BACKGROUND:Double-J stents are commonly inserted following ureteroscopy and stone lithotripsy, potentially leading to various urinary and pain-related symptoms and affecting patients' quality of life. This study aimed to compare the impact of soft and firm silicone stents on stent-related symptoms in patients undergoing ureteroscopy and stone lithotripsy. METHODS:After receiving institutional ethical committee approval (SMC 0119-23), we conducted a prospective, randomized, single-blinded trial between 2023-2024. Patients undergoing ureteroscopy and stone lithotripsy were randomized into two groups: those receiving a soft polymer stent (Universa®, Cook Medical, Bloomington, IN, USA) or a firm polymer stent (Percuflex®, Boston Scientific, Marlborough, MA, USA). Symptoms were assessed using the Ureteral Stent Symptoms questionnaire (USSQ), completed upon stent removal, 14 days postoperatively. The primary outcome was the USSQ index score, with secondary outcomes including individual USSQ domain scores. RESULTS:A total of 120 patients completed the questionnaire. The soft-stent group (N.=60) demonstrated significantly lower USSQ index scores (26 vs. 73, P<0.001) and improved outcomes across all USSQ sub-domains (P<0.001) compared to the firm-stent group. A multiple regression model confirmed that using firm stent material independently resulted in higher USSQ index scores (P<0.001) relative to soft stent. Intraoperative and postoperative complication rates were similar between groups. CONCLUSIONS:Using soft ureteral stents results in fewer stent-related symptoms compared to firm stents, offering superior quality of life while maintaining a comparable safety profile. Based on these findings, when placing a ureteral stent following ureteroscopy and stone lithotripsy, a soft stent is recommended.

Objective This study aimed to explore the anticancer potential of Cannabis sativa (C. sativa) strains, specifically PARIS, Dairy Queen (DQ), and super cannabidiol (sCBD), on bladder cancer cells. Given the increasing interest in cannabinoids like cannabichromene (CBC) and delta-9-tetrahydrocannabinol (THC) for their therapeutic properties, we evaluated their cytotoxic effects on urothelial carcinoma (UC) cell lines and their ability to inhibit cell migration and induce apoptosis in both two-dimensional cell models and three-dimensional ex vivo organ cultures (EVOCs). Methods C. sativa strains were screened for their cytotoxicity against UC cell lines (HTB-4 and HTB-9) using XTT assays. Their phytocannabinoid content was analyzed using high-performance liquid chromatography. We employed fluorescence-activated cell-sorting to determine apoptosis and cell cycle, migration assays to determine cell migration, and EVOCs to evaluate the cytotoxic effect on UC. Gene expression was determined by quantitative polymerase chain reaction. Results Three commercial C. sativa strains, PARIS, DQ, and sCBD, were found to have the most potent anticancer effects on bladder cancer cells. All extracts contain CBC and THC at different concentrations. In XTT assays on UC cell lines, PARIS had a half-maximal inhibitory concentration (IC50) of 21.58 μg/mL, while DQ and sCBD had similar cytotoxic activity with IC50 values for 48-h treatment of 17.99 μg/mL and 17.88 μg/mL, respectively. DQ and sCBD extracts were found to significantly reduce cell migration and increase the percentage of cells in S phase and G2/M phase within the cell population. In EVOCs, the extracts initiated cell death with the expression of apoptosis-related genes increased following exposure to treatment. Conclusion The findings suggest that C. sativa strains PARIS, DQ, and sCBD, containing CBC and THC, exhibit significant anticancer activity against UC cell lines and ex vivo models. These results underscore the therapeutic potential of CBC- and THC-rich C. sativa extracts in bladder cancer treatment.

Prostate cancer (PCa) is the second most diagnosed cancer in men. In recent years, nuclear medicine has played an expanding role in diagnosing, staging, monitoring, and treating PCa. Specifically, the introduction of prostate-specific membrane antigen PET/computed tomography has significantly contributed to detecting locoregional and distant disease. Radioligand therapy, with its capacity to induce highly selective cytotoxic effects, is progressively being integrated into PCa therapy. The advent of novel therapeutic agents, additional indications, and a more comprehensive integration between nuclear imaging and therapy, represent the forefront of nuclear medicine in PCa.

