Metabolic syndrome and risk of prostate cancer: a systematic review and meta-analysis.

INTRODUCTION: Emerging evidence supports the hypothesis that metabolic syndrome is associated with cancer pathogenesis. In particular regarding prostate cancer, observational studies from various settings report different results. This systematic review and meta-analysis aimed to provide a quantitative estimate of the association between metabolic syndrome in prostate cancer, in particular Gleason Score >6, accounting for different study designs. EVIDENCE ACQUISITION: Systematic research of available literature in English language until 2020 was conducted through in Embase, Medline, Cochrane Library and NIH Registry of Clinical Trials. For each study, information regarding the study design, the population, the definition of metabolic syndrome, data relating to prostate cancer were collected, the association between MetS and outcome of interest was determined by calculating the generic inverse variance with random effects method. EVIDENCE SYNTHESIS: In the final sample 19 studies were included with total of 114,329 patients, 29.4% met the criteria for metabolic syndrome. We report a significant association between metabolic syndrome and prostate cancer in cross-sectional studies (OR=1.30; 95% CI: 1.13-1.49) and for patients with clinically significant prostate cancer (OR=1.56; 95% CI: 1.23-1.99). Association between metabolic syndrome and prostate cancer combining all studies, in cohort studies and case-control studies was not significant. CONCLUSIONS: Growing evidence support the association between metabolic syndrome and prostate cancer, bias derived from observational studies might conceal further findings.

RUG technique: replacement of the ureter with gonadal vein. A cadaveric study.

BACKGROUND: Ureteral defect lesions may result from retroperitoneal fibrosis, radiation damage, tumors, or surgical procedures; the management of long-segment ureteral defects is a challenge for urologists. Total or partial replacement of the ureter is sometimes required, with consequent ileal interposition, but this technique may lead to several complications, such as severe urinary infections. In a few cases, nephrectomy may be required. Starting from the above considerations, we can postulate the RUG technique (replacement of the ureter with gonadal vein), using the gonadal vein (GoV) as an autologous graft to substitute the ureter. For this reason, we decided to test this novel idea on an experimental model. METHODS: We tested the above technique on a cadaveric model, performing complete procedure (RUG #1), segmental replacement of the ureter (RUG #2), and ureteroplasty with a GoV patch (RUG #3). All the procedures involved an open approach. After RUG #3, the treated segment of the ureter was sampled for histologic analysis. RESULTS: Four RUGs were performed (two RUG #1, one RUG #2, one RUG #3). All anatomic structures were easily identified, and all procedures were completed successfully. The dimensions of the ureters were comparable to those of the GoV in all cases, as usual. Histologic analysis demonstrated perfect adherence of the two anastomosed structures. CONCLUSIONS: The RUG technique resulted in an adequate, safe and easy-to-perform surgical alternative.