Neoadjuvant Chemotherapy for Muscle-invasive Bladder Cancer in a Lebanese experience: in all aspects.

BACKGROUND: Bladder cancer (BC) is the most common malignant tumor of the urinary tract and the 11th most frequent cancer worldwide. BC is the 2nd most common cancer in Lebanon in men and women. MATERIALS AND METHODS: After searching for patients records in the pathology and oncology database, we identified those who underwent a cystectomy between 2017 and 2019 in our hospital, Hotel Dieu de France - Beirut. We selected for the study the patients who have undergone a cystectomy for MIBC. We excluded patients who initially had a pelvic tumor, or a prostate cancer invading the bladder, and patients with absent medical record from the study. We also noted the gender of the patients, if they are smokers and the number of pack years at the time of diagnosis, as well as their age, the histological type of the tumor, its stage according to the TNM classification and its grade. We also noted whether neoadjuvant chemotherapy was taken by the study 's subjects. RESULTS: The total number of patients who met the inclusion and exclusion criteria was 38. The median age of the population was 66 (± 10) years and the median number of pack years at diagnosis was 60 (± 36). 79% of study 's patients were males and 21% were females. Regarding the tumor 's histological type, the urothelial type predominated with 92% while the remaining 8% were of the squamous type. Regarding treatment modalities, only 20% of patients in the study received neoadjuvant chemotherapy before cystectomy. 80% of patients underwent a cystectomy directly without neoadjuvant and/or adjuvant chemotherapy. No patient received adjuvant chemotherapy. Among the 7 patients, 2 patients (29%) presented a pathological complete response (pCR; equivalent to pT0N0M0). 14% had a pT3 stage post-neoadjuvant chemotherapy and 43% had a pT4 stage. DISCUSSION AND CONCLUSIONS: We can note a reluctance of urologists at our institution to prescribe neoadjuvant chemotherapy. It would therefore be interesting to extend the study to the national level with a larger number of patients, as well as to evaluate survival in patients who received neoadjuvant chemotherapy, especially in those presenting a pCR. Our study can serve as a point of change in the practice of urologists in Lebanon regarding BC.

Pure Laparoscopic Donor Nephrectomy: A Single Institution Experience From a Middle Eastern Country.

BACKGROUND: Laparoscopic live donor nephrectomy (LLDN) is the most adopted technique for kidney transplantation. Several obstacles preclude brain-dead organ transplantation in the Middle East, going from social and cultural barriers to economical and structural difficulties. To our knowledge, this is the first study to report Lebanese experience with pure LLDN, and kidney transplantation. METHODS: We included 120 cases of pure LLDN performed at our center. Demographic, perioperative, and immediate postoperative data were analyzed. Surgical particularities of the technique are described. RESULTS: The reported laparoscopic technique allowed for minimal perioperative morbidity, with an overall complication rate of 3%. Operative time averaged 146 minutes and warm ischemia time averaged 4 minutes. Mean hospital stay was 3 ± 1 days. Postoperative hemoglobin and creatinine showed a mean absolute variation of 0.09 ± 0.06 g/dL for hemoglobin and 0.51 ± 015 µmoles/L increase for creatinine. No Clavien-Dindo III-V complications were recorded. CONCLUSIONS: Strict adherence to the reproducible pure LLDN technique allowed for the performance of almost 45 cases per year with minimal morbidity and results comparable to similar series.

Sexual dysfunction due to pudendal neuralgia: a systematic review.

BACKGROUND: The pudendal nerve is considered as the main nerve of sexuality. Pudendal neuralgia is an underdiagnosed disease in clinical practice. The aim of this systematic review is to highlight the role of pudendal neuralgia on sexual dysfunction in both sexes. METHODS: A PubMed search was performed using the following keywords: "Pudendal" AND "Sexual dysfunction" or "Erectile dysfunction" or "Ejaculation" or "Persistent sexual arousal" or "Dyspareunia" or "Vulvodynia". The search involved patients having sexual dysfunction due to pudendal neuralgia. Treatment received was also reported. RESULTS: Five case series, seven cohort studies, two pilot studies, and three randomized clinical trials were included in this systematic review. Pudendal nerve and/or artery entrapment, or pudendal neuralgia, is a reversible cause of multiple sexual dysfunctions. Interventions such as anesthetic injections, neurolysis, and decompression are reported as potential treatment modalities. There are no studies describing the role of pudendal canal syndrome in the pathophysiology or treatment of delayed ejaculation or penile shortening. DISCUSSION: Pudendal neuralgia is an underestimated yet important cause of persistent genital arousal, erectile dysfunction (ED), premature ejaculation (PE), ejaculation pain, and vulvodynia. Physicians should be aware of this entity and examine the pudendal canal in such patients before concluding an idiopathic cause of sexual dysfunction.

Laparoscopic transperitoneal pudendal nerve and artery release for pudendal entrapment syndrome.

