Synchronous and metachronous urothelial carcinoma of the upper urinary tract and the bladder: Are they clonally related? A systematic review

Purpose: Following radical nephroureterectomy for upper urinary tract urothelial carcinoma (UTUC), intravesical recurrence (IVR) is found in 22% to 47% of patients. Patients with a primary urothelial carcinoma of the bladder (UCB) have an increased risk of a future UTUC (1%–5%). Paired UTUC and UCB might represent clonally related tumors due to intraluminal seeding of tumor cells or might be separate entities of urothelial carcinoma caused by field cancerization. We systematically reviewed all the relevant literature to address the possible clonal relation of UTUC and paired UCB. Materials and Methods: MEDLINE, EMBASE, and COCHRANE databases were systematically searched for relevant citations published between January 2000 and July 2019. This study was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. Of 5038 citations identified, 86 full papers were screened, and 9 studies met the inclusion criteria. Results: The populations studied and the molecular techniques used to assess clonality of UTUC and paired UCB differed largely over time. Eight studies reported on primary UTUC and meta- or synchronous IVR without a history of UCB. A total of 118 tumors

Real-world management of testicular torsion: Level of adherence to the EAU Pediatric Urology guidelines

Background: Testicular torsion is the most frequent cause of irreversible ischemia to the testis. Despite guidelines being available, challenges remain in both diagnosis and management of the disease. Objective: This study aims to determine the adherence of urologists and residents in urology to the European Association of Urology (EAU) Pediatric Guideline on Testicular torsion. Study design: Both Dutch and European urologists, and residents in urology filled in a survey on testicular torsion. Information on demographics, diagnostics, and treatment modalities was retrieved from the questionnaire based on the EAU Guideline on Paediatric Urology. Results: A total of 303 responders participated, of which 214 (71%) were from The Netherlands. Most (61%) responders treated three or more cases of testicular torsion in 2020. Ultrasound was used by 64%, followed by an attempt of manual detorsion by 38% (Summary Fig.). Importantly, 23% preferred not to perform emergency surgery after successful manual detorsion. A Winkelmann procedure was performed by 23%, without fixation of the test is using suture material. A large group of responders (30%) only fixed the contralateral testis by a proven testicular torsion. Discussion: A feasible adherence to the EAU Guideline on Paediatric Urology in treating testicular torsion was reported using this survey, although not all recommendations are implemented as proposed. The fact that outcomes of the different diagnostic and treatment modalities are lacking might be a limitation in interpreting the results of this survey. Conclusion: Majority of the responders followed the EAU Guideline on Paediatric Urology in the diagnosis and treatment of testicular torsion. Ultrasound might contribute to diagnosing testicular torsion as long as this does not cause any delay for surgical exploration. Surprisingly, many urologists do not perform a surgical fixation of the testis after detorsion. Since a wide range of techniques and materials is used in case of surgical fixation, the guideline may provide in preferences for a unified policy among urologists.[Formul

Rising incidence rates and unaltered survival rates for primary upper urinary tract urothelial carcinoma

Aim: To assess trends in the incidence, disease management and survival rates for upper urinary tract urothelial carcinoma (UTUC) in the Netherlands. Materials and methods: Patients diagnosed with primary UTUC in the Netherlands between 1993 and 2017 were identified through the population-based Netherlands Cancer Registry (NCR). Patient and tumour characteristics, as well as information on treatment and vital status, were retrieved from the NCR. Age-standardized incidence rates were calculated, stratified by age, gender, calendar period and disease stage. Rela

Biohydrogen production from untreated and hydrolyzed potato steam peels by the extreme thermophiles Caldicellulosiruptor saccharolyticus and Thermotoga neapolitana

