ISSN: 1735-1308

Instant 2021

ORIGINAL PAPER (ENDOUROLOGY AND STONE DISEASE)


Effect of a Probiotic Supplement Containing Lactobacillus Acidophilus and Bifidobacterium Animalis Lactis on Urine Oxalate in Calcium Stone Formers with Hyperoxaluria: A Randomized, Placebo-controlled, Double-blind and In-vitro Trial

Sanaz Tavasoli, Saba Jalali, Mohammad Naji, Nasrin Borumandnia, Ghazaleh Shakiba Majd, Abbas Basiri, Kianaoush Khosravi Darani, Dina Karamad, Maryam Tajabadi-Ebrahimi, Maryam Taheri

Urology Journal, , , Page 6789
https://doi.org/10.22037/uj.v18i.6789

Purpose: To determine the effect of a probiotic supplement containing native Lactobacillus acidophilus (L. acidophilus) and Bifidobacterium animalis lactis (B. lactis) on 24-hour urine oxalate in recurrent calcium stone formers with hyperoxaluria. Moreover, the in-vitro oxalate degradation capacity and the intestinal colonization of consumed probiotics were evaluated.


Materials and Methods: The oxalate degrading activity of L. acidophilus and B. lactis were evaluated in-vitro. The presence of oxalyl-CoA decarboxylase (oxc) gene in the probiotic species was assessed. One hundred patients were randomized to receive the probiotic supplement or placebo for four weeks. The 24-hour urine oxalate and the colonization of consumed probiotics were assessed after weeks four and eight.


Results: Although the oxc gene was present in both species, only L. acidophilus had a good oxalate degrading activity, in-vitro. Thirty-four patients from the probiotic and thirty patients from the placebo group finished the study. The urine oxalate changes were not significantly different between groups (57.21 ± 11.71 to 49.44 ± 18.14 mg/day for probiotic, and 56.43 ± 9.89 to 50.47 ± 18.04 mg/day for placebo) (= .776). The probiotic consumption had no significant effect on urine oxalate, both in univariable (= .771) and multivariable analyses (P = .490). The consumed probiotics were not detected in the stool samples of most participants.


Conclusion: Our results showed that the consumption of a probiotic supplement containing L. acidophilus and B. lactis did not affect urine oxalate. The results may be due to a lack of bacterial colonization in the intestine.

Purpose: To investigate whether a Percutaneous nephrostomy (PCN) has any impact on the success rate of shock wave lithotripsy (SWL) and to estimate the probability of stone-free in SWL patients with upper ureter stones.


Materials and Methods: Overall, 236 patients who underwent SWL for upper ureter stones between 2015 and 2019 were evaluated. Forty-nine patients who underwent PCN during SWL were identified. Medical data of the patients were retrospectively reviewed, and possible prognostic features were evaluated.


Results: Out of all patients, 147 patients were selected through propensity score matching. There were no significant differences between the PCN and no PCN groups, except for a lower stone-free rate (55.1% vs. 74.5%, p = .018) and one-session success rate (24.5% vs. 50.0%, p = .003) in the PCN group. In univariate analysis, a younger age, the female sex, a smaller size of stone, lower mean stone density (MSD), and absence of PCN were positive predictive factors of being stone-free in patients who underwent SWL. In multivariate analysis, a smaller size, lower MSD, and absence of PCN were positive predictive factors of being stone-free in patients who underwent SWL.


Conclusion: Stone size, MSD, and PCN were prognostic factors that influence the outcome of SWL. The presence of PCN during SWL is associated with adverse success rates in patients with upper ureter stones.

ORIGINAL PAPER(UROLOGICAL ONCOLOGY)


The Association of Cell Surface Fibromodulin Expression and Bladder Carcinoma

Ali-Ahmad Bayat, Niloufar Sadeghi, Ali Salimi, Ghazaleh Fazli, Mohammad Reza Nowroozi, Solmaz Ohadian Moghadam, Amin Radmanesh, Mohsen Tabasi, Ali Reza Sarrafzadeh, Omid Zarei, Hodjattallah Rabbani

Urology Journal, , , Page 6461
https://doi.org/10.22037/uj.v18i.6461

Background: Fibromodulin (FMOD) is a secretory protein which is considered a major component of extracellular matrix. Its dysregulation in different types of cancer implies it as a promising target for cancer therapy. Within the scope of its rather wide expression in different tumors, we studied expression of FMOD and effect of anti-FMOD antibody in bladder cancer cells in order to identify new target for diagnostic and therapeutic interventions. We report here for the first time the expression of FMOD in bladder cancer cell lines in comparison to the normal cell line and tissues.


Methods: A peptide-based produced anti-FMOD murine monoclonal antibody (mAb) (clone 2C2-A1) was applied for evaluation of FMOD expression in bladder cancer and normal tissues by immunohistochemistry (IHC) staining. Furthermore, the expression of FMOD was examined in human bladder cell lines, 5637 and EJ138, as well as a non-cancerous human cell line, human fetal foreskin fibroblast (HFFF), by immunocytochemistry (ICC) and flow cytometry. The apoptosis induction of anti-FMOD mAb was also evaluated in bladder cancer cells.


