Precise knowledge of each patient’s index cancer and surrounding anatomy is required for nerve-sp... more Precise knowledge of each patient’s index cancer and surrounding anatomy is required for nerve-sparing robot-assisted radical prostatectomy (NS-RARP). Complementary to this, 3D printing has proven its utility in improving the visualisation of complex anatomy. This is the first systematic review to critically assess the potential of 3D printed patient-specific prostate cancer models in improving visualisation and the practice of NS-RARP. A literature search of PubMed and OVID Medline databases was performed using the terms “3D Printing”, “Robot Assisted Radical Prostatectomy” and related index terms as per the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Eight articles were included; six were identified via database searches, to which a further two articles were located via a snowballing approach. Eight papers were identified for review. There were five prospective single centre studies, one case series, one technical report and one letter t...
INTRODUCTION AND OBJECTIVE: Pressured irrigation is routinely utilised in treatment of urinary ca... more INTRODUCTION AND OBJECTIVE: Pressured irrigation is routinely utilised in treatment of urinary calculi by uretero-renoscopic surgery. Although this can be in multiple forms, standardised pneumatic pressure upon the fluid irrigation bag is the routine. Another method is the use of similar fluid under pressure with routine intermittent manual pressure on a refillable chamber, which is suggested to provide improved vision during those periods when the hydrostatic pressure is increased. There is little data to suggest preferential outcomes from either format, and consequently the technique utilised tends to be at the discretion of the surgeon. We aimed to evaluate the outcomes of treatment for those patients from our institution who were treated using both of these forms of pressured irrigation. METHODS: Patients were allocated to the operating lists of a group of endourologists at a large teaching hospital by a bookings officer who had no knowledge of which surgeon would routinely use manually pressured irrigation intermittently throughout a period of standard pressured irrigation. There was no stratification of patients to different urologists based upon stone size, location, composition or patient demographics. Stone specific data was recorded in an established database, and outcomes of treatment were identified by an independent researcher who was not one of the treating urologists. RESULTS: 173 patients were treated by flexible ureterorenoscopic stone laser over a 2 year period. Mean patient age was 54 years and 111 patients (64%) were male. 149 (86%) of patients had renal stones and the remainder had proximal ureteric stones. 10 patients had staghorn renal calculi who were treated without percutaneous access. Median stone size was identical (10.0 mm) between the two groups who were treated with and without manually pressured irrigation. Retreatment rate was similar at 17% in each cohort. There was no difference in the inpatient length of stay (1.16 vs 1.14 days), although episodes of hypotension and tachycardia post surgery requiring medical review were more common in the group treated with manually pressured irrigation (29 patients vs 2 patients Chi p [ 0.04). There was no difference in post operative rates of urinary tract infection. Time spent undertaking ureteroscopic stone laser and retrieval was significantly increased in the group who underwent treatment with additional manually pressured irrigation (98.4 vs 81.3 minutes). Representation rates of patients to the emergency department within 60 days were considerably increased in patients who had undergone treatment with routine use of intermittent manually pressured irrigation (44 patients vs 5 patients Chi p [ 0.04), and the main cause of increased representation was flank pain (37 patients vs 1 Chi p [ 0.003). CONCLUSIONS: Routine use of intermittent manually pressured irrigation in addition to background hydrostatic pressure irrigation does not appear to confer any objective benefit in regard to outcomes of stone treatment. Although there may be an anecdotal and temporary benefit in regard to vision during ureterorenoscopy this technique appears to be associated with a significantly greater readmission rate after surgery, and an increased risk of hypotension and tachycardia post surgery. It is hard to justify the routine use of this operative technique, which should be reserved for specific instances where routine techniques are proving inadequate for endoscopic management of upper tract calculi.
