Fala uderzeniowa o niskiej energii w leczeniu zaburzeń erekcji

Fala uderzeniowa o niskiej energii i częstotliwości (LESWT) jest nową, innowacyjną opcją terapeutyczną leczenia zaburzeń erekcji (ED). Aktualnie została zaliczona do metod pierwszego rzutu w leczeniu ED. Mechanizm działania LESWT nie jest dokładnie poznany, jednak wiadomo, że sprzyja on neowaskularyzacji, zwiększeniu proliferacji i różnicowania komórek śródbłonka, zwiększeniu liczby komórek mięśni gładkich oraz promocji wytwarzania tlenku azotu. Skuteczność LESWT wykazano przede wszystkim wśród pacjentów z naczyniopochodnymi zaburzeniami erekcji. W wyniku zastosowania tej terapii dochodzi do istotnej poprawy w zakresie domeny funkcji erekcyjnej, funkcji śródbłonka naczyniowego i wzrostu średniej punktacji skali twardości erekcji. Skuteczność LESWT potwierdzono u pacjentów należących do różnych grup w tym u chorych z najbardziej zaawansowanymi naczyniopochodnymi zaburzeniami erekcji nie reagującymi na leczenie PDE5i. W badaniach z udziałem ludzi nie odnotowano skutków ubocznych zarówno podczas leczenia jak i po terapii, a pacjenci deklarowali wysoki poziom zadowolenia z leczenia. Skuteczność poprawy funkcji erekcyjnej utrzymywała się długoterminowo. Mniej oczywiste są efekty uzyskane przy zastosowaniu tej metody w grupach chorych z ED w przebiegu choroby Pyeroniego, po zabiegu radykalnej prostatektomii metodą oszczędzającą pęczki naczyniowo-nerwowe i u chorych z przewlekłym bólem miednicy. Zalety terapii LESWT wiążą się z usuwaniem przyczyny naczyniopochodnych ED, co skutkuje długotrwałą poprawą sprawności seksualnej i pozwala przywrócić chorym spontaniczność prowadzenia życia seksualnego. Dotychczas uzyskane dowody wskazujące na skuteczność, bezpieczeństwo, komfort pacjenta i prostotą przeprowadzenia terapii LESWT skłaniają do szerszego stosowania tej innowacyjnej metody w celu poprawy funkcji erekcyjnej

Recommendations on the management of prostate cancer - a round table conference

Rak gruczołu krokowego jest jednym z najczęściej rozpoznawanych nowotworów u mężczyzn w wielu krajach Europy i w Ameryce Północnej. W ostatnich latach obserwuje się istotny wzrost liczby zachorowań, co w pierwszej kolejności można wiązać z wydłużeniem średniej długości życia i wprowadzeniem pod koniec lat 80. powszechnego oznaczania stężenia swoistego antygenu sterczowego (PSA) w surowicy. Podstawowymi metodami leczenia chorych na wczesnego raka gruczołu krokowego są zabieg chirurgiczny i radioterapia. U wybranych chorych o krótkim spodziewanym czasie przeżycia i niskim stopniu złośliwości histologicznej można rozważyć jedynie ścisłą obserwację. Leczenie chorych na zaawansowanego raka gruczołu krokowego polega na zmniejszeniu wpływu stymulującego działania androgenów na komórki raka w wyniku tak zwanej ablacji androgenowej. Pozwala ona na osiągnięcie poprawy subiektywnej, obniżenie stężenia PSA w surowicy oraz obiektywną regresję nowotworu (guza pierwotnego i/lub przerzutów w tkankach miękkich) u około 80% chorych. Wysoka zachorowalność na raka gruczołu krokowego i wciąż niezadowalające wyniki leczenia tego nowotworu stały się przyczyną potrzeby sformułowania jednolitych zasad postępowania diagnostyczno- -terapeutycznego opartego na dowodach o charakterze naukowym i wykorzystującego możliwość ścisłej współpracy lekarzy urologów oraz onkologów. Przedstawione w obecnym opracowaniu zalecenia stanowią wspólne stanowisko grupy ekspertów w dziedzinie urologii, onkologii i patomorfologii, które przyjęto podczas spotkania okrągłego stołu oraz uaktualniono na podstawie późniejszych doniesień.Prostate cancer is one of the most common male malignancies in most European countries and the US. A significant increase in the number of new cases has been observed over the last years, most probably due to increase in the life span and introduction of PSA in the 1980s. Two main treatment modalities of early prostate cancer are surgery and radiotherapy. In selected patients with short life expectancy and low histological grade of the tumor, watchful waiting is acceptable. Treatment of advanced prostate cancer is based on inhibition of stimulatory effect of androgens on prostate cancer cells. Androgen ablation allows for subjective improvement, PSA decrease and objective tumor regression in 80% of patients. High incidence of prostate cancer and unsatisfactory results of its treatment created a demand for uniform, evidence-based diagnostic and therapeutic guidelines. Recommendations presented in this paper were prepared during a round table meeting of experts in urology, oncology and pathology, and updated with most current literature data

