Since overdiagnosis and overtreatment pose significant risks in managing prostate cancer (PCa), active surveillance (AS) is the most common treatment in low-risk patients. However, there is no general agreement yet on the inclusion criteria and the required follow-up. Multiparametric magnetic resonance imaging (mpMRI) of the prostate was born as a useful device in these patients both in diagnosis and follow-up, and it is widely used in daily clinical practice. We reflect on the most current evidence described in the literature on the topic, its results, and our experience.

Urethral stricture disease is a recurrent and debilitating condition affecting many men of all ages. Management may involve endoscopic or surgical treatment. Surgical urethral reconstruction remains the gold standard treatment and is associated with higher success rates in terms of stricture recurrence free-survival. However, urethroplasty is not available to patients with significant medical comorbidities, or those wishing to forego invasive surgery. Endoscopic treatment is aimed at improving lower urinary tract symptoms and relieving obstruction while maximizing time to stricture recurrence with the aid of therapeutic adjuncts. The aim of this review is to discuss the mechanism of action and role of therapeutic adjuncts and highlight some of the lesser-known adjuncts that have been utilized with success in this space.

Pelvic disorders affecting both male and female patients are major areas of concern for clinicians in cases where pharmacotherapy and behavioral therapy are not effective. In such cases, pelvic neuromodulation has become an alternative therapy that could relieve chronic pelvic pain and enhance the quality of life. The goal of this paper was to present a summary of the current therapeutic applications of various pelvic neuromodulation techniques and their efficacy in treating patients with a range of pelvic illnesses. Based on the available literature, this review assessed the validity and significance of the last 10 years’ advancements in the fields of sacral neuromodulation (SNM), posterior tibial nerve stimulation (PTNS), and pudendal neuromodulation (PNM), including meta-analyses, randomized controlled trials, and observational, prospective, and retrospective studies.

IntroductionThe urinary microbiome (UMB) includes living bacteria, their genomes, and their products from interactions with the host environment. A “core” UMB could potentially exist, with variations between age and sex groups. Changes in UMB composition have been associated with benign urological disorders, but also with urologic cancers. Mechanisms through which UMB can trigger and maintain cancer can be local inflammation and interaction with immune system.Aim of the studyTo describe the association between UMB and development of urologic cancers.MethodsA non-systematic literature review identified recently published studies (last 5 years), involving human patients, dealing with UMB. The database used for this review was PubMed, and the identified studies served as the base for a narrative analysis of the literature that explored the potential associations between UMB and urological cancers.ResultsIn bladder cancer (BC), UMB may play a role in epithelial-mesenchymal transition (and thus to progression to metastasis), as well as in effectiveness of BCG response rate. BC is also associated with changes in UMB, with bacterial richness indices increased in cancer groups compared to non-neoplastic groups and being different between NMIBC vs MIBC patients. In prostate cancer (PCa), there is an abundance in proinflammatory bacteria and uropathogens. In regard to renal cell carcinoma (RCC), penile cancer and testicular cancer there are still too few studies to draw significant conclusions about its relationship with the UMB.ConclusionsGaining a deeper understanding of UMB role in urologic tumors could aid in the development of new therapies and improve classification of patients’ risk.

BackgroundCongenital anomalies of the kidney and urinary tract (CAKUT) are defined as structural malformations of the kidney and/or urinary tract. Heat shock proteins (HSPs) are expressed in the kidney in response to cellular changes, such as thermal, hemodynamic, osmotic, inflammatory, and mechanical stresses. This study aimed to assess uHSP70 levels during acute urinary tract infections (UTI) and non-infection periods in patients with CAKUT, and to evaluate whether uHSP70 is elevated in CAKUT subtypes.MethodsAmong patients with CAKUT, 89 patients with UTI (CAKUT-A), 111 without UTI (CAKUT-B), and 74 healthy children were included in the study. uHSP70 levels were measured using enzyme-linked immunosorbent assay (ELISA).ResultsuHSP70 level was significantly higher in the CAKUT-A group than in the CAKUT-B and healthy control groups (p < 0.0001). Moreover, the level of uHSP70 was significantly higher in the CAKUT-B group than in the control group (p < 0.0001), but was not different between the CAKUT subtypes (p > 0.05).ConclusionUrine HSP70 can also be used to predict UTI in patients with CAKUT. Moreover, uHSP70 levels were higher in children with CAKUT during the non-infectious period than in healthy controls. This suggests that children with CAKUT are at risk of chronic non-infectious damage.

Prostate cancer (PCa) is a health concern affecting millions of men globally, with a concerning rise in incidence in the Philippines, a country that faces a complex set of barriers to equitable access to quality PCa care. In this article, we describe the unique geographic, economic, socio-cultural, and political factors that influence access to screening, diagnosis, treatment, and supportive services in the country, and explore avenues for development. The country lacks a nationwide PCa registry to inform resource allocation and guide PCa cancer care programs and policy. Misconceptions, cultural barriers and negative attitudes about PCa among Filipino men adversely influence health-seeking behavior. Inadequate insurance coverage, and high out-of-pocket costs obstruct access to essential care. Geographic and political factors contribute to the uneven distribution of healthcare resources needed for comprehensive PCa care, including access to medical specialists, essential medicines, and surgical and radiotherapeutic equipment. Overcoming these challenges requires a collaborative effort encompassing robust data collection, awareness campaigns to reshape societal norms, policy and economic reforms, infrastructure improvements, and enhanced collaboration among healthcare professionals to provide evidence-based care. Addressing these issues holistically can pave the way to better outcomes and improved quality of life for Filipino men with this life-altering disease.