Results: IHC and ICC analyses revealed that the qualitative expression of FMOD in bladder cancer tissues and cell lines is higher than in normal tissues and cell lines. Flow cytometry analyses revealed that 2C2-A1 mAb could recognize FMOD expression in 84.05 ± 1.85%, 46.1 ± .4% , and 2.56 ± 1.26% of 5637, EJ138, and HFFF cells, respectively. An effective apoptosis induction was detected in 5637 and EJ138 cells with no significant effect on HFFF cell.


Conclusion: To our knowledge, this is for the first time reporting surface expression of FMOD in bladder cancer. This significant surface expression of FMOD in bladder cancer with no expression in normal bladder tissues and the capacity of inducing apoptosis through directed targeting of FMOD with specific monoclonal antibody might candidates FMOD as a diagnostic marker as well as a potential immunotargeting with monoclonal antibody.

Purpose: Fournier’s gangrene (FG) is a serious, aggressive, and often fatal multi-organism infection that affects the soft tissues of the perineum, rectum, and external genitalia. This study aimed to analyse the treatment’s strategies of FG.


Materials and Methods: This was a retrospective study of 35 patients with a diagnosis of FG admitted between 2016 and 2021. The diagnosis of FG was established on a clinical basis. Data on patient’s age, sex, comorbidities, laboratory results (C-reactive protein (CRP), white blood cell (WBC), hematocrit (HCT), platelets (PLT), sodium, potassium, creatinine, procalcitonin, international normalized ratio (INR), and gangrene culture), extent of resection, antibiotics used, and hospitalisation time were obtained. The extent of resection was assessed on a scale of 1–5.


Results: The study group consisted of all men (n=35) aged 24–85 (mean, 58) years. In 13/35 (37%) patients, hyperbaric oxygen therapy (HBOT) combined with negative-pressure wound therapy (NPWT) was used as a treatment for wound healing in Fournier’s syndrome (group 1), and in 22/35 (63%) patients, open standard wound care was used (group 2). There were no fatalities in group 1, but four deaths (18%) were noted in group 2. The median extent of resection was 3 in group 1 and 2 in group 2. There was a correlation between the extent of resection and use of HBOT combined with NPWT. The hospitalisation time was much shorter in group 2 (mean, 23 days) than in group 1 (mean, 26 days).


Conclusion: HBOT and NPWT (group 1) showed advanced wound healing with a high efficiency rate. The longer median hospitalisation time in this group may be related to the severity of injury. 

Predictors of Secondary Bladder Cancer in Patients with Prostate Cancer Treated with Brachytherapy: A Single-institution Study of a Japanese Cohort

Kiyoshi Takahara, Makoto Sumitomo, Masayuki Ito, Fumitaka Ito, Masashi Nishino, Takuhisa Nukaya, Masashi Takenaka, Kenji Zennami, Kosuke Fukaya, Manabu Ichino, Naohiko Fukami, Hitomi Sasaki, Mamoru Kusaka, Shinya Hayashi, Hiroshi Toyama, Ryoichi Shiroki

Urology Journal, , , Page 6718
https://doi.org/10.22037/uj.v18i.6718

Purpose: The incidence of secondary bladder cancer after treatment for localized prostate cancer (PCa) remains unclear. In this study, PCa cases treated with brachytherapy (BT) were evaluated to assess the incidence of a second malignancy of bladder cancer in a Japanese cohort.


Materials and Methods: Overall, 969 patients treated with BT at our hospital between July 2006 and January 2019 were included in the study cohort. The incidence and predictors of secondary bladder cancer were also assessed.


Results: The incidence of secondary bladder cancer was 1.5% (n = 14). Of the seven factors (age, pretreatment PSA, Gleason score, cTNM stage, prostate volume, total activity, and combined external beam), prostate volume and total activity showed significant differences between the cohorts with and without secondary bladder cancer (P = .03 and P = .001, respectively). Upon comparison of the seven parameters for the 969 patients treated with BT, we found that only the total activity factor was affected by the incidence of secondary bladder cancer in the multivariate analysis (P = .007).


Conclusion: The incidence of secondary bladder cancer was evaluated after BT for PCa. Total activity was associated with the incidence of secondary bladder cancer in Japanese patients who received BT.

Purpose: Bladder cancer is a common cancer in the world with the highest rates in Southern and Western Europe, North America, and Western Asia. It imposes a high economic burden to the health care system globally. The objective of this study is to provide the incidence of bladder cancer and its geographic distribution in Iran in 2014, 2015 and 2016.


Results: We registered 5817, 5662 and 6630 new bladder cancer cases in 2014, 2015 and 2016, respectively with men counting 82% of cases in every year. The ASR of bladder cancer in total Iranian population was 8.50 (95% CI: 8.28-8.72), 8.05 (95% CI: 7.83-8.27) and 8.74 (95% CI: 8.52-8.96) per 100,000 in those years. The male to female ratio was 5 every year. Kerman has the highest ASR in each of the years, respectively 15.49, 13.07 and 12.46, and Ilam has the lowest ASR during 2014 to 2015, respectively 4.27 and 3.50, and Sistan and Baluchestan has the lowest rate in 2016 (ASR:3.56) in both sexes.


Conclusion: The highest incidence of bladder cancer was observed in Central, southern and northwestern parts of Iran. Through the analysis of the incidence patterns and the identification of risk factors associated with it, steps can be taken towards prevention and control measures.

