Efficacy and safety of photoselective vaporization of the prostate using the Greenlight XPS 180W laser and simple prostatectomy for high-volume prostate hypertrophy: a comparative analysis.

Introduction: This study aimed to compare the safety and efficacy of treatment using simple prostatectomy (SP) and using photoselective vaporization of the prostate (PVP) with a 180W GreenLight XPS laser in patients with high-volume prostate hypertrophy. Material and methods: The study included 120 patients with LUTS symptoms caused by prostatic enlargement of more than 80 ml; 79 patients were treated with SP, while 41 were treated with PVP. The analysis included subjective the International Prostate Symptom Score (IPSS) and Quality of Life (QoL), and objective (Qmax), (Qave), and post-void residual volume (PVR) parameters before treatment and at an average of 38 months after surgical treatment. Early and late adverse effects and length of hospitalisation were assessed. Complication reports were performed according to the modified Clavien-Dindo system. Results: The analysis independently showed the effectiveness of both methods. Subjective parameters (IPSS, QoL), showed no significant differences. Patients treated with SP scored slightly better on objective parameters (Qmax, Qave, and PVR). Analysis of adverse effects and hospitalisation time were more favourable after PVP. Conclusions: SP and PVP were found to be comparable and highly effective in treating benign prostatic hyperplasia in terms of IPSS and QoL. Patients treated with the SP method obtained slightly better results of objective parameters such as Qmax, Qave, and PVR. Compared with SP, PVP has a more favourable safety profile.

Tumour microenvironment as a predictive factor for immunotherapy in non-muscle-invasive bladder cancer.

Bladder cancer (BC) can be divided into two subgroups depending on invasion of the muscular layer: non-muscle-invasive bladder cancer (NMIBC) and muscle-invasive bladder cancer (MIBC). Its aggressiveness is associated, inter alia, with genetic aberrations like losses of 1p, 6q, 9p, 9q and 13q; gain of 5p; or alterations in the p53 and p16 pathways. Moreover, there are reported metabolic disturbances connected with poor diagnosis-for example, enhanced aerobic glycolysis, gluconeogenesis or haem catabolism.Currently, the primary way of treatment method is transurethral resection of the bladder tumour (TURBT) with adjuvant Bacillus Calmette-Guérin (BCG) therapy for NMIBC or radical cystectomy for MIBC combined with chemotherapy or immunotherapy. However, intravesical BCG immunotherapy and immune checkpoint inhibitors are not efficient in every case, so appropriate biomarkers are needed in order to select the proper treatment options. It seems that the success of immunotherapy depends mainly on the tumour microenvironment (TME), which reflects the molecular disturbances in the tumour. TME consists of specific conditions like hypoxia or local acidosis and different populations of immune cells including tumour-infiltrating lymphocytes, natural killer cells, neutrophils and B lymphocytes, which are responsible for shaping the response against tumour neoantigens and crucial pathways like the PD-L1/PD-1 axis.In this review, we summarise holistically the impact of the immune system, genetic alterations and metabolic changes that are key factors in immunotherapy success. These findings should enable better understanding of the TME complexity in case of NMIBC and causes of failures of current therapies.

Preliminary trial of 24 vs 72 hour perioperative meropenem in patients with ESBL-producing Enterobacterales bacteriuria scheduled for urological procedures.

