Ultrasound Evaluation of Mid-Urethral Sling Position: A Potential Predictor of Outcomes and Adverse Effects.

OBJECTIVE: The aim of this study was to evaluate mid-urethral sling (MUS) position and its association with postoperative outcomes and complications. DESIGN: This was a prospective cohort study. Ninety-two women who underwent MUS procedure with a median follow-up period of 11 months (interquartile range 5-24 months) were recruited. PARTICIPANTS/MATERIALS, SETTING, METHODS: Two-dimensional trans-labial ultrasound with an endovaginal probe was used to visualize the urethral length (UL), sling distance to the bladder neck (BN) and to the urethra longitudinal smooth muscle (LSM). RESULTS: Mean sling-LSM, UL, and sling-BN distances were 5.97 ± 2.04 mm, 28.66 ± 3.19 mm, and 18.85 ± 4.46 mm, respectively. Sling position relative to BN (proximal vs. middle vs. distal) was not associated with surgery outcomes and complications; however, mean sling-LSM in patients with exposure (4.3%) was significantly higher compared to those who did not experience exposure (8.80 ± 1.9 mm vs. 5.8 ± 2.0 mm, p = 0.048). Moreover, the mean sling-LSM distance was associated with patient satisfaction (5.87 ± 2.0 mm in satisfied patients with VAS > 6 vs. 6.29 ± 2.1 mm in unsatisfied patients, p value = 0.043). Likewise, patients who had worsened or showed de novo overactive bladder (OAB) symptoms (8.8%) had significantly higher mean sling-LSM distance compared to patients with improved OAB symptoms (6.52 ± 2.0 mm vs. 5.37 ± 1.9 mm, p = 0.007). Mean sling-LSM distance was lower in patients with recurrent urinary tract infection (UTI), voiding dysfunction, and improved stress urinary incontinence, whereas patients with dyspareunia after surgery had higher mean sling-LSM distance; however, these differences were not statistically significant. LIMITATIONS: Both trans-obturator and retropubic procedures with or without concomitant prolapse surgery were assessed. Heterogeneity of the study population and pelvic floor ultrasound being performed by a single urogynecologist were the limitations of the current study. CONCLUSIONS: Ultrasound visualization of MUS is feasible and has the potential to predict outcomes and complications. High sling-LSM distance was associated with exposure, and low sling-LSM distance with increased satisfaction rate, probability of voiding dysfunction, and recurrent UTI.

The role of nutritional interventions in prostate cancer: A review.

The high prevalence rate in conjunction with the long latency period made prostate cancer (PCa) an attractive and reasonable candidate for preventive measures. So far, several dietary and nutritional interventions have been implemented and studied with the aim of preventing the development or delaying the progression of PCa. Calorie restriction accompanied by weight loss has been shown to be associated with decreased likelihood of aggressive PCa. Supplements have played a major role in nutritional interventions. While genistein and lycopene seemed promising as preventive agents, minerals such as zinc and selenium were shown to be devoid of protective effects. The role of vitamins has been widely studied, with special emphasis on vitamins with antioxidant properties. Data related to Vitamin A and Vitamin C were rather controversial and positive effects were of insignificant magnitude. Vitamin E was associated with a decreased risk of PCa in high-risk groups like smokers. However, when it comes to Vitamin D, the serum levels might affect the risk of PCa. While deficiency of this vitamin was associated with increased risk, high serum levels imposed the risk of aggressive disease. Despite the seemingly promising effects of dietary measures on PCa, no firm recommendation could be made due to the limitations of the studies and evidence. However, the majority of these advices could be followed by the patients with the intent of living a healthy lifestyle.

Health Effects of Overweight and Obesity in 195 Countries over 25 Years.

