Percutaneous Nephrolithotomy Using an Individual 3-Dimensionally Printed Surgical Guide.

Percutaneous nephrolithotomy (PNL) is an endoscopic technique used for treating large stones, multiple stones, and staghorn calculi. Although minimally invasive, complication rate of PNL reaches 25%, and it is partially associated with needle puncture during nephrostomy tract preparation. Continuous improvement of armamentarium and imaging methods and the introduction of three-dimensional (3D) visualizations optimize the procedure; however, the rapid and precise establishment of the nephrostomy tract is still difficult. In the present short communication, we present the PNL procedure assisted by a personalized 3D-printed surgical guide (SG) to ensure fast and precise needle access to the renal collecting system. We also describe the workflow for SG preparation, which consists of CT image acquisition and data segmentation, planning a safe needle insertion path, SG designing, and guide manufacturing. With the growing market of low-cost 3D printers, the presented technique can shorten the PNL procedure time and decrease the complication rate associated with needle puncture in a cost-efficient manner.

Three-Dimensional Printing as an Interdisciplinary Communication Tool: Preparing for Removal of a Giant Renal Tumor and Atrium Neoplastic Mass.

Three-dimensional (3D) printing involves preparing 3D objects from a digital model. These models can be used to plan and practice surgery. We used 3D printing to plan for a rare complicated surgery involving the removal of a renal tumor and neoplastic mass, which reached the heart atrium. A printed kidney model was an essential element of communication for physicians with different specializations.

The presence of prostate cancer at biopsy is predicted by a number of genetic variants.

Several single nucleotide polymorphisms (SNPs) have been associated with an elevated risk of prostate cancer risk. It is not established if they are useful in predicting the presence of prostate cancer at biopsy or if they can be used to define a low-risk group of men. In this study, 4,548 men underwent a prostate biopsy because of an elevated prostate specific antigen (PSA; ≥4 ng/mL) or an abnormal digital rectal examination (DRE). All men were genotyped for 11 selected SNPs. The effect of each SNP, alone and in combination, on prostate cancer prevalence was studied. Of 4,548 men: 1,834 (40.3%) were found to have cancer. A positive association with prostate cancer was seen for 5 of 11 SNPs studied (rs1800629, rs1859962, rs1447295, rs4430796, rs11228565). The cancer detection rate rose with the number of SNP risk alleles from 29% for men with no variant to 63% for men who carried seven or more risk alleles (OR = 4.2; p = 0.002). The SNP data did not improve the predictive power of clinical factors (age, PSA and DRE) for detecting prostate cancer (AUC: 0.726 vs. 0.735; p = 0.4). We were unable to define a group of men with a sufficiently low prevalence of prostate cancer that a biopsy might have been avoided. In conclusion, our data do not support the routine use of SNP polymorphisms as an adjunct test to be used on the context of prostate biopsy for Polish men with an abnormal screening test.

Cobalt Serum Level as a Biomarker of Cause-Specific Survival among Prostate Cancer Patients.

Prostate cancer is the most common cancer diagnosed in men and the second leading cause of death in male cancer patients. The WHO suggests that cobalt is involved in the carcinogenesis of prostate cancer. There are, however, no studies associating cobalt levels and prostate cancer patient survival. In this study, 261 Polish prostate cancer (n = 261) patients were recruited into a prospective cohort between 2009 and 2015. Serum cobalt levels were measured using ICP-MS after prostate cancer diagnosis and before treatment. All study participants were assigned into quartiles (QI-QIV) based on the distribution of serum cobalt levels among censored patients. Univariable and multivariable COX regression models were used to calculate hazard ratios (HRs) for each serum cobalt level quartile. We found a significant relationship between high serum cobalt levels and poor prostate cancer patient total survival (HR = 2.60; 95% CI: 1.17-5.82; p = 0.02). In relation to prostate cancer patients who died as a result of other non-cancer causes, the association with high levels of cobalt was even stronger (HR = 3.67; 95% CI: 1.03-13.00; p = 0.04). The impact of high serum cobalt levels on overall survival of prostate cancer-specific-related deaths was not statistically significant.

