Advances in Urology最新文献

{"title":"Experience with Renal Autotransplantation: Typical and Atypical Indications.","authors":"Ali Bourgi,&nbsp;Rana Aoun,&nbsp;Elias Ayoub,&nbsp;Maroun Moukarzel","doi":"10.1155/2018/3404587","DOIUrl":"https://doi.org/10.1155/2018/3404587","url":null,"abstract":"<p><strong>Introduction and objectives: </strong>Renal autotransplantation is a kidney-saving surgical procedure used in selected patients. The purpose of this report is to review nine typical and atypical indications for kidney autotransplantation and evaluate its effectiveness in maintaining kidney function and avoiding cancer recurrence.</p><p><strong>Materials and methods: </strong>From 1999 till 2014, nine renal autotransplantations were performed in our center. A retrospective case review was done. Four of nine patients had a solitary functioning kidney. Typical indications for autotransplantation included extended ureteric disease in 5 patients, intrasinusal tumor on a solitary kidney in 1 patient, and renal artery aneurysm in 1 patient. Atypical indications consisted in bilateral urothelial tumors in 1 patient and interrupted live kidney transplantation in 1 patient. Mean cold ischemia time was 209 minutes. Demographic factors, indications, renal function before and after surgery, and in the long term, cancer recurrence and disease-free survival were evaluated.</p><p><strong>Results: </strong>Renal function was maintained in 8 patients during the early follow-up. No serious complications occurred in the postoperative period. Median duration of follow-up was 50 months. In 4 patients with a normal contralateral kidney, mean preoperative and at discharge creatinine clearance were 105.45 ml/min and 121.02 ml/min, respectively. Although values showed an improvement in the kidney function, the difference was not significant (<i>p</i> value 0.3). In the other 4 patients with a solitary kidney, mean discharge creatinine clearance was 99.24 ml/min surprisingly higher than the preoperative value 96.92 ml/min. At the last follow-up, kidney function was preserved for the two groups (normal contralateral kidney/solitary kidney) with relatively stable creatinine clearance values: 108.45 ml/min and 85.9 ml/min, respectively. No patients required secondary dialysis.</p><p><strong>Conclusion: </strong>Renal autotransplantation is a rare, safe, and effective surgical procedure for the treatment of complex urologic conditions. In some instances, it may be of great utility for kidney salvage in some carefully selected patients.</p>","PeriodicalId":7490,"journal":{"name":"Advances in Urology","volume":"2018 ","pages":"3404587"},"PeriodicalIF":1.4,"publicationDate":"2018-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2018/3404587","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36114523","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Conventional-Dose versus High-Dose Chemotherapy for Relapsed Germ Cell Tumors.","authors":"Deaglan J McHugh, Darren R Feldman","doi":"10.1155/2018/7272541","DOIUrl":"10.1155/2018/7272541","url":null,"abstract":"<p><p>The majority of metastatic germ cell tumors (GCTs) are cured with cisplatin-based chemotherapy, but 20-30% of patients will relapse after first-line chemotherapy and require additional salvage strategies. The two major salvage approaches in this scenario are high-dose chemotherapy (HDCT) with autologous stem cell transplant (ASCT) or conventional-dose chemotherapy (CDCT). Both CDCT and HDCT have curative potential in the management of relapsed/refractory GCT. However, due to a lack of conclusive randomized trials, it remains unknown whether sequential HDCT or CDCT represents the optimal initial salvage approach, with practice varying between tertiary institutions. This represents the most pressing question remaining for defining GCT treatment standards and optimizing outcomes. The authors review prognostic factors in the initial salvage setting as well as the major studies assessing the efficacy of CDCT, HDCT, or both, describing the strengths and weaknesses that formed the rationale behind the ongoing international phase III \"TIGER\" trial.</p>","PeriodicalId":7490,"journal":{"name":"Advances in Urology","volume":"2018 ","pages":"7272541"},"PeriodicalIF":1.4,"publicationDate":"2018-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5874975/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36077530","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Immune-Related Concepts in Biology and Treatment of Germ-Cell Tumors.","authors":"Michal Chovanec, Ugo De Giorgi, Michal Mego","doi":"10.1155/2018/3718165","DOIUrl":"10.1155/2018/3718165","url":null,"abstract":"<p><p>Germ-cell tumors (GCTs) are highly curable with chemotherapy. Salvage chemotherapy or surgery can cure a proportion of patients, but the ones failing these treatments will die of their disease in the young age. Immune checkpoint pathways are emerging as powerful targetable biomarkers, and a significant preclinical and clinical research is underway to widen our knowledge and expand the treatment possibilities with immune therapy. The concept of immune modulation that was currently adopted in many solid tumors is understudied in GCTs. Herein, we summarize the current knowledge of published literature discussing the immune mechanisms and immune therapy in GCTs.