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Background: New-generation imaging techniques and the increasing use of surgery in high-risk prostate cancer (PCa) allow us to detect many cases of nodal disease at initial diagnosis or after resection. The treatment of PCa with pathologic regional nodes has evolved from the exclusive use of systemic therapy to its combination with locoregional treatment. It can also represent a benefit in the overall survival. However, the evidence from randomised studies is limited. Thus, we review the most relevant results in this scenario.
Materials and Methods: A literature search was conducted in MEDLINE, PubMed, EMBASE, Clinical-Trials.gov and Web of Science on January 2023 to review node-positive PCa by considering the relevant literature on this topic published with no restrictions on date and language. The search keywords used were “Prostatic Neoplasms” (MeSh) and “Node-positive” (Text Word) and “Radiotherapy” (MeSh) and (“Androgen Antagonists” (MeSh) or “Antineoplastic Agents, Hormonal” (MeSh)), which are indexed within the Medical Subject Headings database.
Results: The management of node-positive PCa has no clear definitive consensus at the initial disease diagnosis or after surgery. However, in this review, we summarise the existing literature for the management of these patients in both scenarios, considering imaging tests, radiotherapy, hormone therapy and second-generation hormonal treatments.
Conclusions: The combination of radiotherapy and androgen-deprivation therapy is the treatment of choice. The addition of second-generation hormone therapy, plus the intensification of radiotherapy schedules, will likely change the treatment paradigm for these patients.
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Radical prostatectomy (RP) is one of the primary treatment options for localised prostate cancer (PCa). Despite its curative intent, 1/3 of patients will experience biochemical recurrence (BCR) during follow-up. Experts have devoted efforts to associate the influence of each individual factor with the risk of BCR to select the optimal treatment for each patient. Optimal management must aim to find a balance between delaying the onset of metastatic disease and overtreating an indolent disease with treatments that can affect quality of life of the patients. Thus far, effective treatment options for men with BCR remain controversial in terms of ideal treatment timing (adjuvant vs. salvage), radiotherapy (RT) fields and doses, selection and duration of systemic therapy and potential synergies between treatments and their therapeutic sequencing. Next-generation imaging techniques, such as Prostate-Specific Membrane Antigen Positron Emission Tomography, are used for early detection of disease progression and exact site of recurrence or progression, thereby enhancing decision making for future disease management. In this review, we evaluate available evidence of controversial topics regarding BCR after RP and explore future directions, such as prognostic and/or predictive factors of response, genetic panels, second-generation hormone treatments, ultra-hypofractionated RT and ongoing clinical trials in this clinical scenario.
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Erectile dysfunction (ED) is a common sexual dysfunction in men that can occur with the onset of sexual activity or even earlier, and the development of ED involves a variety of pathophysiologic mechanisms. Organic erectile dysfunction refers to a type of erectile dysfunction that is primarily caused by physical or organic factors rather than psychological or emotional factors. Worldwide, the incidence and prevalence of ED are high. Currently, the mainstay of ED treatment is the use of medications such as phosphodiesterase type 5 inhibitors (PDE5Is). However, these medications cause adverse effects such as flushing, indigestion and headaches and are not effective for some ED patients. Therefore, there is an urgent need to explore new targets of action for the treatment of ED. Ferroptosis is a type of iron-dependent regulated cell death initiated by lipid peroxidation and is a novel form of programmed cell death associated with the pathogenesis of various diseases. Prior research has provided evidence that the ferroptosis pathway plays a pivotal role in the modulation of ED, establishing this pathway as a significant foundation for the development of potential therapeutic interventions for ED. Experiments have shown that the inhibition of ferroptosis can improve ED. This article systematically introduces the role and influence of ferroptosis in various types of organic erectile dysfunction and describes the molecular mechanism, related pathways, and potential targets, providing a theoretical basis for the clinical diagnosis and treatment of ED.