Assessment of the Short-Term Effects after High-Inductive Electromagnetic Stimulation of Pelvic Floor Muscles: A Randomized, Sham-Controlled Study

Background: Physiotherapy should be performed by patients with stress or mixed urinary incontinence (SUI and MUI) to increase the strength and endurance of the pelvic floor muscles (PFMs). A method that can positively affect the pelvic floor is stimulation with high-inductive electromagnetic stimulation (HIES). The aim of the study was to evaluate the PFMs after the application of HIES in women with SUI and MUI by using surface electromyography (sEMG). Methods: This was a prospective, randomized, single-blind study with a sham intervention group. The participants were randomly assigned to the HIES group or sham group. The outcomes were features of the bioelectrical PFM activity assessed using sEMG and endovaginal probes. A single-session intervention in the HIES group included 20 min of HIES with an electromagnetic induction intensity of 2.5 T. Results: In the HIES group, there was a statistically significant difference in the PFM sEMG activity during “contractions” (p < 0.001) and “quick flicks” (p = 0.005). In the intergroup comparison, higher PFM sEMG activity after the intervention (“contraction”) was observed in the HIES group than in the sham group (after: p = 0.047; 1 h after: p = 0.017). Conclusions: The assessed HIES method seems effective for SUI and MUI patients in the short term and shows an advantage over the sham intervention in the assessment of PFM contractions

The Diagnostic Value of Nuclear Matrix Proteins in Bladder Cancer in the Aspect of Environmental Risk from Carcinogens

Background. The interaction of environmental factors with genetic susceptibility and detoxification level seems to be an important causative factor in bladder cancer (BC). The aim of this study was to look for a BC marker panel which reflects the environmental risk. The nuclear matrix protein 22 (NMP22), bladder cancer-4 (BLCA-4), and total level proteins NMP22 and BLCA-4 (NMBL) in BC patients with genetic predisposition NAT2 (classified as slow acetylators, SA), DNA damage (8-OHdG), and detoxification by isoenzyme GSTπ activity were measured. Materials and Methods. The urine and blood from 91 BC patients and controls were examined, also according to tumor stage (T) and grade (G). The participants completed a questionnaire in order to evaluate environmental risk. Results. Most patients (75.3%) were previous or actual smokers. The levels of 8-OHdG, NMP22, BLCA-4, NMBL, and GSTπ were significantly higher in BC (p≤0.001). The majority of patients (59.3%) were slow acetylators (SA). The highest BLCA-4/8-OHdG correlation was observed in total BC and SA smokers. Conclusions. The total pool of nuclear matrix proteins in the urine (NMBL) has a higher diagnostic value in bladder cancer than single proteins. The particular value of BLCA-4 and GSTπ in the aspect of environmental risk was noted

Assessment of the Elastographic and Electromyographic of Pelvic Floor Muscles in Postmenopausal Women with Stress Urinary Incontinence Symptoms

