Laser-assisted debonding of ceramic veneers: A systematic review and meta-analysis

STATEMENT OF PROBLEM

The process of removing ceramic veneers is difficult, time consuming, and invasive. However, although lasers should provide a straightforward method for the debonding of ceramic veneers, a systematic review is lacking.

PURPOSE

The purpose of this systematic review and meta-analysis was to investigate the efficacy of the laser-assisted debonding of ceramic veneers.

MATERIAL AND METHODS

A systematic search was conducted in Medline/PubMed, Cochrane, Scopus, and Web of Science databases. Then, an analysis was performed using the meta-analysis approach to investigate the efficacy of the laser-assisted debonding of ceramic veneers. Quality assessment of the included articles was carried out using the Cochrane Collaboration tool. For the meta-analysis, the RevMan 5.4 software program was used to perform a random-effects model of standardized mean differences with 95% confidence intervals.

RESULTS

A total of 1108 studies were identified, of which 627 studies were selected for title and abstract analysis. The qualitative analysis included 16 studies, of which 3 studies were used in the quantitative synthesis. In the meta-analysis, the shear bond strength of the laser groups was compared with that of the control group. A substantial level of heterogeneity was noted in the included studies (I2=67%, P<.001).

CONCLUSIONS

The findings suggest that erbium lasers have a significant immediate effect in decreasing the shear bond strength of ceramic veneers. Furthermore, with proper laser settings, veneers can be safely removed without damaging the underlying tooth structure.

Terminology focused on design and retention methods used for anterior resin-bonded fixed partial dentures in English literature: A scoping review

Purpose

Novel terms describing several designs of resin-bonded fixed partial dentures (RBFPDs) continue to appear. Indeed, a variety of terms are used in the English scientific literature The use of a standard terminology is important for a fair and efficient understanding. This study aimed to investigate if the terminology used to describe designs and retention methods for anterior RBFPDs is standard.

Methods

An electronic search in the English literature was conducted in PubMed/Medline to identify all publications reporting RBFPDs in the anterior region until August 2022. This search was completed by hand searching. Terms indicating different designs of RBFPDs were listed and then classified. Percentages of their use were calculated to determine the commonly used terms. Analysis of the use of these terms was performed based on the standards determined by the latest edition of the Glossary of Prosthodontic Terms (GPT). The impacts of the MeSH Thesaurus and GPT on the nomenclature used for RBFPDs was assessed.

Results

A total of 125 articles were eligible for this review. In the retained articles, 86 terms were found. Among them, thirty-nine terms were classified into three groups. Only six terms were defined in the latest edition of GPT (GPT-9). Several classified terms that are commonly used were not identified in the GPT-9. Conversely to the GPT-9 which impact was insignificant, the MeSH Thesaurus had an important impact on the nomenclature used for RBFPDs.

Conclusion

The terminology used to describe designs and retention methods for anterior RBFPDs was non-standard. The GPT-9, constituting an important reference, defined a limited number of terms related to RBFPDs and had no significant impact on the standardization of the terminology used for RBFPDs. Efforts should therefore be continued to standardize the terminology. A specialized mini-glossary grouping and defining all the terms found in this study will helpful in clarifying the terminology used for the anterior RBFPDs.

An insight into the diagnostic and prognostic value of HOX A13 ’s expression in non‐muscle invasive bladder cancer

Background

Several studies have interrogated the molecular pathways and their interacting genes underlying bladder cancer (BCa) tumorigenesis, yet, the role of homeobox genes is still poorly understood. Specifically, HOXA13, which plays an important role as a major actor in the urogenital tract's development.

Methods

Immunohistochemical (IHC) staining was performed to inspect the differential expression of HOXA13 protein in non‐muscle‐invasive bladder cancer (NMIBC) and non‐tumoral tissues. A semiquantitative scoring system was adopted to evaluate the IHC labeling. Correlation to clinical parameters was performed by descriptive statistics. Overall survival was estimated by the Kaplan–Meier method and Cox regression model. The functional HOX A13 protein association networks (PPI) were obtained using String 11.0 database.

Results

HOX A13 exhibited cytoplasmic and nuclear staining. Its expression levels were lower in high‐grade NMIBC (HG NMIBC) compared to low‐grade ones (LG NMIBC). The expression of HOX A13 was correlated to tumor grade (LG/HG) (p = 0.036) and stage (TA/T1) (p = 0.036). Nevertheless, its expression was not correlated to clinical parameters and was not able to predict the overall survival of patients with HG NMIBC. Finally, PPI analysis revealed that HOX A13 seems to be a part of a molecular network holding mainly PBX1, MEIS, ALDH1A2, HOX A10, and HOX A11.

