Chaperone-mediated autophagy dysregulation during aging impairs hepatic fatty acid oxidation via accumulation of NCoR1.

OBJECTIVE: Alterations in lipid metabolism are associated with aging and age-related diseases. Chaperone-mediated autophagy (CMA) is a lysosome-dependent process involved in specific protein degradation. Heat shock cognate 71 kDa protein (Hsc70) recognizes cytosolic proteins with KFERQ motif and allows them to enter the lysosome via lysosome-associated membrane glycoprotein 2 isoform A (LAMP2A). CMA deficiency is associated with dysregulated lipid metabolism in the liver. In this study, we examined the effect of CMA on lipid metabolism in the aged liver. METHODS: 12-week-old and 88-week-old mice were employed to assess the effect of aging on hepatic CMA activity. We generated CMA-deficient mouse primary hepatocytes using siRNA for Lamp2a and liver-specific LAMP2A knockdown mice via adeno-associated viruses expressing short hairpin RNAs to investigate the influence of CMA on lipid metabolism. RESULTS: We noted aging-induced progression toward fatty liver and a decrease in LAMP2A levels in total protein and lysosomes. The expression of genes associated with fatty acid oxidation was markedly downregulated in the aged liver, as verified in CMA-deficient mouse primary hepatocytes. In addition, the aged liver accumulated nuclear receptor corepressor 1 (NCoR1), a negative regulator of peroxisome proliferator-activated receptor α (PPARα). We found that Hsc70 binds to NCoR1 via the KFERQ motif. Lamp2a siRNA treatment accumulated NCoR1 and decreased the fatty acid oxidation rate. Pharmacological activation of CMA by AR7 treatment increased LAMP2A expression, leading to NCoR1 degradation. A liver-specific LAMP2A knockdown via adeno-associated viruses expressing short hairpin RNAs caused NCoR1 accumulation, inactivated PPARα, downregulated the expression of fatty acid oxidation-related genes and significantly increased liver triglyceride levels. CONCLUSIONS: Our results elucidated a novel PPARα regulatory mechanism involving CMA-mediated NCoR1 degradation during aging. These findings demonstrate that CMA dysregulation is crucial for the progression of aging-related fatty liver diseases.

Epidemiology of mumps, mumps complications, and mumps orchitis in Korea using the National Health Insurance Service database.

PURPOSE: To analyze the presentation of mumps and mumps orchitis using the National Health Insurance Service Database (NHISD). MATERIALS AND METHODS: Using information from the NHISD representing all cases of mumps in Korea, data regarding mumps orchitis were analyzed. The International Classification of Diseases, Tenth Revision, and Clinical Modification codes were used for diagnosis. The incidence estimates of the number of mumps cases were analyzed using the Statistical Analysis System (SAS) software. RESULTS: Based on the NHISD, 199,186 people were diagnosed with mumps, and males accounted for 62.3% cases. Teen males accounted for 69,870 cases, the largest number of patients diagnosed with mumps. The annual incidence of mumps increased every year (poisson regression, hazard ratio [HR] 1.026, 95% confidence interval [CI] 1.024-1.027; p<0.025). The risk of mumps was lower in females than that in males (poisson regression, HR 0.594, 95% CI 0.589-0.599; p<0.001). Of the 199,186 patients diagnosed with mumps, 3,872 patients (1.9%) had related complications. Among the mumps complications, the most diagnosed complication was mumps orchitis, which was seen in 41.8% of the males. Mumps orchitis cases accounted for less than 1.5% of the patients with mumps in minors under the age of 20 years and was somewhat higher in 2009 and 2013-2015. CONCLUSIONS: Among the complications related to mumps, meningitis was most common in females, while orchitis was dominant in males. Mumps orchitis also shows periodic outbreaks but is particularly prevalent in adults, which suggests the potential need for additional vaccination against mumps.

Diagnostic performance of transperineal prostate targeted biopsy alone according to the PI-RADS score based on bi-parametric magnetic resonance imaging.