Introduction: Antimicrobial prophylaxis is an important issue in positive urine culture patients undergoing endourological procedures or extracorporeal shock wave lithotripsy (ESWL). It is especially recognized in asymptomatic bacteriuria patients of alarm pathogen etiology. We designed a preliminary study to determine optimal duration of antibiotic prophylaxis in patients undergoing endourological procedures or ESWL with asymptomatic bacteriuria caused by Enterobacterales with extended spectrum beta-lactamase positive (ESBL+) type resistance. Material and methods: A total of 60 patients with confirmed ESBL+ Enterobacterales bacteriuria were admitted for endourological procedures or ESWL. The patients were randomized into two groups - a one-day (n = 33) and a three-day (n = 27) period of perioperative antibiotic prophylaxis with meropenem. In both groups on the following day after the procedure (24 hours after the procedure) and 7 days after the procedure serum inflammation markers were assessed. Results: Values of white blood count, C-reactive protein and procalcitonin prior to, 24 hours and seven days after the procedure clearly showed no statistically significant differences between groups that have received a one-day and three-day antibiotic regimen. Conclusions: In patients with ESBL+ Enterobacterales asymptomatic bacteriuria undergoing endourological procedures or ESWL a 72-hour perioperative meropenem prophylaxis showed no superiority over a 24-hour regimen. Further studies will be carried out to establish optimal prophylaxis for specific endourological procedures and to test safety of a single dose regimen.

Testosterone Replacement Therapy in Chronic Kidney Disease Patients.

(Background) The aim of our study was to evaluate the efficacy and safety of testosterone replacement therapy (TRT) in men with chronic kidney disease and hypogonadism on conservative and hemodialysis treatment. (Methods) The studied population consisted of 38 men on hemodialysis (HD), 46 men with CKD stages II-IV (predialysis group, PreD) and 35 men without kidney disease who were similar in age to others (control group). Serum total testosterone level (TT) was measured, and free testosterone level (fT) was calculated. Hypogonadism criteria according to the EAU definition were fulfilled by 26 men on HD (68.4%) and by 24 men from the PreD group (52%). Testosterone replacement therapy (TRT) with testosterone enanthate in intramuscular injections every 3 weeks was applied in 15 men from HD and in 14 men from PreD. The safety of TRT was monitored by measuring PSA and overhydration. (Results) A significant rise of TT and fT was observed after 3 months of TRT, but no significant changes were observed after 6 and 12 months in the HD and PreD group. An intensity of clinical symptoms of hypogonadism measured by ADAM (androgen deficiency in the ageing male) questionnaire gradually decreased, and the intensity of erectile dysfunction measured by the IIEF-5 (international index of erectile functioning) questionnaire also decreased after 3, 6 and 12 months of TRT in the HD and PreD group. (Conclusions) The applied model of TRT is effective in the correction of clinical signs of hypogonadism without a significant risk of overhydration or PSA changes.

[Treatment of benign prostatic hyperplasia with the use of lasers]. / Leczenie lagodnego przerostu prostaty z zastosowaniem laserów.

Lasers are becoming more and more widely used in medicine, gaining significant clinical acceptance in the treatment of diseases of the genitourinary system. The aim of this study is to present contemporary methods of treatment of Benign Prostate Hyperplasia with the use of lasers, taking into account the physical characteristics of these devices and the safety of the therapy. According to the recommendations of the European Urological Association, in the treatment of BPH, laser systems based on laser devices can be used, which are characterized by various physical properties such as wavelength, intensity, power, frequency and duration of the emitted light. An important aspect raised in the study is the safety assessment of these methods in patients using anticoagulants, which are commonly used in the treatment of cardiovascular diseases.

Management protocol for Fournier's gangrene in sanitary regime caused by SARS-CoV-2 pandemic: A case report.

BACKGROUND: Fournier's gangrene (FG) is a serious, aggressive and often deadly polymicrobial infection of the soft tissues of the perineum, the rectum and the external genital organs. It is an anatomical subcategory of necrotizing fasciitis, which has a similar etiology and treatment strategy. CASE SUMMARY: A 60-year-old man was admitted to the hospital during severe acute respiratory syndrome coronavirus 2 pandemic with complaints of fever up to 38.9 °C, abdominal pain, and edema of the scrotum, the penis, the perineum, and the right gluteal region for 2 d. Computed tomography of the abdomen and the pelvis revealed extensive inflammatory infiltrations of the subcutaneous tissue of the hypogastrium, and the penis; along with liquefaction and presence of gas in the subcutaneous tissues of the scrotum, the perineum, and the right gluteal region. The patient was diagnosed with FG, and was urgently qualified to undergo surgery in the Department of Urology. After performing the necessary examinations, a resection of the necrotic tissues with bilateral orchiectomy and excision of the penile and scrotal skin was performed. After surgery, he was transferred to the intensive care unit for further management. CONCLUSION: Early management prevents the resection of the other organs by inhibiting the contiguous spread of infection.