Correlation between Selenium and Zinc Levels and Survival among Prostate Cancer Patients.

The most prevalent type of cancer among males is prostate cancer. Survival is considered quite good, but it can be further improved when risk factors are optimized. One of these factors is micronutrients, including Se and Zn. To our knowledge, the interaction between Se and Zn and prostate cancer remains undescribed. This study aimed to investigate the optimal levels of selenium (Se) and zinc (Zn) and their impact on the survival of individuals diagnosed with prostate cancer. A total of 338 prostate cancer patients were enrolled in this study, which was conducted in Poland between 2009 and 2015. Mass spectrometry, which uses inductively coupled plasma mass, was used to assess serum element levels before treatment. The study participants were categorized into quartiles (QI-QIV) based on the distributions of Se and Zn levels observed among surviving participants. Cox regression was used to assess the association between serum Se and Zn levels and the survival of prostate cancer patients. Our results reveal the effect of combined Se and Zn levels on survival in prostate cancer patients (SeQI-ZnQI vs. SeQIV-ZnQIV; HR = 20.9). These results need further research to establish Se/Zn norms for different populations.

The G84E mutation in the HOXB13 gene is associated with an increased risk of prostate cancer in Poland.

BACKGROUND: The G84E mutation in the HOXB13 gene has been associated with a high lifetime risk of prostate cancer in North America (about 20-fold). The geographical and ethnic extent of this recurrent allele has not yet been determined. METHODS: We assayed for the presence of the G84E mutation in 3,515 prostate cancer patients and 2,604 controls from Poland and estimated the odds ratio for prostate cancer associated with the allele. RESULTS: The G84E mutation was detected in 3 of 2,604 (0.1%) individuals from the general population in Poland and in 20 of 3,515 (0.6%) men with prostate cancer (Odds ratio [OR] = 5.0; 95% CI: 1.5-16.7; P = 0.008). The allele was present in 4 of 416 (1.0%) men with familial prostate cancer (OR = 8.4, 95% CI: 1.9-37.7; P = 0.005). CONCLUSIONS: The G84E mutation predisposes to prostate cancer in Poland, but accounts for only a small proportion of cases. We expect that the G84E founder mutation might be present in other Slavic populations.

Assessment of the Impact of Pentafecta Parameters Affecting the Quality of Life of Patients Undergoing Laparoscopic Radical Prostatectomy.

Prostate cancer is being detected in increasingly younger men. These patients expect to preserve their current quality of life and quickly recover after treatment. Medical technology and surgical techniques are advancing along with the growing expectations of patients. In addition, the universal method of assessing the quality of outcomes after operations is constantly being researched. As of today, biochemical remission alone, after radical prostatectomy, is insufficient for the patient. Therefore, multi-parametric evaluation methods are being developed, such as trifecta, which assesses biochemical remission, continence, and erectile function. The improvement over the trifecta is the pentafecta, which additionally evaluates postoperative complications and infiltration of surgical margins. Our study was conducted within a group of patients who were surgically treated for prostate cancer in 2017 at the Clinic of Urology and Urological Oncology of the Pomeranian Medical University. We recruited 237 men for the study. From that group, 131 men met the criteria to be included in the analysis. Maintaining continence (87.78%) is the easiest pentafecta parameter to obtain and will have the greatest impact on quality of life in the future. Maintaining biochemical remission (82.44%) is the second most important aspect for the patient. Retaining erectile function is the most difficult pentafecta parameter to obtain (29.01%) while having little impact on the quality of life. Negative surgical margins (66.41%) showed a negligible impact on the quality of life. The occurrence of complications (32.07%) has a negative impact on the quality of life of patients, but only during the treatment of complications.

