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Purpose: In advanced breast cancer, endocrine therapy is preferred in the absence of visceral crisis. Cyclin-dependent kinase inhibitors (CDKi) are the gold standards. The selection of subsequent treatments after CDKi treatment is still controversial, and the efficacy of everolimus (EVE) combinations is unknown. In this study, we aimed to investigate the efficacy of EVE after CDKi administration in real-life experiences., Method: The study received data from 208 patients from 26 cancer centers. Demographic and histologic features, diagnosis, progression, last visit dates, and toxicities were recorded. This study was a retrospective case series., Results: One hundred and seven patients received palbociclib, while 101 patients received ribociclib as a CDKi. The overall response and disease control rates of EVE combinations were 60% and 88%, respectively. In univariate analysis, the absence of liver metastasis, age > 40 years, better type of response, and immediate treatment after CDKi were related to increased progression-free survival. Liver metastasis and response type were significantly associated with overall survival. In the multivariate analysis, response remained significant in terms of progression-free survival, while response type, liver metastatic disease, and hematologic toxicity were prognostic in terms of overall survival., Conclusion: This study provides evidence of the benefits of EVE combinations after CDKi treatment. EVE combinations may be more appropriate for patients with non-liver metastasis, and the first treatment response shows the benefit of treatment. In addition, immediate treatment after CDKi treatment is more beneficial than later lines of treatment., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Background: There is no standard treatment recommended at category 1 level in international guidelines for subsequent therapy after cyclin-dependent kinase 4/6 inhibitor (CDK4/6) based therapy. We aimed to evaluate which subsequent treatment oncologists prefer in patients with disease progression under CDKi. In addition, we aimed to show the effectiveness of systemic treatments after CDKi and whether there is a survival difference between hormonal treatments (monotherapy vs. mTOR-based)., Methods: A total of 609 patients from 53 centers were included in the study. Progression-free-survivals (PFS) of subsequent treatments (chemotherapy (CT, n:434) or endocrine therapy (ET, n:175)) after CDKi were calculated. Patients were evaluated in three groups as those who received CDKi in first-line (group A, n:202), second-line (group B, n: 153) and ≥ 3rd-line (group C, n: 254). PFS was compared according to the use of ET and CT. In addition, ET was compared as monotherapy versus everolimus-based combination therapy., Results: The median duration of CDKi in the ET arms of Group A, B, and C was 17.0, 11.0, and 8.5 months in respectively; it was 9.0, 7.0, and 5.0 months in the CT arm. Median PFS after CDKi was 9.5 (5.0-14.0) months in the ET arm of group A, and 5.3 (3.9-6.8) months in the CT arm (p = 0.073). It was 6.7 (5.8-7.7) months in the ET arm of group B, and 5.7 (4.6-6.7) months in the CT arm (p = 0.311). It was 5.3 (2.5-8.0) months in the ET arm of group C and 4.0 (3.5-4.6) months in the CT arm (p = 0.434). Patients who received ET after CDKi were compared as those who received everolimus-based combination therapy versus those who received monotherapy ET: the median PFS in group A, B, and C was 11.0 vs. 5.9 (p = 0.047), 6.7 vs. 5.0 (p = 0.164), 6.7 vs. 3.9 (p = 0.763) months., Conclusion: Physicians preferred CT rather than ET in patients with early progression under CDKi. It has been shown that subsequent ET after CDKi can be as effective as CT. It was also observed that better PFS could be achieved with the subsequent everolimus-based treatments after first-line CDKi compared to monotherapy ET., (© 2023. The Author(s).)

