Sacral Meningoceles, ductal ectasia and pseudomeningoceles are all rare spinal defects that occur due to errors in collagen biosynthesis in the setting of Marfan's Syndrome. Meningoceles, which are ...extradural collections of cerebrospinal fluid, can form large pelvic collections which can compress local structures. In rare cases, this can lead to extrinsic ureteric obstruction, which can result in acute renal failure and urosepsis. We present a case of a 35-year old female with Marfan's syndrome, with one of the largest sacral meningoceles reported in the literature, causing acute ureteric obstruction, requiring urgent surgical intervention.
•Meningoceles are rare and are associated with Marfan's syndrome due to errors in collagen biosynthesis.•Management of urinary tract obstruction secondary to external compression from a meningocele requires surgical decompression.•This can be in the form of ureteric stent placement or nephrostomy insertion.•Referral to a spinal surgeon for definitive management should also be undertaken.
Objectives: ChatGPT is a large language model that is able to generate human-like text. The aim of this study was to evaluate ChatGPT as a potential supplement to urological clinical practice by ...exploring its capacity, efficacy and accuracy when delivering information on frequently asked questions from patients with bladder cancer. Methods: We proposed 10 hypothetical questions to ChatGPT to simulate a doctor–patient consultation for patients recently diagnosed with bladder cancer. The responses were then assessed using two predefined scales of accuracy and completeness by Specialist Urologists. Results: ChatGPT provided coherent answers that were concise and easily comprehensible. Overall, mean accuracy scores for the 10 questions ranged from 3.7 to 6.0, with a median of 5.0. Mean completeness scores ranged from 1.3 to 2.3, with a median of 1.8. ChatGPT was also cognizant of its own limitations and recommended all patients should adhere closely to medical advice dispensed by their healthcare provider. Conclusions: This study provides further insight into the role of ChatGPT as an adjunct consultation tool for answering frequently asked questions from patients with bladder cancer diagnosis. Whilst it was able to provide information in a concise and coherent manner, there were concerns regarding the completeness of information conveyed. Further development and research into this rapidly evolving tool are required to ascertain the potential impacts of AI models such as ChatGPT in urology and the broader healthcare landscape.
Urinary tract infections (UTIs) are highly prevalent and have significant implications for patients. As internet-based health information becomes more relied upon, ChatGPT has emerged as a potential ...source of healthcare advice. In this study, ChatGPT-3.5 was subjected to 16 patient-like UTI queries, with its responses evaluated by a panel of urologists. ChatGPT can address general UTI questions and exhibits some reasoning capacity in specific contexts. Nevertheless, it lacks source verification, occasionally overlooks vital information, and struggles with contextual clinical advice. ChatGPT holds promise as a supplementary tool in the urologist’s toolkit, demanding further refinement and validation for optimal integration.
A 61-year-old female presented with an incidental anterior mid pole renal mass on ultrasound. She had previously undergone live directed donor renal transplantation 13 years prior. As the 10 year ...survival of living transplant recipients increases, malignancy presentations will continue to rise. Nephron sparing surgery in renal allografts is sparse due to difficult operative dissection and complicated hila vascular control. We present the use of manual atraumatic graded bowel clamp pressure around the resected tumour as a viable option to safely perform partial nephrectomy in a transplanted kidney.
Normal physiology relies on the organization of transmembrane proteins by molecular scaffolds, such as tetraspanins. Oncogenesis frequently involves changes in their organization or expression. The ...tetraspanin CD151 is thought to contribute to cancer progression through direct interaction with the laminin-binding integrins α3β1 and α6β1. However, this interaction cannot explain the ability of CD151 to control migration in the absence of these integrins or on non-laminin substrates. We demonstrate that CD151 can regulate tumor cell migration without direct integrin binding and that integrin-free CD151 (CD151(free)) correlates clinically with tumor progression and metastasis. Clustering CD151(free) through its integrin-binding domain promotes accumulation in areas of cell-cell contact, leading to enhanced adhesion and inhibition of tumor cell motility in vitro and in vivo. CD151(free) clustering is a strong regulator of motility even in the absence of α3 expression but requires PKCα, suggesting that CD151 can control migration independent of its integrin associations. The histologic detection of CD151(free) in prostate cancer correlates with poor patient outcome. When CD151(free) is present, patients are more likely to recur after radical prostatectomy and progression to metastatic disease is accelerated. Multivariable analysis identifies CD151(free) as an independent predictor of survival. Moreover, the detection of CD151(free) can stratify survival among patients with elevated prostate-specific antigen levels. Cumulatively, these studies demonstrate that a subpopulation of CD151 exists on the surface of tumor cells that can regulate migration independent of its integrin partner. The clinical correlation of CD151(free) with prostate cancer progression suggests that it may contribute to the disease and predict cancer progression.