When Bodybuilding Goes Wrong-Bilateral Renal Artery Thrombosis in a Long-Term Misuser of Anabolic Steroids Treated with AngioJet Rheolytic Thrombectomy.

Bilateral renal infarction is an extremely rare condition with only few cases reported in the literature. We present a case of bilateral renal infarction affecting an otherwise healthy 34 year old bodybuilder chronically misusing testosterone and stanozolol. The patient presented with severe flank pain mimicking renal colic and biochemical features of acute kidney injury. Diagnostic workup revealed thrombosis affecting both renal arteries. Subsequently, the patient underwent a percutaneous rheolytic thrombectomy with AngioJet catheter, along with catheter-directed thrombolysis. Right-sided retroperitoneal hematoma developed as an early complication, mandating surgical exploration and nephrectomy due to kidney rupture and the unstable condition of the patient. Intensive care and continuous renal replacement therapy were instigated until a gradual improvement of the patient status and a return of kidney function was achieved. No abnormalities were found in the cardiological and hematological evaluation. We believe this is a first report of bilateral renal infarction associated with anabolic steroid misuse in an otherwise healthy individual, and a first report of AngioJet thrombectomy in bilateral thrombosis of renal arteries. It stresses the importance of a thorough diagnostic workup of colic patients and emphasizes the need for sports medicine to reach out to amateur athletes with education on the harms of doping.

Increased One-Year Mortality Among Elderly Patients After Radical Cystectomy for Muscle-Invasive Bladder Cancer: A Retrospective, Observational Comparative Study.

Introduction: Muscle invasive bladder cancer (MIBC) is a common malignancy amongst elderly. Increasing life expectancy, prevalence of smoking, lifelong exposure to environmental pollutants and immunosenescence contribute to growing number of cases. Traditionally, radical cystectomy (RC) with pelvic lymph node dissection (PLND) constituted the mainstay of treatment for MIBC, but despite proven feasibility in elderly population, it has been associated with significant burden of morbidity, mortality, and complications. Study Objective: We aimed to re-evaluate the safety and efficacy of RC amongst the elderly patients with MIBC. Material and Methods: This single-center, retrospective, observational comparative study was conducted among 568 patients who underwent RC due to MIBC between 2003 and 2021. We evaluated the influence of chronological age (<70 vs ≥70 years) on clinical, demographic, and pathological variables related to MIBC and RC. Results: Elderly patients had similar clinical and pathological features of disease compared to their younger counterparts; nonetheless, they more often received simplified urinary diversion, ie ureterostomy (60.25% vs 39.33%, p<0.001) and had no PLND (15.76% vs 8.5%, p=0.01) during RC. Furthermore, more elderly patients were treated for secondary MIBCs and fewer had history of smoking. Severe complication and 90-day mortality rates were comparable between groups; however, the elderly had significantly higher all-cause mortality at one year post RC (46.67% vs 33.25%, p=0.003). On multivariate analysis, one-year mortality risk was independently associated with elderly age (HR=2.119, 95% CI: 1.227-3.660, p=0.007), rural residency (HR=1.760, 95% CI: 1.043-2.968, p=0.034), extravesical extension of tumor (HR=2.109, 95% CI: 1.155-3.850, p=0.015), lymph node metastasis (HR=2.268, 95% CI: 1.290-3.987, p=0.004) and omission of PLND (HR=6.064, 95% CI: 2.926-12.568, p<0.001). Conclusion: Radical cystectomy in elderly patients is associated with significant one-year mortality. Our study emphasizes the unmet need for considerate planning of treatment for MIBC in potentially vulnerable groups of elderly patients. Efforts are needed to reliably identify those unlikely to benefit from surgery and facilitate patient-centered choice of alternative therapies.

Management with Santorini's Plexus Should Be Personalized during Prostatectomy.