Purpose: To compare the diagnostic performance of transperineal targeted biopsy (TB) or systematic biopsy (SB) alone based on combined TB+SB and radical prostatectomy (RP) specimen for detecting prostate cancer (PCa) according to the prostate imaging reporting and data system (PI-RADS) score. Materials and methods: This study included 1077 men who underwent transperineal bi-parametric (bp) magnetic resonance imaging (MRI)-ultrasound (US) fusion TB+SB (bpMRI-US FTSB) between April 2019 and March 2022. To compare the performance of each modality (TB, SB, and combined TB+SB) with the RP specimen (as the standard) for detecting PCa and clinically significant PCa (csPCa), receiver operating characteristic (ROC) curves were plotted. Results: PCa was detected in 581 of 1077 men (53.9%) using bpMRI-US FTSB. CsPCa was detected in 383 of 1077 men (35.6%), 17 of 285 (6.0%) with PI-RADS 0 to 2, 35 of 277 (12.6%) with PI-RADS 3, 134 of 274 (48.9%) with PI-RADS 4, and 197 of 241 (81.7%) with PI-RADS 5, respectively. The additional diagnostic value of TB vs. SB compared to combined TB+SB for diagnosing csPCa were 4.3% vs. 3.2% (p=0.844), 20.4% vs 5.1% (p<0.001), and 20.3% vs. 0.7% (p<0.001) with PI-RADS 3, 4, and 5, respectively. TB alone showed no significant difference in diagnostic performance for csPCa with combined TB+SB based on RP specimens in patients with PI-RADS 5 (p=0.732). Conclusion: A need for addition of SB to TB in patients with PI-RADS 3 and 4 lesions, however, TB alone may be performed without affecting the management of patients with PI-RADS 5.

Corrigendum: The learning curve for robot-assisted radical cystectomy with total intracorporeal urinary diversion based on radical cystectomy pentafecta.

[This corrects the article DOI: 10.3389/fonc.2022.975444.].

A comparison between asymptomatic and symptomatic ureteral stones.

To investigate the characteristics and impact of asymptomatic (silent) ureteral stones on renal function and compare them with those of symptomatic stones. We retrospectively reviewed the medical records of 677 patients who underwent ureteroscopic lithotripsy or laparoscopic ureterolithotomy for ureteral stones between 2016 and 2020. Patients were divided into two groups according to the presence of recognizable symptoms. We investigated the characteristics and impact of silent stones on post-treatment renal function recovery and compared them with those of symptomatic stones. Among the 677 patients, 43 (6.4%) had asymptomatic ureteral stones, and 634 (93.6%) had symptomatic ureteral stones. Compared to symptomatic stones, asymptomatic stones were larger (11.4 mm vs. 9.6 mm, p = 0.003), more commonly present in the upper ureter (62.7% vs. 48.0%, p = 0.04), and more commonly associated with high-grade hydronephrosis (32.8% vs. 12.3%, p < 0.001); however, no difference in metabolite composition was observed between the two group of stone. In the asymptomatic stone group, the mean preoperative estimated glomerular filtration rate (eGFR) was 77.37 ± 23.54 mL/min/1.73 m2, and the mean postoperative eGFR indicated no significant improvement at 1 day, 7 days, 3 months, and 12 months (76.66 ± 21.45, 77.89 ± 20.87, 77.29 ± 22.22, and 76.71 ± 24.21 mL/min/1.73 m2, respectively; p = 0.567, p = 0.613, p = 0.924, and p = 0.202, respectively). In the symptomatic stone group, the mean preoperative eGFR was 78.17 ± 28.25 mL/min/1.73 m2; the mean postoperative eGFRs at 1 day, 7 days, 3 months, and 12 months were 81.24 ± 26.38, 86.16 ± 25.61, 89.11 ± 25.43, and 89.50 ± 26.01 mL/min/1.73 m2, respectively and demonstrated significant improvement (p = 0.002, p < 0.001, p < 0.001, and p < 0.001, respectively). Silent stones irreversibly impaired renal function, even after proper management. Therefore, active treatment strategies are required for all patients who are hesitant to receive treatment for silent stones because of their asymptomatic status to prevent permanent renal impairment.

