A pure microcytic bladder carcinoma synchronous to prostatic adenocarcinoma

Small cell carcinoma (SCC) or microcytic carcinoma of the urinary bladder is a rare entity comprising approximately 0.5% of all bladder tumors. Due to its rarity, no prospective studies evaluating the most effective treatment have been published in the medical literature. Several cases of bladder SCC have been presented so far. We describe our case report and we revise the recent literature. Our patient was diagnosed with pure bladder SCC and prostatic adenocarcinoma. After the initial and complete transurethral resection of the bladder tumour (TUR-BT), he underwent a thorax and mediastinum computer tomography (CT) examination to exclude primary pulmonary small cell carcinoma and a bone scan scintigraphy for staging purposes. He received a three 14-day cycles of Cisplatin-containing chemotherapeutic schema and a single dose of Luteinizing-Hormone Releasing hormone (LHRH) analogue injection after 14 days of bicalutamide administration. The patient is followed for 24 months without any signs of bladder SCC recurrence or biochemical or local relapse from prostatic adenocarcinoma

What is the most effective treatment for nocturia or nocturnal incontinence in adult women?

Acknowledgments The authors express their thanks to F.C. Burkhard for invaluable logistic support during the conception of the manuscript.Peer reviewedPostprin

Improving guideline adherence in urology

Dr. Skolarus is supported by the National Cancer Institute R01 CA242559 and R37 CA222885. No conflicts of interest.Peer reviewedPostprin

Medical Treatment of Nocturia in Men with Lower Urinary Tract Symptoms : Systematic Review by the European Association of Urology Guidelines Panel for Male Lower Urinary Tract Symptoms

Context: The treatment of nocturia is a key challenge due to the multi-factorial pathophysiology of the symptom and the disparate outcome measures used in research. Objective: To assess and compare available therapy options for nocturia, in terms of symptom severity and quality of life. Evidence acquisition: Medical databases (Embase, Medline, Cochrane Systematic Reviews, Cochrane Central) were searched with no date restriction. Comparative studies were included which studied adult men with nocturia as the primary presentation and lower urinary tract symptoms including nocturia or nocturnal polyuria. Outcomes were symptom severity, quality of life, and harms. Evidence synthesis: We identified 44 articles. Antidiuretic therapy using dose titration was more effective than placebo in relation to nocturnal voiding frequency and duration of undisturbed sleep; baseline serum sodium is a key selection criterion. Screening for hyponatremia (<130 mmol/l) must be undertaken at baseline, after initiation or dose titration, and during treatment. Medications to treat lower urinary tract dysfunction (alpha-1 adrenergic antagonists, 5-alpha reductase inhibitors, phosphodiesterase type 5inhibitor, antimuscarinics, beta-3 agonist, and phytotherapy) were generally not significantly better than placebo in short-term use. Benefits with combination therapies were not consistently observed. Other medications (diuretics, agents to promote sleep, nonsteroidal anti-inflammatories) were sometimes associated with response or quality of life improvement. The recommendations of the Guideline Panel are presented. Conclusions: Issues of trial designmake therapy of nocturia a challenging topic. The range of contributory factors relevant in nocturia makes it desirable to identify predictors of response to guide therapy. Consistent responses were reported for titrated antidiuretic therapy. For other therapies, responses were less certain, and potentially of limited clinical benefit. Patient summary: This review provides an overview of the current drug treatments of nocturia, which is the need to wake at night to pass urine. The symptom can be caused by several different medical conditions, and measuring its severity and impact varies in separate research studies. No single treatment deals with the symptom in all contexts, and careful assessment is essential to make suitable treatment selection. (C) 2017 European Association of Urology. Published by Elsevier B.V. All rights reserved.Peer reviewe

Diagnostic Tests for Female Bladder Outlet Obstruction : A Systematic Review from the European Association of Urology Non-neurogenic Female LUTS Guidelines Panel

Acknowledgements Jae Hung Jung, Murat Gul, Ege Can Serefoglu (translation of foreign language articles) and Karin Plass for administrative support.Peer reviewedPostprin

Clinical Characterization of Patients Diagnosed with Prostate Cancer and Undergoing Conservative Management:A PIONEER Analysis Based on Big Data