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The area of geriatrics and the study of the aged are gaining prominence all over the world. In the US, the population of people over 65 years old is expected to reach 71 million in 10 years. Men are projected to account for approximately 43% of the population. Owing to their more complex physiological and pathological state, elderly men face many challenges. Erectile function may diminish in elderly and vulnerable people owing to ageing, physical conditions, psychological stress, or a combination of these factors. This propensity is more common in elderly men. This article reviews the literature on frailty syndrome and erectile dysfunction (ED) to better understand them. Complete MEDLINE/PubMed review of non-systematic literature from 1990 to May 2023 was included. This topic is thoroughly researched using “frailty”, “low muscle mass”, “erectile dysfunction”, and “elderly”. Individuals with frailty tend to experience more pronounced instances of ED compared with those who are in good health primarily owing to the anomalies present in their physiological composition. This poses challenges for individuals with physical vulnerabilities to engage in intimate relationships. ED may potentially exert a substantial influence on the mental well-being of older individuals or those who are otherwise vulnerable. Research demonstrates that implementing testosterone replacement therapy (TRT) can effectively enhance erectile function among elderly individuals. This phenomenon persists despite the knowledge that TRT is not devoid of potential adverse effects. The present investigation has revealed a significant association of frailty, exacerbated by advancing age, with the occurrence of ED. Our findings lead to the conclusion that the condition of frailty becomes more pronounced as individuals advance in age.
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Background: YouTube is the second most popular website worldwide. It features numerous videos about radical prostatectomy. The aim of this study was to assess the quality of these videos and screen their benefit for patients and doctors.
Methods: All videos on YouTube about radical prostatectomy were analysed using a specially developed software (python 2.7, numpy). According to a predefined selection process most relevant videos were analyzed for quality and reliability using Suitability Assessment of Materials (SAM)-Score, Global Quality Score and others.
Results: Out of 3520 search results, 179 videos were selected and analysed. Videos were watched a median of 5836 times (interquartile range (IQR): 11945.5; 18–721546). The median duration was 7.2 minutes (min). 125 of the videos were about robotic prostatectomy. 69 videos each were directly addressed to patients and doctors. Medical content generally was of low quality, while technical quality and total quality were at a high level. Reliability was good.
Conclusions: Videos on radical prostatectomy on YouTube allow for patient information. While technical quality and reliability are classified as acceptable, medical content was low and warranted preselection. In contrast to Loeb et al. we did not observe a negative correlation between number of views and scientific quality in different scores. Our findings support the need for preselection of videos on YouTube as the potential benefit may vary between videos with the significant risk of low medical quality.
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Objective: This study aimed to explore the occurrence of acute urinary retention (AUR) and urinary tract infection (UTI) in patients undergoing urinary drainage after colorectal resection and analyse the risk factors.
Methods: Clinical data of 167 patients with urinary drainage after colorectal resection in Affiliated Qingdao Central Hospital of Qingdao University, Qingdao Cancer Hospital from November 2020 to November 2022 were retrospectively analysed. Clinical data included age, gender, diabetes, hypertension, lesion location, surgical method, previous history of abdominal surgery, urinary system diseases (urinary calculi, benign prostatic hyperplasia and urethral stricture), use of antibiotics before surgery, use of analgesic and sedative drugs after surgery, postoperative extubation time and postoperative adhesive intestinal obstruction. The postoperative AUR and UTI in patients were statistically analysed. Univariate and multivariate logistic regression analyses were used to explore the risk factors and odds ratio (OR) for AUR and UTI.