Epigenetics is a growing field and in bladder cancer, it is of particular interest in advanced or... more Epigenetics is a growing field and in bladder cancer, it is of particular interest in advanced or metastatic disease. As opposed to genetic mutations in which the nucleotide sequence itself is altered, epigenetic alterations refer to changes to the genome that do not involve nucleotides. This is of great interest in cancer research because epigenetic alterations are reversible, making them a promising target for pharmacological agents. While chemoimmunotherapy is the mainstay for metastatic disease, there are few alternatives for patients who have progressed on first- or second-line treatment. By targeting reversible epigenetic alterations, novel epigenetic therapies are important potential treatment options for these patients. A search of clinical registries was performed in order to identify and collate epigenetic therapies currently in human trials. A literature search was also performed to identify therapies that are currently in preclinical stages, whether this be in vivo or in...
Bladder cancer is among the most common newly diagnosed cancers in the Western population, with a... more Bladder cancer is among the most common newly diagnosed cancers in the Western population, with an estimated 81,000 new cases diagnosed in the USA in 2018 (ref. 1). Radical cystectomy remains a principal curative treatment option in patients with muscle-invasive bladder cancer (MIBC) (pT2+) 2. Despite radical cystectomy, oncological outcomes are poor, with reports of 5-year survival as low as 58% 3. Accordingly, an inherent need exists for improved treatment regimens for these patients. Organ-confined, muscle-invasive bladder tumours vary in propensity for metastatic progression, and up to 25% have metastatic deposits within the draining lymph nodes 4. Mounting evidence suggests that the addition of pelvic lymph node dissection (PLND) to radical cystectomy provides considerable benefits. The benefits of PLND during cystectomy are highlighted by the prognostic information provided by accurate nodal staging and the therapeutic implications of reducing disease burden 5-11. These potential benefits must be weighed against the potential drawbacks of PLND, including increased operative time, adjacent visceral and vascular injury, and lymphocoele. Despite these benefits, only a few current uro-oncological guidelines recommend the addition of regional lymph node dissection to radical cystectomy for curative treatment of MIBC 2. Limited population-based epidemiological data exist that assess the precise uptake of PLND in cystectomy. The improved oncological outcomes following PLND have prompted changes to dissection practices, with clinicians adopting more extensive dissection templates 12. Various PLND templates are used in clinical practice and reported in contemporary literature (fig. 1). This heterogeneity limits the ability to make comparisons
European Urology Supplements, Volume 5, Issue 2, Pages 290, April 2006, Authors:B. Ali-el-Dein; A... more European Urology Supplements, Volume 5, Issue 2, Pages 290, April 2006, Authors:B. Ali-el-Dein; AA Shaaban; R. Abu-Eideh; A. Mosbah; M. Abdel-Latif; H. Abol-Enein; MA Ghoneim. Advertisement. Journal Home, Access this ...
Prostate cancer is the second most frequent cancer in men, with increasing prevalence due to an a... more Prostate cancer is the second most frequent cancer in men, with increasing prevalence due to an ageing population. Advanced prostate cancer is diagnosed in up to 20% of patients, and, therefore, it is important to understand evolving mechanisms of progression. Significant morbidity and mortality can occur in advanced prostate cancer where treatment options are intrinsically related to lipid metabolism. Dysfunctional lipid metabolism has long been known to have a relationship to prostate cancer development; however, only recently have studies attempted to elucidate the exact mechanism relating genetic abnormalities and lipid metabolic pathways. Contemporary research has established the pathways leading to prostate cancer development, including dysregulated lipid metabolism-associated de novo lipogenesis through steroid hormone biogenesis and β-oxidation of fatty acids. These pathways, in relation to treatment, have formed potential novel targets for management of advanced prostate ca...