BACKGROUND: Although the rising pandemic of obesity has received major attention in many countries, the effects of this attention on trends and the disease burden of obesity remain uncertain. METHODS: We analyzed data from 68.5 million persons to assess the trends in the prevalence of overweight and obesity among children and adults between 1980 and 2015. Using the Global Burden of Disease study data and methods, we also quantified the burden of disease related to high body-mass index (BMI), according to age, sex, cause, and BMI in 195 countries between 1990 and 2015. RESULTS: In 2015, a total of 107.7 million children and 603.7 million adults were obese. Since 1980, the prevalence of obesity has doubled in more than 70 countries and has continuously increased in most other countries. Although the prevalence of obesity among children has been lower than that among adults, the rate of increase in childhood obesity in many countries has been greater than the rate of increase in adult obesity. High BMI accounted for 4.0 million deaths globally, nearly 40% of which occurred in persons who were not obese. More than two thirds of deaths related to high BMI were due to cardiovascular disease. The disease burden related to high BMI has increased since 1990; however, the rate of this increase has been attenuated owing to decreases in underlying rates of death from cardiovascular disease. CONCLUSIONS: The rapid increase in the prevalence and disease burden of elevated BMI highlights the need for continued focus on surveillance of BMI and identification, implementation, and evaluation of evidence-based interventions to address this problem. (Funded by the Bill and Melinda Gates Foundation.).

Resolution of Hydronephrosis in Children with Dysfunctional Voiding After Biofeedback Therapy: A Randomized Clinical Trial.

We assessed efficacy of biofeedback therapy and home pelvic floor muscle exercises in children with dysfunctional voiding (DV) associated with mild to moderate hydronephrosis. This prospective study comprised fifty seven children (21 boys, 36 girls; mean age 8.9 ± 2.6) with DV and mild to moderate hydronephrosis. Children were randomly allocated into two treatment groups including control group who underwent standard urotherapy and case group who received biofeedback therapy in addition to standard urotherapy. A 99mTc diethylenetriamine pentaacetic acid (99mDTPA) scan, voiding cystoureterography, kidney and bladder ultrasounds, voiding diary and uroflowmetry with electromyography (EMG) were performed in all study participants at the baseline. Children with evidence of complete obstruction in DTPA scan and vesicoureteral reflux were excluded from enrollment. A complete voiding diary, kidney and bladder ultrasounds and uroflowmetry/EMG were also performed 6 months and 1 year after completion of the treatment. We noted a more significant decline in anteroposterior pelvic diameter in case group compared to control group (P < 0.05). The mean maximal urine flow rate prior to treatment was 16.5 ± 2.6 and 16.1 ± 3 ml/s in case and control groups, respectively. This finding increased significantly 1 year after the treatment in case group compared to controls (25 ± 7.2 ml/s vs. 18.4 ± 5.9 ml/s, respectively; P < 0.001). Improvement of various parameters in voiding diary was also more significant in the case group. Biofeedback therapy can effectively resolve non-refluxing and non-obstructive hydronephrosis in children with DV.

Global, Regional and National Burden of Bladder Cancer, 1990 to 2016: Results from the GBD Study 2016.

