Role of checkpoint inhibitors immunotherapy in non-muscle invasive bladder cancer: current methods and future perspectives

Immuno-therapy involvement in bladder urothelial malignancies is growing very fast. The use of Immuno-therapy with check-point inhibitor has greatly developed since it was first approved as a second-line treatment for cases who had formerly failed platinum-based chemotherapy. There are recognized applications for first-line metastatic illness in platinum-ineligible or cisplatin-ineligible PD-L1 diagnosed cases, as well as a label for BCG-refractory high-risky non-muscle invasive bladder cancer (NMIBC). It is now being studied in neo-adjuvant and adjuvant muscle invasive bladder cancer (MIBC) clinical trials. This review discusses the clinical trials that led to these FDA agreements, as well as prospective and ongoing trials. Current clinical guidelines support Bacillus Calmette-Guérin (BCG) as the primary treating option for intermediate to high-risk NMIBC. Despite the intra-vesical BCG-instillation, intra-vesical relapse occurs in a considerable number of individuals with intermediate to high risk NMIBC. Furthermore, treating BCG-nonresponsive NMIBC is still difficult. For these individuals with BCG-nonresponsive NMIBC, there are no viable therapy alternatives other than radical cystectomy, which has been shown to have excellent oncological results. In this regard, for the care of BCG-nonresponsive NMIBC, safe and reliable noninvasive or lesser-invasive therapeutic alternatives with adequate oncological results are needed. Regarding the latest introduction of immuno-therapeutic medications, the treatment of progressive or metastatic urothelial cancer has substantially advanced. These developments have sparked a surge in interest in immuno-therapeutic medications for NMIBC, particularly BCG-nonresponsive NMIBC. The goal of this literature review is to provide and debate the most up-to-date information on the function of Immuno-therapy in BCG-nonresponsive NMIBC and the presently accessible treatment options. Furthermore, this page highlights the current research in this topic. We wanted to convey the current state of Immuno-therapy in NMIBC and discuss future directions.

Long-term outcomes of thigh arteriovenous graft stenting

Background: Stents have been increasingly used for treating venous anastomosis stenosis seen in arteriovenous grafts (AVGs). A major reason for this trend is that stents can potentially confer a better patency rate compared to angioplasty. However, limited data are available about the outcomes of stents that are used to treat thigh AVG dysfunction. This study sought to assess the primary and secondary patency rates of stents used to treat thigh AVGs dysfunction at one year. Methods: This is a retrospective study of dialysis patients who received therapy via thigh grafts (N=50) and underwent stent placement between January 2005 and June 2017 at our center. Data on demographics and baseline characteristics of the study population were collected. The primary and secondary patency rates were defined as the time between stent deployment and the first intervention and second intervention, respectively. Patency and re-intervention rates were estimated using Kaplan-Meier survival analysis. Results: This study included 50 patients with thigh AVGs; mean age was 50.5± 15.5 years; 52% were female; 80% were black; and 90% had hypertension. The main indication for stenting was thrombosis due to venous anastomosis stenosis (74%). The number (mean ± SD) of stents deployed was 1.24 ± 0.8. The primary patency rate at three months and one year was 58.7% and 30.7%. In comparison, the secondary patency rate at three months and one year was 68.2% and 40.7% (p=0.04) Conclusions: Thigh AVG stenting can be successfully used to improve the overall patency rates of failing AVGs.

Migration of urolift clip into the bladder causing haematuria 3-years after insertion: a rare delayed complication of prostatic urolift

Prostatic UroLift placement as a minimally invasive technique for the treatment of bladder outlet obstruction due to benign enlargement of prostate has been well accepted in literature and is practised with minimal post-operative complications. We present an unusual cause of haematuria due to migration of one of the prostatic UroLift clips into the bladder after 3 years from its insertion and its subsequent endourological management. To our knowledge, delayed migration of UroLift clip causing haematuria has not been reported in literature in the past. Urologists should be aware of this possible situation while dealing with patients with UroLift implanted.