Comparison between biparametric and multiparametric MRI in predicting muscle invasion by bladder cancer based on the VI-RADS.

This study aimed to compare the diagnostic validity of biparametric magnetic resonance imaging (bpMRI) with that of multiparametric MRI (mpMRI) based on the Vesicle Imaging-Reporting and Data System (VI-RADS) in predicting muscle invasion by bladder cancer (BCa). We retrospectively examined 357 patients with an initial diagnosis of BCa who underwent preoperative MRI; 257 and 100 patients underwent mpMRI and bpMRI, respectively. Two urogenital radiologists evaluated all bpMRI and mpMRI scans using VI-RADS, and the diagnostic validity of VI-RADS for predicting muscle invasion by BCa was analyzed based on histopathology of the first and/or second transurethral resection of bladder tumors and radical cystectomy. Receiver operating characteristic (ROC) curves were plotted with the calculation of area under the curves (AUCs), and the level of significance was P < 0.05. Both groups showed optimal performance with a VI-RADS score ≥ 3. BpMRI showed comparable diagnostic performance to mpMRI (reader 1: AUC, 0.903 [0.827-0.954] vs. 0.935 [0.884-0.968], p = 0.510; and reader 2: AUC, 0.901 [0.814-0.945] vs. 0.915 [0.874-0.946]; p = 0.655). The inter-reader agreement between both readers was excellent (Cohen's kappa value = 0.942 and 0.905 for bpMRI and mpMRI, respectively). This comparative study suggests that bpMRI has comparable diagnostic performance to mpMRI and may be an alternative option to predict muscle invasion by BCa.

The learning curve for robot-assisted radical cystectomy with total intracorporeal urinary diversion based on radical cystectomy pentafecta.

Objective: To analyze the learning curve for robot- assisted radical cystectomy (RARC) with total intracorporeal urinary diversion (ICUD) in terms of both time efficiency and quality of surgery based on radical cystectomy (RC)-pentafecta. Patients and methods: We identified 203 consecutive patients who underwent RARC with ICUD of the ileal conduit (IC, 85) and orthotopic neobladder (ONB, 118) performed by a single surgeon between 2011 and 2021. We grouped ten consecutive patients into time-associated blocks according to the operation order. Process efficiency and operation quality were measured based on the surgeon's console time and attainment/score sum of RC-pentafecta. The overcoming point of the learning curve was defined graphically and statistically. Results: The mean follow-up period was 44.5 ± 30.7 months. Of the 203 patients, 109 (53.7%) attained the five criteria of RC-pentafecta (ONB vs IC, 50.6% vs. 55.9%, p = 0.35). The attainment rate and sum of the RC-pentafecta score of the third group were not significantly different from those of all patients (40.0% vs. 53.7%, p = 0.369, 4.00 ± 1.05 vs. 4.41 ± 0.75, p = 0.137, respectively), and the proficiency in operation quality was satisfactory in the third group. The console times continually improved and stabilized after the 140th case (IC, 60; ONB, 80), and the attainment rate and sum of the RC-pentafecta were significantly different between before and after the 140th case (p<0.001). Conclusion: A single surgeon's learning curve for RARC with ICUD and pelvic lymph node dissection (PLND) showed an acceptable level of proficiency after 30 consecutive cases in terms of the operation quality. However, for an expert surgeon, 140 cases were required to reach a plateau in time efficiency and second leap with the RC-pentafecta. RARC with ICUD and PLND can be performed safely without compromising functional outcomes and complications through sharing and transmission of standardized techniques.

Modified apical dissection improves early continence in robot-assisted laparoscopic radical prostatectomy: Comparative study between modified apical dissection and anterior suspension stitch.

