Benign prostatic hyperplasia (BPH) is one of the widespread diseases affecting aging males globally. As prostatic cell proliferation, it clinically influences a great degree of bladder outlet obstruction and is characterized by bothersome lower urinary tract symptoms. Assessments and treatments should not only be conducted based on the prostate volume or condition, related symptoms and quality of life should be considered also. The present analysis focuses on the update of management for BPH, including pharmacotherapy and slightly invasive surgical options. Despite alpha-1 adrenoceptor antagonists, many other factors and even combination therapy were extensively studied. Regarding slightly invasive surgical treatments, including Aquablation, water vapor thermal therapy, prostatic artery embolization, prostatic urethral lift, and nitinol butterfly-like stent, we analyzed the latest findings of studies, as well as safety issues. Finally, we highlighted current guidelines for clinical practice and future direction for further investigation.

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Purpose: Although intravesical chemotherapy has several antitumoral benefits, it can also have severe side effects. The development of novel therapeutic approaches for bladder cancer (BC) is thus warranted. Hyperthermia (HT) is a widely applicable adjuvant therapy in various cancers. Therefore, this study investigated the effect of HT on improving the chemosensitivity of BC. Materials and Methods: The BC cell lines 5637 and T24 were cultured and treated with HT (43°C) for 24 h. Then, cell viability and survival were assessed using resazurin reagent and colony formation assay, respectively. Western blot assay was used to analyze the levels of Bax, Bcl-2, cleaved caspase-3, and cleaved poly (ADP-ribose) polymerase (PARP) protein expression. Mitochondria degradation was observed by MitoTracker Green staining. Results: In BC cells, HT co-administered with various concentrations of doxorubicin significantly inhibited cell viability and survival. Moreover, HT combined with doxorubicin promoted mitochondrial apoptosis, which caused Bax upregulation and Bcl-2 downregulation. Levels of cleaved caspase-3 and PARP protein expression were also elevated after co-treatment. Conclusion: Taken together, HT improved the chemosensitivity of BC cells to doxorubicin. HT combined with chemotherapy further activated mitochondrial apoptosis in BC cells. The findings suggested that HT may serve as a potential adjunctive treatment for BC that is ready to be applied clinically.

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Purpose: Because bacterial motility has been implicated as a potential virulence factor, we compared the motile and nonmotile properties of bacteria isolated from urine cultures in women with recurrent urinary tract infections (RUTI) to test if such motility properties are linked to the extent of bladder wall infection on cystoscopy. Materials and Methods: After IRB approval, a retrospective review of women with antibiotic-recalcitrant symptomatic RUTI (≥3 Urinary tract infections/year) who underwent electrofulguration (EF) for cystitis was conducted. Pre-operative office cystoscopy staged cystitis as stage 1: trigone (trigonitis), stage 2: stage 1 and bladder base, stage 3: stage 2 and one or both lateral walls, and stage 4: the whole bladder (pancystitis). Positive urine cultures before EF for the type of bacteria (motile vs. non-motile) were compared among stages. Results: From 2006 to 2020, 139 women with RUTI met the study criteria. The median age was 67 with 95% Caucasian. Those with stage 4 cystitis were older (P = 0.0009) and less sexually active (P = 0.038). Patients with a higher stage were associated with a higher number of motile organisms (P = 0.0056), with an increased presence of non-E. Coli motile organisms (P < 0.0001) such as Proteus (P = 0.0024), Pseudomonas (P = 0.0062), Enterobacter (P = 0.020) and Citrobacter (P = 0.0067). Conclusion: The comparison of bacterial motility in women with RUTI at four different stages of bladder surface involvement identified unique characteristics and bacterial strains associated with each stage. RUTI women with higher stages of cystitis had more unique types of motile urinary bacterial strains, possibly suggesting a role in the spread of cystitis beyond the trigone.