PURPOSE: Bladder cancer is among the leading causes of cancer death worldwide. Data on the bladder cancer burden are valuable for policy-making. We aimed to estimate the burden of bladder cancer by country, age group, gender and sociodemographic status between 1990 and 2016. MATERIALS AND METHODS: Data from vital registration systems and cancer registries were the input to estimate the bladder cancer burden. Mortality was estimated in an ensemble model approach, incidence was estimated by dividing mortality by the mortality-to-incidence ratio and prevalence was estimated using the mortality-to-incidence ratio as a surrogate for survival. We modeled the years lived with disability using disability weights of bladder cancer sequelae. Years of life lost were calculated by multiplying the number of deaths by age by the standard life expectancy at that age. Disability adjusted life-years were calculated by summing the years lived with disability and the years of life lost. Moreover, we also estimated the burden attributable to bladder cancer risk factors, smoking and high fasting plasma glucose using the comparative risk assessment framework of the Global Burden of Disease study. RESULTS: In 2016 there were 437,442 incident cases (95% UI 426,709-447,912) of bladder cancer with an age standardized incidence rate of 6.69/100,000 (95% UI 6.52-6.85). Bladder cancer led to 186,199 deaths (95% UI 180,453-191,686) in 2016 with an age standardized rate of 2.94/100,000 (95% UI 2.85-3.03). Bladder cancer was responsible for 3,315,186 disability adjusted life-years (95% UI 3,193,248-3,425,530) in 2016 with an age standardized rate of 49.45/100,000 (95% UI 47.68-51.11). Of bladder cancer deaths 26.84% (95% UI 19.78-33.91) and 7.29% (95% UI 1.49-16.19) were due to smoking and high fasting glucose, respectively, in 2016. CONCLUSIONS: Although the number of bladder cancer incident cases is growing globally, the age standardized incidence and number of deaths are decreasing, as mirrored by a decreasing smoking contribution.

Global, regional and national burden of testicular cancer, 1990-2016: results from the Global Burden of Disease Study 2016.

OBJECTIVE: To provide estimates of the global incidence, mortality and disability-adjusted life-years (DALYs) associated with testicular cancer (TCa) between 1990 and 2016, using findings from the Global Burden of Disease (GBD) 2016 study. MATERIALS AND METHODS: For the GBD 2016 study, cancer registry data and a vital registration system were used to estimate TCa mortality. Mortality to incidence ratios were used to transform mortality estimates to incidence, and to estimate survival, which was then used to estimate 10-year prevalence. Prevalence was weighted using disability weights to estimate years lived with disability (YLDs). Age-specific mortality and a reference life expectancy were used to estimate years of life lost (YLLs). DALYs are the sum of YLDs and YLLs. RESULTS: Global incidence of TCa showed a 1.80-fold increase from 37 231 (95% uncertainty interval [ UI] 36 116-38 515) in 1990 to 66 833 (95% UI 64 487-69 736) new cases in 2016. The age-standardized incidence rate also increased from 1.5 (95% UI 1.45-1.55) to 1.75 (95% UI 1.69-1.83) cases per 100 000. Deaths from TCa remained stable between 1990 and 2016 [1990: 8394 (95% UI 7980-8904), 2016: 8651 (95% UI 8292-9027)]. The TCa age-standardized death rate decreased between 1990 and 2016, from 0.39 (95% UI 0.37-0.41) to 0.25 (95% UI 0.24-0.26) per 100 000; however, the decreasing trend was not similar in all regions. Global TCa DALYs decreased by 2% and reached 391 816 (95% UI 372 360-412 031) DALYs in 2016. The age-standardized DALY rate also decreased globally between 1990 and 2016 (10.31 [95% UI 9.82-10.84]) per 100 000 in 2016). CONCLUSION: Although the mortality rate for TCa has decreased over recent decades, large disparities still exist in TCa mortality, probably as a result of lack of access to healthcare and oncological treatment. Timely diagnosis of this cancer, by improving general awareness, should be prioritized. In addition, improving access to effective therapies and trained healthcare workforces in developing and under-developed areas could be the next milestones.

Global, Regional and National Burden of Prostate Cancer, 1990 to 2015: Results from the Global Burden of Disease Study 2015.

