Temperature changes and thermal laser damage during retrograde intrarenal surgery (RIRS) and percutaneous nephrolithotripsy (PCNL)

Systematic review about the detrimental effect of laser use during lithotripsy for renal or ureteral stones

Special Issue “Prostate Cancer: Recent Advances in Diagnostics and Treatment Planning”

This editorial of the Special Issue “Prostate Cancer: Recent Advances in Diagnostics and Treatment Planning” aims to draw more attention to the broad and diverse field of prostate cancer (PCa) diagnosis and the utilization of different diagnostic means to improve clinical decision-making and treatment strategy planning [...

Clinical significance of kallikrein 13 (KLK 13) in bladder cancer

Despite research advantages on the molecular and subcellular background, bladder cancer (BlCa) remains a clinically neglected malignancy. This is strongly reflected by the generic approach of disease diagnosis and management. Additionally, patients’ prognosis became a rather demanding task due to the great disease heterogeneity. Here, we aimed to evaluate, for the first time, the clinical value of KLK13 in BlCa. 279 bladder specimens (137 tumors, 107 adjacent normal and 35 healthy samples) were included. Total RNA was extracted, reversed transcribed, and KLK13 expression was assessed by quantitative real-time PCR. KLK13 expression is significantly increased in bladder tumors compared to normal epithelium. However, reduced KLK13 expression is correlated with disease aggressiveness, including higher tumor stage and grade, and high-risk TaT1 tumors according to the EORTC stratification. Moreover, Kaplan-Meier and Cox regression analysis highlighted the prognostic value of the reduced KLK13 expression for the prediction of TaT1 patients’ recurrence and shorter disease-free survival following TURBT. This first clinical study of KLK13 in BlCa reveals its deregulated expression in bladder tumors and highlights KLK13 as a promising marker for improving patients’ prognosis following treatment.Παρά τις πρόσφατες εξελίξεις σε μοριακό επίπεδο ο καρκίνος της ουροδόχου κύστης παραμένει σήμερα μια κλινικά παραμελημένη νόσος. Το γεγονός αυτό αντανακλάται από τη γενική προσέγγιση της διάγνωσης και θεραπείας της νόσου. Επιπλέον, η εκτίμηση της πρόγνωσης των ασθενών είναι ιδιάιτερα πολύπλοκη λόγω της ετερογένειας της νόσου. Στην παρούσα μελέτη εκτιμάται η κλινική αξία της KLK13 στον καρκίνο της κύστης. 279 δείγματα (137 καρκινικά, 107 φυσιολογικά παρακείμενα και 35 φυσιολογικά δείγματα) συμπεριλήφθησαν. Πραγματοποιήθηκε εξαγωγή και ανάστροφη μεταγραφή ολικού RNA, και η έκφραση της KLK13 αξιολογήθηκε με την ποσοτική αλυσιδωτή αντίδραση πολυμεράσης σε πραγματικό χρόνο. Η έκφραση της KLK13 είναι σημαντικά αυξημένη στους καρκινικούς σε σχέση με τους φυσιολογικούς ιστούς. Ωστόσο, η μείωση της έκφρασης της However, KLK13 σχετίζεται με την επιθετικότητα της νόσου (υψηλό στάδιο και grade). Επιπλέον, οι αναλύσεις Kaplan-Meier and Cox regression τονίζουν την προγνωστική αξία της μειωμένης έκφρασης της KLK13 στην πρόγνωση της υποτροπής και της ελεύθερης νόσου επιβίωσης των ασθενών με TaT1 όγκο και μετά από τη διουρηθρική εκτομή (TURBT). Η παρούσα είναι η πρώτη κλινική μελέτη της KLK13 στον καρκίνο της κύστης που αποκαλύπτει την απορρύθμιση της έκφρασης της στον καρκίνο της κύστης και καθιστά την KLK13 ως έναν υποσχόμενο δείκτη για τη βελτίωση της πρόγνωσης των ασθενών

A Review of Modern Imaging Landscape for Prostate Cancer: A Comprehensive Clinical Guide

The development of prostate cancer imaging is rapidly evolving, with many changes to the way patients are diagnosed, staged, and monitored for recurrence following treatment. New developments, including the potential role of imaging in screening and the combined diagnostic and therapeutic applications in the field of theranostics, are underway. In this paper, we aim to outline the current landscape in prostate cancer imaging and look to the future at the potential modalities and applications to come

Probiotics for prevention of recurrent urinary tract infections in women - A review of the evidence from microbiological and clinical studies

