Utility of urinary biomarkers in primary haematuria: Systematic review and meta-analysis.

Objectives: To evaluate the diagnostic performance of FDA-approved urinary biomarkers in the evaluation of primary haematuria for investigation of bladder cancer. Methods: The scientific databases MEDLINE, EMBASE, Pubmed and Web of Science were searched to collect studies. Studies that evaluated the diagnostic performance of FDA-approved urinary biomarkers in investigating patients with primary haematuria without a prior history of bladder cancer were included. Quality of studies was assessed using the JBI Criteria. Bivariate mixed-effects regression model was used to calculate pooled sensitivities and specificities for each biomarker. Results: Eighteen studies were included in the analysis. The biomarkers assessed in these studies were CxBladder, AssureMDx, Bladder Tumour Antigen (BTA), NMP22, UroVysion and Immunocyt/uCyt+. Several biomarkers, such as AssureMDx, CxBladder and Immunocyt, were shown to have better diagnostic performance based on their sensitivity, specificity and diagnostic odds ratio, as well as positive and negative likelihood ratios. Across the six biomarkers, sensitivity ranged from 0.659 to 0.973, and the specificity ranged between 0.577 and 0.833. Conclusion: Despite certain biomarkers demonstrated better performance, current diagnostic abilities of the FDA-approved biomarkers remain insufficient for their general application as a rule out test for bladder cancer diagnosis and as a triage test for cystoscopy in patients with primary haematuria. High-quality prospective studies are required to further analyse this and also analyse the correct scenario in which urinary biomarkers may be best utilised.

A Historical Perspective of the Evolution of Laparoscopic Surgeries in Urology.

Recent decades have seen the rapid progression of minimally invasive surgery in urology with continuing developments in robotic technology paving ways into a new era. In addition to these technological innovations, interests from urologists in developing and embracing new techniques have become a forefront in the ongoing evolution of the field allowing for improvement in intraoperative experience as well as morbidity and mortality outcomes. This article aims to provide an overview of the historical development of laparoscopic surgery in urology while also providing a brief look into its future.

Primary localised bladder amyloidosis - A case report with review of the literature.

Primary bladder amyloidosis, a mimicker of bladder malignancy, is a rare but important differential diagnosis for patients presenting with haematuria. We report the case of a 58-year-old man who initially presented with macroscopic haematuria and irritative urinary tract symptoms. There was no radiological evidence of a bladder mass lesion, but cystoscopy revealed an erythematous papillary lesion in the posterior bladder wall concerning for bladder malignancy. Histology demonstrated primary bladder amyloidosis, which was completely excised intraoperatively. He is undergoing regular cystoscopic surveillance and there has been no disease recurrence for 4 years since the initial diagnosis.

Pretreatment of choriocarcinoma syndrome: a rare complication of metastatic germ cell tumours.

A 27-year-old man newly diagnosed with metastatic testicular choriocarcinoma developed a large right perinephric haematoma secondary to a metastatic deposit in his right kidney. His presentation was also complicated by bilateral iliac venous thrombosis and pulmonary embolism identified prior to initiation of chemotherapy. He underwent multiple attempts at angioembolisation of the bleeding vessels and ultimately angioembolisation of the main renal artery had to be performed to control the bleeding. Following resolution and commencement of chemotherapy, the patient also developed spontaneous intracranial haemorrhage requiring craniotomy.

Parotid gland metastasis of lung adenocarcinoma identified on surveillance 18F-FDG PET/CT.

A 79-year-old man with a previous history of primary bilateral pulmonary adenocarcinomas was found to have a new parotid lesion on oncological surveillance imaging, raising the possibility of metastatic disease. Biopsy of the lesion confirmed metastatic deposit from primary lung adenocarcinoma. Following multidisciplinary discussions, the patient underwent a left parotidectomy where clear resection margins and preservation of facial nerve function were achieved.

Testicular-sparing excision for benign paratesticular IgG4-related disease.

A 28-year-old male was referred by his local general practitioner due to recurrence of painful right scrotal mass, first noted 8 years prior. The mass was further characterised with ultrasound and then was locally excised via an inguinal approach, sparing the testicle, without any postoperative complication. Immunoperoxidase staining of the excised lesion confirmed paratesticular IgG4-related disease.

Malignant ascites following radical nephrectomy for cystic renal cell carcinoma.

A 69-year-old man with a history of laparoscopic radical nephrectomy for papillary renal cell carcinoma presented with a 1-week history of generalised abdominal pain, distension and loss of appetite. Clinical examination and CT imaging demonstrated ascites associated with peritoneal nodules, raising the possibility of metastatic disease. Immunochemistry staining from ascites fluid cytology confirmed renal cell carcinoma. Following multidisciplinary discussions, the patient was commenced on a small-molecule tyrosine kinase inhibitor.