PURPOSE: Data on the incidence, mortality and burden of prostate cancer as well as changing trends are necessary to provide policy makers with the evidence needed to allocate resources appropriately. This study presents estimates of prostate cancer incidence, mortality and burden from 1990 to 2015 by patient age, country and developmental status using the results of the Global Burden of Disease 2015 study. MATERIALS AND METHODS: Data from vital registration systems and cancer registries were used to generate mortality estimates. Cause specific mortality served as the basis for estimating incidence, prevalence and disability adjusted life years. The global number of incident cases, deaths and disability adjusted life years attributable to prostate cancer are reported as well as age standardized rates. RESULTS: Incident cases of prostate cancer increased 3.7-fold from 1990 to 2015. The age standardized incidence rate also increased 1.7-fold during the study period and in 2015 it reached 56.71/100,000 person-years (95% uncertainty interval 45.86-78.45). Global estimates of the age standardized death rate decreased slightly to 14.24 deaths (95% uncertainty interval 11.8-17.95) per 100,000 person-years in 2015. The decline in the age standardized death rate was more prominent in high income countries. Disability adjusted life years attributable to prostate cancer increased by 90% during the study period. CONCLUSIONS: The prostate cancer mortality rate is decreasing in high income countries. However, the incidence and burden of disease are steadily increasing globally, resulting in further challenges in the allocation of limited health care resources. The current study provides comprehensive knowledge of the local burden of disease and help with appropriate allocation of resources for prostate cancer prevention, screening and treatment.

Feasibility and Safety of Ultrasonography Guidance and Flank Position during Percutaneous Nephrolithotomy.

PURPOSE: Percutaneous nephrolithotomy is generally performed using fluoroscopy, which is associated with exposure to radiation. Another drawback of fluoroscopic guided percutaneous nephrolithotomy is the prone position, which is not suitable for all patients. In this study we evaluated the feasibility, safety and efficacy of ultrasound guided percutaneous nephrolithotomy with the patient in the flank position. MATERIALS AND METHODS: A total of 603 patients with a mean ± SD age of 50.9 ± 13 years were included in this study from December 2010 to July 2016. Access to the collecting system and tract dilation were performed under ultrasound guidance. Perioperative data on the stone-free rate, operative time, length of stay and complication rates were recorded. RESULTS: Successful access was achieved in all but 1 patient. Mean operative time was 56.6 ± 6.5 minutes. Complete stone clearance was achieved in 529 patients (87.7%) and Clavien-Dindo grade 3 complications were noted in 17 (2.8%). Blood transfusion was necessary in 43 patients (7.1%). However, bleeding was self-limited in all cases and did not require angioembolization. CONCLUSIONS: To our knowledge this is the largest series of ultrasound guided percutaneous nephrolithotomy with the patient in the flank position. Unlike in other studies we used this procedure in all patients irrespective of stone burden, renal anomaly and body habitus. Ultrasound guided percutaneous nephrolithotomy has outcomes comparable to those of conventional percutaneous nephrolithotomy and it is not associated with radiation exposure. Furthermore, anesthesia while in the flank position might be less harmful in some patients, including those with obesity or cardiopulmonary comorbidities.

Association between race and oncologic outcome following radical prostatectomy for clinically organ-confined prostate cancer: a long-term follow-up study.

PURPOSE: Few studies have evaluated prostate cancer oncologic outcomes in different ethnic groups following radical prostatectomy for clinically organ-confined disease. Existing studies lack long-term outcome data. We conducted this study to assess the impact of racial differences on risk profile and oncologic outcomes in a large cohort of patients with prostate cancer who underwent radical prostatectomy. METHODS: Using our institutional review board-approved prostate cancer database, we retrospectively reviewed the records of 3437 patients who underwent radical prostatectomy with curative intent in our institution between 1987 and 2009. Based on ethnicity, patients were divided into Asian Americans (n = 133), African Americans (n = 155) and Caucasians (n = 3149). Baseline characteristics and oncologic outcomes including biochemical recurrence free, clinical recurrence free and overall survival were compared between the study groups. RESULTS: A total of 3437 patients with a mean age of 63 ± 9.8 years and median follow-up period of 8.7 (range 0.1-24.1) years were included in the analysis. Pathologic stage and the frequency of poorly differentiated cancer were higher in Asian Americans; however, margin status did not differ significantly. Moreover, oncologic outcomes were comparable between different ethnic groups. In multivariate analysis, both pathologic stage and grade were independent predictors of oncologic outcomes, but race was not. CONCLUSIONS: In this large, ethnically diverse long-term follow-up study, we noted that Asian Americans compared to African Americans and Caucasians are more likely to have high risk prostate cancer; however, race was not an independent predictor of oncologic outcome following radical prostatectomy with curative intent.

