Introduction
Focal therapy (FT) for localized prostate cancer (PCa) is a promising treatment strategy. Although, according to guidelines, it should be regarded as an experimental option, its ...introduction into clinical practice has occurred at an accelerated speed. It is, thus, crucial for Urologists to understand FT limitations and potential drawbacks that may derive from its use.
Methods
We performed a literature search of peer-reviewed English language articles using Pubmed and the words “focal therapy” AND “prostate cancer” to identify relevant articles. Web search was complemented by manual search.
Results
From a biological perspective, in contrast with the index lesion theory, which still needs to be better supported, PCa is a multifocal and multiclonal entity. Also, the effects of FT on PCa microenvironment are unclear. From a clinical perspective, patient selection is still not precisely defined. Even when all variables potentially decreasing mpMRI and biopsy accuracy are optimized, up to one out of two men may be incorrectly selected for FT, leaving a significant proportion of clinically significant PCa (csPCa) untreated. Underestimation of PCa volume and variant histologies are other additional mpMRI potential limitations. No RCTs have been performed against the standard of care to support FT. There is absence of long-term results and FT series reaching medium-term follow-up have non-optimal oncological control with significant re-treatment needs. When PCa recurs/persists after FT, little is known about the appropriate management strategies and their outcomes. Finally, the optimal follow-up scheme post-FT remains unclear.
Conclusions
Several arguments are present against the use of FT for localized PCa. Studies are needed to overcome current limitations and support FT before it can be included as part of the standard management of prostate cancer.
Purpose
To review the current data on retrograde ejaculation (RE) and ejaculatory dysfunction (EjD) after endoscopic and minimally invasive surgical treatment of benign prostatic obstruction (BPO) ...and, their perceived impact in the quality of life (QoL) and sexual life of patients and their partners.
Methods
Narrative review of systematic reviews (SR) assessing comparative rates of RE, EjD or erectile dysfunction (EF) was carried out. Relevant articles on the prevalence of RE, EjD or EF and on their impact in the QoL or sexual life of patients and partners were manually selected based on relevance.
Results
Twelve SRs reporting on comparisons of different endoscopic/minimally invasive treatments of BPO were found. Data on outcomes varied widely. Overall, after conventional TURP or laser techniques 42–75% of patients present RE. Prostatic incision and ablative procedures present lowest rates of de novo RE or EjD whereas laser adenomectomy and ejaculation preservation procedures preserve antegrade ejaculation in 46–68% of patients. EjDs is associated to LUTS and present in 10% of sexualy active men before intervention. It modulates the QoL and sexual life of the couple. In spite of the scarce literature assessing patient’s and partner’s perception of postoperative EjD, it strongly suggests that both parties value the maintenance of the ejaculatory function.
Conclusion
Ejaculation-preserving techniques and minimally invasive techniques successfully prevent BPO treatment-induced RE or EjD in 70–100% of the cases. While this is appealing to patients and spouses, technique selection and treatment durability are issues to be discussed with the couple.
The aim of this study was to investigate the platelet activity in patients with vasculogenic erectile dysfunction (ED).
The total blood count, including hemoglobin (Hgb), white blood cell (WBC), red ...blood cell (RBC), platelet (PLT) and mean platelet volume (MPV) parameters were measured in the patient (n = 70) and control groups (n = 50).
The average age was 48.1 ± 11.7 and 47.6 ± 12.3 in the patient and control groups (p = 0.8217), respectively. MPV was higher in the patient group and there was a statistically significant difference between two groups (11.27 ± 0.56 and 9.8 ± 0.91, p < 0.0001). PLT counts were lower in the patient group but there was not a statistically significant difference (196.23 ± 37.01 and 209.07 ± 36.71, p = 0.0626). In terms of haemoglobin, WBC and RBC values, there was no difference in the patient and control groups.
Finding high MPV, which reflects the platelet activity, in the patient group shows that platelets also have a role in the VED etiopathogenesis. In the case of the confirmation of this result with additional studies, the efficiency of anti-platelet therapy in the vasculogenic ED should also be researched.
