Alternatives for MRI in Prostate Cancer Diagnostics-Review of Current Ultrasound-Based Techniques.

The purpose of this review is to present the current role of ultrasound-based techniques in the diagnostic pathway of prostate cancer (PCa). With overdiagnosis and overtreatment of a clinically insignificant PCa over the past years, multiparametric magnetic resonance imaging (mpMRI) started to be recommended for every patient suspected of PCa before performing a biopsy. It enabled targeted sampling of the suspicious prostate regions, improving the accuracy of the traditional systematic biopsy. However, mpMRI is associated with high costs, relatively low availability, long and separate procedure, or exposure to the contrast agent. The novel ultrasound modalities, such as shear wave elastography (SWE), contrast-enhanced ultrasound (CEUS), or high frequency micro-ultrasound (MicroUS), may be capable of maintaining the performance of mpMRI without its limitations. Moreover, the real-time lesion visualization during biopsy would significantly simplify the diagnostic process. Another value of these new techniques is the ability to enhance the performance of mpMRI by creating the image fusion of multiple modalities. Such models might be further analyzed by artificial intelligence to mark the regions of interest for investigators and help to decide about the biopsy indications. The dynamic development and promising results of new ultrasound-based techniques should encourage researchers to thoroughly study their utilization in prostate imaging.

Changing patterns of urologic emergency visits and admissions during the COVID-19 pandemic: a retrospective, multicenter, nationwide study.

INTRODUCTION: We aimed to examine the change in the number and severity of visits to the emergency departments (EDs) and subsequent admissions for urgent urologic conditions in the early stage of the coronavirus disease 2019 (COVID-19) pandemic in Poland. MATERIAL AND METHODS: We evaluated data from 13 urologic centers in Poland and compared the number of visits to the EDs and subsequent admissions before and after the advent of COVID-19 in 2020, and before and after the escalating national restrictions. Furthermore, data on types of urologic complaints, crucial laboratory parameters, and post-admission procedures were analyzed. RESULTS: In total 1,696 and 2,187 urologic visits (22.45% decrease) and 387 and 439 urologic urgent admissions (11.85% decrease) were reported in given periods in 2020 and 2019, respectively. The year-over-year difference in daily mean visits was clear (36.1 vs. 46.5; p < 0.001). Declines were seen in all complaints but device malfunction. In 2020 daily mean visits and admissions decreased from 40.9 and 9.6 before lockdowns to 30.9 (p < 0.001) and 6.9 (p = 0.001) after severe restrictions, respectively. There was a trend towards more negative laboratory parameter profiles in 2020, with patients who visited the EDs after severe restrictions having twice as high median levels of C-reactive protein (15.39 vs. 7.84, p = 0.03). CONCLUSIONS: The observed declines in ED visits and admissions were apparent with the significant effect of national lockdowns. Our results indicate that some of the patients requiring urgent medical help did not appear at the ED or came later than they would have done before the pandemic, presenting with more severe complaints.

Influence of SGLT2 Inhibitor Treatment on Urine Antioxidant Status in Type 2 Diabetic Patients: A Pilot Study.

Sodium-glucose cotransporter 2 inhibitors (SGLT2i) have been recognized as potent antioxidant agents. Since SGLT2i are nephroprotective drugs, we aimed to examine the urine antioxidant status in patients with type 2 diabetes mellitus (T2DM). One hundred and one subjects participated in this study, including 37 T2DM patients treated with SGLT2i, 31 T2DM patients not using SGLT2i, and 33 healthy individuals serving as a control group. Total antioxidant capacity (TAC), superoxide dismutase (SOD), manganese superoxide dismutase (MnSOD), free thiol groups (R-SH, sulfhydryl groups), and catalase (CAT) activity, as well as glucose concentration, were assessed in the urine of all participants. Urine SOD and MnSOD activity were significantly higher among T2DM patients treated with SGLT2i than T2DM patients without SGLT2i treatment (p = 0.009 and p = 0.003, respectively) and to the healthy controls (p = 0.002 and p = 0.001, respectively). TAC was significantly lower in patients with T2DM treated with SGLT2i when compared to those not treated and healthy subjects (p = 0.036 and p = 0.019, respectively). It could be hypothesized that the mechanism by which SGLT2i provides nephroprotective effects involves improvement of the SOD antioxidant activity. However, lower TAC might impose higher OS (oxidative stress), and elevation of SOD activity might be a compensatory mechanism.