INTRODUCTION: Pudendal nerve and artery entrapment is an underdiagnosed pathology responsible of several urinary, sexual and anorectal complaints. The aim of our study was to evaluate safety and feasibility of laparoscopic transperitoneal pudendal nerve and artery release in a large retrospective cohort of patients with pudendal nerve entrapment syndrome with both a short and long-term follow-up. Technical details and outcomes are also reported. METHODS: A series of 235 patients with pudendal syndrome underwent laparoscopic transperitoneal pudendal canal release between June 2015 and February 2020. Operative data were recorded prospectively for all patients. A complete history, pain visual analog scale (VAS) for perineodynia, and three scores evaluating the main symptoms (USP, IIEF-5, PAC-SYM) were obtained before and at least 24 months after surgery for 32 patients only. Post-operative complications were also evaluated using Clavien-Dindo classification at regular interval. RESULTS: The mean operating time per side was 33.9 ± 6.8 min and the average hospital stay was 1.9 ± 0.3 days. Blood loss was 20 cc ± 10 cc with no patients needing transfusion. The only significant per-operative complication was hemorrhage (600 ml) in one patient induced by a pudendal artery laceration, successfully treated by laparoscopic suturing. Post-operative complications were noted in 18.7% of patients with no serious Clavien-Dindo complications. Perineodynia VAS dropped from 6.8 ± 0.9 to 2.2 ± 1.8 after surgery (p < 0.001). Mean IIEF-5 scores significantly improved one month after the surgery (15.2 vs 19.3, p = 0.036). Mean USP scores significantly improved for the dysuria domain (4.2 vs 1.6, p = 0.021) but not for stress urinary incontinence (3.9 vs 4.1, p = 0.082) or overactive bladder symptoms (14.1 vs 13.8, p = 0.079). Mean PAC-SYM scores significantly improved after the procedure (1.8 vs 1.1, p < 0.001). CONCLUSION: A complete laparoscopic pudendal nerve and artery release, from the sciatic spine through the Alcock's canal, is a fast and safe surgery with promising functional results. A large prospective trial is needed to validate such an approach.

Early penile-only metastasis of urothelial bladder carcinoma.

Penile metastasis rarely occurs as a unique and early distant recurrence of urothelial bladder carcinoma. A 77-year-old male underwent a radical cystoprostatecomy for a pT3a urothelial bladder cancer. Preoperative imaging workup concluded to a disease confined to the bladder. The patient consulted 5 months later for a penile induration. Computed tomography imaging revealed a suspicious penile nodule with no other nodal or visceral lesion. Total penectomy after a confirmatory biopsy confirmed the infiltration of the corpora cavernosa, the corpus spongiosum and the urethra by a urothelial metastasis of bladder cancer. Distant recurrences after radical surgery for locally advanced bladder cancer may occur as a unique early metastasis located to the penis.

Prospective Multicenter Open-Label One-Arm Trial Investigating a Pumpkin Seed, Isoflavonoids, and Cranberry Mix in Lower Urinary Tract Symptoms/Benign Prostatic Hyperplasia: A Pilot Study.

Phytotherapy for lower urinary tract symptoms (LUTSs) due to benign prostate hyperplasia (BPH) is progressively demanded by patients and trusted by physicians. The aim was to assess the efficacy of a mix of pumpkin seed extract, soy germ isoflavonoids, and cranberry (Novex®) in the management of mild to moderate LUTS in BPH patients. Male patients aged ≥40 years, who had had mild to moderate LUTS for >6 months at screening, with no previous therapy or who are still symptomatic despite current use of alpha-blockers, were recruited. Exclusion criteria were an IPSS >19 and an age >80 years. The mixed compound was administered orally, daily, for 3 months. Patients were evaluated by means of IPSS, urological quality of life (uQoL) index, and International Index of Erectile Function (IIEF-5) at 3 visits: baseline (visit 1), 30 days (visit 2), and 90 days after treatment (visit 3). Among 163 screened patients, 128 patients (61.8 ± 9.9 years) were recruited. IPSS improved from 15 (Q1 : 12-Q3 : 17) in visit 1, to 11 (Q1 : 8-Q3 : 14) in visit 2, and to 9 (Q1 : 6-Q3 : 12) in visit 3 (p < 0.001). uQoL improved from 4 (3-4) in visit 1, to 3 (2-3) in visit 2, and to 2 (1-2) in visit 3 (p < 0.001). The patients had an IIEF-5 score of 15 (12-18.7) in visit 1, 15 (12-18) in visit 2, and 17 (13-19) in visit 3 (p=0.99 visits 1 vs. 2, p=0.004 visits 2 vs. 3, and p=0.001 visits 1 vs. 3). Treating mild to moderate LUTS/BPH patients with Novex® might therefore relieve symptoms, improve the quality of life, and have a mild beneficial effect on erectile function.

Bladder stone following intravesical migration of surgical clip five years after radical prostatectomy.

Bladder stone formation on iatrogenic foreign bodies following radical prostatectomy is an uncommon postoperative complication. We present the case of a bladder lithiasis that developed around a metallic clip five years after radical retropubic prostatectomy.

Arcanobacterium pyogenes and encrusted pyelitis.

AIM: Trueperella pyogenes is known to affect cattle, but was never isolated as a cause of human urinary tract infections. CLINICAL CASE: A 69-year-old male presented for recurring low urinary tract symptoms after a 20-day ciprofloxacin regimen for prostatitis. He previously underwent open right nephrolithotomy and left ureterovesical junction reimplantation for an iatrogenic distal ureteral stricture. Computed tomography showed spontaneous cortical calcifications; renoscopy was performed and deep cultures from the pelvis were taken; culture on chocolate agar revealed T. pyogenes. Intravenous teicoplanin for 3 weeks resulted in resolution of low urinary tract symptoms with regression of bladder and ureteral thickening. CONCLUSION: T. pyogenes can cause encrusted pyelitis in humans especially evoked in a context of persisting or recurring urinary tract infections.