Uro, Volume 2, Issue 2 (June 2022) – 8 articles

If urinary catheters are used during surgeries, epidurals and parturition, patients and their physicians want a return to volitional voiding as soon as possible. Micturition is regained by passing a decatheterization test. Fortunately, only a small percentage of patients fail three or more of these tests and have to use catheters longer-term. Surprisingly, there are no approved drugs that are currently approved to assist with these tests; however, bethanechol, 50 mg/BID, should be considered further for this application. The drug is a bladder wall receptor stimulant and, at this moderate dosage, it is reasonable to expect it to help with decatheterization tests. This position statement includes several designs for future bethanechol use and research. In addition, an International Neuro-Urological Research Group is introduced that is promoting this drug. Full article

Detrusor sphincter dyssynergia (DSD) is defined as an external urethral sphincter anomalous contraction concomitant to detrusor contraction during voiding, due to a neurological disease. It commonly occurs in suprasacral spinal cord-injured (SCI) patients and can be associated with autonomic dysreflexia. DSD generates risks to the urinary system and overall health; hence, it should be promptly diagnosed and managed. Bladder neck dyssynergia is a condition that should be integrated in DSD assessment. We reviewed the literature indexed in PubMed/Medline on the evaluation methods of DSD in SCI patients. Urodynamics is the mainstay evaluation method and has a prognostic value for the progression of upper urinary tract structural degradation and renal function decline. We found a lack of consensus on the optimal urodynamics configuration when evaluating DSD, especially in obtaining and measuring the signal from external urethral sphincter (EUS) activity. It appears that a combination of recordings of voiding cystourethrography and EUS electromyography, either with or without EUS pressure measurement, is the most accurate method available for evaluating DSD. While gathering articles, we came across an interesting approach in evaluating DSD in the past: urodynamics coupled with ultrasound imaging. Despite being considered valuable from a diagnostic standpoint by some prominent authors, it is no longer represented in the current literature. In addition to the instrumental diagnosis, health professionals should consider additional clinical features when evaluating and managing DSD in SCI patients, to design a customized plan to achieve the best compromise between quality of life and urinary system protection. Full article

Prostate cancer (PCa), which is among the most prevalent types of cancer in men, is a prominent topic in imaging research. The primary aim of PCa imaging is to acquire more accurate characterizations of the disease. More precise imaging of the local stage progression, early discovery of metastatic cancers, reliable diagnosis of oligometastatic cancer, and optimum treatment response evaluation are areas in which contemporary imaging is quickly improving and developing. Imaging techniques, such as magnetic resonance imaging (MRI) for the whole body and molecular imaging with combined positron emission tomography (PET), computed tomography (CT), and MRI, enable imaging to support and enhance treatment lines in patients with local and advanced PCa. With the availability of multiple imaging modalities for the management of PCa, we aim in this review to offer a multidisciplinary viewpoint on the appropriate function of contemporary imaging in the identification of PCa. Full article

Background: Urologic complications are the most dreaded complications of renal transplantation, particularly when pediatric en bloc kidneys (EBKs) are used. Current techniques of ureteroneocystostomy (UNC) are not applicable to the very small ureters of very small en bloc kidneys. We reviewed our experience with the pull-through ureteroneocystostomy in kidney transplantation from donors under or equal to 5 kg weight. Material and Methods: The technique was used in 32 EBKs. Complications and 4-year graft survival are discussed. Results: One single graft thrombosed and required nephrectomy. The remaining kidneys provided good renal function. Hematuria was transient in five patients and did not require fulguration. No leakage was experienced. Delayed graft function occurred in 16% of cases. No primary nonfunction was noted. During the follow-up period, hydronephrosis and/or pyelonephritis were not observed. The 4-year graft survival was 95% with serum creatinine levels averaging 0.9 mg/dl. Conclusions: The procedure proved to be safe and reproducible. It can be applied to the ureteral re-implantation of very small EBKs. Full article

