Introduction The study aimed to evaluate the objective response level to neoadjuvant platinum-based chemotherapy and tumour complexity reduction in patients with invasive upper tract urothelial cancer (UTUC), and to estimate the functional and oncological outcomes of the combined organ-sparing approach compared to radical nephroureterectomy. Material and methods This prospective, non-randomised cohort study was conducted by the National Cancer Institute of Ukraine. Patients with invasive UTUC were enrolled between October 2016 and January 2021. Patients were allocated to one of two cohorts depending on the estimated glomerular filtration rate (eGFR) of the affected kidney. In cases where eGFR was preserved, neoadjuvant chemotherapy with an organ-sparing approach was used; all other cases proceeded directly to radical nephroureterectomy. Results A total of 64 patients (32 in each cohort) with invasive UTUC were enrolled. Both groups were comparable in terms of age, sex, T stage, maximal tumour size, eGFR, Eastern Cooperation Oncology Group (ECOG) performance status, body mass Index (BMI), and haemoglobin level. After four cycles of chemotherapy, there were no cases of progressive disease, stable disease [16 (50%), partial response; 12 (38%); and complete response, 4 (12%)]. The average maximal tumour size decreased by 2.3 cm. Prior to surgical treatment, total GFR according to scintigraphy did not statistically differ in both groups (р = 0.13). However, 3 months after surgery patients who underwent the organ-sparing approach had a better total eGFR (р = 0.0039), which was probably owing to the preserved kidney function (18.9 +5.1 mL/min). Better 2-year recurrence-free survival was also observed in the organ-sparing management group (85% vs 72%, log-rank test; p = 0.03). Conclusions Neoadjuvant systemic therapy reduces the surgical complexity of invasive UTUC without influencing the safety profile. The gemcitabine/cisplatin regimen leads to high regression rates among invasive UTUC, which could result in an organ-sparing approach in selected cases. Kidney function preservation remains a key parameter that can increase the possibility of effective systemic treatment.
We describe a case of a 74-year-old patient with recurrent fever of up-to 38.5°C, nocturnal sweating, weight loss of 4 kg, non-characteristic pain, and elevation of liver function tests (LFTs), who was diagnosed with Stauffer's syndrome. The patient successfully underwent laparoscopic heminephrectomy. The histology was clear-cell carcinoma of the right kidney (cT1a). The abnormalities in laboratory tests, such as Erythrocyte Sedimentation Rate, C-reactive protein, LFTs, α2-globulin, and most clinical symptoms abated 2 weeks post-surgery. We hypothesize that elevated LFTs in renal cell carcinoma patients could help deciding in favour of surgery in cases where the initial decision would be watchful waiting.
Introduction Ureteral double-J stent length is an important factor affecting stent-related symptoms. Multiple techniques exist to determine ideal stent length for a given patient, however, little is known about what techniques urologists rely on. Our objective was to identify how urologists determine optimal stent length. Material and methods An online survey was e-mailed in 2019 to all members of the Endourology Society. The survey sought to assess what methods are commonly used to determine choice of stent length, along with frequency of stent placement post ureteroscopy, duration of stenting, availability of different stent lengths and the use of stent tether. Results 301 urologists (15.1%) responded to our survey. Following ureteroscopy, 84.5% of respondents would stent at least 50% of the time. Following uncomplicated ureteroscopy, most respondents (52.0%) would leave a stent for 2-7 days. Patient height was most commonly ranked first as the method of choice in determining stent length (47.0%), followed by estimation based on experience only (20.6%) and intra-operative direct measurement of ureteric length (19.1%). Most respondents utilized multiple methods in determination of optimal stent length. Most respondents (66.5%) were interested in a simple intra-operative technique utilizing a special ureteral catheter that would help choose the most appropriate stent length. Conclusions Post-ureteroscopy stent insertion is common and patient height is the most common method of choice used in determining optimal stent length. Most respondents were interested in using a simple, novel ureteral catheter device that would allow them to more accurately select optimal stent length.
Ureteral stents are useful devices in urological surgery. The main objective of a ureteric stent is to allow passage of urine and reduce early or late complications related to obstruction in the urinary tract. Despite their widespread use, there is a general lack of knowledge and awareness in stent composition and indication of application. We represented a synthesis of our extensive research over materials, coatings and shapes available on the market and then analyzed the main characteristics and peculiarities of ureteral stents. We have also focused our attention over the side effects and complication that must be considered when placing a ureteral stent. Encrustation, microbial colonization, stent-related symptoms and patient's history must always be evaluated when there is the need for a ureteral stent. The perfect stent should have many characteristics including easy insertion and removal, easy manipu-lation, resistance to encrustation and migration, lack of complications, biocompatibility, radio-opacity, biodurability, affordability (cost-effectiveness), tolerability and optimal flow characteristics. Nevertheless, further research and studies need to be done to provide more information about stent composition and efficacy in vivo.In this narrative review, we covered the basic information and main characteristics of ureteral stents, in order to help clinicians choose the appropriate device needed for a given situation.
Introduction:Benign prostatic enlargement (BPE) and type 2 diabetes mellitus (T2DM) are common in elderly men. This study aimed to correlate the Doppler resistive indices of prostatic arteries with the severity of lower urinary tract symptoms (LUTS) and prostate volume in men with concomitant BPE and T2DM.Material and methods:Fifty men with T2DM and BPE (BPE-DM) as cases and 50 age-matched men with BPE but no T2DM (BPE-ND) as controls were enrolled. B-mode and power Doppler ultrasonography of the prostate gland were done for both groups.Results:The mean total prostatic volume of the BPE-DM was 79.18 ±8.9 ml, while that of BPE-ND was 60.73 ±10.6 ml (p <0.0001). The mean prostatic resistive index (PRI) was significantly higher among BPE-DM than BPE-ND (0.74 ±0.02 vs 0.68 ±0.09 for right capsular artery; 0.77 ±0.04 vs 0.71 ±0.02 for left capsular artery; and 0.76 ±0.04 vs 0.70 ±0.02 for the urethral artery). BPE-DM with higher glycated haemoglobin, fasting plasma glucose, and longer duration of T2DM experienced more severe lower urinary tract symptoms and had higher PRI.Conclusions:In conclusion, the BPE-DM group presented larger prostate glands and more bothersome LUTS, which correlated with higher PRI. Strict glycaemic control is necessary in men with co-existing BPE and T2DM.