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Purpose: The five-grade international scale for vesicoureteral reflux (VUR) has been the mainstay for describing VUR severity. The concept of the distal ureteral diameter to the L1–L3 vertebral body distance ratio has been validated. We validated the ureteral diameter ratio (UDR) for predicting VUR outcomes and determined the cutoff value for spontaneous resolution. Materials and Methods: This retrospective review included children with primary VUR and detailed serial voiding cystourethrograms (VCUGs) between March 2005 and December 2016. Patient characteristics, VUR grade, laterality, UDR, laboratory data, and follow-up results were collected. UDR was estimated as the largest distal ureteral diameter within the pelvis divided by the distance of the L1–L3 vertebral bodies. The primary outcome was the prediction of spontaneous VUR resolution. The secondary outcome was the determination of the cutoff value of UDR in the present cohort. Results: We recruited 101 children (59 boys and 42 girls) diagnosed as having primary VUR based on VCUGs at a mean age of 23.48 months. VUR resolved spontaneously in 31 (30.7%) children, 40 (39.6%) children had persistent disease, and 30 (29.7%) received surgical correction. In univariate analysis, laterality, VUR grade, and UDR were significantly associated with spontaneous resolution (P = 0.017, P = 0.026, and P = 0.001, respectively). Multivariate analysis revealed UDR as the prognostic factor for spontaneous VUR resolution (odds ratio, 4.167; P = 0.023). The area under the curve of UDR indicates that the prediction accuracy was 0.74. The optimal cutoff value for UDR in this study was 0.264 (sensitivity, 0.81 and specificity, 0.63). Conclusion: UDR is superior to the VUR grade for predicting spontaneous VUR resolution. Our findings add significant prognostic value for children with primary VUR. A cutoff value of 0.264 may assist with clinical assessment and future management.

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Purpose: To assess the safety and efficacy of self-removing antegrade tethered stents after percutaneous nephrolithotomy (PNL) during the COVID-19 pandemic. Materials and Methods: Instead of routine placement of double-J stent which requires endoscopic removal, a tethered antegrade stent after tubeless PNL as an exit strategy followed by self-removal can obviate the need of early postoperative revisit. A prospective observational study in a university teaching hospital was conducted during the lockdown period from May 2021–June 2021 with the use of antegrade tethered stent in 30 patients and we studied the complications associated with it. Results: The average stone size among the patients was 2.4 cm (1.2–4.9). Postoperative visual analog scale (VAS) till the time of stent removal was 30.8 + 4.4 mm while the VAS at stent removal was 26.6 + 3.8 mm. None of the patients had urine leak or hemorrhage from the site of percutaneous access after self-removal of stent. Two (6.66 percent) patients had grade I and grade II modified Clavien–Dindo complication. The mean score of satisfaction with life scale (SWLS) Questionnaire was 31 (34–27). The present study demonstrates that tubeless PNL with antegrade tethered stent has the advantages of avoiding hospital visits for stent removal during COVID-19. Conclusion: The use of an antegrade threaded stent is safe, culminating in minimal morbidity and patient distress, and greater overall patient satisfaction.

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Purpose: The gold standard for treatment of urothelial carcinoma (UC) of the ureter is radical nephroureterectomy (RNU) with bladder cuff excision. However, segmental ureterectomy (SU) can be considered in specific cases, such as serious renal insufficiency or solitary kidney. This study evaluated oncologic and renal function outcomes of SU compared with RNU for treatment of UC of the ureter. Materials and Methods: This single-center retrospective study assessed 99 patients who underwent SU or RNU for UC of the ureter from October 2005 to May 2021. Exclusion criteria were end-stage renal disease managed with regular hemodialysis (10 patients) and previous or concurrent radical cystectomy due to muscle-invasive bladder cancer (20 patients). The study enrolled 69 patients, with 39 in the RNU group and 30 in the SU group, to compare perioperative outcomes and renal function outcomes between the groups. Kaplan–Meier analysis and the log-rank test were performed to compare overall survival (OS), cancer-specific survival (CSS), intravesical recurrence-free survival (IVRFS), and disease-free survival (DFS) between the groups. Results: The mean age was 67.5 years in the RNU group and 68.3 years in the SU group. The median tumor length was 3.2 cm in the RNU group and 2.4 cm in the SU group. Patients who underwent RNU had a significantly decreased estimated glomerular filtration rate at 3 months postoperatively (−6.4 vs. 3.5 mL/min/1.73 m²; P = 0.001). No significant differences were found for OS, CSS, and IVRFS between the groups. However, the SU group had shorter DFS (P = 0.029). Conclusion: Results showed that SU may preserve better renal function. The OS and CSS were comparable between the groups; however, the SU group had shorter DFS. When preservation of renal function is warranted, SU may be considered for patients with UC of the ureter.

