214 research outputs found
Liquid Biopsy for Predicting Bacillus Calmette-Guérin Unresponsiveness in Non-muscle-invasive Bladder Cancer
Vesical Imaging-Reporting and Data System (VI-RADS) incorporated into bladder cancer clinical practice: whatâs the perspectives beyond diagnostic accuracy?
No abstract availabl
T1G3 high-risk NMIBC (non-muscle invasive bladder cancer): conservative treatment versus immediate cystectomy
Background The management of stage T1 poorly
differentiated G3 bladder cancer invading the lamina
propria continues to be debated. These tumours are
associated with a high risk of recurrence and
progression; concomitant carcinoma in situ and/or
multifocality are negative prognostic factors. Choosing
between a preserving approach such as transurethral
resection of the bladder (TURB) followed by
maintenance bacillus Calmette-Guerin (BCG) and an
invasive approach like cystectomy is critical.
Patients and methods Overall, 80 patients underwent
TURB and RE-TURB followed by intra-vesical
induction treatment with BCG plus maintenance
(Group A) while 72 patients underwent immediate
radical cystectomy with extended lymphadenectomy
(Group B). Patients were divided into 3 subgroups:
uni-focal tumours, multi-focal tumours and carcinoma
in situ associated lesions. In Group A, time to
first recurrence and time to progression were analysed.
A comparison was made between Group A and
Group B regarding progression-free survival, cancerspecific
survival and overall survival with a median
follow-up time of 8.3 years.
Results As far as concerns Group A patients, 42
recurrences (52.5%) were reported in a median time
of 10.4 months (range 3â26) and 25 progressions
(31.2%) in a median time of 25 months (range 3â68).
As far as concerns time to first recurrence and time to
progression, both the KaplanâMeier survival curves
obtained are significant and P values are, respectively,
0.0263 and 0.0011. Comparing Groups A and
B patients, 25 progressions (31.2%) in a median time
of 25 months (range 3â68) and 18 progressions
(25%) in a median time of 25.9 months (range
4â72), respectively, were recorded. Regarding overall
survival, at 10 years, 24 deaths (42.5%) occurred in a
median time of 55.4 months (range 12â94) in Group
A and 42 deaths (58.3%) in a median time of
54.9 months (10â100) in Group B. Cancer-specific
survival was evaluated in Group A with a total of 18
deaths (22.5%) in a median time of 47.5 months
(range 16â78), and in Group B with a total of 16
deaths (22.2%) in a median time of 45.7 months
(range 16â88). The progression-free survival Kaplanâ
Meier curve is not significant, the P value being
0.3801; the overall survival curve is significant with a
P value of 0.0487 while the cancer-specific survival
curve is not significant with a P value of 0.9762.
Discussion In Group A, considering ââtime to first
recurrenceââ, the difference is greater between unifocal
lesions and multifocal or Cis-associated lesions.
Conversely, for ââtime to progressionââ, there is a
greater difference between unifocal and multifocal
tumours and Cis-associated tumours. Looking at
ââprogression-free survivalââ in Group A and Group B
patients, there is no statistically significant difference,
like in cancer-specific survival. A statistically significant
difference was observed in overall survival
being in favour of conservative treatment thus
reflecting that conservative treatment is not burdened
by all the surgical and post-operative complications
of cystectomy.
Conclusions Although NMIBC invading the lamina
propria, stage G3, with or without Cis-associated
lesions are burdened both by a high volume of
recurrences and progressions, cystectomy could be
considered an aggressive approach. New biological
markers are now needed which are able to predict the
behaviour of the cancer and to guide the decisionmaking
process between conservative or aggressive
treatment
Knotless "three-U-stitches" technique for urethrovesical anastomosis during laparoscopic radical prostatectomy
We describe a new technique for urethrovesical anastomosis that consists
of placing three âUâ stitches of Monocryl 2-0 to connect the bladder neck and urethral
stump together. The margins are united by a double passage of the suture, without tying
any knots. The sutures are tied on the bladderâs surface using Lapra-Ty clips fixed at a
certain distance from where to two mucosal margins have been joined. We carried out
this technique on 90 patients who underwent laparoscopic extraperitoneal radical prostatectomy.