Conclusion

The deregulation of HOX A13 is not associated with the prognosis of BCa. It seems to be rather implicated in the early initiation of urothelial tumorigenesis and thus may serve as a diagnostic marker in patients with NMIBC. Further experimentations on larger validation sets are mandatory.

Upper urinary tract urothelial carcinoma diagnosis by biopsy of a vaginal metastasis

Upper tract urothelial carcinoma presents 5% of urothelial cancers. The most frequent revealing symptom gross haematuria. Vaginal metastasis is rare revealing condition. The combination on these two symptoms should recall the diagnosis of this neoplasm. Biopsy of the vaginal mass can make the histologic diagnosis easily.

MO967: Lymphocele After Renal Transplantation: Management, Risk Factors and Impact on Transplant Survival

BACKGROUND AND AIMS

Lymphocele after renal transplantation remains a common complication, despite all the technical precautions taken, in particular the ligation of lymphatic vessels. Its incidence varies according to the series, depending on the diagnostic methodology, and whether or not it is systematically screened.

This study aims to investigate the risk factors for lymphocele and its impact on transplant survival.

METHOD

We performed a retrospective longitudinal descriptive study including all patients who had a kidney transplant in a Urology department from 1986 to 2017. Clinical presentation and management of lymphocele were studied. Then, the characteristics of patients who presented a lymphocele were compared with those of the rest of the population including characteristics related to the recipient, the donor, the transplant and the procedure to identify risk factors. The impact of lymphocele on patient and transplant survival was then studied.

RESULTS

A total of 720 patients were included with a mean age of 32.7 years. The transplant was from a living donor in 79% and a brain-dead donor in 21%. Lymphocele occurred in 51 patients (7.1%). The lymphocele was asymptomatic in 80%, and clinical manifestations were related to the compression of the transplant or its important size, requiring active treatment, most often percutaneous (13.7%). The lymphocele did not require treatment in 42 cases (82.4%) with disappearance in 90.5%. Revision surgery for a lymphocele was necessary in two cases.

The risk factors for lymphocele were a cadaveric donor (P = 0.003) and an advanced age of the recipient (P  &lt; 0.001). No predictive factors related to the transplant (vascular anatomy), or procedure (location and type of anastomoses, ischemia time) were identified.

Transplant survival was 77.9% at 5 years, with a median survival of 15.9 years. The occurrence of a lymphocele did not influence the survival of the transplant (P = 0.25) (Figure 1).

CONCLUSION

Our study showed that lymphocele is usually asymptomatic, not requiring a specific treatment in most cases with a high rate of spontaneous disappearance with no impact on transplant survival. Risk factors were a cadaveric donor which may reflect the absence of careful ligation of the transplant's lymphatic vessels in the context of urgent, sometimes multi-organ, cadaveric procurement and advanced recipient age.

MO968: Vascular Complications of Renal Transplantation: Risk Factors and Impact on Graft Survival

BACKGROUND AND AIMS

Despite the progress made in renal transplantation, vascular complications can occur, jeopardizing the prognosis of the transplant.

This study aims to investigate the risk factors of vascular complications and their impact on transplant survival.

METHOD

We performed a retrospective longitudinal descriptive study including all patients who had a kidney transplant in a Urology department from 1986 to 2017. Transplant Vascular complications included: Arterial thrombosis (AT), Venous thrombosis (VT), hemorrhagic complications (hemorrhage and hematoma) and arterial stenosis (AS). The potential risk factors for vascular complications that were investigated included characteristics related to the recipient, the donor, the transplant and the procedure. The impact of vascular complications on transplant survival was then studied.

RESULTS

A total of 720 patients were included with a mean age of 32.7 years. The transplant was from a living donor in 79% and a brain-dead donor in 21%.

AT occurred in 15 patients (2.1%) and VT occurred in 10 patients (1.4%). Risk factors for vascular thrombosis were recipient age &gt;35 years (P = 0.001; OR = 10.78), recipient smoking (P = 0.005; OR = 1.8), multiple arteries (P  &lt; 0.001; OR = 1.45) and prolonged warm ischemia (P = 0.02). Perirenal hematoma occurred in 11 patients (1.5%) and hemorrhage occurred in six patients (0.8%). The risk factors for bleeding complications were a prolonged pre-transplantation dialysis time (P = 0.03; OR = 1.35), and prolonged warm ischemia (P = 0.02; OR = 1.26). AS was the most frequent vascular complication, occurring in 20 cases (2.8%) and no risk factors were identified.

