An 82-year-old Caucasian man with a ductal prostate adenocarcinoma with unusual cystoscopic appearance: a case report

<p>Abstract</p> <p>Introduction</p> <p>Ductal adenocarcinoma is a rare variety of the common acinar adenocarcinoma. It usually presents with refractory symptoms, and during cystoscopy, it is seen as an exophytic lesion at the area of the verumontanum.</p> <p>Case presentation</p> <p>An 82-year-old Caucasian man was diagnosed with ductal adenocarcinoma of the prostate after undergoing transurethral resection of the prostate for urinary retention. Immunohistochemistry confirmed the nature of the tumor. The patient was treated with triptorelin, 3.75 mg once/month, and bicalutamide, 50 mg 1 × 1. The serum prostate-specific antigen at three, six and 12 months after transurethral resection of the prostate was 0.1 ng/ml. The patient remains asymptomatic, and he entered a six-month follow-up protocol.</p> <p>Conclusion</p> <p>Ductal adenocarcinoma often involves the central ducts of the gland and may present as an exophytic papillary lesion in the prostatic urethra. This is why it usually presents with refractory symptoms. The outcome for men with prostatic ductal adenocarcinoma is, in most studies, worse than the outcome for men with prostatic acinar adenocarcinoma. Aggressive management is indicated, even with low-volume metastatic disease.</p

Immunotherapy options for painful bladder syndrome: what’s the potential?

Introduction: Painful bladder syndrome/interstitial cystitis (PBS/IC) is an enigmatic disease characterized by lack of evidence-based knowledge and an ongoing scientific debate regarding its definition, pathogenesis, diagnostic and treatment algorithm. An autoimmune theory for PBS/IC etiology has suggested immunotherapy as a potential treatment choice. Areas covered: In this review, the authors report existing and future immunotherapeutic options, potentially valuable to the management of PBS/IC while evidence for the immunological aspect of PBS/IC pathogenesis are also presented. Relevant data reported in human clinical studies but also in experimental studies using animal PBS/IC models have been reviewed. Expert opinion: Promising data has emerged lately regarding use of immunotherapy drugs for PBS/IC treatment. Specifically, human monoclonal antibodies inhibiting nerve growth factor and tumor necrosis factor-a have shown high efficacy in pain control for PBS/IC. Also, many other agents modulating immunopathways linked to PBS symptom etiology and leading to positive treatment effects have been reported lately mainly in experimental animal studies. Immunotherapy could potentially improve disease-related and patient-reported outcome; nevertheless, lack of consensus regarding PBS/IC diagnostic criteria, leading to high heterogeneity of patients enrolled in PBS/IC treatment studies, and low number of well-designed randomized clinical trials are limitations which must be addressed in the future. © 2017 Informa UK Limited, trading as Taylor &amp; Francis Group

An 82-year-old Caucasian man with a ductal prostate adenocarcinoma with unusual cystoscopic appearance: A case report

Introduction. Ductal adenocarcinoma is a rare variety of the common acinar adenocarcinoma. It usually presents with refractory symptoms, and during cystoscopy, it is seen as an exophytic lesion at the area of the verumontanum. Case presentation. An 82-year-old Caucasian man was diagnosed with ductal adenocarcinoma of the prostate after undergoing transurethral resection of the prostate for urinary retention. Immunohistochemistry confirmed the nature of the tumor. The patient was treated with triptorelin, 3.75 mg once/month, and bicalutamide, 50 mg 1 × 1. The serum prostate-specific antigen at three, six and 12 months after transurethral resection of the prostate was 0.1 ng/ml. The patient remains asymptomatic, and he entered a six-month follow-up protocol. Conclusion. Ductal adenocarcinoma often involves the central ducts of the gland and may present as an exophytic papillary lesion in the prostatic urethra. This is why it usually presents with refractory symptoms. The outcome for men with prostatic ductal adenocarcinoma is, in most studies, worse than the outcome for men with prostatic acinar adenocarcinoma. Aggressive management is indicated, even with low-volume metastatic disease. © 2011 Sfoungaristos et al; licensee BioMed Central Ltd

Single lower calyceal percutaneous tract combined with flexible nephroscopy: A valuable treatment paradigm for staghorn stones