Prognostic Significance of the Neutrophil-to-Lymphocyte Ratio in Patients with Non-Muscle Invasive Bladder Cancer treated with Intravesical Bacillus Calmette–Guérin and the Relationship with the CUETO Scoring Model

Jae-Wook Chung, Jin Woo Kim, Eun Hye Lee, So Young Chun , Dong Jin Park, Kyeong Hyeon Byeon, Seock Hwan Choi, Jun Nyung Lee, Bum Soo Kim, Hyun Tae Kim, Eun Sang Yoo, Tae Gyun Kwon, Yun-Sok Ha, Tae-Hwan Kim

Urology Journal, , , Page 6765
https://doi.org/10.22037/uj.v18i.6765

Purpose: In this study, we evaluated the predictability of a modified Club Urológico Español de Tratamiento Oncológico (CUETO) scoring model and preoperative neutrophil-to-lymphocyte ratio (NLR) in patients with non-muscle invasive bladder cancer (NMIBC).


Materials and Methods: From August 2005 to May 2016, a total of 281 patients received intravesical bacillus Calmette–Guérin therapy after transurethral resection of a bladder tumor. The pathologic stage of all patients was Ta or T1. Of 281 patients, 84 (29.9%) experienced recurrence and 14 (5.0%) developed progression. The mean follow-up period was 46 months. The cut-off value for NLRs was 2.29.


Results: One hundred-eight patients (38.4%) displayed a high NLR (> 2.29). In Kaplan–Meier curve analysis, a high NLR was associated with lower recurrence-free survival (RFS) (P < .001) and progression-free survival (PFS) (P = .002). CUETO scores were associated with RFS (P < .001), but not with PFS (P = .423). A combination of NLRs and the CUETO risk model correlated with RFS (P < .001) and PFS (P = .002). In multivariate analysis, female gender, concomitant carcinoma in situ (CIS), tumor number >3, recurrent tumors, and a high NLR were independent factors predicting recurrence (all P < .05). Concomitant CIS, recurrent tumors, and a high NLR were independent factors for predicting progression (all P < .05).


Conclusion: In patients with NMIBC, an NLR >2.29 was identified as a significant factor for predicting tumor recurrence and progression. Inclusion of preoperative NLR enhanced the accuracy of the CUETO model to predict disease progression.

The Role of Pentraxin-3, Fetuin-A and Sirtuin-7 in the Diagnosis of Prostate Cancer

Özer Güzel, Arzu Kösem, Yılmaz Aslan, Ahmet Asfuroglu, Melih Balci, Cagdas Senel, Altug Tuncel

Urology Journal, , , Page 6626
https://doi.org/10.22037/uj.v18i.6626

Purpose: Prostate canceris the most commonly diagnosed type of cancer and one of the leading causes of cancer-related death in men.Numerous efforts have been made to improve existing diagnostic methods and develop a new biomarker to identify patients with prostate cancer. In line with current literature, we preferred new serum-based biochemical markers as Pentraxin-3, Fetuin-A and Sirtuin-7 in the present study.


Materials and Methods: A total of 174 patients aged 42-76 years were included in the study. Patients with prostate cancer (n=38) were enrolled as Group 1 and patients with benign prostatic hyperplasia (n=136) as Group 2. The serum levels of Pentraxin-3, Fetuin-A and Sirtuin-7 levels were compared between the groups.


Results: The mean age of the patients was 61.9±7.6 years (p= .001). The mean serum Prostate Specific Antigen levels 32.0±59.6 (2.6-336) ng/mL and 10.0±11.3 (2.5-77.4) ng/mL in Group 1 and 2, respectively (p= .029). The mean serum levels of Pentraxin-3 and Fetuin-Ain Group 1 were statistically significantlydifferent from Group 2(3.3±4.4 ng/mL vs 1.8±2.4 ng/mL, p= .002 and 466.8±11.0 µg/mL vs 513.3±11.0 µg/mL,p= .041,respectively). There was no significant difference between Group 1 and 2 according to serum levels of Sirtuin-7 (12.7±8.2 ng/mL vs 12.7±12.4 ng/mL respectively, p= .145).


Conclusion: Pentraxin-3, Fetuin-A and Sirtuin-7 may be effective in the diagnosis of prostate cancerin light of the current literature.In this study, it was found that Pentraxin-3 and Fetuin-A were significantly different in the diagnosis of prostate cancer.Larger-scale prospective studies are needed to determine the importance of Pentraxin-3 and Fetuin-A in the diagnosis of prostate cancer.

Purpose: To explore the ccRCC clinical and immune characteristics correlated with IL-23 expression level and build pre-operative prediction models based on contrast CT scans.


Materials and Methods: The study included the cancer genome atlas kidney renal clear cell carcinoma cases to build a bioinformatics cohort. The cases with qualified contrast CT images were selected as radiographic and radiomics cohort. The IL-23 expression level groups were defined by median-based thresholding. The clinical characteristics were compared between groups. The impacts of IL-23 on immune microenvironment composition were measured via the CIBERSORT. Two radiologists evaluated the pre-operative contrast CT images. The radiomics features were automatically extracted. IL-23 group-specific radiographic and radiomics features were collected and used for prediction model establishment via Orange Data Mining Toolbox. P < 0.05 was set as statistically significant.


