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Background: Benign prostatic hyperplasia (BPH) is a common urological disorder leading to dysuria in middle-aged and elderly men and significantly reduces the quality of life of patients. Technology for BPH has made a great progress, while there is still a lack of visual and summary literature to make the summary. Summary: The aims of the study were to identify the cooperation of authors, countries, institutions, and explore hot topics' prospects regarding research of BPH. Relevant original articles were obtained from the Web of Science (WoS) database between 2016 and 2022. CiteSpace software was used to perform the analysis and visualization of scientific productivity and emerging trends. Key Messages: A total of 4,738 articles related to study of BPH were identified. We observed a gradual increase in the number of publications from 2016 to 2022. The USA dominated the field in all countries. Shanghai Jiao Tong University was the most productive institution in 6 years. Active cooperation between countries and between institutions was not observed. Journal of Urology was the most co-cited journal. Roehrborn CG (41 papers) was the most productive author and had the largest numbers of citations (820 co-citations) during the past 6 years. Close collaboration was not observed between the different authors. The main hot topics included matters related to BPH, urinary tract symptom, prostatic urethral lift, thermal therapy, and prostatic neoplasms. This scientometric study comprehensively reviewed publications related to BPH during the past 6 years using quantitative and qualitative methods, which can be used to forecast future research developments in BPH. [ABSTRACT FROM AUTHOR]

Background: Hemangioma of the urinary bladder is a rare benign tumor. Although benign, their presenting symptoms are alarming for both patients and doctors, and their rarity makes them challenging to correctly diagnosis and treat. This review paper summarizes current knowledge about hemangioma of the urinary bladder, treatment options, and follow-up modalities. Summary: After the kidney, the bladder is the second most common location of hemangiomas in the urinary tract. There is painless gross hematuria on clinical presentation once the lesion has eroded the urothelium. Magnetic resonance imaging (MRI) has been reported to be valuable in diagnosing soft-tissue hemangiomas. Cystoscopic findings of a sessile, blue, multilocular mass suggest hemangioma. Most tumors are solitary, smaller than 3 cm, and have smooth or irregular surfaces. Histologically, lesions comprise numerous proliferative capillaries with thin-walled, dilated, blood-filled vessels lined with flattened endothelium. The treatment of patients with hemangioma has been controversial. It depends on the tumor size and the degree of penetration. The prognosis of these tumors is excellent. Key Messages: Despite the widespread use of MRI, CT, and endoscopy in evaluating hematuria, hemangioma remains one of the rarest bladder tumors. Moreover, only a histological examination can confirm the diagnosis. Transurethral resection, fulguration, and YAG laser ablation are standard treatments for small tumors. In terms of follow-up, cystoscopy after 6 months of treatment helps assess recurrence. In addition, MRI is a practical, noninvasive technique for follow-up of small hemangiomas. [ABSTRACT FROM AUTHOR]

Introduction: Extramammary Paget's disease of the scrotum and penis is a relatively rare cutaneous malignant tumor. At present, its pathogenesis, and clinical and pathological characteristics are not very clear. This is controversial regarding surgical margin width to decrease the high recurrence rate. This paper aimed to report the case and review the literature of extramammary Paget's disease of scrotum and penis. Case Presentation: We presented the case of a 74-year-old male patient with the patchy erythema and pruritus in the perineum who was admitted to our department. Biopsy of the large plaque revealed Paget disease. Under the condition of ensuring negative surgical margins by rapid frozen pathology, a wide local excision of the lesion, bilateral orchiectomy, and adnexectomy were performed on the patient. Pathology revealed that many scattered vacuolated Paget cells were observed in the epidermal layer, and the diagnosis was Paget's disease of the scrotum and penis. The 2 cm outside the skin lesion was used as the initial surgical margin, and free skin flap transplantation was used to repair the surgical wound. The patient recovered well and was discharged 1 week after surgery. Conclusion: Currently, histopathologic biopsy is the most important diagnostic method for EMPD. Once confirmed, for patients eligible for surgical intervention, wide local excision of the lesion and rapid intraoperative frozen pathological examination should be performed as soon as possible. The skin flap transplantation is the first choice for the repair of large-scale wound after surgery. [ABSTRACT FROM AUTHOR]

Ectopic prostatic tissue is rare, and it is usually only discovered by chance during imaging examinations or surgery. However, between 1967 and 2021, reports of ectopic prostatic tissue in the medical literature increased. It is rarely reported that ectopic prostatic tissue can be misdiagnosed as a nephrogenic adenoma (NA). This case study aimed to increase the awareness of ectopic prostatic tissue to improve its rates of diagnosis. This paper is focused on a 45-year-old male patient with a history of bladder lesions that were accidentally discovered through a health examination. A computed tomography scan revealed a homogeneous isoechoic mass in the posterior inferior wall of the bladder. At first, a transurethral cystoscopy revealed a smooth sessile mass covering the normal bladder mucosa, which was located in the middle of the interureteric ridge. The biopsy results suggested a possible intravesical NA. The mass was then completely resected under pneumovesicoscopy, and the pathological diagnosis was ectopic prostatic tissue. The clinical symptoms of ectopic prostatic tissue are similar to other bladder neoplasms, but there are too few characteristics available in imaging examinations to allow for an accurate diagnosis. Since ectopic prostatic tissue can present as a tumor in the bladder, urologists may easily misdiagnose the condition. Surgery is the basis of treatment for ectopic prostatic tissue, and it has a good prognosis. [ABSTRACT FROM AUTHOR]

Background: The aim of this study was to investigate the long-term effects of ureteral stenting and the exact timing of stent removal in favor of surgery in patients with idiopathic retroperitoneal fibrosis (IRF). Summary: Medline research terms of "idiopathic retroperitoneal fibrosis" AND " medical therapy" OR "ureteral stenting" OR "surgical treatment" were done. Systematic reviews and observational and clinical studies were analyzed to obtain indication regarding the objective of the study for a narrative review. Ninety-two papers were analyzed. The treatment of IRF includes the monitoring of retroperitoneal fibrotic process spread and the prevention of abdominal organs entrapment. Treatment of ureteral obstruction includes medical therapy and ureteral stenting (US) or percutaneous nephrostomy (PNS) to overcome the worsening of renal function. Up to now, the timing of US or PNS removal is not yet clear, both for the complexity of evaluating the efficacy of the medical therapy and demonstrating the resolution of obstructive nephropathy. Moreover, it is not yet clear if the long-term ureteral stent placement or PNS is able to maintain an efficient renal function. Ureterolysis with a laparoscopic robot-assisted approach is now considered as an ultimate treatment for ureteral obstruction, limiting the progression of kidney impairment and improving the quality of life of patients, although nephrologists are generally abdicant regarding the potential switch toward the surgical approach. Key Messages: Prospective studies regarding the long-term effects of US on the renal function impairment in patients with IRF should be structured to obtain adequate information on the exact timing for the surgical approach. [ABSTRACT FROM AUTHOR]

Introduction: Mortality after radical cystectomy (RC) varies widely in the literature. In cohort studies, mortality rates can vary from as low as 0.5% in large-volume academic centers (2) to as high as 25% in developing countries series. This study aims to perform a systematic review of population-based studies reporting mortality after RC. Methods: A Systematic search was performed in Medline (PubMed®), Embase, and Cochrane for epidemiologic studies reporting mortality after RC. Institutional cohorts and those reporting mortality for specific groups within populations were excluded. Case series and non-epidemiologic series were also excluded. The aim of this review is to evaluate in-hospital mortality (IHM), 30-day mortality (30M), and 90-day mortality (90M). Results: Systematic search resulted in 42 papers comprising 449,661 patients who underwent RC from 1984 to 2017. Mean age was 66.1. Overall IHM, 30M, and 90M were 2.6%, 2.7%, and 4.9%, respectively, with 90M being 2.6 times higher than IHM on average. Lowest IHM was found in Canada and Australia (0.2% and 0.6%, respectively), while the highest IHM was 7.8% (Brazil). Canada and Spain showed the highest 90M (6.5%). 159,584 urinary diversions were analyzed, being mostly ileal conduits (76.8%). Conclusions: The majority of the studies available are from major developed economies with paucity of data in the developing world. 90M after RC tends to be at least twice as high as IHM. The knowledge of such epidemiologic data is vital to guide public policies, such as centralization, in order to reduce mortality. [ABSTRACT FROM AUTHOR]

