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Bladder cancer is a leading cancer type in men. The complexity of treatment in late-stage bladder cancer after systemic spread through the lymphatic system highlights the importance of modulating disease-free progression as early as possible in cancer staging. With current therapies relying on previous standards, such as platinum-based chemotherapeutics and immunomodulation with Bacillus Calmette-Guerin, researchers, and clinicians are looking for targeted therapies to stop bladder cancer at its source early in progression. A new era of molecular therapies that target specific features upregulated in bladder cancer cell lines is surfacing, which may be able to provide clinicians and patients with better control of disease progression. Here, we discuss multiple emerging therapies including immune checkpoint inhibitors of the programmed cell death protein 1 (PD-1)/programmed death ligand 1 (PD-L1) pathway, antibody-drug conjugates, modulation of the phosphoinositide 3-kinase (PI3K)/protein kinase B (AKT)/mammalian target of rapamycin (mTOR) cell proliferation pathway, chimeric antigen receptor T-cell therapy, and fibroblast growth factor receptor targeting. Together, these modern treatments provide potentially promising results for bladder cancer patients with the possibility of increasing remission and survival rates.

Priapism is a disorder defined as a persistent erection maintained without an appropriate sexual stimulus lasting for longer than 4 hours. Priapism is generally classified into two categories, ischemic and non-ischemic. Ischemic priapism is considered a true urological emergency as prolongation of this subtype is often associated with loss of sinusoidal endothelial function, corporal fibrosis, and necrosis. Non-ischemic priapism is a type of priapism often caused by the formation of arteriovenous fistulas that create dysregulation of cavernosa blood flow. One less common cause of priapism includes malignancy. Malignancy, either primary or secondary, is considered a rare cause of priapism. During our review of malignant priapism, several etiologies have been identified as potential causes of malignant priapism. Pathologies such as chronic myelogenous leukemia, chronic lymphocytic leukemia, and myelodysplastic syndromes have been implicated in the development of priapism, most likely due to hyperleukocytosis. Metastasis from distal or regional tumors such as the lung, bladder, prostate have been shown to produce secondary tumors that can initiate the development of priapism. Thus, it is important to consider malignancy as a possible cause of a patients priapism. The clinical presentation and prognosis between patients vary greatly and modern treatment modalities have been shown to differ greatly in its efficacy. A comprehensive study that addresses the different forms of malignant priapism may benefit healthcare professionals by providing a better understanding of the complexities, etiologies, and early interventions that can be used for their patients.

The adrenal glands are a common site of metastases in many advanced stages of cancers such as lung cancer and breast cancer. Given the frequent asymptomatic nature of these adrenal metastatic tumors, patients seldom get screened for adrenal metastases unless otherwise medically indicated for. Therefore, it is essential that screening methods should be as accurate and precise as possible. In this review, we summarize the pivotal role of modern screening in the early detection of adrenal metastatic lesions and detail the advancements that have contributed to improved detection. Through our review, we reaffirm that there has yet to be a “gold standard” in the screening process for adrenal metastases. Such a study can help medical professionals more comprehensively understand the contemporary screening methods, promoting early detection and better prognosis of adrenal metastases.

This is a letter to the editor on the discussion on COVID-19 and testicular tumors.

Abstract Background Ciliated muconodular papillary tumor (CMPT) is an incredibly rare pulmonary tumor. Currently, little is known about CMPT, and it has not yet been classified by the World Health Organization. The clinical manifestation of CMPT is nonspecific and the diagnosis is only based on pathology. CMPT has been documented in limited reports as a benign tumor, thus the treatment is typically with surgical excision if a solid tumor is identifiable. The prognosis of CMPT is very positive, as no recurrence has been reported in the limited literature available. However, CMPT accompanied with adenocarcinoma in situ has not been reported previously in the literature. Case presentation In this report, we presented a case of a 53-year-old male smoker with CMPT associated with adenocarcinoma in situ. This diagnosis was confirmed by pathological examination, including immunohistostaining. No solid resectable lesion was identified on CT scan; therefore, no surgery was performed. The patient’s adenocarcinoma in situ was disseminated in both lungs, thus chemotherapeutic treatment with cisplatin and pemetrexed was given. The patient will be continually followed up closely on a wait-and-watch basis. Conclusions In summary, our report reveals a unique case of CMPT in conjunction with adenocarcinoma in situ, potentially revealing an association between CMPT and malignancy which has not been previously reported. More similar case studies will be beneficial to determine the authentic relationship between CMPT and adenocarcinoma in situ.

