OBJECTIVES: To report the clinical outcomes of the VictoTM (Promedon, Cordoba, Argentina) adjustable artificial urinary sphincter (AUS) implantation in a cohort of patients with severe urinary incontinence (UI) after prostate surgery. PATIENTS AND METHODS: This study enrolled patients with UI following prostate surgery who underwent a Victo implantation between May 2018 and December 2023. Patients were prospectively evaluated at baseline, and at 3 and 12 months after device activation, and thereafter annually. The 24-h pad-weight test (24hPWT) was used to assess severity of UI, while the Patient Global Impression of Improvement (PGI-I) and patient satisfaction according to a Likert scale were used to measure patient-reported outcomes. RESULTS: A total of 96 patients with a median (interquartile range [IQR]) age of 68 (65-72) years were included in the final analysis. The median (IQR) follow-up was 3 (1-4) years. In all, 10 patients completed the 5-year follow-up. After the treatment, we observed a significant reduction in 24hPWT by the median of 83% (P < 0.001) at 3 months and by a median of 79% (P < 0.001) at 3 years. According to the PGI-I, a total of 87%, 92%, 87%, 81%, 83%, and 50% (five of 10) of patients rated their condition/incontinence as 'very much improved', 'much improved' or 'little improved' at 3 months, 1-, 2-, 3-, 4-, and 5-year follow-up visits, respectively. The proportion of patients, who were 'very satisfied' or 'satisfied' with the treatment outcome was 79%, 80%, 75%, 69%, 80%, and 60% (six of 10) at 3 months, 1-, 2-, 3-, 4-, and 5-years, respectively. There were a total of 13 (14%) device failures during the follow-up period. CONCLUSION: In conclusion, our data suggest that Victo AUS significantly reduces the severity of UI after prostate surgery and provides a reasonably high patient-reported satisfaction with treatment outcomes at mid-term follow-up.
- MeSH
- inkontinence moči * chirurgie terapie MeSH
- lidé středního věku MeSH
- lidé MeSH
- pooperační komplikace MeSH
- prospektivní studie MeSH
- prostatektomie * škodlivé účinky MeSH
- senioři MeSH
- spokojenost pacientů MeSH
- umělý močový svěrač * MeSH
- výsledek terapie MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- Publikační typ
- časopisecké články MeSH
Nežádoucí účinky anticholinergik užívaných v léčbě hyperaktivního močového měchýře na centrální nervový systém. Podávání anticholinergik je základem terapie hyperaktivního močového měchýře. Jejich efektivita byla prokázána v řadě velkých randomizo- vaných studií. V poslední době je věnována velká pozornost nežádoucím účinkům anticholinergik užívaných v léčbě hyperaktivního močového měchýře na centrální nervový systém. Současná literární evidence ukazuje na sice nízké, ale reálné riziko zhoršení kognitivních funkcí a rozvoje demence při dlouhodobém užívání anticholinergik, zejména oxybutininu a tolterodinu. Před zahájením léčby anticholinergiky by měl být zvažován benefit a potenciální riziko u každého individuálního pacienta. Zvýšené opatrnosti je třeba zejména u pacientů s preexistujícím kognitivním deficitem. Při selhání léčby anticholinergiky nebo při výskytu nežádoucích účinků je třeba časně zvažovat nasazení léčby z dalších linií léčby.
Administration of anticholinergics represents the mainstay of overactive bladder therapy. Their efficacy has been proven in a number of large randomized trials. Recently, much attention has been paid to the adverse effects of anticholinergics used in the treatment of overactive bladder on the central nervous system. Current literature evidence shows a low but real risk of cognitive impairment and the development of dementia with long-term use of anticholinergics, particularly oxybutynin and tolterodine. Before starting anticholinergic therapy, the benefits and potential risk should be carefully considered for each individual patient. Particular caution is required in patients with pre-existing cognitive impairment. If anticholinergic treatment fails or side effects occur, alternative treatment options should be considered early.