Results: The incidences of AUR and UTI were 23.95% (40/167) and 16.77% (28/167). Patients were divided into AUR group (n = 40), non-AUR group (n = 127), UTI group (n = 28) and non-UTI group (n = 139). Logistic regression analysis showed that previous history of abdominal surgery (OR = 3.517, 95% CI: 1.005–12.313), urinary system diseases (OR = 8.253, 95% CI: 2.692–25.303), postoperative extubation time (OR = 0.536, 95% CI: 0.393–0.732) and postoperative adhesive intestinal obstruction (OR = 25.293, 95% CI: 6.747–94.827) were risk factors for AUR in patients with urinary drainage after colorectal resection (p < 0.05). Female (OR = 21.569, 95% CI: 1.094–425.138), long postoperative extubation time (OR = 26.218, 95% CI: 3.318–207.151) and urinary system diseases (OR = 8.647, 95% CI: 3.425–21.831) were risk factors for UTI in patients undergoing urinary drainage after colorectal resection (p < 0.05). Age and preoperative use of antibiotics were not key influencing factors for UTI (p > 0.05).
Conclusions: Clinical attention is paid to high-risk factors and groups. Corresponding interventions are taken as soon as possible to reduce the occurrence of AUR and UTI and further improve the prognosis of patients with urinary drainage after colorectal resection.
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Background: The reasonable selection of anaesthesia methods and drugs is the key to ensuring the perioperative safety of patients with the transurethral resection of the prostate (TURP). The effect of intravenous remazolam injection on stress response and analgesic effect in patients with transurethral prostate cancer electrotomy were explored.
Methods: The medical records of 160 patients with prostatic hyperplasia who underwent TURP in Tianjin hospital from November 2020 to November 2022 were selected for retrospective analysis. Five patients who did not meet the study conditions were excluded, and 155 patients were finally included. According to anaesthesia schemes, the patients were divided into the observation group (OBG, n = 76, routine surgical anaesthesia and intravenous remazolam injection) and control group (COG, n = 79, routine surgical anaesthesia). Postoperative eye-opening times were recorded for both groups. The groups were compared in terms of anaesthetic effects, stress indexes, haemodynamic indexes, and use of postoperative analgesic drugs at different times, and adverse reactions were observed.
Results: The anaesthesia onset time and eye-opening time in the OBG were shorter than those in the COG (p < 0.001). The heart rate and mean arterial pressure of the OBG during anaesthesia induction were higher than those in the COG (p < 0.001). The OBG showed significantly lower noradrenaline and cortisol levels than the COG 1, 12 and 24 h after surgery (p < 0.001). The time of first pressing in the analgesic pump in the OBG was later than that in the COG, and the total consumption of sufentanil was less than that in the COG (p < 0.001). The total incidence of adverse reactions in the OBG was lower than that in the COG (p < 0.05).
Conclusions: Intravenous remazolam injection provides safe and effective sedation and analgesia for patients on TURP and reduces the occurrence of stress responses and adverse reactions. However, cases involved in this study were all from a single centre, and multi-centre research and verification are needed.
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Objective: To analyse the predictive value of prostate health index (PHI) combined with serum testosterone after radical prostatectomy (RP) for prostate cancer (PCa).
Methods: A total of 132 PCa patients who received RP treatment from January 2016 to December 2019 were selected, retrospectively. And then these patients were divided into biochemical recurrence (BCR) group (n = 51) and non-biochemical recurrence (non-BCR) group (n = 81) based on whether BCR was present after RP. Basic data of PCa patients were collected, and preoperative prostate health index (PHI) and serum testosterone levels were measured in both groups. Logistic regression analysis was used to analyse the influencing factors of BCR after RP. The predictive value of PHI and serum testosterone on BCR after RP was analysed using the receiver operating characteristic (ROC) curve. The Kaplan–Meier method was used to plot survival curves, and log rank test was used to analyse the differences between survival curves.
Results: The BCR rate of patients in this study was 38.64% (51/132). Single-factor analysis showed that BCR after RP in PCa patients was associated with prostate-specific antigen (PSA), Gleason score, pathological stage, postoperative adjuvant therapy, testosterone and PHI (p < 0.05). Logistics regression analysis showed that PSA >20 ng/mL, Gleason score (8 scores), pathological stage pT3, increased PHI and increased testosterone were independent risk factors for BCR after RP. ROC curve analysis showed that the area under curve (AUC) of PHI and serum testosterone predicting BCR after RP alone and in combination were 0.769, 0.725 and 0.906, respectively. Kaplan–Meier survival analysis showed that preoperative high PHI and low testosterone are negatively correlated with recurrence-free survival rate.