The use of robot-assisted laparoscopic radical prostatectomy (RALP) continues to increase in the ... more The use of robot-assisted laparoscopic radical prostatectomy (RALP) continues to increase in the management of prostate cancer by minimally invasive approach, with shorter convalescence, reduced blood transfusion and improving oncological outcomes when compared to open surgery. There is a growing evidence base that RALP is significantly associated with incisional hernia (IH) at the specimen extraction site compared to open surgery. A series of 186 RALP patients between August 2012 and August 2018 was reviewed, where 1-7 years follow-up had been observed. The study endpoint was IH rate at the supraumbilical specimen extraction site utilized by the surgeon. Incisional hernia rate at specimen extraction site was 8.6% and incidental 1.1% IH rate at a lateral port site (not associated with specimen removal). Average age at operation was 60.9 years old and hernias were diagnosed at a mean of 11.8 months post-surgery. Common demographics in the population suffering from IH were previous abdominal surgery, adhesiolysis, history of smoking and obesity. Supraumbilical extraction site hernias are an underreported complication of RALP which may impact on quality of life and prompt further surgical correction. Patients should be asked for consent regarding the possibility of this complication ensuing.
This is a letter to the editor in response to Topf et al. We describe the rationale behind much o... more This is a letter to the editor in response to Topf et al. We describe the rationale behind much of the analytical methods following publication of our original article " Globalization of Continuing Professional Development by Journal Clubs via Microblogging: A Systematic Review". Further, we provide some updated results following a subsequent review. [J Med Internet Res 2015;17(9):e217]
Fibroepithelial polyps are the most common benign tumor of the ureter. Most of the literature reg... more Fibroepithelial polyps are the most common benign tumor of the ureter. Most of the literature regarding their cause ascribes it to chronic infection. These publications, however, show that the majority of such cases never were associated with a documented urinary tract infection. Fibroepithelial polyps appear with equal frequency in male and female subjects and are found in all age groups including children, in contrast to what would have been expected with an infectious cause. Four histologically confirmed cases of fibroepithelial polyps were associated with chronic inflammation of the upper urinary tract related to the presence of calculi and/or Double J ureteral stents. All patients were managed successfully by endoscopic means, preserving renal function. Fibroepithelial ureteral polyps may be associated with urolithiasis, which serves as a source of chronic inflammation. A review of the literature is presented and supports these observations.
Background. Multidrug-resistant gram-negative bacterial (MDR-GNB) infections of the prostate are ... more Background. Multidrug-resistant gram-negative bacterial (MDR-GNB) infections of the prostate are an increasing problem worldwide, particularly complicating transrectal ultrasound (TRUS)-guided prostate biopsy. Fluoroquinolonebased regimens, once the mainstay of many protocols, are increasingly ineffective. Fosfomycin has reasonable in vitro and urinary activity (minimum inhibitory concentration breakpoint ≤64 µg/mL) against MDR-GNB, but its prostatic penetration has been uncertain, so it has not been widely recommended for the prophylaxis or treatment of MDR-GNB prostatitis. Methods. In a prospective study of healthy men undergoing a transurethral resection of the prostate for benign prostatic hyperplasia, we assessed serum, urine, and prostatic tissue (transition zone [TZ] and peripheral zone [PZ]) fosfomycin concentrations using liquid chromatography-tandem mass spectrometry, following a single 3-g oral fosfomycin dose within 17 hours of surgery. Results. Among the 26 participants, mean plasma and urinary fosfomycin levels were 11.4 ± 7.6 µg/mL and 571 ± 418 µg/mL, 565 ± 149 minutes and 581 ± 150 minutes postdose, respectively. Mean overall prostate fosfomycin levels were 6.5 ± 4.9 µg/g (range, 0.7-22.1 µg/g), with therapeutic concentrations detectable up to 17 hours following the dose. The mean prostate to plasma ratio was 0.67 ± 0.57. Mean concentrations within the TZ vs PZ prostate regions varied significantly (TZ, 8.3 ± 6.6 vs PZ, 4.4 ± 4.1 µg/g; P = .001). Only 1 patient had a mean prostatic fosfomycin concentration of <1 µg/g, whereas the majority (70%) had concentrations ≥4 µg/g. Conclusions. Fosfomycin appears to achieve reasonable intraprostatic concentrations in uninflamed prostate following a single 3-g oral dose, such that it may be a potential option for prophylaxis pre-TRUS prostate biopsy and possibly for the treatment of MDR-GNB prostatitis. Formal clinical studies are now required.