Results: For total, 530 ccRCC cases were included. The IL-23 group was significantly associated with survival, histologic grade, AJCC tumor stage, AJCC cancer stage, and plasma calcium level. Except for Treg and other T cells, IL-23 showed correlation with NK cell, mast cell, monocyte infiltration. Axial length was the only significant radiographic measurement between IL-23 groups. The radiomics features established an IL-23 group prediction model with the highest 10-fold cross-verification AUC of 0.842.


Conclusion: The clear cell renal cell carcinoma IL-23 expression level had prognosis and immune microenvironment correlation and could be predicted by pre-operative radiomics features.

Purpose: Transperineal template prostate biopsies (TPTPB) are now increasingly commonly performed for the diagnosis of prostate cancer. TPTPB are traditionally performed under general anaesthetic. However, this poses a significant strain on hospital theatre capacity. As such, local anaesthetic (LA) TPTPB are becoming more popular. We describe a novel technique in performing the standard TPTPB under LA in the outpatient setting.


Materials and Methods: Between February 2019- February 2021, 254 consecutive men (median age 69; range: 44-80 years) with a median PSA of 8.7 ng/ml (range: 2.2-76) underwent L/A TPTPB using our novel technique. This is whereby 50mls of 1% prilocaine was injected partially around the perineal skin and partially deep bilateral periprostatic areas. Multiple simultaneous prostate biopsies were then taken with the standard template grid and stepper.


Results: A total of 250/254 (98.4%) men underwent successful L/A TPTPB with a median visual analogue pain score of 4 (range: 2-8). The median prostate volume was 49cc (range: 14-240cc). The median number of cores taken were 18 (range: 14-24). A total of 163/250 men (65.2%) had a positive histology for prostate cancer with a median of 5 cores being involved with prostate cancer (range: 1-18). In addition, 101/163 men (62.0%) diagnosed with prostate cancer had either Gleason score 3+4=7 or greater. None experienced urosepsis and only 2/250 men (0.8%) had temporary urinary retention.


Conclusion: Our novel LA technique in performing the standard TPTPB is safe, feasible and well tolerated and associated with a high rate of prostate cancer detection.

An Update on Biochemical and Genomic Markers for Prostate Cancer

Reza Falahatkar, Gholamreza Mokhtari, Madjid Momeni-Moghaddam , Mojtaba Teimoori, Hamidreza Baghani Aal , Ardalan Akhavan, Siavash Falahatkar, Samaneh Esmaeili

Urology Journal, , , Page 6828
https://doi.org/10.22037/uj.v18i.6828

Purpose: Detecting prostate cancer, developing therapeutic plans after negative biopsies, and prognosis-based patient counseling can be challenging for many urologists dealing with prostate cancer-specific antigens. New Biomarkers advances made improvement for prediction of responses to therapeutic option and can tell us about survival and recurrence. In this review, we have assessed current and upcoming biomarkers that are opening a new era in diagnosing the disease.

Materials and Methods: We conducted a comprehensive literature review of studies describing prostate cancer biomarkers. Two independent investigators searched PubMed, Embase, Web of Science, and Cochrane Databases to identify biomarkers in prostate cancer conducted a literature review.


Results: Recently, combining prostate cancer-specific biomarkers into a single test has gained increasing attention, especially since the introduction of genomic and molecular tools. The development of the Prostate Health Index (PHI), SelectMDx, and Confirm MDx have shown promising results for prostate cancer detection, in addition to risk stratification and biopsy avoidance.
Conclusion: Despite major improvements and innovations in prostate cancer biomarkers, application in current clinical practice is limited. However, these biomarkers have an important role in determining risk, preventing unnecessary prostate biopsies, and predicting prognoses. Additional confirmatory studies will be needed to fully understand the impact of prostate cancer-specific biomarkers.

DNA Hypermethylation af a Panel Of Genes as an Urinary Biomarker For Bladder Cancer Diagnosis

Petros Georgopoulos, Maria Papaioannou, Soultana Markopoulou, Aikaterini Fragou, George Kouvatseas, Apostolos Apostolidis

Urology Journal, , , Page 6743
https://doi.org/10.22037/uj.v18i.6743

Purpose: Several studies have shown frequent changes in DNA methylation in bladder cancer (BCa), which vary among different geographical areas. The aim of this study is to examine the diagnostic accuracy of a panel of DNA methylation biomarkers in a Greek clinical setting contributing to the development of a universal panel of urine biomarkers.


Materials and Methods: Individuals with primary BCa and control individuals matching the gender, age and smoking status of the cancer patients were recruited. DNA methylation was assessed for the gene promoters of RASSF1, RARB, DAPK, TERT and APC in urine samples collected by spontaneous urination using quantitative Methylation Specific PCR (qMSP). All genes had been previously separately associated with BCa.


Results: Fifty patients and 35 healthy controls were recruited, with average age of 70.26 years and average smoking status of 44.78 pack-years. In the BCa group, DNA methylation was detected in 27 (61.4%) samples. RASSF1 was methylated in 52.2% of samples. Only 3 (13.6%) samples from the control group were methylated, all in the RASSF1 gene promoter. The specificity and sensitivity of this panel of genes to diagnose BCa was 86% and 61% respectively. The RASSF1 gene could diagnose BCa with specificity 86.4% and sensitivity 52.3%.