Transplant survival was 77.9% at 5 years, with a median survival of 15.9 years. Vascular thrombosis led to the loss of the transplant in all cases, and externalized hemorrhage significantly reduced transplant survival (P  &lt; 0.001). Perirenal hematoma (P = 0.42) and transplant artery stenosis (P = 0.25) had no impact on transplant survival (Figure 1).

CONCLUSION

Our study showed that the vascular complications impacted the survival of the transplant and that they were related to factors related to the recipient, the transplant and the procedure insisting on a multidisciplinary and personalized management for each case.

Bladder exstrophy in adulthood: About a case report

Bladder exstrophy is a severe malformation characterized by the lack of the anterior sub-umbilical abdominal wall, and the front wall of the bladder. We present a rare case of a 26-year-old woman without any previous medical or surgical history, that we treated for bladder exstrophy. We performed an iliac osteotomy, bladder enlargement using the ileum and a Monti-type continent urinary derivation and a Promentofixation. A vesico-cutaneous fistula was diagnosed after surgery and we failed to manage it after two surgical revision. Therefore, we performed a cystectomy and a non-continent Bricker external urinary derivation.

Ejaculatory duct reflux revealed by chronic scrotal swelling in an adult

Ejaculatory duct reflux is rare and few investigations have focused on this entity, which is usually described in children. This study reports a new case of unilateral ejaculatory reflux in a 32-year-old patient, with a history of urethroplasty at the age of 5 for hypospadias, who presented for right chronic scrotal swelling. Urethrocystscopy showed an anterior urethral stricture and a gaping opening of the right ejaculatory duct. CT scan with opacification through the right ejaculatory duct, showed a dilated right seminal vesicle, associated to a reflux in the right deferent vas and epididymis, which was dilated explaining the scrotal swelling.

A cadaveric anatomical study: anatomy and anatomical variations of left adrenal vein

PURPOSE

Control of adrenal vein is the key of adrenal surgery. Its anatomy can present variations. Our aim was to study the anatomy of the main left adrenal vein (LAV) and its anatomical variations.

METHODS

Our work is based on dissection of 40 cadavers. We studied the number of LAV and the drainage of the main adrenal vein as well as its level of termination. We measured its length, its width and the distance between its termination level and the termination level of the gonadal vein (GV).

RESULTS

The average length of the LAV was 21 mm its mean width was 5 mm. It ended in 100% of cases at the upper edge of the left renal vein after an anastomosis with the lower phrenic vein in 36 cases (90%) and without anastomosis with the lower phrenic vein in four cases (10%). The left adrenal vein ended at the upper edge of the left renal vein either at the same level as the termination of the left GV in 14 cases (35%) or within the termination of the left GV in 26 cases (65%) by an average of 8 mm. The LAV was unique central vein in 22 cases (55%) and in 12 cases (30%), a major central adrenal vein with several small veins was found.

CONCLUSIONS

The LAV is usually unique but there are variations in number. There are also variations in the level of its termination in the left renal vein as well as its anastomosis. During surgery, in case of difficulty, the left GV and the adrenal-diaphragmatic venous trunk could be used as benchmarks.

Development of a custom next-generation sequencing panel for the determination of bladder cancer risk in a Tunisian cohort

BACKGOUND

Bladder cancer (BCa) is a heterogeneous disease caused by the interaction between environmental and genetic risk factors. The goal of this case-control study was to evaluate the implication of a selected SNP panel in the risk of BCa development in a Tunisian cohort. We were also interested in studying the interaction between this predictive panel and environmental risk factors.

METHODS

The case/control cohort was composed with 249 BCa cases and 255 controls. The designed Bladder cancer hereditary panel (BCHP) was composed of 139 selected variants. These variants were genotyped by an amplification-based targeted Next-Generation Sequencing (NGS) on the Ion Torrent Proton sequencer (Life Technologies, Ion Torrent technology).

RESULTS

We have found that rs162555, rs2228000, rs10936599, rs710521, rs3752645, rs804276, rs4639, rs4881400 and rs288980 were significantly associated with decreased risk of bladder cancer. However the homozygous genotypes for VPS37C (rs7104333, A/A), MPG (rs1013358, C/C) genes or the heterozygous genotype for ARNT gene (rs1889740, rs2228099, rs2256355, rs2864873), GSTA4 (rs17614751) and APOBR/IL27 (rs17855750) were significantly associated with increased risk of bladder cancer development compared to reference group (OR 2.53, 2.34, 1.99, 2.00, 2.00, 1.47, 1.96 and 2.27 respectively). We have also found that non-smokers patients harboring heterozygous genotypes for ARNT/rs2864873 (A > G), ARNT/ rs1889740 (C > T) or GSTA4/rs17614751 (G-A) were respectively at 2.775, 3.069 and 6.608-fold increased risk of Bca development compared to non-smokers controls with wild genotypes. Moreover the ARNT CT (rs1889740), ARNT CG (rs2228099), ARNT TC (rs2864873) and GSS GA genotypes were associated with an increased risk of BCa even in absence of professional risk factors. Finally the decision-tree analysis produced a three major BCa classes. These three classes were essentially characterized by an intensity of tobacco use more than 20 pack years (PY) and the CYP1A2 (rs762551) genotype.