The good joining of the margins, the absence of knots and the minimum
trauma to the urethral wall together enable to create an anastomosis that is both
âsealedâ and âtension freeâ, allowing a quick âweldingâ of the margins and an early
catheter removal. Regarding urinary continence, 56.6% (51) of patientswere continent at
catheter removal, 87.6% (78) were continent 3 months later and 98.9% (89) were continent
after 6 months. In nine patients (10%), an episode of acute urinary retention
occurred within 24 h after the removal of the catheter. We did not encounter any cases
of vesicourethral anastomosis stenosis
Prospective open-label study on the efficacy and tolerability of a combination of nutritional supplements in primary infertile patients with idiopathic astenoteratozoospermia
Aim of the study: To evaluate with an open-label study the efficacy and safety of a complex
of nutritional supplements with antioxidant activity (L-carnitine, acetyl-L-carnitine,
fructose, citric acid, selenium, coenzyme Q10, zinc, ascorbic acid, cyanocobalamin, folic
acid) in primary infertile patients with idiopathic astenoteratozoospermia.
Methods: The study was conducted in a population of 114 infertile men (96 completed the
study) diagnosed with idiopathic astenoteratozoospermia since at least 18 months.
Patients orally received a formulation (Proxeed - Sigma-Tau) containing L-carnitine 145 mg,
acetyl-L-carnitine 64 mg, fructose 250 mg, citric acid 50 mg, selenium 50 mcg, coenzyme Q10 20
mg, zinc 10 mg, ascorbic acid 90 mg, cyanocobalamin 1.5 mcg, folic acid 200 mcg in combination
once a day for 4 months.
Results: At the end of study, the mean sperm progressive motility showed a statistically significant
increase from 18.3 ± 3.8 to 42.1 ± 5.5. Sixteen patients achieved pregnancy during the study. No
significant improvement were observed for sperm density and rate of morphologically normal
forms. The treatment was well tolerated.
Conclusions: Carnitines in association with others functional substances can improve the most
important parameters of sperm quality
Reduced intraoperative bleeding during transurethral resection of the prostate: Evaluation of finasteride, vascular endothelial growth factor, and CD34
Finasteride is an antiandrogen that inhibits 5-α-
reductase, an enzyme that converts testosterone to
dihydrotestosterone. Finasteride significantly reduces
intraoperative bleeding when 10 mg/d is administered
for 60 days before transurethral resection of the prostate.
Our double-blind, randomized, placebo-controlled
study evaluated 200 patients with benign prostatic
hyperplasia who underwent transurethral resection of
the prostate. We compared a placebo group (n = 100)
with a group (n = 100) administered 5 mg of finasteride
twice a day for 8 weeks. We intended to demonstrate the
mechanisms and effects of finasteride compared with
those of vascular endothelial growth factor, and to evaluate
CD34, an immunohistochemical marker of blood
vessel density in the prostate. Our results indicated a
lower average microvascular density and vascular endothelial
growth factor index for hypertrophic prostate in
the finasteride group than in the placebo group
Circulating Tumor Cells Identify Patients with Super-High-Risk Non-Muscle-Invasive Bladder Cancer: Updated Outcome Analysis of a Prospective Single-Center Trial
Clinical behavior of non-muscle-invasive bladder cancer (NMIBC) is largely unpredictable, and even patients treated according to European Association of Urology recommendations have a heterogeneous prognosis. High-grade T1 (HGT1) bladder cancer is the highest-risk subtype of NMIBC, with an almost 40% rate of recurrence and 20% of progression at 5 years. Nomograms predicting risk of recurrence, progression, and cancer-specific survival (CSS) are not available specifically within HGT1 bladder cancer, and the identification of robust prognostic biomarkers to better guide therapeutic strategies in this subgroup of patients is of paramount importance. Strategies to identify putative biomarkers in liquid biopsies from blood and urine collected from patients with bladder cancer have been intensively studied in the last few years
Body mass index and age correlate with antioxidant supplementation effects on sperm quality: Post hoc analyses from a double-blind placebo-controlled trial