PURPOSE: Recently, the modified apical dissection (MAD) technique in robot-assisted laparoscopic radical prostatectomy (RARP) has shown excellent functional outcomes but has never been rigorously validated at various institutions. This study aimed to evaluate the effect of MAD on early continence and potency compared with the anterior suspension stitch (SS) technique. MATERIALS AND METHODS: A total of 100 patients who underwent RARP with SS and 100 who underwent RARP with MAD by a single surgeon were propensity score matched and retrospectively compared for continence and potency recovery at 1 week and 1, 3, 6, 9, and 12 months. RESULTS: Continence was reached in 20.6%, 33.3%, 67.2%, 74.1%, 81.1%, and 83.0% of patients in the SS group, compared with 49.2%, 73.3%, 86.8%, 96.6%, 100.0%, and 100.0% in the MAD group at postoperative 1 week and 1, 3, 6, 9, and 12 months, respectively. In the SS group, potency rates were 0.0%, 20.0%, 50.0%, 66.7%, 75.0%, and 83.3%; in the MAD group, the rates were 50.0%, 90.0%, 88.9%, 100.0%, 100.0%, and 100.0%. Recovery of continence was higher in the MAD group within the first 6 months (p=0.005, <0.010, 0.041, 0.016 at 1 week, 1, 3, and 6 months). There were no significant differences in potency recovery rates between the two groups (all p≥0.05). CONCLUSIONS: The MAD technique results in earlier recovery of continence compared with the SS technique.

Frozen section utilization to omit systematic biopsy in diagnosing high risk prostate cancer.

The current guidelines for targeted prostate biopsy recommend an additional systematic biopsy regardless of clinical risk assessment. To evaluate frozen section biopsy utilization in targeted prostate biopsy to omit systematic biopsies in cases of positive frozen section results of patients with clinical features suggestive of high-risk prostate cancer. In this prospective, single-center study, we enrolled patients with a Prostate Imaging-Reporting and Data System (PI-RADS) 5 lesion on magnetic resonance imaging (MRI) with clinical evidence suggestive of high-risk prostate cancer (either an extracapsular extension or prostate-specific antigen level > 20 ng/ml). All patients underwent 2-4 core targeted biopsies utilizing frozen section biopsy with immediate results, allowing patients with a positive result to omit a systematic biopsy. In case of a negative result, additional systematic biopsies were performed. The primary endpoint was the detection rate of targeted biopsy. Patient demographics, clinical variables were analyzed using SPSS version 20. Sixty-six patients were enrolled in this study. Among them, 63 patients were diagnosed with cancer without the need for an additional systematic biopsy. Three patients were non-diagnostic with target biopsy alone. Hence an additional systematic biopsy was performed. Two of these patients were diagnosed with prostate cancer and one tested negative for cancer. In this report we looked into the necessity of taking a routine systematic biopsy in patients with high risk features of prostate cancer. We found that utilizing frozen section biopsy for targeted biopsy reduces unneccessary systematic biopsy in 97% of cases and still provides a means for systematic biopsy when targeted biopsy alone fails to make the diagnosis.

The effect of metabolic risk factors on urinary stone composition: An observational study.

To investigate how the risk factors of metabolic diseases affect urinary stone composition, particularly uric acid (UA) stones. Overall, 583 patients with data on urinary stone composition were retrospectively analyzed and classified into UA and nonUA stone formers according to the presence of the UA component. Various factors were compared between both groups. Participants were categorized according to age, glucose level, HbA1c level, and estimated glomerular filtration rate (eGFR) into subgroups, and the incidence of UA stone was compared. Overall, 137 UA stone formers (23.5%) and 446 nonUA stone formers (76.5%) were included. Mean age and male-to-female ratio were higher in the UA group than in the nonUA group. The rates of diabetes mellitus (DM), hypertension, chronic kidney disease, and coronary artery disease, all of which were associated with differences in urinary stone composition, were higher in the UA group than in the nonUA group. The UA group exhibited lower mean eGFR and higher glucose and HbA1c levels. Similarly, the UA group had higher mean UA levels and predictably lower urinary pH. In subgroup analysis, higher age, glucose level, HbA1c level, and lower eGFR were associated with an increased risk of UA stone formation. In the multivariate logistic regression analysis, the UA group showed a significantly higher age (P < .001), DM frequency (P = .049), and HbA1c level (P = .032), but significantly lower eGFR than the nonUA group (P < .001). Age and DM were independent risk factors for UA urolithiasis, implying a relationship between urinary stone composition and metabolic diseases. Additionally, renal function and HbA1c level were risk factors for UA stones.