Conclusion: Promoter DNA methylation of this panel of five genes could be further investigated as urine biomarker for the diagnosis of BCa. The RASSF1 could be a single candidate biomarker for predicting BCa patients versus controls. Studies are required in order to develop a geographically adjusted diagnostic biomarker for BCa.

Oncologic Outcomes Following Positive Surgical Margins in Patients who Underwent Open Versus Laparoscopic Partial Nephrectomy

Nasser Simforoosh, Fatemeh Simforoosh, Mehdi Dadpour, Hossein Fowzi Fard, Nasrin Borumandnia, Hamed Hasani

Urology Journal, , , Page 6858
https://doi.org/10.22037/uj.v18i.6858

Objectives: To evaluate oncological outcomes in patient with positive surgical margin (PSM) following partial nephrectomy (PN).


Material and methods: In this retrospective study, we enrolled the data of patients who underwent PN between 2008 and 2017. The inclusion criteria were a definite diagnosis of kidney tumor who underwent PN with at least one year follow up.


Results: From the 450 patients who underwent PN, The PSM was found in 35 (22 male/13 female) patients. 18/237 (7.6%) and 17/213 (7.9%) of them were in open and laparoscopic group, respectively. Clear cell RCC was the most prevalent pathology (18 patients) in the PSM patients. The mean time of follow up was 46±2.02 months. Recurrence was developed in 5 (14.2%) patients. There was no correlation between recurrence and sex (p=1.00), surgery type (p=0.658), age (p=0.869), tumor size (p= 0.069), pathology (p=0.258) and stage (p=0.744) in PSM patients. Recurrence free survival was similar between the open and laparoscopy groups in PSM patients (p=0.619).


Conclusion: Beside numerous advantages of minimally invasive techniques, laparoscopic approach would be comparable to conventional open partial nephrectomy in terms of oncologic outcomes. The rate of recurrence following partial nephrectomy in PSM patients is considerable and closely monitoring is mandatory.

Favorable Response of Pembrolizumab as Second-Line Therapy for Advanced Urothelial Carcinoma with Only Small Lesions to not be Considered Measurable by RECIST

Yoshifumi Kadono, Shohei Kawaguchi, Takahiro Nohara, Kazuyoshi Shigehara, Kouji Izumi, Taiki Kamijima, Chikashi Seto, Akinobu Takano, Satoshi Yotsuyanagi, Ryunosuke Nakagawa, Tohru Miyagi, Shuhei Aoyama, Hideki Asahi, Rie Fukuda, Atsushi Mizokami

Urology Journal, , , Page 6652
https://doi.org/10.22037/uj.v18i.6652

Purpose: Pembrolizumab is currently considered the standard second-line treatment for advanced urothelial carcinoma (UC). This study aimed to investigate the efficacy and safety of pembrolizumab in patients with advanced UC in real-world data, which is not well-reported.


Materials and Methods: The study included 97 patients with advanced UC whose lesions were classified according to the Response Evaluation Criteria in Solid Tumors (RECIST). The median age was 73 years. Nineteen patients (20%) with performance status (PS) 2–4 were included. The percentages of liver, lung, bone, and lymph node metastasis were 18%, 27%, 19%, and 76%, respectively. The efficacy, safety, and risk factors for prognosis were evaluated for patients with and without measurable lesions.


Results: The best response was complete response in nine patients (9%) and partial response in 16 patients (17%). The median progression-free survival and overall survival were 3.7 months (95% confidence interval [CI]: 2.8–4.7) and 11.8 months (95% CI: 6.7–17.0), respectively. Twenty-one (22%) patients had no measurable lesions per RECIST. In univariate and multivariate analysis, PS 2–4 and lesions by RECIST were identified as factors associated with short overall survival (OS). The median OS of 18.3 months in patients without lesions by RECIST was significantly longer than the median OS of 6.7 months in patients with lesions by RECIST (p = .012).


Conclusion: We demonstrated that good PS 0–1 and no measurable lesions, especially small lesions, by RECIST were favorable prognostic factors in patients with advanced UC treated by pembrolizumab.


 

Purpose: We aimed to investigate the effects of obturator nerve block (ONB) on obturator reflex, incomplete resection, perforation, progression and recurrence of tumor, presence of muscle tissue in the specimen, need for a second transurethral resection (TURBT) of bladder tumors, and postoperative complications in patients who underwent TURBT for intermediate-high risk lateral wall non-muscle invasive bladder cancers (NMIBC).


Material and Methods: Patients were assigned to one of two groups by drawing lots: ONB or none ONB. Early and late recurrence, tumor progression, obturator reflex beat, incomplete resection, perforation, presence of muscle layer in pathology, second TURBT application, operation time, postoperative hospital stay, and complications were compared between the two groups.


Results: The median follow-up time of the study was32 (23-41) months. Interquartile range (IQR) was 9. Tumor recurrence at the 3rd month cystoscopy controls was observed in 5 (9.8%) patients in the ONB group, while it was observed in 11 (20.8%) patients in the nONB group (p=0.01). Late tumor recurrence was observed in 10 patients (19.6%) in the ONB group, and in 20 patients (37.7%) in the nONB group (p=0.041). The RFS rate at 12th month was 84% in the ONB group, 69% in the nONB group, 79% in the ONB group at 36th month, and 58% in the nONB group at 36 months, the PFS rate was 94% in the ONB group, while it was 85% in the nONB group (p=0.041).