En-bloc resection of urinary bladder tumour - a prospective controlled multicentre observational study.

INTRODUCTION: Transurethral resection of bladder tumour (TURBT) is one of the most commonly performed urologic procedures. Because of the shortcomings of conventional TURBT, the en-bloc resection concept was created. AIM: To analyse the influence of en-bloc technique on surgical and oncological outcomes of TURBT performed with electric current. MATERIAL AND METHODS: This non-randomized, prospective controlled multicentre study enrolled 427 consecutive patients undergoing TURBT performed by five experienced endourologists in five academic institutions. Choice of procedure was at the discretion of the surgeon. The vast majority of patients underwent monopolar resection. The en-bloc procedure was performed with Collin's knife or the classic resection loop. Study end-points were surgery, catheterization and hospitalization time, presence of muscularis propria (MP) in the specimen and 3-month recurrence-free survival (RFS). RESULTS: The study included 427 (274 conventional TURBT vs. 153 en-bloc) patients with mean age of 69 years (range: 18-99). There were more cases with MP present in the specimen in the en-bloc group (91.3% vs. 75.5%; p < 0.001). Surgery and hospitalization times were statistically shorter in the en-bloc group (both p < 0.05). A borderline significant difference was noted when the number of residual tumours in reTURBTs was analysed, with fewer cases of residual tumour in the en-bloc group (p = 0.051). RFS at 3 months was higher in the en-bloc group (88.4% vs. 80.1%; p = 0.027). After propensity score matching, differences in MP presence, hospitalization time and 3-month RFS status remained statistically significant. CONCLUSIONS: When compared to conventional TURBT, en-bloc resection of bladder tumour is associated with higher percentage of MP presence in histopathological specimen, higher 3-month RFS and shorter hospitalization time.

Mean platelet volume-to-lymphocyte ratio: a novel biomarker associated with overall survival in patients with nonmetastatic clear cell renal cell carcinoma treated with nephrectomy.

INTRODUCTION: Renal cell carcinoma is a highly aggressive malignancy that causes significant morbidity and mortality. The rising number of newly diagnosed renal tumors results in a great need to search for new preoperative markers to evaluate the course of the disease and to help select patients who would benefit the most from additional postoperative care. The aim of our study was to evaluate the prognostic value of mean platelet volume-to-lymphocyte ratio (MPVLR) in patients undergoing nephrectomy for nonmetastatic clear cell renal cell carcinoma (ccRCC). MATERIALS AND METHODS: A total number of 344 patients with proven nonmetastatic ccRCC treated with radical or partial nephrectomy at our institution between January 2003 and December 2012 were included in our analysis. Based on the optimal cut-off value of MPVLR, which was determined by the receiver operating characteristic curve, our study population was divided into two groups, with low and high MPVLR. Differences in overall survival between groups were compared using the Kaplan-Meier method with log-rank testing. The Cox proportional hazards regression model was applied to perform univariate and multivariate analysis. RESULTS: Study subjects with high MPVLR were older and had more advanced tumors. Tumor necrosis and higher TNM stages were also more prevalent in this group of patients. Mortality in patients with high MPVLR was significantly higher than in patients with low MPVLR. In the multivariate analysis, after adjustment for pathological and clinical covariates, high MPVLR (≥ 3.61) was independently associated with higher long-term overall mortality in nonmetastatic ccRCC patients. CONCLUSION: MPVLR is an easily obtainable prognostic marker for overall survival in nonmetastatic ccRCC patients treated with nephrectomy.

The comparison of oxidative stress effect in classic and tubeless percutaneous nephrolithotomy.