Advanced Chronic Kidney Disease is a Strong Predictor of Hypogonadism and is Associated with Decreased Lean Tissue Mass.

PURPOSE: In patients with chronic kidney disease (CKD), hypogonadism is more frequent than in the general population and its prevalence ranges between 40% and 60%. The aim of the study was to investigate the prevalence of hypogonadism and its association with kidney function, body composition, inflammatory markers and lipid disorders in patients with CKD. MATERIALS AND METHODS: The study population consisted of 112 men aged ≥40 years in different stages of CKD: 33 participants with eGFR ≥60 mL/min/1.73 m2, 27 men with eGFR 30-59 mL/min/1.73 m2, 17 predialysis patients with eGFR <30 mL/min/1.73 m2, and 35 men on hemodialysis therapy three times a week for more than 3 months (G5D stage). Total testosterone (TT) levels were measured and free testosterone (FT) levels were calculated. Body composition was assessed using bioimpedance spectroscopy (Body Composition Monitor, FMC). Statistical analysis was performed using Statistica version 13.1. RESULTS: CKD stage was a strong predictor of hypogonadism (providing an information value of 0.83). The weight of evidence technique allowed us to differentiate the high-risk group, which was a group of patients with advanced CKD, defined as eGFR <30 mL/min/1.73 m2. In this group, the likelihood of hypogonadism was 69.23%. Another significant predictor of hypogonadism was lean tissue index (LTI). TT and FT levels were significantly lower in the advanced CKD group in comparison to the control group, whereas prolactin, luteinizing hormone and C-reactive protein levels were significantly higher in the advanced CKD group. The LTI was significantly lower in advanced CKD and was positively correlated with TT and FT. CONCLUSION: Decreased eGFR and decreased LTI are predictors of hypogonadism associated with CKD. The study results suggest that hypogonadism screening should be carried out when eGFR deceases below 30 mL/min/1.73 m2.

Selected protein expression in a new prognostic model for patients with non-muscle-invasive bladder cancer.

INTRODUCTION: After transurethral resection of a bladder tumor, patients frequently have a recurrence of the disease, thereby requiring adjuvant therapy. PURPOSE: The study aimed to determine the prognostic value of expression levels of p53, Ki-67, and survivin, and to develop a new prognostic model for patients with non-muscle-invasive bladder cancer (NMIBC) after transurethral resection of a bladder tumor. METHODS: The study group consisted of 101 patients with primary NMIBC. Univariate followed by multivariate Cox proportional hazard regression analysis was performed to obtain a model including the smallest possible number of descriptive variables with the highest statistical significance and impact on risk. RESULTS: The RECINT model (RECurrence In Not Treated) including factors independently associated with cancer recurrence (tumor size [HR 1.148; p = 0.034], intensity of the color reaction for p53 [HR 1.716; p = 0.008], Ki-67 [HR 3.001; p = 0.022], and survivin [HR 1.461; p = 0.021]) adequately stratified recurrence free-survival (R2 = 0.341, p < 0.001) in patients with primary NMIBC. Patients with the lowest RECINT score (0-6) had the lowest probability of cancer recurrence (1- and 5-year recurrence of 16%) in comparison with other groups (p < 0.001). CONCLUSIONS: The RECINT model may be useful for stratifying the risk of recurrence in patients with non-muscle-invasive bladder cancer and may allow for identification of those who may benefit the most from adjuvant BCG immunotherapy.

