The Impact of Physical Activity on the Outcomes of Active Surveillance in Prostate Cancer Patients: A Scoping Review.

INTRODUCTION: Active surveillance has emerged as a valid therapeutic option in patients with low-risk prostate cancer, allowing for the deferral of definitive treatment until the time of possible disease progression. Although it is known that physical activity plays a protective role in the onset and progression of this tumor, its impact on patients with low-risk disease who are managed with active surveillance remains unclear. Our scoping review aims to summarize the existing evidence on this subject. EVIDENCE ACQUISITION: On 9 April 2023, a systematic search was conducted using the PubMed and Scopus databases. The search employed the combination of the following terms: ("prostate cancer" OR "prostate tumor") AND ("active surveillance") AND ("physical activity" OR "physical exercise" OR "physical intensive activity" OR "intensive exercise") AND ("lifestyle"). Out of the 506 identified articles, 9 were used for the present scoping review, and their results were reported according to the PRISMA-ScR statement. EVIDENCE SYNTHESIS: We discovered a lack of uniformity in the assessment of PA and its stratification by intensity. There was no consensus regarding what constitutes cancer progression in patients choosing expectant management. In terms of the impact of PA on AS outcomes, conflicting results were reported: some authors found no correlation, while others (six of total studies included) revealed that active men experience smaller increases in PSA levels compared to their sedentary counterparts. Additionally, higher levels of exercise were associated with a significantly reduced risk of PCa reclassification. CONCLUSION: Due to the heterogeneity of the methodologies used in the available studies and the conflicting results reported, it is not possible to draw definitive conclusions concerning the role physical activity may play in the risk of prostate cancer progression in men managed with active surveillance.

Renal functional and cardiovascular outcomes of partial nephrectomy versus radical nephrectomy for renal tumors: a systematic review and meta-analysis.

This systematic review and meta-analysis aimed to evaluate the postoperative renal and cardiovascular outcomes of partial nephrectomy (PN) versus radical nephrectomy (RN) for the treatment of renal carcinoma. A systematic literature search was performed on scientific databases including Scopus, Web of Science, MEDLINE, and EMBASE from their inception to September 2021. Studies comparing renal and cardiovascular outcomes between PN and RN in patients with renal cancer were included. The generic inverse variance method with random-effects models was used to determine the pooled hazard ratios and odds ratio for each outcome. Quality Assessment for observational studies was guided by the New-Castle Ottawa Scale. Overall, a total of 31 studies (n=51,866) reported renal outcomes, while 11 studies (n= 101,678) reported cardiovascular outcomes. When compared to PN, RN had a higher rate of new-onset postoperative EGFR <60 mL/min/1.73 m2 (HR 3.39; CI 2.45 - 4.70; I2=93%; P=<0.00001) and EGFR <45 mL/min/1.73 m2 (HR 4.70; CI 2.26 - 9.79; I2=98%; P=<0.0001). No difference was observed in new-onset advanced kidney disease and end-stage renal disease. A 19% reduction in cardiovascular events was observed in the PN group (HR 0.81; CI 0.70 - 0.93, P=0.002). No protective effect of PN was observed in new-onset or worsening hypertension (HR 0.85; CI 0.64 - 1.14, P=0.28) nor myocardial infarction (HR 0.86; CI 0.71 - 1.04, P=0.13). PN was associated with a decreased risk of postoperative early-stage CKD and cardiovascular events compared with RN. However, no benefit of PN over RN was observed in advanced CKD, new-onset or worsening hypertension, myocardial infarction, and cardiovascular mortality.

Variations in maximum urethral closure pressure in stress urinary incontinence.