Precise knowledge of each patient’s index cancer and surrounding anatomy is required for nerve-sp... more Precise knowledge of each patient’s index cancer and surrounding anatomy is required for nerve-sparing robot-assisted radical prostatectomy (NS-RARP). Complementary to this, 3D printing has proven its utility in improving the visualisation of complex anatomy. This is the first systematic review to critically assess the potential of 3D printed patient-specific prostate cancer models in improving visualisation and the practice of NS-RARP. A literature search of PubMed and OVID Medline databases was performed using the terms “3D Printing”, “Robot Assisted Radical Prostatectomy” and related index terms as per the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Eight articles were included; six were identified via database searches, to which a further two articles were located via a snowballing approach. Eight papers were identified for review. There were five prospective single centre studies, one case series, one technical report and one letter t...
INTRODUCTION AND OBJECTIVE: Pressured irrigation is routinely utilised in treatment of urinary ca... more INTRODUCTION AND OBJECTIVE: Pressured irrigation is routinely utilised in treatment of urinary calculi by uretero-renoscopic surgery. Although this can be in multiple forms, standardised pneumatic pressure upon the fluid irrigation bag is the routine. Another method is the use of similar fluid under pressure with routine intermittent manual pressure on a refillable chamber, which is suggested to provide improved vision during those periods when the hydrostatic pressure is increased. There is little data to suggest preferential outcomes from either format, and consequently the technique utilised tends to be at the discretion of the surgeon. We aimed to evaluate the outcomes of treatment for those patients from our institution who were treated using both of these forms of pressured irrigation. METHODS: Patients were allocated to the operating lists of a group of endourologists at a large teaching hospital by a bookings officer who had no knowledge of which surgeon would routinely use manually pressured irrigation intermittently throughout a period of standard pressured irrigation. There was no stratification of patients to different urologists based upon stone size, location, composition or patient demographics. Stone specific data was recorded in an established database, and outcomes of treatment were identified by an independent researcher who was not one of the treating urologists. RESULTS: 173 patients were treated by flexible ureterorenoscopic stone laser over a 2 year period. Mean patient age was 54 years and 111 patients (64%) were male. 149 (86%) of patients had renal stones and the remainder had proximal ureteric stones. 10 patients had staghorn renal calculi who were treated without percutaneous access. Median stone size was identical (10.0 mm) between the two groups who were treated with and without manually pressured irrigation. Retreatment rate was similar at 17% in each cohort. There was no difference in the inpatient length of stay (1.16 vs 1.14 days), although episodes of hypotension and tachycardia post surgery requiring medical review were more common in the group treated with manually pressured irrigation (29 patients vs 2 patients Chi p [ 0.04). There was no difference in post operative rates of urinary tract infection. Time spent undertaking ureteroscopic stone laser and retrieval was significantly increased in the group who underwent treatment with additional manually pressured irrigation (98.4 vs 81.3 minutes). Representation rates of patients to the emergency department within 60 days were considerably increased in patients who had undergone treatment with routine use of intermittent manually pressured irrigation (44 patients vs 5 patients Chi p [ 0.04), and the main cause of increased representation was flank pain (37 patients vs 1 Chi p [ 0.003). CONCLUSIONS: Routine use of intermittent manually pressured irrigation in addition to background hydrostatic pressure irrigation does not appear to confer any objective benefit in regard to outcomes of stone treatment. Although there may be an anecdotal and temporary benefit in regard to vision during ureterorenoscopy this technique appears to be associated with a significantly greater readmission rate after surgery, and an increased risk of hypotension and tachycardia post surgery. It is hard to justify the routine use of this operative technique, which should be reserved for specific instances where routine techniques are proving inadequate for endoscopic management of upper tract calculi.