The middle of the 19th century marks the beginning of a global process of science and knowledge transfer from -Europe to the rest of the world. During the phase of globali-zation, Austrian physician and ethnographer Jacob E. Polak (1818–1891) played a key role in the transmission of practical and scientific reasoning, leading to the development of medical science and clinical care in Persia. In 1851, Polak was commissioned by the Persian court to work as an academic teacher at the first secular institution of higher learning in Teheran, the Dār al-Fonūn. After 4 years of teaching and working as a doctor and surgeon, Polak was appointed personal physician to the Qājār king, Nāṣer-ad-Dīn Shāh (r. 1848–1896). During Polak's 9 year stay in Persia, he performed numerous surgical operations with specific focus on lithotomies on men and women of all ages. He documented each operation and collected samples of bladder calculi for the purpose of chemical analysis. After his return to Austria, he published a detailed report on his practice of lithotomy in Persia. This extensive documentation is, we believe, the only known historical evidence that currently exists of the introduction of modern urology to Persia. This study will present Polak's role as a pioneer of modern medicine and lithotomy, and will examine how he introduced the latest achievements of Viennese medicine in the field of operative urology to Persia. [ABSTRACT FROM AUTHOR]

Introduction: A possible association between extended pelvic lymph node dissection (ePLND) in radical prostatectomy (RPE) and functional outcomes such as erectile function (EF) and continence recovery has been previously considered. This association stems from the direct proximity of ePLND to the pelvic plexus. In this paper, we aimed to critically examine an association of ePLND with functional outcomes in patients who underwent bilateral nerve-sparing RPE. Methods: 272 out of 782 patients from a randomized, patient-blinded, multicenter trial were retrospectively classified into two groups based on the D'Amico criteria: 114 had no PLND and 158 had ePLND. Continence (no pad/safety pad) and EF (Index of Erectile Function-5 [IIEF-5] questionnaire ≥17; sufficient erection for sexual intercourse) were assessed at 3, 6, and 12 months as well as postsurgical complications (Clavien-Dindo Classification). Results: After 12 months of follow-up, no significant difference for potency could be found between men without and subjected to ePLND: IIEF-5 ≥17 (23.2% vs. 27.2%; p = 0.55) and sufficient erection for intercourse (44.1% vs. 45.6%; p = 0.84). A multiple linear regression analysis demonstrated that while preoperative EF (p < 0.001), pathological tumor stage (p = 0.027), and robot-assisted bilateral nerve-sparing RPE (p < 0.001) were independent predictors of EF recovery, the same did not apply to ePLND. No association was detected for continence recovery (94.2% vs. 89.7%; p = 0.22) and complications of any grade after surgery (11.4% vs. 16.5%; p = 0.24). Conclusion: ePLND is not associated with increased risk of erectile dysfunction, incontinence or complications after bilateral nerve-sparing RPE. [ABSTRACT FROM AUTHOR]

Objective: Kidney stones are a common medical condition that is increasing in prevalence worldwide. Approximately, ∼80% of urinary calculi are composed of calcium oxalate (CaOx). There is a growing interest toward identifying therapeutic compounds that can inhibit the formation of CaOx crystals. However, some chemicals (e.g., antibiotics and bacterial metabolites) may directly promote crystallization. Current knowledge is limited regarding crystal promoters and inhibitors. Thus, we have developed an in vitro gel-based diffusion model to screen for substances that directly influence CaOx crystal formation. Materials and Methods: We used double diffusion of sodium oxalate and calcium chloride-loaded paper disks along an agar medium to facilitate the controlled formation of monohydrate and dihydrate CaOx crystals. A third disk was used for the perpendicular diffusion of a test substance to assess its influence on CaOx crystal formation. Results: We confirmed that citrates and magnesium are effective inhibitors of CaOx crystals. We also demonstrated that 2 strains of uropathogenic Escherichia coli are able to promote crystal formation. While the other tested uropathogens and most antibiotics did not change crystal formation, ampicillin was able to reduce crystallization. Conclusion: We have developed an inexpensive and high-throughput model to evaluate substances that influence CaOx crystallization. [ABSTRACT FROM AUTHOR]

Introduction: To compare the effects of three techniques: biopsy needle disinfection with 10% formalin solution, povidone-iodine rectal cleaning, and the use of both methods to decrease hospitalization due to infectious complications after transrectal prostate biopsy. Methods: A total of 827 patients were divided into 3 groups. Group 1 patient data were analyzed retrospectively, while patients of groups 2 and 3 were followed up prospectively. Group 1 included 361 patients who underwent biopsy needle disinfection with a 10% formalin solution. Group 2 included 235 patients who underwent biopsy needle disinfection and povidone-iodine rectal cleaning. Group 3 included 231 patients who underwent povidone-iodine rectal cleaning only. The outcome scale was the number of patients hospitalized for biopsy-related infection 30 days after the date of transrectal prostate biopsy. Results: The hospitalization rates due to biopsy-related infectious complications were 3.0%, 0%, and 1.7% in groups 1, 2, and 3, respectively. The only statistically significant difference was found between groups 1 and 2. Conclusion: Biopsy needle disinfection and rectal cleaning with povidone-iodine seem to have greater potential to reduce infectious complications when applied together. Further prospective studies are required to confirm these findings. [ABSTRACT FROM AUTHOR]

Introduction: In addition to bibliometric scores, which are an indicator of academic popularity, it has become frequently used in altmetric scoring that shows the visibility of articles on social media and the internet. In this study, 100 most-cited studies on holmium laser enucleation prostatectomy (HoLEP) were examined, and it was investigated whether the number of citations per year of these studies was affected by altmetric and bibliometric scores. Methods: The 100 most-cited HoLEP articles between 2000 and 2020 were included in the study. Some bibliometric scores such as h-indexes, impact factors, Scientific Journal Rankings (SJR) scores of the journals and demographics of the articles (such as the number of the citations per year, total number of citations, and total altmetric scores) were recorded. The effects of altmetric and bibliometric scores on the number of citations per year were evaluated by correlation analysis. Results: The median number of citations per year of the articles was 5.88 (4.69–8.42). It was determined that altmetric scores were not an effective factor on the number of citations per year (p = 0.335). A moderate relationship was found between the journal impact factor and the number of citations per year (p < 0.001, r = 0.471, R2 = 0.251). Journal h-index (p < 0.001, r = 0.424, R2 = 0.084), the SJR score (p < 0.001, r = 0.374, R2 = 0.254), and the publication year of the article (p = 0.001, r = 0.326, R2 = 0.023) were significantly but weakly correlated with the median number of citations per year. Conclusion: It was seen that the number of citations per year, which is the most important academic quality indicator, is not related to the altmetric scores. In addition, traditional bibliometric parameters still maintain their effectiveness on the number of citations. [ABSTRACT FROM AUTHOR]

Introduction: We report early postoperative complications (PCs) (≤90 days) of one-stage oral mucosa graft (OMG) urethroplasty in treatment of acquired anterior urethral strictures. Material and Methods: In this study, we evaluated 530 males who underwent one-stage substitution urethroplasty (SU) between September 1996 and October 2020. Medical records were reviewed to identify and classify early PCs based on the Clavien-Dindo classification (CDC). We subdivided the PCs into three groups with different kinds of complications which allowed us a more detailed analysis concerning general surgical complications (GSCs), donor site morbidity (DSM) and complications specific for free graft urethroplasty (CSUs). The influence of patient demographics, stricture characteristics and operative procedure on the occurrence of PCs was analysed. Results: Early (90-day) PCs occurred in 90 (16.98%) patients, whereas only 19 patients (3.58%) experienced serious events (CDC grades III and IV). Early complications include 4.5% GSCs, 1.7% DSM and 10.8% CSUs. Only stricture length turned out to be an independent statistically significant risk factor for the occurrence of early PCs. There was a trend towards a higher rate of complications in patients with ASA III compared to ASA I. Conclusion: The incidence of severe early complications in patients undergoing one-stage SU with OMG is low. [ABSTRACT FROM AUTHOR]