Production of hydrogen by the extreme thermophiles Caldicellulosiruptor saccharolyticus and Thermotoga neapolitana was studied in serum flasks and in pH-controlled bioreactors with glucose, and hydrolyzed and untreated potato steam peels (PSP) as carbon sources. Two types of PSP hydrolysates were used: one in which the starch in the PSP was liquefied with alpha-amylase, and one in which the liquefied starch was further hydrolyzed to glucose by amyloglucosidase. When the PSP hydrolysates or untreated PSP were added at circa 10–14 g/L of glucose units, both strains grew well and produced hydrogen with reasonable to high molar yields (2.4–3.8 moles H2/mole glucose units), and no significant production of lactate. The hydrogen production rates and yields were similar with untreated PSP, hydrolyzed PSP, and pure glucose, showing that C. saccharolyticus and T. neapolitana are well equipped for the utilization of starch. When the concentrations of the substrates were increased, growth and hydrogen production of both strains were hampered. At substrate concentrations of circa 30–40 g/L of glucose units, the molar hydrogen yield of C. saccharolyticus was severely reduced due to the formation of high amounts of lactate, while T. neapolitana was unable to grow at all. The results showed that PSP and PSP hydrolysates are very suitable substrates for efficient fermentative hydrogen production at moderate substrate loadings

Intra-cavity Photodynamic Therapy for malignant tumors of the paranasal sinuses: An in vivo light dosimetry study

Background: Photodynamic therapy (PDT) is a promising treatment option for recurrent sinonasal malignancies. However, light administration in this area is challenging given the complex geometry, varying tissue optical properties and difficult accessibility. The goal of this study was to estimate the temporal and spatial variation in fluence and fluence rate during sinonasal mTHPC-mediated PDT. It was investigated whether the predetermined aim to illuminate with a fluence of 20 J⋅cm−2 and fluence rate of 100 mW⋅cm−2 was achieved. Methods: In eleven patients the fluence and fluence rates were measured using in vivo light dosimetry at the target location during real-time sinonasal PDT. There was a variance in sinonasal target location and type of light diffuser used. In four patients two isotropic detectors were used within the same cavity. Results: All measurements showed major fluence rate fluctuations within each single isotropic detector probe over time, as well as between probes within the same cavity. The largest fluence rate range measured was 328 mW⋅cm−2. Only one probe showed a mean fluence rate of ∼100 mW⋅cm−2. Taken all probes together, a fluence rate above 80 mW⋅cm−2 was measured in 31 % of the total light exposure; in 22 % it was less than 20 mW⋅cm−2. Thirty-three percent showed a fluence of at least 20 J⋅cm−2. Conclusions: The current dosimetry approach for sinonasal intra-cavity PDT shows major temporal and spatial variations in fluence rate and a large variance in light exposure time. The results emphasize the need for improvement of in vivo light dosimetry and dosimetry planning

Reduce bladder cancer recurrence in patients treated for upper urinary tract urothelial carcinoma: The REBACARE-trial

Background: Following radical nephro-ureterectomy for urothelial carcinoma of the upper urinary tract (UUT), the reported bladder recurrence rate of urothelial carcinoma is 22-47%. A single intravesical instillation of chemotherapy within 10 days following nephro-ureterectomy has the potential to decrease the risk of a bladder recurrence significantly. Despite recommendation by the European Association of Urology guideline to administer a single instillation postoperatively, the compliance rate is low because the risk of extravasation of chemotherapy. Aim: To reduce the risk of bladder cancer recurrence by a single intravesical instillation of Mitomycin immediately (within 3h) before radical nephro-ureterectomy or partial ureterectomy. Methods: Adult patients (age>/=18 years) with a (suspicion of a) urothelial carcinoma of the UUT undergoing radical nephro-ureterectomy or partial ureterectomy will be eligible and will receive a single intravesical instillation of Mitomycin within 3h before surgery. In total, 170 patients will be included in this prospective, observational study. Follow-up will be according to current guidelines. Results: The primary endpoint is the bladder cancer recurrence rate up to two years after surgery. Secondary endpoints are: a) the compliance rate; b) oncological outcome; c) possible side-effects; d) the quality of life; e) the calculation of costs of a single neoadjuvant instillation with Mitomycin and f) molecular characterization of UUT tumors and intravesical recurrences. Conclusions: A single intravesical instillation of Mitomycin before radical nephro-ureterectomy or partial ureterectomy may reduce the risk of a bladder recurrence in patients treated for UUT urothelial carcinoma and will circumvent the disadvantages of current therapy