Initial experience of single-port robot-assisted radical prostatectomy: A single surgeon's experience with technique description.

Background: With the implementation of da Vinci SP robot platform (Intuitive Surgical, Inc., Sunnyvale, CA, USA), we described our initial experience with the da Vinci SP robot platform (Intuitive Surgical, Inc., Sunnyvale, CA, USA) for single-port robotic-assisted radical prostatectomy (SP-RARP). Methods: This retrospective review included 30 consecutive patients with prostate biopsy-confirmed prostate cancer who underwent SP-RARP by a single surgeon between June and November 2020. SP-RARP was performed with a single-incision plus one method, in which the multichannel guide port was inserted directly with an additional assist port. We report our initial experience of perioperative and early functional outcomes. Results: The mean operative time (SD), console time (SD), and blood loss were 142.8 (15.1) min, 109.9 (15.7) min, and 133.0 (72.9) mL, respectively. No intraoperative complications or blood transfusions were reported. Of the 30 patients, 21 (70.0%), 7 (23.3%) and 2 (6.7%) had stage pT2, pT3a and pT3b disease, respectively. Positive surgical margins were reported in 5 of the 30 (16.7%) patients in the final pathology report, including 2 of 21 (9.5%) with stage pT2 and 3 of 9 (33.3%) with ≥ pT3. At 12 weeks after SP-RARP, 80.0% of patients had achieved continence and the potency was 46.7%; 8 of 11 (72.7%) had sexual health inventory for men (SHIM) scores ≥ 17 and 6 of 19 (31.6%) had SHIM scores < 17. Conclusions: The SP platform for radical prostatectomy was technically safe and feasible. After overcoming the technical learning curve, this platform may provide high-quality outcomes comparable to those of multi-port platforms.

Efficacy of Tadalafil in Penile Rehabilitation Started Before Nerve-Sparing Robot-Assisted Radical Prostatectomy: A Double-Blind Pilot Study.

BACKGROUND: Despite the widespread practice of nerve-sparing robot-assisted radical prostatectomy (nsRARP) for the treatment of localized prostate cancer (PCa), erectile dysfunction remains a significant sequela of radical prostatectomy. AIM: This study aimed to compare the efficacy of tadalafil 5 mg once daily for erectile function recovery in patients who underwent nsRARP according to the timing of rehabilitation initiation. METHODS: In this double-blind, prospective pilot study, a total of 41 patients who underwent nsRARP were randomly assigned into 2 groups according to the timing of rehabilitation initiation. In the preRARP group (n = 20), tadalafil was started 2 weeks before nsRARP, and in the postRARP group (n = 21), it was started 4 weeks after nsRARP. Erectile function recovery after nsRARP was defined as an International Index of Erectile Function (IIEF-5) score of ≥17. OUTCOMES: The measures of EF recovery were the changes in IIEF-5 score. RESULTS: The rate of erectile function recovery at 12-month follow-up was 80.0% and 71.4% in the preRARP and postRARP groups, respectively. The mean differences between baseline and postoperative IIEF-5 scores at 1-, 3-, 6-, and 12-month follow-up were -11.7 ± 3.2, -7.4 ± 3.2, -5.6 ± 1.5, and -4.1 ± 1.1 in the preRARP group and -14.7 ± 4.7, -12.0 ± 5.0, -9.7 ± 3.9, and -6.0 ± 3.1 in the postRARP group, respectively (1-month, P = .259; 3-months, P = .077; 6-months, P = .014; 12-months, P = .007). CLINICAL IMPLICATIONS: Preoperative tadalafil 5 mg once a day could be used effectively and safely as a strategy for penile rehabilitation after nsRARP. STRENGTHS AND LIMITATIONS: This study is the first prospective trial of penile rehabilitation with tadalafil 5 mg once a day prior to nsRARP. This is a pilot study with the limitations of a small sample; further and large-scale studies with multiple cohorts, such as an untreated control group and an early immediate rehabilitation group for EF recovery, are needed. CONCLUSION: This study suggests that preoperative penile rehabilitation using tadalafil may lead to better erectile function recovery than postoperative penile rehabilitation using tadalafil. Noh T, Shim JS, Kang SG, et al. Efficacy of Tadalafil in Penile Rehabilitation Started Before Nerve-Sparing Robot-Assisted Radical Prostatectomy: A Double-Blind Pilot Study. Sex Med 2022;10:100508.