CONCLUSIONS

The determined association between environmental factors, genetic variations and the risk of Bca development may provide additional information to urologists that may help them for clinical assessment and treatment decisions. Nevertheless, the underlying mechanisms through which these genes or SNPs affect the clinical behavior of BCas require further studies.

Management and prognosis of liposarcomas of the spermatic cord: an experience with six cases

Liposarcoma of the spermatic cord (LSC) is a rare tumor with no consensus on therapeutic management. This study reports six new cases of LSC. The patients’ age ranged from 56 to 80 years. All patients presented with a scrotal mass, and it was ultrasound that oriented the diagnosis. The initial treatment consisted of an inguinal orchiectomy. Anatomopathological study coupled with immunohistochemistry using the anti-MDM2 antibody confirmed that the tumors were well-differentiated LSC in four cases and dedifferentiated LSC in the other two cases. Adjuvant radiotherapy was performed in two patients. No recurrence was noted in these two patients at 14 and 34 months of follow-up. The only recurrence we had was local and occurred at 44 months of follow-up in a patient who had a dedifferentiated form ofLSC.

Association of a common genetic variant (insertion/deletion) in ACE gene with prostate cancer susceptibility in a Tunisian population

Background

Angiotensin‐converting enzyme (ACE) plays a pivotal role in several pathologies including cancers. The association of insertion/deletion (I/D) polymorphism of the ACE gene with prostate cancer (PC) risk remains controversial. We aimed to investigate for the first time, to our Knowledge, in North Africa the potential relationship between ACE I/D polymorphism with PC susceptibility and clinical outcomes of PC patients.

Methods

This case‐control study included 143 healthy individuals and 124 patients diagnosed with PC. Using genomic DNA, the samples were genotyped for ACE I/D polymorphism by polymerase chain reaction (PCR).

Results

We found that The D allele is significantly associated with an increased risk of PC and D/D + D/I genotypes were at 3 times increased risk of PC ([p = 0.005], OR = 2.95, IC 95% = 1.26–7.09) compared with I/I genotype (p = 0.003, OR = 0.3, IC 95% = 0.12–0.74). We observed an association between D/D and D/I genotypes with advanced age (≥70 years) (p = 0.014; r² = 0.22). Furthermore, there is a significant prediction of advanced Gleason score ≥8 based on epidemiological parameters and ACE genotype (p = 0.000; R² = 0.349), although no significant association was observed with stage and metastasis.

Conclusion

The ACE I/D polymorphism is likely to predispose to PC and could play a role in PC progression and aggressiveness.

Polymorphisms in NQO1 and MPO genes and risk for bladder cancer in Tunisian population

BACKGROUND

NAD (P) H: quinone oxidoreductase (1) (NQO1-HGNC: 2874) and myeloperoxidase (MPO-HGNC: 7218) are two enzymes involved in phase II of the xenobiotic metabolism pathway.

METHODS

In this study, a case-control analysis was conducted to investigate the relationship between genetic variations in the NQO1 (C609T, rs1800566; IVS1-27 C >G, rs689452) and MPO (G463A, rs2333227) genes and the risk for bladder cancer among Tunisian population.

RESULTS

We have found that the MPO 463GA genotype was associated with a decreased risk of developing bladder cancer (p = 0.049; OR = 0.696; 95% CI 0.484-0.999). In contrast, we have found that the NQO1 609CT genotype could increase the risk of bladder cancer patients (p = 0.0039; OR = 1.454; 95% CI = 1.017-2.078). Moreover, patients with "NQO1 609 CT/IVS1-27 CG" genotype show a 2.180-fold increasing risk for developing bladder cancer in comparison to the control group with wild genotype. This OR is estimated at 5.6-fold in smokers patients with "NQO1 609 CT/IVS1-27 CG" genotype. Lastly, study findings suggest that the NQO1 IVS-27 *CG genotype (rs689452) is associated with a risk of progression to muscle invasive bladder cancer.