PURPOSE: Surgical stone treatment induces oxidative stress in kidney tissue. We hypothesized that tubeless percutaneous nephrolithotomy (tPCNL) may induce less oxidative stress than classic percutaneous nephrolithotomy (cPCNL) with nephrostomy tube. METHODS: Seventy-two consecutive patients with kidney stones qualified for PCNL were enrolled in the study. Patients were assigned to one of two groups (first group 33 patients-cPCNL and second group 39 patients-tPCNL). Four urine samples were collected in four consecutive days, starting the day before operation. Four oxidative stress markers were analyzed in each sample: catalase (CAT), protein sulfhydryl group (SH), total antioxidant capacity (TAC) and superoxide dismutase (SOD). RESULTS: Baseline mean levels of CAT (IU/l), SH (µmol/l), TAC (mmol/l) and SOD (NU/ml) were 19.4 versus 11.7; 18 versus 58.7; 2.02 versus 1.99; 20.5 versus 22.6 in cPCNL and tPCNL group, respectively. On day two, the levels were 89 versus 104.9; 334.7 versus 518.9; 1.87 versus 1.79; 33.7 versus 41.4, respectively. On the third day, the levels were: 67.4 versus 28.3; 206.8 versus 306.9; 2.01 versus 2.06; 38.2 versus 36.6, respectively. On the fourth day, the concentrations were 47.4 versus 18.5; 129.3 versus 208.7; 2 versus 2.06; 35 versus 45.2, respectively. Significant differences were observed only for CAT and TAC concentrations in days 3 (p = 0.04 and 0.04) and 4 (p = 0.02 and < 0.001) in favor of tPCNL. CONCLUSIONS: CAT, SH and SOD significantly rise after operation. TAC represents the inversion of other parameters. CAT is significantly lower, and TAC is significantly higher in tPCNL postoperatively favoring this method.

Basic Parameters of Blood Count, Serum Sodium, and Creatinine as Prognostic Factors for Renal Cell Carcinoma at Five-Year Follow-Up.

BACKGROUND Several nomograms were developed for predicting the potential recurrence and cancer death risk in renal cell carcinoma patients. The combination of TNM classification and appropriately selected clinical classifiers allows for the creation of simple and effective risk calculators. MATERIAL AND METHODS There were 230 patients with renal cell cancer enrolled in this study. Basic parameters of blood count, serum creatinine and sodium concentrations, and histopathological features of the tumors were analyzed. A determination of whether any of the tested parameters could be used to assess the prognosis of kidney cancer was performed. RESULTS When the platelet cell count (PLT) increased by 10 thousand/µL, the risk of metastasis was higher by 5%, and cancer recurrence and death by 10%. A low-risk recurrence group was identified: T1b, PLT <230, Na of 140.6 mmol/L. A high-risk recurrence group was identified: T3a, PLT >280, Na of 143.4 mmol/L. A low-risk cancer specific mortality group was identified: T2a, absence of metastases, preoperative creatinine level of 85.6 µmol/L, and the value of PLT 227.0×103. A high-risk cancer specific mortality group was identified: T3a, the presence of metastases in the lungs (M), serum creatinine before treatment level of 97.9 µmol/L, and the value of PLT 299.5×10³. CONCLUSIONS Preoperative PLT, serum sodium, and tumor staging were independent risk factors for local recurrence. Blood PLT, serum sodium, creatinine, and tumor staging were useful indicators for estimating 5-year cancer specific survival.

Percutaneous Nephrolithotomy with Amplatz and Alken Dilators: An Eight-Year Single Tertiary Care Centre Experience.

BACKGROUND Percutaneous nephrolithotomy (PNL) is the standard procedure for patients with renal stones over 2 cm in diameter. We analyzed complications after this procedure focusing on two different methods of tract dilation. MATERIAL AND METHODS Between August 2008 and April 2016 222 percutaneous nephrolithotomies were performed in a total of 208 patients. The Group I (n=123) comprised patients where Alken dilatators were used, while Group II (n=99) comprised patients where Amplatz dilators were used. Efficacy was examined based on ultrasound and x-ray examination one month after the procedure. Complications were recorded using Clavien Dindo classification. RESULTS Efficacy was 85.3% and 86.8% in group I and II, respectively (p=0.77). Grade I complications were present in 14.6% and 3%, grade II were present in 9.7% and 8%, grade IIIa were present in 2.4% and 2%, grade IIIb were present in 1.6% and 2%, grade IVa were present in 1.6% and 7%, grade IVb were present in 3.2% and 1% in Group I and Group II, respectively. These differences were statistically significant (p=0.03). CONCLUSIONS Efficacy was comparable between Alken dilator and Amplatz dilator groups. In group I, there were more postoperative fevers >38.5 °C and a higher rate of urosepsis. On the other hand, in group II we observed more pleural injuries. All differences resulted from the type of access to the kidney (inter/infracostal), punctured calyx, and utilization (or not) of access sheath rather than type of dilators itself.