Because various criteria are used to define metabolic syndrome (MetS), this study examines the most relevant definition for patients with benign prostatic enlargement (BPE). Most studies regarding the link between MetS and BPE/lower urinary tract symptoms (LUTS) have used the National Cholesterol Education Program Adult Treatment Panel III criteria for diagnosis, while a few have used criteria from the International Diabetes Federation and/or American Heart Association. Patients with LUTS due to BPE are classified as having MetS or not by the aforementioned three definitions. Prostate volume, International Prostate Symptom Score, storage and voiding subscores, maximum urinary flow rate, and the postvoid urine of patients with and without MetS were compared separately in the three different groups. Surgical and medical treatment prevalence was also compared between three groups. No matter which definition was used, the International Prostate Symptom Score, the storage and voiding symptom scores, prostate volume, prostate-specific antigen, and postvoid urine were significantly higher in the patients with MetS. The maximum urinary flow rate was similar between patients with and without MetS, according to all three different definitions. There was no significant difference in the aforementioned parameter between patients with MetS diagnosed with the three different definitions. Irrespective of which definition was used, the surgical treatment rate was not significantly different in patients diagnosed with than without MetS, or between the patients with MetS diagnosed with the three different definitions. The authors suggest that it does not matter which of the aforementioned three definitions is used during the evaluation of MetS in men with BPE/LUTS.

Introduction and Objectives: Which ureteral stone can pass spontaneously? It is hard to answer this question exactly. The size and location of the stone are the most important predictors. However, there is still a considerable gray zone that needs to be clarified. We try to identify the role of stone volume (SV) in the prediction of spontaneous passage (SP)., Materials and Methods: Seventy-eight patients with a solitary ureteral stone were retrospectively evaluated. Ureter SV measurements were taken in three planes and were calculated using the following formula: V = (X) × (Y) × (Z) × 0.52. SVs, and the longest diameters (LDs) were compared between patients who passed stones spontaneously and those who needed intervention., Results: The SVs and LDs were significantly lower in patients who passed stones spontaneously than in patients who required intervention (41.2 ± 35.5 vs 128.1 ± 91.1 mm(3), p = 0.001; 5.7 ± 1.8 vs 7.4 ± 1.7 mm, p = 0.001). The optimum cutoff values were 7.0 mm and 52.6 mm(3) for the LD and SV, respectively. For those stones of ≤7 mm, the volumes of the stones that could and could not pass did not differ significantly. However, the volume of the stones >7.0 mm that could pass was significantly higher than of those that could not. SP was 30.6% for stones >7 mm; however, when we removed the stones >52.6 mm(3), SP increased to 75% for stones higher than 7 mm (p = 0.001)., Conclusions: To classify ureteral stones using only one parameter such as stone diameter may lead to heterogeneity within the group. SV may be used in addition to size to determine a more definite homogeneous group to predict SP more precisely.

Background/aims: We aimed to investigate the efficacy and tolerability of a FOLFOX7 regimen in the first-line treatment of metastatic colorectal cancer (mCRC) patients., Materials and Methods: Patients were evaluated in two groups. Group A did not receive any treatment before, and group B had metastasectomy or metastasectomy plus primary tumor resection., Results: In total, 132 mCRC patients had received FOLFOX7 regimen. The A group consisted of 117 (88.6%) patients, and group B consisted of 15 (11.4%) patients. In the A group, 52.1% had an objective response, 9.4% complete response, 42.7% partial response, 24.8% stable response, and 23.1% progression, and there was a 54.5% rate of primary tumor resection, 22.2% rate of metastasectomy, 80.7% rate of R0 metastasectomy, 19.1% rate of R1 metastasectomy, 15 (10-19) months median progression-free survival, and 32 (22-41) months median overall survival. In the B group, 40 (4-70) months median disease-free survival and 58 (21-94) months median overall survival were found. When toxicities were evaluated, grade 3/4 toxicity was observed in 35.6%. Grade 3/4 hematologic toxicity was the most frequently observed toxicity (29.5%)., Conclusion: FOLFOX7 regimen was found to be an efficient and safe regimen for the first-line treatment of mCRC patients.

Objective: Metabolic syndrome plays a significant role in the development of benign prostate hyperplasia (BPH) and overactive bladder (OAB). Non-alcoholic fatty liver disease (NAFLD) is accepted as the hepatic component of metabolic syndrome. This study investigated the association of NAFLD with BPH and OAB., Material and Methods: In total, 702 men with BPH and 529 women with and without OAB were recruited into the study in a cross-sectional risk factor analysis. All male and female patients were separated into two groups, with or without NAFLD. An overnight fasting blood profile was obtained and whole abdominal ultrasound was performed by a blinded radiologist in each patient to measure hepatic steatosis., Results: NAFLD was diagnosed in 387 (55.8%) of 702 men with BPH. Statistically significantly higher prostate volumes were found in men with NAFLD in comparison to without (p = 0.018). The female population included 207 women with NAFLD and 322 women without. OAB was found in 75.8% and 52.4% of women with and without NAFLD (p = 0.022)., Conclusions: NAFLD is associated with BPH in men and with OAB in women. These findings confirm the hypothesis that BPH is an aspect of the metabolic syndrome and support the hypothesis that OAB is an aspect of the metabolic syndrome.

