotherapeutics, which in the future might be combined with BCG and may serve as an alternative to radical cystectomy in patients, who failed to respond to BCG alone or are at particular a priori risk of BCG failure, especially if RC is not a safe option. Therefore, there is an urgent need to identify NMIBC patients that will not benefit from BCG therapy and demand radical cystectomy. In the following review, we attempt to focus on several clinical and molecular factors and demonstrate the efforts directed to unravel their significance in BCG-failure risk assessment.

Anaesthesia of the posterior urethra and pain reduction during cystoscopy - a randomized controlled trial.

INTRODUCTION: Standard intra-urethral instillation of anaesthetic gel may not sufficiently exclude pain perception during cystoscopy. AIM: To evaluate the impact of the anaesthesia within the posterior urethra on pain intensity related to cystoscopy in men. MATERIAL AND METHODS: One hundred and twenty-seven men undergoing cystoscopy were prospectively enrolled in the study. Patients were randomly assigned to the experimental or control group (66 vs. 61 patients). Intra-urethral instillation of 2% lidocaine gel was done in both groups. In the experimental group, the posterior urethra was additionally anaesthetized with distribution of the lidocaine gel by catheterisation. The study endpoints were pain intensity at successive time points of the procedure assessed on a numeric rating scale, overall pain intensity assessed on a Likert scale, the need for analgesics during 6 h after the procedure, and the frequency of urinary tract infections (UTIs) during 14 days after the procedure. RESULTS: Pain perception during cystoscopy did not differ significantly between the two groups (p > 0.05). However, after 6 h patients in the experimental group were more likely to declare that the cystoscopy was painless (81.8% vs. 70.2%, relative risk = 1.17). The need for analgesics and the incidence of UTI were similar in both groups (p > 0.05). Statistically significant differences regarding pain perception were observed depending on patients' age and the number of transurethral procedures performed in the past, with no relation to type of anaesthesia (p < 0.05). CONCLUSIONS: Anaesthesia of the posterior urethra is not more efficacious in reducing pain related to cystoscopy than standard instillation of anaesthetic gel. However, it improves the general perception of the procedure, and hence may positively influence patients' compliance.

Growth hormone/insulin-like growth factor-1 axis, calciotropic hormones and bone mineral density in young patients with chronic viral hepatitis.

INTRODUCTION: Chronic liver disease caused by HBV and HCV infections, due to its great prevalence and serious medical consequences, is at the present time a significant clinical problem. An impaired liver function can provoke severe disturbances in calcium and phosphorus homeostasis, and consequently in the bone metabolism resulting in hepatic osteodystrophy. The aim of this study was to determine whether there are significant differences in bone mineral density (BMD) and/or circadian levels of hormones connected with bone metabolism and bone turnover markers in patients with chronic viral hepatitis. MATERIAL AND METHODS: Circadian levels (AUC, area under the curve) of GH, IGF-I, IGFBP-3, osteocalcin (BGLAP), C-terminal telopeptide of type I collagen (ICTP), PTH, 25(OH)D, total calcium and total phosporus were measured in the blood of members of the study group (n = 80). BMD was assessed using the dual-energy X-ray absorptiometry method of the L2-L4 lumbar spine. Data was compared to that of healthy individuals (n = 40). RESULTS: BMD (1.05 g/cm3 vs. 1.20 g/cm3), total calcium concentration (2.20 mmol/L vs. 2.45 mmol/L), total phosphorus concentration (1.06 mmol/L vs. 1.33 mmol/L), IGF-I (AUC 3,982.32 ng/mL vs. 5,167.61 ng/mL), IGFBP-3 (AUC 725.09 ng/L vs. 944.35 ng/L), 25(OH)D (AUC 356.35 ng/mL vs. 767.53 ng/mL) and BGLAP (AUC 161.39 ng/L vs. 298 ng/L) were lower in the study group. GH (AUC 88.3 ng/mL vs. 48.04 ng/mL), iPTH (AUC 1,201.94 pg/mL vs. 711.73 pg/mL) and ICTP (AUC 104.30 µg/L vs. 54.49 µg/L) were higher in patients with hepatitis. Positive correlations were noted between bone mineral density and IGF-I, IGFBP-3, and BGLAP levels. CONCLUSIONS: Chronic viral hepatitis causes a decrease in bone mineral density. Impaired liver function disrupts homeostasis of the calcium- vitamin D-parathyroid hormone axis and provokes secondary hyperparathyroidism. Chronic viral hepatitis induces a decrease in the synthesis of IGF-I and IGFBP-3 and an increase in GH secretion. Hepatic osteodystrophy is probably caused by both changes in calciotropic hormones as well as in the somatotropin hormone axis.

Adiponectin, leptin, resistin and insulin blood concentrations in patients with ischaemic cerebral stroke.

INTRODUCTION: Stroke, due to its worldwide prevalence, is not only a medical challenge, but also a serious social problem. Recently, ongoing research has examined whether there are associations between adipose tissue hormones and the risk, mechanisms and course of stroke. The aim of our study was to determine whether there are significant differences in blood concentrations of insulin, adiponectin, leptin, resistin and in insulin resistance among patients in the acute phase of ischaemic stroke, compared to healthy subjects. In addition, we wanted to investigate if those biochemical values show a correlation with the neurological condition of our patients. MATERIAL AND METHODS: Adiponectin, leptin, resistin and insulin were measured in patients (n = 69) with first-ever ischaemic stroke (confirmed by CT), using specific electrochemoluminescence, radioimmunoassay and ELISA methods. Neurological evaluation was performed using Barthel ADL index on the day of admission and on the ninth day of hospitalisation. Insulin resistance value was obtained via the HOMA-IR calculator. Data was compared to that of healthy individuals (n = 26). RESULTS: Insulin concentration (51.08 v. 17.02 uU/mL) and HOMA-IR value (6.3 v. 2.2) were significantly higher in the study group. Leptin (14.98 v. 10.47 ng/mL) and resistin (28.92 v. 12.25 ng/mL) levels were elevated among the stroke survivors compared to controls, but no significant difference was noted in adiponectin. Negative correlations of adiponectin level and Barthel score were observed. CONCLUSIONS: Hyperinsulinaemia and insulin resistance are involved in the pathogenesis of ischaemic stroke. Hyperleptinaemia and hyperresistinaemia play a role in the mechanism of stroke. The severity of stroke is associated with adiponectin blood concentration.