Epigenetics is a growing field and in bladder cancer, it is of particular interest in advanced or... more Epigenetics is a growing field and in bladder cancer, it is of particular interest in advanced or metastatic disease. As opposed to genetic mutations in which the nucleotide sequence itself is altered, epigenetic alterations refer to changes to the genome that do not involve nucleotides. This is of great interest in cancer research because epigenetic alterations are reversible, making them a promising target for pharmacological agents. While chemoimmunotherapy is the mainstay for metastatic disease, there are few alternatives for patients who have progressed on first- or second-line treatment. By targeting reversible epigenetic alterations, novel epigenetic therapies are important potential treatment options for these patients. A search of clinical registries was performed in order to identify and collate epigenetic therapies currently in human trials. A literature search was also performed to identify therapies that are currently in preclinical stages, whether this be in vivo or in...
Bladder cancer is among the most common newly diagnosed cancers in the Western population, with a... more Bladder cancer is among the most common newly diagnosed cancers in the Western population, with an estimated 81,000 new cases diagnosed in the USA in 2018 (ref. 1). Radical cystectomy remains a principal curative treatment option in patients with muscle-invasive bladder cancer (MIBC) (pT2+) 2. Despite radical cystectomy, oncological outcomes are poor, with reports of 5-year survival as low as 58% 3. Accordingly, an inherent need exists for improved treatment regimens for these patients. Organ-confined, muscle-invasive bladder tumours vary in propensity for metastatic progression, and up to 25% have metastatic deposits within the draining lymph nodes 4. Mounting evidence suggests that the addition of pelvic lymph node dissection (PLND) to radical cystectomy provides considerable benefits. The benefits of PLND during cystectomy are highlighted by the prognostic information provided by accurate nodal staging and the therapeutic implications of reducing disease burden 5-11. These potential benefits must be weighed against the potential drawbacks of PLND, including increased operative time, adjacent visceral and vascular injury, and lymphocoele. Despite these benefits, only a few current uro-oncological guidelines recommend the addition of regional lymph node dissection to radical cystectomy for curative treatment of MIBC 2. Limited population-based epidemiological data exist that assess the precise uptake of PLND in cystectomy. The improved oncological outcomes following PLND have prompted changes to dissection practices, with clinicians adopting more extensive dissection templates 12. Various PLND templates are used in clinical practice and reported in contemporary literature (fig. 1). This heterogeneity limits the ability to make comparisons
European Urology Supplements, Volume 5, Issue 2, Pages 290, April 2006, Authors:B. Ali-el-Dein; A... more European Urology Supplements, Volume 5, Issue 2, Pages 290, April 2006, Authors:B. Ali-el-Dein; AA Shaaban; R. Abu-Eideh; A. Mosbah; M. Abdel-Latif; H. Abol-Enein; MA Ghoneim. Advertisement. Journal Home, Access this ...
Prostate cancer is the second most frequent cancer in men, with increasing prevalence due to an a... more Prostate cancer is the second most frequent cancer in men, with increasing prevalence due to an ageing population. Advanced prostate cancer is diagnosed in up to 20% of patients, and, therefore, it is important to understand evolving mechanisms of progression. Significant morbidity and mortality can occur in advanced prostate cancer where treatment options are intrinsically related to lipid metabolism. Dysfunctional lipid metabolism has long been known to have a relationship to prostate cancer development; however, only recently have studies attempted to elucidate the exact mechanism relating genetic abnormalities and lipid metabolic pathways. Contemporary research has established the pathways leading to prostate cancer development, including dysregulated lipid metabolism-associated de novo lipogenesis through steroid hormone biogenesis and β-oxidation of fatty acids. These pathways, in relation to treatment, have formed potential novel targets for management of advanced prostate ca...
