A study of the immunohistochemical profile of bladder cancer in neuro-urological patients by the French Association of Urology.

PURPOSE: To establish whether the expression of markers of cell differentiation (CK7, CK14, CK20, GATA3), apoptosis (p53), proliferation (Ki67, STAG2) and peri-tumoural lymphocytes (CD3, CD8), provides specific information about urothelial carcinogenesis in neuro-urological patients with bladder cancer (NBC). METHODS: Tissue samples from NBC were retrieved from 15 centres in France and compared to control samples from non neuro-urological patients with bladder cancer (NNBC) and from neuro-urological patients without bladder cancer (NB). The expression of CK7, CK14, CK20, GATA3, p53, Ki67, STAG2, CD3 and CD8 markers was analysed using immunohistochemistry of tissue microarray sections. RESULTS: Overall, tissue samples from 124 patients were included in the study (n = 72 NBC, n = 26 NNBC and n = 26 NB). Muscle invasive bladder cancer (MIBC) was found in 52 NBC patients (72.2%) and squamous cell differentiation in 9 (12.5%). In NBC samples, the expression of CK20 and GATA3 was significantly more frequent in NMIBC compared to MIBC (p = 0.015 and p = 0.004, respectively). CK20 and GATA3 were significantly more expressed in NBC compared to NNBC (p < 0.001 and p = 0.010, respectively). The expression of CK14, Ki67, CD3 and CD8 was significantly more frequent in NBC than in NNBC samples (p = 0.005, p < 0.001, p < 0.001 and p < 0.001, respectively). The expression of CD3 and CD8 was similar in NBC and NB samples. CONCLUSION: In NBC, markers of basal differentiation, proliferation and peri-tumoural lymphocytes were significantly more expressed compared to NNBC controls. These results suggest the aggressiveness of NBC and the role of chronic inflammation in the carcinogenesis of bladder cancer in neuro-urological patients.

Comparison of Holmium:YAG and Thulium Fiber Lasers on the Risk of Laser Fiber Fracture.

OBJECTIVES: To compare the risk of laser fiber fracture between Ho:YAG laser and Thulium Fiber Laser (TFL) with different laser fiber diameters, laser settings, and fiber bending radii. METHODS: Lengths of 200, 272, and 365 µm single use fibers were used with a 30 W Ho:YAG laser and a 50 W Super Pulsed TFL. Laser fibers of 150 µm length were also tested with the TFL only. Five different increasingly smaller bend radii were tested: 1, 0.9, 0.75, 0.6, and 0.45 cm. A total of 13 different laser settings were tested for the Ho:YAG laser: six fragmentation settings with a short pulse duration, and seven dusting settings with a long pulse duration. A total of 33 different laser settings were tested for the TFL. Three laser settings were common two both lasers: 0.5 J × 12 Hz, 0.8 J × 8 Hz, 2 J × 3 Hz. The laser was activated for 5 min or until fiber fracture. Each measurement was performed ten times. RESULTS: While fiber failures occurred with all fiber diameters with Ho:YAG laser, none were reported with TFL. Identified risk factors of fiber fracture with the Ho:YAG laser were short pulse and high energy for the 365 µm fibers (p = 0.041), but not for the 200 and 272 µm fibers (p = 1 and p = 0.43, respectively). High frequency was not a risk factor of fiber fracture. Fiber diameter also seemed to be a risk factor of fracture. The 200 µm fibers broke more frequently than the 272 and 365 µm ones (p = 0.039). There was a trend for a higher number of fractures with the 365 µm fibers compared to the 272 µm ones, these occurring at a larger bend radius, but this difference was not significant. CONCLUSION: TFL appears to be a safer laser regarding the risk of fiber fracture than Ho:YAG when used with fibers in a deflected position.

Comparison of intrapelvic pressures during flexible ureteroscopy, mini-percutaneous nephrolithotomy, standard percutaneous nephrolithotomy, and endoscopic combined intrarenal surgery in a kidney model.

PURPOSE: To compare intrapelvic pressure (IPP) levels achieved during f-URS, mini-PCNL, standard PCNL, and endoscopic combined intrarenal surgery in a kidney model. METHODS: A silicone model simulating the complete urinary tract was used for all the experiments. We compared: a 9.5Fr f-URS, a 12Fr mini-nephroscope and a 26Fr nephroscope. The irrigation pressure was set at 40 and 193 cmH2O. We compared: f-URS-S ± ureteral access sheath (UAS, 10/12Fr, 11/13Fr, 12/14Fr) ± 273 µm laser fiber, Mini-PCNL with different sizes of operating sheath (15/16Fr, 16.5/17.5Fr, 21/22Fr) ± 365 µm laser fiber, Standard PCNL with an operating sheath of 30Fr ± Lithotripter LithoClast Master 11.4Fr. RESULTS: f-URS: IPP values ranged between 1.4 and 46.2 cmH2O. Factors reducing IPP were an irrigation pressure at 40 cmH2O, an occupied working channel, and the use of a UAS except with the 10/12Fr at 193 cmH2O. Mini-PCNL: IPP values ranged between 2.4 and 39.7 cmH2O. Factors reducing IPP were irrigation pressure at 40 cmH2O, a large operating sheath (> 15/16Fr). The occupation of the working channel did not affect the IPP at 40 cmH2O, while it decreased at 193 cmH2O. Standard PCNL: IPP values ranged between 1.4 and 7.3 cmH2O. Occupancy of the working channel did not affect IPP at 40 cmH2O, while it increased at 193 cmH2O. CONCLUSION: We recorded for the first time IPP values according to different endourological techniques and configurations. IPP never exceed 50 cmH2O irrespectively of the assessed technique/setup. The factors reducing IPP were a low irrigation pressure (40 cmH2O), the use of a UAS or a working sheath appropriate to the diameter of the endoscope, as well as the occupation of the working channel in the case of f-URS.