Background and Objective: Distal ureter management is an essential part of radical nephroureterectomy (RNU). However, there is no agreement on the optimal surgical treatment for ureter and bladder cuff excision. The classical "pluck" technique following transurethral resection of the intramural ureter increases the risk of extravesical and intravesical tumor cell spillage. We aimed to provide a simple transurethral technique with the Hem-o-lok clip ligation for the management of the distal ureter during retroperitoneal laparoscopic RNU. Methods: Transurethral resection of the bladder cuff was performed using a bipolar β electrode mounted on resectoscope. Subsequently, a Super Scope (S-scope) with a 5.6-mm diameter working channel was used with a clip applier to deliver the 5-mm Hem-o-lok clips, which consequently ligated the ureteral stump and avoided urine spillage from the upper tract. Traditional retroperitoneal laparoscopic surgery was used to treat the renal and upper ureter. The resected distal ureter and the Hem-o-lok clip were gently pulled out of the bladder by the "pluck" technique. Results: A total of 14 upper tract urothelial carcinoma patients were analyzed, including 10 men and 4 women. The Hem-o-lok clip ligation took less than 20 s. In each patient, the clip was clearly visible and attached tightly to the ureter, and a clear distal ureter was observed in all patients. Histopathology results showed pT2 in 8 and pT3 in 6 patients. A median follow-up of 15 months revealed no extravesicular or intravesicular recurrences. Conclusions: Transurethral Hem-o-lok clip ligation technique provides a simple and safe option for distal ureter management in retroperitoneal laparoscopic RNU. This novel approach enables construction of a watertight system of the upper urinary tract, preventing the spread of tumor cells effectively and minimizing local tumor implantation risk. [ABSTRACT FROM AUTHOR]

Introduction: Solitary fibrous tumors (SFTs) of the prostate are extremely rare. We report on a 60-year-old man who was diagnosed with prostatic SFT through transurethral resection (TUR) of the prostate, and we provide a narrative literature review to put the case into perspective. We looked into multiple databases for articles published before June 2022. Case Report: A 60-year-old man without comorbidities presented with acute urinary retention and significant macrohematuria. Due to recurrent bladder tamponades and relevant blood loss despite irrigation, an emergency endoscopic transurethral evaluation was initiated. Intraoperatively, diffuse venous hemorrhage from prostatic vessels around the bladder neck was detected, as well as significant hemorrhage from a grossly enlarged and tumor-suspicious prostate middle lobe. Within the framework of extensive bipolar coagulation, parts of the suspicious middle lobe were removed via TUR. The final histopathology report showed incompletely resected SFT of the prostate. Due to the extremely rare SFT diagnosis, the case was discussed in an interdisciplinary tumor board and further diagnostic workup, including thoracoabdominal computed tomography and magnetic resonance imaging of the pelvis, was performed, which revealed no secondary tumors or signs of metastasis. According to the tumor board recommendation, robot-assisted radical prostatectomy (RARP) with bilateral nerve sparing was performed, supported by intraoperative frozen section. The final histopathology confirmed the SFT that had developed from the transition zone. The SFT was resected with negative frozen section result and negative surgical margins (R0). No intra- and perioperative complications occurred, and in the short-term follow-up, the patient presented in excellent general status with full continence. From 1997 to June 2022, we identified a total of 12 publications reporting on treatment for prostatic SFT (11 case reports and 2 patient series), with none performing bilateral nerve sparing, frozen section, or robot-assisted radical prostatectomy. No common survival endpoints were accessible. Conclusion: This case demonstrates the exceedingly rare case of SFT of the prostate, which has been described in the literature in only 23 men worldwide. Here, we were the first to demonstrate the feasibility of bilateral nerve-sparing RARP supported by frozen section. A systematic review was not possible due to the lack of common endpoints. [ABSTRACT FROM AUTHOR]

Introduction: The goal of this study was to evaluate the efficacy and safety of needle-perc-assisted endoscopic surgery (NAES) in the treatment of staghorn renal stones via a single-center prospective randomized controlled study. Methods: A total of 219 patients with partial or complete staghorn renal stones were prospectively randomized into two groups between January 2020 and April 2022. In group A (n = 112), patients were treated with traditional standard access, multiple if necessary, and in group B (n = 107), only one standard access was made, and needle-perc was assisted to remove the residual stones in the same stage. All procedures were guided under ultrasound totally. Stone size, operating time, blood loss, pain score, complications, and other related characteristics were monitored and analyzed. Results: Procedures were successful in all patients. The baseline characters were similar between the groups. The mean stone size was comparable (4.5 ± 1.4 vs. 4.7 ± 1.7, p = 0.35). The 1-month stone-free status was achieved in 85 patients (75.9%) in group A and 80 (74.8%) patients in group B (p = 0.72). The operation time was shorter in group A than B (75.1 ± 28.1 min vs. 97.2 ± 20.4 min, p = 0.02). A less blood loss (p = 0.01), shorter hospital stay (p = 0.04), lower pain score (p = 0.04), and lower severe complication rates (p = 0.03) were observed in group B. Conclusion: NAES reveals better postoperative recurrence compared with traditional multiple tracts method for treating staghorn renal stones. The stone-free rate was comparable between the two groups. [ABSTRACT FROM AUTHOR]

Eight patients did not require medical evaluation nor antibiotic treatment as fever resolved spontaneously, 8 cases were managed with an oral antimicrobial therapy and 1 patient required hospitalization and intravenous antimicrobial therapy. Between 2018 and 2019, we prospectively evaluated the incidence of infectious complications in 39 patients undergoing routine office nephrostomy tube replacement performed without any antimicrobial prophylaxis. [Extracted from the article]

Introduction: The probability of prostate cancer detection is related to the amount of tissue represented. For optimal tissue representation, the specimens should preserve their regular cylindrical shape and avoid artefacts and deformation caused by fixation and preembedding. The aim of our study was to compare contemporary preembedding methods including a new method of using thick cardboard. Materials and Methods: To compare the preembedding methods, we took 36 nonfragmented cores from fresh prostatectomy specimens for each method, fixed them in formalin and made histological slides. The comparison criteria were a core section area in the middle section and the number of fragments per core after processing. Results: Two methods (preembedding on the edge of thick cardboard and on biplicated paper) provided a bigger section area of specimens. The differences in amounts of fragments were very small among the methods mentioned above and the preembedding glass with grooves, but preembedding between two sponges in a histological cassette showed higher fragmentation. Conclusions: Preembedding on the edge of thick cardboard and on biplicated paper can be recommended as effective methods of prostate biopsy core fixation. Paper or cardboard for fixation of prostate biopsy cores should be presoaked with formalin or normal saline. © 2015 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Background/Aims/Objectives: Women with recurrent urinary tract infections (UTIs) are commonly referred to urology outpatient clinics. However, there is no clear consensus in existing guidelines as to if, or how, these should be investigated. The primary outcome was to evaluate all available literature to determine the percentage of abnormal findings in non-pregnant women with recurrent simple UTIs. Secondary outcomes were to determine the percentage that were serious, consequential or incidental findings. Methods: A full literature search was performed of the following databases: MEDLINE; Pubmed; Cochrane Central Register of Controlled Trials-CENTRAL; and ClinicalTrials.gov. Two assessors reviewed the articles independently. Any discrepancy was discussed and an agreement reached. Results: The literature search yielded 662 titles; 652 were excluded on initial review. A further 13 studies were gathered from references of yielded papers. After full review, 12 were included for analysis. These showed that < 1.5% of women investigated for recurrent simple UTIs with imaging or flexible cystoscopy had life-threatening pathology, but up to 67% had abnormal urodynamics. Conclusions: Women presenting with simple recurrent UTIs should have a flow rate and post-void residual measured. Cystoscopy is not warranted and imaging is unlikely to be of value in the absence of symptoms of upper tract disease or gynaecological problems. [ABSTRACT FROM AUTHOR]