CONCLUSION

Our study suggests that environmental risk factors in association to NQO1 genotypes (NQO1 609 CT/IVS1-27 CG) play an important role in the development of bladder cancer in Tunisian population.

The diagnostic applicability of A-type Lamin in non-muscle invasive bladder cancer

PURPOSE

Lamin A is a major component of the nuclear lamina maintaining nuclear integrity, regulation of gene expression, cell proliferation, and apoptosis. Its deregulation in cancer has been recently reported to be associated with its prognosis. However, its clinical significance in non-muscle invasive bladder cancer (NMIBC) remains to be defined.

MATERIAL/METHODS

Immunohistochemical staining and RT-qPCR were performed to screen the expression patterns of Lamin A/C protein and Lamin A mRNA respectively in 58 high and low grade NMIBC specimens.

RESULTS

Lamin A/C protein was expressed only in the nucleus and less exhibited in NMIBC tissues compared to non-tumoral ones. On the other side, Lamin A mRNA was up-regulated in NMIBC compared to controls. Nevertheless, both expression patterns (protein and mRNA) were not correlated to clinical prognosis factors and were not able to predict the overall survival of patients with high-grade NMIBC.

CONCLUSIONS

The deregulation of A-type Lamin is not associated with the prognosis of NMIBC, but it could serve as a diagnostic biomarker distinguishing NMIBC patients from healthy subjects suggesting its involvement as an initiator event of tumorigenesis in our cohort.

Isolated bladder metastasis from lung adenocarcinoma: a case report

Cancers of extra bladder origin represent between 2 and 12% of bladder neoplasms and are most often secondary to contiguous bladder invasion. Metastasis from distant organs is exceptional, especially from pulmonary adenocarcinoma with <10 cases identified over the last 20 years. We report here a new case of a 55-year-old patient with a recently diagnosed pulmonary adenocarcinoma referred to the urology department for macroscopic hematuria. Computed tomography scan showed, in addition to the lung mass of the right lower lobe with a right mediastinal adenopathy, a thickening of the right lateral bladder wall. Cystoscopy showed inflammatory lesions on the bladder mucosa, which biopsy with immunohistochemical examination revealed to be tumoral proliferation in the lamina propria realizing the same immunohistochemical profile of the primary lung tumor (CK7+/TTF1+/CK20-/PSA-). The patient was treated with palliative platinum-based chemotherapy and unfortunately died 5 months after diagnosis.

Partial open tumorectomy for a renal tumor in a horseshoe kidney with a close contact with the vena cava: A case report

Introduction and importance

Horseshoe kidney has unique anatomical features, such as a complex blood supply. We report a patient with renal tumor in a horseshoe kidney in close contact with the vena cava, who underwent open tumorectomy.

Case presentation

A 72-year-old woman was referred to our hospital with a 4-cm enhancing mid-pole mass in the right moiety of a horseshoe kidney. Open tumorectomy was performed with parenchymal clamping. The warm ischemia time was 18 min. Pathologic examination confirmed a diagnosis of pT1a clear cell renal cell carcinoma with negative surgical margins. At 3 months postoperatively, computed tomography showed no local recurrence or metastasis and renal function was intact.

Clinical discussion

Horseshoe kidney is a rare congenital abnormality. Renal cell carcinoma is the most frequent tumor in adults having this anomaly and treatment in localised tumors if usually tumorectomy. Surgery may be challenging in some cases because of its difficulty.

Conclusion

Open surgery remains the standard treatment for horseshoe kidney tumors because of anatomic complexity and especially in cases where the tumor is difficult to extirpate.

•

Renal cell carcinoma tumors in horseshoe kidneys are a very rare entity.

•

Management of localised tumors in horseshoe kidney is surgical and surgery is challenging due to anatomical difficulties.

•

Open surgery is usually the best option for tumors having a posterior development in the horseshoe kidney.

Urological activity at the time of COVID-19 pandemic: is there any difference between public and private field?

Introduction

as COVID-19 pandemic is rapidly evolving, there is a whole reorganization in hospitals to concentrate more resources to face the crisis. The purpose of this study is to evaluate the impact of COVID-19 disease on urological activity in Tunisia. To assess the differences in the management of urological conditions between the private and the public field.

Methods

a survey was addressed to all certified urologists working in Tunisia in both the public and private sectors (n=194) using the national database of active urologists available and updated. We either called them or looked them up through email or social media. The form was open from March the 28^th to April the 3^rd. Results were obtained via spreadsheet and analysed using SPSS 23.0.

