Impact of Perioperative Blood Transfusions on the Outcomes of Patients Undergoing Kidney Cancer Surgery: A Systematic Review and Pooled Analysis

The aim of the present study is to systematically review current evidence regarding the association between perioperative blood transfusions (PBT) and oncological outcomes of patients with renal cell carcinoma undergoing nephrectomy procedures. A computerized bibliographic search was conducted to identify pertinent studies. The Population, Intervention, Comparator, Outcome (PICO) study design approach was used to define study eligibility according to the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) criteria. Only 7 studies were deemed fully eligible for analysis. Most series included both open and laparoscopic cases. The rate of PBT varied between 9.6% and 76.6%, and the median number of transfused units was 2 for most of the studies. At pooled analysis, a statistically significant association was found between PBT and disease recurrence (HR, 1.79; 95% CI, 1.32-2.41; P < .001), cancer-specific mortality (HR, 1.62; 95% CI, 1.29-2.05; P ≤ .001), and all-cause mortality (HR, 1.45; 95% CI, 1.25-1.69; P < .001). Current evidence suggests that indeed the use of PBT may be associated with worse oncologic outcomes in patients with renal cell carcinoma undergoing nephrectomy procedures. Although presents findings should be interpreted within the intrinsic limitations of this type of pooled analysis, they emphasize the need for evidence-based strategies to minimize the use of PBT during kidney cancer surgery.     

How can food extracts consumed in the Mediterranean and East Asia suppress prostate cancer proliferation?

We have developed a blend of food extracts commonly consumed in the Mediterranean and East Asia, named blueberry punch (BBP), with the ultimate aim to formulate a chemoprevention strategy to inhibit prostate cancer progression in men on active surveillance protocol. We demonstrated previously that BBP inhibited prostate cancer cell proliferation in vitro and in vivo. The purpose of this study was to determine the molecular mechanism responsible for the suppression of prostate cancer cell proliferation by BBP. Treatment of lymph node-metastasised prostate cancer cells (LNCaP) and bone-metastasised prostate cancer cells (PC-3 and MDA-PCa-2b) with BBP (up to 0·8?%) for 72?h increased the percentage of cells at the G0/G1 phase and decreased those at the S and G2/M phases. The finding was supported by the reduction in the percentage of Ki-67-positive cells and of DNA synthesis measured by the incorporation of 5-ethynyl-2'-deoxyuridine. Concomitantly, BBP treatment decreased the protein levels of phosphorylated retinoblastoma, cyclin D1 and E, cyclin-dependent kinase (CDK) 4 and 2, and pre-replication complex (CDC6 and MCM7) in LNCaP and PC-3 cells, whereas CDK inhibitor p27 was elevated in these cell lines. In conclusion, BBP exerts its anti-proliferative effect on prostate cancer cells by modulating the expression and phosphorylation of multiple regulatory proteins essential for cell proliferation.     

Effect of urethral compliance on the steady state p-Q relationships assessed with a mechanical analog of the male lower urinary tract

AIMS: Using a lumped parameter theoretical model of bladder outlet function, we previously explored the relationship between the tube law of the urethra and the pressure-flow characteristics during micturition [Mijailovich et al., 2004]. To validate this theoretical model, we constructed a mechanical analog of the male lower urinary tract that incorporated elements simulating all relevant parameters of the theoretical model. In addition, we determined the effect of alterations in compliance of the flow-controlling zone on these relationships. METHODS: In the mechanical analog, the bladder neck and urethra were represented by a thin-walled conduit made of latex rubber and the prostate with a fluid filled cuff of variable compliance encircling the conduit. We measured in the same system steady-state pressure-flow (p-Q) and pressure-area (p-A) relationships of the flow-controlling zone. The effects of bladder outlet obstruction and prostatic compliance on these relationships were simulated by varying cuff pressure and capacitative coupling of the cuff, respectively. RESULTS: We demonstrated two previously described flow regimes-critical for low Q, and subcritical for higher Q. In the critical flow regime, the cross-sectional area of the collapsible conduit downstream of the cuff became narrow up to a site where the area suddenly expanded (elastic jump). Pressure losses across the cuff region decreased with increasing Q as the elastic jump approached the cuff, and the jump vanished when Q became subcritical. By altering prostatic cuff compliance and cuff pressure, we showed that an increase in opening pressures was associated with a steeper p-Q relationship. CONCLUSIONS: Using this mechanical analog, the measurements of p-A and p-Q relationships under various experimental conduit conditions validated our previous theoretical model of the male lower urinary tract. Both the experimental measurements and our previous theoretical model predictions indicate that an increase in opening pressure is associated with an increase in the slope of the p-Q relationship which becomes steeper with decreased cuff compliance. These data are in accordance with urodynamic findings in patients with benign prostatic hypertrophy (BPH) and suggest that a reduction in prostatic compliance exacerbates the severity of obstruction.     