Urolithiasis has a seasonal pattern, with an established increase in incidence during the summer months. This study aims to assess the impact of high ambient temperatures on emergency room (ER) visits related to renal colic (RC) in a Middle Eastern country over the past decade. Population data were extracted using the MDClone Big Data platform. We recorded demographic and clinical data on all RC-associated ER visits from January 2012 to April 2023 and calculated the heat index (HI) that combines daily average coastal plane temperatures and humidity percentages. There was a total of 12,770 ER visits (median age 48 years, 9,236 (72

Current guidelines recommend a rigorous follow-up for patients with endoscopically treated upper tract urothelial carcinoma, including cystoureteronephscopy, CT urography, and urine cytology. Our retrospective study evaluated the effectiveness of cytology and FISH analysis (flourescence in-situ hybridization) in this followup protocol. Sensitivity and specificity rates were 76% and 50% for cytology, and 58.6% and 63.1% for FISH. Negative predictive values were relatively low as well (69% and 60% for cytology and FISH, respectively). In only one case (0.17%), the tests result changed management. Cytology and FISH may be omitted from the low-grade Background: Current guidelines recommend a stringent follow-up regimen that includes interval cystoureteronephscopy, CT urography, and selective urine cytology sampling for upper tract urothelial carcinoma (UTUC) patients undergoing endoscopic treatment and management. There are no recommendations regarding FISH analysis. Our purpose was to assess the efficacy of cytology and FISH as part of the follow-up protocol and its significance to clinical decision-making in this scenario. Methods: The medical records of all patients who managed endoscopically for UTUC at our institute between 2014 and 2022 were retrospectively analyzed. Demographic and clinical data, histology, cytology, and FISH results were collected. FISH analysis was considered malignant according to Par is cr iter ia. Results: Dur ing the study period, 62 patients underwent 561 ureteroscopies as part of the treatment and follow-up regimen of low-grade UTUC. Urine from the affected upper tract was sampled for cytology in 377 procedures, and FISH analyses were performed in 273. In 75.4% of FISH analyses, the result was different from the cytology results: FISH found malignant aberrations in 15.5% of cases where cytology was benign. Furthermore, FISH classified all the cells defined as atypical via cytology as either benign or malignant. In only one case (0.17%), the urinary cytology report changed the follow-up regimen. Conclusion: Cytology may be omitted from the follow-up protocol of low-grade UTUC. In the handful of cases cytology does assist the diagnosis of UTUC, there is an additional benefit to performing FISH analysis, particularly when cellular atypia is reported in the cytology results.

INTRODUCTION:Aquablation of the prostate is a novel robotic-assisted procedure that uses a powerful ultrasound and cystoscopic guided water jet for the treatment of benign prostatic hyperplasia (BPH). AIMS:To assess the efficiency and safety of the Aquablation procedure for the treatment of BPH among patients treated in our institution. METHODS:A retrospective analysis of the first 50 cases was performed in our institution between 10/2022 and 05/2023. We gathered demographic information, surgical and post-surgical course, and office follow-up 1,3 and 6 months after surgery, including the evaluation of urination parameters and sexual function. RESULTS:Fifty patients were included in the study, with a median age of 69 years and median prostate volume of 74 ml (range 31-138 ml). Thirteen patients carried a urethral catheter or used clean intermittent catheterization due to urinary retention. The median duration of surgery was 51 minutes (intra-quadrate range 38-57). In all patients, the surgery was completed as planned with no intra-operative complications. The average drop in hemoglobin level after surgery was 1.2 mg/dL only. Two patients (4%) were given a blood transfusion due to a symptomatic drop in hemoglobin levels. None of the patients were taken to the operating room (OR) for an urgent hemostasis surgery. The IPSS (international prostate symptoms score) improved by an average of 13 points, with quality-of-life questions improving by 2.25 points. The functional outcomes were stable over 6 months after surgery. All patients with pre-operative urinary retention eventually had their catheter removed (one patient required another procedure - transurethral resection of the prostate (TURP)). Significant urinary incontinence was not reported by any of the 50 patients. CONCLUSIONS:Aquablation of the prostate is a novel surgical technique, which is accurate, efficient, with a low rate of complication and side effects, and is performed over a short duration of time. The procedure may be performed on prostates up to 150 ml in volume. The rate of complication and auxiliary procedures is very low in the short term, and the functional outcomes are very good in the short term. This procedure has a place in the first line of modern BPH surgeries.

Men carrying germline pathogenic sequence variants (PSVs) in the BRCA1/2 (BRCA- PSV) are at an increased risk for early onset aggressive prostate cancer (PrCa). Screening strategies, including prostate MRI (pMRI), are advocated, yet their clinical utility remains uncertain. To this end we employed Decision Curve Analysis (DCA) to compare screening based on either family history of PrCa, age-stratified PSA or pMRI, assessing net benefits with the outcome of performing biopsy. Overall 148 BRCA- PSV carriers (8620 person/years) were included, of whom 80 had ≥ 2 consecutive visits. Of these – 53/80 (66.25%) underwent pMRI screening, and 11 underwent biopsy for radiologically suspicious lesion and 4 were diagnosed with PrCa. Gene-specific and age-stratified analyses were carried out to assess the preferred mode for guiding prostate biopsy. Compared with other strategies, pMRI demonstrated the highest net benefits across all threshold probabilities for the entire cohort and both ≥ 61 and 35–50 years.

