Current Issue : April-June Volume : 2025 Issue Number : 2 Articles : 5 Articles
Background/Objectives: A retrospective analysis was conducted to identify factors associated with disease progression and intravesical recurrence (IVR) in a multi-centre cohort of patients with upper urinary tract urothelial carcinoma (UTUC) treated surgically between 2015 and 2021. Methods: Progression-free survival (PFS) and IVR-free survival were evaluated using a Kaplan–Meier survival curve and a Log-Rank test. Prognostic factors for progression and IVR were analysed using Cox logistic regression analysis. Results: A total of 170 patients were analysed. Up to 32.9% developed progression within 65.64 ± 3.44 months. Multivariate analysis showed that pT (HR 2.9, 95%CI 1.54–5.48, p = 0.01), margin status (HR 2.89, 95%CI 2.88–57.68, p = 0.01), and lymphovascular involvement (HR 7.97, 95% CI 1.43–44.42, p = 0.02) were independent risk factors for PFS. Up to 25.9% of patients presented with IVR at a mean time of 68.33 ± 3.59 months. A previous diagnosis of bladder cancer (BC) (HR 3.73, 95% CI 1.24–11.22, p = 0.02) and the non-invasive appearance of the tumour on computed tomography were significant risk factors for IVR (HR 0.23, 95% CI 0.05–0.95, p = 0.03). Conclusions: pT stage, margin involvement, and lymphovascular involvement were independent risk factors for UTUC progression. The main risk factor for presenting with IVR after UTUC was a previous diagnosis of BC....
Background: The Y chromosome (ChrY) is essential for male sex determination and spermatogenesis. However, recent studies have revealed its broader role in various physiological processes and disease susceptibility, including cancer. Methods: A comprehensive literature review was conducted using databases like MEDLINE, Scopus, Web of Science, and Google Scholar. The review included clinical and preclinical studies in animals and humans focusing on the role of LoY in urological tumors. Data on the frequency of LoY, its clinical implications, and underlying mechanisms were extracted and analyzed. Results: The evidence suggests that LoY is associated with an increased risk of urologic neoplasms, potentially serving as an early marker of genomic instability. Studies reveal that LoY in urologic cancers correlates with worse survival outcomes and may contribute to tumor progression. LoY may interfere with chromatin structure and epigenetic regulation, suggesting its role as a contributor to early tumorigenesis. Conclusions: LoY appears to be a structural aberration with unique biological and clinical relevance in urologic cancers, possibly serving as a biomarker for genomic instability. Further research is necessary to identify specific Y-linked genes affected by LoY, potentially informing targeted therapies and early diagnostic strategies for these cancers....
Background and Objectives: This study aimed to investigate the relationship between lower urinary tract symptoms (LUTS) and tooth loss due to chronic periodontitis. Materials and Methods: A total of 232 patients aged 40 years or older with LUTS were evaluated. The number of remaining teeth and the severity of LUTS were assessed using the overactive bladder symptom score, international prostate symptom score, and urodynamic tests. Statistical analyses, including multivariate and propensity score matching, were conducted to determine the relationship between tooth loss and overactive bladder (OAB). Results: Compared with the non-OAB group, the OAB group had significantly fewer remaining teeth (p < 0.001). A negative correlation was observed between the number of remaining teeth and the severity of LUTS, with symptoms such as urgency, frequency, and nocturia being more severe in patients with fewer teeth (all p < 0.001). Objective measures, including bladder capacity and maximum flow rate, were also significantly lower in patients with fewer teeth. Additionally, having fewer than 21 teeth was identified as a significant risk factor for LUTS. Multivariate analysis confirmed that tooth loss was an independent risk factor for OAB, even after adjusting for age and comorbidities (p < 0.001). Propensity score matching further validated the association between the number of remaining teeth and OAB (p = 0.022), highlighting a clear connection between dental health and urinary function. Conclusions: Tooth loss due to chronic periodontitis is strongly associated with the severity of LUTS, including storage and voiding symptoms. Maintaining good oral health may help reduce the risk of OAB and related urinary symptoms. This study underscores the importance of dental care in managing and preventing LUTS, suggesting that improving oral health could play a key role in mitigating these conditions....
Background and Objectives: Robot-assisted extravesical ureteral reimplantation (REVUR) has been described as valuable alternative to open reimplantation in the pediatric population. This study aimed to report the outcome of REVUR in children with complex obstructed megaureter (COM) needing ureteral dismembering and/or tapering. Materials and Methods: The records of patients with COM, who received REVUR with ureteral dismembering and/or tapering over the last 3 years (2021–2024), were retrospectively reviewed. The inclusion criteria for COM included previous surgery, paraureteral diverticula, or ectopic megaureter. Results: A total of 16 patients (15 boys), with a median age of 7.8 years (range 2–16), were treated over the study period. COM was associated with paraureteral diverticula (n = 6), previous failed endoscopic balloon dilation (n = 4), ectopic megaureter (n = 2), and previous bulking agent endoscopic injection causing iatrogenic ureteral obstruction (n = 4). Presentation symptoms included febrile urinary tract infections (n = 8), flank pain (n = 4), hematuria (n = 2), and pseudo-incontinence (n = 2). All surgical procedures were accomplished robotically without conversions or intra-operative complications. Ureteral tapering was performed in 7/16 (43.7%). The median operative time (including robot docking) was 220 min (range 155–290). The median length of stay was 3.8 days (range 3–7). The indwelling double J stent was removed 4–6 weeks postoperatively. Clavien 2 grade complications occurred postoperatively in 2/16 (12.5%). At median follow-up of 34.5 months, all patients were asymptomatic and showed improved hydroureteronephrosis on ultrasound and improved drainage on diuretic renogram. Conclusions: This study demonstrates that robot-assisted extravesical ureteral reimplantation is a safe and effective treatment for primary obstructive megaureter and other complex ureteral anomalies in our patient cohort. The procedure showed low complication rates, high success rates, and favorable long-term outcomes, supporting the feasibility and effectiveness of robotic surgery for these conditions....
Purpose Robotic surgery is increasingly utilized in the treatment of urothelial carcinoma of the upper urinary tract (UTUC). This study investigates the advantages and burden of robot-assisted surgical treatment of the urothelial carcinoma of the upper urinary tract in a referral urological department, along with their functional and oncological results. Methods The study included 66 prospectively enrolled patients who were surgically treated by a single, robotically specialized surgeon between July 2019 and December 2023. Patients were divided into three groups. Group 1: 50 patients underwent robot-assisted radical Nephroureterectomy (RANU) with bladder cuff excision, Group 2: 11 patients underwent RANU simultaneously with robot-assisted radical cystectomy (RARC), and Group 3: 5 patients underwent robot-assisted segmental ureterectomy (RASU). Clinical and oncological parameters were compared. Perioperative morbidity according to Clavien-Dindo was the primary endpoint of our study. The secondary endpoint was oncologic outcomes. Results 37.8% of patients had locally advanced carcinomas. The average console time of RANU with bladder cuff excision was 69 min. The rate of positive surgical margins was n = 1/66 (2%). Lymphadenectomy (LAD) was performed on 30% of patients, with a mean of 13.7 lymph nodes removed. Of those who received LAD, 33% had lymph node metastasis. n = 6/66 (9%) patients received blood transfusion. The overall complication rate was 24%. The readmission rate was 7.5%. With a median follow-up of 26 months, the 2-year recurrence-free survival rate was 84.4%, and the 2-year overall survival rate was 94%. Conclusion Robotic surgery is a feasible option for treating UTUC that can be adapted to meet the surgical needs of each patient. Prospective studies are warranted to confirm its benefits....
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