Results

one hundred and twenty urologists have filled in the form. Consultations at the outpatient office were restricted to urgent cases in 66% (n=79). Telemedicine was more used by urologists in private than in public fields p=0.03. Urologists in private sector followed more the sterilization protocol of the hospital/clinic and used more disposable materials whenever possible p=0.011. Elective surgical activity has completely stopped in 85% of the responders (n=102). Elective surgery requiring transfusion or intensive care unit was performed in 38% (n=46) and 26% (n=31) if there was a risk of disease progression. Benign Prostate Hyperplasia (BPH) surgery was more performed as usual in private sector than in public sector p=0.012. It was the only condition managed differently between both sectors.

Conclusion

the drop of the urological activity is essential in order to give relevant stakeholders room to act efficiently against the spread of the virus. The context of the pandemic and the hospital´s condition must be taken into consideration without compromising the patient´s outcome.

State of the art: Open prostatectomy for benign prostate hyperplasia: Should we avoid it in all cases?

Surgical procedures for benign prostate hyperplasia (BPH) had considerably evolved during last decades. New techniques can nowadays treat prostate big in size, which are classically treated by open prostatectomy (OP). Therefore, the place of this procedure that has been used for over 150 years is nowadays questioned. Is it outdated? Is there emerging techniques that are more efficient, safer and cost effective? This state of the art based on literature review will assess the place of OP in BPH surgery from efficacy on functional outcomes, security, competitiveness with modern and minimally invasive techniques and socio-economic perspectives. Currently, OP has excellent functional outcomes, with low rate of retreatment after surgery, low morbidity and affordable cost in our country. It remains competitive with new surgery techniques for BPH, even if the latter offer the advantages of a minimally invasive surgery, especially in hospitalization length. Taking in consideration the social and economic context in Tunisia, it remains the most accessible and affordable surgical technique. Besides, OP is a procedure that has to be handled by every urologist given the theoretical risk of conversion during endoscopic surgery of BPH, and its use under certain circumstances (In case of bladder lithiasis ou diverticle or impossibility of lithotomy position).

Comparison of the prognosis of primary vs. progressive muscle invasive bladder cancer after radical cystectomy: Results from a large multicenter study

PURPOSE

To assess whether progressive and primary muscle invasive bladder cancer (MIBC) have different prognosis after radical cystectomy or not. To date only a few data are available on this topic with conflicting results. Further studies on large cohort are needed to clarify these outcomes that may influence bladder cancer management for these patients.

MATERIAL AND METHODS

A multicentre retrospective study was conducted on patient treated for MIBC at 5 centres between 2005 and 2015 by radical cystectomy. Patients' outcomes were compared between patients with primary MIBC vs. progressive MIBC subsequent to a history of non-muscle invasive bladder cancer (NMIBC).

RESULTS

A total of 1197 patients were included. Median (IQ) age was 65 (58-72) years and median follow-up was 65 months. Baseline characteristics were similar between the groups as well as the Tumour pT stage, N status and positive surgical margins. Patients with progressive MIBC had worse overall survival (OS) (hazard ratio [HR] 1.36, [95%CI 1.10-1.76]; P = 0.004), cancer specific survival (CSS) (HR 1.41 [1.13-1.78]; P = 0.002), and recurrence-free survival (RFS) (HR 1.21 [1.01-1.49]; P = 0.05). Pathological stage ≥pT3, positive surgical margins, and positive lymph nodes status (pN+) were also found as predictors of OS, CSS, and RFS.

CONCLUSIONS

Our results suggest that patient having a progressive BC have a worse prognosis in terms of OS, PFS, and CSS than patient with primary disease. These 2 groups may require different management and patients with high risk NMIBC should be assessed properly to avoid progression and be offered early cystectomy.

Uncovering the expression patterns and the clinical significance of miR-182, miR-205, miR-27a and miR-369 in patients with urinary bladder cancer

BACKGROUND

Given the high recurrence and progression rates and the absence of reliable markers for early detection and prognosis prediction of patients with urothelial bladder cancer (BCa), the exploration of new biomarkers with high specificity is imperative. Mainly, microRNAs (miRNAs), which are involved in the initiation and the progression of BCa. Herein, the expression patterns of miR-182, miR-205, miR-27a and miR-369 were evaluated in patients with urothelial BCa.