A 22-year-old male presented at our institution with an incidentally ultrasound-detected testicular tumor. Magnetic resonance imaging showed a contrast-enhanced right intratesticular mass over 1 cm in size. The patient underwent testis sparing surgery. Pathologic examination revealed seminoma. A follow-up nine months later showed no residual tumor, a normal contour of the testis and no evidence of atrophy. Testis sparing surgery is an option for patients with small unilateral testicular tumors even in the presence of a healthy contralateral testis.

Objective: Vascular risk factors frequently coexist with lower urinary tract symptoms (LUTS) in both men and women, suggesting that atherosclerosis and endothelial dysfunction may play a major role in the development of LUTS. Arterial stiffness owing to decreased arterial compliance is one of the major signs of vascular ageing, and carotid intima-media thickness (CIMT) can be used in establishing the extent and severity of vascular impairment. This study investigated the association of arterial stiffness and vascular atherosclerotic involvement with LUTS in men and overactive bladder (OAB) in women., Material and Methods: This study was prospective and cross-sectional, consisting of 66 patients with LUTS (38 men with LUTS, 28 women with OAB) and 62 controls without LUTS or OAB. Carotid-femoral pulse-wave velocity (CF-PWV) was measured as an index of arterial stiffness. CIMT was measured with B-mode ultrasonography to assess vascular impairment., Results: Patients with LUTS had significantly higher CF-PWV (9.8 ± 2.6 vs 7.0 ± 1.4 m/s, p < 0.001) and CIMT (0.89 ± 0.16 and 0.56 ± 0.31 mm, p < 0.001) compared with controls. Age and glucose were also different between LUTS and control groups (p < 0.001 and p = 0.003, respectively). In the multivariate analyses, both CIMT ( = 0.429, p < 0.001) and PWV ( = 0.451, p < 0.001) were related to LUTS., Conclusions: Vascular impairment was found to be associated with LUTS in both men and women. Atherosclerosis-related vascular risk factors are also known to be related to LUTS and both disorders may have pathogenic interactions.

Purpose: Bladder wall thickness has been reported to be associated with overactive bladder (OAB) in women. Diabetic women have an increased risk for OAB syndrome and may have an increased risk for bladder wall thickness., Methods: A total of 235 female patients aged 40 to 75 years were categorized into four groups. The first group consisted of women free of urgency or urge urinary incontinence. The second group included nondiabetic women with idiopathic OAB. The third group consisted of women with diabetes and clinical OAB, and women with diabetes but without OAB constituted the fourth group. Bladder wall thickness at the anterior wall was measured by ultrasound by the suprapubic approach with bladder filling over 250 mL., Results: The diabetic (third group) and nondiabetic (second group) women with OAB had significantly greater bladder wall thickness at the anterior bladder wall than did the controls. However, the difference was not significant between the diabetic (third group) and the nondiabetic (second group) women with OAB. Women with diabetes but without OAB (fourth group) had greater bladder wall thickness than did the controls but this difference was not significant. Additionally, the difference in bladder wall thickness between diabetic women with (third group) and without (fourth group) OAB was not significant., Conclusions: This is the first study to show that bladder wall thickness is increased in diabetic women with and without OAB. Additionally, nondiabetic women with OAB had increased bladder wall thickness. Further studies may provide additional information for diabetic and nondiabetic women with OAB, in whom the etiopathogenesis of the disease may be similar.