Conclusions: Preoperative PHI and testosterone can serve as simple prognostic indicators for postoperative BCR in PCa patients undergoing RP. PCa patients with higher PHI levels and lower testosterone levels may be more prone to developing BCR. The combination of PHI and testosterone has a higher value in predicting BCR after RP.
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Objective: This study aimed to explore the clinical and differential diagnostic value of real-time ultrasound elastography combined with transabdominal prostate calcification in prostate cancer (PCa).
Methods: This study retrospectively analysed the clinical pathological data of 97 patients with PCa and 105 patients with benign prostatic hyperplasia (BPH) diagnosed by postoperative pathology in our hospital from May 2020 to May 2021; Comparatively analysed the clinical data of the two groups, including the elastic strain ratio, elastic image compression index, types of prostate calcification and calcification diameter; And used logistic regression analysis to screen out the independent risk factors for identifying PCa and BPH.
Results: No significant difference in age, body weight, body mass index, location of calcification and calcification diameter was observed between the two groups (p > 0.05), and overt differences in elastic strain ratio, elastic image compression index, types of calcification, and testosterone were found between the PCa group and BPH group (p < 0.05). Logistic regression analysis showed that the elastic strain ratio, elastic image compression index and types of calcification were independent risk factors for identifying PCa (p < 0.05). The area under curve value of combined diagnosis under receiver operating characteristic curve was as high as 0.756 (95% CI: 0.691–0.813), with a sensitivity of 67.60% and a specificity of 76.30%.
Conclusions: A certain correlation is observed amongst elastic strain ratio, elastic image compression index, types of prostate calcification and the occurrence and development of PCa. The application of real-time ultrasound elastography combined with the detection of transabdominal prostate calcification in clinical diagnosis can improve the detection rate of PCa, which has an important clinical application value.
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Background: This study aimed to explore technetium-99m-diethylenetriaminepentaacetic acid (99mTc-DTPA) renal dynamic imaging to evaluate duplex kidney function in adult patients.
Subjects and Methods: We retrospectively analyzed the clinical data of 25 patients with duplex kidneys who underwent 99mTc-DTPA renal dynamic imaging between June 2011 and March 2023 at our hospital. Patients in the duplex kidney group (n = 25) were divided into renogram normal (n = 9) and abnormal (n = 16) groups according to the imaging data. Additionally, normal patients were selected as the control group (n = 25). After imaging, the region of interest of the kidneys was delineated, and renography was performed. Renography can provide renal function parameters, including glomerular filtration rate (GFR), Tmax, T1/2, renal clearance, and the GFR ratio of the duplex renal segment (upper renal moiety).
Results: Compared with the control group, the serum creatinine level in the duplex kidney group was higher (p = 0.025), GFR was lower (p = 0.001), and patients with impaired renal function were mainly in the abnormal renography group (p = 0.001). In the duplex kidney group, the GFR (p = 0.026) and renal clearance (p = 0.006) of the affected kidneys were lower than those of the contralateral kidneys, and Tmax (p = 0.025) was higher than that of the contralateral kidneys. There were no differences in renal function indicators of duplex renal segments with different GFR ratios. However, when the GFR ratio exceeded 50%, the renal function tended to decline.
Conclusions: 99mTc-DTPA renal dynamic imaging was found useful to evaluate the total renal function, split renal function, and upper urinary tract patency in patients with duplex kidneys. Patients with abnormal renography results had worse renal function, and those with poor renal clearance in the affected renal moiety required surgical treatment.
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Objective: This study aimed to conduct a systematic review of studies investigating the influencing factors of sepsis in patients following prostate biopsy and to provide clinical references for the prevention and reduction of sepsis occurrence.
