Although metabolic acidosis is a common phenomenon, its differential diagnoses include a variety of rare conditions. Among the causes of high anion gap metabolic acidosis is an accumulation of 5-oxoproline or pyroglutamic acid. It is commonly understood that development can occur in the context of high-dose paracetamol intake and either relevant clinical risk factors or comedication with flucloxacillin or oxacillin. As a rare condition, it has become well-known only to specialized clinicians. We reported a case of high anion gap metabolic acidosis caused by 5-oxoproline in a middle-aged male treated only with high-dose flucloxacillin. Our patient had neither a history of paracetamol use nor classical risk factors to a degree, making the development of 5-oxoproline/pyroglutamic acidosis plausible. Although there have been plenty of case reports of this condition because of the coadministration of paracetamol/acetaminophen and flucloxacillin/oxacillin, to our knowledge, this is only the second published case of 5-oxoproline acidosis without paracetamol use, making it either highly unusual or potentially underdiagnosed. Therefore, we suggest considering 5-oxoproline/pyroglutamic acidosis when evaluating the etiology of metabolic acidosis in patients on high-dose flucloxacillin/oxacillin, even without a history of concomitant or previous paracetamol exposure or other classical risk factors.
Abstract Background There is still controversy about the best minimally invasive surgical method for the treatment of calyceal diverticulum calculi. We conducted meta-analysis to evaluate the effectiveness and safety of PCNL and FURL in the treatment of calyceal diverticulum calculi. Methods We searched Pubmed, Cochrane Library, Web of Science, Embase, Clinical trial platform, CNKI, VIP until April 2024. We utilized the Newcastle–Ottawa Scale (NOS, 0 to 9 stars) to assess the quality of the included literature. Results Totally 15 high-quality studies with 755 patients were included in the meta-analysis. Meta-analysis showed that FURL group was better than PCNL group in blood loss [SMD = 1.713, 95%CI:(0.858, 2.568), Z = 3.928, P = 0.000] and hospital stay [SMD = 2.611, 95%CI: (1.726, 3.496), Z = 5.784, P = 0.000], there was no significant difference in operating time [SMD = 0.079, 95%CI:(-0.43, 0.589), Z = 0.306, P = 0.760], complication rate [OR = 1.793,95%CI: (0.952,2.602), Z = 1.586, P = 0.113], stone-free rate [OR = 1.339, 95%CI: (0.576, 3.112), Z = 0.678, P = 0.497] and symptom-free rate [OR = 3.826,95%CI: (0.561,10.238), Z = 0.966, P = 0.334] as well. Conclusion Whether FURL is indeed superior to PCNL in safety, whether FURL's efficacy is really close to PCNL, and whether FURL can surpass PCNL as the first choice for the treatment of renal diverticulum stones in the future need to be further verified by multi-center, large-sample and high-quality studies.
