The effects of obesity and diet on prostate cancer risk

Prostate cancer is nowadays the most common malignancy in males of the western world, but little is as yet known regarding the causes of initiation and progression of this disease. To explain the geographical variations in the incidence of clinical prostate cancer, the changes in its prevalence in migrants moving from countries with a low prostate cancer incidence to those with a high incidence, and the lack of international variation in the prevalence of microfocal or latent prostatic tumors, environmental factors have been implicated. Obesity, western-type diet, increased total energy and saturated animal fat intake have all been suspected as potential risks. In contrast, consumption of vegetables and soy products and intake of certain vitamins and micronutrients, such as vitamins E and D, lycopene and selenium, may exert a protective effect. The hypothesis that dietary changes might affect the development of prostate cancer is strengthened by the fact that of all mammals almost only humans and dogs (at a much lower rate) get prostate cancer. Both have dramatically altered their diets during the last 15,000 years of their evolution, while other primates and mammals in which the disease is absent, made no significant changes. Case-control and cohort studies have failed to find a consistent association between prostate cancer risk and body mass index, dietary fat, total energy intake or other life-style changes. The conflicting results of past and recent trials are perhaps due to methodological and statistical limitations, measurement errors, different questionnaires, heterogeneity of prostate cancer patients, unsuspected biases and the retrospective nature of these investigations. Nevertheless, pending more extensive, well-controlled prospective studies, dietary and life-style changes should be advised, based on reduced morbidity and mortality from cardiovascular disease, the number 1 cause of death in western countries, and the number 1 or 2 cause of death in patients diagnosed with prostate cancer

Stem cells and lower urinary tract dysfunction: Has its potential finally reached clinical maturity? ICI-RS2018

Aims: Efforts to engineer and repair genitourinary tissue to treat lower urinary tract dysfunction (LUTD) have recently increased thanks in part to advances in stem cell (SC) research. At the International Consultation on Incontinence-Research Society meeting in Bristol in 2018 a proposal was convened to address the question: has the potential of SCs in treating LUTD reached clinical maturity?. Methods: The proposal conducted a literature review and an expert consensus meeting focusing on available data from animal models and clinical trials involving the use of SCs for LUTD. Results: To date, there are only small studies investigating bladder replacement using scaffolds with or without SC. Results have been conflicting because of the variability in cell numbers, biomaterials types, and graft surface differences. Similarly, preclinical results suggest a possible role of SC in bladder outlet obstruction (BOO); however, SC clinical trials for BOO are lacking. Research into the use of SC for female stress urinary incontinence (SUI) is close to reaching clinical maturity. In the Canadian phase 3 randomized controlled trial (RCT), a beneficial effect of adult muscle–derived cells (AMDC) over placebo was detected in reducing the frequency of incontinence episodes, especially after prior anti-incontinence surgery. Only two small studies have been published on male SUI. Conclusions: Questions remain regarding the mechanism of action of SC injected into the LUT and the viability of cells seeded onto grafts placed into the LUT. Also, the optimal time for intervention with SC therapy in the LUT remains to be elucidated. © 2019 Wiley Periodicals, Inc

Plasmacytoid transitional cell carcinoma of the urinary bladder

A case of rare plasmacytoid transitional cell carcinoma of the urinary bladder in a 60-year old man is described. The presence of end-stage disease did not allow for any efficacious therapy. Immunohistochemistry showed the tumor cells to be reactive for epithelial markers and syndecan-1 (CD138)

The Impact of Technique Standardization on Total Operating and Fluoroscopy Times in Simple Endourological Procedures: A Prospective Study

Purpose: To present the positive impact of technique standardization on successful outcome, fluoroscopy, and total operating time (TOT) shortening in a prospective study. Methods: Six experienced endourologists participated. To assess whether the adaptation of standardized surgical steps improved their methodology with time, 253 patients were prospectively divided in three consecutive 1-month groups. Patients underwent stent placement and exchange and total operating and fluoroscopy times (FTs) were recorded. All surgeons were unaware of their mean recorded results until the end of the study. At the end of the third month, we evaluated if the suggested technique standardization established a decrease for both FT and TOT. Statistical significance was set to p < 0.05. Results: Total operating and FTs were significantly reduced with time between all groups of patients. For stent placement, TOT showed significant reduction between Groups A and C (p < 0.001), while between other group comparisons did not reach significance. FT showed a significant reduction (p < 0.001) in all group comparisons. For stent exchange, TOT reached significant improvement (p = 0.003) between Groups A and C, whereas between other groups was insignificant. FT improvement was significant between Groups A and C (p < 0.001) and Groups B and C (p < 0.001), but insignificant between Groups A and B. Conclusions: Even in experienced hands, the adaptation of technique standardization results in significant decrease of total operating and FTs and it is independent from feedback regarding their time performance. © Copyright 2018, Mary Ann Liebert, Inc. 2018