Background: It has been reported that compared with no local therapy (NLT), patients treated with local therapy (LT) using radiotherapy (RT) possess higher survival rate in metastatic prostate cancer (mPCa). The aim of this meta-analysis was to evaluate the impact of RT on prognosis in patients with mPCa. Methods: We retrieved the literature in PubMed, Embase, and Cochrane Library databases until June 2019 using structured search terms. Several studies were included, which evaluated patients with mPCa who received RT versus NLT. Results: A total of 14,542 patients were analyzed in 7 included papers (2 randomized controlled trials [RCTs] and 5 cohort retrospective studies [CRS]), and 2,232 mPCa patients were treated with RT and 12,310 with NLT. The data of RCTs and CRS were analyzed separately. In RCTs, RT was associated with no significant difference in overall survival (OS) (pooled hazard ratio [HR] = 0.96; 95% confidence interval [CI]: 0.85–1.09; p = 0.55; I2 = 42%) relative to NLT, while survival benefit was observed in the low-metastatic burden group (pooled HR = 0.68; 95% CI: 0.54–0.86; p = 0.001; I2 = 0%), and no survival benefit was observed in the high-metastatic burden group (pooled HR = 1.07; 95% CI: 0.92–1.24; p = 0.39; I2 = 0%). In CRS, RT results in lower cancer-specific mortality (CSM) (pooled HR = 0.49; 95% CI: 0.34–0.75; p < 0.00001; I2 = 0%) and higher OS (pooled HR = 0.61; 95% CI: 0.55–0.68; p < 0.00001; I2 = 0%) relative to NLT. Subsequent analysis demonstrated that high level of M-stage or N-stage was associated with increased CSM (pooled HR = 2.08; 95% CI: 1.69–2.55; p < 0.00001; I2 = 0% and pooled HR = 1.16; 95% CI: 1.03–1.30; p < 0.00001; I2 = 0%; respectively). Conclusions: Our observations in aggregate indicated that RT at least does not appear to be harmful and may be beneficial for low-metastatic burden patients and better condition patients. More prospective and randomized studies evaluating RT for mPCa are warranted. [ABSTRACT FROM AUTHOR]

Background: Pre-stenting (PS) on the outcomes of semirigid and flexible ureteroscopic lithotripsy for a different upper urinary urolithiasis remains controversial. We performed a meta-analysis comparing the outcomes of ureteroscopic lithotripsy between PS and non-PS. Materials and Methods: Randomized, controlled trials and observational studies comparing PS and non-PS were identified from electronic databases. Stone-free rate (SFR), operative time, and complications were compared by qualitative and quantitative syntheses (meta-analyses). Results: Eleven articles were included in this study. Nearly, all of recently published studies exhibited relatively moderate or high quality during quality assessment. PS was more likely to achieve good SFR compared with non-PS (p < 0.00001). The subgroup results indicated that PS improved the SFR for renal stones and the stones dealt by flexible ureteroscopy (p = 0.0002; p < 0.0001, respectively; some ureteral stones were dealt by flexible ureteroscopy). Ureteral stones and the stones dealt by semirigid ureteroscopy were not influenced by PS (p = 0.62; p = 0.90, respectively). PS is equal as non-PS in terms of operative time for renal stones and the renal and ureteral stones dealt by flexible ureteroscopy (p = 0.47; p = 0.05). No significant difference was found in major complications between the 2 groups for total or for the subgroup of renal stones (p = 0.3; p = 0.69). Conclusions: For ureteral stones or the stones dealt by semirigid ureteroscopy, PS does not show any benefits. For renal stones or the stones dealt by flexible ureteroscopy, PS improves the SFR and may be as safe as non-PS. [ABSTRACT FROM AUTHOR]

Background: The aim of the study was to identify the cooperation of authors, countries, institutions and explore the hot spots regarding research of tyrosine kinase inhibitors (TKIs) for renal cell carcinoma (RCC) treatment in the past 22 years. Summary: Relevant original and review articles were obtained from the Web of Science Core Collection from 2000 to 2022. CiteSpace software was used to perform the visualization of scientific productivity and emerging trends. Network maps were generated to evaluate the collaborations between different authors, countries, institutions, and keywords. Key Messages: A total of 4,951 articles related to TKI for RCC treatment were identified. We observed a gradual increase in the number of publications from 2000 to 2022. The USA dominated the field in all countries, and Mem Sloan Kettering Cancer Centre (USA) had more extensive cooperating relationships with other institutions. Motzer RJ and Escudier B were two of the authority scholars in this specific field with the most publications and co-citations. Journal of Clinical Oncology had the most citations of all the journals. A total of 10 major clusters were explored based on the reference co-citation analysis. From 2000 to 2022, the research hot spots have undergone two dramatic shifts during 2006 and 2019, respectively, relevant topics were TKI and TKI combined with immune checkpoint inhibitors (CPIs). At present, the research hot spots focus on CPI and targeted therapies. Bibliometric analysis is allowing researchers to recognize the current research status by providing a comprehensive overview of the development of scientific literature related to TKI for RCC treatment, and information for further research be demonstrated as well. [ABSTRACT FROM AUTHOR]

Introduction: The relationship between cruciferous vegetables and prostate cancer (PCa) risk remains contentious. This study aimed to assess the association between consuming cruciferous vegetables and PCa risk. Methods: We carried out a systematic search through PubMed, Embase, Web of Science, and the Cochrane Library until September 20, 2022. The results of the article will be analyzed using the Stata 14 software. This meta-analysis was reported as directed by the PRISMA guidance, and the study protocol was recorded in PROSPERO (CRD42022361556). Results: 7 case-control studies and 9 cohort studies were eventually included, including 70,201 PCa cases and 1,264,437 members. The higher the intake of cruciferous vegetables, the lower the risk of PCa. In comparison to the lowest dose of cruciferous vegetables, the overall relative risk (RR) of cruciferous vegetables having the highest dose was 0.87 (95% confidence interval [CI]: 0.80–0.95; I2 = 59.2%). A significant linear trend (p = 0.002) was observed for the association, with a combined RR of 0.955 (95% CI: 0.928–0.982) for every 15 g of cruciferous vegetables per day. Conclusions: The study revealed that consumption of cruciferous vegetables may be linked to reduced PCa risk. [ABSTRACT FROM AUTHOR]

Introduction: The aim of this study was to perform a systematic review of studies reporting the outcomes of ACT® balloons in female patients with stress urinary incontinence (SUI) due to intrinsic sphincter deficiency (ISD). Methods: In accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) standards, a systematic search of the PubMed (Medline) and Scopus electronic database was performed in June 2022. Terms used for the query were ("female" or "women") and ("adjustable continence therapy" OR "periurethral balloons"). Results: Thirteen studies were included. All were retrospective or prospective case series. The success rates ranged from 13.6% to 68% and the improvement rates from 16% to 83%. The intraoperative complication rate ranged from 3.5 to 25% and consisted of urethral, bladder, or vaginal perforations. The rate of postoperative complications varied from 11 to 56% without major complications. Between 6% and 38% of ACT® balloons were explanted and subsequently reimplanted in 15.2–63% of cases. Conclusion: ACT® balloons can be considered as an option to treat SUI due to ISD in female patients with a relatively modest success rate and quite a high complication rate. Well-designed prospective studies and long-term follow-up data are needed to fully elucidate their role. [ABSTRACT FROM AUTHOR]