Abstract Background Type-III prostatitis is the most common prostate disease in adult males below 40 years old. The actual operation of its diagnosis process is cumbersome. Recently, a group of top Chinese urologists have proposed the theory of “prostate-pelvic syndrome (PPS)” and suggested using it to replace the traditional term for type-III prostatitis. However, the practical application effectiveness of PPS theory in clinical practice is still unclear. Objective The aims of this study were to verify the clinical outcome of PPS theory in diagnosing the adult patients with type-III prostatitis below 40 years old and analyze the related factors for the main symptoms of PPS in adult males below 40 years old, providing references for the prevention and treatment of PPS in young adult males. Methods The clinical medical records of 548 adult outpatients with type-III prostatitis under 40 years old between August 2018 and May 2023 were retrospectively analyzed. The patients were diagnosed retrospectively again by using PPS diagnostic criteria in this retrospective cohort study. Subsequently, the age, disease duration, prostate volume (PV), PV ≥ 20 mL detection rate and other related indicators among different symptom groups were analyzed by univariate analysis. The correlation between different symptoms of PPS patients and PV as well as disease duration was analyzed by correlation analysis. Additionally, the related factors for different main symptoms of PPS patients were analyzed by multivariate analysis. Results Of the 548 patients, 229 patients had lower urinary tract symptoms, 159 patients had pelvic pain symptoms, and 160 patients had lower urinary tract and pelvic pain symptoms, respectively corresponding to those with voiding symptoms (VS), pain symptoms (PS), and voiding + pain symptoms (VS + PS) defined according to the concept of PPS. There were significant differences in PV and disease duration among the three main symptoms groups of PPS. PV in the VS group was larger than that in the PS group. Spearman correlation analysis showed that VS was positively correlated with PV and disease duration, while four secondary symptoms (including sexual dysfunction, psychosocial symptoms, reproductive dysfunction and other symptoms) were not related to PV. The proportion of VS patients in the PV ≥ 20 mL group was higher than that in the PV < 20 mL group. Multivariate logistic analysis showed that PV and disease duration were independent related factors for VS in adult PPS patients below 40 years old. Conclusions Type-III prostatitis in Chinese adult males below 40 years old can be diagnosed and treated with PPS. PV and disease duration were independent related factors for VS in Chinese adult PPS patients below 40 years old. The risk of VS in PPS patients with PV ≥ 20 mL was 5.348 times as long as that in PPS patients with PV < 20 mL.
Prostate cancer is the most frequently diagnosed tumor of male reproductive system. Clinically, there is a lack of effective treatment drugs for prostate cancer. Previous studies have shown that AMPK inhibitor dorsomorphin was demonstrated to have potent antitumor effects. However, the effect of dorsomorphin on prostate cancer and its molecular mechanism are still unclear. In this study, the effects of dorsomorphin on the invasion and infiltration, epithelial-mesenchymal transition (EMT), and angiogenesis were investigated in two types of prostate cancer cells (DU145 and PC-3). In addition, nude mouse tumorigenic experiments were performed to confirm the antitumor effect of dorsomorphin. We found that dorsomorphin treatment concentration- and time-dependently inhibited the invasion and infiltration of DU145 and PC-3 cells. In addition, dorsomorphin reduced the expression levels of extracellular matrix components and angiogenesis-related proteins (HIF-1α and VEGF). Further study showed that dorsomorphin inhibited matrix deposition by antagonizing the EMT. Our results from nude mouse tumorigenic experiments further demonstrated dorsomorphin’s tumor-growth inhibitory effect, whereas its antimetastatic potential is supported by in vitro invasion and EMT assays. Mechanistically, dorsomorphin treatment suppressed TGF-β1 expression and thereby inhibited the phosphorylation and nucleation of Smad2/3 signaling, which plays a key role in the regulation of EMT. Further study showed that dorsomorphin-triggered inactivation of JAK2/STAT3 and sonic hedgehog (Shh) signaling was involved in the inhibition of TGF-β1-mediated EMT. Interestingly, dorsomorphin inhibited the expression and nucleation of Gli1 and Gli3 but not affected the expression of Gli2. Thus, these findings reveal that the new mechanism of AMPK inhibitor dorsomorphin against prostate cancer metastasis is through synergistically antagonizing JAK2/STAT3 and Gli2-independent Shh activation.
Diseases of the genitourinary system. Urology, Neoplasms. Tumors. Oncology. Including cancer and carcinogens
Saad Andaloussi, Zakarya Alami Hassani, Saad Annattah
et al.
Circumcision is among the most commonly performed surgical procedures in boys. In Morocco, this practice is often carried out by traditional practitioners, exposing patients to potentially catastrophic complications that are challenging to manage. We report the case of a 2-year-old boy who underwent ritual circumcision complicated by total penile amputation, with loss of the amputated stump. A meatoplasty was performed, and the postoperative course was uneventful. This case underscores the importance of recognizing circumcision as a surgical procedure that should not be trivialized. Furthermore, it highlights the necessity of implementing training programs for traditional practitioners to promote safe circumcision practices.