The use of robot-assisted laparoscopic radical prostatectomy (RALP) continues to increase in the ... more The use of robot-assisted laparoscopic radical prostatectomy (RALP) continues to increase in the management of prostate cancer by minimally invasive approach, with shorter convalescence, reduced blood transfusion and improving oncological outcomes when compared to open surgery. There is a growing evidence base that RALP is significantly associated with incisional hernia (IH) at the specimen extraction site compared to open surgery. A series of 186 RALP patients between August 2012 and August 2018 was reviewed, where 1-7 years follow-up had been observed. The study endpoint was IH rate at the supraumbilical specimen extraction site utilized by the surgeon. Incisional hernia rate at specimen extraction site was 8.6% and incidental 1.1% IH rate at a lateral port site (not associated with specimen removal). Average age at operation was 60.9 years old and hernias were diagnosed at a mean of 11.8 months post-surgery. Common demographics in the population suffering from IH were previous abdominal surgery, adhesiolysis, history of smoking and obesity. Supraumbilical extraction site hernias are an underreported complication of RALP which may impact on quality of life and prompt further surgical correction. Patients should be asked for consent regarding the possibility of this complication ensuing.
This is a letter to the editor in response to Topf et al. We describe the rationale behind much o... more This is a letter to the editor in response to Topf et al. We describe the rationale behind much of the analytical methods following publication of our original article " Globalization of Continuing Professional Development by Journal Clubs via Microblogging: A Systematic Review". Further, we provide some updated results following a subsequent review. [J Med Internet Res 2015;17(9):e217]
Fibroepithelial polyps are the most common benign tumor of the ureter. Most of the literature reg... more Fibroepithelial polyps are the most common benign tumor of the ureter. Most of the literature regarding their cause ascribes it to chronic infection. These publications, however, show that the majority of such cases never were associated with a documented urinary tract infection. Fibroepithelial polyps appear with equal frequency in male and female subjects and are found in all age groups including children, in contrast to what would have been expected with an infectious cause. Four histologically confirmed cases of fibroepithelial polyps were associated with chronic inflammation of the upper urinary tract related to the presence of calculi and/or Double J ureteral stents. All patients were managed successfully by endoscopic means, preserving renal function. Fibroepithelial ureteral polyps may be associated with urolithiasis, which serves as a source of chronic inflammation. A review of the literature is presented and supports these observations.
Background. Multidrug-resistant gram-negative bacterial (MDR-GNB) infections of the prostate are ... more Background. Multidrug-resistant gram-negative bacterial (MDR-GNB) infections of the prostate are an increasing problem worldwide, particularly complicating transrectal ultrasound (TRUS)-guided prostate biopsy. Fluoroquinolonebased regimens, once the mainstay of many protocols, are increasingly ineffective. Fosfomycin has reasonable in vitro and urinary activity (minimum inhibitory concentration breakpoint ≤64 µg/mL) against MDR-GNB, but its prostatic penetration has been uncertain, so it has not been widely recommended for the prophylaxis or treatment of MDR-GNB prostatitis. Methods. In a prospective study of healthy men undergoing a transurethral resection of the prostate for benign prostatic hyperplasia, we assessed serum, urine, and prostatic tissue (transition zone [TZ] and peripheral zone [PZ]) fosfomycin concentrations using liquid chromatography-tandem mass spectrometry, following a single 3-g oral fosfomycin dose within 17 hours of surgery. Results. Among the 26 participants, mean plasma and urinary fosfomycin levels were 11.4 ± 7.6 µg/mL and 571 ± 418 µg/mL, 565 ± 149 minutes and 581 ± 150 minutes postdose, respectively. Mean overall prostate fosfomycin levels were 6.5 ± 4.9 µg/g (range, 0.7-22.1 µg/g), with therapeutic concentrations detectable up to 17 hours following the dose. The mean prostate to plasma ratio was 0.67 ± 0.57. Mean concentrations within the TZ vs PZ prostate regions varied significantly (TZ, 8.3 ± 6.6 vs PZ, 4.4 ± 4.1 µg/g; P = .001). Only 1 patient had a mean prostatic fosfomycin concentration of <1 µg/g, whereas the majority (70%) had concentrations ≥4 µg/g. Conclusions. Fosfomycin appears to achieve reasonable intraprostatic concentrations in uninflamed prostate following a single 3-g oral dose, such that it may be a potential option for prophylaxis pre-TRUS prostate biopsy and possibly for the treatment of MDR-GNB prostatitis. Formal clinical studies are now required.
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