Background: The etiology of overactive bladder (OAB) remains unclear. Observed neurogenic factors in the literature are limited to suprapontine or spinal pathologies. The blink reflex is a useful tool in the evaluation of brainstem functions. Blink reflex latency times were evaluated in order to reveal pathology in the brainstem., Methods: A total of 60 women, 30 patients with idiopathic OAB and 30 healthy controls, were enrolled in the study. Blink reflex latency times were analyzed by electrical stimulation of the supraorbital nerve. Two responses in the orbicularis oculi muscle, early ipsilateral response (R1) and late bilateral response (R2) latency times, were recorded., Results: Mean ages of the patients and controls were 51.9 ± 5.3 and 49.2 ± 6.2 years, respectively. R2 latency times were significantly higher in patients than in controls. However, R1 latency times were similar between the two groups., Conclusions: The results of the study suggest a significant relation between late blink latency times and OAB. An oligosynaptic path via the trigeminal nuclei is responsible for R1; however, R2 response is relayed through the reticular formation. Stimulation of pontine reticular formation inhibits micturition contraction. In some patients, idiopathic OAB may result from reticular formation-originated pathology. Additional studies on other reticular formation-mediated reflexes are needed to reveal possible dysfunction of reticular formation., (Copyright © 2013 S. Karger AG, Basel.)

Background: Urethral stricture is a common condition, and direct vision internal urethrotomy is prefered as the first treatment option by many urologists, for strictures shorter than 2 cm. This procedure is generally performed under general or spinal anaesthesia., Objectives: To investigate the feasibility of adding local urethral anaesthesia to intravenous sedation and analgesia (sedoanalgesia) methods in patients undergoing internal urethrotomy., Patients and Methods: A total of 21 and 15 patients with anterior urethral strictures underwent internal urethrotomy under local urethral anaesthesia, with or without sedoanalgesia, respectively. Patient discomfort and pain levels were evaluated using the visual analog scale (VAS). Statistical analyses were calculated with a Mann-Whitney U test to compare difference in VAS scores between the subjects in both groups., Results: Two of the 15 (13%) patients operated under local urethral anaesthesia without sedoanalgesia were converted to general anaesthesia due to patient intolerability. Mean pain VAS scores for patients operated under 2% lidocain urethral gel anaesthesia with or without sedoanalgesia were 2.86 cm and 4.5 cm, respectively (P = 0.001). In addition, a VAS score over 3 cm was found in 3 of the 21 (14%) patients with, and 13 of the 15 (86%) patients without sedoanalgesia (P = 0.001)., Conclusions: The addition of intravenous sedoanalgesia improved the VAS scores of pain and discomfort, compared to patients operated under only local urethral anaesthesia. This may offer patients safer anaesthesia and shorter operative times with equilavent results in selected patients.

Objective: To investigate the relevance of metabolic syndrome in the etiopathogenesis of overactive bladder in female patients. It has been shown that obesity has been associated with overactive bladder (OAB), and the metabolic syndrome and insulin resistance have been related to the annual growth rates of prostate and lower urinary tract symptoms., Methods: Female patients applying to our policlinics with OAB symptoms or other urologic complaints were enrolled in the study. The International Diabetes Federation criteria were used for the definition of the metabolic syndrome. The chi-square, Student t, and Mann-Whitney U tests and logistic regression analyses were used to compare differences in the variables., Results: The metabolic syndrome was diagnosed in 201 (64%) of 313 patients with OAB and 73 (35%) of 208 patients without OAB. The difference was statistically significant (P=.002). A larger waist circumference, greater body mass index, low high-density lipoprotein level, and incidence of hypertension were significantly greater statistically in the OAB group than in the controls., Conclusion: The metabolic syndrome correlates highly with OAB in female patients. The metabolic syndrome can be an etiologic pathway for the onset of symptoms., (Copyright © 2012 Elsevier Inc. All rights reserved.)

Chorionic bump is a rare abnormal condition of the gestational sac seen in the first trimester of pregnancies, extending from the choriodecidual surface to the gestational sac. We report the sonographic and histopathologic findings in a case involving three "chorionic bumps" extending from the choriodecidual surface to the gestational sac. Chorionic bump can be associated with a poor prognosis for the pregnancy. Therefore, cases with chorionic bumps must be followed with serial ultrasound examinations throughout the first trimester., (Copyright © 2010 Wiley Periodicals, Inc.)