Oncological Outcomes After Radical Prostatectomy for High-Risk Prostate Cancer Based on New Gleason Grouping System: A Validation Study From University of Southern California With 3,755 Cases.

BACKGROUNDS: To assess the prognostic value of new Gleason grade grouping system in high-risk prostate cancer patients, we compared oncological outcomes after radical prostatectomy for patients with Gleason score 8 versus 9-10. METHODS: Between 1987 and 2008, 3,755 men underwent radical prostatectomy with curative intent at University of Southern California. Patients who had Gleason score 8-10 at final histopathological evaluation (pT2-4N0) were included in this study. Eligible patients were divided into two groups; 226 with Gleason score 8 and 132 with Gleason score 9-10. Various patient and disease characteristics as well as oncological outcomes (biochemical recurrence, clinical recurrence, and overall survival) were compared between the groups. Impact of Gleason score on outcomes was controlled for preoperative prostate specific antigen, pathological stage, use of adjuvant radiotherapy, and neoadjuvant/adjuvant hormone therapy in multivariable analyses. RESULTS: A total of 358 patients (mean age: 65 years) were included in the analysis. Mean age and median duration of follow-up (9.6 years) were comparable between the study groups. Gleason 9-10 prostate cancer was associated with worse biochemical (HR 1.6; 95%CI [1.1-2.3]) and clinical recurrence free survival (HR = 1.9; 95%CI [1.1-3.3]); however, overall survival did not differ significantly between the groups. In addition, more patients with Gleason score 9-10 received adjuvant hormone therapy in the course of disease. CONCLUSIONS: Long-term follow-up after radical prostatectomy revealed significant differences in disease-specific outcomes between patients with Gleason score 8 versus 9-10. This sub-classification of high-risk patients might be helpful for patient counseling and determining therapeutic strategies. Prostate 77:743-748, 2017. © 2017 Wiley Periodicals, Inc.

The role of serum and urinary carbohydrate antigen 19-9 in predicting renal injury associated with ureteral stone.

This study was designed to evaluate the role of urinary and serum carbohydrate antigen 19-9 (CA19-9) as a biomarker in the assessment of patients with ureteral stone. A total of 38 patients with ureteral stone and hydronephrosis who underwent transurethral lithotripsy (TUL) (Group A) and 24 age-matched healthy controls (Group B) were evaluated in this study. Urinary and serum CA19-9 concentrations were measured in group A patients before TUL as well as 4 and 8 weeks following the operation. Urinary and serum CA19-9 concentrations were also measured in group B participants. Median concentration of urinary and serum CA19-9 was 34.0 and 15.0 kU/L in group A patients and 16.1 and 5.3 kU/L in group B, respectively (p < 0.001). Medians of CA19-9 concentration in urine and serum reduced to 12.5 and 4.5 kU/L 8 weeks after TUL (p < 0.001). Following successful TUL and hydronephrosis resolution, a significant decline was detected in serum and urinary CA19-9. We also noted that duration of ureteral obstruction was associated with serum and urinary CA19-9 concentrations, suggesting the potential role of this marker in predicting renal damage associated with urinary tract obstruction and determining the appropriate timing of interventions.

Applying extender devices in patients with penile dysmorphophobia: assessment of tolerability, efficacy, and impact on erectile function.