Spermatozoa are vulnerable to lack of energy and oxidative stress as a result of elevated levels of reactive oxygen species. Therefore, it is essential that appropriate nutrients are available during maturation. This randomised, double-blind, placebo-controlled trial investigated the effect of 6-month supplementation with carnitines and other micronutrients on sperm quality in 104 subjects with oligo- and/or astheno- and/or teratozoospermia with or without varicocele. Semen analyses were done at the beginning and end of the treatment. In addition to main analyses, post hoc analyses for age and body mass index (BMI) were carried out. Results were interpreted by dividing the population into two age and BMI classes. In 94 patients who completed the study, all sperm parameters increased in supplemented patients compared to the placebo group. A significant (p = .0272) difference in supplementation efficacy was observed for total motility on patients with varicocele and BMI < 25. In the same group, also the progressive motility was significantly superior (p = .0159). For Responder analysis, total motility results were confirmed in both the cited group (p = .0066) and in the varicocele group with BMI < 25 and age < 35 (p = .0078). This study suggests that supplementation is more effective in subjects with varicocele younger than 35 years with BMI < 25
An evaluation of morphological and functional multi-parametric MRI sequences in classifying non-muscle and muscle invasive bladder cancer
Objectives: Our goal is to determine the ability of multi-parametric magnetic resonance imaging (mpMRI) to differentiate muscle invasive bladder cancer (MIBC) from non-muscle invasive bladder cancer (NMIBC). Methods: Patients underwent mpMRI before tumour resection. Four MRI sets, i.e. T2-weighted (T2W) + perfusion-weighted imaging (PWI), T2W plus diffusion-weighted imaging (DWI), T2W + DWI + PWI, and T2W + DWI + PWI + dif-fusion tensor imaging (DTI) were interpreted qualitatively by two radiologists, blinded to histology results. PWI, DWI and DTI were also analysed quantitatively. Accuracy was determined using histopathology as the reference standard. Results: A total of 82 tumours were analysed. Ninety-six percent of T1-labeled tumours by the T2W + DWI + PWI image set were confirmed to be NMIBC at histopathology. Overall accuracy of the complete mpMRI protocol was 94% in differentiating NMIBC from MIBC. PWI, DWI and DTI quantitative parameters were shown to be significantly different in cancerous versus non-cancerous areas within the bladder wall in T2-labelled lesions. Conclusions: MpMRI with DWI and DTI appears a reliable staging tool for bladder cancer. If our data are validated, then mpMRI could precede cystoscopic resection to allow a faster recognition of MIBC and accelerated treatment pathways. Key Points: âą A critical step in BCa staging is to differentiate NMIBC from MIBC. âą Morphological and functional sequences are reliable techniques in differentiating NMIBC from MIBC. âą Diffusion tensor imaging could be an additional tool in BCa staging
Penile prosthesis implant for erectile dysfunction: A new minimally invasive infrapubic surgical technique
Erectile dysfunction, the most common
male sexual disorder after premature ejaculation,
with its important impact on man and partnerâs sexuality
and quality of life is a persistent inability to obtain and
maintain an erection sufficient to permit satisfactory sexual
performance. Non-surgical treatments with controversial
results are usually applyed before surgical treatment that has
reached high levels of satisfaction.
We describe a new surgical technique to implant three-pieces
penile prosthesis in patients suffering from erectile dysfunction
(ED) not responding to conventional medical therapy or
reporting side effects with such a therapy.
Implantation of an inflatable prosthesis, for treatment of ED,
is a safe and efficacious approach with high satisfaction
reported by patients and partners. Surgical technique should
be minimally invasive and latest technology equipment should
be implanted in order to decrease common complications and
to obtain a better aesthetic result
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