The aim of this study is to compare the results of laparoscopic prostatectomy in terms of management with Dorsal Venosus Complex (DVC)/Santorini's plexus as it is still an open question in the field of urology. For this purpose, 457 patients after prostatectomy derived from two high volume centers were compared. In one center, patients underwent DVC ligation in all cases, whereas in the second center, this step was omitted. Subsequently, the histological and functional results were compared. Results showed that DVC management has an impact on blood loss and the duration of the surgery. In addition, omitting DVC ligation is demonstrated to reduce positive margin rate within the apex if the cancer was localized in this region. The continence and erectile function were similar in the 12-month follow up.

Survival differences of patients with ureteral versus pelvicalyceal tumours: a systematic review and meta-analysis.

INTRODUCTION: Worse survival in upper tract urothelial carcinoma (UTUC) in the presence of a tumour in the ureter vs. pelvicalyceal tumours is reported in some studies; however, the definition of ureteral involvement (UI) varies across studies. We systematically evaluated evidence regarding the prognostic role of UI in overall and cancer-specific survival of patients with UTUC. MATERIAL AND METHODS: A systematic search of PubMed, Scopus and Web of Knowledge was performed in March 2018. RESULTS: The results were presented as a comparison between ureteral vs. pelvicalyceal tumours. A total of 14,895 patients were identified. Cumulative analyses indicated that UI worsens cancer-specific survival (CSS) and overall survival (OS), with a pooled HR of 1.52 (p < 0.001) and 1.39 (p = 0.004), respectively. CONCLUSIONS: Our meta-analysis identified UI in UTUC as an adverse prognostic factor.

Does smoking have any effect on urinary stone composition and the distribution of trace elements in urine and stones?

The role of particular elements in lithogenesis is still unclear and debated. Probably some of them may promote or conversely inhibit crystal nucleation of organic or mineral species. A few epidemiological data link smoking with the risk of calcium stones. The aim of this hospital-based study was to evaluate the distribution of trace elements in urine and urinary stones, and possible correlation with stone constituents in smoking and non-smoking individuals. 209 stones and urine samples collected from idiopathic stone-formers were analyzed to evaluate the mineral composition and the distribution of elements, 29 in stones and 21 in urine. Values were statistically compared considering smoking, arterial hypertension and coronary heart disease as grouping variables. No differences were noted either for comparison of mineral components or the elements concentrations in stones in both groups. The concentration of mercury in urine was higher in smokers than in non-smokers, but the statistical significance was at the moderate level. Our findings do not support the concept of possible association between smoking and urinary lithogenesis, but we believe that further investigations are needed in this area.

Laparoscopic live-donor nephrectomy with retroperitoneoscopic access - first case experience.

BACKGROUND: Despite observed huge progress in understanding the immunological basis of transplantation and the development of new immunosuppressive agents that have significantly improved both -- the patient and graft survival, still the kidney donation from live volunteers remains the most consistent factor which affects the long-term survival. The conventional, open method of donor nephrectomy is associated with significant surgical trauma. The laparoscopic live-donor nephrectomy (LDN) is the alternative for open approach. CASE REPORT: We present our experience of the case of laparoscopic removal of the kidney from a living donor. We applied retroperitoneoscopic access, the operation time was 210 minutes. Kidney was implanted shortly after LDN and its immediate function was observed. We have observed no serious postoperative complications either in donor or recipient. CONCLUSIONS: We hope that this successful initial case of LDN will have a positive effect on cooperation between transplantologists and urologists, and on rate of kidney donation in Poland.

Assessment of the infiltrative character of bladder cancer at the time of transurethral resection: a single center study.