We report a case presenting with thyroid and lung metastases of renal cell carcinoma that was treated with molecular targeted therapy followed metastasectomy. A 52-year-old female underwent radical ...nephrectomy of right renal cell carcinoma in 2007. The patient presented 9 years after nephrectomy at the age of 61 years with sudden loss of vision on the left side and a mass on the neck. On magnetic resonance imagining, there was a mass on the midline of the neck, extending to the left, measuring 46 x 31 mm and containing central cystic-necrotic areas. Fine-needle aspiration biopsy was performed. The histopathological examination of the biopsy specimen revealed a lesion composed of malignant epithelial cells compatible with metastasis of renal carcinoma. Computed tomography showed multiple metastases in bilateral lungs. Metastasectomy and total tiroidectomy were performed. Thyroid and lung metastasis of renal cell carcinoma were pathologically confirmed. But on the first computed tomography after metastasectomy, there was residual tumor in the thyroid. Interferon-alpha therapy was given for 8 weeks. After that, pazopanib therapy started. Three months later, on computed tomography, residual metastatic foci were regressed. The patient was followed up for 1 year after metastasectomy. The patient is currently receiving a single dose of pazopanib per day (400 mg/day) and the general condition is good. Thyroid metastasis should be considered in patients with a thyroid nodule and positive history for renal cell carcinoma. Successful results can be obtained with metastasectomy and systemic targeted therapy.
Foreign body in the urethra is a relatively rare occurrence. A variety of foreign bodies, majority of which were mostly self-inflicted for psychiatric disorder, senility, intoxication, and autoerotic ...stimulation, have been reported in the literature. We report a case of self-inserted foreign body (olive seed) in the urethra.
Purpose
It is reported that surgical procedures performed during the COVID-19 pandemic are accompanied by high complications and risks. In this study, the urological interventions applied with ...appropriate infrastructure and protocols during the pandemic in the pandemic hospital that is carrying out the COVID-19 struggle are analyzed.
Methods
Urological interventions were reviewed in the 5-week period between March 11 and April 16. The distribution of outpatient and interventional procedures was determined by weeks concurrently along with the COVID-19 patient workload, and data in the country, subgroups were further analyzed. Patients intervened were divided into four groups as Emergency, High, Intermediate, and Low Priority cases according to the EAU recommendations. The COVID-19-related findings were recorded; staff and patient effects were reported.
Results
Of the 160 interventions, 65 were minimally invasive or open surgical intervention, 95 were non-surgical outpatient intervention, and the outpatient admission was 777. According to the priority level, 33 cases had emergency and high priority, 32 intermediate and low priority. COVID-19 quarantine and follow-up were performed at least 1 week in 22 (33.8%) operated patients at the last week, 43 (66.2%) patients who were operated in the previous 4 weeks followed up at least 2 weeks. No postoperative complications were encountered in any patient due to COVID-19 during the postoperative period.
Conclusion
In the COVID-19 pandemic, precautions, isolation, and algorithms are required to avoid disruption in the intervention and follow-up of urology patients; priority urological interventions should not be disrupted in the presence of necessary experience and infrastructure.
LUTS and voiding dysfunctions are prevalent in urology clinics, with uroflowmetry and IPSS as the prevailing diagnostic methods. Nevertheless, objective assessment can be constrained by age, gender, ...and variability in the test conditions. Portable (home) uroflowmetry addresses these limitations, allowing for more natural urinary flow recordings beyond clinic confines. This study aims to characterize spontaneous voiding patterns in healthcare professionals, exploring gender differences, variability in repeated measurements, and correlations among voiding parameters, IPSS, age, and BMI.
This cross-sectional study was conducted during the SIU 43rd Congress in Istanbul using smart uroflow devices such as the Oruba Oruflow Uroflow Recorder, which were installed in public toilets. A total of 431 healthcare professionals participated by providing demographic information and completing the IPSS questionnaire. The data analysis included uroflowmetric parameters such as maximum flow rate (Q
), average flow rate (Q
), and voided volume (VV), in addition to IPSS and demographic data to assess the possible associations with IPSS, age, BMI, and gender differences.
Of the participants, 76% were male and 24% female, with a higher prevalence of LUTS in women. Despite no significant gender difference in voided volume, men with lower volumes demonstrated more severe LUTS. Notably, women exhibited higher Q
and Q
rates irrespective of their IPSS scores, contrasting with men whose flow rates declined with age and LUTS severity. In men, the total IPSS score was inversely associated with uroflowmetric performance, particularly impacting voiding symptoms over storage symptoms. Repeated measurements revealed noteworthy variability in Q
and VV, without any influence from gender, BMI, age, or symptom severity.