Background: Conservative management is an option for prostate cancer (PCa) patients either with the objective of delaying or even avoiding curative therapy, or to wait until palliative treatment is needed. PIONEER, funded by the European Commission Innovative Medicines Initiative, aims at improving PCa care across Europe through the application of big data analytics. Objective: To describe the clinical characteristics and long-term outcomes of PCa patients on conservative management by using an international large network of real-world data. Design, setting, and participants: From an initial cohort of &gt;100 000 000 adult individuals included in eight databases evaluated during a virtual study-a-thon hosted by PIONEER, we identified newly diagnosed PCa cases (n = 527 311). Among those, we selected patients who did not receive curative or palliative treatment within 6 mo from diagnosis (n = 123 146). Outcome measurements and statistical analysis: Patient and disease characteristics were reported. The number of patients who experienced the main study outcomes was quantified for each stratum and the overall cohort. Kaplan-Meier analyses were used to estimate the distribution of time to event data. Results and limitations: The most common comorbidities were hypertension (35–73%), obesity (9.2–54%), and type 2 diabetes (11–28%). The rate of PCa-related symptomatic progression ranged between 2.6% and 6.2%. Hospitalization (12–25%) and emergency department visits (10–14%) were common events during the 1st year of follow-up. The probability of being free from both palliative and curative treatments decreased during follow-up. Limitations include a lack of information on patients and disease characteristics and on treatment intent. Conclusions: Our results allow us to better understand the current landscape of patients with PCa managed with conservative treatment. PIONEER offers a unique opportunity to characterize the baseline features and outcomes of PCa patients managed conservatively using real-world data. Patient summary: Up to 25% of men with prostate cancer (PCa) managed conservatively experienced hospitalization and emergency department visits within the 1st year after diagnosis; 6% experienced PCa-related symptoms. The probability of receiving therapies for PCa decreased according to time elapsed after the diagnosis.</p

Thermal flow in ducts and application of a new numerical method for the study of the incompressible laminar flow in curved and helical ducts

A new computational method is presented for the study of general three-dimensional parabolic or partially parabolic incompressible flows. The method is based in the use of a co-location grid for the velocity components and the pressure field, the insertion of three additional variational representations for the continuity, the vorticity and the pressure equations respectively and is named, in short, as CVP computational method. The method is used for the study of the characteristics of the laminar incompressible flow in a square cavity with a moving boundary, for the study of fully developed flow and heat transfer in curved square ducts and for the study of fully developed flow in helical square ducts. Also, results are presented for the problems of the thermally developed flow in straight elliptic or square finned ducts. Numerical results are presented for the effects of the flow parameters like the curvature, the torsion, the Dean number, the Prandtl number and the stream pressure gradient on the velocity, the temperature, the friction factor and the Nusselt number distribution. The new CVP method does not introduce the spurious pressure field oscillations presented in other pressure-linked methods. The use of co-location grid yields to an ease discretization of the involved equations, reducing the mathematical complexity, particularly in the case of complex geometries. The validity and the accuracy of the method is discussed and the results are in close agreement with those obtained by other methods. For the case of the flow in a helical square duct, the results show that the torsion deforms substantially the symmetry of the two vortices of the secondary flow. The friction factor decreases for torsion in the range 0 to 0.1 and increases as the torsion increases further, a behaviour which is more profound as the Dean number increases. Our results are stable for the calculated Dean numbers

Changes in lower urinary tract cholinergic pathways in patients with BPH - associated LUTS and OAB symptoms – the effect of oral antimuscarinics