Conclusion: Our study showed that ONB decrease the early and late recurrence and increase recurrence free survival in patients with intermediate-high risk lateral wall bladder cancer.

Development and External Validation of a Prediction Model to Identify Candidates for Prostate Biopsy

Vinayak G Wagaskar, Anna Lantz, Stanislaw Sobotka, Parita Ratnani, Sneha Parekh, Ugo Giovanni Falagario, Li Li, Sara Lewis, Kenneth Haines III, Sanoj Punnen, Peter Wiklund, Ash Tewari

Urology Journal, , , Page 6852
https://doi.org/10.22037/uj.v18i.6852

Purpose: Prostate biopsies are associated with infectious complications and approximately 80% are either benign or clinically insignificant prostate cancer. Our aim is to develop and independently validate prediction model to avoid unnecessary prostate biopsies by predicting clinically significant prostate cancer (csPCa)


Materials and Methods: Retrospective analysis of single-center cohort (Mount Sinai Hospital, NY) of 1632 men who underwent systematic or combined systematic and Magnetic Resonance Imaging (MRI)/ultrasound fusion targeted prostate biopsy between 2014-2020. External cohort (University of Miami) included 622 men that underwent biopsy. Outcome for predicting csPCa was defined as International Society of Urologic Pathology (ISUP) Gleason grade  ³ 2 on biopsy. Multivariable logistic regression analysis was performed to build nomogram using coefficients of logit function. Nomogram validation was performed in external cohort by plotting receiver operating characteristics (ROC). We also plotted decision curve analysis (DCA) and compared nomogram-predicted probabilities with actual rates of csPCa probabilities in external cohort.    


Results: Of 1632 men, 43% showed csPCa on biopsy. PSA density, prior negative biopsy, and Prostate Imaging and Reporting Data System (PI-RADS) scores 3, 4, and 5 were significant predictors for csPCa. ROC for prediction of csPCa was 0.88 in external cohort. There was agreement between predicted and actual rate of csPCa in external cohort. DCA demonstrated net benefit using the model. Using the prediction model at threshold of 30, 35% of biopsies and 46% of diagnosed indolent PCa could be avoided, while missing 5% of csPCa.


Conclusion: Using our prediction model can help reduce unnecessary prostate biopsies with minimal impact on csPCa detection rates.

ORIGINAL PAPER (ANDROLOGY)


Evaluation of Sperm Parameters and DNA Integrity Following Different Incubation Times in PVP Medium

Ali Nabi, Farahnaz Entezari, Seyed Mohsen Miresmaeili, Serajoddin Vahidi, Keivan Lorian, Fatemeh Anbari, Leila Motamedzadeh

Urology Journal, , , Page 6936
https://doi.org/10.22037/uj.v18i.6936

Purpose: Polyvinylpyrrolidone (PVP) is a chemical material used in intracytoplasmic sperm injection (ICSI) program.  The aim of this study was to investigate the ideal time that sperm can be safely incubated in PVP with less structure and DNA damage.


Method: Thirty-one Oligoasthenoteratospermia (OAT) samples were used. Sperm samples were prepared by discontinuous density-gradients method and incubated in 10% PVP at different time intervals (0, 5, 10, 15, 20, and 30 min). The effect of PVP was assessed on sperm DNA fragmentation and viability via SCD assay and Eosin–nigrosin staining respectively.


Results: Data showed there was a significant increase in sperm DNA fragmentation at 10 min compared to 0 min. The viability rate also significantly reduced at 10 min  compared to 0 min.


Conclusion: As a result, sperm samples could be incubated with PVP for less than 10 min.  While prolonged incubation may significantly damage the sperm DNA integrity and viability.

LETTER


Background: The pandemic of COVID-19 is nowhere from over, which pushes us to adapt to it.  Social distancing rules were applied to restrict the people and prevent virus transmission. Despite these restrictions, the patient's care should not be compromised. Doctors are encouraged to technologically improve themselves to get used to the utilization of telemedicine.


Methods: We conducted an online survey of urology specialists and urology residents throughout the country. The survey was accompanied by the Indonesian Urological Association, and the survey was opened for one month and sent by email to all members of the association.


Results: A total of 50 urologists and 182 urology residents participated. Almost half (48%) currently do not have facilities to hold a telemedicine practice in their institution, and 14% reported inadequate facilities. The majority reveals that the barrier to conducting this method was due to insufficient facility. Other issues like insurance coverage and patient's interest in telemedicine, the risk of patient's data leak, and the urologist's lack of interest in telemedicine might also be challenging. Despite some doubts, in sum, more than half have thought that telemedicine would keep utilized although the pandemic is resolved.


Conclusions: We are currently learning the novel telemedicine implementation and some challenges still need to be resolved. Starting from the regulation and legal protection fundamentally, and the health insurance coverage needs to be determined. After all, the low interest in adopting this method has become the greatest barrier.