Our findings highlight the importance of gender-specific considerations in evaluating voiding complaints through uroflowmetry and IPSS. The significant variability observed in repeated uroflowmetry studies underlines the need for multiple measurements. Overall, this research emphasizes the significance of portable (home) uroflowmetry and calls for a reassessment of normal voiding standards in (non) clinical settings.
: Urinary incontinence diminishes quality of life, and its severity can be worsened by mobility impairments. This study explored the link between urinary incontinence, osteoarthritis, and back ...musculoskeletal system disorders, considering pain, mobility issues, and daily activity difficulties.
: This cross-sectional study included respondents aged ≥ 15 years from the 2008 Turkish Health Studies Survey (n = 13,976). We assessed self-reported urinary incontinence, daily activity, mobility impairment, pain, osteoarthritis, and musculoskeletal disorders to explore their association with urinary incontinence. Gender-specific logistic regression models included chronic conditions related to urinary incontinence.
: The prevalence of urinary incontinence was higher in the participants with osteoarthritis and back musculoskeletal system problems. Among the patients with osteoarthritis, the prevalence was 25.84% in the mobility-impaired group and 10.03% in the non-impaired group. Similarly, 33.02% of those with activities of daily living (ADL) difficulties and 12.93% of those without difficulties had incontinence. The frequency of urinary incontinence increased with pain severity. According to the multivariable logistic regression analyses, the adjusted odds ratio (95% confidence interval) of urinary incontinence for osteoarthritis was 1.58 (95% CI 1.23-2.02,
< 0.01) for females and 2.38 (95% CI 1.62-3.49,
< 0.01) for males.
: Urinary incontinence was more common in females, increased with age, and was found to be associated with osteoarthritis and back musculoskeletal system disorders. Among the patients with osteoarthritis and back musculoskeletal system disorders, those with mobility impairment and daily activity difficulties had a higher prevalence of urinary incontinence. The patients with more severe pain had a higher frequency of urinary incontinence.
Although penile fracture is a rare case, it is a well-described urologic emergency. It results from the rupture of the tunica albuginea of corpora cavernosa by blunt strain that commonly mandates ...immediate surgical exploration. Urethral injury may also accompany penile fracture. An ideal anamnesis and a special physical examination were determinant to achieve a correct diagnosis. It is usually diagnosed based on clinical examination, but ultrasonography can be very helpful in diagnosis. The treatment is based on the presence of associated urethral injury. Early surgery is preferable to conservative management, because it is associated with better outcomes and fewer long-term complications. The surgical repair of cavernous body can produce good results, with a favorable prognosis and minimal rate of complications. We present a penile fracture case of 34-year-old with subtotal rupture of the right corpus cavernosum without urethral injury who treated by early surgery and good results.
In longitudinal and cross-sectional studies, depression and anxiety have been associated with urinary incontinence (UI) in women. However, this association has not been studied in men. Utilizing data ...from the 2008 Turkish Health Studies Survey conducted by the Turkish Statistical Institute, we analyzed 13,830 participants aged 15 years and above. We investigated the association of UI with psychological discomfort in both sexes using multivariable logistic regression. High psychological discomfort significantly correlated with UI in males (OR 2.30, 95% CI 1.43–3.71) and females (OR 2.78, 95% CI 1.80–4.29). Anxiety increased UI likelihood in females (OR 2.36, 95% CI 1.61–3.46) and males (OR 2.37, 95% CI 1.10–5.13). Depression related significantly to UI in females (OR 2.54, 95% CI 1.81–3.58) but not males (OR 1.63, 95% CI 0.71–3.76). Antidepressant and anxiolytic use was not significantly related to UI in either gender. Anxiety and psychological discomfort contribute to UI in both genders. While depression significantly correlates with UI in females, it does not show the same magnitude and significance in males. Antidepressant and anxiolytic use did not significantly influence the association. These findings underscore the psychological distress-UI link, advocating a holistic approach for managing UI in individuals with mental health conditions.
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