INTRODUCTION: Most men seeking penile enhancement techniques have a normal penile size. They are either misinformed or suffer from penile dysmorphophobia and should be discouraged from undergoing invasive procedures. Less invasive techniques including penile extenders are not associated with major complications and may be beneficial from a psychological perspective. AIM: We conducted this study to assess the efficacy and safety of AndroPenis (Andromedical, Madrid, Spain) penile extender. METHODS: Between December 2010 and December 2013, 163 men presented to our institution complaining of small penile length and/or girth. All patients received structured psychosexual counseling. Fifty-four patients were willing to use the AndroPenis penile extender after counseling. Patients with major psychiatric disorders were excluded from enrollment. The patients were instructed to wear the device between 4 and 6 hours per day for 6 months. Penile dimensions including flaccid stretched and erected lengths were measured at baseline and after 1, 3, 6, and 9 months. Erectile function was assessed at baseline and 9 months after treatment using the simplified International Index of Erectile Function (IIEF-5). An institutional nonstandardized questionnaire was used to evaluate patient satisfaction at the end of study. MAIN OUTCOME MEASURES: Penile length and girth enhancement as well as satisfaction rate and improvement in erectile function were assessed during follow-up. RESULTS: At 6-month follow-up, a mean gain of 1.7 ± 0.8, 1.3 ± 0.4, and 1.2 ± 0.4 cm was noted for the flaccid, stretched, and erected penile lengths, respectively (all P values < 0.001). During the off treatment period, there were no significant changes in penile lengths. No effect on penile girth was observed. Patient satisfaction survey revealed modest satisfaction. From 13 patients with mild baseline erectile dysfunction, nine patients reported normal erectile function after 9 months. CONCLUSION: Penile extender as a minimally invasive technique is safe and provides modest benefits and patient satisfaction.

Long-term complications of urinary diversion.

PURPOSE OF REVIEW: Radical cystectomy and urinary diversion remains the cornerstone in surgical management of patients with muscle-invasive or high-risk nonmuscle-invasive bladder cancer. This approach has been associated with remarkable increase in patient survival and more patients are now living for years after surgery who may present with long-term complications. This review describes long-term complications associated with urinary diversion including renal function deterioration, voiding dysfunction, stoma and bowel-related complications, ureteroenteric stricture, metabolic disorders, and infectious complications. RECENT FINDINGS: The overall complication rate reported in recent large studies assessing long-term complications of urinary diversion is as high as 60%. Stoma-related complications followed by urinary tract infections are among the most common complications. Some of these complications may occur years after surgery; therefore, long-term follow-up of patients with urinary diversion is of utmost importance. SUMMARY: Long-term regular follow-up is imperative in patients with urinary diversion as nonfatal complications may occur years after surgery.

Upper Tract Urothelial Carcinoma (UTUC) Diagnosis and Risk Stratification: A Comprehensive Review.

Diagnosis and risk stratification are cornerstones of therapeutic decisions in the management of patients with upper tract urothelial carcinoma (UTUC). Diagnostic modalities provide data that can be integrated, to provide nomograms and stratification tools to predict survival and adverse outcomes. This study reviews cytology, ureterorenoscopy and the novel tools and techniques used with it (including photodynamic diagnosis, narrow-band imaging, optical coherence tomography, and confocal laser endomicroscopy), and biopsy. Imaging modalities and novel biomarkers are discussed in another article. Patient- and tumor-related prognostic factors, their association with survival indices, and their roles in different scores and predictive tools are discussed. Patient-related factors include age, sex, ethnicity, tobacco consumption, surgical delay, sarcopenia, nutritional status, and several blood-based markers. Tumor-related prognosticators comprise stage, grade, presentation, location, multifocality, size, lymphovascular invasion, surgical margins, lymph node status, mutational landscape, architecture, histologic variants, and tumor-stroma ratio. The accuracy and validation of pre-operative predictive tools, which incorporate various prognosticators to predict the risk of muscle-invasive or non-organ confined disease, and help to decide on the surgery type (radical nephroureterectomy, or kidney-sparing procedures) are also investigated. Post-operative nomograms, which help decide on adjuvant chemotherapy and plan follow-up are explored. Finally, a revision of the current stratification of UTUC patients is endorsed.