This is a letter to the editor on the discussion on COVID-19 and prostate cancer.

Recurrent or metastatic peri-urethral pelvic malignancies are a difficult-to-treat entity. Re-resection is recommended when possible but is frequently unfavorable due to scar tissue, fibrosis, and obliteration of tissue planes following previous interventions such as surgical resection and/or radiation therapy. Curative options for patients that have unresectable cancer are limited. Cryo-ablation has been extensively studied in the treatment of unresectable renal, liver and lung malignancies and has the potential to provide definitive treatment for recurrent pelvic malignancy. There is a paucity of reports of salvage cryo-ablation in patients with recurrent pelvic malignancies, as most of these tumors are located close to critical structures that could be irreversibly injured by thermal ablation and are hence treated with some form of radiation therapy. But, for patients who fail surgical and radiation treatments, options are limited. Here, we describe two cases of regional tumor recurrence in the pelvis treated with percutaneous cryoablation using protective techniques to avoid thermal injury to adjacent structures. In each case, cryo-ablation was performed successfully despite extensive previous surgical and radiation interventions. Salvage cryo-ablation resulted in a positive clinical and imaging response with an improvement in quality of life and absence of recurrence on follow-up imaging which continues to persist at the writing of this manuscript about 8 and 12-months following treatment.

As a prevalent medical problem that burdens millions of patients across the world, chronic wounds pose a challenge to the healthcare system. These wounds, often existing as a comorbidity, are vulnerable to infections. Consequently, infections hinder the healing process and complicate clinical management and treatment. While antibiotic drugs remain a popular treatment for infected chronic wounds, the recent rise of antibiotic-resistant strains has hastened the need for alternative treatments. Future impacts of chronic wounds are likely to increase with aging populations and growing obesity rates. With the need for more effective novel treatments, promising research into various wound therapies has seen an increased demand. This review summarizes photodynamic therapy, probiotics, acetic acid, and essential oil studies as developing antibiotic-free treatments for chronic wounds infected with Pseudomonas aeruginosa. Clinicians may find this review informative by gaining a better understanding of the state of current research into various antibiotic-free treatments. Furthermore. this review provides clinical significance, as clinicians may seek to implement photodynamic therapy, probiotics, acetic acid, or essential oils into their own practice.

This is a letter to the editor on the discussion on COVID-19 vaccine and bladder cancer.

