Prostate and gut: Any relationship? A narrative review on the available evidence and putative mechanisms.

BACKGROUND: Gut microbiome is a community of microorganisms that lives in the human intestine and exerts various functions on the host, including metabolic, immunoregulatory, and control over cell proliferation. Gut microbiome alterations have been associated with various pathological conditions, such as diabetes mellitus, obesity, and cardiovascular diseases. Gut-prostate axis is explained by the association between gut microbiome quantitative and functional alterations along with increased intestinal epithelial permeability with prostatediseases. However, the pathophysiological mechanisms and clinical importance of this association are not completely clarified yet. METHODS: We conducted a narrative review of the most relevant articles in the Medline (US National Library of Medicine, Bethesda, MD, USA), Scopus (Elsevier, Amsterdam, The Netherlands) and Web of Science Core Collection (Thomson Reuters, Toronto, ON, Canada) databases. No chronological restrictions were applied, and the most related papers published until December 2023 were included. RESULTS: Gut microbiota (GM) and its metabolites are capable of modifying host androgen level, as well as prostate cancer (PCa) therapy response. Moreover, patients with inflammatory bowel disease have higher rates of prostatitis-like symptoms and a potential risk of developing PCa. CONCLUSIONS: There is evidence that interventions on the GM and its metabolites have a high potential to serve as diagnostic and therapeutic tools for prostate diseases, including PCa.

Robotic partial nephrectomy for large renal Leiomyoma: first case report

ABSTRACT Aim: Renal leiomyoma is a rare benign mesenchymal tumor arising from the smooth muscle cells of the kidney. Renal capsule is its most common location (1). Large tumor may require surgical excision which can be challenging in case of proximity to major vessels (2). Indications of robotic partial nephrectomy (RPN) have exponentially expanded over the past few years (3). We aim to report a case of large renal leiomyoma successfully managed with RPN. Methods: A 59-year-old female patient with BMI 51 presented with chief complaint of abdominal discomfort. The patient underwent a CT scan that revealed a massive circumscribed exophytic complex solid cystic mass of 4.5 × 7.7 × 6.2 cm, arising from the lower pole of right kidney and abutting the inferior vena cava. RENAL score was 11ah (high complexity). Past surgical history included mid-urethral sling, breast reduction, and hysterectomy with salpingectomy. Preoperative creatinine and eGFR were 0.9 (mg/dL) and 77 (mL/min), respectively. A robotic excision of this mass was successfully performed by using Da Vinci Xi platform. Main steps of the procedure are illustrated in the present video. Results: Dissection and isolation of the tumor were carefully performed after identifying key anatomical structures such as the ureter, the IVC and the renal hilum. Intraoperative ultrasound was used to confirm the margins of the mass. The renal artery was clamped and then the tumor was resected/enucleated. Renal parenchyma was re-approximated with a single layer of interrupted CT-1 Vicryl 0 with sliding clip technique. Warm ischemia time was 19 min. Estimated blood loss (EBL) was 250 ml. Operative time was 165 min. No intraoperative complications occurred. No drain was placed. Patient was discharged on postoperative day 2. Post-operative hypotension was managed with fluid bolus. Postoperative creatinine and eGFR were 1,0 (mg/dL) and 69 (mL/min/1.72m2), respectively. Pathology revealed a leiomyoma of genital stromal origin with hyalinization and calcification. Conclusions: To the best of our knowledge, this is the first description of RPN for the management of a large (about 8 cm) renal leiomyoma. Robotic assisted surgery allows to expand the indications of minimally invasive conservative renal surgery whose feasibility becomes even more clinically significant in case of benign masses which can be managed without sacrificing healthy renal parenchyma.

A diagnostic-therapeutic pathway for patients with kidney stone disease: 2020 update / Percorso diagnostico-terapeutico per il paziente con calcolosi renale: update 2020

The natural history of urinary kidney stone disease includes the risk of relapses and can be associated with the risk of chronic kidney disease, bone and cardiovascular disease. For this reason, a wide clinical-metabolic assessment of the kidney stone patient is of great importance since the first presentation of the stone, to set an appropriate preventive treatment. The proposed diagnostic-therapeutic pathway includes a careful medical history, in order to highlight a secondary kidney stone disease and the main risk factors for kidney stones, chronic renal disease, or cardiovascular and bone disease; a metabolic evaluation on multiple levels, according to the severity of the disease, and the presence or absence of risk factors, and appropriate instrumental investigations. Thus, the information collected makes it possible to set a preventive treatment consisting of general rules and, if necessary, specific pharmacological or nutritional interventions. This paper has been prepared by the Italian Multidisciplinary Study Group for Kidney Stone Disease, and it is addressed to the several professional figures involved in the management of patients suffering from nephrolithiasis, from the emergency doctor to the general practitioner, urologist, nephrologist, radiologist, and dietician. A diagnostic-therapeutic pathway for patients with kidney stone disease was first published on this Journal in 2010. The present contribution aims at amending and updating the article published exactly ten years ago, to serve as an easy-to-use reference and to guide good clinical practice in this field.