- Klíčová slova
- Oxybutynin,
- MeSH
- cholinergní antagonisté * farmakologie škodlivé účinky terapeutické užití MeSH
- demence chemicky indukované etiologie MeSH
- hyperaktivní močový měchýř * farmakoterapie komplikace MeSH
- kognitivní dysfunkce * chemicky indukované etiologie patofyziologie MeSH
- kyseliny mandlové farmakologie škodlivé účinky terapeutické užití MeSH
- lidé MeSH
- receptory muskarinové fyziologie účinky léků MeSH
- Check Tag
- lidé MeSH
Nádory penisu patří mezi poměrně vzácná onkologická onemocnění se značně variabilní prognózou. Nejdůležitějším ukazatelem nádorově specifického přežití (cancer specific survival, CSS) je postižení regionálních lymfatických uzlin, které nemusí být při klinickém vyšetření či konvenčními zobrazovacími metodami identifikováno. Z toho důvodu jsou v současnosti zkoumány nové prognostické a terapeuticko-indikační markery dlaždicobuněčného karcinomu penisu (penile squamous cell carcinoma, SCC) na histologické, imunohistochemické a molekulární úrovni. Ačkoliv WHO klasifikuje pSCC na HPV-asociovaný a HPV-independentní, vliv HPV statutu na prognózu je podle řady studií a našich dat sporný. V naší studii byl zjištěn negativní prognostický vliv nádorového grade buddingu na celkové přežití (overall survival, OS) i CSS. Nádorový budding byl u SCC aso- ciován s metastatickým postižením regionálních lymfatických uzlin. Prognostický význam infiltrace imunitními buňkami u pSCC zkoumá jen málo relevantních studií. V naší studii byl řídký/chybějící lymfocytární lem signifikantně asociovaný s kratším OS i CSS. Mutovaný profil p53 koreluje s agresivním fenotypem a nepříznivou prognózou u mnoha typů nádorů včetně pSCC. V naší práci jsme potvrdili jeho negativní prognostický dopad na OS i CSS. Vysoká nádorová mutační nálož (tumor mutational burden, TMB) byla asociovaná s kratším OS, s vysokou expresí programmed death ligandu 1 (PD-L1) a HPV/p16 negativitou. Nález časté PD-L1 pozitivity u HPV-negativních nádorů s vysokým TMB ilustruje onkogenezi pSCC v souvislosti s chronickým zánětem, vysokým množstvím získaných mutací a produkcí neoantigenů (PD-L1) a činí z nemocných s HPV-independentními SCC kandidáty anti-PD-1/PD-L1 léčby. Popsané znaky, jako je nádorový budding, lymfocytární infiltrát a p53, korelují s přežitím významněji než pT stadium, histopatologický grade nebo morfologický subtyp karcinomu penisu.
Penile cancer is a relatively rare malignancy with a highly variable prognosis. The most important indicator of cancer specific survival (CSS) is the involvement of regional lymph nodes, which may not be identified during clinical examination or by conventional imaging methods. For that reason, new prognostic and therapeutic markers of penile squamous cell carcinoma (SCC) are currently being investigated at the histological, immunohistochemical and molecular level. Although the WHO classifies penile SCC into HPV-associated and HPV-independent, the prognostic impact of HPV status remains questionable according to several studies and our data. In our study, a negative prognostic effect of tumour grade budding on overall survival (OS) and CSS was found. Tumour budding has been associated with the metastatic involvement of regional lymph nodes in penile SCC. A few relevant studies have investigated the prognostic significance of immune cell infiltration in pSCC. In our study, a non-brisk/absent lymphocyte infiltrate was significantly associated with shorter OS and CSS. Mutated p53 profile correlates with aggressive phenotype and poor prognosis in many tumour types including penile SCC. Our data confirmed its negative prognostic impact on both OS and CSS. High tumour mutational burden (TMB) was associated with shorter OS, with high programmed death ligand 1 (PD-L1) expression and HPV/p16 negativity. The PD-L1 positivity enrichment in HPV-negative tumours harboring high TMB illustrates pSCC oncogenesis in association with chronic inflammation, high amount of acquired mutations, and neoantigen (PD-L1) production. This discovery suggests that patients with HPV-independent SCC could be suitable candidates for anti-PD-1/PD-L1 treatment. In summary, tumour budding, tumour lymphocytic infiltration and p53 show a stronger correlation with survival outcomes compared to factors such as pT stage, histopathological grade or morphological subtype in penile carcinoma.
- MeSH
- biologické markery * analýza MeSH
- infekce papilomavirem komplikace MeSH
- lidé MeSH
- metastázy nádorů patofyziologie MeSH
- mutace MeSH
- nádorový supresorový protein p53 škodlivé účinky MeSH
- nádory penisu * chirurgie diagnóza terapie MeSH
- prognóza * MeSH
- tumor infiltrující lymfocyty patologie MeSH
- Check Tag
- lidé MeSH
The current prostate cancer (PCa) screen test, prostate-specific antigen (PSA), has a high sensitivity for PCa but low specificity for high-risk, clinically significant PCa (csPCa), resulting in overdiagnosis and overtreatment of non-csPCa. Early identification of csPCa while avoiding unnecessary biopsies in men with non-csPCa is challenging. We built an optimized machine learning platform (ClarityDX) and showed its utility in generating models predicting csPCa. Integrating the ClarityDX platform with blood-based biomarkers for clinically significant PCa and clinical biomarker data from a 3448-patient cohort, we developed a test to stratify patients' risk of csPCa; called ClarityDX Prostate. When predicting high risk cancer in the validation cohort, ClarityDX Prostate showed 95% sensitivity, 35% specificity, 54% positive predictive value, and 91% negative predictive value, at a ≥ 25% threshold. Using ClarityDX Prostate at this threshold could avoid up to 35% of unnecessary prostate biopsies. ClarityDX Prostate showed higher accuracy for predicting the risk of csPCa than PSA alone and the tested model-based risk calculators. Using this test as a reflex test in men with elevated PSA levels may help patients and their healthcare providers decide if a prostate biopsy is necessary.