Vaginal Mullerian cysts are usually small and asymptomatic. Occasionally, they are enlarged and mimic other anatomical disorders, such as anterior vaginal wall prolapse, middle compartment defects (enterocele, apical vaginal wall prolapse) or urethral diverticulum.  Herein we report a female case with a huge vaginal wall Mullerian cyst which was initially misdiagnosed as stage 4 cystocele. Pelvic MRI and cysto uerthroscopy revealed no communication between the cyst and adjacent structures. The cyst was completely excised through a vaginal approach. The pathologic evaluation revealed a benign Mullerian cyst lined with mucinous epithelium. Diagnostic approach to space occupying lesions in the vaginal cavity needs assessment by history, physical examination and appropriate imaging which are essential to prevent misdiagnosis and mistreatment.

As world is going through the COVID-19 pandemic, the mass vaccination of newly approved vaccines for COVID-19 has begun around the world. There has been some concern among the vaccine recipients regarding the potential effect of vaccine on male fertility. Does COVID-19 affect the male reproductive health? Does COVID-19 vaccine impair the sperm parameters?

Abstract:


The terminology of gonadal dysgenesis conditions is considerably abstruse and variable. Despite some efforts in the 2006 Chicago Consensus Statement on DSD , it is still difficult to assign a category and name for some distinct conditions in this document. The rest of the literature has used redundant and variable words, e.g. partial, pure, and complete gonadal dysgenesis suffering equivocality and redundancy, aggravating this inconclusiveness. We attempted to highlight this problem and propose an easier terminology blueprint.


 


Abstract:


The terminology of gonadal dysgenesis conditions is considerably abstruse and variable. Despite some efforts in the 2006 Chicago Consensus Statement on DSD , it is still difficult to assign a category and name for some distinct conditions in this document. The rest of the literature has used redundant and variable words, e.g. partial, pure, and complete gonadal dysgenesis suffering equivocality and redundancy, aggravating this inconclusiveness. We attempted to highlight this problem and propose an easier terminology blueprint.


 


 

UNCLASSIFIED


A Proposal for Data Registry system for Urologic Cancers in Iran

Fatemeh Simforoosh, Nasser Simforoosh, Mehdi Dadpour, Mohammad Hadi Radfar

Urology Journal, , , Page 6790
https://doi.org/10.22037/uj.v18i.6790

Purpose: Data registries are organized systems that facilitate collection, storage, and analysis of data related to a specific disease in a defined population. Here we introduce a data registry system which was designed to cover the four most common urologic cancers (prostate, bladder, renal and testis).


Materials and methods: All contributing centers can enter data into the system after logging in with their unique usernames and passwords. In this system, the information of each individual patient will be entered in several structured forms covering various steps of management of the patients.


Results: Our proposed registry is an interactive, web-based database designed to collect complete data of patients with common urological cancers. We devised a council that functions as the central committee that will initiate, supervise, and monitor all steps of the projects including data collection, data audit, as well as data analysis and publication. To facilitate manuscript publication, the system will provide assistance and support throughout all the steps of statistical analysis and manuscript preparation.


Conclusion: This proposed registry can have a national target and is designed to provide evidence-based information that could support strategic planning and national multi-centric studies.

Assessment of the Prognostic Effect of Blood Urea Nitrogen to Serum Albumin Ratio in Patients with Fournier’s Gangrene in a Referral Center

Farzad Allameh, Saeed Montazeri, Vahid Shahabi, Seyyed Ali Hojjati, Amir Alinejad Khorram, Zahra Razzaghi, Sahar Dadkhahfar

Urology Journal, , , Page 6556
https://doi.org/10.22037/uj.v18i.6556

Purpose: To assess the prognostic effect of blood urea nitrogen to serum albumin ratio in patients with Fournier’s gangrene (FG) in a referral center in order to reduce the mortality of FG patients.


Materials and Methods: Patients with FG were admitted and enrolled consecutively in this study from March 2008 to April 2020. Statistical analysis was done to evaluate the differences between the two groups and to identify the best cutoff value to predict mortality and the need for intensive care.


Results: Of all 114 patients, 46 patients (40.35%) died in the course of hospitalization and 40 entered the study. No variable manifested a notable difference except for the BUN to albumin ratio, which was significantly different (P-value = 0.045). The ratio of BUN to albumin was not associated with any other variables and was independently a predictor of death in FG patients.


Conclusion: The ratio of BUN to albumin was significantly different among deceased and survived patients with FG. Therefore, more studies with a larger sample size are still needed to access this parameter properly.

The effect of Melatonin on Improving the benign Prostatic Hyperplasia Urinary Symptoms, a Randomized Clinical Trial

Amirreza Fotovat, Bahram Samadzadeh, Mohsen Ayati, Mohammad Reza Nowroozi, Seyed Ali Momeni, Samira Yavari, Ali Nasseri, Laleh Sharifi

Urology Journal, , , Page 6761
https://doi.org/10.22037/uj.v18i.6761

Purpose: to investigate the effect of melatonin along with tamsulosin in the improving the BPH urinary symptoms.


Materials and Methods: A total of 108 men with BPH symptoms, age of ≥50 years, and International Prostate Symptom Score (IPSS) ≥8 entered into the parallel group randomized, double-blind clinical trial with balanced randomization. Treatment group received of 3mg melatonin plus 0.4mg tamsulosin and control group received placebo plus 0.4mg tamsulosin. Patients and physicians were concealed by sealed and opaque envelopes. Symptoms were assessed at baseline and 1 month after treatment. Finally all scores at the initial and end of the study compared and analyzed using SPSS software.