A rare case report of muscular metastasis of prostate cancer.

Skeletal muscle metastasis of prostate cancer is a very rare phenomenon that has only been described in limited case reports. In this study, we present a case of neuroendocrine prostate cancer with muscle metastasis, a histological subtype associated with a grim prognosis. This case illustrates the potential efficacy of urgent surgical resection of the metastatic muscle mass, followed by adjuvant radiation therapy, as a suitable management strategy for this condition. However, a comprehensive understanding of the biological characteristics of neuroendocrine prostate cancer is imperative in our fight against this lethal form of the disease and in the prevention of metastatic spread.

Log Odds of Positive Lymph Nodes (LODDS) as an Independent Predictor of Overall Survival Following Radical Cystectomy in Urothelial Bladder Cancer: Time to Rethink Conventional Node Staging.

BACKGROUND: Radical cystectomy (RC) with lymph node dissection is the mainstay of treatment for patients with muscle-invasive bladder cancer (MIBC) and high risk non-MIBC. The American Joint Committee on Cancer's (AJCC) node staging and lymph node ratio (LNR) systems are used in estimating prognosis; however, they do not directly factor in negative dissected nodes. In this study, we evaluated the log odds of positive lymph nodes (LODDS), a novel measure of nodal involvement, as a predictor of survival. PATIENTS AND METHODS: Eighty-three patients who underwent RC were retrospectively included and their demographic and clinical data were collected. Kaplan-Meier curve and Cox regression were used for survival analyses. RESULTS: Median number of dissected lymph nodes was 13 (range 3-45). ROC curve analysis indicated -0.92 as the optimal LODDS cutoff. LODDS > -0.92 was associated with higher T stage, lymphovascular invasion, and significantly worse overall survival (OS) (mean OS 18.6 vs. 45.1 months, P-value < .001). Furthermore, we evaluated AJCC node staging, LNR, and LODDS in three separate multivariable Cox regression models. Among 3 different measures of nodal disease burden, only LODDS was an independent predictor of OS (HR 2.71, 95% CI 1.28-5.73, P = .009). CONCLUSIONS: Our results show that LODDS is an independent predictor of OS and outperforms AJCC node staging and LNR in forecasting prognosis among patients with urothelial bladder cancer who undergo RC.

Global and regional quality of care index for prostate cancer: an analysis from the Global Burden of Disease study 1990-2019.

BACKGROUND: Prostate cancer (PCa) is one of the most prevalent cancers worldwide, with a significant burden on societies and healthcare providers. We aimed to develop a metric for PCa quality of care that could demonstrate the disease's status in different countries and regions (e.g., socio-demographic index (SDI) quintiles) and assist in improving healthcare policies. METHODS: Basic burden of disease indicators for various regions and age-groups were retrieved from Global Burden of Disease Study 1990-2019, which then were used to calculate four secondary indices: mortality to incidence ratio, DALYs to prevalence ratio, prevalence to incidence ratio, and YLLs to YLDs ratio. These four indices were combined through a principal component analysis (PCA), producing the quality of care index (QCI). RESULTS: PCa's age-standardized incidence rate increased from 34.1 in 1990 to 38.6 in 2019, while the age-standardized death rate decreased in the same period (18.1 to 15.3). From 1990 to 2019, global QCI increased from 74 to 84. Developed regions (high SDI) had the highest PCa QCIs in 2019 (95.99), while the lowest QCIs belonged to low SDI countries (28.67), mainly from Africa. QCI peaked in age groups 50 to 54, 55 to 59, or 65 to 69, depending on the socio-demographic index. CONCLUSIONS: Global PCa QCI stands at a relatively high value (84 in 2019). Low SDI countries are affected the most by PCa, mainly due to the lack of effective preventive and treatment methods in those regions. In many developed countries, QCI decreased or stopped rising after recommendations against routine PCa screening in the 2010-2012 period, highlighting the role of screening in reducing PCa burden.