Background. Shear wave elastography is an effective method for studying the condition of various musculoskeletal soft tissues. The primary aim of this study was the objective elastographic and electromyographic assessment of the pelvic floor during the rest and contraction of the pelvic floor muscles (PFM) in postmenopausal women. Methods. This was a prospective observational study that was carried out at the University Hospital in Wroclaw, Poland, between January 2017 and December 2019. Patients. The target group of the study included postmenopausal women with stress urinary incontinence. The primary outcomes were the features of the elastographic assessment of the pelvic floor during rest and contraction of the PFM obtained using shear wave elastography. Results. Based on the inclusion and exclusion criteria for the study, 14 patients took part in the measurements. There was a significant difference between the elastographic assessment of the pelvic floor during rest and contraction of the PFM at all locations in front of the urethra. No statistically significant correlation was found between the results of elastography and the bioelectrical activity of PFM. Conclusion. The elasticity of the periurethral structures is higher during active pelvic floor muscle contraction than at rest, it seems that shear wave elastography is an effective test that objectively assesses the strength of PFM contraction

Sentinel Lymph Node Techniques in Urologic Oncology: Current Knowledge and Application

Lymph node (LN) metastases have a significant negative impact on the prognosis of urological malignancies. Unfortunately, current imaging modalities are insufficient when it comes to detecting micrometastases; thus, surgical LN removal is commonly used. However, there is still no established ideal lymph node dissection (LND) template, leading to unnecessary invasive staging and the possibility of missing LN metastases located outside the standard template. To address this issue, the sentinel lymph node (SLN) concept has been proposed. This technique involves identifying and removing the first group of draining LNs, which can accurately stage cancer. While successful in breast cancer and melanoma, the SLN technique in urologic oncology is still considered experimental due to high false-negative rates and lack of data in prostate, bladder, and kidney cancer. Nevertheless, the development of new tracers, imaging modalities, and surgical techniques may improve the potential of the SLN procedures in urological oncology. In this review, we aim to discuss the current knowledge and future contributions of the SLN procedure in the management of urological malignancies

Assessment of Pain Management, Acceptance of Illness, and Adjustment to Life with Cancer in Patients with Nonmuscle Invasive Bladder Cancer

Purpose. According to the European Association of Urology bladder cancer is the seventh most commonly diagnosed malignancy in the world’s male population. Despite its high incidence, papers evaluating psychological state in those patients’ group are lacking. The purpose of the study was to evaluate pain management, disease acceptance, and adjustment to cancer in homogenous group of patients diagnosed with nonmuscle-invasive bladder cancer (NMIBC). Methods. Group of 252 male patients who were scheduled for NMIBC treatment were prospectively evaluated. Patients fulfilled Acceptance of Illness Scale (AIS), Mini-Mental Adjustment to Cancer (Mini-MAC) and Coping Strategies (CSQ) questionnaires before treatment introduction. Results. Highest CSQ score was achieved by the coping self-statements subscale (mean=18,37). The catastrophizing subscale score was the lowest (mean=11,24). Place of residence affected results of CSQ statement about pain control. Catastrophizing and coping self-statements strategies were associated with matrimonial status. In the Mini-MAC questionnaire the fighting spirit way of coping had the highest (21,73) and the helplessness-hopelessness subscale had the lowest mean value (13,3). Matrimonial status was strongly associated with anxious preoccupation, fighting spirit, and helplessness – hopelessness way of coping. The mean AIS test score was 28.8. AIS result was influenced by patient’s marital status, yet not by education, place of residence, nor any clinical factor. Conclusions. In the examined group, the level of acceptance of the disease reached values that were slightly higher than the average. It indicated a fairly good adaptation to cancer. Among the methods of coping with cancer, the constructive style is definitely dominant with a high intensity of the fighting spirit strategy. The destructive style of cancer coping reached low values with a low intensity of helplessness/hopelessness strategy. From pain coping strategies, self-statements and praying/hoping were the most commonly chosen ways, whereas catastrophizing was the rarest. Many associations between various questioners’ results were also observed