Prophylactic effect of ethyl pyruvate on renal ischemia/reperfusion injury in rats

Background: Following our hypothesis that oxidative stress might play a primary role in renal ischemia/reperfusion injury (RIRI), we investigated if ethyl pyruvate (EPy) with potent antioxidant activity might prevent or alleviate RIRI induced in rats. Methods: Sprague-Dawley rats were randomly divided into four groups: (A) Sham, (B) renal ischemia/reperfusion (RIR), (C) RIR with EPy supplement (RIR+EPy), and (D) RIR with Mann supplement (RIR+Mann). Mannitol (Mann), a preoperative agent being clinically used, was tested for comparison with EPy. Rats were subjected to 40-min ischemia, followed by 24-h reperfusion. Either EPy or Mann was given to rats 30 min prior to ischemia and immediately before the reperfusion period. Results: The RIR and RIR+Mann groups showed palpable kidney injuries with the ~5-fold elevated blood urea nitrogen (BUN) and creatinine (Cr) levels, indicating renal dysfunction. However, the kidneys in the RIR+EPy group appeared merely normal (similar to the Sham’s) with the basal BUN/Cr levels, indicating normal renal function. No effects on histology, BUN or Cr were yet seen with Mann. Moreover, specific kidney injury markers were up-regulated and oxidative stress was also ~2.1-fold severer in the RIR group, whereas little changes in those markers and oxidative stress were seen with EPy supplement (RIR+EPy). Conclusions: Although oxidative stress feasibly plays a key role in RIRI, EPy with antioxidant activity is capable of protecting the kidneys from such an assault. Thus, EPy (not Mann) should be considered as an effective perioperative renoprotective agent that could be used clinically.

Antibiotic sensitivity patterns of uropathogens isolated from catheterized patients in a tertiary care hospital in Dhaka, Bangladesh

Among nosocomial infections catheter associated urinary tract infection (CAUTI) is one of the most common infection. The antibiotic resistance amongst the uropathogens isolated from CAUTI are multi-drug resistant and a growing public health problem in the world including Bangladesh. The study objective was to determine the aetiology of uropathogens in catheter associated urinary tract infection and find out their anti-microbial sensitivity pattern among the isolates. A cross sectional study was done from July 2016 to June 2017 in Dhaka Medical College, Bangladesh. Urine samples were collected from 400 patients with suspected CAUTI which were processed microbiologically and antimicrobial sensitivity was performed. Out of 400 patients Escherichia coli (38.93%) was the most common isolated organism followed by Pseudomonas spp, (15.98%), Klebsiella spp, (8.61%), Proteus spp. (7.38%) Enterobacter spp, (6.56%) and Acinitobacter spp. (1.22%). Among the Gram positive isolates Staphylococcus aureus (1.64%) and Coagulase negative Staphylococeus (6.97%%) were isolated. Enterobacteriaceae showed high resistant to commonly used antimicrobials Amoxiclav, Gentamycin, Ceftriaxone, azithromycin , ciprofloxacin, cortimoxazole and were sensitive to colistin ,nitrofurantoin ,imepenem, Meropenem. Many isolates showed multi- drug resistance pattern hence strict aseptic precaution has to be taken prior to catheter insertion and after to prevent infection.

Peritoneal dialysis versus hemodialysis in the management of sickle cell disease patients with endstage renal disease: an observational study

There is paucity of studies that discussed the role of peritoneal dialysis (PD) in managing end stage renal disease (ESRD) in sickle cell disease (SCD) patients. The present study compares the outcome of SCD-ESRD patients treated with hemodialysis (HD) or PD. Sixty incident ESRD patients were allotted to HD, (HD group, n=40) or PD, (PD group, n=20). Causes and severity of renal injury were assessed at the time of initiating dialysis. The primary outcome was hospital mortality at 5 years, and secondary outcomes were infection rates, incidents of vasoocclusive crisis (VOC) and acute chest syndrome (ACS), response to erythropoietic agents and improvement of cardiac function. No statistically significant differences were observed between groups in regard to patients’ characteristics. The survival at 5 years was significantly better in the patients treated with PD when compared to HD (75.0% vs. 57.5%, p=0.026). Infectious complications (15% vs 35%, p<0.001), blood transfusion requirements (p < 0.001), VOC (15% vs. 42.5%, p<0.001) and ACS (10% vs. 27.5%, p<0.001) were significantly less in the PD group. Response to erythropoietic agents and improvement of left ventricular ejection fraction (LVEF) were significantly better in the PD group (p = 0.022 and p < 0.001, respectively). This study suggests that there are better outcomes with PD compared to HD in the treatment of SCD-ESRD patients with different dialysis modalities. Key Words: SCD, HD, PD, erythropoiesis, blood transfusion, VOC, ACS, sepsis, cardiac function, survival.

