Neutrophil-to-lymphocyte ratio as a predictor of overall survival and cancer advancement in patients undergoing radical cystectomy for bladder cancer.

Introduction: Neutrophil-to-lymphocyte ratio (NLR) has proven to be promising as a prognostic factor in many malignancies. We investigated the prognostic significance of NLR in patients undergoing radical cystectomy (RC) for bladder cancer (BC). Material and methods: We retrospectively evaluated the data of 134 consecutive patients with BC who underwent RC between 2011 and 2017 at a single center. Overall survival (OS) was assessed using the Kaplan-Meier method and compared between NLR subpopulations using the log-rank test. Univariate and multivariate Cox proportional hazard models were used to identify the variables affecting OS. Results: At a median follow-up of 2.2 years, high NLR (>2.7) correlated with worse a survival outcome (p = 0.0345 in log-rank test), higher tumor stage (p = 0.0047), and higher frequency of positive lymph nodes (p = 0.0285). The univariate model showed that a high NLR (p = 0.038528), advanced pathological tumor stage (p = 0.000763), lymph node involvement (p = 0.013384), a high grade of cancer (p = 0.015611), lymphovascular invasion (LVI) (p = 0.001530), positive margins (p = 0.000890) and ureterocutaneostomy as urinary diversion (p = 0.038854) had a negative impact on OS. Tumor extending beyond the submucosa (>pT1) (hazard ratio 2.161, confidence interval 1058-4411, p = 0.0345) and lymphatic infiltration (hazard ratio 1.599, confidence interval 1028-2482, p = 0.037) have been recognized as independent risk factors of poor prognosis in multivariate Cox regression analysis. Conclusions: In our cohort, an elevated NLR is associated with worse OS and adverse histopathological findings. Consequently, the NLR is an easily acquired biomarker, which may be useful in pretreatment patient risk stratification.

Extraperitoneal Laparoscopic Prostatectomy in a Prostate Cancer Patient Undergoing Continuous Ambulatory Peritoneal Dialysis.

Radical prostatectomy (RP) in patients on continuous ambulatory peritoneal dialysis (CAPD) is a challenging procedure. The following key points need to be considered: the peritoneal cavity integrity, adjustment of the trocar positions to the peritoneal dialysis (PD) tube location, and the oncological and functional outcomes. We present a clinical case of a patient on CAPD, incidentally diagnosed with prostate cancer (PCa) during the pre-transplant evaluation. The patient suffered from LUTS, due to bladder outlet obstruction (BOO). A transurethral bladder neck incision (TUNI), with median lobe resection, was performed. A PCa Gleason score of six (3 + 3) was found in the histopathological specimen. The primary procedure was complicated by bladder neck sclerosis and acute urinary retention (AUR), resolved by suprapubic cystostomy. After proper staging determination, the patient was qualified for laparoscopic extraperitoneal RP. The standard trocar placement was modified to align with the route of the PD tube, and Retzius' space scarring was released to allow extraperitoneal prostatectomy. There were no signs of peritoneal wall damage or dialysis tube displacement. Peritoneal dialysis was resumed after 4 weeks. Laparoscopic extraperitoneal RP should be considered as an acceptable treatment method for selected patients with localized prostate cancer, allowing CAPD resumption. To the best of our knowledge, this is the first report of retroperitoneal laparoscopic RP being used in the PD population.

Urinary Incontinence in Adulthood in a Course of Ectopic Ureter-Description of Two Clinical Cases with Review of Literature.

Urinary tract pathologies are the most common congenital abnormalities. Duplex colleting system occurs at different stages of completion and is usually asymptomatic. Ureteral ectopia is an associated anomaly which may manifest as continuous incontinence. The aim of this article is to present two patients with duplex kidney and ureteral ectopia. Both patients presented symptoms of continuous urinary incontinence and became symptomatic in the adult life.

Concurrent Bilateral Emphysematous Pyelonephritis and Emphysematous Cystitis: A Case Report of Glomerulonephritis Severe Complication.

Emphysematous pyelonephritis (EPN) and emphysematous cystitis (EC) are severe, necrotizing emphysematous urinary tract infections (EUTI) characterized by the presence of gas in the lumen and wall of the urinary tract and renal parenchyma. EUTIs are quite uncommon, but combination of bilateral EPN and EC is extremely rare. We report a case of 57-year-old diabetic female diagnosed with septic shock due to concurrent bilateral EPN and EC. Patient was successfully treated with a drainage of pelvicalyceal systems and the bladder combined with a conservative approach. This unique case presents a possible association between glomerulonephritis and EUTI.

Radiation-Induced Recurrent Vesicovaginal Fistula-Treatment with Adjuvant Platelet-Rich Plasma Injection and Martius Flap Placement-Case Report and Review of Literature.

Vesicovaginal fistula is the non-physiological connection between the urinary bladder and vagina. This results in continuous urine leakage. In developed countries, the prevalence of this condition is low and affects (mainly) women with a history of gynaecological procedures or radiotherapy. The aim of this study was to present the therapeutic process of a patient with radiation-induced, recurrent vesicovaginal fistula. The thirty-eight-year-old patient underwent radical hysterectomy with follow-up radiotherapy due to cervical cancer. Five years after the therapy, she was diagnosed with vesicovaginal fistula. After two unsuccessful Latzko procedures and two adjuvant platelet-rich plasma injections, a third Latzko reconstructive surgery was performed with additional transposition of the Martius flap-with successful closure of the fistula.