Prognostic Value of Liquid-Biopsy-Based Biomarkers in Upper Tract Urothelial Carcinoma

Currently, there are no reliable prognostic factors to determine which upper tract urothelial carcinoma (UTUC) patients will progress after radical nephroureterectomy (RNU). We aim to evaluate whether liquid-biopsy-based biomarkers (circulating tumor cells (CTCs), cell-free DNA (cfDNA), and circulating tumor DNA (ctDNA)) were able to predict clinical outcomes in localized UTUC patients undergoing RNU. Twenty patients were prospectively enrolled between 2021 and 2023. Two blood samples were collected before RNU and three months later. CTCs and cfDNA were isolated and evaluated using the IsoFlux system and Quant-iT PicoGreen dsDNA kit, respectively. Droplet digital PCR was performed to determine ctDNA status. Cox regression analysis was performed on CTCs, cfDNA, and ctDNA at two different follow-up time points to examine their influence on tumor progression and cancer-specific survival (CSS). During a median follow-up of 18 months, seven (35%) patients progressed and three (15%) died. Multivariate analysis demonstrated that cfDNA levels three months after RNU are a significant predictor of tumor progression (HR = 1.085; p = 0.006) and CSS (HR = 1.168; p = 0.029). No associations were found between CTC enumeration and ctDNA status with any of the clinical outcomes evaluated. The evaluation of cfDNA levels in clinical practice could improve the disease management of UTUC patients.

A new biaxial epilated scrotal flap for reconstructive urethral surgery

PURPOSE

We describe a new type of perineum based scrotal flap with biaxial vascularization supplied by both superficial perineal arteries. Flap length of up to 20 cm. may be attained for urethral reconstruction.

MATERIALS AND METHODS

A total of 37 men with complex urethral stenosis of different etiologies underwent surgery using 1 of 3 urethroplasty techniques based on this new flap. The whole anterior urethra, including pendulous and bulbar segments, was reconstructed with a scrotal patch in 10 patients. A scrotal tubular flap was used as a substitute for the bulbar urethra in 7 patients and for the membranous portion in 4. Bulbar urethroplasty with a scrotal island patch was performed in 16 patients.

RESULTS

Of the patients 86% achieved normal voiding after 1-stage urethroplasty. Mean followup was 39.5 months.

CONCLUSIONS

The excellent axial vascularization of this new flap permits successful resolution of the most complex urethral stenoses regardless of extension, location and etiology.

Scrotal flap epilation in urethroplasty: concepts and technique

PURPOSE

We describe our technique of scrotal epilation and the advantages of using the resultant glabrous scrotal skin in reconstructive urethral surgery.

MATERIALS AND METHODS

An insulated needle model adapted to scrotal hair characteristics and a thermocoagulation current generator were used.

RESULTS

An average of 3 epilatory sessions with a 4-week interval between treatments was the optimal schedule. No cutaneous infection was noted.

CONCLUSIONS

The good results permitted the conversion of predetermined scrotal zones into wide areas of alopecia to be used as excellent skin flaps in complex urethral stenosis surgery in postpubertal male patients.

[Clinical value of intraesophageal pH measurement in children. Experience in 235 cases]

The intra-esophageal pH test is presented as a diagnostic method and as a control of GER, considering the 24-hour test as the best among all exploratory methods. The authors present 235 studied cases, distributed as follows: a control group of 20 normals, 24 cases explored after surgery, 80 cases of children with recently diagnoses GER or cases of bad response to postural treatment and 111 cases at the end of a favourable postural treatment. The normal quantitative values of 24-hour esophageal monitoring by pH-metry are presented in children and these are compared between the aforementioned groups. A detailed study of these explorations allows the authors to make a quantitative value of GER and to find out which ones of the studied parameters are more reliable for diagnosis (percentage of time under pH less than 4), and which ones indicate the severity of the process (refluxes of more than five minutes) that condition a change of treatment for the patient. Likewise, this study also permits the establishment of a relationship between GER and respiratory symptoms.