Feasibility, safety, and effectiveness of adult-sized instruments in pediatric percutaneous nephrolithotomy: A systematic review and meta-analysis.

INTRODUCTION: Little evidence exists regarding the benefits and disadvantages of adult-sized instruments for Percutaneous Nephrolithotomy (PCNL) in pediatric patients. This systematic review aims to clarify the safety and efficacy of this approach. MATERIALS AND METHODS: We conducted a systematic literature review using databases of PubMed, Scopus, Embase, Web of Science, and Cochrane and included studies that evaluated PCNL in children. All identified records underwent two-phase title/abstract and full-text screening. Pediatric patients were defined as 17 years or younger, and adult-sized instruments as 24Fr and above. The primary outcomes were success (stone-free) rate and surgical complications obtained from studies comparing adult-sized and pediatric-sized instruments. RESULTS: A total of 84 abstracts and 16 full text article were assessed till July 2021 and 6 studies were included. All studies were retrospective. Number of accesses (Odds ratio (OR), adult-sized to pediatric-sized: 0.96, 95% CI: 0.52-1.78, p = 0.89), initial stone-free rate (OR: 0.73, 95% CI: 0.42-1.27, p = 0.26), final stone-free rate (OR: 1.14, 95% CI: 0.38-3.44, p = 0.82), and residual stones (OR: 0.79, 95% CI: 0.42-1.49, p = 0.46) could be analyzed, none with significant differences. Overall complication rates did not differ significantly between the groups. However, one study reported more grade III/IV complications in the adult-sized instrument group. The adult-sized instrument group had a higher hemoglobin/hematocrit decrease in 3 studies. Duration of surgery, fluoroscopy time, length of hospital stay, times to nephrostomy tube removal, and transfusion rate could not be assessed in meta-analysis; however, they were comparable between the adult-sized and pediatric-sized groups. Studies also showed that adult-sized instruments are applicable in children younger than 3 years and those with staghorn calculi as well as in fluoroscopy-free ultrasound-guided PCNL. CONCLUSION: Adult-sized instruments had comparable outcomes to the pediatric-sized ones and can be applied in pediatric PCNL when factors such as accessibility justify their use. The number and design of the studies restrict the reliability of the comparisons. Therefore, future studies with improved methodology may better reveal the impact of instruments on the outcome of PCNL in children.

Radical cystectomy, bilateral lymphadenectomy and native ureteral ligation in a patient with history of kidney transplantation.

We reported radical cystectomy (RC), bilateral lymphadenectomy and orthotopic ileal neobladder reconstruction in a patient with history of kidney transplant. A 71-year-old man was referred to us with bladder tumor, elevated serum creatinine (1.9 mg/dl), hydroureteronephrosis in transplanted kidney and a 5-6-cm sessile mass in the right bladder wall with involvement of transplanted ureter orifice. The patient was candidate for RC. The native ureters were ligated permanently. Extended lymphadenectomy in left side and limited lymphadenectomy in right side were performed. The patient underwent ileal orthotopic neobladder reconstruction, and the graft ureter was reimplanted to ascending loop of the pouch with end-to-end anastomosis. In conclusion, bilateral lymphadenectomy is feasible in patients with a history of kidney transplantation during RC. Permanent ligation of native ureters is better to perform to reduce the time of surgery and prevent late probable morbidities due to uretero-intestinal reimplantation complications.

Renal mucormycosis following transurethral resection of prostate in the time of COVID-19: Unique imaging features resembling emphysematous pyelonephritis.

We report a case of isolated renal mucormycosis 2 weeks following transurethral resection of prostate. The patient also mentioned history of admission for COVID-19, two months earlier. Symptoms progressed and patient underwent urgent nephrectomy. CT scan resembled imaging features of emphysematous pyelonephritis and therefore, patient did not receive timely treatment with amphotericin B in addition to nephrectomy and succumbed to the disease.