METHODS AND RESULTS

The expression levels of the miRNAs were investigated in 90 FFPE tissue samples (23 LG NMIBC, 44 HG NMIBC, 23 MIBC) and 10 non tumoral bladder tissues using TaqMan based RT-qPCR. Data analysis was performed using 2^-ΔΔCT method. Correlation to clinical characteristics of the patients was performed using descriptive statistics and the receiver operating characteristic (ROC) curve was performed to evaluate the diagnostic value of all miRNAs. MiR-27a, miR-205 and miR-369 were down-regulated whereas miR-182 was up-regulated in patients compared to controls (p < 0.001). MiR-205 and miR-182 positively segregate between NMIBC and MIBC (p = 0.002 and p = 0.000 respectively) whereas the distribution of miR-27a's expression among these tumor groups was almost significant (p = 0.05) and that of miR-369's expression was irrelevant (p = 0.618). Interestingly, miR-182 was discriminative between LG NMIBC and HG NMIBC (p < 0.001) and Ta/T1 tumors (p = 0.000). Furthermore, high levels of miR-182 were potentially predictive of progression in NMIBC patients (p = 0.01).

CONCLUSION

Collectively, a selection of miRNAs was found to be aberrantly expressed in BCa suggesting a potential diagnostic value in BCa. In addition, the clinical value of miR-182 and miR-205 as potential prognosis biomarkers was highlighted. Indeed, our data provide additional insights into cancer biology. Further functional or target studies are mandatory to strengthen these findings.

A cadaveric anatomical study of the adrenals: Relationship with the posterior abdominal wall muscles revisited

AIM OF THE STUDY

The main difficulties during retroperitoneal laparoscopic adrenalectomies are due to its location. Our objective was to define the relationship of the adrenals with the diaphragm and the psoas muscle.

METHODS

Our work is an anatomical dissection of 80 fresh cadavers' adrenals. To study the right adrenal, we performed a right nephrectomy and adrenal remained attached to the Inferior vena cava by its main vein. On the left, the edges of the adrenal have been identified by needles and the adrenal was reclined to study its projection on the posterior muscular wall.

RESULTS

The right adrenal is located higher, 13mm [4-20mm] above the medial arcuate ligament (MAL) in 16 cases (40%). Its lower border was at the same level as the MAL in 18 cases (45%) and 11mm [10-17mm] below the MAL in 6 cases (15%). The posterior support of the right adrenal was the right crus of the diaphragm (Right-CD) in 34 cases (85%) and straddling the Right-CD and the psoas in 6 cases (15%). The study of the relationships of the left adrenal with the MAL showed that the lower edge of the gland was at its same level in 16 cases (40%) and below in 24 cases (60%) by 14mm [8-24mm]. The posterior support of the left adrenal was the left crus of the diaphragm (Left-CD) in 16 cases (40%) and straddling the Left-CD and the psoas in 24 cases (60%).

CONCLUSIONS

Our results showed that the right adrenal is higher. The MAL is an important posterior element to the adrenal gland that could serve as an anatomical landmark to identify the adrenal during laparoscopic adrenalectomy.

Endoscopic meatotomy in the treatment of ureterocele: results in adult patients

To evaluate the efficacy of endoscopic meatotomy in the treatment of ureterocele in adults. A retrospective study of adult patients with ureterocele, treated between January 1987 and December 2014. In 47 patients, 55 intravesical ureteroceles were diagnosed and classified as 18 right, 21 left and eight bilateral (38%, 44% and 17% respectively). According to the Bruézière classification, 41 (75%) ureteroceles were type A and 14 (25%) others were type C. These ureteroceles were complicated by calculus formation in 22 cases, moderately dilated excretory pathways in 16 cases and both complications in a total of 9 cases. Four patients had a complicated ureterocele with pyelonephritis, one of which was emphysematous. The endoscopic treatment was performed in cases of complicated and/or symptomatic ureteroceles. Fifty one cases were treated by a “smiling mouth” meatotomy consisting in a transverse horizontal incision, with the treatment of any associated complication. The mean operative time was 35 minutes (10-90). The operative follow-up was uneventful in 42 patients and complications occurred in 5 patients (2 urinary retentions, 2 infectious complications and one hematuria). The mean duration of postoperative stay was 1-2 days. The mean follow-up was 15 months. Four patients developed vesicoureteral reflux and no stenosis was noted. The endoscopic incision of the ureteroceles seems today, after reviewing the results, to be a good treatment of adult ureterocele. It is a simple, minimally invasive and has a low morbidity rate.

Prostatic cystadenoma presenting as a large multilocular pelvic male mass

Multilocular cystadenoma are benign lesions located most commonly between the rectum and the bladder. Their presence manifests as obstructive or/and irritative lower urinary tract symptoms or transit disorders. Computed tomography scan and magnetic resonance imaging may help to establish the diagnosis. Surgery is the established treatment standard, with a high risk of recurrence in case of incomplete excision of the lesions. Here we report a case of 59-year-old man presenting with an acute urinary retention due to a giant multilocular prostatic cystadenoma treated by complete excision. The diagnosis has never been suspected before surgery and has been confirmed histologically after complete excision.