Introduction: We evaluated the efficacy and safety of single lower calyceal tract combined with flexible nephroscopy for the management of staghorn renal stones by percutaneous nephrolithotomy. Methods: The medical records of patients who underwent percutaneous nephrolithotomy for the management of staghorn stones were analyzed. We included patients aged &gt;18 years, while patients with incomplete data and renal anatomical anomalies were excluded from the study. Stone-free rate, postoperative complications, procedure duration, fluoroscopy time, and length of hospitalization were recorded. Postoperative outcomes were evaluated by non-contrast computed tomography scan 4-6 weeks after the operation. Stonefree status was defined as the absence of residual stones &gt;4 mm. Results: The study cohort consisted of 103 consecutive patients. Stonefree rate was 65.0%. No complications were observed in 69.9% of the cases; most postoperative complications were Grade 1 (13.6%) and 2 (10.7%). Five patients (4.9%) suffered a Grade 3a complication and another patient (1.0%) suffered a Grade 3b complication. Conclusions: Percutaneous nephrolithotomy through a single lower calyceal tract combined with flexible nephroscopy can be a valuable treatment option for the treatment of staghorn calculi, providing efficacy and safety. Nevertheless, the present study is limited by both its retrospective nature and being conducted at a single centre and, thus, proper prospective studies with head-on comparisons are needed to prove or disprove the advantages and disadvantages of either approach. © 2018 Canadian Urological Association

External validation of Resorlu–Unsal stone score as predictor of outcomes after retrograde intrarenal surgery

Purpose: To externally validate Resorlu–Unsal stone score (RUSS) and to evaluate its predictive accuracy. Methods: Data of patients who underwent retrograde intrarenal surgery (RIRS) between October 2013 and June 2015 were collected. RUSS was applied to all patients, and the nomogram was externally validated. Area under the curve (AUC) was used for clinical validity assessment. Results: A total of 85 patients were included in the study. Mean patient age was 54.3 ± 16.5, and mean stone size was 12.0 ± 6.21 mm. After applying RUSS, 56.5, 28.2, 9.41, and 5.88 % had score 0, 1, 2, and 3, respectively. RUSS was significantly associated with stone location and size. Postoperative stone-free rate was 74.1 %. Postoperative outcomes were significantly associated with RUSS and stone size. RUSS was found to be the only significant independent predictor in multivariate analysis, while it provided high predictive accuracy with an estimated AUC of 0.707. Conclusions: RUSS is a simple scoring system that may predict postoperative stone-free rate after RIRS with great efficacy and accuracy. © 2016, Springer Science+Business Media Dordrecht

Comparing the efficacy and safety of 365- and 550-μm laser fibers in semirigid ureteroscopic Ho:YAG lithotripsy

Purpose: To compare the efficacy and safety of 365- and 550-μm Ho:YAG laser fiber in semirigid ureteroscopic lithotripsy and to identify parameters that may affect laser energy and time during the procedure. Methods: A database of 111 patients who undergone a semirigid ureteroscopy (SRURS) for ureteral stone lithotripsy was analyzed. A 365-μm core fiber was used in 56 cases, and a multiple-uses 550-μm laser fiber was used in 55 cases. A standard 6.4 W protocol (8 Hz, 0.8 J/pulse) was used in all cases. The association between laser fiber diameter and several preoperative, intraoperative and postoperative parameters was evaluated. Results: Mean stone burden was 54.1 ± 39.1 mm2, and postoperative stone-free and complication rate was 100.0 and 16.2 %, respectively. The 550-μm laser fiber diameter was significantly associated with lower laser energy (p = 0.01), energy/mm3 (p = 0.031), number of pulses (p = 0.012), laser time (p = 0.012) and laser time/mm3 (p = 0.043), while it did not affect postoperative outcomes. The multivariate analysis showed that shorter procedure duration, smaller stone burden and the 550-μm laser fiber were all significant independent predictors for decreased laser energy consumption. Conclusion: The 550-μm laser fiber may decrease laser energy and time during SRURS lithotripsy with Ho:YAG laser compared to the 365 μm. Given its lower cost, it may represent the optimal choice for semirigid procedures. © 2015, Springer Science+Business Media Dordrecht