Urodynamic Risk Factors for Renal Dysfunction in Men With Obstructive and Nonobstructive Voiding Dysfunction

Purpose

Urodynamic investigation of men with lower urinary tract symptoms, usually attributed to benign prostatic hyperplasia, often reveals bladder outlet obstruction, detrusor instability and/or diminished vesical compliance. We investigated whether these urodynamic abnormalities alone or in combination contribute to renal dysfunction.

Materials and Methods

A total of 161 men with lower urinary tract symptoms was evaluated by urodynamics, but outlet obstruction, detrusor instability and decreased compliance (30 ml./cm. water or less) were noted. Serum blood urea nitrogen (BUN) and creatinine were measured. Cases were categorized according to the urodynamic diagnosis. Mean values of serum BUN and creatinine as well as the incidence of elevated BUN and creatinine were compared among groups.

Results

of the cohort 54 men (34%) had elevated BUN and 19 (12%) had elevated serum creatinine. No significant correlation was found between the degree of obstruction and BUN or creatinine level. Mean serum BUN and creatinine, and the incidence of abnormal laboratory tests did not significantly differ among those with outlet obstruction, detrusor instability, both conditions or neither condition. However, in patients with outlet obstruction and detrusor instability there was a significantly increased incidence of azotemia in the subgroup with diminished compliance (78%) versus the subgroup with normal compliance (36%).

Conclusions

In men with voiding dysfunction of a nonneurogenic etiology outlet obstruction with or without detrusor instability does not appear to be a risk factor for elevated BUN and creatinine. However, when decreased bladder compliance is associated with a combination of outlet obstruction and detrusor instability, this risk is substantially increased.     

The role of the mucosa in modulation of evoked responses in the spinal cord injured rat bladder

Aims

Mounting evidence indicates that a variety of factors released from the urothelium or suburothelium can modulate smooth muscle activity. Although the relationship between the mucosa and smooth muscle has been investigated, little is known about the pathophysiologic changes in detrusor‐mucosa interactions in neurogenic bladders. The goal of the study was to determine the impact of the mucosa on evoked responses in spinal cord injured (SCI) bladders.

Methods

Urinary bladders were obtained from 6wk SCI rats or age‐matched uninjured controls. Ex vivo isometric tension studies were performed and muscarinic receptor expression was measured in bladder tissue with and without mucosa.

Results

The magnitude and area of nerve evoked responses in SCI tissue with mucosa was higher than without mucosa. The duration and decay time of nerve‐evoked responses were longer in SCI than control tissue irrespective of the mucosa. The level of the muscarinic M₂ receptor was decreased in the mucosa of SCI bladders.

Conclusions

Detrusor‐mucosa interactions are substantially altered in the neurogenic bladder. After spinal cord injury, an excitatory modulation of smooth muscle contraction by the mucosa emerges, and could be targeted via intravesical treatment in the context of neurogenic bladder dysfunction.     

Hydroxyurea therapy for priapism prevention and erectile function recovery in sickle cell disease: a case report and review of the literature

Prolonged ischemic priapism in patients with sickling hemoglobinopathies is a urologic emergency requiring immediate intervention to avoid irreversible anoxic penile injury, corporal fibrosis, and erectile dysfunction. Therapeutic options, however, are limited and often ineffective. Here, we report recovery of erectile function with hydroxyurea therapy in an adolescent with hemoglobin SS following a prolonged episode of priapism and subsequent severe erectile dysfunction. This case suggests a potential role of hydroxyurea in reversing end organ damage in patients with hemoglobin SS and also supports basic science work indicating involvement of the NO-dependent pathway in the pathogenesis of sickle cell disease-associated priapism.