Infectious complications secondary to prostate biopsy

Introduction: Prostate biopsy (PB) is a routine procedure performed by urologists in cases of suspected prostate cancer, any abnormality in the prostate-specific antigen (PSA) assay, and/or perceived by the digital rectal exam. Although this is a safe and rapid procedure, it is not without potentially serious complications, including infectious complications ranging from asymptomatic bacteriuria to acute prostatitis and even septic shock. Materials and methods: This work reports the experience of the urology department of the Hassan II University Hospital of Fez in the study of post-biopsy prostatitis through the analysis of a retrospective series of 538 cases during the period January 2014 - December 2018. Results: We report 11 cases of acute post-biopsy prostatitis diagnosed in the urology department of the Hassan II University Hospital in Fez. The bacteria most frequently involved in post-biopsy infections are gram-negative bacteria (Escherichia coli, Klebsiella pneumonia, Acinetobacter baumannii) although gram-positive cocci (Enterococcus faecalis and Staphylococcus saprophyticus) can also be responsible. Anaerobic bacteria are rarely found. The treatment of these post-biopsy infections is based on prolonged antibiotic therapy (3 to 6 weeks) using third-generation cephalosporins (Ceftriaxone). In our series, no death, septic shock, or prostatic abscess was found. The evolution was towards a good improvement under antibiotic treatment with discharge at home after 48 hours of apyrexia. Conclusion: The study of infectious complications secondary to prostate biopsy makes it possible to determine the most appropriate empirical (therapeutic and prophylactic) regimens to minimize the risks. Because of the prevalence of infection by multi-resistant bacteria, particularly to quinolones, the biopsy must be performed following the rules of antibiotic prophylaxis.

A successful management of acute cholemic nephropathy secondary to acute liver abscess and pylephlebitis associated severe sepsis by ercp, combined cvvhdf and stepwise hemodialysis

Cholemic nephrosis or yellow kidneys, is a rare condition and can be associated with acute kidney injury secondary to various etiologies. We are reporting a difficult case presented with fatal severe sepsis associated with hepatic, pancreatic and renal injury secondary to impacted biliary stone at the ampulla of vater and complicated by infection. With proper management and early drainage of biliary system and continuous renal replacement therapy the patient survived. The early recognition and interference leads to reversal of symptoms and improvement of renal and patient survival.

The evolution of surgical treatment of urolithiasis: from lithotomy to combined intrarenal technologies

Urolithiasis (hereinafter ICD) has a long thousand-year history, worldwide spread, frequent recurrence and occupies a leading place in the structure of surgical diseases of the urinary system. The development of urology as a clinical discipline is thorny and is associated with the stages of origin and formation as a science, oblivion and revival - as a modern field of surgery. The progress of technical thought, achievements of fundamental science, naturally led to the formation of urology and, in particular, surgery of urolithiasis on the basis of new concepts of operative capabilities, preoperative diagnostics, new methods of physical impact on the structure of the calculus. The creation and improvement of new low-traumatic techniques, their active and widespread introduction into practice, contributed to the displacement of open traumatic interventions used for centuries, and made it possible to successfully remove stones from the urinary tract with minimal complications. The work is devoted to the historical review of the formation of urolithiasis surgery, comparative characteristics of alternative minimally invasive methods of treatment of KSD. The scientific work reveals the modern achievements of percutaneous surgery, the history of the development of technical improvements and the possibilities of retrograde fiber-optic intrarenal technologies. The promising directions of development of antegrade and retrograde surgery of nephrolithiasis in the present and near future have been determined.

The epidemiological determinants of prostate cancer: a retrospective analytical study

Introduction: The study of the epidemiological profile of cancers is one of the pillars of the population's health problems and their determinants. One of the objectives of this type of prospecting is to analyze the impact of behavioral, environmental and professional factors. Material and methods: This is a retrospective study conducted in our university hospital center, including 120 patients followed for prostate cancer over two years between January 2018 and December 2019. The choice of patients was subject to a number of criteria inclusion and exclusion. The quantitative and qualitative variables were described by their proportion and their percentage. Descriptive statistical analysis of the data was performed using SPSS 20 software. Results: In our study we objectified 42% of our patients had no specific history, 65.5% of our patients were smokers, 16% were alcoholics, 69.1% had red meat consumption deemed excessive. The prostate was hard on digital rectal examination in 39.62% of cases, unilateral nodular in 47% of cases, and normal in 13% of cases. We separated our patients into three groups according to the risk factors, group 1 without risk factors, group 2 with 1 risk factor, and group 3 with at least 2 risk factors, in the same way, we tried to establish a correlation with the presence or absence of metastases. Conclusion: Prostate cancer in its metastatic stage is very common in our context unlike in developed countries where screening can detect cancer at an early stage. The study of risk factors in our university center allowed us to identify the epidemiological profile of cancer in our hospital structure.