You have accessJournal of UrologyKidney Cancer: Localized: Surgical Therapy V (MP67)1 May 2024MP67-18 INCIDENCE AND DETERMINANTS OF POSITIVE SURGICAL MARGINS FOLLOWING ROBOTIC-ASSISTED PARTIAL NEPHRECTOMY Husny Mahmud, Dorit Zilberman, Barak Rosenzwieg, Menachem Laufer, and Zohar Dotan Husny MahmudHusny Mahmud , Dorit ZilbermanDorit Zilberman , Barak RosenzwiegBarak Rosenzwieg , Menachem LauferMenachem Laufer , and Zohar DotanZohar Dotan View All Author Informationhttps://doi.org/10.1097/01.JU.0001009496.54470.10.18AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Positive surgical margins (PSM) serve as a significant indicator for the assessment of the completeness in oncological resections. Partial nephrectomy stands as the standard surgical intervention for renal tumors measuring up to 7 cm. In the preceding decade, the advent of robotic-assisted techniques has revolutionized the practice of partial nephrectomy. This research intends to ascertain the frequency of PSM in robotic-assisted partial nephrectomy, elucidate the correlating risk determinants, and quantify local recurrence rates post-operatively in relation to PSM. METHODS: A comprehensive retrospective analysis was undertaken on data acquired from nephrectomies spanning 1987 to 2022. Extracted data encompassed demographic profiles, preoperative evaluations, intraoperative observations, and postoperative outcomes. The incidence of PSM post-robotic-assisted partial nephrectomy was meticulously analyzed. Furthermore, potential risk determinants—including age, gender, Tumor size and location, underlying comorbidities, prior intra-abdominal surgeries, and the RENAL score—were scrutinized in association with PSM and consequent local recurrence. RESULTS: A total of 2,737 patients underwent nephrectomy, of which 1,319 (48.4%) underwent partial nephrectomy. Of these, 408 (30.9%) underwent RAPN. 94% of all partial nephrectomies since 2020 were completed robotically. The PSM occurrence stood at 5.8% for all partial nephrectomies. Remarkably, this incidence witnessed a reduction to 3.9% between the years 2020-2023. Intriguingly, the PSM rates remained invariant across different surgical modalities—be it robotic, laparoscopic, or open partial surgery. Univariate analyses did not identify any substantive correlation between PSM occurrence and factors such as surgical side, patient gender, Renal size, RENAL SCORE, or the specific year of surgery. Moreover, there was no substantial increase in the likelihood of local cancer recurrence in patients who were diagnosed with positive surgical margins (PSM) after undergoing robotic-assisted partial nephrectomy. CONCLUSIONS: Robotic-assisted partial nephrectomy is associated with low risk of positive surgical margins. The PSM incidence remains consistent irrespective of the surgical approach, tumor size or complexity score. Notably, patients diagnosed with PSM following a partial nephrectomy did not present an increased risk for local recurrence. These findings suggest that postoperative surveillance protocols for patients with PSM can align with those demonstrating negative surgical margins. Source of Funding: None © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e1105 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Husny Mahmud More articles by this author Dorit Zilberman More articles by this author Barak Rosenzwieg More articles by this author Menachem Laufer More articles by this author Zohar Dotan More articles by this author Expand All Advertisement PDF downloadLoading ...

While partial nephrectomy offers oncologic efficacy and preserves renal function for T1 renal tumors, renal artery pseudoaneurysm (RAP) remains a rare but potentially life-threatening complication. This study compared RAP incidence across robotic-assisted (RAPN), laparoscopic (LPN), and open (OPN) partial nephrectomies in a large tertiary oncological center. This retrospective study analyzed 785 patients undergoing partial nephrectomy between 2012 and 2022 (398 RAPN, 122 LPN, 265 OPN). Data included demographics, tumor size/location, surgical type, clinical presentation, treatment, and post-operative outcomes. The primary outcome was RAP incidence, with secondary outcomes including presentation, treatment efficacy, and renal function. Seventeen patients (2.1%) developed RAP, presenting with massive hematuria (100%), hemorrhagic shock (5.8%), and clot retention (23%). The median onset was 12 days postoperatively. RAP occurred in 4 (1%), 4 (3.3%), and 9 (3.4%) patients following RAPN, LPN, and OPN, respectively (p = 0.04). Only operative length and surgical approach were independently associated with RAP. Selective embolization achieved immediate bleeding control in 94%, with one patient requiring a second embolization. No additional surgery or nephrectomy was needed. Estimated GFR at one year was similar across both groups (p = 0.53). RAPN demonstrated a significantly lower RAP incidence compared to LPN and OPN (p = 0.04). Emergency angiographic embolization proved effective, with no long-term renal function impact. This retrospective study lacked randomization and long-term follow-up. Further research with larger datasets and longer follow-ups is warranted. This study suggests that robotic-assisted partial nephrectomy is associated with a significantly lower risk of RAP compared to traditional approaches. Emergency embolization effectively treats RAP without compromising long-term renal function.