Introduction: We aimed to evaluate clinical features, prognostic factors, and treatment preferences in patients with non-clear cell renal cell carcinoma (nccRCC). Methods: Patients with metastatic nccRCC were selected from the Turkish Oncology Group Kidney Cancer Consortium (TKCC) database. Clinical features, prognostic factors, and overall survival (OS) outcomes were investigated. Results: A total of 118 patients diagnosed with nccRCC were included in this study. The median age at diagnosis was 62 years (interquartile range: 56–69). Papillary (57.6%) and chromophobe tumors (12.7%) are common histologic subtypes. Sarcomatoid differentiation was present in 19.5% of all patients. When the patients were categorized according to the International Metastatic RCC Database Consortium (IMDC) risk scores, 66.9% of the patients were found to be in the intermediate or poor risk group. Approximately half of the patients (55.9%) received interferon in the first line. At the median follow-up of 53.2 months (95% confidence interval [CI]: 34.7–71.8), the median OS was 19.3 months (95% CI: 14.1–24.5). In multivariate analysis, lung metastasis (hazard ratio [HR]:2.22, 95% CI: 1.23–3.99) and IMDC risk score (HR: 2.35, 95% CI: 1.01–5.44 for intermediate risk; HR: 8.86, 95% CI: 3.47–22.61 for poor risk) were found to be independent prognostic factors. Conclusion: In this study, survival outcomes are consistent with previous studies. The IMDC risk score and lung metastasis are the independent prognostic factors for OS. This is an area that needs research to better treat this group of patients and create new treatment options. [ABSTRACT FROM AUTHOR]

Introduction: Urolithiasis is one of the most common diseases in the world, and at present, ureteroscopy (URS) is the first choice for its treatment. Although the effect is good, there is a risk of insertion failure of ureteroscope. Tamsulosin, as an α-receptor blocker, has the function of relaxing ureteral muscles, and can help stones to be discharged from ureteral orifice. In this study, we aimed to determine the effect of preoperative tamsulosin on ureteral navigation, operation, and safety. Methods: This study was conducted and reported according to the meta-analysis extension of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). The PubMed and Embase databases were searched for studies. Data were extracted according to the PRISMA principles. We collected and combined randomized controlled trial and researches in reviews of preoperative tamsulosin to explore the effect of preoperative tamsulosin on ureteral navigation, operation, and safety. A data synthesis was performed using RevMan 5.4.1 software (Cochrane). Heterogeneity was mainly evaluated with I2 tests. Key metrics include: success rate of ureteral navigation, time of URS, stone-free rate, and postoperative symptoms. Result: We summarized and analyzed 6 studies. We noted a statistically significant improvement in the success rate of ureteral navigation (Mantel-Haenszel [M-H], odds ratio [OR]: 3.78, 95% confidence interval [CI]: [2.34, 6.12], p < 0.01) and stone-free rate (M-H, OR: 2.25, 95% CI: [1.16, 4.36], p = 0.02) with tamsulosin preoperatively. At the same time, we also observed that postoperative fever (M-H, OR: 0.37, 95% CI: [0.16, 0.89], p = 0.03) and postoperative analgesia (M-H, OR: 0.21, 95% CI: [0.05, 0.92], p = 0.04) were also reduced because of preoperative tamsulosin. Conclusion: Preoperative tamsulosin can not only increase the one-time success rate of ureteral navigation and the stone-free rate of URS but also reduce the incidence of postoperative adverse symptoms such as postoperative fever and postoperative pain. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study was to evaluate the efficacy and safety of transperitoneal and retroperitoneal laparoscopic ureterolithotomy (TLU and RLU). Materials and Methods: We undertook a literature search PubMed, Embase, and the Cochrane Library. Search date will range from inception to January 1, 2020. The final article results will be analyzed using StataSE 12 software. This meta-analysis was reported according to PRISMA guidelines, and a protocol was registered in PROSPERO (CRD42020160906). Results: Eleven articles eventually met the requirements, involving a total of 609 patients. The final result shows the operative time (Std. Mean Difference [SMD] = 0.58; 95% CI 0.36–0.80; p < 0.01), hospital stay (SMD = 0.26; 95% CI 0.02–0.49; p = 0.031), and the complication of paralytic ileus (risk difference = 0.11; 95% CI 0.05–0.17; p < 0.01) are significant difference between TLU and RLU, and TLU are higher or longer. Conclusions: Our meta-analysis suggests that if there are no other constraints, it is better to choose RLU. And more clinical trial data are needed to confirm this conclusion. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic has caused a global health threat. This disease has brought about huge changes in the priorities of medical and surgical procedures. This short review article summarizes several test methods for COVID-19 that are currently being used or under development. This paper also introduces the corresponding changes in the diagnosis and treatment of urological diseases during the COVID-19 pandemic. We further discuss the potential impacts of the pandemic on urology, including the outpatient setting, clinical work, teaching, and research. [ABSTRACT FROM AUTHOR]

This paper reviews the files in the archive of the Nobel Prize Committee for Physiology or Medicine on the Austrian physiologist and pioneering researcher in the emerging fields of urology and sexual medicine: Eugen Steinach (1861–1944). It reconstructs and analyzes why and by whom Steinach was nominated for the Nobel Prize between 1920 and 1938 and discusses the reasons why he never received the award, although the Nobel Committee judged him as prizeworthy. Steinach's Nobel nominee career is extraordinary – not only because of his strong support by renowned international nominators from different scientific and medical disciplines, but also because of the controversial discussions within the Nobel Committee on his achievements, colored by the debates in the international scientific community. The Nobel Prize story adds a new perspective on how contemporary international scholars evaluated Steinach's research on reproduction, "male-making" females, "female-making" males, homosexuality, and the concept of rejuvenation. [ABSTRACT FROM AUTHOR]

Introduction: DNA methylation regulates gene transcriptional functions in the pathogenesis of malignant diseases. In prostate cancer, several tumor suppressors are known to be tumor specifically methylated. Methods: In this study, 450K methylation data and mRNA expression data were accessed from The Cancer Genome Atlas-Prostate Adenocarcinoma database and analyzed bioinformatically. Methylation-specific PCR was used to examine the methylation condition in AOX1 promoter. qRT-PCR was applied to measure the mRNA expression of AOX1. Western blot was employed to detect the expressions of AOX1 and the EMT associated proteins. Transwell and scratch healing assays were used to examine the invasive and migratory abilities of the prostate cancer cells respectively. Results: AOX1 was lowly expressed and hypermethylated in the prostate cancer tissues and cells. Also, AOX1 was downregulated at protein level in prostate cancer cells. Knocking down AOX1 could promote cell migration and invasion in the prostate cancer cells. By using a DNA methylation inhibitor, 5-AzadC was found to promote the expression of AOX1 and reverse the promoting effects of short interfering RNA against AOX1 on cell migration and invasion. Conclusion: This study suggested that DNA methylation and low AOX1 level might be biomarkers for prostate cancer. [ABSTRACT FROM AUTHOR]

