Prostatic Artery Embolization as an Alternative to Indwelling Bladder Catheterization to Manage Benign Prostatic Hyperplasia in Poor Surgical Candidates.

PURPOSE: To prospectively assess discontinuation of indwelling bladder catheterization (IBC) and relief of lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia (BPH) following prostate artery embolization (PAE) in poor surgical candidates. METHODS: Patients ineligible for surgical intervention were offered PAE after at least 1 month of IBC for management of urinary retention secondary to BPH; exclusion criteria for PAE included eligibility for surgery, active bladder cancer or known prostate cancer. Embolization technical and clinical success were defined as bilateral prostate embolization and removal of IBC, respectively. Patients were followed for at least 6 months and evaluated for International Prostate Symptom Score, quality of life, prostate size and uroflowmetric parameters. RESULTS: A total of 43 patients were enrolled; bilateral embolization was performed in 33 (76.7%), unilateral embolization was performed in 8 (18.6%), and two patients could not be embolized due to tortuous and atherosclerotic pelvic vasculature (4.7%). Among the patients who were embolized, mean prostate size decreased from 75.6 ± 33.2 to 63.0 ± 23.2 g (sign rank p = 0.0001, mean reduction of 19.6 ± 17.3%), and IBC removal was achieved in 33 patients (80.5%). Clavien II complications were reported in nine patients (21.9%) and included urinary tract infection (three patients, 7.3%) and recurrent acute urinary retention (six patients, 14.6%). Nine patients (22.0%) experienced post-embolization syndrome. CONCLUSIONS: PAE is a safe and feasible for the relief of LUTS and IBC in highly comorbid patients without surgical treatment options.

Coffee, Tea, Cola, and Bladder Cancer Risk: Dose and Time Relationships.

OBJECTIVE: To further analyze the relation between coffee, tea, and energy drinks and bladder cancer risk, considering dose, duration, and other time-related factors. METHODS AND RESULTS: A multicentric case-control study on 690 bladder cancer cases and 665 hospital controls was conducted in Italy between 2003 and 2014. Odds ratios (ORs) for bladder cancer were estimated using multiple logistic regression models. Sex-, age-, and tobacco-adjusted ORs were 1.27 (95% confidence interval [CI] 0.84-1.94) for current drinkers and 1.69 (95% CI 1.05-2.72) for lifetime drinkers of ≥4 cups/day, compared with non- or occasional coffee drinkers. The corresponding ORs for an increment of 1 cup/day were 1.03 (95% CI 0.96-1.11) and 1.07 (95% CI 0.99-1.15). No association was found between bladder cancer risk and duration or age at starting, and no significant heterogeneity was found according to age and sex, although a slight increased risk emerged in never smokers. Decaffeinated coffee, tea, cola, and energy drinks were not related with bladder cancer risk. CONCLUSION: Our study found no significant relation between coffee and bladder cancer risk after accounting for smoking, although the OR was above unity for high lifetime habit. The lack of dose and duration relationships, however, suggests the absence of a causal relation.

Risk stratification and prognostication of renal cell carcinoma.

OBJECTIVES: To review the most recent data on prognostic factors and describe the characteristics and prognostic accuracy of the most important prognostic systems available to predict the risk of recurrence, progression, and mortality in patients with renal cell carcinoma (RCC). METHODS: The study was based on a non-systematic review of literature. RESULTS: Clinical (performance status, and mode of presentation), anatomical (size and extension of the primary tumor, lymph node involvement, and distant metastasis), and histological factors (histological subtypes, nuclear grade, and tumor necrosis) are the most largely evaluated prognostic factors in RCC. Valuable prognostic accuracy has been shown for several laboratory parameters (erythrocyte sedimentation rate, platelet count, serum calcium, hemoglobin, and lactate dehydrogenase levels) and a few genetical and molecular markers (CAIX, B7-H1, and B7-H4). A few integrating systems have been proposed and validated, integrating both clinical and pathological (UCLA Integrating Staging Systems, Kattan nomogram, and Sorbellini nomogram) or only pathological variables (SSIGN score). CONCLUSIONS: Several large and methodologically consistent studies have been published. The chance to integrate the data derived from each prognostic factor into prognostic algorithms and scores has allowed improving significantly the stratification of the prognosis of patients with RCC. The currently available prognostic systems can be further improved through the inclusion of molecular and genetic variables. Integrating prognostic systems should be used to design randomized controlled trials (RCTs), which will evaluate the efficacy of the new-targeted therapies in either neoadjuvant, adjuvant, or salvage treatments of patients with RCC.