Recurrent urinary tract infections (UTIs) afflict a great number of women around the world. The use of probiotics, especially lactobacilli, has been considered for the prevention of UTIs. Since lactobacilli dominate the urogenital flora of healthy premenopausal women, it has been suggested that restoration of the urogenital flora, which is dominated by uropathogens, with lactobacilli may protect against UTIs. This review is based on a search of PubMed for relevant articles. Many in vitro studies, animal experiments, microbiological studies in healthy women, and clinical trials in women with UTIs have been carried out to assess the effectiveness and safety of probiotics for prophylaxis against uropathogens. Most of them had encouraging findings for some specific strains of lactobacilli. Lactobacillus rhamnosus GR-1 and L. reuteri RC-14 (previously called L fermentum RC-14) seemed to be the most effective among the studied lactobacilli for the prevention of UTIs. L. casei shirota and L crispatus CTV-05 have also shown efficacy in some studies. L. rhamnosus GG did not appear to be quite as effective in the prevention of UTIs. The evidence from the available studies suggests that probiotics can be beneficial for preventing recurrent UTIs in women; they also have a good safety profile. However, further research is needed to confirm these results before the widespread use of probiotics for this indication can be recommended

Role of Pediatric Ureteral Access Sheath and Outcomes Related to Flexible Ureteroscopy and Laser Stone Fragmentation : A Systematic Review of Literature

Flexible ureteroscopy and laser lithotripsy (FURSL) represent a good treatment option for pediatric urolithiasis. Scarce evidence is available about the safety and efficacy of the concomitant use of a ureteral access sheath (UAS) in the setting of pediatric ureteroscopy (URS). To acquire all the available evidence on UAS usage in pediatric FURSL, focusing on intra- and postoperative complications and stone-free rates (SFRs). We performed a systematic literature research using PubMed/MEDLINE, Embase, and Scopus databases. The inclusion criteria were cohorts of pediatric patients <18 yr old, submitted to URS for FURSL, reporting on more than ten cases of UAS placement. The primary outcomes were prestenting rates, operating time, ureteric stent placement rates after surgery, rates and grades of complications, ureteral injuries, and overall SFR. A total of 22 articles were selected. Evidence synthesis: In total, 26 intraoperative and 130 postoperative complications following URS with UAS placement were reported (1.8% and 9.18% of the overall procedures, respectively). According to the Clavien-Dindo classification, 32 were classified as Clavien I, 29 as Clavien II, 43 as Clavien I or II, six as Clavien III, and one as Clavien IV. Twenty-one cases of ureteral injuries (1.59%) were noted in the whole cohort; most of them were ureteral perforation or extravasation, and were treated with a temporary indwelling ureteric stent. The overall SFR after a single URS procedure was 76.92%; after at least a second procedure, it was 84.9%. FURSL is a safe and effective treatment option for pediatric urolithiasis. UAS use was associated with a low rate of ureteric injuries, mostly treated and resolved with a temporary indwelling ureteric stent. We performed a systematic literature research on the utilization of a UAS during ureteroscopy for stone treatment in pediatric patients. We assessed the outcomes related to the rates of intra- and postoperative complications and the rates of efficacy of the procedure in the clearance of stones. The evidence shows a low rate and grade of complications associated with UAS placement and good stone-free outcomes. A ureteric injury may occur in 1.6% of cases, but it is usually managed and resolved with a temporary indwelling ureteric stent

Urinary tract infections after pelvic floor gynecological surgery: prevalence and effect of antimicrobial prophylaxis. A systematic review

We evaluated the prevalence of urinary tract infection (UTI) after pelvic floor operations for non-malignant etiology and the effectiveness of antibiotic prophylaxis. This was made possible by a review of the evidence from relevant randomized controlled trials (RCTs). Nineteen out of 879 initially identified studies met the criteria for inclusion in our review. Four RCTs compared an antibiotic prophylactic regimen with placebo, 11 two different prophylactic antibiotic regimens, and four had three different treatment arms. Among placebo recipients undergoing pelvic floor surgery, 10-64% developed UTI. In contrast, UTI after pelvic floor gynecological surgery occurred in 0-15% of the patients who received cephalosporins as antibiotic prophylaxis; the likelihood for postoperative UTI was higher for patients receiving cotrimoxazole (28%), ampicillin/sulbactam (13.6%), metronidazole plus ampicillin (20%), metronidazole (10-22.7%), or ciprofloxacin (27.2%). The use of a cephalosporin as perioperative antimicrobial prophylaxis is the optimal regimen in preventing UTIs after pelvic floor surgery

Iatrogenic direct rectal injury: An unusual complication during suprapubic cystostomy (SPC) insertion and its laparoscopic management

Suprapubic cystostomy (SPC) is commonly used, instead of indwelling urethral catheter- ization, as indicated in many pathological conditions. Although considered to be a safe procedure that can be easily performed in an outpatient basis several complications have been reported in international literature. Bowel injury can be a serious complication with the small intestine affected in the majority of cases. We present a case of an acci- dental rectal injury by a suprapubic catheter misplacement, in a 76 year old demented patient with prostatic hyperplasia and chronic urinary retention. The injury was confirmed by cystogra- phy and injection of contrast meterial through the suprapubic catheter, and successfully treated laparoscopically by an extraperitoneal approach. The patient was discharged after 10 days with- out any complications. The above method, in experienced hands, can be an effective primary treatment option for such rare but devastating complications. The case and management is unique as, to our knowledge, as no similar cases have been presented