Same sized three-way indwelling urinary catheters from various manufacturers present different irrigation and drainage properties

Background:

The three-way indwelling urinary catheter (IUC) is used for continuous bladder irrigation and is considered the cornerstone for clinical treatment of patients with macroscopic hematuria. Although there seems to be a logical relationship between catheter size and efficacy of irrigation and drainage, we often observe relevant variations in these parameters between different brands of catheters available on the market. The aim of this study was to compare the mechanical properties of different models of latex and silicone three-way catheters in an in vitro setting that resembles clinical use.

Methods:

Three different three-way catheters were evaluated: Gold Silicone-Coated Rusch^® (Model A), 100% Silicone Rusch^® (Model B) and X-Flow Coloplast^® (Model C). Irrigation channel, drainage channel, and overall cross-sectional areas were all digitally measured. Irrigation and drainage channel flow rates were measured and correlated with their corresponding catheter cross-sectional area values.

Results:

Different catheter models of the same caliber have different internal irrigation port diameters, internal drainage port diameters and internal cuff port diameters. The Model C IUC internal irrigation port diameter is significantly larger than models A and B. When flows were evaluated, we found that in the same model, the increase in caliber of the IUC was related to an increased drainage flow, but not to an increased irrigation flow.

Conclusion:

Precise measurements of the internal architecture of the three-way catheter, rather than relying on the caliber itself, could assist surgeons in choosing the best product for each specific patient, while minimizing complications.

Should aspirin be suspended prior to robot-assisted radical prostatectomy? A systematic review and meta-analysis

Background:

Low-dose aspirin use has been correlated with an increased risk of bleeding and overall complications in surgical and invasive diagnostic procedures. In this review, our aim was to analyze the current literature on whether robot-assisted radical prostatectomy (RARP) is feasible and safe in patients taking low-dose aspirin perioperatively.

Methods:

A systematic review was performed identifying a total of 767 studies, published between January 2000 and September 2017, with five of these studies meeting the inclusion criteria for the meta-analysis, totalizing 1481 patients underwent RARP. Patients were divided into two groups: taking aspirin (group A) and those not taking aspirin (group B) perioperatively.

Results:

There were no significant differences between groups in the overall [group A 10.7% versus group B 15.7%, risk ratio (RR) 0.83; p = 0.45; I² = 0%] or major complication rates (group A 1% versus group B 3%, RR 0.98; p = 0.98; I² = 0%), rate of cardiovascular events (group A 1.4% and group B 0.5%, RR 2.06; p = 0.24; I² = 9%), blood loss (group A 278 ml versus group B 307 ml, SMD −0.12; p = 0.91; I² = 96%), or hospital length of stay [group A 4 days (3–5) and group B 4 days (3–4), SMD −0.09; p = 0.52; I² = 0%]. There was a slightly higher blood-transfusion rate in group A (2.6%) versus group B (1.6%) (RR, 5.05; p = 0.04; I² = 0%).

Conclusion:

Continued aspirin use in the perioperative period does not correlate with an increase in surgical morbidity, blood loss, or hospital length of stay. There was a slightly higher blood-transfusion rate in patients taking low-dose aspirin (group A) perioperatively.

The Role of Immunohistochemical Analysis as a Tool for the Diagnosis, Prognostic Evaluation and Treatment of Prostate Cancer: A Systematic Review of the Literature

Background: Prostate cancer (PCa) is a heterogeneous disease that lends itself toward numerous therapeutic options depending on its risk stratification. One of the greatest challenges in PCa urologic practice is to select patients who should be referred for biopsy and, for those patients who are diagnosed with cancer, to differentiate between patients with indolent disease from those with an unfavorable prognosis and, to determine ideal patient management and avoid unnecessary interventions. Accordingly, there is a growing body of literature reporting immunohistochemical studies with the objective of determining a prostate cancer prognosis. Among the most frequent biomarkers studied are Ki-67, p53, PTEN, MYC, and ERG. Based on these findings, we systematically reviewed articles that assessed the role of these main prognostic markers in prostate cancer.

Methods: Consistent with PRISMA guidelines, we performed a systematic literature search throughout the Web of Science and PubMed Medline databases. We considered all types of studies evaluating the role of Ki-67, p53, PTEN, MYC, and ERG immunohistochemical analysis in prostate cancer until July 2017.

Results: We identified 361 articles, 44 of which were summarized in this review. Diagnostically, no single immunohistochemical marker was able to define a tumor as benign or malignant. Prognostically, Ki-67, p53, and MYC were related to the tumor grade given by Gleason score and to the tumor stage (higher levels related to higher tumor grade). Furthermore, Ki-67 was also related to higher PSA levels, shorter disease-free intervals and shorter tumor-specific survival; the latter was also related to p53. The loss of PTEN protein expression showed a higher association with biochemical recurrence and with a worse prognosis, beyond that predicted by the Gleason score and tumor stage. ERG staining also showed a strong association with biochemical recurrence.

Conclusion: There are several studies relating immunohistochemical markers with clinical-laboratorial outcomes in prostate cancer, the most frequent being Ki-67, p53, ERG, PTEN, and MYC. However, none of these markers have been validated by literary consensus to be routinely applied in medical practice.

Aspirin use in robot-assisted radical prostatectomy? Systematic review and metanalysis

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Background: Low dose aspirin (81-100mg) used as secondary prevention in cardiovascular diseases is correlated with increased bleeding and overall complications in surgical procedures. However, the suspension of this medication can increase the risk of cerebrovascular accident and myocardial infarction. Robot-assisted radical prostatectomy (RARP) has significantly decreased the surgical morbidity and the peri-operative bleeding. Our aim was to analyze whether RARP is feasible and safe in patients with low dose aspirin intake. Methods: Systematic review of the literature using MEDLINE, ESCOPUS, Lilacs, Scielo and Cohcrane articles published until June 2016. We included prospective trials and large cohorts that evaluated patients with (Group A) or without the maintenance of aspirin (Group B). Results: 5 trials (n = 1481 men) were included. One thousand and thirteen men stopped the use of the medication and 168 kept it during the peri-operatory setting, including the procedure. For the analyses of overall complications 3 articles with 458 men were included. The overall complication rate was 19%, without statistically significant difference between groups (Group A: 10.5%; Group B: 21.8% - OR: 0.70 IC:0.31- 1.56; I2= 0%). In a sub analysis evaluating major complications (Clavien > 2), cardiovascular events were similar between groups (Group A: 10.5%; Group B: 19% OR: 0.67 IC: 0.34- 1.70; I2= 0%). There were 5 trials included to evaluate blood loss, with 1481 patients (168 Group A and 1313 Group B). The overall transfusion rate was 1.9%, without difference between groups (Group A = 3,5% and Group B = 1.7% - OR:3.24 IC:0.87- 12.06; I2= 0%). The estimate perioperative bleeding rate was significantly lower in patients using aspirin during surgery (OR:-33.74 IC:-44.99, -22.49, I2= 92%). The hospital stay length was similar between groups (OR:0 IC:-0.04, 0.04; I2= 0%). Conclusions: Low dose aspirin does not correlate with larger peri-operatory surgical morbidity, transfusion rate or hospital stay. The blood loss was lower in the aspirin intake group, but this fact should be interpreted with caution due to the high heterogeneity among studies. RARP in patients under continuous aspirin intake was feasible and safe.