</p>","PeriodicalId":7490,"journal":{"name":"Advances in Urology","volume":"2018 ","pages":"3718165"},"PeriodicalIF":1.4,"publicationDate":"2018-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5872660/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36068615","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Urinary Bladder Cancer in Egypt: Are There Gender Differences in Its Histopathological Presentation?","authors":"Fiorina Kyritsi,&nbsp;Christopher A Loffredo,&nbsp;Yun-Ling Zheng,&nbsp;George Philips,&nbsp;Sania Amr","doi":"10.1155/2018/3453808","DOIUrl":"https://doi.org/10.1155/2018/3453808","url":null,"abstract":"<p><p>We investigated gender differences in the histopathologic presentation of bladder cancer cases in Egypt, where both urothelial cell carcinoma (UC) and squamous cell carcinoma (SCC) types are highly prevalent. We used logistic regression to estimate the unadjusted (OR) and adjusted odds ratio (AOR) and 95% confidence interval (CI) of the associations between gender and different histopathologic and sociodemographic parameters of 2,186 confirmed cases of primary bladder cancer (1,775 males and 411 females; 784 SCC and 1,402 UC). There were no statistically significant gender differences in tumor grade, stage, mucosal ulcer, or inflammatory cystitis, regardless of the cancer type, but men were less likely than women to have undergone cystectomy with pelvic lymphadenectomy. Having <i>Schistosoma haematobium</i> (<i>SH</i>) ova in the bladder tissue was significantly associated with male gender in the fully adjusted model of either SCC (AOR (95% CI) = 2.12 (1.15-3.89)) or UC cases (3.78 (1.89-7.55)). Compared to females, male cases were significantly older at time of diagnosis and smokers. In Egypt, regardless of the type of bladder cancer (SCC or UC), male more than female cases had evidence of <i>SH</i> infection, but not other histopathologic differences, in bladder tissue specimens.</p>","PeriodicalId":7490,"journal":{"name":"Advances in Urology","volume":"2018 ","pages":"3453808"},"PeriodicalIF":1.4,"publicationDate":"2018-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2018/3453808","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36068614","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Supine Percutaneous Nephrolithotripsy in Double-S Position.","authors":"Giuseppe Giusti,&nbsp;Antonello De Lisa","doi":"10.1155/2018/7193843","DOIUrl":"https://doi.org/10.1155/2018/7193843","url":null,"abstract":"<p><strong>Background: </strong>At present, the percutaneous nephrolithotripsy (PCNL) is performed both in supine and in prone position. The aim of this paper is to describe an innovative position during PCNL.</p><p><strong>Methods: </strong>We describe a supine position. The patient's legs are slightly abducted at the hips. The thorax is laterally tilted (inclination 30°-35°) and kept in the right position by one or two gel pads placed between the scapula and the vertebrae. External genitalia can be accessed at any time, so that it is always possible to use flexible instruments in the upper urinary tract. We used this position for a period of 12 months to treat with PCNL 45 patients with renal lithiasis.</p><p><strong>Results: </strong>All the procedures were successfully completed without complications, using the position we are describing. The following are some of its benefits: an easier positioning of the patient; a better exposure of the flank for an easier access to the posterior renal calyces of the kidney; a lower risk of pressure injuries compared to positions foreseeing the use of knee crutches; the possibility of combined procedures (ECIRS) through the use of flexible instruments; and a good fluoroscopic visualization of the kidney not overlapped by the vertebrae.</p><p><strong>Conclusions: </strong>This position is effective, safe, easy, and quick to prepare and allows for combined anterograde/retrograde operations.