Methods: A comprehensive computer search was performed on multiple databases, including PubMed, Web of Science, Embase, and Scope. The search period extended from the inception of each database to September 2023. Two independent researchers screened the literature, extracted data, evaluated the risk of bias, and conducted a meta-analysis using R software. The included studies comprised cohort and case-control studies, and the inverse variance method was utilized to combine odds ratio (OR) values with corresponding 95% confidence intervals (CIs).
Results: The analysis included a total of 22 studies involving 374,021 patients. Meta-analysis results indicated that targeted prophylactic antibiotics (OR = 0.48, 95% CI [0.23, 0.98]), combined use of antibiotics (OR = 0.44, 95% CI [0.25, 0.76]), history of antibiotic use (OR = 2.54, 95% CI [1.49, 4.31]), and diabetes (OR = 2.95, 95% CI [1.25, 6.98]) may be influential factors for sepsis after prostate biopsy. However, factors such as biopsy procedure, positive biopsy, and previous biopsy did not exhibit a significant association with sepsis after prostate biopsy.
Conclusions: Targeted prophylactic antibiotics, combined use of antibiotics, history of antibiotic use, and diabetes are identified as influential factors for sepsis in patients after prostate biopsy. However, due to limitations in the quantity and quality of the included studies, further high-quality research is necessary to validate these findings.
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Patients with chronic diarrhoea or ileostomies suffer from electrolyte and urinary disorders and are prone to developing uric acid or calcium oxalate stones. Evidence is lacking regarding the management of uric acid stones in patients with inflammatory bowel diseases. We present the case of a male patient with Crohn’s disease and carrying an ileostomy. He was diagnosed with uric acid urolithiasis (stone size of 11 mm located in the left pyeloureteral junction) after presenting to the emergency room during an episode of left renal colic. Results of the 24-hour urinalysis showed an acidic pH (pH <5), consistent with hyperuricosuria. The suspicion of uric acid lithiasis was confirmed after performing an X-ray diffraction analysis of a lithiasic fragment that passed during acute renal colic. The patient was prescribed with urinary alkalinisers (medical treatment) and dietary recommendations. After 12 months of treatment and urine pH monitoring, the patient achieved complete chemolysis while maintaining the stability of his underlying Crohn’s disease. The patient had no complications during follow-up, referring adequate gastrointestinal tolerance to treatment and denying side effects. The patient remains asymptomatic and is being followed-up on an outpatient basis. He continues on prophylactic treatment (Lit-Control® pH Up) to maintain the pH in the non-acidic range.
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Background: Injectable hyaluronic acid (HA) gel has emerged as a widely used soft tissue filler for surgeries. In penile reconstructive surgery, HA gel has been employed for penile or glans augmentation in selected patients diagnosed with micropenis. This augmentation technique involves injecting the gel into submucosal tissue and increasing the size of the penis for approximately 1 year. A few studies have investigated the possible complications correlated with medically assisted penile injections of HA gel. However, no previous reports have shown the complications of self-administered HA injection. This case report aims to present the first documented case of ischaemic priapism as a complication of self-administered HA injection.
Case Presentation: We present the case of a 43-year-old male who self-administered a 20 mL injection of HA into the dorsal side of his penis. The injected material probably reached the corpora cavernosa, leading to priapism within a few hours. However, the patient did not seek medical attention until 72 h later. The first two initial conservative attempts of blood drainage were unsuccessful because the gel had obstructed vein drainage, causing the penis to remain in a state of priapism. The final treatment approach involved shunting, high enoxaparin doses and oral Effortil administration.
Conclusions: While complications from medically assisted HA injections have been documented, this case report sheds light on the complications arising from self-administered penile injections. Priapism is a severe medical condition that requires immediate treatment to avoid potentially serious long-term consequences. Healthcare providers and patients must acknowledge its symptoms and its appropriate course of treatment, especially in the context of penile medical injections.