Introduction: The Mayo imaging classification model (MICM) requires a prestep qualitative assessment to determine whether a patient is in class 1 (typical) or class 2 (atypical), where patients assigned to class 2 are excluded from the MICM application. Methods: We developed a deep learning–based method to automatically classify class 1 and 2 from magnetic resonance (MR) images and provide classification confidence utilizing abdominal T2-weighted MR images from 486 subjects, where transfer learning was applied. In addition, the explainable artificial intelligence (XAI) method was illustrated to enhance the explainability of the automated classification results. For performance evaluations, confusion matrices were generated, and receiver operating characteristic curves were drawn to measure the area under the curve. Results: The proposed method showed excellent performance for the classification of class 1 (97.7%) and 2 (100%), where the combined test accuracy was 98.01%. The precision and recall for predicting class 1 were 1.00 and 0.98, respectively, with F1-score of 0.99; whereas those for predicting class 2 were 0.87 and 1.00, respectively, with F1-score of 0.93. The weighted averages of precision and recall were 0.98 and 0.98, respectively, showing the classification confidence scores whereas the XAI method well-highlighted contributing regions for the classification. Conclusion: The proposed automated method can classify class 1 and 2 cases as accurately as the level of a human expert. This method may be a useful tool to facilitate clinical trials investigating different types of kidney morphology and for clinical management of patients with autosomal dominant polycystic kidney disease (ADPKD).
Kathryn L. Taylor, George Luta, Vasiliki Zotou
et al.
Abstract Objectives In a prospective, comparative effectiveness study, we assessed clinical and psychological factors associated with switching from active surveillance (AS) to active treatment (AT) among low‐risk prostate cancer (PCa) patients. Methods Using ultra‐rapid case identification, we conducted pretreatment telephone interviews (N = 1139) with low‐risk patients (PSA ≤ 10, Gleason≤6) and follow‐up interviews 6–10 months post‐diagnosis (N = 1057). Among men remaining on AS for at least 12 months (N = 601), we compared those who continued on AS (N = 515) versus men who underwent delayed AT (N = 86) between 13 and 24 months, using Cox proportional hazards models. Results Delayed AT was predicted by time dependent PSA levels (≥10 vs. <10; HR = 5.6, 95% CI 2.4–13.1) and Gleason scores (≥7 vs. ≤6; adjusted HR = 20.2, 95% CI 12.2–33.4). Further, delayed AT was more likely among men whose urologist initially recommended AT (HR = 2.13, 95% CI 1.07–4.22), for whom tumour removal was very important (HR = 2.18, 95% CI 1.35–3.52), and who reported greater worry about not detecting disease progression early (HR = 1.67, 1.05–2.65). In exploratory analyses, 31% (27/86) switched to AT without evidence of progression, while 4.7% (24/515) remained on AS with evidence of progression. Conclusions After adjusting for clinical evidence of disease progression over the first year post‐diagnosis, we found that urologists' initial treatment recommendation and patients' early treatment preferences and concerns about AS each independently predicted undergoing delayed AT during the second year post‐diagnosis. These findings, along with almost one‐half undergoing delayed AT without evidence of progression, suggest the need for greater decision support to remain on AS when it is clinically indicated.
Objective: Urothelial carcinoma (UC) is heterogeneous, and variant histologies (VH) are more frequent than initially reported. Reporting VH is recommended by several guidelines because of prognostic and therapeutic implications. We evaluated the concordance of VH between the first transurethral resections of the bladder (TURBs) and the following radical cystectomy (RC). This paper is the first to compare VH with a central pathology review between TURB and RC.
Material and methods: In this retrospective study, we only included those patients who underwent TURB with VH and then RC between 01/2010 and 12/2013 at our institution. The presence of VH in both TURB and RC was assessed and compared according to the 2016 World Health Organization (WHO) classification by a central pathology review.