INTRODUCTION: Determining the clinical stage of bladder carcinoma before radical cystectomy is characterized by a high inaccuracy rate. The discrepancy in some reports reaches up to 48%. Therefore intraoperative clinical staging of bladder carcinoma is not recommended before radical treatment as it is for prostate cancer. However, the accuracy of clinical assessment of the muscle invasive character of the tumors at the time of transurethral resection has not been studied. In our study we estimate the accuracy of clinical staging during endoscopic treatment. MATERIAL AND METHODS: 332 patients who had undergone transurethral resection of bladder cancer were studied in this retrospective analysis. Data such as age, gender, presence of hydronephrosis, operator, the results of bimanual bladder examination, TURB report and pathologic report, were collected from each patient. Intraoperative prediction of the muscle invasive nature of the tumor was compared with pathological reports. A logistic regression analysis was used to evaluate the influence of particular variables on upstaging and downstaging. RESULTS: Overall accuracy between clinical and histopathology staging was 87.8%. Discrepancy was observed only in 36 patients. Patients with pTa stage were the most numerous group among patients with accurate prediction of the muscle invasiveness character of the tumor. Univariable logistic regression indicated that the presence of a palpable mass in the bimanual examination was a predictor of upstaging, with an OR 11.75 CI95% [2.49-55.32]. CONCLUSIONS: The study indicated the high accuracy between clinical and pathological reports. Intraoperative evaluation of tumor character should be an indispensable part of treatment, which can be useful for planning in advance the further stages of treatment.

Laparoscopic Partial Nephrectomy Supported by Training Involving Personalized Silicone Replica Poured in Three-Dimensional Printed Casting Mold.

BACKGROUND: Most kidney neoplasms are found incidentally and qualify for nephron-sparing surgery. Laparoscopic approach is beneficial to these patients because of its minimally invasive approach. However, these operations are both difficult and require plenty of experience and extended training. Some stages of the operation are limited by permissible time of transient ischemia. We applied three-dimensional (3D) printing technology to create individual silicone models of kidney to be used for training in laparoscopic procedures before the actual surgeries. MATERIALS AND METHODS: Three patients who qualified for laparoscopic partial nephrectomy were selected. Digital models of their kidneys with tumors were designed based on computed tomography scans, followed by creation of silicone models. These were cast into the forms printed in 3D. The proper surgery was preceded by an operation carried out in a silicone model of laparoscopic simulator in which the tumor was excised and lodged after tumorectomy was filled. RESULTS: Average time of the live kidney tumor operation was slightly shorter than that of the silicone model (16 versus 17 minutes). Relatively short period of ischemia did not exceed 9 minutes. One patient underwent surgery without closing the vascular pedicle. CONCLUSIONS: Experience gained during training with these silicone models improved the actual surgery and can reduce the need for/duration of intraoperative renal ischemia. We believe this training method can be successfully used in other procedures.

Impact of ureteric stent on outcome of extracorporeal shockwave lithotripsy: A propensity score analysis.

INTRODUCTION: Extracorporeal shockwave lithotripsy (SWL) is one of the most frequently performed procedures in patients with urolithiasis. For ureter-localized stones, SWL is often preceded by a double J stent insertion. However, fear of serious complications, including sepsis associated with stents, is often expressed. The following study assessed the impact of stent insertions on the results of SWL in patients with ureteric stones. MATERIAL AND METHODS: The study group consisted of 411 ureteric stone patients who were treated with SWL from January 2010 to December 2014. In 60 cases, treatment was preceded by ureteric stent insertion. A propensity scoring system was used to pair non-stented patients with the stented group. Success rates were assessed and compared using the chi-squared test. Multivariate logistic regression analysis was used to evaluate the influence of particular variables on the stone-free rate. RESULTS: The overall success rate was 82.2%. After matching, the success rate of the stented group was not significantly different from the control group (85.0% vs. 83.3% respectively, p = 0.80). The mean number of sessions was higher in the stented group (1.88 per patient). Stones located in the lower part of the ureter have the greatest chance of being successfully treated. CONCLUSIONS: The double J stent has no influence on the outcome of SWL treatment. In view of the greater likelihood of having additional sessions, this approach should be reserved for selected cases.