INTRODUCTION: Urethral Pressure Profilometry (UPP) assesses the urethral closing function. The literature is scarce regarding the change in the Maximum Urethral Closure Pressure (MUCP) values during Pelvic Floor Muscle Contraction (PFMC). The objective was to evaluate the change in the urethral closure pressure (UCP) at rest and during a PFMC in patients with Stress Urinary Incontinence. MATERIALS AND METHODS: This was a descriptive, comparative, and observational study. The study comprised female patients with either Pure Stress Urinary Incontinence (PSUI) or Complicated Stress Urinary Incontinence (CSUI). The urethral closure pressure was measured at rest and during PFMC using urethral profilometry. The effect of the pelvic musculature contraction was evaluated by comparing the changes in the indicated values. RESULTS: Patients with pure stress urinary incontinence had a mean age of 57.18 ± 10.74 years (p = 0.12), while those with complicated stress urinary incontinence had a mean age of 58.26 ± 14.39 years (p = 0.12). UCP in PSUI was 58.58 ± 26.96 cmH2O at rest compared to 61.26 ± 34.17 cmH2O in CSUI (p = 0.59), with MUCP increasing to 73.93 ± 31.51 and 79.71 ± 36.26 cmH2O during PFMC (p = 0.001). Between the two measurements, there was an average rise of 26.2% (range 26.2%-32.59%) (p = 0.001). MUCP during PFM contractions was found to be inversely associated to age (r = -0.28, p = 0.007). CONCLUSION: The urethral pressure profile is the same for all types of urinary stress incontinence, whether simple or complicated. When comparing UCP at rest to MUCP during PFMC, there is at least a functional 25% increase.

Predictive factors for nephrectomy in renal trauma; assessment of a 6-point score.

PURPOSE: To evaluate predictive and associated risk factors for nephrectomy in renal trauma and assess a 6-point score for surgical decision-making. PATIENTS AND METHODS: This multicenter, retrospective, and observational study assessed 247 subjects with blunt or penetrating kidney trauma. Kidney injuries were classified according to the American Association for the Surgery of Trauma (AAST) Injury Scoring Scale. Renal trauma was classified as "low-grade" (Grades I-III), Grade IV, and Grade V. Subjects were compared according to conservative treatment (CTrt.) or nephrectomy. Predictive factors were evaluated with a multiple regression model. A 6-point score was evaluated with a ROC analysis. RESULTS: Patients requiring nephrectomy had a lower mean arterial pressure MAP compared to CTrt, 64.71 mmHg (SD ± 10.26) and 73.86 (SD ± 12.42), respectively (p = < 0.001). A response to IV solutions was observed in 90.2% of patients undergoing CTrt. (p = < 0.001, OR = 0.211, 95%CI = 0.101-0.442). Blood lactate ≥ 4 mmol/L was associated with nephrectomy (p = < 0.001). A hematoma ≥ 25 mm was observed in 41.5% of patients undergoing nephrectomy compared to 20.1% of CTrt. (p = 0.004, OR = 9.29, 95% CI = 1.37-5.58). A logistic regression analysis (p = < 0.001) showed that blood lactate ≥ 4 mmol/L (p = 0.043), an inadequate response to IV solutions (p = 0.041) and renal trauma grade IV-V (p = < 0.001), predicted nephrectomy. A 6-point score with a cut-off value ≥ 3 points showed 83% sensitivity and 87% specificity for nephrectomy with an AUC of 89.9% (p = < 0.001). CONCLUSIONS: An inadequate response to IV solutions, a lactate level ≥ 4 mmol/L, and grade IV-V renal trauma predict nephrectomy. A score ≥ 3 points showed a good performance in this population.

Perioperative predictors for complications in patients with Xanthogranulomatous Pyelonephritis treated with nephrectomy.

INTRODUCTION: Xanthogranulomatous pyelonephritis is an inflammatory disease characterized by chronic obstruction and infection. This pathology is a life-threatening condition when surgical treatment is carried out. We decided to retrospectively evaluate whether there were perioperative factors that predict complications in patients who undergo nephrectomy. METHODS: We reviewed all nephrectomies done in the period of 2013-2018, in a tertiary referral Hospital with the histopathological diagnosis of Xanthogranulomatous Pyelonephritis. RESULTS: The presence of renal abscess at admission was observed as a risk factor associated with perioperative complications (p = 0.002), presence of abscess was observed in 47.4% of subjects without complications compared to 89.3% of the perioperative complication group. Higher rates of blood transfusion requirement were observed in the perioperative complication group, 89.3% compared to 68.4% (p = 0.029), furthermore, perioperative bleeding was slightly greater in the complication group compared to its counterpart, 700 mL, and 600 mL, respectively (p = 0.01). CONCLUSIONS: Anemia and the presence of abscess were important perioperative factors that predict perioperative complications.

A Perspective of the Urinary Microbiome in Lower Urinary Tract Infections - A Review.