- Publikační typ
- časopisecké články MeSH
- MeSH
- chirurgická centra MeSH
- lidé MeSH
- nemocnice fakultní MeSH
- roboticky asistované výkony * ekonomika metody výchova MeSH
- úhradový mechanismus MeSH
- urologické chirurgické výkony MeSH
- zdravotní péče - kvalita, dosažitelnost a hodnocení MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- novinové články MeSH
- rozhovory MeSH
OBJECTIVES: In this study, we aimed to investigate whether peroneal electrical Transcutaneous Neuromodulation invented for overactive bladder (OAB) treatment elicits activation in brain regions involved in neural regulation of the lower urinary tract. MATERIALS AND METHODS: Among 22 enrolled healthy female volunteers, 13 were eligible for the final analysis. Functional magnetic resonance imaging (fMRI) (Siemens VIDA 3T; Erlangen, Germany) was used to compare the brain region activation elicited by peroneal electrical Transcutaneous Neuromodulation with the activation elicited by sham stimulation. Each subject underwent brain fMRI recording during eight 30-second periods of rest, alternating with 30-second periods of passive feet movement using the sham device, mimicking the motor response to peroneal nerve stimulation. Subsequently, fMRI recording was performed during the analogic "off-on" stimulation paradigm using peroneal electrical transcutaneous neuromodulation. Magnetic resonance imaging data acquired during both paradigms were compared using individual and group statistics. RESULTS: During both peroneal electrical Transcutaneous Neuromodulation and sham feet movements, we observed activation of the primary motor cortex and supplementary motor area, corresponding to the cortical projection of lower limb movement. During peroneal electrical Transcutaneous Neuromodulation, we observed significant activations in the brain stem, cerebellum, cingulate gyrus, putamen, operculum, and anterior insula, which were not observed during the sham feet movement. CONCLUSIONS: Our study provides evidence that peroneal electrical Transcutaneous Neuromodulation elicits activation of brain structures that have been previously implicated in the perception of bladder fullness and that play a role in the ability to cope with urinary urgency. Our data suggest that neuromodulation at the level of supraspinal control of the lower urinary tract may contribute to the treatment effect of peroneal electrical Transcutaneous Neuromodulation in patients with OAB.
- Publikační typ
- abstrakt z konference MeSH
- Publikační typ
- abstrakt z konference MeSH
INTRODUCTION: Human urine microbiota (UM) research has uncovered associations between composition of microbial communities of the lower urinary tract and various disease states including several reports on the putative link between UM and bladder cancer (BC). The aim of this study was to investigate male UM in patients with BC and controls using catheterised urine specimens unlike in previous studies. METHODS: Urine samples were obtained in theatre after surgical prepping and draping using aseptic catheterisation. DNA was extracted and hypervariable region V4 of the 16S rRNA gene was amplified using 515F and 806R primers. Sequencing was performed on Illumina MiSeq platform. Sequencing data were processed using appropriate software tools. Alpha diversity measures were calculated and compared between groups. Prevalence Interval for Microbiome Evaluation was used to test differences in beta diversity. RESULTS: A total of 63 samples were included in the analysis. Mean age of study subjects was 65.1 years (SD 12.5). Thirty-four men had bladder cancer and 29 participants were undergoing interventions for benign conditions (benign prostate hyperplasia or upper urinary tract stone disease). BC patients had lower UM richness and diversity than controls (83 vs. 139 operational taxonomic units, P = 0.015; Shannon index: 2.46 vs. 2.94, P = 0.049). There were specific taxa enriched in cancer (Veillonella, Varibaculum, Methylobacterium-Methylorubrum) and control groups (Pasteurella, Corynebacterium, Acinetobacter), respectively. CONCLUSION: BC patients had lower bladder microbiota richness and diversity than controls. Specific genera were enriched in cancer and control groups, respectively. These results corroborate some of previous reports while contradicting others. Future microbiota research would benefit from parallel transcriptomic/metabolomic analysis.