ObjectiveThis study aimed to investigate the efficacy of six episodes of percutaneous tibial nerve stimulation (PTNS) treatment for overactive bladder (OAB) symptoms in men and women and to determine the duration of the effects over a 6-month period.MethodsWomen and men with OAB symptoms participated in the study, which was conducted in accordance with an approved ethical protocol (ISRCTN15733799). Patients underwent six 30-min PTNS sessions, twice per week. The symptoms of OAB were assessed using a voiding diary, the short form of the Overactive Bladder Symptom Score questionnaire (OAB-q SF), and the Patient Perception of Bladder Condition (PPBC), which were self-completed by patients before and after treatment (24 h and at 1, 3, and 6 months). The outcome data were compared for sex and time points using two-way ANOVA for repeated measures.ResultsPTNS treatment significantly improved the OAB symptoms and quality of life in men and women. PTNS increased the voided volume (p < 0.05) and decreased the frequency of voiding, nocturia, and urgency at 24 h and up to 6 months (p < 0.001). The OABq-SF and PPBC scores were significantly decreased after PTNS (p < 0.001). Urgency was greater in men than in women. The duration of PTNS clinical success on frequency and the perception of improvement in quality of life were greater in women than in men.ConclusionThe clinical effects of six sessions of PTNS strongly suggest its potential for shortening, from the standard 12 sessions, to effectively alleviate symptoms of OAB. This therapeutic procedure would reduce both the time and economic costs of OAB treatment.

IntroductionInduction intravesical Bacillus Calmette-Guerin (BCG) followed by maintenance after transurethral resection of bladder tumor, is the standard adjuvant therapy for high-risk non-muscle invasive bladder cancer (NMIBC). There is sparse evidence on the practice of intravesical BCG in Australia. Our aim was to determine the outcomes of intravesical BCG therapy in NMIBC in Southwestern Sydney.MethodsThis was a multi-center retrospective audit of NMIBC patients who received intravesical BCG between January 2008 and June 2020. Data was collected across six tertiary hospitals in South Western Sydney. Primary outcome was disease-free survival (DFS). Secondary outcomes were overall survival (OS), BCG induction and maintenance rates.ResultsOf the 200 eligible patients over 12.5 years, median age was 77 years and 83% were male. Of these, 55%, 4.5%, 35% and 5% were Tis, Ta, T1 and unknown stage, respectively. All patients received induction BCG and 56% received maintenance BCG (range 3-36 months). Completion rate of induction BCG was 91%. Only 9% ceased treatment due to intolerance. The median duration of cystoscopy follow-up was 17 months. After a median follow-up time of 37 months, 55% developed recurrence (29% non-muscle invasive, 32% muscle-invasive disease, 8% distant metastasis). The 1-year and 5-year DFS rates were 72% and 41% (median DFS: 39 months). The 1-year and 5-year OS rates were 98% and 87% (median OS: not reached).ConclusionThe DFS and OS rates were comparable to previous literature. This provides real-world data to assist future clinical trials in NMIBC.

IntroductionAnimal cystometry, a process of infusing fluid into the urinary bladder to evoke reflex contractions, is a common way to study the effects of pathology, injury, or experimental therapy on lower urinary tract (LUT) dynamics. By monitoring fluid movement during the cystometric micturition cycle, one can compute important quantities that indicate the health and function of the LUT, such as bladder capacity and voiding efficiency. Unfortunately, volume measurements in these difficult studies are often unpreventably corrupted by noise, leading to uncertainty when estimating key cystometric parameters.MethodsThis work proposes a criterion, based on measurable quantities, that flags micturition cycles in cystometry studies that are likely to contain large measurement errors, potentially allowing experimenters to remove them from analysis to obtain a more accurate summary of LUT dynamics.ResultsWe describe the criterion, validate it against experimental data, and use computer simulations to demonstrate its utility.

Ureteral stents are hollow tubes that are inserted into the ureter to maintain the flow of urine from the kidney to the bladder. However, the use of these indwelling stents is associated with potential complications. Biofilm, an organized consortium of bacterial species embedded within a self-producing extracellular matrix, can attach to the outer and inner surfaces of ureteral stents. Furthermore, encrustation - defined as the buildup of mineral deposits on the stent surface - can occur independently or in parallel with biofilm formation. Both phenomena can cause stent obstruction, which can lead to obstructive pyelonephritis and make stent removal difficult. Understanding the influence of flow on the development of biofilm and encrustation and the impact of small mechanical environmental changes (e.g., wall shear stress distribution) is key to improve the long-term performance of stents. Identifying the optimal stent properties to prevent early bacterial attachment and/or crystal deposition and their growth, would represent a breakthrough in reducing biofilm-/encrustation-associated complications. This review identifies the most prevalent bacterial strains and crystal types associated with ureteral stents, and the process of their association with the stent surface, which often depends on patient comorbidities, stent material, and indwelling time. Furthermore, we focus on the often-overlooked role of fluid dynamics on biofilm and encrustation development in ureteral stents, across a range of physical scales (i.e., from micro- to macro-scale) with the aim of providing a knowledge base to inform the development of safer and more effective ureteral stents.