Results: This study showed that adding melatonin to classic treatment of BPH patients with tamsulosin could significantly reduce the likelihood of nocturia by 2.39 times (95% CI: 1.07-5.32, OR = 2.39, p = 0.033) and could also reduce the frequency of urination by 2.59 times (95% CI: 1.15-5.84, OR = 2.59, p = 0.021). There was no statistically significant difference between the two groups in IPSS, intermittency, incomplete emptying, straining, urgency, and weak stream.


Conclusion: Melatonin plus tamsulosin treatment is associated with a significant improvement of nocturia and frequency in patients with benign proststic hyperplasia. However, it is necessary to do more studies.

An investigation into the Effects of Intravenous Vitamin C on Pulmonary CT Findings and Clinical Outcomes of Patients with COVID 19 Pneumonia A Randomized Clinical Trial

Shabnam Tehrani, Davood Yadegarynia, Alireza Abrishami, Hamideh Moradi, Babak Gharaei, Masoomeh Rauofi , Fatemeh Maghsoudi Nejad, Shahnaz Sali, Neda Khabiri

Urology Journal, , , Page 6863
https://doi.org/10.22037/uj.v18i.6863

Purpose:In late December 2019, a series of unexplained cases of pneumonia were reported in Wuhan, China. On January 12, 2020, the World Health Organization temporarily named the virus responsible for the emerging cases of pneumonia as the 2019 coronavirus. Acute respiratory distress syndrome (ARDS) due to Covid-19 has rapidly spread around the world, and while no specific treatment or vaccine has been reported, mortality rates remain high. One of the suggested treatments for cellular damage in the pathogenesis of ARDS caused by the coronavirus is the administration of high doses of intravenous vitamin C. Considering the paucity of literature on the therapeutic effects of high doses of intravenous vitamin C in patients with ARDS resulting from the coronavirus, this study was conducted to assess this therapeutic supplement in these patients.


Materials and Methods: This study was performed as a single-center clinical trial in patients with a documented diagnosis of COVID-19 pneumonia. 54 eligible patients with moderate to severe COVID-19 symptoms, based on specific inclusion and exclusion criteria, were included in the investigation and randomly divided into two groups. The control group consisted of 26 patients who received standard treatment, whereas the treatment group was comprised of 18 patients administered intravenous vitamin C at a dose of 2 g every 6 hours for 5 days in addition to standard treatment. Demographic characteristics, underlying diseases, length of hospital stay, and mortality rates were reviewed and collected. Oxygen saturation, respiratory rates, serum C Reactive Protein (CRP) levels, lymphopenia and lung parenchymal involvement on CT were investigated at the time of admission and on the sixth day after hospitalization. Finally, all variables were analyzed with IBM SPSS Statistics 23 software and a significant statistical difference was defined for all variables, P <0.05.


Results: Of these variables, the amount of oxygen saturation in the vitamin C group increased significantly from 86±5% on the first day of hospitalization to 90±3% on the sixth day of hospitalization (P value=0.02). Also, the respiratory rate in the vitamin C group decreased significantly from 27±3 on the first day of hospitalization to 24±3 on the sixth day of hospitalization (P value=0.03). Lung CT scans of patients in the two groups reported by two radiologists were also compared. Based on the report of the radiologists, the rate of lung involvement in the vitamin C group was significantly lower than in the control group at the end of treatment (P value=0.02).


Conclusion: Due to the effectiveness of high doses of intravenous vitamin C on reducing lung involvement and improving clinical symptoms, further studies with a larger sample size are recommended to demonstrate the effects of this drug supplement.

Purpose: To study the incidence, risk factors for developing asymptomatic venous thromboembolism and the compliance of patients on anticoagulants for asymptomatic venous thromboembolism (VTE) in nononcological urological medium-high risk inpatients, and build a risk assessment model (RAM) for early screening for asymptomatic VTE.


Materials and Methods: We conducted a retrospective analysis of 573 inpatients admitted to a nononcological urological ward of a tertiary hospital in China from January 1, 2017, to June 30, 2019. Data were collected using the electronic medical record system, and patients underwent a follow-up by phone 6 months after discharge.


Results: Among the 573 medium-high risk inpatients, 73 (15.4%) were diagnosed with VTE, including 20 (4.2%) symptomatic and 53 (11.2%) asymptomatic. Prior history of VTE, a history of anticoagulants or antiplatelet agents before admission, and D-dimer ≥ 1 were the potential risk factors identified for asymptomatic VTE. Patients with poor awareness of VTE and its dangers, and patients who lived more than 1 hour away from the hospital had a high probability of poor compliance with anticoagulation therapy after discharge. Using D-dimer (1.785 μg/ml), we built a RAM for the early diagnosis of asymptomatic VTE.


Conclusion: We found that patients with urinary nontumor VTE had low compliance with anticoagulation therapy after discharge. The key factors for determining asymptomatic VTE in nononcological urological inpatients included prior history of VTE, a history of taking anticoagulants or anti-platelet agents before admission, and D-dimer ≥ 1. Furthermore, we found that the threshold of D-dimer should be elevated to 1.785 μg/ml to predict asymptomatic VTE.