Concordance between biparametric MRI, transperineal targeted plus systematic MRI-ultrasound fusion prostate biopsy, and radical prostatectomy pathology.

We aimed to confirm the reliability of the results of bi-parametric magnetic resolution imaging-ultrasound fusion targeted and systematic biopsies (bpMRI-US transperineal FTSB) compared to prostatectomy specimens. We retrospectively analyzed the records of 80 men who underwent bpMRI-US transperineal FTSB with region of interest (ROI) and subsequent robot-assisted radical prostatectomy. Changes in the grade group determined by MRI and biopsy versus surgical specimens were analyzed. Thirty-five patients with insignificant prostate cancer and 45 with significant cancer were diagnosed using bpMRI-US transperineal FTSB. Among those with insignificant PCa, 25 (71.4%) were upgraded to significant PCa in prostatectomy specimens: 9/12 (75.0%) with Prostate Imaging Reporting and Data System (PI-RADS) 3, 12/16 (75.0%) with PI-RADS 4, and 4/7 (57.1%) with PI-RADS 5. In the PI-RADS 3 group, the upgraded group showed higher prostate specific antigen (PSA) and PSA density (PSAD) than the concordance group; PSA 8.34(2.73) vs. 5.31(2.46) (p = 0.035) and PSAD 0.29(0.11) vs. 0.18(0.09) (p = 0.025). The results of prostate biopsy and prostatectomy specimens were inconsistent and underestimated in patients with MRI-visible lesions. Therefore, for precise and individualized treatment strategies for PCa with MRI-visible lesions, careful interpretation of biopsy result is required.

Toggling Technique Allows Retrograde Early Release to Facilitate Neurovascular Bundle Sparing During Robot-Assisted Radical Prostatectomy: A Propensity Score-Matching Study.

BACKGROUND: This study aimed to present the surgical facilitation of neurovascular bundle (NVB) sparing using the toggling technique (30° lens down/up switching) and to evaluate erectile dysfunction (ED) recovery after robot-assisted radical prostatectomy (RARP). METHODS: We assessed 144 patients (group with toggling, n = 72; group without toggling, n = 72) who underwent RARP with bilateral NVB sparing using propensity score matching. Inclusion criteria were ≥ 1 year follow-up and preoperative potency as per the Sexual Health Inventory for Men (SHIM) questionnaire (≥ 17 points). Recovery of ED after RARP was defined as return to baseline sexual function or self-assessment regarding successful intercourse. The subjective surgeon's nerve sparing (SNS) score and tunneling success rates were used to evaluate surgical facilitation. The recovery rate of ED between the groups was analyzed using Kaplan-Meier analysis. RESULTS: A better ED recovery trend was confirmed according to the SNS score (R² = 0.142, P = 0.004). In the analysis of NVB sparing ease, the toggling group showed higher SNS scores (on right/left side: P = 0.011 and < 0.001, respectively) and overall tunneling success rates (87% vs. 74%, P = 0.001) than the group without toggling. Overall, ED recovery rates were 82% (59/72) and 75% (54/72) in the groups with and without toggling, respectively, at the 1-year follow-up (P = 0.047), and the toggling group showed a faster ED recovery rate at 3 months (47% vs. 35%, P = 0.013). In a specific analysis of the potent cohort (< 60 years, bilateral full NVB spared, SHIM score ≥ 22), the ED recovery rate reached 87% (14/16) in the toggling group. CONCLUSION: The retrograde early release with the toggling technique improves the facilitation of NVB sparing, leading to improved ED recovery.