PURPOSE OF REVIEW: Greater availability of sequencing methods has broadened the knowledge of the urinary microbiome in an environment previously believed to be sterile. This review discusses internal and external influences that promote either a balance or a dysbiosis of the urinary tract and the future perspectives in understanding lower urinary tract infections. RECENT FINDINGS: Efforts have been made to identify a "core" urinary microbiome in which Firmicutes and Bacteroidetes account for most of the bacterial representations. A shift to a Proteobacteria-dominant representation shapes the fingerprint of the infectious urinary microbiome; furthermore, the virome and the mycobiome are important modulators of the urinary microbiome, which have been recently explored to determine their role in the health-disease process of the lower urinary tract. A disturbance of bacterial representation and diversity triggers a transition from health to disease; conversely, a functional cooperative interplay between the host and microbiome allows for basic metabolic and immune functions to take place.

Risk factors associated with urethral stricture recurrence after end-to-end urethroplasty and buccal mucosal graft urethroplasty.

OBJECTIVES: (1) Assess risk factors associated with urethral stricture recurrence (USR). (2) Assess urethral stricture recurrence after end-to-end urethroplasty (EE) and buccal mucosal graft urethroplasty (BMG). SUBJECTS AND METHODS: A total of 29 males with urethral stricture who underwent either an end-to-end urethroplasty or a buccal mucosal graft urethroplasty were included in this study and followed for 18 months. The association between risk factors and stricture recurrence was assessed. RESULTS: Overall mean patient age was 51.69 ± 14.22 years, time to recurrence was 3 months (IQR: 1-6.25), and stricture length was 2.57 ± 1.30 cm. Important risk factors for USR were stricture length ⩾ 2 cm (p = 0.024), older age (p = 0.042), BMI > 25 kg/m2 (p = 0.021), Qmax after catheter removal <15 ml/s (χ2 = 14.87 p ⩽ <0.001) and previous urethral procedures adjusted for re-do BMG urethroplasty (χ2 = 6.10, p = 0.021). End-to-end urethroplasty showed less USR than BMG, however, these differences were not statistically significant (41.6% vs 22.2%, respectively, p ⩾ 0.05). CONCLUSIONS: Stricture length, age, BMI, and previous urethral procedures predict USR, furthermore, an initial Qmax after catheter removal is an objective measure predictive of USR. There's no difference in USR rate between BMG and EE urethroplasties.

Alto porcentaje de ausencia de reflejo bulbocavernoso en pacientes neurológicamente sanos con disfunción vesical / High Percentage of Absence of Bulbocavernosus Reflex in Neurologically-Healthy Patients with Bladder Dysfunction

Introducción y Objetivo El reflejo bulbocavernoso (RBCV) se ha observado ausente incluso en pacientes neurológicamente sanos. Los trastornos funcionales del piso pélvico deben incluir su evaluación. Nuestro objetivo primario fue evaluar la prevalencia de ausencia de RBCV en pacientes sanos. El objetivo secundario fue observar la afectación del RBCV en presencia de otras comorbilidades cómo enfermedad neurológica y diabetes mellitus tipo 2. Métodos Estudio descriptivo y retrospectivo, en el que se revisaron mil expedientes clínicos de pacientes sometidos a estudio urodinámico a quienes se les realizó exploración mecánica del RBCV como parte de una exploración rutinaria. Se realizó estadística descriptiva para las variables cuantitativas y cualitativas utilizando la prueba tde Student y la de chi cuadrado, respectivamente. Se consideraron estadísticamente significativos valores de p < 0,05. Resultados La muestra tenía una media de edad de 59,84 años (desviación estándar [DE]: ± 14,13 años), y contenía 36,19% de mujeres y 21,13% de hombres sin enfermedad neurológica y RBCV ausente. Se observó mayor ausencia de RBCV en pacientes con presencia de enfermedad neurológica en comparación con pacientes neurológicamente sanos: 21,6% versus 10,6%, respectivamente (p < 0,0001); además, se observó una ausencia importante de RBCV en presencia de diabetes mellitus en comparación con pacientes no diabéticos: 30.8% versus 18.8%, respectivamente (p < 0,0001). No se observaron diferencias al comparar grupos con respecto a disfunción vesical. Conclusión La ausencia de RBCV no es exclusiva de una enfermedad neurológica con repercusión de síntomas del tracto urinario inferior, y la proporción de pacientes neurológicamente sanos con ausencia de RBCV no es despreciable. No se encontró una diferencia significativa en los grupos con ausencia de RBCV con respecto a disfunción vesical.