</p>","PeriodicalId":7490,"journal":{"name":"Advances in Urology","volume":"2018 ","pages":"7193843"},"PeriodicalIF":1.4,"publicationDate":"2018-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2018/7193843","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36060532","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dissecting the Evolving Risk of Relapse over Time in Surveillance for Testicular Cancer.","authors":"Madhur Nayan,&nbsp;Robert J Hamilton","doi":"10.1155/2018/7182014","DOIUrl":"https://doi.org/10.1155/2018/7182014","url":null,"abstract":"<p><p>Testicular cancer is the most common malignancy in young men, and the incidence is increasing in most countries worldwide. The vast majority of patients present with clinical stage I disease, and surveillance is being increasingly adopted as the preferred management strategy. At the time of diagnosis, patients on surveillance are often counselled about their risk of relapse based on risk factors present at diagnosis, but this risk estimate becomes less informative in patients that have survived a period of time without experiencing relapse. Conditional survival estimates, on the other hand, provide information on a patient's evolving risk of relapse over time. In this review, we describe the concept of conditional survival and its applications for surveillance of clinical stage I seminoma and nonseminoma germ cell tumours. These estimates can be used to tailor surveillance protocols based on future risk of relapse within risk subgroups of seminoma and nonseminoma, which may reduce the burden of follow-up for some patients, physicians, and the health care system. Furthermore, conditional survival estimates provide patients with a meaningful, evolving risk estimate and may be helpful to reassure patients and reduce potential anxiety of being on surveillance.</p>","PeriodicalId":7490,"journal":{"name":"Advances in Urology","volume":"2018 ","pages":"7182014"},"PeriodicalIF":1.4,"publicationDate":"2018-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2018/7182014","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36021202","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Combined Dorsal and Ventral Onlay Buccal Graft Technique for Large and Complex Penile Strictures.","authors":"Nikolaos Mertziotis,&nbsp;Andreas Konandreas,&nbsp;Christos Kyratsas","doi":"10.1155/2018/1846060","DOIUrl":"https://doi.org/10.1155/2018/1846060","url":null,"abstract":"<p><strong>Purpose: </strong>To present a modified technique of managing extensive penile urethral strictures with dorsal and ventral onlay buccal mucosa grafts.</p><p><strong>Patients and methods: </strong>From October 2014 to January 2016, a total of 12 patients underwent urethroplasty for penile urethral strictures, using dorsal and ventral onlay grafts from buccal mucosa. The mean age was 42.75 (17-71). All patients completed the IPSS and QoL questionnaire, and uroflowmetry was done preoperatively. After surgery, the follow-up included completion of IPSS and QoL questionnaire and measuring of uroflow at 1, 3, 6, and 12 months. Postoperative urethrography was performed in complex cases or in the event of deterioration of voiding symptoms.</p><p><strong>Results: </strong>The mean length of the strictures was 5.45 (2, 2-16) cm. Mean Qmax changed from 3.45 ml/sec preoperatively to 18.33 postoperatively, and mean IPS score significantly decreased from 20.1 preoperatively to 8.98 postoperatively. All values were statistically significant (<i>p</i> < 0.001). No intraoperative or immediate postoperative complications were recorded. Overall, at 12 months, 11 out of 12 patients (91.6%) had a marked improvement in quality of life and uroflowmetry parameters.</p><p><strong>Conclusions: </strong>In the properly selected patient, the combined use of double graft for penile urethral strictures can be successful with minimal morbidity, at short-term follow-up.</p>","PeriodicalId":7490,"journal":{"name":"Advances in Urology","volume":"2018 ","pages":"1846060"},"PeriodicalIF":1.4,"publicationDate":"2018-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2018/1846060","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36022724","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Toxicities Associated with Cisplatin-Based Chemotherapy and Radiotherapy in Long-Term Testicular Cancer Survivors.","authors":"Chunkit Fung,&nbsp;Paul Dinh,&nbsp;Shirin Ardeshir-Rouhani-Fard,&nbsp;Kerry Schaffer,&nbsp;Sophie D Fossa,&nbsp;Lois B Travis","doi":"10.1155/2018/8671832","DOIUrl":"https://doi.org/10.1155/2018/8671832","url":null,"abstract":"<p><p>Testicular cancer has become the paradigm of adult-onset cancer survivorship, due to the young age at diagnosis and 10-year relative survival of 95%. This clinical review presents the current status of various treatment-related complications experienced by long-term testicular cancer survivors (TCS) free of disease for 5 or more years after primary treatment. Cardiovascular disease and second malignant neoplasms represent the most common potentially life-threatening late effects. Other long-term adverse outcomes include neuro- and ototoxicity, pulmonary complications, nephrotoxicity, hypogonadism, infertility, and avascular necrosis. Future research efforts should focus on delineation of the genetic underpinning of these long-term toxicities to understand their biologic basis and etiopathogenetic pathways, with the goal of developing targeted prevention and intervention strategies to optimize risk-based care and minimize chronic morbidities. In the interim, health care providers should advise TCS to adhere to national guidelines for the management of cardiovascular disease risk factors, as well as to adopt behaviors consistent with a healthy lifestyle, including smoking cessation, a balanced diet, and a moderate to vigorous intensity exercise program. TCS should also follow national guidelines for cancer screening as currently applied to the general population.