Single-Port vs Multiport Robot-Assisted Radical Prostatectomy: A Propensity Score Matching Comparative Study.

Purpose: The aim of this study was to compare the perioperative outcomes of patients who underwent single-port (SP) robot-assisted radical prostatectomy (RARP) (SP-RARP) with those who underwent multiport (MP) RARP (MP-RARP). Methods: Data on 40 consecutive patients who underwent SP-RARP between June 2020 and February 2021 and 129 who underwent MP-RARP between June 2019 and February 2021 were retrospectively reviewed. Using logistic regression, 31 patients who underwent SP-RARP were matched to 31 patients who underwent MP-RARP (1:1) based on propensity scores. The available perioperative parameters and outcomes were analyzed. Results: Compared with MP-RARP, SP-RARP showed no significant differences in perioperative parameters, including the console time (111.0 ± 15.7 vs 102.6 ± 18.8 minutes, p = 0.569), operation time (151.3 ± 15.1 vs 158.7 ± 20.3 minutes, p = 0.863), estimated blood loss (121.1 ± 64.7 vs 140.5 ± 90.5 mL, p = 0.638), positive surgical margins (19.4% in both groups), and 3-month continence (77.4% vs 83.9%, p = 0.563) and potency (45.2% vs 48.4%, p = 0.891) rates. Patients who underwent SP-RARP had lower proportions of complete nerve sparing than those who underwent MP-RARP (SP-RARP vs MP-RARP in subjective scores: 4.0 ± 0.8 vs 4.4 ± 0.9, p = 0.046; SP-RARP vs MP-RARP in pathologic score of 5, 35.5% vs 64.5%, p = 0.049; score of 4, 41.9% vs 19.4%, p = 0.038; score of 3, 19.4% vs 9.7%, p = 0.398; score of 2, 3.2% vs 0.0%, p = 0.365; and score of 1, 3.2% vs 3.2%, p = 0.932, respectively). Conclusions: SP-RARP showed lower nerve-sparing scores than MP-RARP. The present study suggests that SP-RARP is safe and feasible with short-term functional outcomes comparable to those of MP-RARP.

Effects of ß3-adrenoceptor agonist on acute urinary retention in a rat model.

PURPOSE: To investigate the protective effect of mirabegron on bladder dysfunction in an acute urinary retention rat model. MATERIALS AND METHODS: Thirty-six 16-week Sprague-Dawley rats were assigned to the mirabegron and normal saline (N/S) groups. Each group of eighteen was divided into sub-groups of 6 for 30 min, 2 h, and 24 h. They were administered mirabegron (10 mg/kg) and N/S daily for 4 weeks, respectively. Mirabegron and N/S groups were divided into sub-groups of 6 rats for 30 min, 2 h, and 24 h. The changes in bladder blood flow were measured using laser Doppler (moorVMS-LDF2). Histopathological examination of the bladder and nitric oxide (NO) measurement were performed. RESULT: During the urinary retention phase in the mirabegron group, it showed higher and rapider recovery of blood flow; the lowest at 19.5% ± 3.68% at 3 min, a significant recovery from the lowest value as 23.7 ± 3.4% at 10 min, than that in the N/S group; 15.1 ± 1.84% at 5 min, 23.7 ± 3.4% at 20 min, respectively (P < 0.05). At 30 min, 120 min, and 24 h after reperfusion, the recovery of blood flow in the mirabegron group was significantly higher than that in the N/S group (mirabegron: 41.1 ± 1.7%, 59.9 ± 7.2%, and 89.7 ± 4.4%, N/S: 31.3 ± 2.1%, 47.3 ± 4.5%, 83.9 ± 3.6%, respectively (P < 0.05)). NO levels tended to be higher in the mirabegron group; however, the difference was not statistically significant. Histological examination revealed that the mirabegron group showed recovery close to normal tissue after 24 h. CONCLUSIONS: In an acute urinary retention rat model, mirabegron maintained and restored higher bladder blood flow, resulting in protective and recovery effect after acute urinary retention.

A Predictive Model Based on Bi-parametric Magnetic Resonance Imaging and Clinical Parameters for Clinically Significant Prostate Cancer in the Korean Population.