Objective: The aim of this study was to evaluate the outcomes of single-stage trans-vestibular and Foley’s assisted epispadias repair (STAFER) technique in girls with incontinent epispadias. Methods: The records of all girls who had undergone epispadias repair and bladder neck plication via the STAFER technique over a four-year study period (January 2016 to December 2019) were retrospectively reviewed from the archives. A comparison of preoperative and postoperative functional outcomes was performed. Incontinence status was divided into four grades on the basis of severity: grade 0 (completely dry during day and night), grade 1 (occasional episodes of urine leakage leading to damp undergarments or requiring pads occasionally but not daily), grade 2 (frequent episodes of urine leakage with a dry period of <3 h), and grade 3 (completely incontinent). Renal bladder ultrasound (RBUS), micturating cystourethrogram (MCUG) scan, technetium-99m diethylenetriamine pentaacetate (DTPA) scan, and technetium-99m dimercaptosuccinic acid (DMSA) scan were performed to assess the upper tract function. Results: Nine girls with average (SD) age at surgery of 7.9 (3.8) years were operated on utilizing the STAFER technique during the study period. All cases had grade 3 incontinence and normal upper tracts prior to the surgery. Postoperatively, 8/9 girls had a dry period of more than 3 h. Six of them were completely dry and had no wetting episodes (grade 0 incontinence). DMSA and DTPA scans showed preserved upper tracts while MCUG scans revealed grade II VUR in only one case. Conclusions: In a limited cohort of girls with incontinent epispadias, the STAFER technique provides favorable functional outcomes in terms of continence and upper tract function. Further studies comprising a larger cohort of patients with a younger average age at surgery need to be conducted before definite conclusions regarding the efficacy of this technique are drawn. Full article

Advanced prostate cancers have a poor survival rate and a lack of effective treatment options. In order to broaden the available treatments, immunotherapies have been investigated. These include cancer vaccines, immune checkpoint inhibitors, chimeric antigen receptor T cells and bispecific antibodies. In addition, combinations of different immunotherapies and with standard therapy have been explored. Despite the success of the Sipuleucel-T vaccine in the metastatic, castrate-resistant prostate cancer setting, other immunotherapies have not shown the same efficacy in this population at large. Some individual patients, however, have shown remarkable responsiveness to these therapies. Therefore, work is underway to identify which populations will respond positively to therapy via the identification of predictive biomarkers. These include biomarkers of the immunologically active tumour microenvironment and biomarkers indicative of high neoantigen expression in the tumour. This review examines the constitution of the prostate tumour immune microenvironment, explores the effectiveness of immunotherapies, and finally investigates how therapy selection can be optimised by the use of biomarkers. Full article

Introduction, The aim of this systematic review was to evaluate the current evidence for the effectiveness of ginseng, Rutin and Moringa for treating erectile dysfunction. Methods, A broad search of the Scopus, PubMed, Cochrane and Web of Science databases was performed in complicance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. The following criteria were required for articles to be included in the review: English language; observational studies (cohort studies, case control/comparative studies, single-arm studies); randomized controlled trials; non-randomized comparative studies; case series; number of participants: ≥5 for case series or ≥5 patients per group for comparative studies. The Cochrane risk of bias (RoB) assessment tool for RCTs was used to assess the risk of bias of included studies. Results, Seven full-text articles were included in this review. All studies were randomized controlled trials. No studies on Rutin and Moringa alone matched the inclusion criteria. The methodological quality of the RCTs was variable. In all studies, the group treated with ginseng reported an improvement of erectile function (EF) compared to the control groups. IIEF and IIEF-5 were used to evaluate erectile function in six studies and in four of them, the improvement of the scores in the group treated with ginseng over the control group reached the statistical significance. Conclusion, This review suggests a positive effect of ginseng on EF in men. The association of ginseng along with other nutritional components with potential beneficial effects on ED appears promising and deserves further investigation in large randomized controlled trials. Full article