</p>","PeriodicalId":7490,"journal":{"name":"Advances in Urology","volume":"2018 ","pages":"8671832"},"PeriodicalIF":1.4,"publicationDate":"2018-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2018/8671832","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36021675","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Kidney Stone Disease: An Update on Current Concepts.","authors":"Tilahun Alelign,&nbsp;Beyene Petros","doi":"10.1155/2018/3068365","DOIUrl":"https://doi.org/10.1155/2018/3068365","url":null,"abstract":"<p><p>Kidney stone disease is a crystal concretion formed usually within the kidneys. It is an increasing urological disorder of human health, affecting about 12% of the world population. It has been associated with an increased risk of end-stage renal failure. The etiology of kidney stone is multifactorial. The most common type of kidney stone is calcium oxalate formed at Randall's plaque on the renal papillary surfaces. The mechanism of stone formation is a complex process which results from several physicochemical events including supersaturation, nucleation, growth, aggregation, and retention of urinary stone constituents within tubular cells. These steps are modulated by an imbalance between factors that promote or inhibit urinary crystallization. It is also noted that cellular injury promotes retention of particles on renal papillary surfaces. The exposure of renal epithelial cells to oxalate causes a signaling cascade which leads to apoptosis by p38 mitogen-activated protein kinase pathways. Currently, there is no satisfactory drug to cure and/or prevent kidney stone recurrences. Thus, further understanding of the pathophysiology of kidney stone formation is a research area to manage urolithiasis using new drugs. Therefore, this review has intended to provide a compiled up-to-date information on kidney stone etiology, pathogenesis, and prevention approaches.</p>","PeriodicalId":7490,"journal":{"name":"Advances in Urology","volume":"2018 ","pages":"3068365"},"PeriodicalIF":1.4,"publicationDate":"2018-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2018/3068365","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35893051","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pediatric Germ Cell Tumors: A Developmental Perspective.","authors":"Joshua L Pierce,&nbsp;A Lindsay Frazier,&nbsp;James F Amatruda","doi":"10.1155/2018/9059382","DOIUrl":"https://doi.org/10.1155/2018/9059382","url":null,"abstract":"<p><p>Germ cell tumors (GCTs) arising in infants, children, and adolescents present a set of special challenges. GCTs make up about 3% of malignancies in children aged 0-18 and nearly 15% of cancers in adolescents. Epidemiologic and molecular evidence suggests that GCTs in young children likely represent a distinct biologic group as compared to GCTs of older adolescents and adults. Despite this difference, pediatric GCTs are typically treated with cisplatin-based multiagent regimens similar to those used in adults. There is evidence that children are particularly vulnerable to late effects of conventional therapy, including ototoxicity, pulmonary abnormalities, and secondary malignancies, motivating the search for molecular targets for novel therapies. Evidence is accumulating that the genes and mechanisms controlling normal germ cell development are particularly relevant to the understanding of germ cell tumorigenesis. Perturbations in the epigenetic program of germ cell differentiation, with resulting effects on the regulation of pluripotency, may contribute to the marked histologic variability of GCTs. Perturbations in the KIT receptor signaling pathway have been identified via next-generation sequencing studies and in genome-wide association studies of testicular cancer susceptibility. Here, we review these and other biological insights that may fuel further translational and clinical research in childhood GCTs.</p>","PeriodicalId":7490,"journal":{"name":"Advances in Urology","volume":"2018 ","pages":"9059382"},"PeriodicalIF":1.4,"publicationDate":"2018-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2018/9059382","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35893053","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}