Intensity of Nuclear Staining for Ki-67, p53 and Survivin as a New Prognostic Factor in Non-muscle Invasive Bladder Cancer.

The aim of the study was to determine the prognostic value of expression levels of biomarkers selected on the basis of the literature: p53, Ki-67, survivin, ß-catenin, E-cadherin and N-cadherin in patients with non-muscle invasive bladder cancer. Immunohistochemistry was performed on sections of primary papillary carcinoma of the bladder removed during transurethral resection of the tumor in 134 patients. The expression of ß-catenin and E-cadherin was found in all analyzed cases and N-cadherin expression was demonstrated in 3.73% of the tissues examined. The expression of the p53 protein was confirmed in 96.27% of tissues examined. The expression of the Ki-67 protein was demonstrated in all analyzed cases. Survivin expression was found in 95.52% of the study group. Multivariate analysis confirmed the relationship between the recurrence-free survival (RFS) and the intensity of the nuclear reaction for p53 (HR 1417, 95% CI 1.001-2.007, p = 0.049) and survivin (HR 1.451; 95% CI 1.078-1.955; p = 0.014), the expression level of the Ki-67 protein expressed by the TS index (HR 1.146, 95% CI 1.116-1.823, p = 0.005) and the use of adjuvant BCG therapy (HR 0.218, 95% CI 0.097-0.489, p = 0.0002). The evaluation of Ki-67 expression and the intensity of nuclear staining for survivin and p53 may provide additional information that will allow more accurate stratification of the risk of NMIBC recurrence after TURBT.

Evaluation of the effectiveness of laser photoselective vaporization of the prostate in the treatment of patients with benign prostatic hyperplasia.

INTRODUCTION: The prolongation of the life of men results in the growing number of people suffering from benign prostatic hyperplasia (BPH). In 2010, BPH concerned more than 200 million men in the whole world, which at that time made up 6% of the population of men at large. Currently, the population of men in the world amounts about three billion six hundred million. The modern surgical treatment of BPH consists of minimally invasive techniques, including laser systems. AIM: Evaluation of the effectiveness of photoselective vaporization of the prostate (PVP) on the basis of subjective parameters assessed by patients using IPSS and QoL questionnaires as well as objective parameters obtained from results of urodynamic tests. MATERIAL AND METHODS: Between 2012 and 2015, 120 patients with benign prostatic hyperplasia were included in the study and underwent PVP. Finally, 77 patients were included in the study. In all patients, IPSS and QoL sheets were carried out 1, 6 and 12 months, and urodynamic tests 12 months a er the surgical treatment. RESULTS: The statistically significant change in the value of each parameter assessed: decrease in the IPSS, QoL, PVR, Pmax, Pop, the degree of obstruction according to Schäfer and ICS nomogram, and an increase in the values of Qmax and Qave. CONCLUSIONS: Photoselective vaporization of the prostate is an effective method of therapy in patients with benign prostatic hyperplasia.

Effects of genistein on insulin pathway-related genes in mouse differentiated myoblast C2C12 cell line: evidence for two independent modes of action.

