Impact of previous malignancy at diagnosis on oncological outcomes of upper tract urothelial carcinoma

BACKGROUND

The evidence of prognostic factors and individualized surveillance strategies for upper tract urothelial carcinoma are still weak.

OBJECTIVES

To evaluate whether the history of previous malignancy (HPM) affects the oncological outcomes of upper tract urothelial carcinoma (UTUC).

METHODS

The CROES-UTUC registry is an international, observational, multicenter cohort study on patients diagnosed with UTUC. Patient and disease characteristics from 2380 patients with UTUC were collected. The primary outcome of this study was recurrence-free survival. Kaplan-Meier and multivariate Cox regression analyses were performed by stratifying patients according to their HPM.

RESULTS

A total of 996 patients were included in this study. With a median recurrence-free survival time of 7.2 months and a median follow-up time of 9.2 months, 19.5% of patients had disease recurrence. The recurrence-free survival rate in the HPM group was 75.7%, which was significantly lower than non-HPM group (82.7%, P = 0.012). Kaplan-Meier analyses also showed that HPM could increase the risk of upper tract recurrence (P = 0.048). Furthermore, patients with a history of non-urothelial cancers had a higher risk of intravesical recurrence (P = 0.003), and patients with a history of urothelial cancers had a higher risk of upper tract recurrence (P = 0.015). Upon multivariate Cox regression analysis, the history of non-urothelial cancer was a risk factor for intravesical recurrence (P = 0.004), and the history of urothelial cancer was a risk factor for upper tract recurrence (P = 0.006).

CONCLUSION

Both previous non-urothelial and urothelial malignancy could increase the risk of tumor recurrence. But different cancer types may increase different sites' risk of tumor recurrence for patients with UTUC. According to present study, more personalized follow-up plans and active treatment strategies should be considered for UTUC patients.

Radiomics in Urolithiasis: Systematic Review of Current Applications, Limitations, and Future Directions

Radiomics is increasingly applied to the diagnosis, management, and outcome prediction of various urological conditions. Urolithiasis is a common benign condition with a high incidence and recurrence rate. The purpose of this scoping review is to evaluate the current evidence of the application of radiomics in urolithiasis, especially its utility in diagnostics and therapeutics. An electronic literature search on radiomics in the setting of urolithiasis was conducted on PubMed, EMBASE, and Scopus from inception to 21 March 2022. A total of 7 studies were included. Radiomics has been successfully applied in the field of urolithiasis to differentiate phleboliths from calculi and classify stone types and composition pre-operatively. More importantly, it has also been utilized to predict outcomes and complications after endourological procedures. Although radiomics in urolithiasis is still in its infancy, it has the potential for large-scale implementation. Its greatest potential lies in the correlation with conventional established diagnostic and therapeutic factors.

Impact of stone density on outcomes in percutaneous nephrolithotomy (PCNL): an analysis of the clinical research office of the endourological society (CROES) pcnl global study database

OBJECTIVE

This study aimed to explore the relationship between stone density and outcomes of percutaneous nephrolithotomy (PCNL) using the Clinical Research Office of the Endourological Society (CROES) PCNL Global Study database.

MATERIAL AND METHODS

Patients undergoing PCNL treatment were assigned to a low stone density [LSD, ≤ 1000 Hounsfield units (HU)] or high stone density (HSD, > 1000 HU) group based on the radiological density of the primary renal stone. Preoperative characteristics and outcomes were compared in the two groups.

RESULTS

Retreatment for residual stones was more frequent in the LSD group. The overall stone-free rate achieved was higher in the HSD group (79.3% vs 74.8%, p = 0.113). By univariate regression analysis, the probability of achieving a stone-free outcome peaked at approximately 1250 HU. Below or above this density resulted in lower treatment success, particularly at very low HU values. With increasing radiological stone density, operating time decreased to a minimum at approximately 1000 HU, then increased with further increase in stone density. Multivariate non-linear regression analysis showed a similar relationship between the probability of a stone-free outcome and stone density. Higher treatment success rates were found with low stone burden, pelvic stone location and use of pneumatic lithotripsy.

CONCLUSIONS

Very low and high stone densities are associated with lower rates of treatment success and longer operating time in PCNL. Preoperative assessment of stone density may help in the selection of treatment modality for patients with renal stones.

Bipolar transurethral resection of the prostate ‐ technical modifications and early clinical experience

The purpose of the study was to update the current modifications of transurethral resection of the prostate (TURP) using bipolar high frequency current and to report on our first own clinical experience. Based on a Medline search covering the period from January 2000 to September 2006 and our clinical experience with three different devices (VISTA-ACMI, Gyrus, Storz), the technical basis of these modifications was described. In addition, an analysis of the actual outcome (handling, complications, morbidity) of bipolar TURP (n = 124) compared to a parallel series of monopolar TURP (N = 148) was carried out. Recently, five different modifications of bipolar resection devices (ACMI, Gyrus, Olympus, Storz, Wolf) have been introduced. Experimental and clinical data were available for four of these modifications (VISTA-ACMI, Gyrus, Olympus, Storz). The devices differ in terms of modification of the passive electrode (two loops, single loop, resectoscope sheath). Bipolar technology allows the use of 0.9% sodium chloride (instead of glycine) as irrigant. In all bipolar devices, a slight prolongation was noted for initiation of the cut, with the VISTA showing the poorest cutting behaviour. Finest apical dissection could be performed with the Storz device. Phase III-studies comparing bipolar and monopolar TURP showed advantages for bipolar concerning the rate of TUR-syndrome/fluid absorption, bleeding, catheter time, whereas the resection speed was similar. In two studies using two different devices (Gyrus, Olympus) a higher rate of urethral strictures was detected. We conclude that TURP still represents the reference standard in the management of benign prostatic hyperplasia. Initial data suggest that bipolar technology is safe and effective. It may offer some advantages with respect to the reduction of TUR-syndrome, less conductive trauma (i.e. tissue charring), cheaper irrigation solution, and a shorter catheter time. In addition to already existing phase III-studies, larger randomized mulit-institutional trials will have to substantiate these advantages.

Changing patterns of keratin expression could be associated with functional maturation of the developing human bladder

PURPOSE

We investigate the keratin phenotype of human transitional epithelium at various gestational ages and whether keratin composition of transitional epithelium is related to bladder function and morphology.

MATERIALS AND METHODS

Consecutive sections from formalin fixed paraffin embedded blocks of autopsy bladder tissue from 21 male and 5 female fetuses, gestational age 12 to 40 weeks and 7 infants 2 days to 19 months old were cut and stained with antibodies recognizing basal cell keratins 5, 14 and 17, intermediate squamous cell keratin 13 and columnar cell keratins 7, 8, 18 and 20.

RESULTS

With gestational age there were distinct changes in expression of keratins recognizing columnar cells, consisting of focal loss of keratin 7 in transitional epithelium, restriction of keratin 20 expression to umbrella cells and expression of keratin 18 throughout the full thickness of transitional epithelium. Basal cell keratin 5 was found above the basal cell layer while keratins 14 and 17 were not found. Squamous cell keratin 13 was found throughout the full thickness of the urothelium.

CONCLUSIONS

The changes with gestational age in expression of some keratins may be related to the development of the reservoir function of the bladder. The impermeability of transitional epithelium, particularly during early fetal development, is possibly a function of umbrella and intermediate transitional cells.