Background: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the novel coronavirus responsible for the COVID-19 pandemic. The viral protein of SARS-CoV-2, spike protein (SP), mediates entry into host cells, contributing to pathogenesis of COVID-19. Prostate cancer is the most common cancer among men in the United States. Inducible T-cell costimulator ligand (ICOSL) and intercellular cell adhesion molecule 2 (ICAM-2) are expressed in cancer cells and their roles in cancer growth remain controversial. It is unknown if SP can affect the expression of ICAM-2 or ICOSL in prostate cancer. This study investigated the effects of SARS-CoV-2 SP on the expression of ICAM-2 and ICOSL and the time-dependent effect of SP on growth and survival of prostate cancer cells. Methods: The effect of SARS-CoV-2 SP on the survival of a widely-used prostate cancer cell line, LNCaP, was assessed using clonogenic cell survival assay and quick cell proliferation assay. Reverse transcription-polymerase chain reaction (RT-PCR) and immunohistochemistry (IHC) were performed to investigate the expression of ICAM-2 and ICOSL. The survival of an additional prostate cancer cell line, PC-3, was also evaluated by clonogenic survival assay. Results: After 3 days, a significant decrease in the percentage of colonies in LNCaP cells treated with SP was found, which was paralleled by a decrease in optical density (OD) value in LNCaP cells in the presence of SP. A significant decrease in the percentage of colonies treated with SP was also found in PC-3 cells evaluated by clonogenic survival assay. In addition, the mRNA expression of ICAM-2 was lower, whereas the mRNA expression of ICOSL was higher in SP-treated LNCaP cells. This was supported by protein expressions for ICAM-2 and ICOSL evaluated with IHC. Conclusions: In LNCaP cells, SARS-CoV-2 SP downregulates the expression of ICAM-2 but upregulates the expression of ICOSL. SARS-CoV-2 SP inhibits growth of prostate cancer cells in a time-dependent manner. Further studies are needed to fully address the roles of ICAM-2 and ICOSL in the inhibition prostate cancer growth by SARS-CoV-2 SP.

Background: The SARS-CoV-2 virus displays a strong impact on the respiratory, digestive, and reproductive systems, and has led to questions about long-term effects. Erectile dysfunction is the inability for a male to achieve or sustain an erection during sexual intercourse, and commonly develops in men due to both physiological and psychologic factors. SARS-CoV-2 can affect the vasculature that surrounds endothelial tissue and thus has raised the question of a possible relationship between SARS-CoV-2 infection and erectile dysfunction (ED). Thus far, no studies have established a relationship between COVID-19 and ED. In this review, we analyze current available data and summarize the concepts regarding the current known relationship between COVID-19 and ED. Such a study might be helpful for urologists and andrologists to manage patients with ED and a history off COVID-19 infection. Methods: A systematic review was used to analyze the relationship between COVID-19 and ED. A literature search on three databases, Google Scholar, PubMed, and ResearchGate was conducted. Search terms used were COVID-19, erectile dysfunction, and SARS-CoV-2. All available studies were analyzed up to December 2021. Results: The COVID-19 pandemic led to a significant increase in male reproductive and sexual health diagnoses, including ED, with numbers showing that COVID-19 increases the chance of developing ED nearly sixfold. Physiological issues were also found in the reproductive system of men who had contracted COVID-19. For example, endothelial progenitor cells were much lower in patients positive with COVID-19 even when compared to men with severe ED who had never contracted COVID-19. However, it is still not clear how consistent it is to find SARS-CoV-2 in the reproductive system as one study showed only two out of five testes were positive for SARS-CoV-2 in the reproductive system and another study showed that there were only 3 out of 26 cases in which the SARS-CoV-2 spike existed in the endothelia of the blood-testis barrier, seminiferous tubules, and sperm of the epididymis. Conclusions: Many correlations can be made between COVID-19 and ED. However, future testing and research must be completed to determine a causal relationship between COVID-19 and ED.

Adolescent idiopathic scoliosis (AIS) is a deformity of the spine of unknown etiology and no definitive cure. A novel technique for correction during growth known as vertebral body tethering (VBT) was introduced in 2005 in animal models, and then quickly adapted for human implementation [Courvoisier, 2015]. This method is in the early stages of growth and adaptation as well as evaluating risks to improve safety and feasibility. Some of the most common complications reported are atelectasis [Newton, 2018], proximal junctional kyphosis and reoperation for device breakage or addition [Hardesty, 2017]. There are no case reports describing ureteral injury following VBT. We present a case of primary ureteral injury following VBT with subsequent erosion and stricture formation requiring definitive ureteral reconstruction. We discuss the possible causes of this complication, its management, follow up, and short-term outcome. Keywords: Vertebral body tethering, Surgical complication, Ureteral injury