Urethral stone of unexpected size: case report and short literature review.

Urolithiasis is a well-known disease. Stones can form in all parts of the urinary tract. Diagnosis and treatment usually do not create clinical problems. However from time to time in daily practice doctors are confronted with casuistic cases. Here, we report a 54-year-old man with a large stone localized to the urethra. Because of the size of the stone, confirmed on radiography, and the presence of a cutaneous fistula, open surgery was performed. Due to urethral stricture, the patient required a second stage of reconstructive surgery. This case emphasizes that unusual presentation of urolithiasis may occur, and different surgical approaches as well as other surgical manipulations in such cases must be considered.

The variant allele of the rs188140481 polymorphism confers a moderate increase in the risk of prostate cancer in Polish men.

A number of single nucleotide polymorphisms (SNPs) in the human genome have been associated with increased risk of prostate cancer. Recently, a single SNP in the region of chromosome 8q24 (rs188140481) has been associated with a three-fold increased risk of prostate cancer in Europe and North America. To establish whether rs188140481 is associated with the risk of prostate cancer in Poland, we genotyped 3467 men with prostate cancer and 1958 controls. The A allele of rs188140481 was detected in 44 of 3467 (1.3%) men with prostate cancer and in seven of 1958 (0.4%) controls (odds ratio=3.6; 95% confidence interval 1.6-7.9; P=0.0006). The allele was present in eight of 390 (2.1%) men with familial prostate cancer (odds ratio=5.8; 95% confidence interval 2.1-16.2; P=0.001). A positive family history of cancers at sites other than the prostate was observed in 27% of men who carried the rs188140481 risk allele and in 44% of noncarriers (P=0.04). No cancer at a site other than the prostate was more common in first-degree or second-degree relatives of carriers of the rs188140481 risk allele than relatives of noncarriers. The rs188140481 polymorphism in the 8q24 region confers a moderate increase in the risk of prostate cancer in Polish men. The SNP does not appear to be associated with susceptibility to cancers of other types.

Common variants of xeroderma pigmentosum genes and prostate cancer risk.

The genetic basis of prostate cancer (PC) is complex and appears to involve multiple susceptibility genes. A number of studies have evaluated a possible correlation between several NER gene polymorphisms and PC risk, but most of them evaluated only single SNPs among XP genes and the results remain inconsistent. Out of 94 SNPs located in seven XP genes (XPA-XPG) a total of 15 SNPs were assayed in 720 unselected patients with PC and compared to 1121 healthy adults. An increased risk of disease was associated with the XPD SNP, rs1799793 (Asp312Asn) AG genotype (OR=2.60; p<0.001) and with the AA genotype (OR=531; p<0.0001) compared to the control population. Haplotype analysis of XPD revealed one protective haplotype and four associated with an increased disease risk, which showed that the A allele (XPD rs1799793) appeared to drive the main effect on promoting prostate cancer risk. Polymorphism in XPD gene appears to be associated with the risk of prostate cancer.

Simplified laparoscopic technique for the treatment of long distal ureteral stenosis.

Laparoscopic interventions with the application of vesico-psoas hitch and Boari flap methods for the reconstruction of pronounced ureter defects require considerable physical skill and competence. This case series aims to present our experience in the treatment of long, distal ureteral stenoses via simplified laparoscopic ureteroneocystostomy in 3 male patients in whom the stenoses ranged from 5 cm to 6 cm. Prior to each laparoscopic intervention, intravenous urography and pyelography via a nephrostomy tube were performed. The mean operation time was 157 min (120-180 min), and blood loss averaged 33 ml (20-50 ml). No intra-operative or post-operative complications were recorded. The post-operative hospital stay was ≤ 6 days. Follow-up imaging examinations revealed normal kidney-urinary bladder urine flow in all cases. In conclusion, we consider that simplified ureteral replantation facilitates laparoscopic treatment of long, distal ureteral stenoses.