Percutaneous suprapubic cystolithotripsy under local anesthesia

Objectives. To assessed the feasibility and effectiveness of percutaneous cystolithotripsy under local anesthesia in selected patients. Methods. Thirty-one patients with bladder stones of different etiologies underwent percutaneous cystolithotripsy under local anesthesia. Suprapubic access was obtained with ultrasound guidance, and fragmentation of the stone was performed using the Swiss lithoclast. Suprapubic and transurethral catheters were placed postoperatively. Results. No major intraoperative complications occurred. The whole procedure was well tolerated, and no significant differences were found in the mean pain score between the percutaneous suprapubic cystolithotripsy group and a group of male patients who underwent rigid cystoscopy under local anesthesia (P = 0.35). Complete stone clearance was achieved in all but 1 patient (96.78%). Bladder irrigation because of gross hematuria was needed in 5 patients, but no blood transfusion was required. Fever developed in 1 patient and was treated with intravenous antibiotics. The average hospitalization was 2.3 days (range 2 to 5). After a mean follow-up of 10 months, no recurrent stone developed. Conclusions. Percutaneous suprapubic cystolithotripsy under local anesthesia is a safe and effective technique to remove bladder calculi. Thus, it may be used as an alternative treatment option in selected patients

B3 agonists or anticholinergics in the treatment of the lower urinary tract dysfunction in patients with multiple sclerosis?—A randomized study

Introduction and objective: Multiple sclerosis (MS) is the most frequent autoimmune demyelinating disease of the central nervous system. MS patients usually present with lower urinary tract dysfunction (LUTD). Objective of this study is to evaluate and compare the efficacy and safety of treating MS patients with LUTD with either a b3 agonist (mirabegron) or anticholinergics. The study’s primary outcome is the LUTD symptom improvement. Material and Methods: This is a multi-center, single-blinded, comparative study including 91 MS patients with LUTD. At baseline, patients underwent thorough clinical examination, urine cultivation and abdominal ultrasound and completed urination diaries and specific, validated questionnaires (NBSS, MusiQoL). At second visit, patients were administered either mirabegron or anticholinergics. Treatment was always carried out alongside with MS treatment. Reevaluation was performed 3 months after first visit. Patients underwent the same clinical and imaging tests that were carried out at first visit. Results: We compared several clinical and imaging parameters between the two groups at first visit and month 3 after treatment. Νo statistical difference was noted between the mirabegron group and the anticholinergic group in terms of LUTD improvement. In both groups, improvement from baseline regarding LUTD was recorded. Statistical analysis was performed using the paired and unpaired t test method. No patient discontinued either medication due to side effects. Conclusions: MS patients receiving either mirabegron or anticholinergic therapy for LUTD showed improvement. Nevertheless, no statistical difference was noted between the two cohorts at 3 months in terms of drug efficacy in all the statistically significant parameters. © 2021, The Author(s), under exclusive licence to Springer-Verlag GmbH, DE part of Springer Nature

Analgesia during extracorporeal shockwave lithotripsy: Fentanyl citrate versus parecoxib sodium

Background and Purpose: Shockwave-induced pain may become an important issue during extracorporeal shockwave lithotripsy (SWL), although the new generation of lithotriptors generally produces less pain than previous models. The aim of the study was to compare the analgesic effect of a cyclooxygenase-2-specific inhibitor (parecoxib sodium) with that of our standard method of analgesia (fentanyl citrate) in patients who needed pain relief when undergoing SWL. Patients and Methods: Fifty-eight patients who were undergoing SWL for renal calculi were randomized to receive intravenously either fentanyl citrate (group A, n = 30) or parecoxib sodium (group B, n = 28) when they felt that their pain during the session became intolerable. Lithotripsy was recommenced 10 minutes after administration of analgesia. The severity of pain before and after administration of the analgesic regimens was evaluated using a five-level verbal scale. The effectiveness of each drug was evaluated with respect to degree of pain relief and ensuing tolerance of the procedure to completion, as well as the need for supplementary analgesia (half the standard dose of fentanyl citrate). Results: The patients in the two groups were comparable with regard to age, sex, body mass index, and stone size. There was no statistically significant difference in the maximum energy level achieved as well as in the total number of shock waves given in the two groups. Administration of fentanyl citrate resulted in alleviation of pain and completion of SWL in 27 patients (90%), whereas parecoxib sodium was effective in five patients (17.8%) (P < 0.01). The remaining 23 patients in group B received supplementary analgesia, and 22 completed the lithotripsy session. Conclusions: Parecoxib sodium was not as effective as fentanyl citrate in alleviating pain during SWL. Its use, however, may lower the dose of opioid-based analgesia in this group of patients