INTRODUCTION: Genistein (plant isoflavone) is a well-known anti-cancer drug with estrogenic-like properties. Genistein also regulates sugar and lipid metabolism; thus, it has anti-diabetic properties. The aim of the study was to evaluate in vitro effects of genistein on glucose transport, fatty acids oxidation, activation of PKB, and expression of genes related to insulin pathway in differentiated myoblast C2C12 mouse cell line. MATERIAL AND METHODS: Differentiated myoblast C2C12 mouse cell line was used to assess the effects of different genistein concentrations on glucose transport and fatty acids oxidation measured by radioactivity technique, activation of PKB, and expression of selected genes related to insulin signaling pathway (IR-a, IR-b, IRS-1, PKB, GLUT-4, PP2A, SH-PTP2) at the mRNA and protein levels. Cells were incubated with various concentrations of genistein under standard conditions for 0-48 hours. RESULTS: Genistein in low concentrations (0.1-1 µM) significantly increased glucose transport and decreased fatty acids oxidation in C2C12 cells after 48 h of incubation. High concentration of genistein (50 µM) had the opposite effect. Genistein stimulated PKB phosphorylation during the first 5-10 minutes of incubation. There was no significant impact on the protein expression of selected genes (IR-a, IR-b, IRS-1, PKB, GLUT-4, PP2A-Ca, ER-a and ER-b) after 48 h treatment. We observed inverse correlation between genistein concentration and the expression of SH-PTP2 protein. Genistein affected the expression pattern of mRNAs for genes related to the insulin pathway, however, not the expression of the encoded proteins. CONCLUSIONS: The results of this study showed that depending on the concentration and time of incubation genistein significantly affects glucose and lipid metabolism and at low concentration modifies expression pattern of a few genes in C2C12 cells.

Neutrophil-to-lymphocyte Ratio, Platelet-to-lymphocyte Ratio, and C-reactive Protein as New and Simple Prognostic Factors in Patients With Metastatic Renal Cell Cancer Treated With Tyrosine Kinase Inhibitors: A Systemic Review and Meta-analysis.

BACKGROUND: Inflammation plays a crucial role in cancer development. In this study, we evaluate the prognostic values of systemic inflammation markers such as neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and C-reactive protein (CRP) for the progression-free survival and overall survival in patients with metastatic renal cell carcinoma treated with tyrosine kinase inhibitors. MATERIALS AND METHODS: PubMed and the Cochrane Library databases were searched for published studies on the effect of NLR, PLR, and CRP in patients with metastatic renal cell carcinoma treated with tyrosine kinase inhibitors. RESULTS: In the meta-analysis, NLR (hazard ratio [HR], 2.01; 95% confidence interval [CI], 1.27-3.18; P = .003) and PLR (HR, 6.96; 95% CI, 5.04-9.62; P < .001) had a significant influence on progression-free survival, whereas all considered proinflammatory markers had a significant impact on overall survival: NLR (HR, 2.14; 95% CI, 1.67-2.73; P < .001), PLR (HR, 14.67; 95% CI, 11.10-19.57; P < .001), and CRP (HR, 1.96; 95% CI, 1.26-3.05; P = .003). CONCLUSIONS: Inflammation markers such as NLR, PLR, and CRP are predictors of clinical outcome and could provide additional information to individualize treatment.

Efficacy and Safety of Photoselective Vaporization of the Prostate with 120 W 532 nm Laser in Patients with Benign Prostatic Hyperplasia on Anticoagulation or Antiplatelet Therapy: Observations on Long-Term Outcomes.

OBJECTIVE: The objective of this study was to evaluate the safety and effectiveness of photoselective vaporization of the prostate (PVP) in the treatment of patients with benign prostatic hyperplasia (BPH) on anticoagulant or antiplatelet therapy. BACKGROUND: The "gold standard" of surgical treatment of BPH is transurethral resection of the prostate (TURP). Since the risk of complications associated with TURP is still significant, there is a continuous search for safer and equally effective procedures. One of them is PVP with a 532 nm potassium-titanyl-phosphate/lithium triborate (KTP/LBO) laser. MATERIALS AND METHODS: A total of 109 patients underwent PVP with the use of the GreenLight HPS 120 W laser. Sixty-five (59.6%) of the patients were on anticoagulants or antiplatelet drugs, whereas 44 (40.4%) patients were not. Various objective and subjective parameters were evaluated intra- and postoperatively along with a 5-year follow-up to compare the results and safety of PVP in these two groups of patients. RESULTS: No difference between the groups was found in intraoperative parameters, including operation and lasing time, as well as laser energy used. Also, no intraoperative complications were observed. There was no significant bleeding in any of the groups, and none of the patients required a blood transfusion. Catheterization and hospitalization time did not differ between both groups, and during the 5-year follow-up period, good objective and subjective results were observed, and the complication rates were comparable between the groups. CONCLUSIONS: Our results demonstrate that PVP for patients with BPH is an effective and safe procedure with satisfactory long-term outcomes. Anticoagulant and antiplatelet drugs did not significantly influence the results, or the complication rates.