Results: Among 110 patients who had the initial TURB/RC, 54 (49.1%) were diagnosed with VH, 48 (43%) had a single pattern, and six had (5%) multiple histological patterns. Squamous differentiation was the most common single VH (31%). Twenty patients with UC (18%) showed discordance between TURB and RC, especially in micropapillary versus nested (n=3) cases. Concordant histology between TURB/RC was seen in 82% of the cases.
Conclusion: Discrepancies can be seen between TURB and RC when reporting VH, which can be problematic for selection of therapy and management. TURB alone might be insufficient to evaluate the presence of VH, especially in VH with heavy therapeutic implications, such as micropapillary carcinomas. Nevertheless, concordance with a central review by an experienced uropathologist when applying the WHO 2016 classification is 82%.
Cite this article as: Ngo C, Cussenot O, Compérat E. Transurethral resection of bladder and radical cystectomy: Concordance of histology. Are we good enough? Turk J Urol 2020; 46(5): 354-9.
Chihiro Kato, Naohiko Fujii, Chisato Miyakoshi
et al.
Abstract Background There is limited evidence on the association between short-term changes in mineral and bone disorder parameters and survival in maintenance hemodialysis patients. Methods We investigated the association between changing patterns of phosphorus, calcium and intact parathyroid hormone levels and all-cause mortality in hemodialysis patients with secondary hyperparathyroidism. Each parameter was divided into three categories (low [L], middle [M] and high [H]), and the changing patterns between two consecutive visits at 3-month intervals were categorized into nine groups (e.g., L-L and M-H). The middle category was defined as 4.0–7.0 mg/dL for phosphorous, 8.5–9.5 mg/dL for calcium and 200–500 pg/mL for intact parathyroid hormone. Adjusted incidence rates and rate ratios were analyzed by weighted Poisson regression models accounting for time-dependent exposures. Results For phosphorus, shifts from low/high to middle category (L-M/H-M) were associated with a lower mortality compared with the L-L and H–H groups, whereas shifts from middle to low/high category (M-L/M-H) were associated with a higher mortality compared with the M-M group. For calcium, shifts from low/middle to high category (L–H/M-H) were associated with a higher mortality compared with the L-L and M-M groups, whereas shifts from high to middle category (H-M) were associated with a lower mortality compared with the H–H group. For intact parathyroid hormone, shifts from low to middle category (L-M) were associated with a lower mortality compared with the L-L group. Conclusions Changes in the 3-month patterns of phosphorus and calcium toward the middle category were associated with lower mortality. Our study also suggests the importance of avoiding hypercalcemia.
Oscar Storme, José Tirán Saucedo, Arturo Garcia-Mora
et al.
Understanding individual and population-specific risk factors associated with recurrent urinary tract infections (UTIs) can help physicians tailor prophylactic strategies. Frequent intercourse, vulvovaginal atrophy, change of the local bacterial flora, history of UTIs during premenopause or in childhood, family history, and a nonsecretor blood type are substantiated risk factors for recurrent uncomplicated UTIs. This is a narrative review based on relevant literature according to the experience and expertise of the authors. Asymptomatic bacteriuria is generally benign; however, during pregnancy it is more common and is associated with an increased likelihood of symptomatic infection, which may harm the mother or fetus. Screening of pregnant women and appropriate treatment with antimicrobials must be balanced with the potential for adverse treatment-related outcomes; appropriate prophylaxis should be considered where possible. High-quality data are currently lacking on risks related to asymptomatic bacteriuria in pregnancy and further data in this hard-to-study population should be a primary concern for researchers. Incomplete voiding represents the primary risk factor for UTIs associated with conditions such as urinary incontinence and prolapse. Correcting the presence of residual urine remains the most effective prophylaxis in these populations. Bladder function alters throughout life; however, changes in function may be particularly profound in clinical populations at high risk of UTIs. Patients with neurogenic bladder will also likely have other evolving medical issues which increase the risk of UTIs, such as repeated catheterization and increasing residual urine volume. More aggressive antimicrobial prophylactic strategies may be appropriate in these patients. Again, the paucity of data on prophylaxis in these high-risk patients requires the attention of the research community.