Introduction: Previous studies have revealed that Gleason score upgrading (GSU) was closely related to an increased biochemical recurrence rate and adverse oncologic outcomes in patients with prostate cancer (PC). Therefore, we performed a meta-analysis to determine the predictive factors for GSU following radical prostatectomy (RP). Methods: We performed an extensive literature search using PubMed, Embase, and Cochrane in September 2022. In order to calculate the pooled odds ratio (OR), standardized mean difference (SMD), and 95% confidence intervals, a fixed effect or a DerSimonian and Laird random effect was applied. Results: Twenty-six studies included 18,745 PC patients that were available for further analysis. Our results revealed that GSU was significantly correlated with age (summary SMD = 0.13; p = 0.004), prostate volume (PV) (summary SMD = −0.19;p < 0.001), preoperative PSA (p-PSA) (summary SMD = 0.18; p < 0.001), PSA density (PSAD) (summary SMD = 0.40; p < 0.001), number of positive cores (summary SMD = 0.28; p = 0.001), percentage of positive cores (summary SMD = 0.36; p < 0.001), Prostate Imaging Reporting and Data System (PI-RADS) scores (>3/≤3) (summary OR = 2.27; p = 0.001), clinical T stage (>T2/≤T2) (summary OR = 1.73; p < 0.001), positive surgical margins (PSM) (summary OR = 2.12; p < 0.001), extraprostatic extension (EPE) (summary OR = 2.73; p < 0.001), pathological T stage (>T2/≤T2) (summary OR = 3.45; p < 0.001), perineural invasion (PNI) (summary OR = 2.40; p = 0.008), and neutrophil to lymphocyte ratio (NLR) (summary SMD = 0.50; p < 0.001). However, we found that GSU was not significantly correlated with body mass index (BMI) (summary SMD = −0.02; p = 0.602). Moreover, our sensitivity and subgroup analyses showed that the findings were reliable. Conclusions: Age, PV, p-PSA, PSAD, number of positive cores, percentage of positive cores, PI-RADS score, clinical T stage, PSM, EPE, pathological T stage, PNI, and NLR are independent factors predicting GSU following RP. The findings may be helpful in risk stratification and personalized treatment in PC patients. [ABSTRACT FROM AUTHOR]

Background: This prospective single-arm study is designed to compare in parallel 68Ga-PSMA PET/TRUS (transrectal or transperineal) fusion biopsy ("experimental test") with multiparametric MRI (mpMRI)/TRUS fusion prostate biopsy ("standard test") in men with a high suspicion of prostate cancer (PCa) after at least one negative biopsy. The primary objective was to evaluate the diagnostic performance of 68Ga-PSMA PET/TRUS fusion prostate biopsy in comparison to mpMRI/TRUS fusion prostate biopsy analyzed in parallel. Secondarily, we aimed to determine the relationship between the "experimental test" and the histopathological characteristics of the specimen, along with the clinical utility of the "experimental test" compared to the "standard test." Summary: To test the superiority of 68Ga-PSMA PET/CT compared to mpMRI, we will enroll a minimum cohort of 128 patients. Inclusion criteria comprise: age >18 years; blood PSA level >4.0 ng/mL; free-to-total PSA ratio <20%; progressive rise of PSA levels in two consecutive blood samples despite antibiotics; serum blood tests suspicious for PCa; at least one previous negative biopsy; ASAP and/or high-grade PIN; negative digital rectal examination. All eligible patients will undergo 68Ga-PSMA PET/CT and mpMRI scans within 1 month's distance from each other, followed by biopsy session to be completed within 1 month's distance. Targeted TRUS fusion needle biopsy will be performed for all lesions detected with PET and mpMRI. The total duration of the study is 36 months.Key Messages: By comparing the "experimental test" and the "standard test" in parallel, we will be able to determine the superior diagnostic performance of 68Ga-PSMA PET/CT over mpMRI in detecting PCa, and in particular clinically significant PCa, in the specific cohort of patients with a high suspicion of PCa who are candidates to re-biopsy. The clinical impact of the "experimental test" will be subsequently analyzed in terms of the number of prostate biopsies that could be spared, time-consuming, patient friendliness, and cost-effectiveness. [ABSTRACT FROM AUTHOR]

Objectives: This study aimed to evaluate the cumulative incidence of overall and severe radiation cystitis following external beam radiation therapy for prostate cancer and investigate the clinical factors predictive of radiation cystitis. Methods: This retrospective study comprised 246 patients who received external beam radiation therapy for localized or locally advanced prostate cancer between 2013 and 2016 in our institution. Of these, 189 received primary radiation therapy and 57 received adjuvant/salvage radiation therapy. Radiation cystitis was recorded using the Common Terminology Criteria for Adverse Events version 5.0 definition, and severe radiation cystitis was defined as grade 3 or higher. All medical records were reviewed to calculate the cumulative incidence of radiation cystitis. Univariate and multivariate Cox regression analyses were used to evaluate its association with clinicopathologic features. Results: The median follow-up period after radiation therapy was 56 months (range 5–81). The 5-year cumulative incidence of radiation cystitis and severe radiation cystitis was 16.2% and 3.0%, respectively. Multivariate analyses identified radiation therapy in the adjuvant/salvage setting was the sole risk factor associated with the development of radiation cystitis (hazard ratio: 2.75, p = 0.02). Conclusions: Radiation therapy in the post-prostatectomy setting was associated with increased risk of radiation cystitis compared with radiotherapy as the primary treatment. [ABSTRACT FROM AUTHOR]

Introduction: The aim of the study was to provide data related to endoscopic combined intra-renal surgery learning curve using minimally invasive techniques with vacuum-assisted devices. Minimal data exist on the learning curve for these techniques. Methods: We conducted a prospective study monitoring the training of a mentored surgeon learning ECIRS with vacuum assistance. We use varied parameters for improvements. After collection of peri-operative data, tendency lines and CUSUM analysis were used to investigate the learning curves. Results: 111 patients have been included. Guy's Stone Score 3 and 4 stones 51.3% of all cases. The mostly used percutaneous sheath was 16 Fr (87.3%). SFR was 78.4%. 52.3% patients were tubeless, and 38.7% achieved trifecta. High-degree complication rate was 3.6%. Operative time improved after 72 cases. We observed a decrease of complications throughout the case series, with improvement after 17 cases. In terms of trifecta, proficiency was reached after 53 cases. Proficiency seems achievable in a limited number of procedures, but results did not plateau. Higher number of cases might be necessary for excellence. Discussion: A surgeon learning ECIRS with vacuum assistance can obtain proficiency in 17–50 cases. The number of procedures required for excellence remains unclear. Exclusion of more complex cases might positively affect the training, reducing unnecessary complications. [ABSTRACT FROM AUTHOR]

Introduction: The Butterfly Prostatic Retraction device is a novel transurethral implant designed to dilate the prostatic urethra and treat lower urinary tract symptoms. We assessed its safety, efficacy and impact on urinary flow, ejaculation, and quality of life. Materials and Methods: We included 64 men, treated for benign prostate hyperplasia for at least 1 year. All patients had Qmax≤ 13 mL/s and IPSS >12. Insertion of the device was performed via cystoscopy. Follow-up visits were performed at 2 weeks, 1, 3, 6, and 12 months and included uroflowmetry, IPSS, QoL, and sexual function questionnaires. Cystoscopy was performed on 3 and 12 months. Results: Patients age was 50–83 years. 28 patients completed a 1-year follow-up with an intact device. Mean Qmax improved by 2 mL/s (25%), IPSS median drop was 10 points (40%), and QoL score was 1.5 points (38%). Sexually active patients reported antegrade ejaculation. On cystoscopy, gradual coverage of the devices with urethral mucosa was observed. In 1 patient, the device was repositioned. In 19 patients, the device was removed. 12 patients returned to alpha-blocker therapy and 7 patients underwent TURP. One patient developed a bulbar urethral stricture. Conclusions: We demonstrated feasibility and good tolerability of the Butterfly device. [ABSTRACT FROM AUTHOR]

Introduction: Low skeletal muscle mass (LSMM) can be assessed by cross-sectional imaging. LSMM is associated with several clinically relevant factors in various disorders with predictive and prognostic implications. Methods: Our aim was to establish the effect of computed tomography (CT)-defined LSMM on mortality in renal cell cancer (RCC) and urothelial carcinoma (UC) undergoing palliative treatment. The MEDLINE library, Cochrane, and SCOPUS databases were screened for the associations between CT-defined LSMM up to May 2022. In total, 11 studies were suitable for the analysis. Results: The included studies comprised 481 patients with RCC and 394 patients with UC. The pooled hazard ratio for the association between LSMM and overall survival was 1.64 (95% CI: 0.90–2.99), p = 0.10 in univariable analysis and 1.55 (95% CI: 0.91–2.63), p = 0.10 in multivariable analysis for RCC. For UC, the pooled hazard ratio was 2.75 (95% CI: 1.77–4.28), p < 0.00001 in univariable, and 2.77 (95% CI: 1.91–4.02), p < 0.00001 in multivariable analysis. For progression-free survival, it was 2.02 (95% CI: 1.24–3.27), p = 0.004 for RCC and 2.43 (95% CI: 1.59–3.74), p < 0.0001 for UC (univariable analysis). Conclusions: CT-defined LSMM predicts OS and PFS in RCC and UC in the palliative setting. The effect was higher in UC. Therefore, LSMM assessment should be included as a relevant prognostic biomarker in clinical routine. [ABSTRACT FROM AUTHOR]