[Hypogonadism in patients with testicular tumors and prostate cancer].

Hypogonadism is defined as an array of symptoms arising from a deficiency of androgens. It is caused by a hormonal and spermatogenic dysfunction of the testes. It results in impaired fertility and has a negative impact on the functions of multiple organs and systems, physical well-being, sexual functions and also mental state. Particularly patients with a history of cancer have a high risk of developing hypogonadism as a result of not only the nature of the disease, but mainly its treatment. While leaving the patient with cancer without treatment does not fall within the concept of the art of medicine and the ethical canon of a physician, the symptoms of hypogonadism are often ignored and left untreated. Among urological patients special attention should be given to those with testicular tumors and prostate cancer.

[Kidney cancer with venal thrombus-principles of menagement].

Frequency of renal cell carcinoma with tumor thrombus may reach up to 30% of cases. Epidemiologic data show that tumor thrombus by itself is not negative predictive factor. Meticulous preparation by analisis of high quality imaging, acurate preoperative patient and team preparation enables to make complete thrombus resection. In our analisis we propouse rules of holistic treatment for patients suffering from renal cell carcinoma with tumor thrombus. Applying of these rules results in satisfactory long term results.

An upper lip tumour as the presenting symptom of metastatic renal cancer.

INTRODUCTION: Renal cell carcinoma (RCC) constitutes about 3% of solid tumours in adults. Unfortunately, in spite of continuous development of more and more efficient diagnostic methods, in about 30% of patients with RCC metastatic spread is found at presentation. Only in 1% of patients with advanced RCC metastases are limited exclusively to the head-and-neck region. We present a case of a male patient in whom a tumour of the upper lip was the first symptom of advanced renal cancer. CASE REPORT: A 59-year-old male was admitted to the Urology Department due to a large tumour of the right kidney. About two months earlier the patient noted a nodule located within the upper lip. In the same period painless hematuria occurred twice, which was disregarded by the patient. A CT scan of the chest and abdomen showed a large tumour of the kidney, multiple lung and bone metastases. The patient underwent local surgical excision of the lip tumour and palliative renal artery embolization. CONCLUSIONS: In natural history of renal cancer there is a risk of metastatic spread to the head-and-neck region. Contrast enhanced computed tomography of the abdomen should be considered if a tumour of unknown origin is found within the head-and-neck region. Prognosis in case of confirmed metastatic renal cancer is unfavourable and patient's treatment should be conducted in specialist centres.

[Tumour in the ureter stump 13 years after nephrectomy--a rare case of endometriosis]. / Guz w kikucie moczowodu po trzynastu latach od wykonania nefrektomii--rzadka postac endometriozy.

Endometriosis is found in the urinary tract in 1-2% of women suffering from this disease. The most common site is urinary bladder (81%). In the ureter it is found in only 15% of cases and it mainly involves the pelvic part. The authors present a case of 49-year old woman who was diagnosed with an endometriotic tumour in the stump of the ureter, 13 years after left nephrectomy performed for hydronephrosis and lack of the kidney's function confirmed in renal scintigraphy. After laser ablation and hormonal therapy the tumour burden was diminished and symptoms resolved.

[Current opinion on the hepatorenal syndrome]. / Wspólczesne poglady na zespól watrobowo-nerkowy.

According to a new definition proposed by International Ascites Club, the hepatorenal syndrome is functional renal insufficiency in patients with severe liver failure. The article discusses current views on pathogenesis, clinical symptoms, diagnosis and treatment of the syndrome.