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Purpose: The Prostate Health Index (PHI) and multiparametric magnetic resonance imaging (mpMRI) are used as complementary tools for more accurate diagnosis in men with suspected prostate cancer (PCa). This study investigated whether the combination of PHI and mpMRI better predict clinically significant PCa (csPCa), defined as a Gleason score of ≥7. Materials and Methods: Ninety-four men with clinical suspicion of csPCa were prospectively included. PHI was determined before the prostate biopsy. A uroradiologist reviewed mpMRI findings by using the Prostate Imaging Reporting and Data System version 2.1 (PI-RADS version 2.1). Fusion-targeted biopsy with systematic biopsy was performed in patients with any suspicious lesions on MRI (PI-RADS assessment category ≥3), whereas systematic biopsy was performed in patients without suspicious lesions. The diagnostic values of different biomarkers and PI-RADS were compared by the area under the receiver operating curve (area under the curve [AUC]) for detecting csPCa. Results: Forty-nine (52%) patients were diagnosed with csPCa. The csPCa group had higher median PHI and more abnormal MRI findings than did the non-csPCa group. The median total prostate-specific antigen (PSA) level was similar between the PI-RADS 3 and 4 lesion groups. The median PHI values increased and more patients were diagnosed as having csPCa with an increase in PI-RADS. The receiver operating characteristic curve indicated that PHI and MRI (AUC 0.85 and 0.82, respectively) predicted csPCa more accurately than did the total PSA, free PSA ratio, and PSA density. Adding PHI to mpMRI significantly increased the diagnostic accuracy for csPCa (P = 0.004). PHI remained the optimal biomarker in patients with “gray zone” PI-RADS 3 or PI-RADS 4 lesions. Conclusion: PHI can guide decision-making for prostate biopsy for patients with gray-zone mpMRI lesions. We proposed a biopsy strategy incorporating PHI and MRI which resulted in the avoidance of biopsies in 35% of the patients.

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Purpose: Comparative studies on the outcomes of robot-assisted partial nephrectomy (RAPN) procedures conducted using the da Vinci Xi and Si platforms remain sparse. We retrospectively reviewed and compared the Trifecta and Pentafecta rates of the two robotic surgical platforms. Materials and Methods: A total of 338 patients who had undergone RAPN using da Vinci Si platform or Xi platform were included. Pentafecta was defined herein as Trifecta (a warm ischemia time <25 min, a negative surgical margin, and the absence of significant perioperative complications) with the addition of estimated glomerular filtration rate preservation of over 90% and no chronic kidney disease stage progression by 12 months postsurgery. Multivariate logistic regression analysis was conducted to identify the predictors of Trifecta and Pentafecta achievement. Results: The trifecta and pentafecta rates were higher in the Xi group than in the Si group (65% vs. 29%, P < 0.001 for trifecta; 31% vs. 14%, P = 0.001 for pentafecta). In addition, a significantly shorter average WIT (19 vs. 28 min, P < 0.001) and console time (141 vs. 163 min, P = 0.004) were identified in the Xi group than in the Si group. RAPN conducted using the Xi platform was independently associated with both higher achievement rates of trifecta and pentafecta. In addition, multivariate regression analyses revealed that no history of hypertension, low tumor complexity as measured using the RENAL nephrometry score, anterior orientation of the renal tumor were associated with higher Trifecta rates; while history of diabetes and anterior–posterior renal tumor orientation were the significant predictors of Pentafecta achievement, respectively. Conclusion: A significantly higher rates of trifecta and pentafecta achievement were observed in the Xi group than in the Si group. The use of the Xi platform was also significantly associated with low operative times and acceptable complication rates.

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