PURPOSE: This study aimed to develop and validate a predictive model for the assessment of clinically significant prostate cancer (csPCa) in men, prior to prostate biopsies, based on bi-parametric magnetic resonance imaging (bpMRI) and clinical parameters. MATERIALS AND METHODS: We retrospectively analyzed 300 men with clinical suspicion of prostate cancer (prostate-specific antigen [PSA] ≥ 4.0 ng/mL and/or abnormal findings in a digital rectal examination), who underwent bpMRI-ultrasound fusion transperineal targeted and systematic biopsies in the same session, at a Korean university hospital. Predictive models, based on Prostate Imaging Reporting and Data Systems scores of bpMRI and clinical parameters, were developed to detect csPCa (intermediate/high grade [Gleason score ≥ 3+4]) and compared by analyzing the areas under the curves and decision curves. RESULTS: A predictive model defined by the combination of bpMRI and clinical parameters (age, PSA density) showed high discriminatory power (area under the curve, 0.861) and resulted in a significant net benefit on decision curve analysis. Applying a probability threshold of 7.5%, 21.6% of men could avoid unnecessary prostate biopsy, while only 1.0% of significant prostate cancers were missed. CONCLUSION: This predictive model provided a reliable and measurable means of risk stratification of csPCa, with high discriminatory power and great net benefit. It could be a useful tool for clinical decision-making prior to prostate biopsies.

Increased incidence of bladder cancer with metabolically unhealthy status: analysis from the National Health Checkup database in Korea.

We assessed the association between metabolic health status and the incidence of bladder cancer using nationally representative data from the National Health Insurance System and National Health Checkups (NHC) databases in South Korea. Data for 11,781,768 men who participated in the NHC between 2009 and 2012 were analysed. The normal-weight and physically obese categories were defined as body mass indexes (BMI) < 25 and ≥25 kg/m2, respectively. Metabolically obese was defined as the presence of ≥3 components of metabolic syndrome. The participants were stratified into metabolically healthy, normal-weight (MHNW); metabolically obese, normal-weight (MONW); metabolically healthy, obese (MHO); metabolically obese, obese (MOO). Multivariate-adjusted Cox regression analysis was conducted to examine the association between metabolic health status and the incidence of bladder cancer. The study participants included 17,777 men newly registered with bladder cancer. Analysis according to metabolic health status classification revealed a higher multivariable-adjusted hazard ratio in the MOO, MONW group than in the MHO group (1.307 [95% CI: 1.258-1.358], 1.183 [95% CI: 1.137-1.231] and 1.066 [95% CI: 1.017-1.119], respectively; hazard ratios given relative to MHNW group) We found an association between metabolic health status and the incidence of bladder cancer, with an increasing risk according to the number of metabolic health status components.

Diagnostic Performance of the Prostate Cancer Antigen 3 Test in Prostate Cancer: Systematic Review and Meta-analysis.

PURPOSE: To explore the diagnostic accuracy of prostate cancer antigen 3 (PCA3) test for the diagnosis of prostate cancer in this systematic review and meta-analysis. PATIENTS AND METHODS: A systematic literature search of Medline, Embase, and Cochrane Library databases up to October 2019 was performed. The sensitivity, specificity, and diagnostic odds ratio with 95% confidence intervals (CIs) were calculated. The summary receiver operator characteristic graph came from individual studies. We also conducted metaregression analysis to identify the moderated factors. RESULTS: Across 54 studies (17,575 patients), the pooled sensitivity, specificity, and diagnostic odds ratio of PCA3 were 0.71 (95% CI, 0.67-0.74), 0.68 (95% CI, 0.63-0.74), and 5.28 (95% CI, 4.28-6.51), respectively. The area under the summary receiver operator characteristic curve was 0.75 (95% CI, 0.71-0.79). CONCLUSION: Pooled data indicated that the PCA3 test had moderate sensitivity and specificity in the diagnosis of prostate cancer. PCA3 could be used as a noninvasive method for the diagnosis of prostate cancer.