Introduction: According to the EAU guidelines, botulinum toxin type A (BoNT-A) detrusor injections are one of the last options in the management of overactive bladder before opting for invasive surgery. So far, there have been no studies dedicated exclusively to such patients who have undergone this treatment and in whom this treatment has presumably failed. From the patient's point of view, there are questions regarding what reasons led to discontinuation, how patients perceive their BoNT-A treatment in hindsight, what further treatment do these patients receive, and how satisfied such patients are with their current situation. Methods: A database of clinical and inpatient records was searched, and 695 records from 406 patients were identified in a 6-year period, who had received BoNT-A detrusor injections. There were 255 cases that were treated with BoNT-A injections into the detrusor muscle where the therapy was not repeated for at least 12 months (= suspected treatment failures). Interviews with these patients were conducted by mail and phone, and 115 questionnaires could be included in the analysis. Results: From the subjective and prospective points of view of the patients, the most common reason for stopping the therapy was a lack of efficacy of BoNT-A injections (39.1%). For 26.1% of all patients, side effects were a reason for dissatisfaction but never a reason for discontinuation. For 10.4%, the reason for stopping the therapy was spontaneous improvement. 35.6% of the respondents had no follow-up therapy. Those with a follow-up therapy mostly returned to anticholinergic treatment (33%). Operations were carried out on 13%, of which about half were highly invasive. For 71.3% of those patients, who were under any current therapy, this therapy led to no improvement or only some improvement of the symptoms. Surprisingly, 50.4% of the respondents would choose to undergo BoNT-A injection therapy again. Discussion/Conclusion: The majority of patients who did not continue BoNT-A therapy are still suffering from lower urinary tract symptoms. The lack of efficacy was the reason for stopping the BoNT-A injection therapy for less than half of the patients. From the patient's point of view, reasons other than the effectiveness also seem to be relevant in the choice of the treatment. When changing therapy, most returned to drug treatment. However, for the majority of patients with any follow-up therapy, this therapy could not improve the symptoms. [ABSTRACT FROM AUTHOR]

Introduction: To understand the significance of ANLN (anillin, actin-binding protein)-mediated c-Jun N-terminal kinase (JNK) signal pathway on the progression of bladder urothelial carcinoma (BLCA). Methods: The Cancer Genome Atlas (TCGA) database was utilized to perform the clinical significance of ANLN in BLCA. Then, ANLN expression was determined in human normal primary bladder epithelial cells (BdEC) and BLCA cells. Later, ANLN knockdown was performed in BLCA cells, where the expression of MAPK8, MAPK9, and p-JNK/JNK was detected. BLCA cells were divided into the Mock, siNC, siANLN, SP600125 (a selective JNK inhibitor), and ANLN + SP600125 group, followed by measurements of real-time quantitative polymerase chain reaction, 3-4,5-dimethylthiazol-2-yl)-2,5-diphenyl tetrazolium bromide, Annexin V-FITC/PI, Wound-healing, Transwell, and immunofluorescence assays. Results: ANLN was upregulated in the BLCA tissues, which showed a relation with the stage of patients. Besides, BLCA patients with high expression of ANLN had a worse prognosis than those with low expression of ANLN. Besides, the expression of ANLN in the BLCA tissues was positively correlated with MAPK8 and MAPK9. SP600125 suppressed the JNK signal pathway, reduced the proliferation, and increased BLCA cell apoptosis, with the reductions in the invasion and migration and the upregulation of phospho-histone H3 Ser-10 (pHH3), which was abolished by the overexpression of ANLN. Conclusion: ANLN, as an oncogene of BLCA, may associate with the activation of JNK signal pathway. Inhibiting ANLN could deactivate the JNK signal pathway, thereby suppressing the proliferation, invasion, and migration while promoting the apoptosis of BLCA cells. [ABSTRACT FROM AUTHOR]

Introduction: This study aimed to assess patient compliance with a newly established electronic patient-reported outcome measure (ePROM) system after urologic surgery and to identify influencing factors. Methods: Digital surveys were provided to patients undergoing cystectomy, radical or partial nephrectomy, or transurethral resection of bladder tumor via a newly established ePROM system. Participants received a baseline survey preoperatively and several follow-up surveys postoperatively. Multivariable regression analysis was performed to identify factors predicting compliance. Results: Of N = 435 eligible patients, n = 338 completed the baseline survey (78.0%). Patients who did not participate were significantly more likely male (p = 0.004) and older than 70 years (p = 0.005). Overall, 206/337 patients (61.3%) completed the survey at 1-month, 167/312 (53.5%) at 3-month, and 142/276 (51.4%) at 6-month follow-up. Lower baseline quality of life (odds ratio: 2.27; p = 0.004) was a significant predictor for dropout at 1-month follow-up. Low educational level was significantly associated with low compliance at 3- (OR: 1.92; p = 0.01) and 6-month follow-up (OR: 2.88; p < 0.001). Conclusion: Acceptable compliance rates can be achieved with ePROMs following urologic surgery. Several factors influence compliance and should be considered when setting-up ePROM surveys. [ABSTRACT FROM AUTHOR]

Background: The aim of the study was to assess the effectiveness of the main classes of drugs used at reducing morbidity related to ureteric stents. Summary: After establishing a priori protocol, a systematic electronic literature search was conducted in July 2019. The randomized clinical trials (RCTs) selection proceeded in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines and was registered (PROSPERO ID 178130). The risk of bias and the quality assessment of the included RCTs were performed. Ureteral Stent Symptom Questionnaire (USSQ), International Prostate Symptom Score (IPSS), and quality of life (QoL) were pooled for meta-analysis. Mean difference and risk difference were calculated as appropriate for each outcome to determine the cumulative effect size. Fourteen RCTs were included in the analysis accounting for 2,842 patients. Alpha antagonist, antimuscarinic, and phosphodiesterase (PDE) inhibitors significatively reduced all indexes of the USSQ, the IPSS and QoL scores relative to placebo. Conversely, combination therapy (alpha antagonist plus antimuscarinic) showed in all indexes of the USSQ, IPSS, and QoL over alpha antagonist or antimuscarinic alone. On comparison with alpha blockers, PDE inhibitors were found to be equally effective for urinary symptoms, general health, and body pain parameters, but sexual health parameters improved significantly with PDE inhibitors. Finally, antimuscarinic resulted in higher decrease in all indexes of the USSQ, the IPSS, and QoL relative to alpha antagonist. Key message: Relative to placebo, alpha antagonist alone, antimuscarinics alone, and PDE inhibitors alone have beneficial effect in reducing stent-related symptoms. Furthermore, there are significant advantages of combination therapy compared with monotherapy. Finally, PDE inhibitors are comparable to alpha antagonist, and antimuscarinic seems to be more effective than alpha antagonist alone. [ABSTRACT FROM AUTHOR]

