Challenges and technical aspects in the management of muscle invasive bladder cancer as retrograde radical cystectomy with ileal conduit.

Objective: To evaluate long-term outcomes in patients homogenously treated with radical cystectomy and ileal conduit for muscle invasive bladder cancer. METHODS: The retrospective study was conducted at the Urology Department of Pakistan Kidney and Liver Institute and Research Centre, Lahore, Pakistan, and comprised data from December 25, 2017, to January 16, 2023, related to patients who underwent radical cystectomy with ileal conduit with or without neo-adjuvant and adjuvant radiation, chemotherapy, or immunotherapy for papillary urothelial carcinom of the bladder. Clinical trajectory, histopathological characteristics and long-term clinical outcomes were noted. Data was analysed using SPSS 20. RESULTS: In our study of 40 patients with muscle invasive bladder cancer, males predominated (32, 80%), with a median age of 57.4 years (IQR: 29-80). Diagnosis was early in 5 (12.5%) patients with varying haematuria durations, while 34 (85%) patients had a smoking history. Comorbidities included hypertension in 17 (42.5%) patients, diabetes in 1 (2.5%) patient, both hypertension and diabetes in 9 (22.5%) patients and a combination of hypertension, diabetes, and ischaemic heart disease in 3 (7.5%) patients. Transurethral resection was performed once in 13 (32.5%) patients and multiple times in 27 (67.5%) patients. Additionally, 5 (12.5%) patients received immunotherapy, 11 (27.5%) patients underwent non-adjuvant radiation, and 14 (35%) patients received non-adjuvant chemotherapy. Papillary urothelial carcinoma was the predominant histological subtype among 37 (92.5%) patients. Patients receiving chemotherapy had significantly better overall survival (p=0.02). No significant differences were noted in recurrence or survival by therapy modality (p>0.05). These findings highlight the significance of early diagnosis, tailored treatments, and comorbidity management in muscle invasive bladder cancer patients. Age stratification revealed significant survival differences across groups (χ²=10.923, df=3, p= 0.012). Analysis by complications did not show age-related survival variations (χ² =3.978, df = 3, p=0.264). Conclusion: Achieving excellent long-term survival in MIBC patients requires a multidisciplinary approach, emphasizing early diagnosis, tailored treatment, and adherence to guidelines and protocols.

Outcomes of initial 100 cases of laparoscopic nephrectomy at tertiary care center (PKLI).

Objective: Laparoscopic nephrectomy has been adopted by many centers in the last few decades. However, there are a few inherent challenges while adopting laparoscopic nephrectomy in a new unit. These include a significant learning curve required to adopt this modality. This study aimed to share the initial experience of adopting laparoscopic nephrectomy at our center. Methods: In total, 101 patients were analyzed in the study. These patients underwent laparoscopic radical or simple nephrectomy (for renal mass and noncancer renal cases respectively) at Department of Urology, Pakistan Kidney and Liver Institute and Research Centre, Lahore from April 2018 till January 2021. Data were entered in the statistical analysis software file. Analysis was attained by utilizing SPSS version 20. Implementation of Mean along with standard deviation values was utilized in the case of the continuous variables. While frequency/percentages represented categorical factors. Results: The mean age of patients was 42.81±15.49 years and their overall BMI was 26.41±5.30 kg/m2. Out of these, 57 (56.43%) were males and 44(43.56%) were female. Eighteen percent of patients had a previous surgical history on the ipsilateral side. Total operative time was 163.98±58.02 minutes while mean hospital stay reached 3.2±0.87 days. The tumor-free margin was attained in all cases of radical nephrectomy. Based on Clavien-Dindo classification, Grade-1 (n=3; 2.97%), Grade-2 (n=6; 5.94%), Grade-3A (n=1; 0.99%), and Grade-3B (n=1; 0.99%) complications were observed. Conclusion: In a newly developed urology center, laparoscopic nephrectomy can be a daunting task. Good teamwork among the surgical team members and careful selection of cases can result in satisfactory procedural outcomes.

Topical Anesthetics and Premature Ejaculation: A Systematic Review and Meta-Analysis.

This meta-analysis was conducted to assess the effectiveness of topical anesthetics in preventing premature ejaculation. We conducted an online database search for original studies comparing topical anesthetic agents with placebo in patients with premature ejaculation. After selecting relevant articles, we extracted data on baseline characteristics and predetermined endpoints. Intravaginal ejaculatory latency time (IELT) was the primary outcome for efficacy. Mean differences and corresponding 95% confidence intervals were used to present continuous data. A random-effects model was used to pool the data, and subgroup analysis was performed based on the type of anesthetic agent used. Eleven randomized controlled trials were examined, involving a total of 2008 participants. After analyzing the combined results, it was found that Severance Secret (SS) cream (CJ CheilJedang Corporation, Seoul, South Korea) demonstrated significantly higher effectiveness than a placebo in increasing IELT (P = 0.001). Similarly, the topical eutectic mixture for premature ejaculation (TEMPE), lidocaine, and the eutectic mixture of local anesthetics (EMLA) were significantly more efficient than a placebo (P<0.00001; P = 0.0001; P<0.00001). Additionally, it was found that lidocaine gel was more efficient than paroxetine or sildenafil (P = 0.04; P<0.00001). In conclusion, topical anesthetics increase IELT in men with premature ejaculation more effectively than placebo, sildenafil, tadalafil, paroxetine, and dapoxetine.