Scientific backgroundEven though LUTS, BPH and OAB are clearly causally related, the extent to which they are and the nature of the mechanisms linking them are ill-understood. In conditions of bladder outlet obstruction (BOO), OAB is thought to be the result of detrusor overactivity (DO) generated to overcome the BOO, although alternative mechanisms in the cause of this condition seem likely, as the incidence of LUTS and OAB in elderly women matches that of men, a proportion of men with OAB have no BOO, and 30% of men with both OAB and BOO continue to have symptoms despite correcting the BOO.Aim of the studyTo identify potential effects of antimuscarinics on the prostate as well as on the bladder at both molecular and clinical level in patients with BPE-OAB.MethodsWe recruited non-neurological patients with prostate volume >30ml, predominately storage LUTS, ≥3 urgency episodes per 24h, maximum flow rate ≥10ml/s and post-void residual ≤100ml. Patients were randomized to receive either Tamsulosin or Tamsulosin+Solifenacin. Recruited patients were submitted to transrectal and transvesical ultrasonography, pressure-flow study, PSA test and completed the IPSS, bladder diary and OABq questionnaire at induction and at 6 months. At the end of the study, patients were given the choice of prostatectomy. Bladder and prostate tissue samples were evaluated at gene and proteins expression level of muscarinic (M1, M2, M3), adrenergic (Adra 1a, Adra 1d), androgenic and TRPV1 receptors. End-study changes in questionnaires scores, morphometric prostate parameters (total prostate and adenoma volumes, prostate vascular surface) as measured by TRUS and urodynamic parameters were secondary outcomes. Results A statistical significant difference was noted, in protein expression of M3 receptors in prostates of treatment naïve and asymptomatic men as well as in gene expression men receiving combination therapy. There was no difference in M2 expression while M1 expression was reduced in men receiving tamsulosin. A reduction in total prostate volume (mean: -9.5%) was noted in the combination group, as opposed to an increase in monotherapy group (+9.2%)(p30ml, μέγιστη ροή ούρων ≥10ml/s, υπόλοιπο στη μετά ούρηση ≤100ml, τουλάχιστον 8 ουρήσεις ημερησίως με τουλάχιστον 3 επεισόδια έπειξης ανα 24ωρο με σκορ ≥3 της ερώτησης 4 του IPSS. Οι ασθενείς τυχαιοποιήθηκαν να λάβουν ταμσουλοσίνη ή συνδιασμό ταμσουλοσίνης – σολιφενακίνης για διάστημα 6 μηνών. Κατά την ένταξη και την ολοκλήρωση της μελέτης υπεβλήθηκαν σε ουροδυναμική και υπερηχογραφική μελέτη, συμπλήρωσαν ερωτηματολόγια (IPSS, OABq) και ημερολόγιο ούρησης. Μετά το πέρας των 6 μηνών τους δόθηκε η επιλογή της προστατεκτομής. Δείγματα ιστού χρησιμοποιήθηκαν για την ανοσοιστοχημική μελέτη των μουσκαρινικών (Μ1, Μ2, Μ3), αδρενεργικών (Adra 1a, Adra 1d), του ανδρογονικού και του TRPV1 υποδοχέων. Αποτελεσματα Βρέθηκε στατιστικά σημαντική διαφορά την πρωτεϊνική έκφραση του Μ3 στον προστατικό ιστό ασυμπτωματικών και συμπτωματικών ανδρών, όπως και στους άνδρες που έλαβαν συνδιαστική θεραπεία.Δεν βρέθηκε καποια διαφορά στην έκφραση του Μ2 ενώ η έκφραση του Μ1 βρέθηκε μειωμένη στους άνδρες που έλαβαν ταμσουλοσίνη. Στο κλινικό σκέλος της μελέτης βρέθηκε σημαντική μείωση του μεγέθους του προστάτη (-9.5%) των ανδρών που έλαβαν συνδιαστική αγωγή ενώ στους άνδρες που έλαβαν μονοθεραπεία με ταμσουλοσίνη παρατηρήθηκε αύξηση (+9.2%)(p<0.001). Αντίστοιχες ήταν οι μεταβολές στην ογκομέτρηση του αδενώματος (μονοθεραπεία :+17.4% έναντι συνδιαστικής θεραπείας :-12.5%, p=0.001) και στην αγγείωση του προστάτη (μονοθεραπεία:+149.3% v έναντι συνδιαστικής θεραπείας:-19.8%, p=0.001). Και οι δύο θεραπείες βελτίωσαν το σκορ του IPSS. Η ομάδα της μονοθεραπείας υπερτερεί στο σκορ ερωτημάτων κένωσης (p=0.01) σε αντίθεση με την ομάδα συνδιαστικής θεραπείας που υπερτερεί στο σκορ ερωτημάτων αποθήκευσης (p=0.024). Η κυστεομανομετρική χωρητικότητα βελτιώθηκε στην ομάδα συνδιασμού (p<0.001). Το υπόλοιπο στη μετά ούρηση αυξήθηκε στην ομάδα συνδιαστικής θεραπείας (+34.79%) ενω μειώθηκε στην ομάδα μονοθεραπείας (-17.05%) (p=0.001).ΣυμπεράσματαΤα αποτελέσματά της πιλοτικής αυτής μελέτης καταδεικνύουν τον πιθανό ρόλο των Μ3 υποδοχέων στους παθολογικούς μηχανισμούς υπεύθυνους για την ΟΑΒ σε ασθενείς με ΚΥΠ. Η σολιφενακίνη φαίνεται να έχει δράση και στον προστάτη αφού επηρεάζει το μέγεθος του αδένα και την αγγείωσή του

Latest Evidence on Post-Prostatectomy Urinary Incontinence

A radical prostatectomy is frequently used as the first-line treatment for men with prostate cancer. Persistent urinary incontinence after surgery is one of the most severe adverse events. We report the results of a comprehensive literature search focused on post-prostatectomy urinary incontinence (PPI), performed by a panel of experts on non-neurogenic lower urinary tract symptoms. The data on the prevalence and timing of PPI are very heterogeneous. The etiology of PPI can be multifactorial and mainly dependent on patient characteristics, lower urinary tract function or surgical issues. The medical history with a physical examination, the use of validated questionnaires with a voiding diary and pad tests are determinants in identifying the contributing factors and choosing the right treatment. Lifestyle intervention and urinary containment are the most frequently used strategies for the conservative management of PPI, while antimuscarinics, beta-3 agonists and duloxetine (off-label) are drugs indicated to manage PPI with a concomitant overactive bladder. Surgical therapies for the management of post-prostatectomy SUI include non-adjustable trans-obturator slings in men with mild-to-moderate incontinence and an artificial urinary sphincter in men with moderate-to-severe incontinence