Leptin Promotes Prostate Cancer Proliferation and Migration by Stimulating STAT3 Pathway

To better understand the link between obesity and prostate cancer (PC) aggressiveness, we investigate the role of leptin, an obesity associated adipokine, and its receptor (Ob-R) in PC cells migration. The migration assay (Wound-healing) was used to study the leptin impact on DU-145 and PC3 cells lines. STAT3 activation was performed by Western Blot. E-cadherin expression was studied using fluorescence microscopy and Ob-R expression in PC and benign prostatic Hyperplasia (BPH) biopsies was assessed by RT-PCR. In this study we demonstrate that high dose of leptin promotes PC cells migration and EMT transition via the stimulation of STAT3 pathway. In addition, we report that although Ob-R mRNA is expressed by ADK and BPH resections biopsies, significant higher levels were observed for ADK patients. Finally, we found a positive association between Ob-R mRNA expression and worse PC prognosis. A better understanding of the molecular processes of leptin signaling is crucial for identifying appropriate approaches for treatment of obesity-related PC patients.

Evaluating prognostic utility of preoperative Neutrophil to Lymphocyte Ratio and hsa-let-7g/c up-regulation in patients with urinary bladder cancer

BACKGROUND

Stratification and risk-evaluation of bladder cancer (BCa) patients are far-reached issues, especially for those with non muscle invasive disease. Thus, setting-up biomarkers, especially after resection of the primary tumor, is crucial. Specifically, Neutrophil to lymphocyte ratio NLR and let-7 deregulation which have been preliminarily but not consistently described to be associated to unfavorable prognosis.

OBJECTIVE

To explore the clinical value of pre-treatment Neutrophil to Lymphocyte Ratio (NLR), let-7c and let-7g's deregulation.

METHODS

Data were extracted from ninety BCa samples. Pre-treatment NLR was estimated as the absolute neutrophil count divided by the absolute lymphocyte count. Expression patterns of let-7c and let-7g were assessed by qRT-PCR. Correlation with clinical characteristics was performed by descriptive statistics.

RESULTS

Both let-7 miRs were upregulated. Interestingly, let-7g was associated to pathological stage (p= 0.001) and tumor multiplicity (p= 0.003). NLR was associated to histological grade (p= 0.005) and clinical stage (p= 0.006). They were both associated to more aggressive phenotype and their worth as potential stratification biomarkers was confirmed by ROC curve.

CONCLUSIONS

Our data demonstrated the potential clinical value of all markers, especially pretreatment NLR and let-7g. Further studies are recommended to confirm their utility in improving the clinical decision-making regarding treatment and follow-up scheduling.

Is imagery distinctive in papillary renal cell carcinoma subtypes?

INTRODUCTION

The subdivision into two entities of papillary renal cell carcinoma (PRCC) was established on histological criteria. It's in fact possible to distinguish the two subtypes by the means of radiological and progressive data. The subtype 1 is associated with the favorable profile. The ultrasound and especially CT urography ensure an accurate diagnostic approach with substantial therapeutic and prognostic involvement. The aim of the study is to define the radiological features that distinguish the two subtypes of renal papillary carcinoma, and to study the radiological predictive factors of locoregional recurrence, metastases free survival and specific survival.

METHODS

It's about a monocentric, retrospective study led between January 2005 and June 2017, gathering 49 cases of operated PRCC. The study concerned patients over the age of 18, who were diagnosed after anatomopathological examination of the operative specimen (enlarged nephrectomy or conservative surgery). Cases in which diagnosis was made by renal biopsy were excluded. The comparative study concerned ultrasound and CT scan data. Univariate and multivariate analysis were performed to determine factors having a prognostic value in terms of locoregional recurrence, metastases-free and specific survival.

RESULTS

On the ultrasound, the subtype 1 tumors were significantly homogenous with regular contours. Tumors were globally spontaneously hypodense and hypo vascular in 97,8% of cases. Enhancement was significantly more heterogonous for subtype 2 (p=0,01). Intratumoral necrosis and adenomegalies were associated with subtype 2 (p=0,0001 and 0,005). The predictive factors of locoregional recurrence, metastases-free survival and specific survival in univariate analysis were the contours' aspect, moderate enhancement and the presence of adenomegalies. On multivariate analysis, only the irregular contours were retained for locoregional recurrence-free survival and specific survival.

CONCLUSIONS

Significant differences between the PRCC subtypes were observed when studying the radiological data. Irregular contours, adenomegalies and enhancement degree seemed to predict the progression of PRCC after curative surgery.