New insights on possible vaccine development against SARS-CoV-2.

In December 2019, a novel virus, namely COVID-19 caused by SARS-CoV-2, developed from Wuhan, (Hubei territory of China) used its viral spike glycoprotein receptor-binding domain (RBD) for the entrance into a host cell by binding with ACE-2 receptor and cause acute respiratory distress syndrome (ARDS). Data revealed that the newly emerged SARS-CoV-2 affected more than 24,854,140 people with 838,924 deaths worldwide. Until now, no licensed immunization or drugs are present for the medication of SARS-CoV-2. The present review aims to investigate the latest developments and discuss the candidate antibodies in different vaccine categories to develop a reliable and efficient vaccine against SARS-CoV-2 in a short time duration. Besides, the review focus on the present challenges and future directions, structure, and mechanism of SARS-CoV-2 for a better understanding. Based on data, we revealed that most of the vaccines are focus on targeting the spike protein (S) of COVID-19 to neutralized viral infection and develop long-lasting immunity. Up to phase-1 clinical trials, some vaccines showed the specific antigen-receptor T-cell response, elicit the humoral and immune response, displayed tight binding with human-leukocytes-antigen (HLA), and recognized specific antibodies to provoke long-lasting immunity against SARS-CoV-2.

Unravelling the prostate-specific antigen controversy: a West of Scotland perspective.

BACKGROUND: The use of serum prostate-specific antigen (PSA) as a screening tool for prostate cancer in asymptomatic men is hugely controversial in the light of randomised controlled trials failing to demonstrate a benefit without risk of significant overtreatment. However, PSA can be used as a tool to risk assess disease progression in men with lower urinary tract symptoms suggestive of benign prostatic enlargement (LUTS/BPE). The aim of this study was to canvas the opinions of West of Scotland Urologists regarding the use of PSA in both symptomatic and asymptomatic patients. METHODS: A questionnaire-based survey was sent to all the Consultants and Trainees in the West of Scotland. RESULTS: Survey response rate was 45% (47/105). In patients <70 years, 93% would perform a PSA testing in patients symptomatic of LUTS/BPE, but only 17% would offer PSA screening to asymptomatic patients. In patients >70 years, only 48% of urologists would perform a PSA if patients were symptomatic and none would offer PSA screening. In terms of self-testing, 59% of urologists would have a PSA test if symptomatic and 31% of urologists would have PSA screening. CONCLUSIONS: This study highlights significant variability in the use of PSA for both asymptomatic and symptomatic men. Despite a lack of evidence, PSA screening is still offered to asymptomatic men. Further randomised studies are required to determine the utility of PSA-based screening algorithms for prostate cancer detection.

Laparoscopic pyeloplasty in a solitary kidney.

BACKGROUND: A 40-year-old male presented with right-sided abdominal pain and no lower urinary tract symptoms. Examination was unremarkable, apart from mild right renal angle tenderness. INVESTIGATIONS: Renal function, full blood count and C-reactive protein levels were all normal. Ultrasound of renal tract, abdominal computed tomography (CT) and (99m)Tc-mercaptoacetyltriglycine (MAG3) renogram confirmed ureteropelvic junction obstruction. DIAGNOSIS: The ureteropelvic junction obstruction of the right kidney was identified, with a crossing lower pole renal vessel as the possible cause. An absent left kidney was also noted. MANAGEMENT: Laparoscopic transperitoneal dismembered Anderson-Hynes pyeloplasty was performed, with posterior transposition of the crossing lower pole vessel.

Reducing warm ischaemia time during laparoscopic partial nephrectomy: a prospective comparison of two renal closure techniques.

OBJECTIVE: To test the hypothesis that a modified technique for renal parenchymal closure during laparoscopic partial nephrectomy (LPN) enables a significant reduction in warm ischaemia (WIT). METHODS: Perioperative factors including WIT were prospectively recorded during 40 consecutive LPNs performed by a single experienced laparoscopist. In the first 20 (controls), renal parenchyma was closed by conventional technique (haemostasis and closure of the collecting system with interrupted sutures, then closure of the renal parenchyma over a Surgicel bolster before unclamping the renal artery). In the second consecutive 20 patients (group 1), a modified closure technique was used, which involved earlier arterial unclamping after two (group 1a) or one (group 1b) running suture on the tumour bed. Vascularised renal parenchyma was then closed over a surgical bolster. RESULTS: All LPNs were performed successfully without conversion. WIT was significantly less in group 1 compared with the control group (27.2+/-5 min vs. 13.7+/-4 min, respectively; p<0.01). WIT was 16.8+/-3.6 vs. 10.3+/-1.2 min in groups 1a and 1b (p<0.01); no other significant differences were observed in perioperative factors. All specimens had negative tumour margins histologically. Major complications and haemoglobin reduction were lower in group 1 compared with the control group. CONCLUSIONS: The described technique is effective and allows a significant reduction of WIT, even in challenging cases, without increasing perioperative bleeding or morbidity. Its use therefore reduces the need for hypothermic techniques, and allows more time for careful tumour resection and renal reconstruction.