T1 Bladder Cancer: Comparison of the Prognostic Impact of Two Substaging Systems on Disease Recurrence and Progression and Suggestion of a Novel Nomogram

Background: The T1 substaging of bladder cancer (BCa) potentially impacts disease progression. The objective of the study was to compare the prognostic accuracy of two substaging systems on the recurrence and progression of primary pathologic T1 (pT1) BCa and to test a nomogram based on pT1 substaging for predicting recurrence-free survival (RFS) and progression-free survival (PFS).Methods: The medical records of 204 patients affected by pT1 BCa were retrospectively reviewed. Substaging was defined according to the depth of lamina propria invasion in T1(a-c) and the extension of the lamina propria invasion to T1-microinvasive (T1(m)) or T1-extensive (T1(e)). Uni- and multivariable Cox regression models evaluated the independent variables correlated with recurrence and progression. The predictive accuracies of the two substaging systems were compared by Harrell's C index. Multivariate Cox regression models for the RFS and PFS were also depicted by a nomogram.Results: The 5-year RFS was 47.5% with a significant difference between T1(c) and T1(a) (p = 0.02) and between T1(e) and T1(m) (p < 0.001). The 5-year PFS was 75.9% with a significant difference between T1(c) and T1(a) (p = 0.011) and between T1(e) and T1(m) (p < 0.001). Model T1(m-e) showed a higher predictive power than T1(a-c) for predicting RFS and PFS. In the univariate and multivariate model subcategory T1e, the diameter, location, and number of tumors were confirmed as factors influencing recurrence and progression after adjusting for the other variables. The nomogram incorporating the T1(m-e) model showed a satisfactory agreement between model predictions at 5 years and actual observations.Conclusions: Substaging is significantly associated with RFS and PFS for patients affected by T1 BCa and should be included in innovative prognostic nomograms

Feasibility of mirabegron in the treatment of overactive bladder in patients affected by Parkinson's disease: a pilot study

Background: We investigated the effectiveness and safety of mirabegron oral treatment in a group of patients with Parkinson’s disease (PD) and overactive bladder (OAB), refractory to antimuscarinics. Materials and methods: Thirty patients with PD and refractory OAB were prospectively included in the study. At baseline, motor symptoms, severity of disease and cognitive status were assessed with the Hoehn–Yahr Scale, the Unified Parkinson’s disease Rating Scale, the Mini Mental State examination and the Montreal Cognitive Assessment. At baseline, urinary symptoms, satisfaction with treatment and the impact of urinary incontinence on quality of life (QoL) were assessed with the 3-day voiding diary, the Visual Analogue Scale (VAS), the Incontinence–QoL questionnaire and urodynamics. Patients started assuming mirabegron 50 mg tablets once daily. Evaluation of urinary symptoms and related questionnaires, motor symptoms, severity of PD and uroflowmetry with postvoid residual volume measurement were then repeated at the 3- and 6-month follow up. Side effects were also noted. Results: At baseline, the most frequently reported urinary symptoms were: urinary urgency (present in all the patients), urge urinary incontinence in 28/30 (93.3%) and increased daytime urinary frequency in 25 (83.3%) patients. At the 3-month follow up, 7 out of the 30 patients achieved a complete urinary continence. Significant improvements in VAS and Incontinence–QoL scores were observed in 24 patients. These benefits were maintained for the whole observation period. Four patients discontinued treatment due to poor efficacy, and two due to the cost of the drug. Conclusions: Mirabegron is a safe and effective treatment in patients with PD and OAB refractory to anticholinergics in the short-term follow up. © The Author(s), 2019

The emerging role of PTBP1 in human cancer: Novel prognostic factor in non-muscle invasive bladder cancer

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Intermittent catheterization with a prelubricated catheter in spinal cord injured patients: A prospective randomized crossover study

Purpose: We compared the safety and patient acceptance of a conventional Nelaton and a prelubricated nonhydrophilic catheter in 18 spinal cord injured patients on intermittent catheterization. Materials and Methods: In a prospective crossover study each catheter was used for 7 weeks and the initial course was randomized. Urinalyisis and urine culture were performed at 2, 4 and 7 weeks. Urethral trauma was evaluated by urethral cell count on the surface of each catheter used on the last day of each study period. Patient satisfaction was assessed at the end of the study by a questionnaire using multiple visual analog scales. Results: Urinary tract infection was identified in 12 and 4 patients on a Nelaton and a prelubricated nonhydrophilic catheter (p = 0.03), while asymptomatic bacteruria was identified in 18 and 8 (p = 0.0244), respectively. The mean urethral cell count, plus or minus standard deviation on the catheter surface was 6.7 +/- 2.8 x 10(4) and 15.1 +/- 8.9 x 10(4) for the prelubricated nonhydrophilic and the Nelaton catheter, respectively (p = 0.01). The prelubricated nonhydrophilic catheter resulted in a better mean satisfaction score than the Nelaton catheter (2.33 +/- 1.06 versus 4.72 +/- 2.13, p = 0.022). Urethral bleeding was reported in 2 patients during the study period while using the Nelaton catheter. Conclusions: The prelubricated nonhydrophilic catheter is a safe, effective and comfortable option in spinal cord injured patients on intermittent self-catheterization

Intravesical electromotive drug administration

"Iontophoresis" is the common term used to define the active transport of ionic molecules across biologic tissues under the influence of an electric field. The term "electro-osmosis" defines the subsequent transport of the solvent. The term "electrophoresis" indicates the transport of a solution and a solute, by means of an electric current, independently of the electric charge of the solute. The three terms: iontophoresis, electroosmosis and electrophoresis are now usually included in the following few words: "Electromotive Drug Administration" (EMDA), and indicate the phenomena involved in drug transport across the biologic membranes, with the application of an electric current. In urology, EMDA has been used in different fields of application, as uro-oncology, neuro-urology, andrology and infective urological diseases. All the studies conducted, showed that EMDA is more effective than intravesical passive drug diffusion, without inducing any local or systemic side-effects. The basic premises of EMDA, as a greater knowledge of physical and chemical properties of the bladder wall and a more comprehensive knowledge of the drug employed, allow us to perform a non-empiric intravesical treatment. Repeatability of the results is one of the major concerns, which makes this methodology a really scientific treatment modality