AbstractPurposeTo demonstrate feasibility and toxicity of linear accelerator–based stereotactic radiation therapy boost (SBRT) for prostate cancer, mimicking a high-dose-rate brachytherapy ...boost.Methods and MaterialsA phase 1 sequential dose escalation study of SBRT compared 20 Gy, 22 Gy, and 24 Gy to the prostate and 25 Gy, 27.5 Gy, and 30 Gy to the gross tumor volume in 2 fractions, combined with 46 Gy in 23 fractions of external beam radiation. Feasibility of dose escalation (volume receiving 125% and 150% of the dose) while meeting organ-at-risk dose constraints, grade 2 acute and late gastrointestinal and genitourinary toxicity, and freedom from biochemical failure were secondary endpoints.ResultsThirty-six men with intermediate- and high-risk prostate cancer were enrolled with a median follow-up of 24 months. Sixty-four percent of patients had high-risk features. Nine men were enrolled to dose level 1, 6 to level 2, and 6 to level 3. Another 15 patients were treated at dose level 3 on the continuation study. Dose level 3 achieved superior 125% (23.75 Gy) and 150% (28.5 Gy) dose compared to dose levels 1 and 2, with minimal differences in organ-at-risk doses. Kaplan-Meier estimate of freedom from biochemical failure at 3 years was 93.3%. There were no late grade 2 or 3 gastrointestinal events. The late grade 2 genitourinary toxicity at 2 years was 19.3%. Prostate-specific membrane antigen positron emission tomography was performed at 2 years with no local recurrences.ConclusionsWe have shown that a linear accelerator–based SBRT boost for prostate cancer is feasible and can achieve doses comparable to high-dose-rate boost up to the 150% isodose volumes. Rectal, bladder, and urethral doses remained low, and long-term toxicity was the same as or better than previous reports from high-dose-rate or low-dose-rate boost protocols.
Prostatic artery embolization is becoming increasingly popular in the management of benign prostatic hyperplasia, particularly for patients with significant comorbidities that make them poor ...candidates for either general anaesthesia or surgical intervention. Penile tip necrosis as a complication following prostatic artery embolization is exceedingly rare, with only 4 cases previously reported in the world literature. It occurs as a result of the embolization material passing into and occluding collateral arterial networks such as those supplying the glans penis. This paper identifies 3 further cases of penile tip necrosis, outlines its natural history, and proposes management strategies, so that clinicians can better identify and treat this condition.
The combination of multiparametric magnetic resonance imaging with prostate-specific membrane antigen positron emission tomography/computerised tomography in the diagnostic assessment of prostate ...cancer has the potential to identify clinically significant prostate cancer in selected men who might then be able to proceed to radical prostatectomy without the need for a prostate biopsy.
Prostate-specific membrane antigen (PSMA) positron emission tomography/computerised tomography (PET/CT) is increasingly being utilised in the diagnostic pathway for prostate cancer (PCa). Recent publications have suggested that this might help identify those who can avoid biopsy.
The primary objective of this study was to determine whether PET magnetic resonance imaging (MRI) fusion could negate the need to biopsy prior to prostatectomy in a selected population of men.
Multiparametric MRI (mpMRI) for PCa is our standard of care prior to prostate biopsy. Biopsy-naïve men with one or more Prostate Imaging Reporting and Data System (PI-RADS) 4 or 5 lesions ≥10 mm on mpMRI were invited to undergo PSMA PET/CT prior to biopsy. Following ethics approval, 60 men were recruited between September 2020 and March 2021. The key exclusion criteria included a previous history of PCa and previous prostate surgery or biopsy.
A positive PET MRI fusion scan was defined as “consistent with” as per the Memorial Sloan Kettering Cancer Center lexicon of certainty, and concordance with biopsy results was analysed. Clinically significant PCa (csPCa) was defined as grade group (GG) ≥2 on pathology. A chi-square analysis was performed with statistical significance defined at p < 0.05.
A total of 71 mpMRI lesions were positive on 61 (86%) PET MRI fusion scans. Fifty-nine of 61 lesions biopsied confirmed csPCa in 54 (92%). Of five of 59 lesions for which either biopsy was negative or low-grade cancer was found, three had rebiopsy of which two were confirmed to have csPCa corroborating with PET MRI fusion and one was reconfirmed to have GG1 only. For the remaining two, both had another lesion elsewhere in the gland confirming csPCa, and hence rebiopsy was not performed. Ultimately, 56 of 59 (95%) lesions with a positive PET MRI fusion scan were confirmed to have csPCa. All GG ≥3 cancers had a positive PET MRI fusion scan.
This prospective study of PET MRI fusion assessment of men with PI-RADS 4 or 5 lesion ≥10 mm on mpMRI confirms that the majority of men (95%) with a positive PET MRI fusion scan will have csPCa. This supports recently published retrospective data suggesting that selected men might avoid prostate biopsy prior to radical prostatectomy.
In this research, we have confirmed that prostate-specific membrane antigen positron emission tomography/computerised tomography in combination with magnetic resonance imaging could have an important role in enabling a diagnosis of prostate cancer. Using the combination of these scans, we could confidently predict the presence of aggressive prostate cancer in some men for which treatment is warranted. This means that there are some men who could possibility proceed directly to having prostate cancer surgery without the need for a confirmatory prostate biopsy.
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