Introduction: Rhabdomyomas are benign tumors of striated muscle, the bladder localization is very rare. Clinical Case: We present an 87-year-old male consulting for gross hematuria. Cystoscopy was done with evidence of bulged bladder mucosa in right side wall and dome. Post-transurethral resection of the bladder (TURB) pathological anatomy was negative for malignancy. As extension study abdominopelvic computed tomography was performed identifying a bladder thickening of right posterior sidewall and an increased density of the adjacent fat. Second TURB was performed and a fetal bladder rhabdomyoma intermediate type was obtained. We performed another biopsy to confirm this rare pathology, with the same diagnosis. Subsequently, the patient continues with hematuria deciding on hemostatic radiotherapy (not candidate for cystectomy or arterial embolization). Currently, the patient is asymptomatic. Discussion: Bladder rhabdomyomas are rare tumors, and, in fact, there have been only 5 papers published. Some cases are only isolation cited in the bladder mesenchymal tumors, and other polemic cases in which clinical and macroscopic characteristics remembered a rhabdomyosarcoma. The importance of this publication case is the macro- and microscopic images that can corroborate the final diagnosis, helping us to differentiate between rhabdomyoma, rhabdomyofibroma, or the malignant rhabdomyosarcoma, and shows the treatment possibilities of these tumors. [ABSTRACT FROM AUTHOR]

Background: Non-contrast computed tomography of the kidneys, ureters, and bladder (CT KUB) is the investigation of choice for renal colic; however, radiation exposure can be a concern. Aims: The study aimed to investigate the diagnostic accuracy of low dose (LD) and ultra-low dose (ULD) CT of the urinary tract for detection of urinary tract stones in patients with renal colic. Methods: A Cochrane style systematic review of the literature from 1995 to 2017 was carried out. Literature search and data extraction were conducted by 2 reviewers. Specificity and sensitivity values were calculated for LD (<3.5 mean radiation dose [mSv]) and ULD (<1.9 mSv) CT separately. Results: A total of 12 studies were included following screening. A total of 1,529 patients were included in the review (475 in the LD group and 1,054 in the ULD group). Using standard dose CT KUB as the reference standard, the sensitivity of LD CT KUB ranged from 90 to 98% and specificity from 88 to 100%. The sensitivity of ULD CT KUB ranged from 72 to 99% and the specificity ranged from 86 to 100%. The diagnostic accuracy for LD CT was 94.3% and for ULD CT was 95.5%. Conclusions: LD and ULD CT KUB provide effective methods of identifying urinary tract stones. High diagnostic accuracy, sensitivity, and specificity are maintained despite significant radiation dose reduction in comparison to standard dose CT. [ABSTRACT FROM AUTHOR]

Introduction: Different types of grafts have been described in urethral reconstruction (UR), with penile skin graft (PSG) and buccal mucosa graft (BMG) as the most frequently used ones. It still remains unclear whether one graft is superior in terms of success when compared to the other. Material and Methods: A systematic review of the literature was performed searching the MEDLINE database with the following search strategy: 'urethroplasty' AND 'penile skin'/ 'urethroplasty' AND 'buccal mucosa'. 266 and 144 records were retrieved for urethroplasty with PSG and BMG, respectively. These records were reviewed to identify papers where PSG and BMG were used in UR and where individualized data on success were available within the same series. Results: 18 papers were found eligible for further analysis. In total, 428 and 483 patients were respectively treated with PSG or BMG. If available, follow-up duration was 64.1 versus 42.1 months (p < 0.0001) and stricture length 6.2 versus 4.6 cm (p < 0.0001) for PSG and BMG, respectively. Success of UR with PSG was 81.8 versus 85.9% with BMG (p = 0.01). Conclusions: Success of UR using BMG is significantly better compared to PSG. Results might be seriously biased by a longer follow-up duration and stricture length for PSG compared to BMG. Copyright © 2012 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Introduction: Conventional open surgical techniques allow proper surgical management for renal malignancies but have their intrinsic drawbacks. The aim of this paper is to present our technique in minimal renal exposure while avoiding the intrinsic complications of conventional techniques. Methods: We described our technique, which can be easily understood and replicated by urologists performing open kidney surgery. Results: Ninety-five patients had this technique done safely over the last 4 years, and 3 patients had this exposure changed into intraperitoneal extended wound for very large upper pole tumours. The median operating time was 70 min. No single patient required intraoperative blood transfusion. Median warm ischemic time was 9 min. Conclusion: Transverse lumbotomy is a safe reproducible technique that allows proper kidney exposure through a relatively smaller wound and avoiding unnecessary auxiliary techniques as rib resection, pleural tear management, and intraperitoneal exposure. [ABSTRACT FROM AUTHOR]

A unipapillary kidney is a very rare anomaly in humans. In this paper, we report on a case of a 47-year-old woman with end-stage kidney disease (ESKD) due to unipapillary kidney, who had been on hemodialysis for 20 years and who had successfully received deceased-donor kidney transplantation. The aim of this report is to present a case of a rare unipapillary kidney patient who underwent kidney transplantation without any urological complications. Our results suggest that kidney transplantation may be an effective renal replacement therapy for patients with ESKD due to unipapillary kidney. [ABSTRACT FROM AUTHOR]

Objective: Laparoscopic adrenalectomy (LADX) improves hypertension in patients with primary aldosteronism (PA). However, the antihypertensive impact of LADX appears restricted in older patients with PA. In this study, we evaluated the impact of LADX in older patients focusing on the health-related quality of life (HRQoL). Methods: A total of 156 patients with PA who underwent LADX in a single institution were enrolled in this prospective cohort study. The patients were divided into 2 groups, with a boundary of 60 years. The HRQoL was evaluated using the Medical Outcomes Study's 36-Item Short-Form Health Survey version 2 (SF-36v2) questionnaire before and after LADX. Demographics, clinical features, antihypertensive drugs before and after surgery, and perioperative evaluation were recorded. We compared all scale scores and summed scores between groups. Multivariate regression models were used to determine the associations between various covariables and the HRQoL. Results: In the older PA patients, most subscales of HRQoL at baseline were lower than the national standard values. The antihypertensive drug-free rate by LADX was only 21% in older patients, compared to 58% in younger patients. However, a significant improvement in mental HRQoL was observed after LADX (p = 0.002). The much preoperative antihypertensive drugs, lower preoperative potassium level, and smaller degree of comorbidities were predictors of improved mental HRQoL by LADX on multivariate analyses. Conclusion: The older PA patients showed lower mental HRQOL than the national standard populations. Although antihypertensive effects were limited for these patients, LADX was beneficial as PA treatment via improvement of mental HRQoL. [ABSTRACT FROM AUTHOR]

Objectives: Bladder cancer is a common type of malignancy. UBC®Rapid is a novel immunoassay detecting urine cytokeratin 8/18 protein. Studies have shown good accuracy of UBC®Rapid in detecting bladder cancer. UBC®Rapid has however to date not been evaluated in Asian patients. We evaluated UBC®Rapid in detecting Asian bladder cancer, together with urine cytology. Methods: In total, 112 patients were recruited from National University Hospital Singapore and 103 patients were included in this study, comprising 49 patients with bladder urothelial carcinoma (UC), 21 patients with bladder benign lesions, and 33 patients with normal bladder. All the bladder cancer and benign lesions were confirmed by histology. Voided urine was collected for UBC®Rapid test. The results were compared with urine cytology. Results: The bladder UC group had remarkably higher UBC®Rapid value than the control groups. The sensitivity, specificity, positive, and negative predictive value of UBC®Rapid in detecting bladder UC were 53%, 85.5%, 76.5%, and 66.8%, respectively. Those of urine cytology were 40.8%, 96.3%, 90.9%, and 64.2%, respectively. Adding UBC®Rapid to urine cytology increased sensitivity to 57.1% but decreased specificity to 81.8%. UBC®Rapid was sensitive in detecting high-grade bladder UC (61.1%) and carcinoma in situ (CIS) (72.7%), as compared to urine cytology for bladder UC (55.6%) and CIS (54.5%), respectively. Conclusion: UBC®Rapid is sensitive in detecting high-grade bladder UC and CIS in Asian population. It may be useful as an adjunct test to achieve better detection of bladder cancer. [ABSTRACT FROM AUTHOR]