Introduction and Objective Absence of the bulbocavernosus reflex (BCVR) has been observed even in neurologically-healthy subjects. Functional disorders of the pelvic floor should include its assessment. The primary objective of the present study was to evaluate the absence of BCVR in healthy subjects. The secondary objective was to evaluate the BCVR with regards to the presence of other comorbidities, such as neurogenic bladder and type-2 diabetes mellitus. Methods A descriptive and retrospective study in which we reviewed the clinical files of one thousand subjects who underwent a urodynamic study and were submitted to a mechanical exploration of the BCVR as part of a routine evaluation. Descriptive statistics were performed for the quantitative and qualitative variables using the Student t and the Chi-squared tests accordingly. Values of p < 0.05 was considered statistically significant. Results The sample had a mean age of 59.84 years (standard deviation [SD] ± 14.13 years), and it contained 36.19% of women and 21.13% of men without neurological disease and absent BCVR. A higher proportion of BCVR absence was observed in patients with neurological disease compared to their healthy counterparts: 21.6% and 10.6% respectively (p ≤ 0.0001); furthermore, an important absence of the BCVR was observed in patients with type-2 diabetes mellitus compared to non-diabetic patients: 30.8% and 18.8% respectively (p ≤ 0.0001). No statistically significant differences were observed in the group comparison regarding bladder dysfunction. Conclusion The absence of the RBCV is not exclusive to a neurological disease with repercussions in terms of lower urinary tract symptoms, and the proportion of neurologically healthy subjects with absence of the BCVR is not negligible. No significant difference was found in groups with absence of the BCVR with regards to bladder dysfunction

Metastatic Penile Adenocarcinoma in the Context of Rectal Cancer.

The presence of penile metastatic lesions proceeding from primary rectal tumors is a rare entity usually associated with a poor prognosis. Clinical presentation and localization may vary. There exists no consensus gold standard treatment for penile metastatic lesions, and there is continuous debate on whether lesions should undergo surgical, chemotherapeutic or palliative management.

Optimization of kidney dysfunction prediction in diabetic kidney disease using targeted metabolomics.

AIMS: Metabolomics have been used to evaluate the role of small molecules in human disease. However, the cost and complexity of the methodology and interpretation of findings have limited the transference of knowledge to clinical practice. Here, we apply a targeted metabolomics approach using samples blotted in filter paper to develop clinical-metabolomics models to detect kidney dysfunction in diabetic kidney disease (DKD). METHODS: We included healthy controls and subjects with type 2 diabetes (T2D) with and without DKD and investigated the association between metabolite concentrations in blood and urine with eGFR and albuminuria. We also evaluated performance of clinical, biochemical and metabolomic models to improve kidney dysfunction prediction in DKD. RESULTS: Using clinical-metabolomics models, we identified associations of decreased eGFR with body mass index (BMI), uric acid and C10:2 levels; albuminuria was associated to years of T2D duration, A1C, uric acid, creatinine, protein intake and serum C0, C10:2 and urinary C12:1 levels. DKD was associated with age, A1C, uric acid, BMI, serum C0, C10:2, C8:1 and urinary C12:1. Inclusion of metabolomics increased the predictive and informative capacity of models composed of clinical variables by decreasing Akaike's information criterion, and was replicated both in training and validation datasets. CONCLUSIONS: Targeted metabolomics using blotted samples in filter paper is a simple, low-cost approach to identify outcomes associated with DKD; the inclusion of metabolomics improves predictive capacity of clinical models to identify kidney dysfunction and DKD-related outcomes.

Metabolomics in diabetes, a review.

Metabolomics is a promising approach for the identification of chemical compounds that serve for early detection, diagnosis, prediction of therapeutic response and prognosis of disease. Moreover, metabolomics has shown to increase the diagnostic threshold and prediction of type 2 diabetes. Evidence suggests that branched-chain amino acids, acylcarnitines and aromatic amino acids may play an early role on insulin resistance, exposing defects on amino acid metabolism, ß-oxidation, and tricarboxylic acid cycle. This review aims to provide a panoramic view of the metabolic shifts that antecede or follow type 2 diabetes. Key messages BCAAs, AAAs and acylcarnitines are strongly associated with early insulin resistance. Diabetes risk prediction has been improved when adding metabolomic markers of dysglycemia to standard clinical and biochemical factors.