Sacrocolpopexy with polyvinylidene fluoride mesh for pelvic organ prolapse: Mid term comparative outcomes with polypropylene mesh.

OBJECTIVE: The aim of this study was to compare the surgical, anatomical, and functional outcomes of sacrocolpopexy (SCP) using polyvinylidene fluoride (PVDF) mesh versus SCP using the standard polypropylene (PP) mesh. STUDY DESIGN: This was a retrospective single centre case-control study including female patients who underwent laparoscopic or abdominal SCP for POP with either PP (Cousin Biotech®) or PVDF (DynaMesh®-PRS) mesh between March 2005 and May 2015. Anatomical outcomes were assessed by the Pelvic Organ Prolapse Quantification (POP-Q) system. Functional outcomes included voiding and storage urinary symptoms (VS and SS, respectively), urgency and stress urinary incontinence (UUI and SUI) and sexual dysfunction (SD). Symptoms and their impact on patients' quality of life (QoL) were assessed using validated questionnaires as Incontinence Impact Questionnaire (IIQ-7), Urinary Distress Inventory (UDI-6) and Female Sexual Function Index (FSFI). Global patient perception of improvement (PGI-I questionnaire) and mesh erosion rates were also recorded. RESULTS: Of the 166 patients enrolled, 136 could be included in the analysis: 73 in the PP group and 63 in the PVDF group. The mean follow-up was 94± 17.31 months for the PP and 25.6± 13.8 months for the PVDF group. There were no statistically significant differences in patient demographics and preoperative clinical characteristics. Postoperative anatomical correction were not significantly different between the two groups. The PVDF group showed superior results in term of storage symptoms (PVDF=0% versus PP=8.2%; p=0.02) and lower rate of sexual dysfunction (PVDF=0% versus PP=16,4%; p=0.001). Only 1 patient in PP group and 2 in PVDF group (p=0.47) presented a mesh exposure. There was no statistical difference in PGI-I scores (PP=1.5±1.0 vs PVDF=1.8±0.5; p=0.40). CONCLUSIONS: Our findings suggest that both meshes can be safely and effectively used with good anatomical outcomes. Interestingly, PVDF use was associated with significantly less storage symptoms and sexual dysfunction.

Selección del paciente para cirugía urológica por puerto único (LESS) / Patient selection for less Urological surgery

Laparoendoscopic single-site surgery (LESS) should theoretically improve perioperative results and cosmesis minimizing skin incision. LESS surgery is technically demanding and the result of any procedure depends on the surgeon skill and experience, on the condition to be treated and finally on careful patient selection. As cosmesis is the main advantage over standard laparoscopy, LESS is particularly indicated in young patients with low BMI. While at the beginning LESS surgery was limited to demolitive procedures, increasing experience lead to widen indications to reconstructive and more challenging conditions. New technologies and robotics may increase LESS indications in the next future(AU)

La Cirugía laparoscópica por puerto único (LESS) debería teóricamente mejorar los resultados perioperatorios y cosméticos minimizando la incisión cutanea. La cirugía LESS es técnicamente demandante y el resultado de cualquier procedimiento depende de la habilidad y la experiencia del cirujano, de la enfermedad que se ha de tratar y finalmente de una cuidadosa selección del paciente. Siendo la cosmética la principal ventaja sobre la laparoscopia convencional estándar, la cirugía LESS está particularmente indicada en pacientes jóvenes con índice de masa corporal bajo. Mientras que al principio la cirugía LESS estaba limitada a procedimientos de extirpación, el aumento de la experiencia ha llevado a que se amplíen las indicaciones a cirugía reconstructiva y otras situaciones más desafiantes. Las nuevas tecnologías y la robótica pueden incrementar las indicaciones de LESS en un futuro próximo(AU)

Fate of abstracts presented at the World Congress of Endourology: are they followed by publication in peer-reviewed journals?

PURPOSE: To estimate the acceptance rate of peer-reviewed journals, to describe the time course of subsequent full publication, and to identify those with characteristics associated with publication of the abstracts presented at the World Congress of Endourology (WCE). METHODS: All abstracts accepted for presentation at the 2001 and 2002 WCE meetings were identified from the published supplements to the Journal of Endourology. The subsequent publication rate for the corresponding studies was evaluated by scanning MEDLINE for the 5-year period after the meetings. RESULTS: Overall, 20.5% of the abstracts were followed by publication in peer-reviewed journals. Abstracts on transurethral, laparoscopic, and percutaneous procedures had the highest publication rates (25.5%, 25%, and 24.3%, respectively). Studies from North America had the highest publication rate (29.2%). The mean time to publication was 14.6 months. There was an 80% chance that an eventually published abstract was in print 2 years after presentation. The largest number of the reports were published in the Journal of Endourology (75 of 234; 32%), the official publication of the society that sponsors the WCE. CONCLUSIONS: Only one fifth of the abstracts presented at the WCE are ultimately published in peer-reviewed journals. Attendees should be aware of this limitation, and scientific committees should be encouraged to be more selective. Although presentation at major urological congresses constitutes an invaluable method for rapid scientific dissemination, abstracts contain data that usually are difficult to access and of questionable validity. In this respect, investigators are encouraged to publish their data.